中心静脉导管联合高渗葡萄糖治疗肝性胸水的疗效观察

目的观察中心静脉导管联合高渗葡萄糖治疗肝性胸水的临床疗效。方法 55例肝性胸水患者随机分成治疗组（27例）和对照组（28例）,治疗组采用中心静脉导管留置胸腔持续引流胸水,胸水经B超或胸部X线片证实完全排净后注入高渗葡萄糖溶液。对照组则采用常规胸腔穿剌抽胸水治疗。两组患者均给予护肝、输白蛋白等支持治疗,观察两组患者的治疗效果和并发症的发生情况。结果 治疗组治疗总有效率为81.5%,对照组治疗总有效率为71.4%,两组比较有明显差异（P〈0.05）;治疗组胸水穿刺次数、胸水消退的天数、穿刺费用和住院天数较对照组均明显缩短（P〈0.05）,并发症少。结论中心静脉导管联合高渗葡萄糖治疗肝性胸水的疗效显著,操作简便,副作用少,值得临床推广。     

呼出气一氧化氮在中央型气道疾病气管镜治疗前后的变化

目的 探讨中央型气道疾病患者气管镜治疗前后呼出气一氧化氮(FeNO)变化及意义。方法 选取2019年7月至2019年8月于应急总医院明确诊断的中央型气道疾病且需行气管镜治疗患者48例,其中良性中央型气道病变患者18例,恶性中央型气道病变患者30例,每例患者均于气管镜治疗前及治疗24h后行FeNO 检查。结果 良、恶性中央型气道病变患者FeNO水平差异无统计学意义;中央型气道病变位置不同,所测量FeNO 水平差异无统计学意义;良、恶性病变患者气管镜治疗后FeNO 均较治疗前明显下降(t 值分别为2. 701、2 .895,P值均<0 05)。结论 将FeNO 应用于中央型气道疾病气管镜治疗前后气道炎症研究有一定的提示意义。     

The effects of prophylactic treatment of the central nervous system on the intellectual functioning of children with acute lymphocytic leukemia

The effect of central nervous system prophylaxis (cranial radiation and intrathecal chemotherapy) on intellectual function was studied in 24 children with acute lymphocytic leukemia. The Wechsler Intelligence tests were administered to these children and to a sample of their healthy siblings, who served as a comparison group. The mean Full Scale IQ was 98.6 for the patients and 112.5 for the sibling controls (p < 0.001 level). Those patients who received central nervous system preventive treatment at a young age exhibited a greater decrement in intellectual abilities than did patients who were older when they received this treatment. In contrast, leukemia patients who had not received central nervous system prophylaxis had IQs that did not differ statistically from those of their siblings. These data suggest that central nervous system prophylaxis may have an adverse effect on the intellectual capability of children with acute lymphocytic leukemia.     

Description of a multidimensional classification system for patients with expiratory central airway collapse

BACKGROUND AND OBJECTIVE: Patients with expiratory central airway collapse present with various symptoms, aetiologies, morphologies, extent and severity of airway collapse. The aim of this study was to delineate a multidimensional classification system and common language for evaluating patients with expiratory central airway collapse. METHODS: The classification system was based on the morphology and origin of the airway abnormality as well as stratification parameters such as functional status, extent and severity of airway collapse. Patients with expiratory central airway collapse who underwent clinical and bronchoscopic examination before and after treatment were identified from a bronchoscopy database. The classification was applied to the study patients before and after treatment to assess the utility of this stratification approach. RESULTS: Eighteen patients were studied. Four had excessive dynamic airway collapse and 14 had tracheobronchomalacia. Post-treatment, functional status improved by one class in 12 patients, by two classes in four patients and remained unchanged in two. Severity of airway collapse improved in 15 and remained unchanged in three patients. The extent of abnormality diminished in 14 patients and did not change in four. CONCLUSIONS: Using this classification, the morphologies and aetiologies of expiratory central airway collapse are identified, and an objective stratification of patients according to degree of functional impairment, extent of disease and severity of airway collapse is possible.     

