Objective To observe the effectiveness of using double trunks arterialized venous free flap to repair finger soft tis-sue.Methods From March 2014 to September 2014,3 cases of finger soft tissue were treated.Machine crush injury were 4 cases and bruise was 1 case.The locations were index finger in 3 cases,ring finger in 2 cases.The duration of injury and adminssion was 0.5~2 hours.The size of defects ranged from 1.5cm ×2cm to 2.0cm ×3cm.All defects were repaired by forearm arterialized venous flap.Results Five flaps all survived,dulling and blister were observed in 1 flap and it got well later.Conclusion It is feasible to repair finger tissue to using arterial-ized venous free flap.It has the advantages of flap sources,small major vascular injury and good postoperative appearance.

目的：探讨高龄不稳定性转子骨折采用半髋关节置换治疗的临床效果。方法采用双动人工股骨头置换术治疗70岁以上股骨转子间粉碎性骨折48例。骨折按Evans分型，ⅢA型l4例，ⅢB型20例，Ⅳ型8例，Ⅴ型6例。手术取外侧切口前入路，术中争取将大、小转子骨折块复位，用薇乔线和（或）钢丝捆扎和（或）捆绑固定，安放人工股骨头。结果手术时间平均85 min，平均出血量350 ml，住院时间平均l7.5 d。Harris关节功能评价：优26例，良l6例，优良率达87.50%（42/48）。无一例死亡。平均随访l8个月。合并下肢深静脉栓塞2例，泌尿系统感染42例。结论人工半髋关节置换术具有术后功能恢复快、负重活动早，可避免长期卧床并发症等优点，是治疗高龄不稳定性股骨转子间骨折较为合理的手术方法。

<正>硬化性血管瘤样结节性转化(sclerosing angiomatoid nodular transformation,SANT)是一种近年来才得到命名的罕见的脾脏良性病变,临床和病理医师对其缺乏足够的认识,临床存在过度治疗风险,病理诊断存在差异。现对3例SANT患者的临床表现、病理特征及免疫组化表型进行分析,并通过文献复习,探讨该病变的临床特点和发生机制。1资料与方法

目的 探讨应用游离前臂骨间背穿支皮瓣修复手部皮肤缺损的临床效果.方法 应用游离前臂骨间背穿支皮瓣修复手指腹部皮肤缺损8例,背部3例,指侧4例,转移皮瓣面积大小(2.0~4.0)cm×(2.0~6.0)cm.结果 本组14例皮瓣全部成活,1例部分成后,随访6周~6个月,修复手部皮肤外观功能满意.结论 该皮瓣是以前臂骨间背动脉穿支为蒂,具有不损伤前臂主干血管、血管解剖恒定、皮瓣较薄、供区损伤小与受区皮肤质地颜色相近等特点,适合修复手指皮肤缺损.

Objective To investigate the changes of pathomorphological features and lumen diameter of varicose great saphenous veins wall with thrombus. Methods Eighteen cases of varicose great saphenous veins with thrombus(thrombus group), 18 cases of simple varicose veins(varicose group), and 12 cases of normal great saphenous veins (control group) were collected. Using hemotoxylin and eosin staining and Masson staining, the wall structure was observed, and the vein diameter and the thickness of the inner, middle and outer membranes were measured. Results In thrombus group, a large number of inflammatory cells were observed in full-thickness of venous wall, endothelial cells were lost on adhesion of thrombus, and partal thrombus organization was caused by a lot of collagen fibers extending from rupture of intima to introthrombus. In varicose group,inflammatory cells were observed occasionally in full-thickness of venous wall, intimal thickened, smooth muscle cells in mid layer were proliferated irregularly and disordered, and collagen fibers proliferated. In control group, intima of venous wall was thin, the medial smooth muscle bundles was regular on arrangement. The lumen diameter, the thickness of the inner,middle and outer membranes thrombus group were significantly higher than that of varicose group and control group (P<0.05), while the lumen diameter and intima thickness of varicose group were significantly higher than that of control group(P<0.05). Conclusion Lumen increasing and wall thickening are important features of path morphological changes.

