部分性脾栓塞术在肝癌伴脾功能亢进治疗中的应用

目的评价部分性脾栓塞术（PSE）在原发性肝癌伴脾功能亢进介入治疗中的疗效及临床意义。方法原发性肝癌伴脾功能亢进患者12例，男10例，女2例．平均年龄51．1岁；肝功能Child－PughA级3例，B级9例；在行肝动脉插管化疗栓塞术（TACE）的同时行PSE；术后定期复查血常规和肝功能。结果本组脾栓塞面积为50％～60％，无脾脓肿等严重并发症。术后WBC和PLT显著提高（P〈0．05），并长期维持在较高水平，RBC数量和HG量无明显改变（P〉0．05）。TBIL、ALT和AST无明显变化（P〉0．05），TBA下降（P〈0．05）。结论PSE能纠正脾功能亢进，提高血WBC和PLT的数量，使原发性肝癌伴脾功能亢进患者的TACE能顺利进行，是一种安全、有效的治疗方法。     

超选择脾下极动脉栓塞术治疗脾功能亢进的疗效分析

目的评价超选择脾下极动脉栓塞治疗脾功能亢进的疗效。方法应用介入治疗的手段，采用同轴导管技术，将微导管超选择送至脾下极动脉进行栓塞治疗肝硬化脾功能亢进症48例，观察术前术后外周血细胞、凝血酶原时间、免疫球蛋白、肝功能的变化、脾脏大小、并发症的发生及愈后情况。结果术后白血胞、血小板和凝血酶原时间迅速恢复或接近正常水平，与术前比较差异具有非常显著性（P〈0．01），红细胞和血红蛋白与术前比较差异无显著性（P〉0．05）；术后2周内肝功能有不同程度的损害，以后逐渐改善；术后血清免疫球蛋白无变化；术后近期（1～3个月）脾脏大小变化不明显，6～9个月后明显缩小；术后并发症：均有腹痛、发热等。48例脾功能亢进患者行超选择脾下极动脉栓塞术后治愈（CR）37例（77．1％），有效（PR）9例（18．1％），总有效率95．8％，37例获CR者随访1年，7例复发，复发率18．9％。结论超选择脾下极动脉栓塞术是肝硬化脾功能亢进安全有效的治疗方法。     

经导管动脉化疗栓塞术联合部分性脾动脉栓塞术治疗原发性肝癌合并脾功能亢进

目的评价TACE联合部分性脾动脉栓塞术（PSE）治疗原发性肝癌（PHC）合并脾功能亢进的临床效果。方法对26例PHC合并脾功能亢进患者行TACE联合PSE治疗。术后采用肝脏CT、超声、肝功能、血常规及甲胎蛋白（AFP）检查,并进行随访。结果对26例患者共进行63次TACE、27次PSE治疗,全部治疗均获成功,无严重并发症。全部患者随访2个月,均生存;23例患者随访6个月,17例生存;13例患者随访12个月,9例生存;8例患者随访24个月,5例生存。结论 TACE联合PSE治疗PHC合并脾功能亢进可取得较好的临床效果。     

脾切除术与部分性脾栓塞术治疗肝硬化脾功能亢进的比较研究

目的对比研究脾切除术（包括开腹脾切除和腹腔镜下脾切除）与部分性脾栓塞术治疗肝硬化脾功能亢进的疗效。方法回顾分析我院1999年3月至2006年12月42例获得完整随访资料的行外科手术或介入处理的42例肝硬化脾功能亢进患者的临床资料，其中外科切除组19例，部分性脾栓塞组23例，比较观察两组术后第3、7、14、30天及1年的外周血象主要指标（RBC、WBC、PLT）、术后1个月及1年的NK细胞活性、术后住院时间、住院费用及并发症的发病率。结果两组患者术后不同时间的血细胞水平差异无统计学意义（P〉0．05），部分性脾栓塞组患者术后住院时间及住院费用明显低于外科手术组（P〈0．05），术后1个月及1年外科手术组NK细胞活性低于部分性脾栓塞组，差异具有统计学意义（P〈0．05）。结论外科脾切除与部分性脾栓塞治疗肝硬化脾功能亢进均有确切疗效，部分性栓塞在减少患者住院时间、降低住院费用及维持患者免疫功能方面更有优势，但治疗方案需个体化。     

