Ultrastructure of intracellular membranous system and intracellular transport of asialoglycoproteins in rat hepatocytes.

The ultrastructure of the intracellular membranous system in rat hepatocytes was observed three dimensionally with a scanning electron microscope using the aldehyde prefix osmium-dimethyl sulfoxide-osmium method. Intracellular organelles were clearly observed in three dimensions, and direct connection of tubular structures with the bile canalicular membrane was clearly seen. The transcellular pathway of asialoglycoproteins in isolated cultured rat hepatocytes was also investigated, by affinity cytochemistry, using gold-conjugated asialofetuin, under a transmission electron microscope. Gold particles were clearly seen not only in vesicles, endosomes and lysosomes, but also in the tubular structures. These results suggest that the tubular structures in rat hepatocytes directly participate in the transcellular transport of macromolecules. In addition, the frequent connections of tubular structures with the bile canalicular membrane indicate that these structures around the bile canaliculus may supply membrane components to the bile canalicular membrane.     

供肝热和冷保存性缺血性损伤的超微结构观察

目的:探索供肝热、冷缺血对肝组织的超微结构影响,并讨论与某些手术并发症发生的关系.方法:从我院实施的67例原位肝移植病例中选择9例移植前供肝活检组织病理学检查无明显形态学改变、供肝者临床肝功能正常、肝炎病毒及巨细胞病毒检测均为阴性的供肝组织进行透射电镜观察.结果:在供肝中央静脉周围肝细胞质中常有较多吞噬溶酶体,少数肝细胞核出现浅的切迹,胞质中线粒体明显减少,部分线粒体肿胀.少部分毛细胆管腔扩大,微绒毛肿胀,微绒毛芯中微丝束减少或消失.部分小叶间胆管上皮细胞凋亡,管腔中含凋亡小体及细胞碎片.少数小叶间静脉内皮细胞肿胀,胞质空泡变性,甚者内皮细胞脱离管腔,细胞质膜断裂.结论:供肝毛细胆管和小叶间胆管上皮细胞的损伤是保存性损伤引起轻度胆汁淤积的主要因素.而小叶间胆管周围小血管内皮细胞的损伤可能是导致小叶间胆管上皮细胞凋亡的直接原因.小叶间静脉内皮细胞的损伤使血管壁平滑度受损,血流减缓,加重肝细胞的缺氧.     

Dual-row needle arrays under an electromagnetic thermotherapy system for bloodless liver resection surgery

Electromagnetic thermotherapy has been extensively investigated recently and may become a new surgical modality for a variety of medical applications. It applies a high-frequency alternating magnetic field to heat up magnetic materials inserted within the human body to generate tissue coagulation or cell apoptosis. Using a new procedure with dual-row needle arrays under an electromagnetic thermotherapy system with a feedback temperature control system, this study demonstrates bloodless porcine liver resection, which is challenging using existing methods. In vitro experiments showed that hollowed, stainless-steel needles could be heated up to more than 300 °C within 30 s when centered under the induction coils of the electromagnetic thermotherapy system. In order to generate a wide ablation zone and to prevent the dual-row needle arrays from sticking to the tissue after heating, a constant temperature of 120 °C was applied using a specific treatment protocol. The temperature distribution in the porcine livers was also measured to explore the effective coagulation area. Liver resection was then performed in Lan-Yu pigs. Experimental results showed that seven pigs underwent liver resection without bleeding during surgery and no complications afterward. The dual-row needle arrays combined with the electromagnetic thermotherapy system are thus shown to be promising for bloodless tissue resection.     

Intraoperative laparoscope augmentation for port placement and resection planning in minimally invasive liver resection

