严重复杂的胰腺创伤临床处理探讨

Objective To summarize the experience in diagnosis and management for severe and complicated pancreatic trauma. Methods The clinical data of 21 patients with severe pancreatic trauma treated in our hospital were retrospectively analyzed. Of the 21 with a mean age of 26 (9-53), 14were male and 7 female. The causes of trauma were blunt injuries in 13 and patent injuries in 8 of them. The injury grade distribution for these patients was grade Ⅲ in 8 cases, grade Ⅳ in 8, and grade V in 3. The main diagnostic modalities included amylase measurement, ultrasonography, CT,endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP) etc. All patients received surgical procedures. Roux-en-Y distal pancreatojejunostomy was performed in 10 patients, pancreatoduodenectomy in 3, modified duodenal diverticulization in 2, distal pancreatectomy in 3, tube installing in major duct and external drainage, and suture of pancreatic section in 2, and suture of two broken side respectively (delayed distal pancreatojejunostomy in the second time) in 1. Results Pancreatic injury was confirmed in 11 cases preoperatively and intraoperatively in the others. The early emergency operation was performed in 18 patients within 12hours, and delayed operation was done in 3 cases. Twenty patients were cured and 1 died after a procedure of pancreatoduodenectomy. The postoperative pancreatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusion The diagnosis of severe and complicated pancreatic trauma is difficultly yet, so the earlier exploratory laparotomy should be suggested. The individual surgical modality based on the grade should be adopted in the operation and the concept of "Damage Control Surgery" should be carried out in the procedure. Extended operation should be avoided.     

严重复杂的胰腺创伤临床处理探讨

Objective To summarize the experience in diagnosis and management for severe and complicated pancreatic trauma. Methods The clinical data of 21 patients with severe pancreatic trauma treated in our hospital were retrospectively analyzed. Of the 21 with a mean age of 26 (9-53), 14were male and 7 female. The causes of trauma were blunt injuries in 13 and patent injuries in 8 of them. The injury grade distribution for these patients was grade Ⅲ in 8 cases, grade Ⅳ in 8, and grade V in 3. The main diagnostic modalities included amylase measurement, ultrasonography, CT,endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP) etc. All patients received surgical procedures. Roux-en-Y distal pancreatojejunostomy was performed in 10 patients, pancreatoduodenectomy in 3, modified duodenal diverticulization in 2, distal pancreatectomy in 3, tube installing in major duct and external drainage, and suture of pancreatic section in 2, and suture of two broken side respectively (delayed distal pancreatojejunostomy in the second time) in 1. Results Pancreatic injury was confirmed in 11 cases preoperatively and intraoperatively in the others. The early emergency operation was performed in 18 patients within 12hours, and delayed operation was done in 3 cases. Twenty patients were cured and 1 died after a procedure of pancreatoduodenectomy. The postoperative pancreatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusion The diagnosis of severe and complicated pancreatic trauma is difficultly yet, so the earlier exploratory laparotomy should be suggested. The individual surgical modality based on the grade should be adopted in the operation and the concept of "Damage Control Surgery" should be carried out in the procedure. Extended operation should be avoided.     

Traumatic anterior hip dislocation in a 12-year-old child

Hip dislocation in children can occur congenitally in isolation or in conjunction with other congenital abnormalities.Traumatic hip dislocations in children are relatively uncommon and anterior disloca...     

Comparison of road traffic fatalities and injuries in Iran with other countries

Objective： To compare fatalities and injuries in road traffic crashes （RTC） in Iran with other countries. Methods： Data were obtained from national health sources of Iran. These data included population number, registered motor-vehicles number, number of RTCs and consequent fatalities and injuries from 1997 to 2006. Results： RTC fatality and injury rates increased from 1997 to 2005, but decreased in 2006. The overall men/women ratio in the RTC fatalities was 4.2：1. High RTC fatality rate of 39 per 100 000 population in Iran was almost the same as some other developing countries. In Iran, RTC fatalities in recent years were almost twice as much as the highest rate among the European countries. Conclusions： This investigation shows that in spite of reduction of RTC fatality in Iran in 2006, it is still one of the highest in the world. Moreover, this paper describes the state of RTC-related parameters in a developing country in comparison with the developed countries.     

