类风湿关节炎关节镜下滑膜切除术（附119例随访分析）

作者分析了自１９８２～１９９４年间在本院行滑膜切除术后２年以上的类风湿关节炎病人６６例１３２个关节。其中关节镜下滑膜切除术１１９个关节，开放滑膜切除术１３个关节。平均随访７．３年，优良率为７４．２％。关节软骨无破坏组与有破坏组的优良率分别为９２．８％及１４．３％。作者认为保守治疗半年而效果不佳者应尽早行滑膜切除术。     

关节镜下滑膜切除术：病例选择和手术技术（附89例报告）

作者旨在说明关节镜下滑膜切除术是治疗早期滑膜炎的优选手术方法。作者从１９８３年２月～１９９２年１２月应用关节镜下滑膜切除术治疗各类滑膜炎，有随访资料的共８９例，１１１个关节。年龄１４～６０岁，平均３８岁。无一例感染，并在术后两周关节活动度恢复正常。随访２～１１年，平均５．９年，仅４例复发，其中２例再手术，疗效肯定。要获得良好的手术效果，必须注意病例的选择，和掌握手术技术。     

腹部手术后肠瘘的治疗

为提高手术后肠瘘的治愈率，作者总结了１９８９年１２月至１９９６年１０月间收治的腹部手术后肠瘘２４例，包括十二指肠瘘６例，高位小肠瘘３例，低位小肠瘘７例，结肠瘘８例，１６例行保守治疗，治愈率７５％（１２／１６），８例行手术治疗，治愈率８７．５％（７／８），全组死亡率２０．８％（５／２４），作者认为治疗应遵循以下原则：（１）明确诊断；（２）结合生长抑素的应用加强营养支持治疗；（３）控制感染；（４）针对     

滑膜切除术治疗血友病关节出血26例随访报告

本文作者报告了２６例（３５个关节）滑膜切除术治疗血友病关节出血的远期随诊结果。３５个关节中（１５个膝关节、１５个肘关节、３个踝关节及２个肩关节）８个膝关节行镜下滑膜切除术，余２７个关节行开放切除术。术后平均随诊５８个月。２１个关节无再出血，占６０％，１４个关节偶有出血，占４０％。关节功能改善者６个关节，占１７。２％，无变化者１１个关节，占３１。４％，减少者１８个关节，占５１。４％，镜下膝关节滑膜切     

关节镜在诊治急性痛风性关节炎中的价值

目的探讨关节镜诊断和治疗痛风性关节炎的价值。方法应用关节镜微创技术行滑膜组织多点取样病理检查；同时行滑膜刨削切除、关节软骨表面尿酸盐结晶体刮除。结果38例术前诊断急性痛风性关节炎18例（47．37％），漏诊20例（52．63％）。经关节镜下所见及多点滑膜病理检查和滑膜切除。30例得到随访，时间1～10年。采用Lysholm临床评分系统对关节功能进行评估，术后1年平均评分97．6分（95～100分）。结论关节镜微创技术对急性痛风性关节诊断和治疗有极其重要的价值。     

腹部手术后肠瘘的治疗

为提高手术后肠瘘的治愈率，作者总结了１９８９年１２月至１９９６年１０月间收治的腹部手术后肠瘘２４例，包括十二指肠瘘６例，高位小肠瘘３例，低位小肠瘘７例，结肠瘘８例。１６例行保守治疗，治愈率７５％（１２／１６）；８例行手术治疗，治愈率８７．５％（７／８）。全组死亡率２０．８％（５／２４）。作者认为治疗应遵循以下原则：（１）明确诊断；（２）结合生长抑素的应用加强营养支持治疗；（３）控制感染；（４）针对患者的具体情况，正确选择手术时机；（５）积极治疗肠道原发疾病，加强重要脏器功能的监护。     

