面部皮肤厚度的高频超声测量

目的 通过高频超声技术测量面部不同部位皮肤的厚度。方法 自2022年2月至2022年7月,蚌埠医学院采用切面宽度为12.8 mm的23 MHz高频探头,对30名健康的中国汉族成年人面部的32个部位进行扫查,将每个部位的切面3等分,对其中点的皮肤厚度进行测量,共获得2880个测量数据。对于同部位3个测量数据接近、无统计学差异的列为“一致区”,计算出平均厚度;对于同部位3个测量值差异较大、有统计学差异的列为“差异区”,将3个测量值的平均值分别列出。结果 高频超声可以清晰地显示面部表皮、真皮、皮下组织等各层结构。面部大部分区域属于“一致区”,而上睑、下睑、鼻背、鼻尖、鼻唇沟部、人中、颏部等7个部位属于“差异区”。上睑下缘的皮肤最薄处为（0.238±0.043）mm,鼻尖部的皮肤最厚处为（2.244±0.341）mm;额部的皮肤由内向外逐渐变薄、由上向下逐渐变厚;颊部的皮肤以内侧中央部位最厚;男性的皮肤厚度（1.120±0.162）mm>女性（0.952±0.080）mm,P<0.05。不同的BMI、不同的年龄,其皮肤厚度差异无统计学意义（P>0.05）。结论 健康成人面部皮...     

青壮年肺癌特点及外科治疗

９８２例肺癌病人中有４０岁以下者８０例，占全年龄组的８．１５％，误诊率７０％。小细胞肺癌居多占３８．７５％。咳嗽、血痰、胸疼为常见症状。有吸烟史者４５例中鳞癌和小细胞癌占３２例。Ｘ线表现有肺部或肺门肿块、肺不张、空洞等，以肺部肿块影较多占４３％。肿瘤位于左肺４２例，右肺３８例；周围型４１例，中心型３９例。Ⅲ期者５０％。多误诊为肺结核、肺炎、炎性假瘤、肺脓肿。共切除６４例，根治性切除４２例，姑息性２２例；全肺切除２６例，肺叶切除３８例。术后１、３、５、７年生存率分别为７８％、３９％、３５．１％、２１％。并对流行病学、诊断及治疗问题进行了讨论。     

头面部皮肤鳞癌的治疗

目的 分析头面部皮肤鳞癌手术治疗加辅助放疗的效果，总结和探讨其治疗的方法和经验。方法 1998年1月～2002年12月，对37例头面部皮肤鳞癌患者行手术加辅助放疗治疗。手术根据肿瘤的分期决定切除范围，并根据切除范围和周边组织活动度分别采用一期直接缝合、二期游离植皮、一期游离植皮3种方案。术后放疗剂量60～65Gy／6～7周。随访截止于2004年6月。结果 术后37例获随访5～69个月，中位时间38个月，失访3例。有4例局部复发，其中3年内复发者2例。至随访截止，有2例患者死于原发癌，4例死于其他原因，28例生存。术后生存率，3年为97．14％，标准误为0．0358；5年为92．28％。标准误为0．1047。结论 采用适当的手术方式结合放疗可提高头面部皮肤鳞癌的术后生存率。     

青壮年肝癌患者的临床特点

本文对３９名４０岁以下的青壮年及２５６例４０岁以上的中老年原发性肝癌（ＰＨＣ）患者的临床特点进行了回顾性研究。结果：２０．６％的青壮年患者具有肝癌家族史，６２％有明确肝炎史，ＨＢｓＡｇ携带率８２％，半数以上就诊时无自觉症状，小肝癌１００％合并肝硬化，治疗以手术为佳，但复发率较高；在普查及随访中发现的患者预后较好。提示：对肝癌易患人群包括具有肝癌家族史、肝炎患者、早期肝硬化、ＨＢＶ携带者、ＡＦＰ持续     

应用眼轮匝肌蒂皮瓣修复面部皮肤缺损

目的:总结如何应用眼轮匝肌皮瓣修复面部皮肤缺损。方法:设计以眼轮匝肌为蒂的皮瓣修复鼻翼皮肤缺损13例,鼻翼邻近面部皮肤缺损2例。结果:15例中皮肤缺损的最大面积为2.5cm×2.0cm。除1例表皮部分坏死外,其余皮瓣成活良好,形态恢复满意。结论:以眼轮匝肌为蒂的皮瓣可转移修复较大面积的鼻翼及邻近面部皮肤缺损,并能获得满意效果,尤其适合中老年面部皮肤缺损的患者     

上睑皮肤厚度的测定

通过实测健康人双上睑各部皮肤皱褶厚度和新鲜尸体皮上睑各部皮肤厚度表明，上睑皮肤以外侧最厚，上部次之，下部最薄。上睑皮肤较厚者行上睑皱襞成形术后效果不佳。去皮上睑皱襞成形术后皮肤皱褶是由原位于上睑中、上部位的皮肤构成的，所以常显得臃肿。     

