ObjectiveTo introduce the advances in diagnosis and treatment of superior mesenteric artery syndrome (SMAS). MethodsLiteratures about SMAS published in domestic and abroad were collected and reviewed. ResultsSMAS was a rare medical condition characterized by acute or chronic ileus resulting from vascular compression of the third part of the duodenum by superior mesenteric artery. Images of upper gastrointestinal series, CT, MRI, and color Doppler ultrasonography were the major methods of diagnosing the syndrome and the upper gastrointestinal series was the most important. Conservative approaches were usually preferred to the treatment of SMAS. Surgery was performed on symptomatic patients when conservative treatment failed, and duodenojejunostomy was the best surgical procedure. ConclusionAwareness of the clinical and imaging features may be helpful to diagnosis and treatment of SMAS, and reasonable therapy shall include etiological treatment and relief of the obstruction by conservative treatment or surgery.
Objective To analyze the outcome of patients with Blunt Abdominal Injury (BAI) in the Deyang People’s Hospital after the Wenchuan Earthquake, in order to provide evidence for future improvement in emergency response after earthquakes and in the treatment of BAI patients. Methods Data on the BAI patients within 1 week after the earthquake were collected from the Information Department of the Hospital. Microsoft EXCEL was used for data input. Results A total of 23 BAI inpatients were treated, of whom 15 were from Mianzhu City and sent to hospital within 12 hours of the earthquake. This was 1.9% of the total inpatients. The BAI inpatients suffered severe and complex injuries, and 5 of them died (mortality rate: 22%). Linenectomy was conducted for patients with spleen injuries and two inpatients developed incision infection due to lack of antibiotics during the perioperative period. Conclusions It is important to establish an emergency response mechanism for medical rescue for patients with the viscera injury, including BAI, after an earthquake. This would help to guarantee rational allocation of the rescue workers, triage of the wounded, optimization of operation, as well as a reduction in mortality from BAI.
Objective To evaluate the preliminary effect of using the sternal head of the sternocleidomastoid myocutaneous flap to reconstuct a defect in the maxillofacial region. Mathods From May 2004 to September 2006, 5 male patients aged 2334 underwent the reconstruction for the defect in the maxillofacial region by using the sternal head of the sternocleidomastoid myocutaneous flap. Their defects were caused by an infection of the face, an injection of medicine in the mother’s uterus or a scar or depressed abnormality left by an electric injury. The defects ranged in size from 5 cm×3 cm to 9 cm×6 cm. Results All the 5 sternocleidomastoid myocutaneous flaps survived, with a little necrosis of the epidermis because of the venous return disturbance, but 2-3 weeks after operation the necrosis healed spontaneously with just a little scar formation around the flap. One patient had weakness in the left shoulder after operation, which almost recovered 6 months after operation. The postoperative follow-up for 1-6 months revealed that 1 patient had a little fat and clumsy appearance in the flap pedicle, 1 patient had an obvious scar at the operation site, but the 2 patients still felt satisfaction. The other 3patients were satisfied with their good appearance at the operation sites. Conclusion The sternal head of the sternocleidomastoid myocutaneous flap can be designed with more flexibility compared with the entire sternocleidomastoid myocutaneous flap. It can provide an enough tissue mass for restoring the defect. The sternal head of the sternocleidomastoid myocutaneous flap is an ideal tissue flap for restoring defects in the maxillofacial region.
Objective To describe cultured human retinal pigment epithelial (RPE) cells transdifferentiation and investigate the effects of human vitreous fluid on the morphologic and cytoskeleton changes of RPE cells in vitro. Methods Cytoskeleton characteristics in the 2nd, 5th, 8th passage of RPE cells in normal culture, which included cytokeratin 18 (CK18) and α-smooth muscle actin (α-SMA) were analyzed by Western blot. RPE cells were cultured in human vitreous-conditioned medium (VCM) at the concentration of 1∶4 for 6 days, morphologic changes were examined by light and electron microscopy, and cytoskeleton characteristics were analyzed by imunocytochemistry and Western blot. Results During culture in vitro, RPE cells lost epithelial characteristics and aquired fibroblast-like phenotype. The expression of CK18 was the highest at the 5th passage, and it decreased in the following passage, but α-SMA increased gradually. The morphologic transdifferentiation from epithelial to fibroblast-like cells of RPE was accelerated by VCM. Ultrastructural changes such as decreased microvilli and gradually increased rough endoplasmic reticulum and Golgi complex were found during the cultivation. CK18 produced by RPE cells decreased in VMC (P＜0.05), and α-SMA increased (P＜0.01). Conclusion Morphologic changes in epithelialmesenchymal transdifferenetiation of RPE cells are stimulated by VCM and accomplied by the shift of cytoskeleton proteins, The results imply that cells migration may be decreased and contraction may be enhanced in VCM. It may suggest that vitreous accelerates the pathogenesis of PVR and RPE cells play an important role. (Chin J Ocul Fundus Dis, 2002, 18: 289-292)
目的探讨胃肠道间质瘤（GISTs）的临床表现、病理特点及诊断、治疗和预后。方法回顾性分析2002年1月至2004年3月期间收治的21例GISTs患者的临床和病理资料。结果主要临床表现为腹部不适或疼痛、消化道出血、腹部包块和贫血。术前无一例确诊。均接受手术治疗，术中均未见淋巴结肿大转移。肿瘤直径＜5 cm者有9例，5～10 cm者有 9例，＞10 cm者3例。常规病理检查见梭形细胞，最终依靠免疫组化染色确诊。良性5例，低度恶性14例，恶性2例； 免疫组化检测CD117阳性18例，CD34阳性13例，而CD117阳性和（或）CD34阳性20例。随访3～30个月，平均11.5个月，随访率为100%，1例于术后13个月死亡，1例术后7个月出现肝转移，其余均无瘤生存。结论GISTs术前确诊非常困难，病理检查时发现非上皮性的梭形细胞肿瘤应作常规免疫组化染色以确诊，手术切除为主要治疗方法。