15年肾移植的临床经验

１９７８年４月至１９９４年３月共实施尸体肾移植５９１例，６０６次。迄今人存活５１０例（８６．３％），死亡９６例（１６．２％），肾脏存活４３４例（７３．４％），摘除移植肾７６例（１２．８％）。术后应用Ａｚａ，泼尼松（Ｐｒｅｄ），环磷酰胺，环孢素（ＣｓＡ）、ＡＴＧ、ＯＫＴ３免疫抑制剂。发生超急性排斥９例次，急性排斥反应２１２例次，慢性排斥反应５８例次。本组带肾存活最长１３年３个月，术后１、３、５、１０年肾存活分别为４２０例（８５．７％），２２２例（７７．４％），１１８例（６９．８％），１例（１６．７％）。就怎样合理地选用免疫抑制剂，术后并发症发生的原因，长期存活的经验进行讨论。     

儿童股骨头无菌坏死疗效分析

报告３０例（３５髋）股骨头无菌坏死治疗结果。随诊期４－１２．５年。可供分级的３１髋皆属ＣａｔｔｅｒａｌｌⅢ，Ⅳ组。保守治疗１１髋，滑膜切除１０髋，血管植入７髋，髋臼造盖３髋，髂骨截骨３髋，内收肌松解１髋。按Ｓｔｕｌｂｅｒｇ标准评定，优良率３１．４％，差２２．９％。疗效差原因为（１）发病年龄大，８岁以上占半数；（２）病情重，８８．６％病例属ＣａｔｔｅｒａｌｌⅢ，Ⅳ组；（３）来院就诊晚，股骨头多已严重     

宫颈妊娠12例临床分析

宫颈妊娠是一种少见的异位妊娠，发病率不到异位妊娠的１％犤１犦，但常常出现突发性阴道大出血而危及生命。本文总结了本院近６年来收治的１２例宫颈妊娠的临床资料，以探讨早期诊断及保守治疗的方法。临床资料１．一般资料：１９９６年１月至２００１年１０月，本院共收治宫颈妊娠１２例，占本院同期收治的异位妊娠的０．８％。年龄２４～３９岁，平均３２岁。经产妇８例（其中剖腹产６例），未产妇４例（既往人工流产史２次～５次）。放置宫内节育器３例，服用事后避孕药２例。２．临床表现：停经６～８周８例，占７５％；停经８～１０周…     

关节镜下诊治单关节发病的类风湿关节炎

目的 探讨单关节发病的类风湿关节炎(rheumatoid arthritis,RA)的早期诊断及治疗。方法 早期出现单膝关节肿胀、疼痛的患者5例，男1例．女4例；年龄23～47岁，平均36．8岁；左膝3例，右膝2例；自发病到手术时间为6个月～3年，平均162个月。检查患者的关节液、血液的同时进行影像学检查和关节镜下探查，并行关节镜下滑膜切除术。对术中所见滑膜形态进行记录、比较，切取滑膜组织做病理检查。手术前、后关节炎症指数、活动范围进行对比。结果 关节镜下可见：滑膜呈暗紫色团簇状增生，绒毛呈杵状膨大，软骨面可见血管翳爬行．有坏死纤维素沉积．病理学诊断均符合RA。术后患者疼痛缓解率为100％．肿胀消失率为60%．活动范围平均增加19%。5例患者在随访过程中逐渐出现多关节发病，症状及体征均符合美国风湿病协会（ARA)诊断标准。由单膝症状到典型症状出现的时间为3～25个月，平均10．9个月；本组5例患者术后无一例出现并发症，结论 关节镜下滑膜形态的特异性表现可早期诊断RA，关节镜下滑膜切除术对膝关节RA的治疗和控制病情发展是一种有效的方法。     

32P as an Adjunct to Standard Therapy for Locally Advanced Unresectable Pancreatic Cancer: A Randomized Trial