Transforming growth factor β receptor Ⅱ expression inexperimental cryptorchidism and apoptosisin spermatogenic cells in rats

Objective: To study the transforming growth factor β receptor Ⅱ (TGFβ-R Ⅱ) expression in experimental cryptorchidism and apoptosis in spermatogenic cells in rats. Methods: The apoptosis of spermatogenic cells was detected by means of the terminal deoxynucleotldyl transferase mediated dUTP nick end lableling method (TUNEL) and the TGFβ-R Ⅱ expression was observed with the immunohistochemistry SABC methods. Results: There was a significant increase in the TGFβ-R Ⅱ expression in unilateral undescended testes (UUTs) compared with that in contralateral descended testes (CDTs, P<0.01). However, there was a significant and time-dependent increase in the mean apoptotic index in UUTs than in CDTs. Conclusion: TGFβ-R Ⅱ may play an important role in spermatogenic cell apoptosis.     

T-condylar fracture delayed for 10 days in a 5-year-old boy: a case report and review of the literature

T-condylar fracture is rare in paediatric age group,especially in skeletally immature children less than 9 years old,with very few cases reported in available literature.We present such a case in a 5 y...     

Susumu Tamai MD,PhD——Autobiography

I follow a long line of ancestors in my family pedigree.The first physician in my family dates back to 1650 and this occupation continues for 370 years up to the present time.I was born March 13,1935,in Kashihara city,in Nara,Japan.I graduated with my medical degree from Nara Medical University in 1959,continuing the line of 21 generations of physicians in my family.     

CT尿路成像和IVU检查诊断泌尿系统疾病的比较研究

Objective The purpose of this study was to evaluate computed tomography urography (CTU) and compared with conventional intravenous urography (IVU) in diagnosis of urological disease. Methods One hundred and sixty-five patients with 111 males and 54 females underwent CTU urography including 78 cases underwent IVU were reviewed in this study. There were 12 cases underwent retrograde pyelography. There were 75 cases of nephrolithiasis and ureterolithiasis, 30 cases of ureteropelvic junction obstruction (UPJO), 30 cases of bladder cancer, 15 cases of pyelogenic cyst and parapelvic cyst, 9 cases of megaloureter and 6 cases of cancer in pelvis and ureter. Results The accuracy of diagnosis was 94.5% (156/165) in CTU group and 46.7% (42/90) in IVU group.The accuracy of diagnosis was 100.0% (75/75)of nephrolithiasis and ureterolith in CTU group and 78. 6%(33/42)in IVU group, 90.0% (27/30) of UPJO in CTU group, 100.0% (30/30) of bladder cancer in CTU group and 75.0%(9/12)in IVU group, 80.0%(12/15)of pyelogenic cyst and parapelvic cyst in CTU group, 100.0% (9/9)of megaloureter in CTU group, 100.0% (6/6)of cancer in pelvis and ureter in CT group. The displayed rate of the distal end of stenosis and obstruction was 79.4%(81/102)in CTU group and 25.0%(15/60)in IVU group. The examination time was (18.9±8.4)min in CTU group and (67.1±26.7)min in IVU group. Conclusion The CTU can provide more information than conventional IVU and can replace the IVU as routine examination in most cases.     

