颏形态综合分析在颏部水平截骨整形术中的应用

目的探讨分析小颏畸形的颏部形态特征及其在颏部水平截骨整形手术应用中的效果。方法通过头颅正侧位X线头影测量分析12例小颏畸形患者的颏部形态,按测量值与正常值之间的差值,计算截骨段移动范围,手术采用颏部水平截骨整形手术方法。结果12例患者均按照术前预测值移动截骨段,术后头颅正侧位X线头影测量结果与术前预测值相近,治疗效果满意。结论通过头颅正侧位X线头影测量分析小颏畸形的特点,精确计算截骨段的移动范围和方向,是保证颏部水平截骨整形术达到良好美容效果的基础。     

AmpC酶的检测技术研究进展

在细菌耐药酶研究机制中，革兰阴性杆菌中的AmpC酶备受临床床关注，使人类对抗AmpC酶的斗争更加艰难。AmpC酶属BushI型酶或AmberC类酶，是不被克拉维酸抑制的“丝氨酸”头孢菌素酶，主要存在于肠杆菌，枸橼酸杆菌，粘质沙雷菌，摩根摩根菌，铜绿假单胞菌等菌属中。AmpC酶可分为诱导型、结构型、质粒型。本文将三型AmpC酶的检测技术综述如下。     

Smoking Impairs Rectal Mucosal Bloodflow—A Pilot Study: Possible Implications for Transanal Advancement Flap Repair

ABSTRACT Transanal advancement flap repair has been advocated as the treatment of choice for transsphincteric perianal fistulas, because it enables the healing of almost all fistulas without sphincter damage and consequent continence disturbance. After initial promising reports, recently less favorable results have been reported. It remains unclear why there is such a large variety in the reported healing rates. Recently, it has been suggested that impaired wound healing caused by a diminished rectal mucosal perfusion in patients who smoke may lead to the breakdown of the advancement flap in patients undergoing flap repair for perianal fistulas. This study was designed to investigate the difference in blood flow in rectal mucosa between patients who smoke and those who do not smoke. Furthermore, we assessed the impact of the creation of a mucosa advancement flap and the difference in blood flow in the flap between smoking and nonsmoking patients. Between July 2001 and July 2002, 23 consecutive patients (19 males; median age, 46 (range, 26–69) years) with a perianal fistula of cryptoglandular origin underwent surgery for a perianal fistula. Among them were 13 patients who smoked cigarettes. All patients underwent intraoperative laser Doppler flowmetry. Median blood flow before transanal advancement flap repair was 35 (range, 8–70) volts in patients who did not smoke. In patients who smoked the median blood flow before transanal advancement flap repair was 18 (range, 7–35) volts. Blood flow was significantly lower in patients who smoked (P = 0.018; Mann-Whitney). In conclusion, it seems likely that impaired wound healing caused by a diminished rectal mucosal perfusion is a contributing factor in the breakdown of advancement flaps in patients who smoke cigarettes.Read at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.Reprints are not available.     

慢性阻塞性肺疾病伴发营养不良的机制及其干预研究进展

目前研究表明,慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)除了会出现特征性的肺部病理改变外,也可以引起全身(或称肺外)的不良反应,即COPD的肺外效应(全身效应).其中营养不良是COPD常见的肺外效应,其对疾病的发展及预后有着重要影响.以下就目前国内外有关CO...     

RESTORATION OF INVOLUNTARY TONIC CONTRACTION OF THE LEVATOR MUSCLE IN PATIENTS WITH APONEUROTIC BLEPHAROPTOSIS OR HORNER SYNDROME BY APONEUROTIC ADVANCEMENT USING THE ORBITAL SEPTUM

Müller's muscle can be thought of as a large serial type of muscle spindle of the levator muscle. Effective stretching of the mechanoreceptor in the proximal part of Müller's muscle by voluntary phasic contraction of the levator muscle for initial opening of the eye induces involuntary tonic contraction of the levator muscle as a stretch reflex via the mesencephalic trigeminal nucleus, to maintain an adequate visual field. After disinsertion of the levator aponeurosis from the tarsus by habitual rubbing, elongation of Müller's muscle secondary to thinning (aponeurotic blepharoptosis) or paralysis (Horner syndrome) desensitises the mechanoreceptor of Müller's muscle, resulting in blepharoptosis. Shortening of the elongated and thinned Müller's muscle by instillation of phenylephrine, and surgical shortening, and fixation of the disinserted, elongated, and thinned aponeurosis using the orbital septum, restored involuntary tonic contraction of the levator muscle in nearly all of 2000 patients with aponeurotic blepharoptosis and in 11 patients with Horner syndrome.     