Treatment of chronic coronary insufficiency with Irrigor]

The results of treatment of 103 patients suffering from ischemic heart disease with irrigor for 7--25 days are discussed. The drug was given in a daily dose of 30 to 150 mg in tablets, intramuscularly, and intravenously. Ergometry, study of the values of central hemodynamics and lipid metabolism, and recording of the rheoencephalo-, rheovaso-, and electroencephalogram were conducted before and after the treatment. The efficacy of irrigor was appraised in treatment applied in courses, in a single intravenous infusion, and under conditions of the double blind method. A relatively stable clinical effect was noted on the 9th--12th day. A good effect was produced in 49.3% of patients. The efficacy of irrigor was the highest in patients with grade I and II chronic coronary insufficiency, with no history of circulatory insufficiency or myocardial infarction, and in intramuscular and intravenous administration. Treatment with irrigor improved the indices of central hemodynamics and cerebral and peripheral blood flow. No side effects of the treatment were noted. The study showed irrigor to be an effective agent in the treatment of ischemic heart disease.     

中心静脉导管置入胸腔治疗结核性胸膜炎临床疗效分析

目的探讨中心静脉导管置入胸腔持续引流替代反复多次胸腔穿刺抽液治疗结核性胸膜炎临床应用价值。方法对我院2005年1月～2008年10月收治的结核性胸膜炎病例中经胸部X线和／或胸部超声检查确诊为中或大量胸腔积液的病例87例，随机分成2组（治疗组40例及对照组47例），分别用中心静脉导管持续胸腔引流和反复多次的胸腔穿刺抽液治疗，对这两种治疗方法的效果、出现并发症情况、住院费用进行比较。结果两种方法相比：胸水吸收时间、胸膜反应、胸水包裹发生率、气胸发生率、住院费用、治疗后第三个月的胸膜厚度等各项指标对比其差异均有统计学意义（P〈0．05）。结论中心静脉导管置入胸腔持续胸腔引流治疗结核性胸膜炎方法简单、方便、安全、经济，患者痛苦少、效果好，值得基层医院推广。     

Treatment of sleep-disordered breathing in children with myelomeningocele

The prevalence of moderate to severe sleep-disordered breathing (SDB) in patients with myelomeningocele may be as high as 20%, but little information is available regarding treatment of these patients. To assess the efficacy and complications of treatments for these children, we collected data on 73 patients from seven pediatric sleep laboratories. Obstructive sleep apnea (OSA, n = 30) and central apnea (n = 25) occurred more frequently than central hypoventilation (n = 12). We also describe a sleep-exacerbated restrictive lung disease type of SDB in 6 patients who had hypoxemia during sleep without apnea or central hypoventilation. For each type of SDB, effective treatments were identified in a stepwise process, moving towards more complex and invasive therapies. For OSA, adenotonsillectomy was often ineffective (10/14), whereas nasal continuous positive airway pressure (CPAP) was usually successful (18/21). For central apnea, methylxanthines and/or supplemental oxygen proved sufficient in 2 of 9 and 3 of 6, respectively, but noninvasive positive pressure ventilation was required in 7 children. For central hypoventilation, supplemental oxygen (alone or with methylxanthines), noninvasive positive pressure ventilation, and tracheostomy with positive pressure ventilation were effective in 3, 2, and 2 patients, respectively. Sleep-exacerbated restrictive lung disease always required supplemental oxygen treatment, but in 2 cases also required noninvasive positive pressure ventilation; nutritional and orthopedic procedures also were helpful. Posterior fossa decompression was used for the first three types of SDB, but data were insufficient to delineate specific recommendations for or against its use. In summary, evaluation by an experienced, multidisciplinary team can establish an effective treatment regime for a child with myelomeningocele and SDB.     

Pathogenesis and treatment of pruritus in patients with cholestasis

The pathogenesis of initiating the pruritus in patients with cholestasis is still not completely understood. One hypothesis is, that the cause for initiating the pruritus in patients with cholestasis is the activation of nerves in the skin. The activating substances are unknown, probably they are substances who accumulate in patients with cholestasis. Therefore one of the conventional approaches to treat pruritus is to remove pruritogenic substances from the body. Examples of this approach include the administration of anion exchange resins as cholestyramine or the administration of hepatic enzyme-inducing drugs such as rifampicin or phenobarbital. None of these drugs has been conclusively shown to be efficacious. A new hypothesis is the association of pruritus with altered central neurotransmission. Altered opioid concentrations probably play a central role in the pathogenesis of pruritus. This hypothesis is corroborate by the possibility of treating pruritus in patients with cholestasis with opiate antagonists such as naloxone or nalmefene. The treatment with ondansetron may also have effects on the pruritus of patients with cholestasis. A completely new treatment strategy is the application of dronabinol (r-9-tetrahydrocannabinol).     