原发性肝癌合并脾功能亢进的外科治疗

目的 探讨原发性肝癌合并脾功能亢进的合理治疗方法。方法 1994年1月至2004年12月我院收治67例原发性肝癌合并脾功能亢进患者，17例行肝切除联合脾切除，7例行单纯肝切除，43例行肝动脉栓塞化疗联合脾动脉栓塞。结果 肝切除联合脾切除组术后30d患者脾功能亢进症状消失，外周血细胞恢复正常。单纯肝切除组术后脾功能亢进症状加重，其中6例于术后3～7个月分别行脾动脉栓塞治疗。肝动脉栓塞化疗联合脾动脉栓塞组治疗后30 d 79％（34／43）的病例脾功能亢进症状改善，外周血细胞恢复正常。结论 原发性肝癌合并脾功能亢进的处理应争取行肝切除联合脾切除治疗，如肝癌不能切除，则应争取行肝动脉栓塞化疗联合脾动脉栓塞治疗。     

部分脾动脉栓塞术后肝脏血流改变的CT灌注成像

目的观察肝硬化门静脉高压伴脾脏功能亢进患者部分脾动脉栓塞术（PSE）后的肝脏血流改变。方法肝硬化门静脉高压伴脾脏功能亢进患者20例,肝功能A级16例,B级4例;脾肿大轻度5例,中重度15例。分别在脾脏栓塞前2d及术后1个月接受肝脏CT灌注成像,测量以下参数：肝总血流灌注量（HBF）、肝总血容量（HBV）,肝动脉灌注指数（HPI）,门静脉灌注量（PVP）,肝动脉灌注量（HAP）,平均通过时间（MTT）,毛细血管表面通透性（PS）。对术前、术后参数进行统计学分析。结果PSE前、后的各项灌注参数为：HBF129.30/116.30ml/（min.100ml）（P〉0.05）,HBV18.50/19.90ml/100ml（P〉0.05）,HPI0.23/0.45（P〈0.05）,PVP102.80/67.80ml/（min.100ml）（P〈0.05）,HAP27.46/48.53ml/（min.100ml）（P〈0.05）,MTT15.40/14.60s（P〉0.05）,PS36.10/37.30ml/（min.100ml）（P〉0.05）。结论肝硬化门静脉高压伴脾脏功能亢进患者在PSE术后HPI升高,PVP降低。研究肝脏CT灌注成像参数可对制定个体化治疗方案、选择治疗手段和评价疗效提供帮助。     

脾动脉栓塞治疗肝癌伴肝硬化脾功能亢进20例体会

目的探讨脾动脉栓塞对原发性肝癌伴肝硬化脾功能亢进的治疗效果。方法采用常规的Seldinger法做脾动脉栓塞共20例,术前血小板计数1.9×10     

部分性脾动脉栓塞对肝硬化门静脉高压血流动力学的影响

门静脉高压症是临床多发并发症,常继发于肝硬化,其主要表现为脾肿大,侧支循环的建立和腹水,同时亦可引起脾功能亢进.大量临床研究报道,部分性脾栓塞（PSE）是治疗门静脉高压症的一种有效方法.本文总结了近年来门脉高压症、脾肿大的发病机制,分析了门脉高压与脾脏的血流动力学关系,从门静脉高压症的发病机制及脾脏与门静脉高压症的发生、发展的密切关系出发,进一步总结了PSE对脾脏及门静脉血流动力学影响的机制.     

经食管内窥镜曲张静脉结扎联合部分脾栓塞术治疗门静脉高压症

目的 研究内镜下食管曲张静脉结扎联合部分脾栓塞术治疗门静脉高压症的临床疗效。方法自1999年5月至2003年2月对68例合并食管静脉曲张和脾功能亢进的门静脉高压症患者实施内镜结扎加部分脾栓塞术进行治疗,观察术后食管曲张静脉闭塞和止血效果及并发症和死亡率,门奇静脉侧支循环情况,并与对照组进行对比。结果联合术后患者食管曲张静脉获得根治,脾功能亢进缓解,门静脉血流速度减慢,血流量减少(P＜0．05),奇静脉血流量降低(P＜0．01),胃左静脉血流速度减慢(P＜0．05)。术后随访2-24个月,未出现复发性出血。结论内镜结扎联合部分脾栓塞术能有效地治疗门静脉高压症食管静脉曲张出血和脾功能亢进,减少了闭塞曲张静脉所需重复结扎次数及近期再出血,对于肝功能较差、难以耐受分流及断流手术的患者尤为适用。     