目的 检测曲张大隐静脉管壁各参数,并探讨曲张大隐静脉管壁发生、发展过程中组织形态学特征与临床病期之间的关系.方法 回顾性分析我院2008年7月至2009年7月期间收治的49例高位结扎剥脱加旋切治疗的大隐静脉曲张患者的临床资料,按临床CEAP分级分为单纯静脉曲张组(C2～C3级,简称单纯曲张组),24例;静脉曲张并皮肤改变组(C4～C6级,简称皮肤改变组),25例;另选6例因外伤行截肢术但大隐静脉正常无损伤者作为对照组.采用Masson染色测量静脉内膜和中膜厚度,以测量静脉截面的最大直径作为管腔内径值,采用免疫组织化学SP法观察静脉管壁的结构变化.结果 管腔内径:与对照组比较,单纯曲张组及皮肤改变组上、中、下三段静脉管腔内径均明显增大(P＜0.05);皮肤改变组上、中段静脉管腔内径较下段也明显增大(P＜0.05);单纯曲张组三段静脉管腔内径变化差异无统计学意义(P＞0.05).单纯曲张组和皮肤改变组的静脉管壁结构改变大致相似,主要表现为内膜不均匀增厚,管璧厚薄不等,以胶原纤维和细胞外基质增生为主,伴有平滑肌增生,中膜厚度略增加,平滑肌束排列紊乱,部分萎缩、凋亡,部分局灶增生,肌束间纤维胶原间质增生,两者相互穿插,排列混乱,弹力纤维断裂.皮肤改变组还可见内膜继发性改变,包括黏液变性、玻璃样变性、内膜炎、血栓形成等.单纯曲张组和皮肤改变组上、中、下三段静脉内膜厚度明显大于对照组(P＜0.05);单纯曲张组上、下段静脉内膜厚度明显小于中段(P＜0.05);单纯曲张组中段内膜厚度明显大于皮肤改变组中段(P＜0.05).中膜厚度单纯曲张组、皮肤改变组和对照组之间以及同一组内上、中、下三段间比较差异均无统计学意义(P＞0.05).结论 下肢曲张静脉管腔扩张,内膜增厚,内膜改变以中段出现较早且显著,上、下二段血管壁的重塑与临床病期之间无关.

Objective: To explore the association of the A1762T/G1764A mutant with hepatocelluar carcinogenesis by detecting the frequent mutation sites in basal core promoter(BCP) of HBV X gene in the liver tissues of the patients with hepatocellular carcinoma(HCC)、chronic hepatitis B(CHB) and liver cirrhosis(LV).Methods: Detecting the HBV X gene in 67 patients including 37 patients with HCC,35 patients with CHB and LV using polymerase chain reaction(PCR),then the obtained PCR products were sequenced.Results: In the HCC,the rate of HBV A1762T/G1764A mutation was 85.71%(30/35);in the non-HCC(including the patients with CHB and LV),the rate of mutation was 40.63%(13/32).Obviously,the A1762T/G1764A double mutant rate in the HCC was higher than the non-HCC,the difference was significant(P0.001).Conclusion: HBV A1762T/G1764A mutation may be important in hepatocarcinogenesis.

瘢痕样恶性纤维组织细胞瘤(MFH)非常罕见.现报告1例并对其病因、临床病理特征、诊断与鉴别诊断,误诊原因及预防对策进行讨论. 1 临床资料

<正>患者女,32岁。左手不能持重物伴第三掌骨基底部疼痛半月余。入院半月前,患者自觉左手第三掌骨基底部疼痛伴局部肿胀,时好时坏,未予诊治,近日疼痛逐渐加重,左手不能持重物,局部肿胀明显。X线片示:左手第三掌骨基底部可

<正>患者女,55岁。3个月前无意间发现下腹部包块,无腹痛,腹胀,无腹泻,便秘,无寒战、发热,无胸闷、憋气,无尿急、尿频、尿痛及血尿,未做任何治疗,以腹腔肿瘤于2009-08-03入院。自发病以来,精神、饮食、睡眠好,大小便正常,3个月来

<正>患者女性,28岁。G2P1。哺乳期后1年发现双侧乳房逐渐增大、肿胀,偶有刺痛,长时间挤压乳房可出现凹陷,曾诊断为"双侧乳腺积乳伴乳腺增生",对症治疗未见好转。行"右乳房切开引流术"后右乳肿痛减轻。近期患者双侧乳房进一步肿胀,伴有疼痛及触痛,右乳头及内侧皮肤出现紫