In recent years, an increasing number of liver tumor indications were treated by minimally invasive laparoscopic resection. Besides the restricted view, two major intraoperative issues in laparoscopic liver resection are the optimal planning of ports as well as the enhanced visualization of (hidden) vessels, which supply the tumorous liver segment and thus need to be divided (e.g., clipped) prior to the resection. We propose an intuitive and precise method to plan the placement of ports. Preoperatively, self-adhesive fiducials are affixed to the patient's skin and a computed tomography (CT) data set is acquired while contrasting the liver vessels. Immediately prior to the intervention, the laparoscope is moved around these fiducials, which are automatically reconstructed to register the patient to its preoperative imaging data set. This enables the simulation of a camera flight through the patient's interior along the laparoscope's or instruments' axes to easily validate potential ports. Intraoperatively, surgeons need to update their surgical planning based on actual patient data after organ deformations mainly caused by application of carbon dioxide pneumoperitoneum. Therefore, preoperative imaging data can hardly be used. Instead, we propose to use an optically tracked mobile C-arm providing cone-beam CT imaging capability intraoperatively. After patient positioning, port placement, and carbon dioxide insufflation, the liver vessels are contrasted and a 3-D volume is reconstructed during patient exhalation. Without any further need for patient registration, the reconstructed volume can be directly augmented on the live laparoscope video, since prior calibration enables both the volume and the laparoscope to be positioned and oriented in the tracking coordinate frame. The augmentation provides the surgeon with advanced visual aid for the localization of veins, arteries, and bile ducts to be divided or sealed.     

Distribution of one of the ascitic fluid antigens of ovarian cancer patients in malignant tumors of the stomach and intestines

The indirect immunofluorescent technique was used to study the distribution of the ascitic fluid antigen (AgD) on histological sections from surgical specimens of gastric and colon tumours from proximal to distal lines of resection. AgD was found in gastric tumours exceptionally in the tumour area and in colon cancer--both in the tumour stroma and in surrounding histologically normal mucosa.     

经胆道镜激光碎石治疗肝胆管结石

探讨经胆道镜NdYAG激光碎肝胆管术后残余结石的有效性与安全性。对22例肝胆管术后残余结石,常规内镜取石失败的患者实施经胆道镜导入NdYAG激光碎石治疗。通过T管窦道经胆道镜插入0.3mm光纤对准结石中心,生理盐水快速灌注冲洗胆道,NdYAG激光28～30W,以40J/s脉冲式重复照射。反复脉冲式发射直至击碎,用取石钳或网篮取出碎石。22例患者其中左肝内胆管11例,右肝内胆管8例,胆总管3例。结石2.0×2.0～1.0×1.0cm。碎石1次取净治愈者16例,2次取净治愈4例,2例为早先使用直径0.6mm光纤缺乏柔软性,无法到达残余结石所在部位而失败。经胆道镜NdYAG激光碎石治疗肝胆管术后残余结石安全有效。     

毛细胆管发育不良致先天性阻塞性黄疸的超微结构观察

用电子显微镜观察了一例先天性阻塞性黄疸病例的肝脏超微结构,结果显示肝细胞内有不同程度的淤胆,大部分肝细胞间未见毛细胆管结构或毛细胆管发育不良,提示本例患者的阻塞性黄疸由先天性毛细胆管发育不良引起,电镜检查有利于判断患儿的预后。     

Dubin Johnson综合征的肝细胞超微结构观察

采用肝穿刺的方法,利用透射电镜对Dubin Johnson综合征(结合型高胆红素血症)患者进行了肝细胞超微结构的电镜观察。观察结果：电镜下可见到肝细胞内及毛细胆管周围有大量的外有单层膜包绕的色素颗粒,颗粒大小不均匀;其内容物有三种形态,即电子密度较高且均匀的颗粒,电子密度略低的颗粒及电子密度不均匀的内含有小脂滴样物质的颗粒;毛细胆管扩张,腔内微绒毛减少,管壁增厚;粗面内质网及滑面内质网明显扩张成许多小囊泡,使得肝细胞成筛孔状,肝细胞间有胶原纤维增生,肝细胞间隙增宽,并有微绒毛出现。其结果有助于临床的诊断。     

强直性脊柱炎重度后凸矫形的围手术期护理

目的探讨强直性脊柱炎重度后凸矫形的围手术期护理。方法对24例强直性脊柱炎重度后凸畸形患者,施行单纯后路蛋壳截骨后凸矫形术,术前进行心理护理、营养支持、呼吸功能训练等护理干预,术后监测生命体征、观察脊髓神经功能、防止各种并发症和加强康复训练。结果术后患者达到70%的矫形效果,肺活量明显增加,未出现严重并发症。结论有效的围手术期护理有助于降低重度脊柱后凸矫形术后并发症的发生,提高临床治疗效果。     

Force controlled and teleoperated endoscopic grasper for minimallyinvasive surgery-experimental performance evaluation