癌症支持治疗中血栓形成的危险因素

癌症的支持治疗在癌症患者的抗癌治疗中有重要意义,但存在血栓形成的风险.癌症患者常见的辅助支持治疗包括输血治疗、红细胞生成刺激因子、孕酮和中心静脉导管.明确支持治疗与血栓形成的关系,有利于癌症患者防治血栓形成.     

HIV/AIDS合并中枢神经系统机会性感染73例临床分析

目的 探讨HIV感染及AIDS患者群(HIV/AIDS)的各种中枢神经系统机会性感染(opportunistic infections,OIs)情况,以提高诊断水平及临床治愈率,改善预后.方法 统计73例HIV/AIDS中枢神经系统OIs的临床数据,分析其临床表现、实验室检查结果和头颅影像学表现,评价其疗效及预后.结果...     

Prevalence of esophagogastric varices in patients with non-alcoholic steatohepatitis.

Aim: In non-alcoholic steatohepatitis (NASH), fibrosis begins around the central veins, as also happens with alcoholic liver disease, so the symptoms of portal hypertension may be due to central vein occlusion. The aim of this study was to define the prevalence of esophagogastric varices and the clinical outcome after endoscopic treatment in NASH patients with severe fibrosis. Methods: The subjects were 72 patients with clinicopathologically confirmed NASH who had bridging fibrosis (F3) or cirrhosis (F4) determined by the examination of liver biopsy specimens, and who underwent upper gastrointestinal endoscopy. The prevalence and pattern of endoscopically detected varices at the time of liver biopsy were evaluated. The results of NASH patients (n = 11) with endoscopically treated esophageal varices were compared to those with alcoholic (n = 67) and hepatitis C virus-associated cirrhosis (n = 152). Results: Esophagogastric varices were detected in 34 out of the 72 (47.2%) patients; esophageal varices in 25 (34.7%) and gastric varices in nine (12.5%), while six of these patients had variceal bleeding. In NASH patients, the cumulative recurrence-free probability at 24 months after endoscopic treatment was 63.6%, the bleeding-free probability was 90.9%, and the 5-year survival was 100%. Only one out 11 patients died of liver failure at 70 months after treatment. Conclusion: About half of NASH patients with severe fibrosis had esophagogastric varices. The clinical status and course of the varices do not necessarily improve after endoscopic treatment. NASH patients with esophagogastric varices need to be followed up carefully, like patients with other chronic liver diseases.     

电子支气管镜下支架植入联合氩气刀治疗恶性肿瘤引起中央气道狭窄的临床观察

目的观察电子支气管镜下支架植入联合氩气刀治疗恶性肿瘤引起中央气道狭窄的临床疗效,缓解患者呼吸困难症状。方法回顾31例患者的临床资料,分析支架一次性置入成功率等、治疗前后p H值、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、动脉血氧饱和度(Sa O2)、用力肺活量(FVC)、一秒用力呼气容积(FEV1)和气促评分变化,评价治疗后中央气道狭窄疗效,以及术后并发症及处理情况。结果30例患者支架一次性置入成功,成功率96.77%。治疗1周,患者气道阻塞症状减轻,p H值、Pa O2、Pa CO2、Sa O2及FVC、FEV1较治疗前明显改善,差异有统计意义(P0.05)。气道支架置入后1周,呼吸困难症状均明显缓解,治疗后患者气促评分明显优于治疗前,差异有统计意义(P0.05)。治疗即刻及治疗后3月患者中央气道狭窄疗效相似,差异无统计意义(P0.05)。术后6例咽喉及胸骨后疼痛、10例刺激性咳嗽、7例痰中带血、3例术后再次狭窄、1例大咯血猝死和1例术后支架边缘出现瘘口。中央气道狭窄程度级别越高,并发症发生的例次越高,差异有统计意义(P0.05)。结论电子支气管镜下支架植入联合氩气刀能有效缓解恶性肿瘤引起的中央气道狭窄,快速缓解患者呼吸困难症状,是非常有效的姑息治疗手段之一,但是中央气道狭窄程度越重,术后并发症发生率越高。     

Treatment of superior vena cava obstruction secondary to pacemaker wires with balloon venoplasty and insertion of metallic stents.