Barrett's食管的研究现状

Barrett's食管是以食管下段逐步肠化及不典型增生为主要特征的食管腺癌癌前状态.本文系统阐述了Barrett's食管定义、发病机制、诊断方法、环氧化酶2(COX-2)等癌基因治疗及内镜下激光、黏膜下切除、光动力治疗等最新进展,为Barrett's食管发病机制的揭示、早期诊断、根治性治疗以及食管腺癌的预防提供了新的思路.     

非小细胞肺癌治疗新进展

肺癌是全世界最常见的恶性肿瘤之一.近20年来,每年肺癌新病例以大约0.5%的速率在增长,目前肺癌已成为严重危害人类生命和健康的常见病.非小细胞肺癌(non-small cell lung cancer,NSCLC)是指除小细胞癌以外的所有类型的肺癌,约占所有肺癌的75%～80%.此类肺癌的治疗早期多采用以手术为主的治疗方法,中、晚期则以放、化疗为主,但是疗效并不佳,中位生存期短.近年来,以表皮生长因子酪氨酸激酶抑制剂和血管内皮生长因子抑制剂为代表的分子靶向治疗为NSCLC提供了新的治疗手段.     

The outcome of transanal advancement flap repair of rectovaginal fistulas is not improved by an additional labial fat flap transposition

Transanal advancement flap repair (TAFR) has been advoated as the treatment of choice for patients with low rectovaginal fistulas. Recently, several studies have reported a significantly lower healing rate. We also encountered low healing rates after TAFR. In an attempt to improve our results, we added labial fat flap transposition (LFFT) to the TAFR of rectovaginal fistulas. The aim of the present study was to evaluate the outcome after TAFR and to investigate the impact of an additional LFFT. Between 1991 and 1997, 21 consecutive patients of median age 33 years underwent TAFR. The etiology of the fistulas was: obstetric injury (n=9), cryptoglandular abscess (n=8) and wound infection after anterior anal repair (n=4). The first 9 patients underwent TAFT with (n=3) or without (n=6) anterior anal repair. In the following 12 patients, LFFT was added to the advancement flap. In 4 of these a concomitant anterior anal repair was performed. The median follow-up was 15 months. The overall healing rate was 48%. In the first 9 patients, in whom no additional LFFT was performed, the rectovaginal fistula healed in 4 cases (44%). In the following 12 patients in whom an additional LFFT was performed, a similar healing rate was observed (50%). In conclusion, the outcome of transanal advancement flap repair of rectovaginal fistulas is poor. Addition of a labial fat flap transposition does not improve this outcome. Received: 25 January 2002 / Accepted in revised form: 6 February 2002     

An Investigation into the Changes in Airway Dimension and the Efficacy of Mandibular Advancement Appliances in Subjects with Obstructive Sleep Apnoea

Abstract

This prospective clinical study evaluates a group of 37 male Caucasians with obstructive sleep apnoea for changes in airway dimension and the efficacy associated with the use of mandibular advancement splints. Lateral skull radiographs were obtained with the subjects—upright in occlusion, supine in occlusion, and supine in protrusion. Each radiograph was traced and digitized, and changes in mandibular position, airway dimensions, and hyoid were examined. Subjects were invited to complete pre- and post-treatment questionnaires, and interviewed following fitting of a removable Herbst mandibular advancement splint.

Significant changes were recorded in the airway dimensions in response to both a change in position, from upright to supine, and in response to mandibular advancement. A compliance rate of 76 per cent was achieved with no reported serious complications associated with the use of mandibular advancement devices.     

宫腔超声造影的临床应用及进展

宫腔超声造影技术是指向子宫腔内注入造影剂使宫腔扩张、内膜分离后,在经阴道超声下观察子宫内膜及宫腔内病变情况,该技术能清晰显示宫腔内病变为弥漫性或局灶性以及局灶性病变的位置和特征,具有很高的临床应用价值。本文综述宫腔超声造影的发展和操作过程及技术要领,重点讨论宫腔超声造影诊断宫腔内病变的临床应用价值,并介绍该技术临床应用的最新进展。