Minimally invasive surgery generates new user interfaces which create visual and haptic distortion when compared to traditional surgery. In order to regain the tactile and kinesthetic information that is lost, a computerized force feedback endoscopic surgical grasper (FREG) was developed with computer control and a haptic user interface. The system uses standard unmodified grasper shafts and tips. The FREG can control grasping forces either by surgeon teleoperation control, or under software control. The FREG performance was evaluated using an automated palpation function (programmed series of compressions) in which the grasper measures mechanical properties of the grasped materials. The material parameters obtained from measurements showed the ability of the FREG to discriminate between different types of normal soft tissues (small bowel, lung, spleen, liver, colon, and stomach) and different kinds of artificial soft tissue replication materials (latex/silicone) for simulation purposes. In addition, subjective tests of ranking stiffness of silicone materials using the FREG teleoperation mode showed significant improvement in the performance compared to the standard endoscopic grasper. Moreover, the FREG performance was closer to the performance of the human hand than the standard endoscopic grasper. The FREG as a tool incorporating the force feedback teleoperation technology may provide the basis for application in telesurgery, clinical endoscopic surgery, surgical training, and research.     

Virtual surgery in a (tele-)radiology framework

Presents telemedicine as an extension of a teleradiology framework through tools for virtual surgery. To classify the described methods and applications, the research field of virtual reality (VR) is broadly reviewed. Differences with respect to technical equipment, methodological requirements and areas of application are pointed out. VR, desktop VR and augmented reality are differentiated and discussed in some typical contexts of diagnostic support, surgical planning, therapeutic procedures, simulation and training. Visualization techniques are compared as a prerequisite for VR and assigned to distinct levels of immersion. The advantage of a hybrid visualization kernel is emphasized with respect to the desktop VR applications that are subsequently shown. Moreover, software design aspects are considered by outlining functional openness in the architecture of the host system. A teleradiology workstation was extended by dedicated tools for surgical planning through a plug-in mechanism. Examples of recent areas of application are introduced, such as liver tumor resection planning, diagnostic support in heart surgery, and craniofacial surgery planning. In the future, surgical planning systems will become more important. They will benefit from improvements in image acquisition and communication, new image processing approaches and techniques for data presentation. This will facilitate pre-operative planning and intra-operative applications     

Nd:YAG激光刀兔肝叶切除实验及电子显微镜的观察

为改进肝脏外科手术,除试制肝脏切除的特殊器械外,我们针对存在的一些问题,如时间长、出血多、并发症多、死亡率高等,应用掺钕 YAG 连续激光作为“激     

胆道镜对胆管结石的治疗效果分析

目的:探讨胆道镜对肝内胆管结石的治疗效果.方法:对2010年住院的57例肝内胆管结石患者的临床资料进行回顾性分析.比较32例胆道镜手术患者和25例常规手术患者的治疗效果、术后残石率和术后并发症有无差异.结果:胆道镜手术患者术后优良率为93.8%,术后残余结石发生率为15.6%,术后并发症发生率为3.1%;常规手术患者术...     

YAG激光切除包皮的探讨

传统外科手术切除包皮存在着某些弊病,作者试用YAG激光改进其手术方法,为证实激光治疗的可行性,特设手术切除为对照组,对比观察,现介绍如下。 资料与方法 一、临床资料:共80例患者,其中包茎46例,包皮过长35例;年龄16～29岁之间,随机     

胸腰椎转移性肿瘤的外科治疗

目的:探讨胸腰椎转移性肿瘤的临床特点、手术适应证)及外科治疗的临床效果.方法;回顾性分析21例胸、腰椎转移性肿瘤患者前路手术治疗效果,其中男性13例,女性8例,年龄37～75岁,平均年龄45.7岁.结果:随访3～36个月,平均17.5月,2例3个月内死亡,19例,所有患者手术后疼痛得到缓解甚至消失,脊髓压迫症状改善或缓解.结论:胸腰椎转移性肿瘤的手术治疗虽不能延长患者的生存时间,但能够缓解疼痛、重建脊柱的稳定性,改善脊髓压迫症状或延缓瘫痪的发生,从而改善患者的生活质量.手术中彻底切除肿瘤、减压及坚强内固定是保证治疗效果的关键.     