局部皮瓣在面部皮肤缺损修复中的应用

<正>面部是人体重要的形态器官,由于颜面部为暴露部,常常被他人首先看见。对于该部位发生的肿瘤,患者往往有美容要求。自2004年以来,我们应用局     

Full thickness skin graft versus split thickness skin graft in paediatric patients with hand burns: Systematic review and meta-analysis

Our objective was to compare the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was conducted to identify all Randomised Controlled Trials and non-randomised studies comparing the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. Primary outcomes included development of post-graft contracture and the necessity for surgical release. Secondary outcomes consisted of evaluation of function, cosmesis and colour, scar and feeling, hair growth, and other complaints. For the analysis, fixed effects modelling was applied. Results: ten non-randomised trials with a total of 532 grafts were found. Full thickness skin grafts exhibited a statistically significant decrease in the development of post-graft contracture (Odds Ratio [OR] = 0.35, P = 0.0001) and later surgical releases (OR = 0.06, P = 0.00001). For secondary outcomes, full thickness skin grafts outperformed split thickness skin grafts in post-operative functional ability. However, split thickness skin grafts, showed to be superior in scar, aesthetic, and colour assessments, and less hair growth was observed for split thickness skin grafts. No significant difference was seen in sensation and donor or recipient site complaints. Overall, full thickness skin grafts are a better alternative for paediatric hand burns than split thickness skin transplants because they are linked with reduced post-graft contracture and the requirement for surgical release.     

Carcinomas of the stomach in the young adults

The clinical and pathologic characteristics of the gastric carcinomas in the young adults were described in special comparison with the carcinomas in the old men. They were found to be similar in many respects, but had some different features like the histologic findings with particular references to the histogenetic background.     

Ischemic colitis in young adults: A single-institution experience

Ischemic colitis is not well characterized in the young adult population, despite its commonness in older patients. The aim of this study was to investigate the demographics, etiology, clinical features, and prognosis of ischemic colitis in young adults. We conducted a retrospective study of 39 young adults (<50 years of age) diagnosed with ischemic colitis over a period of 9 years (1990 to 1998). The mean age at diagnosis was 38 ±2 years (range 18 to 49 years); the female:male ratio was 1.8. Fifty-two percent (13 of 25) of women were using oral contraceptives at the time of diagnosis. Other potential associations identified were vascular thromboembolism (4 of 39), vasoactive drugs (4 of 39), hypovolemia (4 of 39), and vasculitis (2 of 39); 19 patients (49%) had no identifiable predisposing factors. Dominant presenting symptoms were abdominal pain (77%), bloody diarrhea (54%), and hematochezia (51%). Most patients were diagnosed at colonoscopy, and most disease was left sided. Twenty-nine patients were successfully managed with intravenous fluids, broad-spectrum antibiotics, and bowel rest; 10 patients required surgery. There was one disease-related death in the operative group. We found a strong female predominance and an association with oral contraceptive use, but almost half of the patients did not have an identifiable etiology. Mortality from ischemic colitis in this patient population is low. Presented in part at the Fortieth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Fla., May 16–19, 1999.     

异体脱细胞真皮基质与自体皮片复合移植的临床应用

目的:探讨异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面及其愈合后皮肤的外形和功能。方法:应用异体脱细胞真皮基质与自体刃厚皮片组成复合皮移植,以自体刃厚皮片移植作为对照,采用一步移植法治疗切痂后大面积深度烧伤创面及瘢痕切除后皮肤缺损共56例患者60处创面,观察术后皮片的成活情况、外形及功能恢复情况并随访。结果:60处创面全部愈合,移植皮片生长良好,瘢痕增生不明显,未见明显挛缩,皮肤弹性较好。在6～12个月的观察期内,自体刃厚皮片与异体脱细胞真皮基质复合移植后,功能和形态优于单纯自体刃厚皮片移植;随访2年复合移植未发现明显的排异反应。结论:异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面愈合良好,无瘢痕增生,皮肤外观功能满意,无排异反应。     

Improving rate of decline of FEV1 in young adults with cystic fibrosis

BACKGROUND: CF is characterised by a progressive decline in lung function; reductions in this decline are often used as a measure of success in clinical trials. With improvements in treatment it may be that there has been a temporal shift in the pattern of the disease. METHODS: 318 patients born in five successive cohorts and attending a specialist clinic with at least two routine measurements of lung function made between the ages of 18 and 22 were included. The declines in their lung function were estimated and compared. RESULTS: The mean (SE) slopes for percentage predicted forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC) were -1.53 (0.36)% and -1.27 (0.34)%, respectively (NS). The annual deterioration in FEV(1) was -2.49%, -1.99% -2.20%, -1.65%, and -0.65% from the earliest to the most recent birth cohort; a similar pattern was observed for changes in FVC. There were no differences between male and female patients. Patients infected with Pseudomonas had a greater average decline in FEV(1) (-1.6% v -1.1%). CONCLUSIONS: The rates of decline in lung function in young adults with CF have diminished with successive birth cohorts. This has important implications for the design of clinical studies in this disease.     

