The treatment of sulphur mustard burns with laser debridement.

The chemical warfare agent, sulphur mustard (SM), is a potent blistering agent in man. Skin exposure can produce partial-thickness burns which take up to three months to heal. The aim of this study was to investigate the use of early laser ablation as a means of accelerating this exceptionally slow rate of healing. Four circular partial-thickness SM burns were induced on the dorsum of nine large white pigs (under general anaesthesia). At 72 h post-exposure, three burns per animal were ablated with a single pass of an UltraPulse 5000C CO(2) laser, at a fluence of 5-6 J cm(-2). All the burns were dressed with silver sulphadiazine and a semi-occlusive dressing. At one, two and three weeks post-surgery three animals were culled and all lesions excised for histological analysis. Burn depth was confirmed and measurements of the radii of regenerative epithelium were performed allowing the area of the zone of re-epithelialisation in each lesion to be calculated. Laser-treated lesions showed a significant increase (350%) in healing rates compared to controls (p<0.005). At two weeks, the laser-treated sites were 95% healed in comparison with control sites (28% healed). These data suggest that laser ablation may be effective in the treatment of partial-thickness SM-induced skin injury.     

大肠癌肝转移射频消融后局部复发影响因素的分析

目的 探讨射频消融（radiofrequency ablation,RFA）治疗大肠癌肝转移后局部肿瘤复发的风险因素。方法 回顾性研究213例347个肿瘤实施RFA治疗后局部复发的临床资料,对可能影响RFA局部治疗效果的临床因素进行统计学处理。结果 175例（82.2%）298个肿瘤（85.9%）得到CT或MRI随访资料。大肠癌肝转移灶RFA后肿瘤局部复发率为36.9%（110/298）,局部复发的平均时间为16.4月（2～57个月）。单因素分析显示肝脏转移灶的部位、大小和射频针类型与肿瘤射频后的局部复发相关（P值分别为P=0.000,P=0.021和P=0.026）,但Cox多因素分析则显示只有瘤大小和转移灶部位是大肠癌肝转移射频消融后局部复发的独立预后因素（χ^2=8.522,P=0.000;χ^2=1.321,P=0.022）。结论 肝脏肿瘤的大小和部位是RFA治疗效果的独立影响因素,正确的电极选择和布针是获得肿瘤完全坏死的关键。     

支气管动脉化疗灌注联合多极射频治疗中晚期肺癌

目的评价支气管动脉化疗灌注联合多极射频治疗中晚期肺癌的临床疗效。方法对32例失去手术机会或放弃手术治疗的中晚期肺癌患者,在进行常规支气管动脉化疗灌注的同时,于首次化疗灌注后2周,在CT引导下对病灶进行多极射频治疗1次。随访并记录术后半年、1年、2年、3年的有效率与患者生存率,与单纯进行常规支气管动脉化疗灌注的38例对照组进行同期有效率与生存率的比较。结果联合治疗组术后半年、1年、2年、3年的有效率/生存率分别为:87.5%/96.9%、71.9%/81.3%、34.4%/46.9%、12.5%/21.9%。对照组有效率/生存率分别为:63.2%/78.9%、36.9%/52.6%、26.3%/36.8%、5.3%/7.9%,联合治疗组有效率与生存率均明显高于对照组,统计学有明显差异(P<0.05)。结论支气管动脉化疗灌注联合多极射频治疗中晚期肺癌,疗效明显优于单纯支气管动脉化疗灌注(P<0.05),同时可明显提高患者的生存率,是一种较为理想、安全有效的综合性治疗手段,值得推广应用。     

Epicardial radiofrequency ablation for chronic atrial fibrillation undergoing simultaneous on-pump beating coronary artery bypass grafting

Off-pump coronary artery bypass grafting has become an attractive surgical alternative for myocar-dial revascularization because of the advantage of myocardial protection and other benefits of patients. However, it is still regarded as a controversial treatment for the coronary artery disease accompanied by atrial fibrillation (AF). A significant number of patients in need of coronary revascularization have chronic AF. Although the Cox-Maze III procedure is the gold standard for the surgical treatment of AF, few of these patients undergo AF operations at the time of their coronary bypass grafting. We report herein a case of the pulmonary vein isolation to eliminate the AF by means of epicardial radiofrequency ablation combined with 2 vessels coronary artery bypass grafting on the beating heart with the aid of cardiopulmonary bypass.     

内镜联合肝动脉栓塞化疗、射频消融治疗肝细胞癌合并胆管癌栓

目的探讨内镜联合肝动脉栓塞化疗（transcatheter arterial chemoembolization，TACE）、射频消融（percutaneous radiofrequency ablation，PRAF）治疗肝细胞癌（hepatocellular carcinoma，HCC）合并胆管癌栓的治疗效果。方法回顾总结1999年1月～2005年12月收治的65例肝细胞癌合并胆管癌栓的诊疗情况。结果65例中，均行内镜胆道引流术或EST及取栓，联合TACE，PRAF治疗。本组无手术死亡。癌栓清除率为95．4％（62／65），肿瘤坏死率为96．9％（63／65），1年生存率为60．0％（39／65），3年生存率为38．5％（25／65）。结论内镜联合TACE及PRAF治疗肝细胞癌合并胆管癌栓不失为一种行之有效的微创治疗方法，疗效优于单纯的内镜、TACE及PRAF治疗。     