胆小管超微细胞酶学研究

以电镜细胞化学的方法,观察了小鼠胆小管酶的分布。观察的12种酶中,NDPase和G6Pase三种酶分布于胆小管微绒毛;AlPase、Na~+-K~+ATPase、Mg~(++)-ATPase、Ca~(++)-ATPase、CMPase、ACase和5＇-Nase等7种酶分布于胆小管微绒毛,也分布于肝细胞邻接面细胞膜和Disse间隙微绒毛;ACPase、细胞色素氧化酶以及线粒体ATPase不分布胆小管微绒毛,也不分布Disse间隙微绒毛和肝细胞膜。据信,胆小管微绒毛上的酶参与胆汁成份的转运,提供转运所需能量以及还可能与某些代谢过程有关。本实验中磷酸水解酶类使用的铈基法及亚铁氰化钾半还原的锇酸后固定法,效果优于铅法。     

超声动态观察Nd：YAG激光对羊肝组织损伤的实验研究

目的 :超声动态观察Nd :YAG激光凝固羊肝组织的稳定性及安全性。方法 :应用超声动态观察组织间激光凝固 (interti tiallaserphotoloaglationILP)术后羊肝凝固靶区不同时期声像图特征及相应病理改变情况。ILP术后 10只山羊 ,第 3 5 7 10 15天各处死 2只 ,处死前超声观察靶区声像图特征及血流显像 ,并监测其肛温及肝功能变化 ,并与术前相应指标对照 ;处死后靶区取组织送病检。结果 :随着凝固术后时间延长损伤区声像图显示越来越清晰 ,从内到外呈无回声区、强回声区、低回声带及强回声环 ;强回声区范围渐渐缩小 ,低回声带渐渐增宽 ,强回声环渐渐清晰等变化趋势。损伤区边缘早期为充血、出血 ,一周后可见增生的纤维细胞 ,毛细胆管及毛细血管。羊血清谷丙转酶术后呈一过性升高 ;肛温术后呈反应性升高。无气栓、出血等术后并发症。结论 :声显像能准确反映靶区动态变化 ;Nd :YAG激光凝固肝组织效果肯定 ;方法安全可靠 ;无严重并发症。     

激光扫描共聚焦显微镜在人胆管癌组织免疫荧光染色切片观察中的应用

目的：探讨利用激光扫描共聚焦显微镜鉴定单克隆抗体特异性。方法：正常人胆管组织、正常人肝组织及人胆管癌组织切片经免疫荧光染色后置于普通荧光显微镜及激光扫描共聚焦显微镜进行观察,比较二者效果。结果：与普通荧光显微镜相比,激光 聚焦显微镜能清晰地显示染色组织的荧光染色部位及强弱,能较好地显示染色组织的形态,显示出良好的准确性及精确性。结论：激光扫描共聚焦显微镜在免疫荧光染色切片的检测中具有准确、特异、清晰的特点,在单克隆抗体的鉴定中具有良好的应用前景。     

Coil design for real and sham transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) can be used to excite the human cortex noninvasively. TMS also activates scalp muscles and sensory receptors; additionally, the loud sound from the stimulating coil activates auditory pathways. These side effects complicate the interpretation of the results of TMS studies. For control experiments, we have designed a coil that can produce both real and sham stimulation without moving the coil. The sham TMS is similar to the real TMS, except for the different relative direction of the currents in the two loops of the figure-of-eight coil. While the real TMS elicited activation of hand muscles, sham TMS had no such effect; however, the auditory-evoked potentials were similar.     

Tracking of vessels in intra-operative microscope video sequences for cortical displacement estimation

This article presents a method designed to automatically track cortical vessels in intra-operative microscope video sequences. The main application of this method is the estimation of cortical displacement that occurs during tumor resection procedures. The method works in three steps. First, models of vessels selected in the first frame of the sequence are built. These models are then used to track vessels across frames in the video sequence. Finally, displacements estimated using the vessels are extrapolated to the entire image. The method has been tested retrospectively on images simulating large displacement, tumor resection, and partial occlusion by surgical instruments and on 21 video sequences comprising several thousand frames acquired from three patients. Qualitative results show that the method is accurate, robust to the appearance and disappearance of surgical instruments, and capable of dealing with large differences in images caused by resection. Quantitative results show a mean vessel tracking error (VTE) of 2.4 pixels (0.3 or 0.6 mm, depending on the spatial resolution of the images) and an average target registration error (TRE) of 3.3 pixels (0.4 or 0.8 mm).