腹膜返折下直肠损伤3例治疗体会

本文结合我们自1991年5月～1993年7月经治的腹膜返折下直肠损伤3例病人,总结了对腹膜返折下直肠损伤的治疗体会。我们认为这类病人关键是一期原位修补。一期修补,可去除污染源,减少并发症。总结适应证:①通过术前检查,确定直肠损伤位置较高,在返折附近;②创口新鲜,创缘挫灭轻;③直肠后壁或侧壁的损伤。其次是术后的双冲洗,即冲洗远端结直肠,冲洗直肠损伤周围。第三为双引流,即骶前经左下腹腹膜外及尾骨与直肠间各放一枚胶管引流。术后连续3天以甲硝唑250ml自腹膜外引流管注冲洗,于尾骨前引流管排出、双冲洗及双引流对防止直肠损伤后并发证均有重要意义。

肛管直肠损伤的诊断和治疗

肛管直肠因其特定的解剖部位，外伤的发生率较低。若发生损伤则伤情复杂，且多合并其它脏器的联合伤，在诊断、治疗上有其特殊之处，并发症的发生率高，如处理不当，后果严重。本文总结１９７８年３月一２０００年３月收治的肛管直肠损伤１８例，报告如下。

直肠癌经腹会阴联合切除术术后护理体会

直肠癌是胃肠道恶性肿瘤之一，其特点是以低位（即位于距肛缘7cm以内，腹膜返折下癌肿）为多见，约占直肠癌的75％．直肠癌经腹会阴联合癌切除术（Miles术式）特点为病变切除较彻底，治愈率高，由于手术复杂，创伤大，患者需做永久性肛门，因此，做好术后护理对患者的康复至关重要。现将直肠癌行造口术患者术后护理体会报告如下。

Stability analysis of shallow tunnels subjected to seepage with strength reduction theory

Based on strength reduction theory,the stability numbers of shallow tunnels were investigated within the framework of upper and lower bound theorems of limit analysis. Stability solutions taking into account of water seepage were presented and compared with those without considering seepage. The comparisons indicate that the maximum difference does not exceed 3.7%,which proves the present method credible. The results show that stability numbers of shallow tunnels considering seepage are much less than those without considering seepage,and that the difference of stability numbers between considering seepage and without considering seepage increase with increasing the depth ratio. The stability numbers decrease with increasing permeability coefficient and groundwater depth. Seepage has significant effects on the stability numbers of shallow tunnels.

AN IMMUNOCYTOCHEMICAL STUDY OF BONE MORPHOGENETIC PROTEIN IN EXPERIMENTAL FRACTURE HEALING OF THE RABBIT MANDIBLE

A monoclonal antibody raised against bone morphogenetic protein (BMP-McAb) has been used to demonstrate the presence of bone morphogenetic protein(BMP) in experimental fracture healing. Rabbit mandibles were fractured using standardized methods and left to heal for 3, 7, 14, 21 and 24 d, respectively. The avidin-biotin complex (ABC) method demonstrated an accumulation of positively stained primitive mesenchymal cells at the fracture site in the hematoma stage of bone repair. These cells appeared to undergo differentiation into positively-stained chondroblasts and osteoblasts during the phase of callus formation. Undifferentiated mesenchymal cells showed a high positive reactivity in the early post-fracture stages but a much lower reactivity during the remodelling phase.The results of our study suggest that bone inductive processes are accompanied by the presence of BMP in osteoprogenitor cells during fracture healing of the mandible and that BMP may play a significant role in osteogenesis during bone healing.