经尿道前列腺汽化电切术中电切深度标识的探讨

目的 探讨经尿道前列腺汽化电切术(transurethral electrovaporization of the prostate，TUVP)电切深度标识的可行性。方法 回顾性分析616例前列腺增生症临床资料，其中310例术前彩超提示合并前列腺钙化，156例合并膀胱结石，23例合并膀胱肿瘤。TUVP操作过程中，观察到合并前列腺结石和机械操作“打滑现象”，停止电切。结果 全组手术时间30～120min，平均75min。术中验证术前彩超提示合并前列腺钙化的310例前列腺钙化为结石，同时发现其余306例均存在结石。1例术中膀胱穿孔，无尿道直肠瘘和尿道电切综合征发生。325例随访3～6个月，平均4．5月，最大尿流率由6．5～8．5ml／s提高到18～22ml／s，残余尿由70～150ml降至0～10ml，国际前列腺症状评分由19～24．5分降至0～7分。138例膀胱结石和23例膀胱肿瘤无复发。结论 前列腺结石和机械操作“打滑现象”作为TUVP的电切深度标识是切实可行的。     

Complicated transseptal puncture during intervention catheter ablation on atrial fibrillation concomitant with straight back syndrome

Straight back syndrome (SBS) is a thoracic deformity with absence of upper thoracic spine kyphosis and heart compression. The anatomic abnormity of SBS may raise the difficulty of introcardial operation and increase the complicated risk of intervention performance. Here we report a case of SBS with complicated transseptal puncture during intervention catheter ablation of atrial fibrillation.     

Dynamics of ablation plume particles generated during excimer laser corneal ablation

Background and Objective: Although the empirical characteristics of ArF excimer laser corneal ablation have been well documented, the exact ablation mechanisms are not well understood. The present paper reports a quantitative analysis of corneal ablation plumes using in situ time resolved laser light scattering and Raman spectroscopy. Study Design/Materials and Methods: Bovine corneas were used as the ArF excimer laser ablation targets. Light scattering data were recorded from the ablation plume as a function of height above the tissue surface and as function of delay time with respect to the ablative ArF laser pulse. Results: Raman spectra of the ablation plume allow identification of the particles as water. Mean plume particle diameters are found to decrease with height, while the particle volume fractions are relatively constant. The total volume of plume particles correlates well with the total volume of water in the ablated corneal tissue. Conclusion: The finding of a non-evolving plume composed of water spherules, combined with the excellent agreement between total volume of water in the plume and the content of water in the ablated corneal tissue, support the concept of photodecomposition or “cold ablation” for corneal tissue during ArF excimer laser ablation. © 1995 Wiley-Liss, Inc.     

Pulsed CO2 laser tissue ablation: effect of tissue type and pulse duration on thermal damage

Tissue removal by infrared lasers is accompanied by thermal damage to nonablated tissue. The extent of thermal damage can be controlled by a choice of laser wavelength, irradiance, and exposure duration. The effect of exposure duration has been studied in vivo by using CO2 lasers with pulse widths that vary from 2 microseconds to 50 msec. Pulse widths of 50 msec, typical of a shuttered, continuous-wave CO2 laser, produce damage regions 750 micron wide in normal guinea pig skin; the use of a 2-microseconds-long pulse reduced this damage zone to as little as 50 micron. Using 2-microseconds-long pulses, in vitro studies showed that the minimum zone of thermal damage varied significantly with tissue type. The thermal denaturation of these tissues has been studied and correlated with damage. The effect of denaturation temperature and pulse duration on the width of the damage zone is explained by a simple model.     

Clinical Recurrences After Successful Accessory Pathway Ablation:

Dormant Accessory Pathways. Introduction : Recurrence of clinical symptoms after radiofrequency catheter ablation of an accessory atrioventricular pathway (AP) may be due to the late manifestation of an additional AP that was not detected during the initial ablation session. It was the purpose of this study to elucidate the phenomenon of these "dormant" APs.
Methods and Results : Of 1280 consecutive patients who underwent radiofrequency catheter ablation of an AP, 54 patients (4.2 %) developed clinical symptoms postablation, necessitating a repeat ablation session. Recurrence of conduction over the AP targeted al the initial ablation session was found in 45 patients, whereas in the other 9 patients (0.7%) the manifestation of a previously unnoticed AP had caused symptom recurrence. Retrospective analysis of the data from these patients' ablation sessions revealed that the late manifesting AP was ablated at a site clearly different from that of the initially targeted AP, and that the manifestation of conduction over a previously "dormant" AP occurred significantly later than the recovery of a presumably ablated AP. Seven (78%) of the 9 "dormant" APs were concealed, and none exhibited decremental conduction properties.
Conclusion : The incidence of clinical recurrences mediated by the late manifestation of conduction over a previously "dormant" AP is low. The lack of an anatomic vicinity of these predominantly concealed APs with the initially targeted AP and the lack of evidence for their presence during the initial ablation session suggest intermittent conduction as the most likely explanation for their late manifestation.