This prospective randomized trial was undertaken to determine the added efficacy of (32)P in treating locally advanced unresectable pancreatic cancer. Thirty patients with biopsy proven locally advanced unresectable adenocarcinoma of the pancreas were assessable after receiving 5-fluorouracil and radiation therapy with or without (32)P, followed by gemcitabine. Intratumoral (32)P dose was determined by tumor size and volume and was administered at months 0, 1, 2, 6, 7, and 8. Tumor cross-sectional area and liquefaction were determined at intervals by computed tomography scan. Tumor liquefaction occurred in 78% of patients receiving (32)P and in 8% of patients not receiving (32)P, although tumor cross-sectional area did not decrease. Serious adverse events occurred more often per patient for patients receiving (32)P (4.2 +/- 3.1 vs. 1.8 +/- 1.9; p = 0.03) leading to more hospitalizations. Death was because of disease progression (23 patients), gastrointenstinal hemorrhage (4 patients), and stroke (1 patient). One patient not receiving (32)P and one receiving (32)P are alive at 28 and 13 months, respectively. (32)P did not prolong survival (7.4 +/- 5.5 months with (32)P vs. 11.5 +/- 8.0 months without (32)P, p = 0.16). (32)P promoted tumor liquefaction, but did not decrease tumor size. Intratumoral (32)P was associated with more serious adverse events and did not improve survival for locally advanced unresectable pancreatic cancer.     

肾动脉灌注化疗联合栓塞与免疫治疗巨大肾癌32例

目的 探讨巨大肾癌动脉灌注化疗联合栓塞免疫治疗的疗效。方法 1990年4月～2003年4月，我院对32例巨大肾癌行动脉灌注栓塞术，灌注抗癌药物为表阿霉素30～40mg、丝裂霉素20～30mg、5-FU 500mg；应用无水酒精、5％鱼肝油酸钠、40％碘油加明胶海绵颗粒施行肾动脉栓塞；干扰素和白介素-2辅助治疗。结果 32例均成功施行动脉灌注栓塞术。8例栓塞术后l～3个月实施手术切除，术中见肿瘤血供基本中断，病理见肿瘤细胞坏死明显，周边有少许炎性淋巴细胞及不同程度纤维增生，毛细血管栓塞。总有效率为87．5％（28／32），6个月及1、2、3年生存率分别为78．1％（25／32）、68．8％（22／32）、46．9％（15／32）、31．2％（10／32），平均生存期41．5月。结论 肾动脉灌注化疗联合栓塞与免疫治疗巨大肾癌，临床疗效较好。     

Treatment of dysthyroid myopathy with adjustable suture recession

Extraocular muscle recessions with adjustable sutures were performed on 32 muscles for diplopia secondary to dysthyroid-myopathy. Orthophoria in the primary position was achieved in 30 of the 32 (94%) 1 day after surgery. All remained orthophoric for at least 6 weeks. Of 20 patients followed for 6 months or more, 12 (60%) remained orthophoric for the full extent of their follow-up (6 months to 8 years), and another three (15%) were asymptomatic with prisms (3, 4, and 8 prism diopters). Thus, a total of 15 of 20 (75%) patients remained asymptomatic at least 6 months after surgery.     

~（32）磷－玻璃微球肝动脉灌注治疗晚期肝癌的初步应用

作者评价了３２磷－玻璃微球作为新的内放射栓塞剂治疗晚期肝癌的疗效及毒副作用。自１９９４年３月至１９９５年４月，作者采用术中肝动脉插管或经Ｓｅｌｄｉｎｇｅｒ′ｓ导管栓塞治疗不能切除的晚期肝癌患者２４例，肿瘤直径３．６～１８．５ｃｍ（平均１１．３ｃｍ），主瘤位于右叶９例，左叶１例，弥散于全肝１４例。栓塞部位：右肝８例，全肝１６例。治疗用放射剂量１２００～８０００ｒａｄ（平均３２５０ｒａｄ）。治疗结果：微球主要浓集于癌区，癌与肝的放射性强度比为３．３∶１。术后１～３个月，肿瘤缩小＞５０％者１７例，＜５０％者５例，增大２例；术后３、６、１２、１８、２４个月生存率分别为９２％、７５％、５４％、３３％、２９％。作者认为：３２磷－玻璃微球肝动脉栓塞在不能切除的肝癌的治疗中具有较好的效果，使用安全，值得进一步研究及推广。     

Long-term results of bulk femoral head autograft in cementless THA for developmental hip dysplasia