AIMS: Pacemaker wires can result in stenosis of the superior vena cava and other central veins. The aim of this study is to demonstrate the safety and effectiveness of treating stenoses of the superior vena cava (SVC) and central veins with balloon venoplasty and metallic stent insertion in the presence of cardiac pacemaker wires. METHODS AND RESULTS: Three patients were referred to the department after developing symptomatic SVC obstruction following implantation of a cardiac pacemaker several years earlier. They were examined with duplex ultrasound and venography, which revealed significant stenoses of the central veins. These patients subsequently underwent endovascular treatment which involved balloon dilation and stent insertion. The treatment was successful in all three patients, without any complications. Long-term patency of up to 4 years is recorded. No pacemaker function dysfunction was encountered. CONCLUSION: SVC stenting is safe and effective in patients who develop the SVC obstruction after cardiac pacemaker insertion.     

Effect of a short-term treatment with alendronate on bone density and bone markers in patients with central diabetes insipidus.

The aim of this open prospective randomized study was to evaluate the effect of a 6-month treatment with alendronate on the bone mineral density (BMD) at lumbar spine in patients with central diabetes insipidus. Eighteen patients with central diabetes insipidus and 18 sex- and age-matched healthy subjects entered this study. At study entry, all subjects underwent BMD assessment at the lumbar spine and measurement of serum osteocalcin (OC) and cross-linked N-telopeptides of type I collagen (Ntx). Thereafter, 9 of the 18 patients were randomized to receive treatment with alendronate at a dose of 10 mg, orally, once daily for 6 months (group 1), whereas the remaining 9 patients did not receive any treatment affecting bone status during this period (group 2). After 6 months, bone metabolism and bone density study were repeated in all patients. At baseline, lumbar BMD values (0.86+/-0.03 vs. 1.01+/-0.02 g/cm2; P<0.001) and serum OC levels (4.7+/-0.3 vs. 7.9+/-0.2 microg/L; P<0.001) were significantly lower, whereas urinary Ntx levels were significantly higher [72.0+/-1.9 vs. 64.6+/-1.7 nmol bone collagen equivalents (BCE)/nmol creatinine (Cr); P<0.01] in patients than in controls. After randomization, no difference in lumbar BMD, serum OC, or urinary Ntx was found between patients of group 1 and group 2. At the 6 month follow-up, no difference in serum OC levels was found compared to baseline evaluation in patients of both group 1 and group 2. By contrast, a significant decrease in urinary Ntx levels was found in patients of group 1 (70.3+/-3.0 vs. 75.4+/-2.1 nmol BCE/nmol Cr; P<0.05), but not in patients of group 2 (68.8+/-3.3 vs. 68.5+/-3.0 nmol BCE/nmol Cr; P = NS). A significant increase in lumbar BMD values was found in patients of group 1 (0.88+/-0.04 vs. 0.83+/-0.04 g/cm2; P<0.05), whereas a significant decrease in lumbar BMD values was found in patients of group 2 (0.86+/-0.05 vs. 0.89+/-0.05 g/cm2; P<0.05). Lumbar BMD increased 7.0+/-1.5% in patients of group 1 and decreased 4.2+/-1.8% in patients of group 2 (P<0.001). In conclusion, this study demonstrated that a 6-month treatment with alendronate in patients with central diabetes insipidus was effective in significantly improving BMD at the lumbar spine, which was significantly worsened in untreated patients. Therefore, alendronate treatment could be used in patients with central diabetes insipidus with documented osteopenia or osteoporosis.     

Clinical experience with and side-effects of tacrine hydrochloride in Alzheimer's disease: a pilot study

Pharmacological manipulation of central cholinergic neurotransmission may prove beneficial in the treatment of Alzheimer's disease (AD). Tacrine hydrochloride is a central anticholinesterase which has been said to improve intellectual function in patients with AD. We report here our clinical experience with this drug in eight patients with AD, diagnosed according to DSM III and NINCDS-ADRDA criteria. Cholinergic side-effects occurred in five patients, three of whom tolerated a reduced dose. Liver function tests rose within the normal range in all patients and became abnormal in one.     

Percutaneous intervention for symptomatic central vein stenosis in patients with upper limb arteriovenous dialysis access

