真性红细胞增多症伴发脑梗死18例临床分析

真性红细胞增多症（polycythemia vera，PV）是一种克隆性红细胞增多为主的慢性骨髓高增殖、低凋亡疾病。其外周血红细胞显著增多，并常伴有白细胞和血小板增高，因而易并发血栓性疾病，尤以脑血管最常受累。PV所致的脑血管病起病隐袭、进展缓慢，临床缺乏特异性，易误诊、误治，死亡率高，因而提高对PV所引起的脑血管病的认识，尽早诊断及时治疗，具有重要的临床意义。     

Portal vein stenosis after pancreatectomy following neoadjuvant chemoradiation therapy for pancreatic cancer

Extrahepatic portal vein (PV) stenosis has various causes, such as tumor encasement, pancreatitis and as a postsurgical complication. With regard to post-pancreaticoduodenectomy, intraoperative radiation therapy with/ without PV resection is reported to be associated with PV stenosis. However, there has been no report of PV stenosis after pancreatectomy following neoadjuvant chemoradiation therapy (NACRT). Here we report the cases of three patients with PV stenosis after pancreatectomy and PV resection following gemcitabine-based NACRT for pancreatic cancer and their successful treatment with stent placement. We have performed NACRT in 18 patients with borderline resectable pancreatic cancer since 2005. Of the 15 patients who completed NACRT, nine had undergone pancreatectomy. Combined portal resection was performed in eight of the nine patients. We report here three patients with PV stenosis, and thus the ratio of post-operative PV stenosis in patients with PV resection following NACRT is 37.5% in this series. We encountered no case of PV stenosis among 22 patients operated with PV resection for pancreatobiliary cancer without NACRT during the same period. A relationship between PV stenosis and NACRT is suspected, but further investigation is required to determine whether NACRT has relevance to PV stenosis.     

心房颤动肺静脉电隔离术后三磷酸腺苷激发试验的相关因素分析

目的 分析心房颤动(房颤)射频消融术中应用三磷酸腺苷(ATP)激发肺静脉(PV)传导恢复的相关因素.方法 连续56例接受PV电隔离术治疗的房颤患者[男38例,年龄(59±12)岁],在PV隔离20 min后给予ATP(0.2 mg/kg),观察PV传导恢复与否,并对传导恢复的PV再次消融,直至ATP激发试验阴性,分析与PV传导恢复相关的临床及术中指标.结果 19例(33.9％)患者PV传导恢复,其中右侧PV(RPV)4例,左侧PV(LPV)10例,双侧PV传导均恢复5例.室间隔增厚(＞11 mm)和LPV消融时间长(≥20 min)的患者在ATP试验时更易出现阳性反应(与室间隔≤11 mm及LPV消融时间＜20 min者比较,P值分别为0.024和0.021).结论 室间隔增厚和LPV消融时间长是房颤导管射频消融术中PV电位恢复的预测因子.     

真性红细胞增多症20例临床分析

真性红细胞增多症（PV）是一种以红细胞增多为主的慢性骨髓增殖性疾病,其发病率低,起病隐匿,常因临床症状不典型而易误诊或漏诊。现就我院2000年1月～2010年5月共收治的20例PV患者进行临床分析,以提高对本病的认识。     

Killing of p53-deficient hepatoma cells by parvovirus H-1 and chemotherapeutics requires promyelocytic leukemia protein

AIM： To evaluate the synergistic targeting and killing of human hepatocellular carcinoma （HCC） cells lacking p53 by the oncolytic autonomous parvovirus （PV） H-1 and chemotherapeutic agents and its dependence on functional promyelocytic leukemia protein （PML）. METHODS： The role of p53 and PML in regulating cytotoxicity and gene transfer mediated by wild-type （wt） PV H-1 were explored in two pairs of isogenic human hepatoma cell lines with different p53 status. Furthermore, H-1 PV infection was combined with cytostatic drug treatment. RESULTS： While the HCC cells with different p53 status studied were all susceptible to H-1 PV-induced apoptosis, the cytotoxicity of H-1 PV was morepronounced in p53-negative than in p53-positive cells. Apoptosis rates in p53-negative cell lines treated by genotoxic drugs were further enhanced by a treatment with H-1 PV. In flow cytometric analyses, H-1 PV infection resulted in a reduction of the mitochondrial transmembrane potential. In addition, H-1 PV cells showed a significant increase in PML expression. Knocking down PML expression resulted in a striking reduction of the level of H-1 PV infected tumor cell death. CONCLUSION： H-1 PV is a suitable agent to circumvent the resistance of p53-negative HCC cells to genotoxic agents, and it enhances the apoptotic process which is dependent on functional PML. Thus, H-1 PV and its oncolytic vector derivatives may be considered as therapeutic options for HCC, particularly for p53-negative tumors.     

