胃肠道来源转移性卵巢癌的诊断及治疗探讨

目的探讨胃肠道来源的转移性卵巢癌的诊断及治疗措施。方法对53例胃肠道来源的转移性卵巢癌病人的临床资料进行回顾性分析。结果53例病人的平均发病年龄为45．2岁，绝经前妇女43例，占81．13％；来源于胃癌者39例，占73．58％。首发的主要临床症状为腹胀、腹痛及下腹部包块；病理类型以印戒细胞癌为主者27例，占50．94％；侵及双侧卵巢者41例，占77．35％。手术治疗后辅以化疗病人的0．5、1．0、2．0年生存率高于术后非化疗病人，差异均有显著性（x^2=4．100，P〈0．05；P=0．002、0．000）。结论胃肠道来源的转移性卵巢癌预后较差，早期诊断及积极进行以手术为主的综合治疗有望改善病人的生存率和生存质量。     

中医综合疗法治疗股骨头无菌性坏死60例临床观察

目的探讨中医综合疗法对股骨头缺血性坏死的临床疗效。方法以中医综疗法治疗股骨头缺血性坏死60例，并观察治疗前后症状、功能及X线临床表现的改善情况。结果治疗组60例患者通过治疗，临床症状、功能及X线临床表现明显改善，总有效率为88．33％。结论中医综合疗法能够明显改善股骨头局部血液循环，促进坏死股骨头的修复和患髋关节功能恢复。     

The Science behind Topical Negative Pressure Therapy

Topical negative pressure therapy (TNP) is an established part of modern wound healing. With an increasing choice in TNP providers, understanding the differing modes of action, the biochemical and biophysical effects on the wound at a microscopic and macroscopic level, plus the role of the interface dressings, will aid the clinician in planning a clear goal of therapy. This article reviews the scientific evidence for TNP to date and explores each mechanism of action and the implications for wound healing and patient outcomes.     

Intraobserver and interobserver agreement of volume perfusion CT (VPCT) measurements in patients with lung lesions

Objectives

To evaluate intraobserver and interobserver agreement of manually encompassed lung lesions for perfusion measurements using volume-perfusion computed tomography (VPCT).

Materials and methods

Institutional review board approval and informed consent were obtained. HIPAA guidelines were followed. A 65-s dynamic study was acquired with scan parameters 80 kV, 60 mA s (80 mA s for patients ≥70 kg), 128 × 0.6 mm collimation. Blood flow (BF), blood volume (BV) and K^trans parameters were determined by syngo volume perfusion CT body with 88 lesions analyzed retrospectively.

Results

Within-subject coefficients of variation for intraobserver agreement (range 6.59–12.82%) were superior to those for interobserver agreement (range 21.75–38.30%). Size-dependent analysis revealed lower agreements for lesions <4 cm as compared to larger lesions. Additionally, agreements of the upper, middle and lower lung zones were different.

Conclusions

Intraobserver agreement was substantial for VPCT lung cancer perfusion measurements encouraging the use for tumor characterization and therapy response monitoring. Interobserver agreement is limited and unexperienced readers should be trained before using this new method.     

咪唑安定在早期食管癌及其癌前病变内镜治疗过程中的镇静作用

目的：探讨咪唑安定在早期食管癌及其癌前病变内镜治疗过程中的镇静作用。方法：在对99例早期食管癌及其癌前病变行内镜下黏膜切除及氩气等离子凝固治疗过程中，静脉应用咪唑安定进行镇静。进镜前2min静脉给予咪唑安定，首次剂量为2mg，治疗前常规静脉追加1mg，根据情况间隔2min以上可追加1mg，但总剂量不超过5mg。术中观察镇静分级及术中症状。术后评价病人对治疗过程的配合程度、感受、耐受程度及记忆缺失情况。治疗过程中给予病人持续吸氧，持续心电、血氧、血压、脉搏监测。结果：本组患者咪唑安定剂量均≤5mg，其中97例（98％）在患者治疗过程中无焦虑且能配合治疗。7例（8％）患者治疗时略有不适，无1例患者不能耐受内镜治疗。74例（75％）患者对内镜治疗过程记忆缺失，25例（25％）患者记忆或部分记忆。治疗成功率100％，无1例并发症及意外发生。除1例由于病人肝功能欠佳出现嗜延外，余无不良反应及副作用。结论：咪唑安定在一定剂量（≤5mg）范围内作为早期食管癌及其癌前病变内镜治疗的镇静用药是安全有效的。     