微型万向外固定器与微型钢板治疗掌指骨关节内骨折脱位的疗效比较

Objective To compare the clinical outcome of external fixation device with Kirschner wire or fragment fixation pin with mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture dislocation. Methods From October 2002 to March 2008, 106 patients with metacarpal and phalangeal articular fracture dislocation were randomly divided into A and B group. The 53 patients in A group were treated with external fixation device with Kirschner wire or fragment fixation pin. There were thumb injury in 24 cases, fracture-dislocation of proximal interphalangeal joint(PIP) in 36 cases, fracture-dislocation of metacarpophalangeal joint (MP) in 17 cases. The 53 patients in B group were treated with mini plate and screw fixation. There were thumb injury in 22 cases, fracture-dislocation of PIP in 30 cases, fracture-dislocation of MP in 23 cases. Duncan rating criteria were used to compare finger range of motion. Results The mean follow-up of 16.8 and 17.5 months in A group and B group. According to Duncan rating criteria, there were excellent in 33 cases, good in 16, fair in 3, and poor in 1 case. The excellent and good rate was 92.5% in A group. There were excellent in 30 cases, good in 17, fair in 5, and poor in 1 case. The excellent and good rate was 88.7% in B group. In A group, 1 case of wound infection was found. The average arc of motion of thumb joint was 134°±21° while the average arc of motion of other fingers was 248°±19°. In B group, no wound infection occurred. The average arc of motion of thumb joint was 122°±18° while the average arc of motion of other fingers was 225°±17°. Conclusion External fixation device with Kirschner wire or fragment fixation pin was better than the application of mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture-dislocation.     

The Asian Journal of Andrology： view of an outsider coming in

My interest in science in China, .stimulated in 1980 by reading theabridged version of Joseph Needham＇s ＂Science and Civilization in China＂, continued when I was a Consultant to the National Family Planning Research Institute in Beijing in 1983, and to the Shandong Stem Cell Engineering Research Center, Yantai in 2009-2012. During that time, I have acted as reviewer of the Asian Journal of Andrology （AJA）, and I continue to be one of its editorial board members. What I can contribute as the second Deputy Editor-in-Chief for the journal will depend on the challenges faced by the journal in the coming years.     

肌间脂肪瘤的高频彩超诊断价值

【摘要】〓目的〓探讨肌间脂肪瘤的高频彩超特征。方法〓对18例肌间脂肪瘤的高频彩超图像进行回顾性分析。结果〓18例中,其中位于下肢5例,上肢3例,颈部3例,肩背部2例,腰背部5例;类圆形1例、椭圆形12例、不规则形5例;5例边界清楚,7例边界部分清楚,6例边界不清楚。对比局部肌肉回声,高回声11例,低回声3例,等回声1例,混合回声3例。8例检出血流信号,均位于肿块周围,4例为静脉血流信号。结论〓肌间脂肪瘤具有相对特征性的声图像表现,高频彩超可准确判断肿物的位置、深度,具有较大的诊断价值。     

经尿道输尿管镜技术在泌尿外科的应用(附1100例报告)

目的探讨输尿管镜技术在泌尿外科疾病诊治中的临床应用价值。方法2003年1月至2005年6月应用经尿道输尿管镜技术诊断和治疗泌尿系疾病患者1100例。其中行输尿管镜治疗者1010例，包括输尿管结石945例1000侧，其中上段结石68例侧、中段360例370侧、下段517例562侧；输尿管狭窄20例侧；医原性双J管滞留28例；小儿后尿道狭窄2例、后尿道瓣膜症2例、下尿路结石3例、小儿逆行输尿管插管8例侧、内支架管置入2例侧。用于泌尿系疾病诊断90例侧。结果输尿管下段结石取石成功率为97．3％（547／562）；中段为93．0％（344／370）；上段为73．5％（50／68）。输尿管狭窄及小儿后尿道狭窄扩张、小儿后尿道瓣膜症等疾病疗效满意。用于诊断的90例患者中，发现肿瘤8例、阴性结石40例、息肉12例、腺性输尿管炎4例、输尿管狭窄12例、无阳性发现13例。手术失败12例。发生严重手术并发症30例，发生率2．7％（30／1100），其中输尿管高位横断拖出2例、穿孔10例、假道12例、黏膜撕脱3例、严重出血3例。结论只要熟练掌握，输尿管镜技术的并发症发生率较低，对输尿管下段结石可作为首选治疗措施，对其他疾病尤其是小儿患者有独特优势。     

Calcium absorption and osseous organ-, tissue-, and envelope-specific changes following ovariectomy in rats