目的 探讨Caveolin-1在膀胱癌中的表达状况及意义.方法 采用免疫组化和统计学方法,分析39例膀胱癌组织中Caveolin-1的表达情况及其与各临床病理参数间的相关性.结果 膀胱癌组织中Caveolin-1阳性率为28.2%(11/39),与正常对照组存在差异显著性(P<0.05),阳性信号主要定位于胞质,少数病例显示核中定位,Caveolin-1在膀胱癌中表达阳性率与肿瘤的分级(1级0%、2级23.5%、3级53.9%)、分期(pTa-pT1 6.3%、pT2-pT4 43.5%)、生长方式(表浅型4.2%、侵袭型66.7%)密切相关,与年龄、性别无关.结论 Caveolin-1表达可作为判断膀胱癌生物学行为和预后的指标,Caveolin-1的异常表达、异常定位及可能的氨基酸突变,在膀胱癌发展过程中起着重要作用.

[病例] 男,75岁.因发现右前胸局部隆起无痛性包块2年余,增大半年入院.患者2年前无明显诱因右胸部出现一直径2 cm肿块并逐渐增大,近半年增大至直径5 cm,病程中无发热、胸闷、呼吸困难、咳嗽、咳痰、咯血,无心悸、体重减轻.平素体健,有烟酒嗜好,无家族遗传病史.查体:一般情况尚好.

Objective To investigate the clinical feature,histological characterestics and immunohistochemical characterstics of littoral cell angioma of spleen.Methods The clinical data of two patients with littoral cell angioma were analyzed retrospectively.In a while,the radiological examination and morphologic characteristics were studied and some specific antigens were detected.Results The clinical feature and radiographic appearance of the tumor were atypical.Histologically,littoral cell angioma was located in red pulp and characterized by anastomosing vascular channels interspersed with dilated vascular spaces and pseudopapillary foci.The vascular channels were lined by spindle or plump,bland-looking cells,and hemosiderin was commonly found in the cytoplasm of some tumor cells.FⅧAg,CD34,CD31,CD68,AAT and Lysozyme showed immunopositive expression in the cases.Conclusion Littoral cell angioma is a rare vascular lesion of the spleen.Its diagnosis is on the basis of microscopic and immunohistochemical features.Operative treatment is the effective measure for the patients.The disease may be associated with maligant neoplasms,so close follow-up and careful investigation are strongly recommended.

Objective To investigate the pathologic diagnosis and differential diagnosis of extremity paraganglioma.Method One case of extremity paraganglioma was studied with conventional pathological and immunohistochemical stains,and its clinical and pathological findings were analyzed with review of the literature.Result Extremity paraganglioma had a long history of slow growth.On gross examination,the tumor appeared well-encapsulted without necrosis and hemorrhage.Histologic features consisted of alveolar architecture or Zellballen pattern,prominent sinusoids,no or low mitotic activity.Chief cells were positive for neuroendocrine markers,such as NSE and CgA.A chraracteristic immunostain for S-100 and GFAP,but sometimes negative,demonstrating distinctive sustentacular cells,could help to arrive in diagnosis.Ki-67 index showed low level.Conclusion Because of the rarity of lesion site,extremity paraganglioma is often confused with other malignant tumors.The correct diagnosis could be made through careful analysing the characteristics of clinical pathology.

患者女性,55岁.20年前右腕部不明原因出现肿物,逐渐增大,疼痛明显,于外院行肿物切除、植骨及内固定术.5年前右腕部再次出现肿物伴不适,在89医院行"内固定物取出,病灶清除术",病理诊断为"副脊索瘤".最近患者右腕部又出现肿物,伴疼痛及右腕关节活动受限.查体:右手背桡侧见一8 cm长手术瘢痕,右前臂远端外侧见一不规则肿块,大小5 cm×4 cm,质韧,边界不清,无活动度,触痛明显,右腕关节最大活动度约10°,右拇指内收功能受限,曲伸外展功能不佳,余指活动良好.MRI显示:右腕关节外侧偏前方不规则异常信号,边界尚清楚,边缘欠光整,病变内可见间隔,邻近骨质呈侵及征象,病变周围软组织结构较紊乱.入院后行"病段扩大切除、受累骨组织体外乙醇灭活回植、钢板螺钉内固定术",术中见肿瘤约4 cm×4 cm,灰白半透明结节状,位于桡骨及舟骨之间,侵犯桡骨远端,并沿大鱼际两侧蔓延.