Central venous stenosis is an important hindrance to long-term maintenance of arteriovenous access in the upper extremities in dialysis patients.AimThe present study was done to determine feasibility and clinical success of endovascular approach for the treatment of symptomatic central venous stenosis associated with significant ipsilateral limb edema in dialysis patients with vascular access in the upper limb.MethodsA database of hemodialysis patients who underwent endovascular treatment for central venous stenosis from January 2014 to January 2017 at our institute was retrospectively reviewed. Follow-up was variable.ResultsThe study included ten patients (6 men and 4 women) with a mean age of 45.2 years, who underwent thirteen interventions during a period of 3 years. The technical success rate for endovascular treatment was 100%. One patient underwent primary PTA (percutaneous transluminal angioplasty). Seven patients underwent primary PTA and stenting. Three patients underwent secondary PTA. One among these patients underwent secondary PTA twice along with fistuloplasty. One patient underwent secondary PTA with stenting. No immediate complications were encountered during the procedure. Our study shows a primary patency rate of 67% and 33% at 6 months and 12 months for PTA with stenting. Our study also shows secondary or assisted primary patency of 75% at 6 months of follow-up.ConclusionsEndovascular therapy (PTA) with or without stenting for central venous stenosis is safe, with low rates of technical failure. Multiple additional interventions are the rule and long-term patency rate is not very good.     

心包内处理血管肺切除术治疗中央型肺癌62例临床分析

目的探讨心包内处理血管肺切除术治疗中央型肺癌的临床价值。方法对无法采用常规肺切除而准备放弃手术的62例中央型肺癌患者施行心包内处理血管肺切除术。结果全部成功手术切除肺癌。无围手术期死亡。主要并发症发生率15例（24.19%）,1,3,5年生存率分别为44例（70.97%）、21例（33.87%）和10例（16.13%）。结论心包内处理血管肺切除术治疗中央型肺癌是安全有效的方法,扩大了肺癌的切除指征,提高了根治性切除率。     

Depressed Melatonin Secretion in Patients with Nightmares Due to β-Adrenoceptor Blocking Drugs

ABSTRACT. Nocturnal urinary melatonin excretion was evaluated in six patients with nightmares and hallucinations during treatment with β-adrenoceptor blocking agents, and compared to six control patients with similar diagnoses and treatment but without such symptoms from the central nervous system (CNS). Nightly melatonin excretion was lower in all cases with nightly CNS-symptoms than in the control patients. The results also suggest drug differences and dose dependency. It is concluded that in predisposed patients CNS side-effects induced by β-adrenoceptor antagonists are related to depressed nightly melatonin secretion.     

Outcome of Collagen Vascular Diseases by Treatment with Plasmapheresis

Abstract: The outcome of collagen vascular diseases after treatment with plasmapheresis was studied in 9 patients with polyarteritis nodosa (PN), in 2 patients with Wegener's granulomatosis (WG), in 1 patient with allergic granulomatous angitis (AGA), and in 20 patients with systemic lupus erythematosus (SLE) associated with antiphospho-lipid syndrome (APS). Improvement after treatment with plasmapheresis was observed in 41.7% of the patients with PN, WG, and AGA. On the other hand, with the exception of 1 patient with thrombocytopenia and 1 patient with renal failure, all of the clinical manifestations, including thrombocytopenia, central nervous system (CNS) lupus, thrombophlebitis, lung infarction, and recurrent abortions in the SLE patients with APS, improved after plasmapheresis. Plasmapheresis is thought to be an influential strategy of treatment for patients with collagen vascular diseases.     

Prevalence and treatment of breathing disorders during sleep in patients with heart failure

Opinion statement Heart failure is a highly prevalent disorder, with significant economic impact, and is associated with excess morbidity and mortality. One factor that may contribute to the progressively declining course of heart failure is the occurrence of recurrent episodes of apnea and hypopnea. There are two major kinds of sleep-related breathing disorders: obstructive and central sleep apnea. In patients with heart failure, in contrast to the general population, central sleep apnea is the most common form of sleep-related breathing disorder. Episodes of apnea, hypopnea, and the subsequent hyperpnea cause sleep disruption, arousals, hypoxemia-reoxygenation, hypercapnia/hypocapnia, and changes in intrathoracic pressure. These pathophysiologic consequences of sleep-related breathing disorders have deleterious effects on the cardiovascular system, and may be even more pronounced in the setting of established heart failure and coronary artery disease. Therefore, sleep apnea in heart failure should be treated. Central sleep apnea may be treated with nocturnal supplemental nasal oxygen, theophylline, or nasal-positive pressure devices, such as nasal continuous positive airway pressure (CPAP). The treatment of choice for obstructive sleep apnea is nasal CPAP. Although long-term controlled trials of the effect of treatment of sleep apnea on mortality in patients with heart failure are still pending, treatment of sleep apnea, both obstructive and central, does result in a decrease in sympathetic activity and an improvement in systolic function, which are known surrogates of mortality. Therefore, diagnosis and treatment of sleep-related breathing disorders may increase survival of patients with heart failure.