Because cancellous bone loss occurs following ovariectomy (OVX) in rats, this has become a popular model to explore therapeutic modalities for postmenopausal bone loss in humans. The purpose of this study was to determine intestinal calcium absorption in situ and organ-, tissue-, envelope-, and site-specific changes in osseous tissues at six weeks after OVX in rats using chemical, biochemical, absorptiometric, microradiographic, and morphometric methods. There were no changes in intestinal absorption of calcium, but duodenal weight per length was significantly increased in the OVX animals compared with age-matched, sham-operated controls. There was an increase in wet bone weight, but decreases in ash/dry bone weight, total bone Ca, and Ca per ash weight in the OVX animals. There were significant decreases in the OVX animals in metaphyseal bone mineral content, as determined by photon absorptiometry and metaphyseal cancellous bone volume. The perimeter to area ratio of the metaphyseal cancellous bone in the OVX animals was increased compared with controls. Endochondral growth rates were increased in the OVX animals, attributable to an increased growth plate hypertrophic cell size and rate of chondrocyte proliferation. In the OVX animals there was an increase in modeling in the formation mode of the periosteal surface at the tibio-fibular junction. Increased periosteal modeling in the formation mode was also observed in the body of the mandible, suggesting that the changes in periosteal bone formation are not strictly coupled with changes in endochondral growth. There was an increase in modeling in the resorption mode of the endocortical surface at the tibio-fibular junction in the OVX animals. There was increased bone turnover in the OVX animals compared with controls on the endosteal surface, as indicated by increases in both formation and resorption indices, including an increase in the osteoclast population. In the long bones, OVX results in larger bones due to increases in endochondral growth and modeling in the formation mode at the periosteal surfaces, with a loss of cancellous bone and total bone calcium due to increased resorption on the endocortical surfaces and turnover (increased formation and resorption) on endosteal surfaces. This study emphasizes that osseous tissue changes following OVX in rats are tissue-specific, envelop-specific, and site-specific.     

腹腔镜腹股沟疝修补术的电外科安全

目的:探讨腹腔镜腹股沟疝修补术中不同器械可能出现的电外科操作风险及相应的处理对策。方法:选取2010年1月至2012年1月行腹腔镜完全腹膜外疝修补术(totally extraperitoneal,TEP)的193例患者。详细统计其一般资料及手术时间,出、入液量,气腹压力等术中情况,对比单极电凝、绝缘剪刀及超声刀应用的时间、经常出现的术中问题等。结果:应用绝缘剪刀术中出血量、手术时间明显少于其他两种器械。意外气腹情况绝缘剪刀组发生1例,超声刀组发生13例,单极电凝组发生11例。结论:绝缘剪刀具有锐性切割组织、解剖层次清晰、术中牵拉及出血少、节约时间的特点,但对术中解剖要求较高。超声刀类产品由于气化及组织变性严重,会增加侧方损伤的几率。由于单极电凝的锐性切割效果较差、腹膜外空间小,更容易出现漏电及损伤腹膜的情况。     

Association of EMMPRIN and fascin expression in renal cell carcinoma: correlation with clinicopathological parameters

EMMPRIN and fascin are important factors in tumor invasion and progression. We tested the hypothesis that expression of EMMPRIN and fascin correlate with clinicopathological parameters of renal cell carcinoma (RCC). Immunohistochemical analysis of EMMPRIN and fascin were performed in tissue microarrays of 100 surgical specimens, including 35 clear-cell RCC (CRCC), 21 clear-cell RCC with granular differentiation (GRCC), 12 chromophobe RCC (ChRCC), 8 papillary RCC (PRCC), 9 carcinoma of the collecting duct of Bellini (CDC), 10 clear-cell RCC with sarcomatoid differentiation (SRCC), and 6 metastatic RCC. Average immunoscores of EMMPRIN were 100.8 in CRCC, 195.2 in GRCC, 298.4 in ChRCC, 219.2 in PRCC, 186.1 in CDC, 226.9 in SRCC, and 151.7 in metastatic RCC. Among all included cases, average EMMPRIN immunoscores were 84.6 in grade I, 130.4 in grade II, 184.3 in grade III, and 223.5 in grade IV. Additionally, average immunostaining scores of fascin were 53.6 in CRCC, 289.3 in GRCC, 193.3 in ChRCC, 151.8 in PRCC, 181.3 in CDC, 275.4 in SRCC, and 131.7 in metastatic RCC. Average fascin immunoscores were 59.3 in grade I, 91.6 in grade II, 130.2 in grade III, and 194.7 in grade IV. Higher EMMPRIN and fascin immunoscores also correlated significantly with TNM stages and survival rates in RCC. Significant correlation was found between EMMPRIN and fascin expression. In conclusion, higher expression of EMMPRIN and fascin correlate significantly with histological grades, clinical stages, and survival rates of RCC     