老年人真性红细胞增多症合并脑血栓形成5例临床分析

真性红细胞增多症(PV)易发生身体各部位血栓,以脑血栓最为常见,且多发生于老年患者,常与一般的脑血管病相混淆。现将5例以脑血栓首发症状的老年PV患者的临床资料分析报告如下。 1 临床资料 1.1 一般资料 本组患者,男4例,女1例,年龄62～70岁。均以一侧肢体运动障碍就诊,以“脑血栓”收入院,经临床、实验室及头颅CT检查后给予抗栓治疗。从发生脑血栓到确诊为PV病程1个月～4年。     

亚急性重型肝炎的肝脏血流动力学改变

目的探讨亚急性重型肝炎时肝固有动脉(PHA)、门静脉(PV)的血流动力学改变.方法应用彩色多谱勒超声检测25例亚急性重型肝炎患者的PHA、PV的管径、时间平均血流速度(Vmean)、血流量及PHA的阻力指数(RI),并对21例进行了随访;设30例为正常对照组.结果亚急性重型肝炎时,PHA内径增宽,Vmean增加,血流量增多;PV内径增宽,Vmean降低,血流量减少;PHA血流量与TBIL呈正相关,PV血流量与TBIL呈负相关.治疗后PV血流量增加,PHA血流量减少.结论亚急性重型肝炎时,肝脏血流动力学检测有助于提示病情程度,并可为治疗提供参考依据.     

Portal vein stenting as a signiifcant risk factor for biliary stricture in adult living donor liver transplantation

BACKGROUND: Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) re-cipients, we experienced high incidence of biliary anastomotic strictures (BAS) after PV stenting. In this study, we sought to clarify the relation between BAS and PV stenting and to suggest the possible mechanism of BAS and measures to reduce its in-cidence.
METHODS: We retrospectively analyzed 44 LDLT recipients who underwent PV stent implantation across the line of PV anastomosis regardless of the location of steno-occlusion (stent group) and their matched controls (non-stented LDLT recipients, n=131).
RESULTS: The incidence of BAS was higher in patients in the stent group than that in the control group (43.2% vs 17.6%, P=0.001). Cumulative 6-month and 1-, 2- and 5-year BAS rates were 31.8%, 34.1%, 41.4% and 43.2%, respectively, in the stent group and 13.0%, 13.8%, 16.1% and 17.8%, respectively, in the control group (P=0.001). Multivariate analysis revealed that PV stenting was an independent risk factor for BAS.
CONCLUSIONS: Although PV stent implantation is a reliable treatment modality for steno-occlusive PV in adult LDLT recipients, innovative methods to prevent the PV stent from crossing the line of PV anastomosis may be necessary to reduce the incidence of postoperative BAS.     

A three-pulmonary vein isolation approach to treat paroxysmal atrial fibrillation

To investigate the safety and efficacy of a 3-pulmonary vein (PV) isolation approach in treatingparoxysmal atrial fibrillation (AF).Methods Radiofrequency catheter ablation was used to eliminate PVpotential in 11 patients with frequent paroxysmal AF refractory to anti-arrhythmic agents.During sinus rhythm,PVpotential was mapped in the left and right superior PVs and left inferior PV.The procedural success was defined asthe elimination of PV potential in the 3 PVs.Results PV potential was identified and abolished in a total of 24PVs,mostly in the left and fight superior PV.There was no pulmonary stenosis or other complications during or afterthe procedures.AF recurred in one patient after an average of 12±3 month follow-up.Conclusions PVpotentials were present mostly in the left or right superior PV.The 3-PVs isolation approach is safe and effective inpreventing drug-resistant paroxysmal AF.(J Ceriatr Cardiol 2004;1:29-34.)     