We evaluated the fate of bulk femoral head autograft in cementless total hip arthroplasty (THA) for developmental hip dysplasia. Of 87 hips (80 patients) studied, 37 hips (32 patients) were available for follow-up at a mean of 18.5 years (range, 15-24 years) postoperatively. The mean age of these 32 patients at the index procedure was 53.8 years (range, 40-65 years). The initial diagnosis was osteoarthritis in all 32 patients. The degree of acetabular dysplasia according to Crowe classification was type I in 18 hips (48.6%), type II in 14 (37.8%), type III in 5 (13.5%). The mean percentage of horizontal coverage of the acetabular components with graft bone was 34% (range, 25%-45%). Trabecular bridging across the graft-host interface was seen at a mean of 4 months (range, 2-6 months) postoperatively. Trabecular reorientation of the grafted bone was seen in all hips at a mean of 27 months (range, 12-36 months) postoperatively. There was no evidence of collapse and bony resorption of the grafted bone in the weight-bearing portion. Acetabular component fixation was stable in all hips at final follow-up. Of the 37 hips (32 patients), 2 acetabular components required revision: 1 for a late postoperative deep infection and 1 for dissociation of the polyethylene liner. The survival rate was 94.5% (95% confidence interval, 91.3-96.5) for the acetabular component at 18.5 years of follow-up. This study found that bulk femoral head autograft in cementless THA for developmental hip dysplasia produces excellent long-term results.     

Phase II study of intravesical therapy with AD32 in patients with papillary urothelial carcinoma or carcinoma in situ (CIS) refractory to prior therapy with bacillus Calmette-Guerin (E3897): a trial of the Eastern Cooperative Oncology Group

ObjectiveTo assess the safety and effectiveness of AD32, a doxorubicin analogue with little systemic exposure when administered intravesically, in patients with recurrent or refractory superficial urothelial carcinoma (formerly called transitional cell carcinoma [TCC]), or carcinoma in situ (CIS), who have failed prior BCG-based immunotherapy.MethodsEligible patients received six weekly doses (800 mg) of intravesical AD32 and were evaluated at 12-week intervals for 24 months or until date of worsening disease. Primary analysis was the proportion of all patients recurrence-free at 12 months. Treatment-related and GU-specific toxicities were also examined. All participating institutions submitted the protocol for Institutional Review Board (IRB) approval.ResultsThe study was halted due to unavailability of study drug after accrual of 48 of a planned 64 patients; 42 were included in the analysis. Of these, 28 (67%) were still alive after median follow-up of 61.1 months. Of 21 TCC patients, 18 (85.7%) experienced disease recurrence (median time to recurrence, 5.3 months). Of the 5 CIS patients with complete response (CR), 3 (60%) experienced disease recurrence; (median time to recurrence, 37.3 months). Recurrence-free rates at 12 and 24 months were 20% (90% CI, 7.8%, 36.1%) and 15% (90 CI, 4.9%, 30.2%), respectively, for patients with TCC and 80% (90% CI, 31.4%, 95.8%) at both intervals for CIS patients with CR. Infection was the most common treatment-related toxicity; no grade 4 or higher toxicity was observed. The most common GU-specific toxicity was increased frequency/urgency.ConclusionsAD32 is safe and active for treatment of recurrent or refractory superficial bladder carcinoma. The agent awaits more complete characterization when drug production problems can be solved.     

Bi-weekly epirubicin, etoposide and low-dose dexamethasone for hormone-refractory prostate cancer

BACKGROUND: Recent studies have demonstrated the efficacy and favorable toxicity profile of chemotherapy regimens given at lower doses and frequent intervals. The aim of our study was to evaluate the efficacy and toxicity of a bi-weekly chemohormonal regimen consisting of epirubicin, etoposide, and low-dose dexamethasone (EED) in patients with hormone-refractory prostate cancer (HRPC). METHODS: We treated a total of 32 patients who had failed hormonal therapy and antiandrogen withdrawal. Chemotherapy was given every 2 weeks and consisted of epirubicin (30 mg/m2 intravenously, day 1) and etoposide (50 mg/m2 orally, days 1-7). Dexamethasone (1.5 mg orally, every other day) was given continuously until disease progression. Twenty patients (63%) had received prior treatment with estramustine phosphate. Each patient's pain response was evaluated according to analgesic use. Toxicity was graded using the Common Toxicity Criteria (version 2.0). RESULTS: Prostate-specific antigen (PSA) levels showed a decline of 50% or greater in 16 of 32 patients (50%, 95% confidence interval [CI], 32-68%) with a median time to biochemical progression of 5 months (range, 4-9 months). The median survival for all patients was 10.5 months (range, 3-35 months). Four of 10 patients (40%) with measurable soft tissue lesions achieved partial response according to standard criteria. Eleven of 23 symptomatic patients (48%, 95% CI, 27-69%) experienced an improvement in pain with a median duration of 6 months. The regimen was tolerated well by the patients, with only four patients (12%) having grade 3 leukopenia. CONCLUSION: Chemohormonal EED regimen proved to be active and well-tolerated in patients with HRPC.     