Breed and seasonal variation of plasminogen activator activity and plasminogen activator inhibition in spermatozoa and seminal plasma of the ram in correlation with testosterone in the blood

Summary. Plasminogen activator activity (PAA) and plasminogen activator inhibition (PAI), against t-PA (t-PAI) or u-PA (u-PAI), in spermatozoa and seminal plasma as well as testosterone in the blood of Friesland, Chios, and Karagouniki rams all showed a seasonal variation with the highest values during the corresponding breeding season of the ewes (Autumn-Winter). The seasonal variation of PAA and PAI in spermatozoa or seminal plasma as well as blood testosterone was different among the three breeds studied. Increased spermatozoal PAA was observed in November and May in Friesland rams, in October and November in Chios rams, and in October in Karagouniki rams. Spermatozoal t-PAI was increased in December and June in Friesland rams, in November and December in Chios rams, and in November in Karagouniki rams. Spermatozoal u-PAI was increased in December in Friesland rams, in October and December in Chios rams, and in November and December in Karagouniki rams. Plasminogen activator activity and PAI in seminal plasma also showed similar seasonal variations. Plasminogen activator activity and PAI in spermatozoa and seminal plasma showed a positive correlation with blood testosterone. The results of the present study support our previous findings on the possible role of spermatozoal PAA and PAI in the fertilizing ability of spermatozoa.     

Expression of bone morphogenetic proteins, receptors, and tissue inhibitors in human fetal, adult, and osteoarthritic articular cartilage.

Coordinate expression of BMPs and their receptors and inhibitors is likely necessary for physiologic BMP regulation and activity. To characterize the expression of such factors in fetal, normal adult, and end-stage osteoarthritic articular cartilage, samples from these sources were analyzed. PCR-amplified sequences (BMPs 1-11), receptors (IA, IB, II), TGF-beta1, TGF-beta2, inhibitors noggin and follistatin, CDMP-1, COMP, and GAPDH from cDNAs generated from extracted total RNA were resolved by gel electrophoresis. Protein levels of BMPs 3, 7, and 8 were also analyzed by SDS-PAGE and Western blotting. RT-PCR revealed that BMPs 1, 2, 4-6, and 11, BMPR-IA and II, noggin, follistatin, CDMP-1, COMP, and GAPDH mRNAs were expressed in similar fashion in both fetal and adult (normal or osteoarthritic) cartilage. BMPs 9 and 10 mRNAs were not expressed in either group. BMPs 7, 8, and BMPR-IB mRNAs were consistently expressed in fetal but not in adult cartilage. BMP-3 mRNA was expressed in fetal and normal adult, but not in osteoarthritic samples. TGF-beta1 was expressed in both adult normal and osteoarthritic, but not fetal, samples. Similarly, Western blotting demonstrated BMPs 7 and 8 to be present in fetal but not in adult samples. BMP-3 protein was present in fetal and adult normal samples, to a lesser extent, but absent in osteoarthritic cartilage.     

