Objective To study the significance of the levels of plasma inflammatory cytokines (IL-6，IL-8，IL-10 and TNF-α) in patients with acute deep venous thrombosis (DVT) of lower extremity. Methods Forty untreated DVT cases were selected as the subjects in the DVT group, while thirty healthy subjects, whose ages and genders showed no significant difference with the DVT patients, were collected as the control group. The plasma levels of IL-6, IL-8 and TNF-α were detected by radioimmunoassay (RIA), and the plasma level of IL-10 was measured by enzyme-linked immunosorbent assay (ELISA). Correlation analysis was used to investigate the relationships between the levels of different inflammatory cytokines within DVT group. Results The levels of plasma cytokines in the DVT group were all significantly higher than those in control group (P＜0.001). The results of the correlation analysis showed that there were positive correlations between IL-6 and TNF-α (r=0.383, P＜0.05), IL-10 and TNF-α (r=0.390, P＜0.05), respectively, within the DVT group; whereas there were no correlations between IL-6 and IL-8, IL-6 and IL-10, IL-8 and IL-10, and IL-8 and TNF-α. Conclusion The levels of plasma cytokines increased significantly in patients of DVT. Inflammatory cytokines may play an important role in acute DVT by accelerating the pace of thrombosis, intensifying the inflammatory reaction around thrombus and aggravating the injured blood vessel.
【Abstract】 Objective To investigate the effects of different surgical methods in treating scalp mal ignanttumors. Methods From January 1995 to September 2004, 70 patients with scalp mal ignant tumor were treated with different surgical methods. There were 41 males and 29 females with an average age of 50.3 years (30-85 years). The course of disease ranged from 2 weeks to 3 years(mean 3.5 months). There were 31 cases of basal cell carcinoma, 24 cases of squamous carcinoma, 8 cases of melanocarcinoma, 4 cases of fibrous sarcoma, 2 cases of l iposarcoma, and 1 case of vasculosarcoma. Leision size ranged from 1.0 cm × 0.5 cm to 10.0 cm × 8.0 cm. Scalp defect ranged from 3 cm × 3 cm to 12 cm × 11 cm after clearing up the tumors. Defect was repaired with free skin transplantation in 51 cases, scalp flap in 12 cases, cervico-shoulder flap in 2 cases, trapizius myocutaneous flap in 3 cases, and radial artery retro-island flap in 2 cases. The flap sizes ranged from 5 cm × 4 cm to 18 cm × 12 cm. Results Of 70 cases, 67 skin flaps survived and incision healed by first intention; 2 flaps necrosed at distal part(lt; 1 cm) and healed by second intention after dressing change; 1 flap infected and was treated with symptomatic medication.All the donor sites healed by first intention. Fifty-five patients were followed up for 1 to 5 years and 5 cases had tumor recurrence. In patients receiving skin transplantation, 1 case of squamous carcinoma and 1 case of fibrous sarcoma relapsed after 1 year and 2.5 years respectively and were given radical resection and skin flap grafting; in patients receiving skin flap grafting, 1 case of vasculosarcoma and 1 case of squamous carcinoma relapsed after 6 months and 3 months respectively, and gave up treatment; 1 case of fibrous sarcoma relapsed after 2 years and was given radical resection and skin flap grafting. The other cases survived and had no tumor recurrence. Conclusion Scalp mal ignant tumors should be diagnosised and treated as early as possible. Clearing up completely by surgery is an effective method.
Objective To investigate the operative procedure and the effectiveness of cranial bone reconstruction after one-stage resection of scalp squamous carcinoma invading the skull. Methods Between January 2005 and December 2008,14 patients with scalp squamous carcinoma invading the skull were treated. There were 6 males and 8 females with a median age of 53 years (range, 29-76 years). The disease duration ranged from 3 to 8 years (mean, 6 years). The tumor locations were right temporal area in 2 cases, left temporal area in 2 cases, right frontal area in 3 cases, left frontal area in 1 case, right occi pital area in 1 case, left occi pital area in 2 cases, frontal area in 2 cases, and the top of the head in 1 case. Scalp lesions showed exogenous growth, and lesion diameter ranged from 5 to 12 cm (mean, 8 cm). TNM classification showed T4N0M0 tumor in all cases. MRI showed that tumors invaded the skull, 12 cases had smooth intradural side and 2 cases had brain involvement without lymph node metastasis or detected distant metastasis. Under general anesthesia, all the lesions of the scalp, skull, dura, and brain tissue were removed completely. The size defect of the scalp, skull, and dura ranged from 8 cm × 7 cm to 15 cm × 14 cm, from 5 cm × 4 cm to 12 cm × 12 cm, and from 4 cm × 4 cm to 9 cm × 8 cm, respectively, which were repaired with artificial patch, titanium metal, mesh, and local flaps, respectively. The donor site was repaired by spl it-thickness skin graft. Results The skin flaps and grafts survived and incision healed by first intention without cerebrospinal fluid leakage, intracranial and subdural hemorrhage, andother compl ications. All patients were followed up 2 to 5 years (mean, 4 years), and no recurrence was found. The compatibil ity of titanium mesh and local tissue was good. The patients had good hair growth without exposure of titanium mesh, seizures, partial paralysis, and other neurological damage performance. Conclusion After one-stage resection of scalp squamous carcinoma invading the skull, it is effective to reconstruct the skull with titanium mesh and to repair dural defects with artificial dura.