内镜注射硬化疗法联合部分脾栓塞术治疗门脉高压症的临床疗效

目的对内镜注射硬化疗法(EIS)联合部分脾栓塞(PSE)治疗肝硬化门脉高压的疗效进行评价。方法对我科于2005年2月至2008年11月收治22例食道胃底静脉曲张合并脾功能亢进的门脉高压患者采用内镜硬化剂注射联合部分脾栓塞的治疗进行回顾性分析。术后定期随访和比较术前术后的消化道出血、肝功能评级及外周血象的变化。结果 EIS平均次数1.8次,所有患者均行1次PSE治疗。术后随访5-30个月,无严重并发症出现,未见有再出血,肝功能部分改善,外周血血小板和白细胞计数明显升高(P<0.05)。结论 EIS联合PSE方法对肝硬化所致的食管胃底静脉曲张出血和门脉高压症是安全有效的。     

Bradycardia with sevoflurane in siblings with Branchio-oto-renal syndrome

Branchio-oto-renal syndrome (BOR, Melnick-Fraser syndrome, MIM#113650) refers to a rare autosomal dominant disorder characterized by branchial cysts or fistulas, hearing loss, external ear malformation, preauricular pits and renal abnormalities. The authors present three episodes of significant bradycardia in two siblings diagnosed with BOR syndrome during the sevoflurane general anesthesia. There is no published experience of anesthesia with this syndrome. Bradycardia occurred variously at induction, maintenance and immediately prior to emergence and required surgical stimulation, atropine, or epinephrine to treat. We seek to raise awareness of the potential for bradycardia during the procedures in patients with this syndrome requiring volatile anesthesia, especially sevoflurane.     

Increases in BMD correlate with improvements in bone microarchitecture with teriparatide treatment in postmenopausal women with osteoporosis.

Increases in BMD are correlated with improvements in 2D and 3D trabecular microarchitecture indices with teriparatide treatment. Therefore, improvements in trabecular bone microarchitecture may be one of the mechanisms to explain how BMD increases improve bone strength during teriparatide treatment. INTRODUCTION: Bone strength is determined by BMD and other elements of bone quality, including bone microarchitecture. Teriparatide treatment increases BMD and improves both cortical and trabecular bone microarchitecture. Increases in lumbar spine (LS) BMD account for approximately 30-41% of the vertebral fracture risk reduction with teriparatide treatment. The relationship between increases in BMD and improvements in cortical and trabecular microarchitecture has not yet been studied. MATERIALS AND METHODS: The relationship between increases in BMD and improvements in cortical and trabecular microarchitecture after teriparatide treatment was assessed using data from a subset of patients who had areal BMD measurements and structural parameters from transiliac bone biopsies in the Fracture Prevention Trial. 2D histomorphometric and 3D microCT parameters were measured at baseline and 12 (n = 21) or 22 (n = 36) mo. LS BMD was assessed at baseline and 12 and 18 mo, and femoral neck (FN) BMD was measured at baseline and 12 mo. Pearson correlation was performed to assess the relationship between actual changes in BMD and actual changes in microarchitectural parameters. RESULTS: Changes in LS BMD at 12 mo were significantly correlated with improvements in trabecular bone structure at 22 mo: 2D bone volume (r = 0.45, p = 0.02), 2D mean wall thickness (r = 0.41, p = 0.03), 3D bone volume (r = 0.48, p = 0.006), 3D trabecular thickness (r = 0.44, p = 0.01), 3D trabecular separation (r = -0.37, p = 0.04), 3D structural model index (r = -0.54, p = 0.001), and 3D connectivity density (r = 0.41, p = 0.02). Changes in LS BMD at 18 mo had similar correlations with improvements in bone structure at 22 mo. Changes in FN BMD at 12 mo were significantly correlated with changes in 2D mean wall thickness (r = 0.56, p = 0.002), 3D bone volume (r = 0.51, p = 0.004), 3D trabecular thickness (r = 0.44, p = 0.01), 3D trabecular separation (r = -0.46, p = 0.01), and 3D structural model index (r = -0.55, p = 0.001). CONCLUSIONS: Increases in BMD are correlated with improvements in trabecular microarchitecture in iliac crest of patients with teriparatide treatment. Therefore, improvements in trabecular bone microarchitecture may be one of the mechanisms to explain how BMD increases improve bone strength during teriparatide treatment.     