巧用软包装输液袋

在临床护理工作中,由PV材料制成的一次性软包装输液袋,分别有100 ml、250 ml、500 ml及三升袋等.在使用后往往弃置不用,不仅造成了浪费,还易造成环境污染.一、我科发现输液后的空软包装输液袋用处诸多:1.首先:100 ml、250 ml空软包装输液袋头端剪掉可以用来当笔袋,因为护士要用的笔比较多,常常把工作服口袋沾上笔水,很难洗掉,影响美观.     

JAK2 V617F阴性真性红细胞增多症患者JAK2 exon 12的突变研究

真性红细胞增多症(PV)是源于造血干细胞的克隆性骨髓增殖性疾病.2008年WHO正式将JAK2 V617F突变纳入了PV的诊断标准[1].但是临床上仍然有部分PV患者JAK2 V617F呈阴性,2007年Scott等[2]首次报道在这些病例中存在JAK2 exon 12突变,而目前国内尚无此方面的报道.为此我们对在山西医科大学第二医院就诊的JAK2 V617F阴性的PV患者进行JAK2 exon 12突变检测.     

真性红细胞增多症患者JAK2V617F突变的临床意义

目的 探讨真性红细胞增多症(PV)患者JAK2V617F突变的临床意义.方法 用等位基因特异性PCR法检测26例PV、10例继发性红细胞增多症(SE)、5例Ph+慢性粒细胞白血病(CML)患者,以及5例健康志愿者的JAK2V617F突变,并经DNA测序验证.用PCR-限制性片段长度多态性分析检测JAK2V617F突变状态,分析突变状态与PV临床及实验室特征的关系.结果 PV患者92.3%(24例)出现JAK2V617F 突变,其中纯合子突变7例,杂合子突变17例;纯合子突变者初诊时Hb及乳酸脱氢酶高于杂合子者(P＜0.05).SE、Ph+CML患者及健康志愿者均未检出JAK2V617F突变.结论 JAK2V617F 突变可能成为PV的分子学诊断标准.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

Extrahepatic portacaval shunt via a magnetic compression technique: A cadaveric feasibility study

AIM: To explore the anatomical feasibility of portacaval shunt using a magnetic compression technique(MCT) in cadavers.METHODS: Computed tomography(CT) images of 30 portal hypertensive patients were obtained.The diameters of the portal vein(PV),the inferior vena cava(IVC),and distance between the two structures were measured.Similar measurements were performed on 20 adult corpses.The feasibility of portacaval shunt based on those measurements was analyzed.First stage of the extrahepatic portacaval shunt using MCT was performed on five cadavers.Specifically,the PV and IVC were exposed through an abdominal incision of the cadavers.The parent magnet was introduced from the femoral vein and was delivered into the IVC by an anchor wire and a 5F Cook catheter.The daughter magnet was introduced into the PV through the splenic vein using aninterventional guide wire.When the daughter magnet met the parent magnet,they automatically clipped together and the first stage of the portacaval shunt was set up.RESULTS: The average diameters of the PV and the IVC measured from the 30 CT image were 14.39 ± 2.36 mm and 18.59 ± 4.97 mm,respectively,and the maximum and minimum distances between the PV and the IVC were 9.79 ± 4.56 mm and 9.50 ± 4.79 mm,respectively.From 20 cadavers,the average diameters of the PV and the IVC were 14.48 ± 1.47 mm and 24.71 ± 2.64 mm,and the maximum and minimum distances between the PV and the IVC were 10.14 ± 1.70 mm and 8.93 ± 1.17 mm,respectively.The distances between the PV and the IVC from both the CT images and the cadavers were within the effective length of portacaval anastomosis using MCT(30.30 ± 4.19 mm).The PV and IVC are in close proximity to each other with no intervening tissues or structures in between.Simulated surgeries of the first stage using MCT on five cadavers was successfully performed.CONCLUSION: Anatomically,extrahepatic portacaval shunt employing MCT is highly feasible in humans.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.