肝移植术后中远期黄疸的原因分析与治疗

目的 探讨肝移植术后中远期黄疸的发生原因,并总结诊断和治疗体会.方法 对2005年6月至2008年12月移植内科住院的822例肝移植受者进行统计,回顾性分析其中129例发生肝移植术后中远期黄疸患者的临床资料.结果 129例患者出现黄疸的时间为肝移植术后43 d至39个月,胆红素总量水平为27.4～503 μmol/L.出现黄疸的原因及治疗:胆道并发症59例(45.7％),排斥反应36例(27.8％),病毒感染11例(8.5％),药物性肝损害5例(3.9％),肿瘤复发4例(3.1％),Gilbert综合征4例(3.1％),乳头肌功能紊乱3例(2.3％),血管并发症2例(1.6％),放射性肝炎2例(1.6％),肝脓肿1例(0.8％),以及不明原因黄疸2例(1.6％).上述基础疾病得到相应治疗后,大多数患者的黄疸得到逆转;5例患者治疗无效后接受了再次肝移植,4例死于疾病进展.结论 肝移植术后中远期黄疸的原因多样而复杂,临床上应首先明确其病因,及时作出正确诊断,并选择合理的治疗方案,才能使移植受者获得长期存活.     

肺移植术后原发性移植物功能丧失的预防和治疗

目的 探讨肺移植术后原发性移植物功能丧失(PGD)的预防和治疗.方法 回顾性分析2002年9月至2011年6月间108例肺移植的临床资料.术后监测所有受者的血液气体分析及胸部X线表现,连续监测有创动脉压、肺动脉压和(或)中心静脉压.术后3d保持受者液体负平衡,根据动脉血氧分压(PaO2)和(或)血氧饱和度控制吸入氧浓度(FiO2),根据血液气体分析结果及生命体征调节呼吸机通气参数,以预防PGD的发生.术后早期一旦出现PaO2、FiO2急剧下降(低于200),且胸部X线片显示移植肺中下肺野密度增高,在排除超急性排斥反应、静脉吻合口梗阻、心源性肺水肿及肺部感染后,根据国际心肺移植协会制定的标准将PGD分级为3级的患者明确诊断为PGD.对于PGD级别的不同,分别给予受者加强通气支持、液体负平衡、延长呼吸机治疗时间、使用肺血管扩张药如前列地尔及使用ECMO等治疗措施.结果 术后共有10例受者发生PGD,发生率为9.3％(10/108).10例患者中,6例常规使用呼吸机支持治疗,持续时间为(285.8±238.6)h,其中2例逆转,4例死于PGD后呼吸衰竭;4例使用了体外膜肺氧合(ECMO)辅助治疗,其中2例在发生PGD后24 h内应用了ECMO,成功逆转后长期存活,另2例由于应用时间较晚(24 h后),病情恶化,分别在应用ECMO后第8和第11天死于PGD导致的急性肾功能衰竭和多器官功能衰竭.结论 肺移植后PGD的发生率高,应在围手术期加强管理,进行积极预防;一旦受者发生PGD,应尽快给予相应治疗,如达到使用EC MO的指征,应尽早使用.     

A Preliminary Assessment of the Benefits of the Addition of Botulinum Toxin A to a Conventional Therapy Program on the Function of People With Longstanding Stroke

Meythaler JM, Vogtle L, Brunner RC. A preliminary assessment of the benefits of the addition of botulinum toxin A to a conventional therapy program on the function of people with longstanding stroke.

Objective

To determine if botulinum toxin type A (BTX-A) combined with therapy can facilitate improved upper-extremity (UE) functional status versus therapy alone.

Design

Double-blind randomized crossover trial.

Setting

Tertiary care outpatient rehabilitation center.

Participants

Convenience sample of 21 men and women (ages 19-80y) with stroke more than 6 months after insult who had tone greater than 3 on the Ashworth Scale for 2 joints in the involved UE.