Pyloroplasty in association with Nissen fundoplication in children with neurologic disorders

Previous studies have suggested that delayed gastric emptying occurs in severely mentally retarded patients with gastroesophageal reflux. Based on this data, pyloroplasty was employed in such patients. A retrospective analysis of 99 consecutive patients who underwent primary fundoplication for GER was performed. Gastric emptying, as measured by successful removal of the nasogastric tube or elevation of the gastrostomy tube, was studied. Children with neurologic disorders had no clinically significant difference in gastric emptying after fundoplication (3.31 days) when compared with neurologically normal patients (2.21 days). When added to Nissen fundoplication, pyloroplasty did not hasten the return of gastrointestinal function in the severely impaired patients (4.91 days). A prospective study employing gastric isotope bolus feedings before and after Nissen fundoplication will determine if pyloroplasty improves gastric emptying when used in conjunction with Nissen fundoplication for patients with severe neurologic disorders.     

Chemotherapy in patients with teratoma with malignant transformation

OBJECTIVE: Germ-cell tumours (GCTs) with a non-GCT malignant component are a unique and rare phenomenon called teratoma with malignant transformation (TMT). The only published series of patients with TMT treated with chemotherapy comprised 10 patients. We report here our experience in treating 14 patients with TMT. PATIENTS AND METHODS: Sarcoma was identified in 10 of 14 patients, with rhabdomyosarcoma ranking first (n=4). Other histological types included adenocarcinoma (n=3) and bronchoalveolar carcinoma (n=1). Immunohistochemistry was performed to help in identifying the malignant non-GCT component. RESULTS: Primary treatment consisted of surgery alone in 4 patients. The remaining 10 patients received first-line cisplatin-based chemotherapy with resection of residual masses (n=5): 4 patients had a complete response and 5 had a partial response. Overall, 9 patients developed a relapse with a median time of 84 mo (range: 6-168). At relapse, 8 patients received a chemotherapy regimen directed to the non-GCT component. Four of these patients achieved a partial response. With a median follow-up of 59 mo (range: 3-180), 4 of 14 patients are alive, including 3 who are disease-free. CONCLUSION: To our knowledge, this is by far the largest reported European series of chemotherapy in TMT. Although TMT has a poor prognosis compared to GCT, its management may be improved by adapted chemotherapy associated with surgical resection of residual masses.     

Bradycardia with sevoflurane induction in patients with trisomy 21

The authors present a series of three paediatric patients with trisomy 21 who developed significant bradycardia during inhalation induction with sevoflurane. All three were undergoing adenotonsillectomy. The possible association of such problems with trisomy 21 and treatment options are reviewed. Although the occurrence of bradycardia in these three patients may have been a random occurrence, given its occurrence in three of five consecutive patients with trisomy 21, a causal relationship may be involved and future observation of these patients appears warranted.     

Atherosclerosis in patients with analgesic nephropathy treated with haemodialysis

SUMMARY: Accelerated atherosclerosis was reported to be associated with chronic analgesic consumption, but most studies were retrospective, and individual findings have almost never been controlled with regard to other atherosclerotic risk factors. Ten haemodialysis patients with analgesic nephropathy (group I) and 19 haemodialysis patients where renal failure was not caused by analgesic nephropathy (group II) were included in the study. All patients were female without diabetes. Using B-mode ultrasonography, we compared intima-media thickness (IMT) in the carotid arteries and plaque occurrence, and their thickness in group I with that in group II. the possible differences in atherosclerotic risk factors in both groups were also investigated. In group I, the average age was 60.2 years, and the average dialysis treatment was 55.7 months. In group II, the average age was 54.6 years, and the average duration of dialysis treatment was 50.4 months. We found no statistically significant difference in the age and duration of dialysis treatment between groups I and II. the IMT values of the carotid arteries (0.97 vs 0.78 mm; P = 0.027) were significantly higher in group I. More patients had plaques in group I (90 vs 57.9%), and the number of plaques ( P = 0.037) and their thickness ( P = 0.043) were significantly higher in this group. There was no statistically significant difference in the atherosclerotic risk factors between groups I and II. the results indicate that patients with analgesic nephropathy treated with haemodialysis showed advanced atherosclerosis compared with other haemodialysis patients, despite no difference being found in the atherosclerotic risk factors between these patients.