Structural changes in aging bone: osteopenia in the proximal femurs of female mice

A computerized image analysis system was used to quantitate age-related changes in the structure of the proximal femur in CW-1 female mice, ranging from 3 to 32 months of age. Morphological findings revealed a progressive thinning of bone trabeculae within the femoral head, accompanied by the development of marrow cavities in the cortical bone of the femoral neck and in the subchondral bone. As a result, the compact bone in senescent mice acquired an appearance similar to trabecular bone. Quantitative image analysis revealed a similarity in the pattern of changes in the three types of bone: cortical, trabecular, and subchondral. Bone density increased from 3 to 12 months of age and subsequently declined. A similar pattern was noted for the changes in the thickness of the cortical and the subchondral bone. Regression analysis revealed that the changes with age fitted a second-order model; thus it was possible to predict the age of maximal values for each parameter. Hence, the age of maximal bone density for cortical, trabecular, and subchondral bone was 12.3, 14.8, and 18.0 months, respectively. The rate of bone loss after 12 months was most prominent for trabecular bone (1.47% per month), so that by 32 months of age its overall mass had declined by 57% in comparison to peak values seen at 12 months of age (p less than 0.001). The density of the subchondral and cortical bones decreased at a slower rate (0.6% to 0.8% per month) and at the age of 32 months their values had decreased by 12% to 18% in comparison to those at 12 months (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Repair of truncus arteriosus in infancy

Improvements in myocardial protection, surgical technique, and postoperative care have decreased operative mortality for neonatal repair of truncus arteriosus. Primary repair of truncus arteriosus in infancy without prior pulmonary artery banding is currently the preferred approach. During the period from 1982 to December 1990, 32 patients under the age of 12 months underwent surgical correction of truncus arteriosus at UCLA. The average age was 3.5 months (range, 12 days to 12 months). Three patients had interrupted aortic arch. Early mortality for the entire group was 15.6% (5/32); for those older than 1 month early mortality was 7% (2/28). In the past 4 years, early mortality has decreased to 8.3% (2/24); both of these patients had interrupted aortic arch. Excluding patients with interrupted aortic arch, there were no early deaths in the last 22 patients (1986 to 1990). Late mortality overall was 7.4% (2/27). In a mean follow-up of 73 months (range, 40 to 110 months), 71% (5/7) of the survivors with Dacron porcine-valved conduits required conduit replacement secondary to obstruction. In a mean follow-up of 36 months (range, 1 to 89 months), only 14% (3/21) of the patients with homografts required replacement secondary to obstruction.     

Stanford B型主动脉夹层覆膜支架血管腔内修复术后的中、远期严重并发症

目的评价应用覆膜支架血管腔内修复术治疗StanfordB型主动脉夹层后的中、远期严重并发症。方法2005年1月-2011年1月,189例症状性StanfordB型主动脉夹层患者接受覆膜支架血管腔内修复术治疗,其中男157例,女32例。分析治疗术后中、远期严重并发症的发生率。结果随访时间平均为32个月（3-63个月）,随访率71．43％（135／189）,失访率28．57％（54／189）。术后中、远期随访,19例（19／135,14．07％）发生严重并发症,包括死亡8例（8／135,5．93％）,截瘫2例（2／135,1．48％）,StanfordB型夹层转为逆行性StanfordA型夹层2例（2／t35,1．48％）,严重内瘘7例（7／135,5．19％）。结论覆膜支架血管腔内修复术治疗StanfordB型主动脉夹层与外科手术相比较有重要意义,但术后严重的并发症仍时有发生,应该引起重视。