Retrospective analysis of clinical characteristics and prognostic factors for pathologic fracture in 44 patients with extremity osteosarcoma

Objective: The aim of this study was to identify the clinical features and prognostic factors associated with extremity osteosarcoma with pathologic fracture. Methods: The clinical records of 271 patients with extremity osteosarcomas were retrospectively reviewed. The data obtained covered the period from October 2003 to May 2012, and included sex, age, tumor site etc. The mean follow-up time was 25.2 months(ranged from 1 to 117). Chi-square method and Kaplan-Meier method were used to compare clinical differences and overall survival between patients with or without pathologic fracture, respectively. The univariate analysis was used to determine the prognostic factors related with survival rate by log-rank test. The multivariate analysis of prognosis was performed by COX proportional hazards regression model. Results: The proportions of patients having a tumor's diameter of 10 cm or more(P = 0.038), locating upper limbs(P = 0.004) and receiving amputation surgery(P = 0.02) were significantly higher with pathological fracture group than without pathological fracture group. The local recurrence rate(P = 0.000) was also significantly higher in the pathological fracture group. The median survival time of patients with or without pathological fracture was 16(95% confidence interval: 14.6–17.4) months and 22(95% confidence interval: 19.8–24.1) months(P = 0.002). The Log-rank univariate analysis indicated that the tumor size, Enneking's surgical staging, Karnofsky performance status(KPS) score, cycles of adjuvant chemotherapy, local recurrence and metastasis were significantly related to overall survival. Multivariate Cox regression analysis revealed KPS score, cycles of adjuvant chemotherapy and metastasis were independent prognostic factors(P < 0.05). Conclusion: Compared with the patients without pathological fracture, a higher proportion of patients receiving amputation surgery or having larger tumor size, humeral osteosarcoma or local recurrence was observed in patients with pathological fracture, and the prognosis of these patients was poor. The independent prognostic factors of extremity osteosarcoma with pathologic fracture were the KPS score, cycles of adjuvant chemotherapy and metastasis.

直肠癌术后肠系膜上动脉供血不足一例

患者，男性，84岁，因“排便次数增多2月伴间断脓血便1周”于2007年12月3日入院。入院诊断为直肠癌并低位结肠不全梗阻。入院后术前准备1周，在全身麻醉下行“直肠癌经腹前切除术加回肠末端预防性造口术”。术中见肿瘤位于腹膜返折下3cm，环行生长，大小3cm×3cm．侵及外膜。术毕检查吻合口通畅，无张力。

元刊杂剧《双赴梦》【天下乐】曲校勘研究

元刊杂剧现有诸校本对《双赴梦》第一折【天下乐】曲的校勘结果还存在两个问题。"镫折皮"一词无误,"折"本字为"靼",其古文为"?",俗字作"?",音近别字作"徹",这五种形体体现了端章分化与知章合流两条声纽演变规律。"滴此"为"滴些"之误。根据这两条校勘意见,并结合曲谱对整支曲子的句读做了标注。

《东方少年·快乐文学》2017年2期内容提要

《向日葵的孩子》……………………………………九穗金黄的葵花开得正好,我折下一只硕大的花盘。可惜,葵花籽还有些嫩,我失望地把花盘扔到了地上。正在这时,耳边传来一个愤怒的声音:'你在干什么?'……《咕噜咕噜火锅店》………………………………孙君飞哪家火锅店愿意接待流浪汉、小丑、乞丐、侏儒和兔子呢?

盆腔淋巴结清扫治疗腹膜返折以下直肠癌的疗效分析

目的：减少腹膜返折以下直肠癌传统的Ｍｉｌｅｓ术后盆腔复发，提高５年生存率。方法：将４５例盆腔淋巴结清扫术与５３例Ｍｉｌｅｓ手术的疗效进行比较，对盆腔淋巴结清扫所得的淋巴结分组病检。结果：盆腔淋巴结清扫组死亡２例，出现并发症３８例，５年生存率为６０．０％±３．８５％，局部复发率为６．６７％；Ｍｉｌｅｓ手术组死亡１例，并发性功能障碍３９例，５年生存率为４５．２％±３．０１％，局部复发率为２０．７５％。结论：只要不过多地清除骶前及盆腔侧壁组织，并注意止血，盆腔淋巴结清扫手术的并发症和手术危险性并不明显增加，盆腔清扫组５年生存率高于Ｍｉｌｅｓ组，但无统计学意义（Ｐ＞０．０５），局部复发率明显低于Ｍｉｌｅｓ组，Ｐ＜０．０５有统计学意义。

