喉气管异位甲状腺1例

患者女,44岁,因"痰多4年余,反复咽痛2年,夜间呼吸困难2个月"就诊。查体:左侧声门下区可见肿物隆起,堵塞声门约1/2,表面光滑。CT平扫:环状软骨左上部及气管入口处见1.6cm×1.0cm×1.7cm软组织影突入腔内,其下与左侧甲状腺分界不清,病变游离缘光整,CT值62～75HU,气管腔狭窄呈新月状。增强CT:肿物均匀明显强化,CT值380HU,强化     

腹膜后异位肝细胞肝癌一例

正病例患者,男,51岁,因"突发右侧腰腹部疼痛3 d"急诊入院。体格检查:右下腹压痛反跳痛,肌紧张。实验室检查:谷丙转氨酶552 U/L,谷草转氨酶379 U/L;Hbs Ag、HBe-Ab、HBcAb阳性;梅毒螺旋体抗体TP阳性。CT检查增强显示:腹膜后右肾上方及后方见团块状混杂密度影,大小约94 mm×127 mm;病灶前上部病变密度略低,CT值约39 HU,增强扫描病变强化不均匀,下腔静脉内可见小结节状充盈缺损;后下部密度略高,     

气管孤立性纤维性肿瘤1例

正患者女,47岁,因"受凉后咳嗽、咳痰2周,咯鲜红色血痰1天"入院。气管镜检查:气管管腔内距气管隆突约2~3cm处见一新生物,约1.2cm×0.8cm,气管管腔近1/2被堵塞,表面有较多血性分泌物(图1A)。胸部CT:平扫见气管隆突前上方的气管左侧壁有一乳头状结节影,密度均匀,CT值61 HU,边缘光整,与相邻的气管壁呈窄基相连,气管壁未见异常;增强后肿块明显均匀强化(图1B),CT值201 HU,相邻的气管壁无明     

脾血管肉瘤一例

患者男,75岁.因左上腹隐痛不适1个月入院.入院前半年患者有车祸外伤致脾破裂病史,予以保守治疗好转出院.入院后查体:腹部无压痛,无反跳痛及肌卫,未及明显包块,肝脾肋下未及,移动性浊音阴性.辅助检查:无明显异常.B超:肝内弥漫分布粟粒状高回声结节,4 mm×5 mm,5 mm ×6 mm等.脾内见混合性回声区81 mm×92 mm×106mm,边界欠清.CT:脾脏外形增大,脾内见一大小约97 mm×80 mm低密度肿块,增强扫描后不均匀强化(图1),CT值约为50 HU.肝内见多发小圆形低密度影,边界欠清.     

原发性下腔静脉平滑肌肉瘤1例

<正>患者女,55岁,因"无明显诱因出现腹部包块2年余"入院。查体:下腹部触及约15cm×15cm×20cm肿物,活动性欠佳,无明显压痛、反跳痛及肌紧张。CT:右侧腹膜后见团块状浅分叶型软组织密度影,约18.1cm×10.4cm×8.6cm,CT值约9~70HU,边缘尚清,增强扫描病灶呈不均匀延迟强化,内见     

肾盂原发性恶性纤维组织细胞瘤一例报告

患者,女,71岁.因间歇性全程无痛性肉眼血尿伴乏力、低热、体质量减轻3个月于2006年12月10 日入院.查体:体温38.2℃,腹部未触及包块.实验室检查:尿常规红细胞0.138×1012/L,白细胞0.820×1010/L;血常规血红蛋白112 g/L,血细胞沉降率50 mm/h,肾功能正常.CT检查:左肾盂见3.2 cm×2.9 cm团块影,平扫呈略低密度,CT值31 HU,密度不均匀,增强后皮质期轻度强化,CT值43 HU,密度低于肾皮质,等于肾髓质;髓质期密度低于皮质和髓质,CT值52 HU;肾盂期密度等于皮质和髓质,CT值46 HU,肿块与皮质髓质界限欠清,左肾静脉见充盈缺损.     

食管壁支气管源性囊肿1例

病人男,37岁.体检时行X线胸透发现胸腔内高密度影.CT检查亦发现后纵隔胸主动脉偏左方见42 mm×41mm ×31 mm大小的类椭圆形囊性占位性病变,密度较均匀,CT值约56 HU,肿块内侧可见一尖端伸入食管右后壁,食管右后壁局部增厚 2009年6月手术经左胸后外切口进胸,见后纵隔约40mm×40mm×20mm囊性肿块,内有灰白色液体,肿块同食管肌层、黏膜粘连紧密,仔细剥离肿块送病理检查.     

膀胱肉瘤样癌一例报告

膀胱肉瘤样癌临床罕见,2007年8月我院收治1例,现报告如下. 患者,女,77岁.因全程肉眼血尿伴尿频、尿急1周人院.B超检查:膀胱右侧壁可见4.4 cm×3.7 cm中低回声结节,内部回声不均匀,有蒂,其内可见少许血流信号,盆腔淋巴结阴性,双肾、输尿管末见异常.膀胱增强CT:膀胱右后壁可见一3.5 cmX 4.2 cm软组织密度影,平扫CT值21 HU,增强扫描病变强化明显,CT值94 HU,膀胱周围脂肪间隙清晰,盆腔内未见明显肿火淋巴结.     

原发于腹膜的上皮样血管内皮瘤一例

患者男,63岁,因“左腰部疼痛1d”于2011年6月15日入院.查体提示左中上腹包块.CT平扫:左侧腹腔可见巨大不规则块影,边界尚清,密度不均匀.CT值平均:15～33 HU,其内可见点灶高密度影及散在稍高密度影,病灶上缘与胃底部胃壁分界不清(图1A),其周围肠管受压移位.增强:左侧腹腔内巨大肿块,增强后动脉期轻度强化,并可见胃动脉小分支进入,门静脉期及平衡期强化范围扩大,强化程度增高,病灶范围约90 mm×157 mm×184 mm.遂行开腹探查,术中见左中上腹区约21 cm×19 cm×8 cm的质中等肿物,与胃后壁关系密切.     

CT误诊胃淋巴瘤1例

患者男,49岁,主因"食欲缺乏、乏力2月余"就诊。外院B超示脾占位、胰腺占位。入院CT:胃底后部、脾脏及胰尾间见12.2cm×14.4cm×13.1cm巨大等密度软组织肿块,边缘欠规则,平扫CT值约30HU,增强后轻度强化,动脉期CT值为42HU,静脉期CT值为52HU;病灶与胃底关系密切,表面见溃疡形成,并包埋脾动     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.