Cementless modular centroid reconstruction cup in young adults with congenital dysplasia of the hip

The anatomic abnormalities associated with the dysplastic acetabulum make total hip arthroplasty a very complex and challenging procedure. Various techniques have been reported for the reconstruction of the dysplastic acetabulum. This prospective study examined the clinical results and technical challenges associated with acetabular reconstruction using a cementless modular centroid reconstruction cup in 62 dysplastic hips. The mean follow-up period was 62 +/- 9.2 months (range, 46-84 months). No patient was lost to follow-up. There were no revisions and no radiographic signs of osteolysis. There was a significant improvement in hip pain (P < .0001), mobility (P < .0001), and walking (P < .0001) according to D'Aubigne score. Midterm results have been favorable and patients have gained high clinical function. Longer-term follow-up is registered concerning wear and loosening.     

锁定钢板治疗青壮年桡骨远端粉碎性骨折

目的探讨青壮年桡骨远端骨折的临床特点及手术疗效。方法对17例青壮年桡骨远端骨折采用切开复位锁定钢板内固定,术后早期功能锻炼。结果17例均获得随访,时间8～16（10.0&#177;3.4）个月,患者均获得骨性愈合。疗效根据Dienst et al评分系统进行评定：优13例,良3例,可1例。结论青壮年桡骨远端骨折常为高能量损伤,多为不稳定骨折;早期切开复位锁定钢板内固定治疗可获得较满意的临床疗效。     

筛网状全厚皮片移植联合封闭负压引流治疗四肢皮肤缺损

目的探讨全厚皮片延期移植联合封闭负压引流(VSD)治疗四肢皮肤缺损的临床效果。方法对38例外伤性四肢皮肤缺损患者行清创+VSD术,待缺损区创面肉芽新鲜时,行筛网状全厚皮片移植并用VSD敷料覆盖,持续负压吸引,3～5 d后去除VSD敷料。结果 38例均获随访,时间3个月～2年。35例皮片一次全部成活,3例皮片边缘少许坏死伴渗液,经换药治愈;植皮区外观满意,弹性好,无瘢痕挛缩;取皮区留有线形瘢痕,无瘢痕增生、疼痛等。结论筛网状全厚皮片联合VSD延期植皮修复四肢皮肤缺损成活率高,外观满意,疗效好。     

Telephonic management of rectal bleeding in young adults – a prospective randomized controlled trial

OBJECTIVE: The majority of young adults referred with rectal bleeding to a colorectal specialist clinic have a very low risk of serious disease such as cancer, and a high chance of gaining symptom relief by simple dietary changes. To determine whether young low-risk patients with rectal bleeding can be managed with a structured telephonic interview and dietary advice, rather than an outpatient visit. METHOD: A single-blinded, prospective, randomized controlled trial was performed in two stages. Patients under 40 years with rectal bleeding only were offered inclusion. Part-I trial: Patients were interviewed on telephone by the colorectal nurse specialist (CNS) and randomized to receive dietary advice (Advice Group) or not (Control Group). All patients were seen in clinic 6 weeks later by a doctor 'blinded' to their trial status. Part-II trial: Patients were interviewed on telephone by the CNS and again randomized to an Advice Group or a Control Group. The Control Group were seen in clinic 6 weeks later. The Advice Group were telephoned again 6 weeks later, and if their bleeding had stopped, were not brought to clinic. All patients were tracked for a year after the study to ensure no adverse diagnoses came to light. RESULTS: Part-I trial: 63 of 89 eligible patients were contactable and none refused the study. Seventy per cent of the Advice Group compared with 33% (P = 0.001) of the Control Group had symptomatic improvement when seen in clinic. Approximately 30% of each group required further treatment. Part-II trial: 54 of 94 eligible patients were contactable. However a further nine declined to enter the trial; 90% of patients in the Advice Group had improved at 6 weeks as judged by telephone interview compared with 56% of patients in the Control Group (P = 0.024) who were seen in clinic. The 90% of patients who improved in the Advice Group did not need to come to clinic to be seen. In both parts of the trial, the CNS identified a small number of patients with urgent symptoms at interview and brought them to clinic. The majority had anal fissures or haemorrhoids although in Part-II, one patient had ulcerative colitis and one had colorectal cancer. CONCLUSION: Telephonic consultation is an effective way of identifying those patients with urgent symptoms among a cohort of young adults referred to the hospital with rectal bleeding. Telephonic dietary advice leads to resolution of rectal bleeding in the majority of patients without urgent symptoms.     

自体刃厚头皮片移植厚中厚皮片供区以抑制瘢痕增生

目的:探讨应用自体刃厚头皮片移植厚中厚皮片供区以抑制瘢痕增生的可行性及应用效果。方法:烧伤后全身大范围的增生性瘢痕患者24例,行功能部位的增生性瘢痕切除,应用非功能部位的大张厚中厚皮片修复,厚中厚皮片供区应用刃厚头皮片移植修复。结果:24例患者非功能部位厚中厚皮片供区经刃厚头皮片移植后,未见有明显的瘢痕增生。经随访半年至2年11例,2年以上3例,均未见有明显的瘢痕增生。头皮片供区无瘢痕形成,头发生长良好。结论:应用自体刃厚头皮片移植厚中厚皮片供区抑制瘢痕增生是一种可行的方法,值得临床推广。