Object ive To inves t igate the operat ive method and cl inical ef fect of repai r ing and reconstructing the traumatic defect of medial malleolus in children with complex tissue flap of vascularized fibular head epiphysis. Methods From July 2003 to December 2007, 8 children with defect of medial malleolus due to wheel injury were treated, including 5 boys and 3 girls aged 2-10 years old. The medial malleolus were completely defected (5 cases at left foot and 3 cases at right foot) and combined with the skin defect around the medial malleolus (4.0 cm × 2.0 cm - 9.5 cm × 5.5 cm). The time from injury to hospital admission was 6-8 hours in 2 cases, and 24-168 hours in 6 cases. The complex of vascularized fibularhead epiphysis and tissue flap was adopted to repair the defect. The flap 4.5 cm × 2.5 cm - 10.0 cm × 6.0 cm in size and the fibular head epiphysis 2.5-3.0 cm in length were harvested. The donor site was sutured directly. Results All wounds healed by first intention, all the composite tissue flap survived with good blood circulation, all the epiphysis of medial malleolus healed within 6-9 weeks, and all the donor sites healed well. All the child patients were followed up for 1-5 year. The color and elasticity of the flaps were good, without cicatricial contracture. The patients had no inversion of ankle joint, with satisfying loading and walking function. Six cases had normal flexion and extension of the ankle and 2 cases were l imited sl ightly (dorsiflexion 10-20°, plantarflexion 35°). Talus has no inner move and ankle joint had no eversion. Seven cases were graded as excellent and 1 as good according to the standard of American Orthopaedic Foot amp; Ankle Society. For the medial malleolus, no premature closure of epiphysis occurred, and the center of ossification grew gradually and well developed l ike the contralateral side. The donor knee joint had normal flexion and extension function, without inversion and instabil ity. Conclusion The complex of vascularized fibular head epiphysis and tissue flap can repair the epiphysis and soft tissue defect of medial malleolus in children at one stage, and the reconstructed medial malleolus can develop with the growth of children. It is a satisfactory method of reconstructing the traumatic defect of medial malleolus in children.
Objective To investigate the surgical treatment and curative effect of hemangioma and vascular malformation in body surface. Methods From May 2003 to December 2006, 145 patients with hemangioma or vascular malformation (81 males and 64 females, aging from 2 months to 40 years with median of 17 years) were treated with surgical therapy. The course of disease was from 2 months to 40 years. The locations were head and face in 85 cases, extremities in 34 casesand trunk in 26 cases. The size ranged from 1 cm × 1 cm to 27 cm × 24 cm. Wounds were sutured directly after lesions excision in 40 cases, were repaired with 3 cm × 2 cm-18 cm × 11 cm local flap transferring in 21 cases (donor site sutured directly in 18 and free skin grafted in 3) and with 5 cm × 3 cm-27 cm × 18 cm middle-thick skin graft in 84 cases (abdominal skin donor site sutured directly in 61, thigh skin donor site thin-partial-thickness grafted in 5 and skin in-situ regrafted in 18). Results The pathological results showed 38 cases of capillary hemangioma, 23 cases of venular malformation, 67 cases of venous malformation, 15 cases of arteriovenous malformation and 2 cases of lymphatic malformation. Six of 84 cases receiving free skin graft had partial skin necrosis; one case compl icating by skull exposure achieved heal ing after local fascial flap transferring and other 5 cases achieved heal ing by second intention after dressing changes. Other free skin graft survived. All the donor sites healed by first intention. All patients were followed up for 1-3 years. Recurrence occurred in 12 cases 6 months to 2 years after operation, including 4 cases of arteriovenous malformation, 7 cases of venous malformation and 1 case of venular malformation. They were cured after second operation. The others achieved good results with no recurrence. Conclusion Extensive and thorough excision was the effective way to cure hemangioma and vascular malformation in body surface. All cases should be followed up closely to deal with recurrence promptly.
目的 探讨成年人颅骨表面遮盖重建（SSD）的理想阈值设定，为利用SSD进行的头部CT血管成像（CTA）去骨成像提供阈值设定的依据。 方法 选取2012年8月，在成都市第一人民医院体检的、同一单位工作的86位体检对象，进行颅骨平均CT值、腰椎骨质密度、性别及年龄的两两对照及多重线性回归拟合，建立起预估颅骨平均CT值的多重线性回归方程，计算出18～80岁人群的理论平均颅骨CT值作为SSD的理想阈值。同时收集2012年10月－2013年2月在该院进行头部CTA检查的12例患者的相关资料以验证其可行性。 结果 18～80岁人群的理论平均颅骨CT值约为640 Hu。以该值作为SSD的阈值进行去骨成像，所有患者图像质量评分均为5分，可视为去骨成功。 结论 在利用理论颅骨平均CT值作为重建阈值的基础之上，通过简单的SSD图像质量再判断及修正，即可简便地完成后处理工作，具有可行性。