Clinical curative effect of fuzi-cake-separated moxibustion for preventing dysuria after operation for lower limb fracture

OBJECTIVE: To assess the clinical curative effect of fuzi-cake-separated moxibustion at Zhongji(CV 3)and Guanyuan(CV 4) for preventing dysuria after internal fixation of lower limb fractures.METHODS: Sixty patients conforming to the inclusion standards were randomly divided into a treatment group(n=30) and a control group(n=30).Fuzi-cake-separated moxibustion was performed at Guanyuan(CV 4) and Zhongji(CV 3), 20 min at a time, twice a day, for 3 days before operation in the treatment group. No fuzi-cake-separated moxibustion was performed in the control group. After treatment, the score for symptoms of first urination, urinary time, urinary volume, 24 h remaining urinary volume, incidence of uroschesis, and rate of controlling dysuria were compared to evaluate the curative effect of preventing post-operative dysuria.RESULTS: The score for symptoms of first urination,24 h remaining urinary volume(maximum 120 m L vs 250 m L, and less than 10 m L in 24 cases vs 15 cases), and the rate of controlling dysuria(83.34% vs30%) were significantly better(P<0.05, P<0.05, and P<0.001, respectively) in the treatment compared with the control group. There was no statistical difference(P>0.05) between the two groups in first post-operative urinary time, urinary volume, or incidence of 24 h uroschesis.CONCLUSION: Fuzi-cake-separated moxibustion at Zhongji(CV 3) and Guanyuan(CV 4) can better prevent post-operative dysuria, effectively promote the functional restoration of the urinary bladder,and control the incidence of post-operative dysuria.

Multiple bilateral lower limb fractures in a 2-year-old child： previously unreported injury with a unique mechanism

Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a balcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2), right distal metaphysis of the tibia and fibula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open reduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily activities comfortably. We also proposed the unique mechanism of injury in this report.

Effects of recombinant human basic fibroblast growth factor on cell proliferation during mandibular fracture healing in rabbits

Objective:: To investigate the effects of recombinant human basic fibroblast growth factor (rhbFGF) on the cell proliferation during mandibular fracture healing in rabbits. Methods: The complex of rhbFGF and bovine type I collagen was implanted into the mandibular fracture site under periosteum of the animal. The whole mandible was harvested at 7, 14, 28, 56 and 84 days respectively after operation. The expression of proliferating cell nuclear antigen (PCNA) in callus was examined with immunohistochemical staining. Results: PCNA-positive cells in callus in the rhbFGF-treated group on days 7 and 14 were more than that in the control group (P< 0.01 ). Conclusions: It indicates that rhbFGF can stimulate cell proliferation during mandibular fracture healing in rabbits.

Extremity fractures in children： a hospital based study in Tehran

Objective： Although long bone fracture in children is not life-threatening, it may cause major disability, loss of working days and severe psychological distress. We conducted this study to determine the pattern of extremity fracture due to trauma in children. Methods： During one year in six general hospitals in Tehran, trauma patients who were hospitalized for more than 24 hours and sustained injuries within seven days before admission were included in the study. The records of children （≤16 years old） hospitalized in six general hospitals in Tehran due to trauma were reviewed prospectively. Results： During the study period, 1 274 children had sustained extremity fractures. Male to female ratio was 3.6/ 1, with the mean age of （10.3±4.2） years. Falls and traffic crashes were the main causes of injuries, with the percentages of 57.3 % and 37.1%, respectively. Simple fall （falling on the ground） consisted 60% of patients that sustained fall-related injuries. Pedestrians and bicycle riders comprised most of the cases that were injured due to traffic crashes. Of our cases, 56.8% sustained fractures in the upper extremities and 43.2% in the lower extremities. Forearm was the most common fracture site （34.1%）. Comparing our results in preschool and school-age children, falls were the main cause of injuries in both groups, but fractures of lower extremities were significantly more common in preschool children. Conclusions： Improvement of physical condition of sidewalks and crossings in roads will be necessary for prevention of injuries. More attention to safety of home environment should be paid for control of preschools＇ injury at home. Education of children and adults is necessary to reduce injuries resulting from road traffic crashes.