Intervention

Subjects were consecutively recruited and randomized to a double-blind crossover trial. Subjects received either BTX-A combined with a defined therapy program or placebo injection combined with a therapy program in two 12-week sessions.

Main Outcome Measures

The primary functional outcome measure was the Motor Activity Log (MAL). Subjects were also assessed on physiologic measures including tone (Ashworth Scale), range of motion, and motor strength.

Results

Improvements were noted in the functional status of the subjects in both arms of the study as measured by the MAL. All subjects had a significant change in functional status on MAL with therapy (P<.05). The use of BTX-A combined with therapy as compared with therapy only improved the functional status of the subjects on the MAL Quality of Movement subscale (P=.0180, t test) and showed a trend toward significance in the Amount of Use subscale (P=.0605, analysis of variance). Six weeks after treatment, the BTX-A combined with therapy decreased the Ashworth score statistically (P=.0271), but the therapy alone group decreased a similar amount at 6 weeks (P=.0117), indicating that most of the physiologic tone change could be attributed to therapy. After each 12-week period, tone had largely returned to baseline (P>.05).

Conclusion

A focused therapy program showed the most improvement in function in this defined stroke population. BTX-A combined with a focused traditional therapy program slightly enhanced the functional status of stroke subjects beyond that obtained with therapy alone 12 weeks after injection.     

怀化市新生儿先天性甲低的筛查与治疗评估

目的 探讨先天性甲状腺功能减低症的筛查、治疗方法、随访以及疗效评价. 方法 筛查采用时间分辨荧光免疫法进行TSH水平检测,对召回的可疑患儿采用全自动化学发光分析仪检测甲状腺功能,确诊后给予左旋甲状腺素钠4～10 μg/kg·d治疗,治疗2～3年后,停药观察,结合甲状腺B超、体格发育评价、骨龄评定和智力检测进行综合评估. 结果 筛查了活产新生儿153951人,检出甲低60例,发病率0.39‰.54例坚持治疗的患儿体格发育正常,智力发育与正常对照组比较差异无统计学意义,48人做了甲状腺B超,其中1例甲状腺缺如,4例甲状腺小,29人甲状腺肿大或稍大,14人甲状腺正常.27人进行了疗效评估,14例为暂时性甲低,11人为原发性甲低,2人为亚临床甲低. 结论 开展新生儿疾病筛查,结合早期安全有效的治疗和长期随访,可避免先天性甲低智残的发生,保障儿童体格和智能发育正常.     

74例胰腺癌的治疗策略及生存分析

目的 通过分析胰腺癌患者临床特点及生存情况,探索最佳治疗方案.方法 收集经病理(手术病理或穿刺活检)诊断或临床(影像学+肿瘤标志物CA19-9)诊断的74例胰腺癌患者的临床资料;根据治疗方法不同分为五组进行比较:单纯手术组11例、术后化疗组20例、姑息化疗组13例、姑息放疗组13例、未行治疗组17例.对五组患者的临床特点及总生存时间进行分析.结果 术后化疗组患者的中位总生存时间(300 d)优于未行治疗组(119d),差异有统计学意义(P＜0.01);而单纯手术组、姑息化疗组、姑息放疗组与未行治疗组中位总生存时间比较差异无统计学意义(120、164、109 d比119d,P＞0.05).胰腺癌晚期常出现腹痛、黄疸、恶心呕吐、消瘦等伴随症状,其中接受手术患者与非手术患者相比,黄疸的发生率较低[ 19.35％(6/31)比37.21％( 16/43)],但是差异无统计学意义(r=2.75,P=0.10);接受放疗患者与非放疗患者相比,腹痛的发生率较低[23.08％(3/13)比68.85％ (42/61)],差异有统计学意义(x2=12.59,P=0.00).胰腺癌患者腹水的发生率达75.68％(56/74),总生存时间缩短,未行治疗组出现腹水的危险度最高.结论 手术联合化疗可提高胰腺癌患者总生存时间,是胰腺癌治疗的较好选择;放疗使腹痛明显减轻;治疗过程中出现腹水是预后不佳的信号.