Oestrogen receptor alpha and beta in rat prostate and epididymis

The cellular localization of two oestrogen receptor (ER) subtypes, ER alpha and ER beta, was investigated in neonatal, postnatal, immature and adult male rats to determine whether these receptor subtypes are differentially expressed in prostate and epididymis. A monoclonal antibody against ER alpha and two polyclonal ER beta antibodies were used. Paraffin sections revealed a specific nuclear immunoreaction product in certain cells but not in others. In the epididymis, nuclear ER alpha immunoreactivity (IR) was detected in epithelial cells of efferent ductules and initial segments as well as in connective tissue surrounding the tubules in caput, corpus and cauda. No IR was observed in rete testis. Epithelial cells of the prostate lacked ER alpha IR, but connective tissue cells surrounding prostatic buds in the early neonatal period revealed IR. In prostate, ER beta IR was expressed in epithelial cells of the ventral and dorsolateral lobes, but the IR intensity was higher in the ventral lobe. In neonatal rats, ER beta was expressed in the epididymis but not in the prostate gland. Weak ER beta expression was found in the prostates of 5-day-old rats, and the reaction increased in intensity thereafter. In the epididymis, a similar developmental expression pattern of ER beta was observed. ER beta expression in prostate and epididymis was similar to expression of androgen receptors reported previously for these organs. The results support that both ER alpha and ER beta may be involved in oestrogen modulation of prostate and epididymal functions.     

Clinical Characteristics of Resected T3 Non-small Cell Lung Cancer Characterized by Parietal Pleural Invasion or Chest Wall Invasion

This study investigated the clinicopathological characteristics and the surgical outcome in patients with non-small cell carcinoma (NSCLC) with parietal pleura invasion or chest wall invasion (p3/T3). This study clinicopathologically evaluated 760 patients who had undergone a resection for NSCLC between 1999 and 2008. There were 43 (5.7 %) patients with p3/T3 NSCLC. The patients included 37 males and 6 females. The histological types included 23 squamous cell carcinomas, 13 adenocarcinomas, 3 large cell carcinomas, 3 pleomorphic carcinomas, and 1 spindle cell carcinoma. Pneumonectomy was performed in 2 patients, bilobectomy in 1, lobectomy in 31, segmentectomy in 3, and partial resection of the lung in 6. The combined resection regions were parietal pleural in 23, ribs in 16, pericardium in 2, and diaphragm in 2 patients. Major complications included empyema in 1, chylothorax in 1, and postoperative bleeding in 1 patient. The first recurrence sites in 16 patients with recurrent disease were the lung in 5 patients, brain in 3, bone in 2, adrenal gland in 2, skin in 2, liver in 1, mesenterium in 1, mediastinal lymph node in 1, axillary lymph node in 1, and carcinomatous pleuritis in 1. The overall 5-year survival rate after surgery was 50.6 %. An en bloc resection for p3/T3 NSCLC provides a modestly favorable prognosis. Local recurrence was observed in a minority of case, and recurrence by distant metastasis was observed in most cases, suggesting a greater need for postoperative chemotherapy.     

慢性肾功能衰竭患者细胞内外氨基酸水平的改变

目的观察游离氨基酸在正常人体细胞内外液中的浓度及其在慢性肾功能衰竭(CRF)时的代谢变化.方法对15例CRF患者和10例健康志愿者的血浆、红细胞内、骨骼肌细胞内的游离氨基酸浓度进行了比较.结果正常人体红细胞内天冬氨酸(Asp)、谷氨酸(Glu)和丝氨酸(Ser)浓度较血浆内高(P＜0.05),而胱氨酸(Cys)、精氨酸(Arg)和蛋氨酸(Met)浓度较血浆内低(P＜0.05),其余大多数游离氨基酸浓度与血浆基本一致;骨骼肌细胞内游离氨基酸浓度普遍较高.CRF时血浆中缬氨酸(Val)、亮氨酸(Leu)、异亮氨酸(Ile)、赖氨酸(Lys)、苏氨酸(Thr)、苯丙氨酸(Phe)、Ser、Cys、酪氨酸(Tyr)浓度和红细胞内Val、Tvr浓度明显降低(P＜0.05),而部分非必需氨基酸浓度升高;骨骼肌细胞内除Val、Thr、Lys浓度降低(P＜0.05)外余变化不显著.结论正常人体血浆、红细胞、骨骼肌细胞内游离氨基酸浓度不完全相同;CRF时这3种介质中的游离氨基酸代谢均发生改变,主要表现为一些必需氨基酸浓度明显降低,然而降低的幅度3者并不平行.