The relationship between extension of lower crust and displacement of the shelf break

With deep sea petroleum explorations become more and more popular,some geological phenomena have emerged:extension of lower crust and upper crust is inhomogeneous;shelf break has been moved rapidly after crustal stretching.These geological phenomena are important to the continental margin evolution.To investigate the thinning of the whole crust and the contribution of the upper crust versus the lower crust to the crustal stretching since the Cenozoic,we calculated the stretching factors of the upper and the lower crust based on the 13 seismic lines in the Baiyun Sag from CNOOC.The results indicated that the whole crustal thickness decreases seaward while the whole crustal stretching factor increases from shelf to slope.Our calculations showed that the lower crustal stretching factor is higher than that of the upper crust in the Baiyun Sag.In the Cenozoic,deformation of the Baiyun Sag is controlled mainly by ductile shearing rather than brittle shearing.Based on the numerical modeling,we can conclude the initial crust in the Baiyun Sag is thermally attenuated.The stretching factor(β)of the lower crust increases from the north to the south of the continental margin,indicating two stretching centers:the Baiyun Sag and the Liwan Sag.The geometry of the shelf break and theβisoline trap have the similar trend in 23.8 and 13.8 Ma,both located in the intense deforming zone of the lower crust,and therefore we conclude the stretching and flowing of the lower crust cause the displacement of the shelf break before and after 23.8 Ma.

Application of MRI in indirect temporomandibular joint injury without condylar fracture

Objective： To discuss the application of MRI in indirect temporomandibular joint injury without condylar fracture. Methods： MRI examination on temporomandibular joint was conducted in 28 patients with indirect injury to temporomandibular joint without condylar fracture. The scanning sequence included TIWI, PDWI on oblique sagittal section at both open and closed mouth positions, and T1WI, T2WI on oblique coronal section. The MRI appearance was analyzed by 2 senior radiologists. Results： Among the 56 temporomandibular joints of28 patients, 35 joints exhibited pathological changes on MRI, in which there were 9 bone injuries, 21 articular disc dislocation, 24 intracapsular hematocele and hydrops. Conclusions： MRI can clearly reveal bone injury, articular disc dislocation as well as articular capsule abnormality in the indirect injury of temporomandibular joint without condylar fracture. It is highly advocated in clinical use.

Effect of recombinant human basic fibroblast growth factor on angiogenesis during mandible fracture healing in rabbits

Objective: To investigate the effect of recombinant human basic fibroblast growth factor ( rhbFGF) on angiogenesis during mandible fracture healing in rabbit.Methods: Fifty adult white rabbits were used for animal model and randomly divided into a control group (25 rabbits) and an experimental group (25 rabbits). The membranous complex of rhbFGF and bovine type I collagen was prepared and implanted into the rabbit mandible fracture site under periosteum. The animals were sacrificed on 7, 14, 28, 56 and 84 days respectively after operation and the whole mandibles were harvested. The expression of factor Vm related antigen (F8-RA) in callus was examined with immimohistochemical staining.Results: The amounts of microvascular formation in calluses in the rhbFGF-treating group on days 7, 14, 28 and 56 were more than those of the control group (P < 0.01).Conclusions: The results indicated that rhbFGF could stimulate microvascular formation during mandible fracture healing in rabbits.

Death due to fracture of thin calvarial hones after a fall： A forensic approach

A 45-year-old male was autopsied. He had fallen backwards from a two-stairs height to the ground and passed away. A skull fracture was detected in the left occipital area, extending up to the left side of the skul! base. The patient＇s death occurred due to the very low thickness of the calvarial bones, which led to the aforementioned fracture, and in turn resulted in subarachnoid hemorrhage and death. The cortical thickness was measured and compared with average values at standardized points. Uniform bone thinning was confirmed rather than localized. Calvarial thinning may result from various conditions. In the present case study, however, the exact mechanism which led to the low thickness of the calvarial bones of the patient is undetermined. Death due to the susceptible structure and fracture of calvarial bones has rarely been reported throughout relevant literature.