A modified technique for ethanol injection of liver tumors: preliminary results

The technique for ethanol injection of liver tumors was modified in order to obtain less reflux with a better intratumoral distribution of ethanol, leading to more extensive necrosis and to a reduction of pain. The needle was stopped just before its entrance into the tumor and ethanol was injected while the needle was advanced a little beyond the distant border of the tumor. Pain and change in echogenicity during and immediately after each injection were evaluated in 11 patients with 38 malignant lesions who received 90 injections with the new or 46 with the conventional technique. Computed tomography and biopsies were used for later follow-up. With the new technique the injected tissue volume converted much more markedly to high echogenicity (p 0.005), the pain was significantly reduced (p 0.001), and posttreatment biopsies significantly less often contained viable cells (p 0.005). These preliminary results suggest that the modified injections were more effective and less painful, and have enabled us to inject a larger volume of ethanol at each session to reduce the number of treatments. Correspondence to: N. M. Elgindy     

小儿腹股沟疝注射治疗后的手术及有关问题探讨

总结腹股沟疝注射治疗未愈患儿的手术，讨论术中注意事项，评价注射治疗的利弊。对１３例注射治疗未愈的小儿腹股沟疝进行了手术补治。术中发现全部病例精索组织及疝囊壁纤维化、增厚、粘连，分离困难，手术损伤较重；３例输精管消失，１例医源性隐睾。注射疗法效果不确实，并发症较多，不宜推广。     

维生素D2果糖酸钙注射液稳定性的研究

维生素D₂果糖酸钙注射液为非均匀体系的乳浊液。维生素D₂在油溶液中很稳定,而在此注射液中不稳定,其主要原因在于为非均匀体系乳浊所致,以界面对稳定性的影响最大。乳化剂用量增加维生素D₂稳定性亦降低。根据此注射液不稳定的主要原因,采用了添加油溶性抗氧剂和充以惰性气体的抗氧化措施,结合乳浊液的特点,此种措施是合理的,留样观察证明也是有效的。     

Heroin overdose among young injection drug users in San Francisco

OBJECTIVES: We sought to identify prevalence and predictors of heroin-related overdose among young injection drug users (IDU). METHODS: A total of 795 IDU under age of 30 years were interviewed in four neighbourhoods in San Francisco, California, USA. Participants were recruited as part of a broader study of HIV, hepatitis B and C among injecting drug users in San Francisco using street outreach and snowball techniques. Independent predictors of recent heroin overdose requiring intervention were determined using regression analysis. RESULTS: Of 795 injecting drug users under age of 30 years, 22% (174/795) of participants reported a heroin overdose in the last year. In stepwise multiple logistic regression, independent predictors of recent heroin overdose were lifetime incarceration exceeding 20 months (odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.52-5.88); heroin injection in the last 3 months (OR = 4.89, 95% CI = 2.03-11.74); cocaine injection in the last 3 months (OR = 1.67, 95% CI = 1.14-2.45); injection of heroin mixed with methamphetamine in the last 3 months (OR = 1.74, 95% CI = 1.15-2.65); ever tested for hepatitis B or C (OR = 1.66 per year, CI = 1.09-2.54) and ever having witnessed another person overdose (OR = 2.89, 95% CI = 1.76-4.73). CONCLUSIONS: Individuals with high levels of incarceration are at great risk of overdose, and prison or jail should be considered a primary intervention site. Further research on the role of cocaine and amphetamine in heroin-related overdose is indicated.     

罗库溴铵注射痛防治的研究进展

罗库溴铵是一种起效迅速的非去极化肌松药,注射部位疼痛和注射后体动反应在一定程度上限制了其临床运用。其发生机制可能与药液的理化性质和注射后导致中间介质的释放有关。改变溶液的理化性质或在注射前使用一定剂量的局部麻醉药、全身麻醉药、阿片类镇痛药、激肽释放酶抑制剂、抗组胺药、环氧化酶抑制剂等能有效预防这一不良反应的发生。     

银杏达莫注射液联合奥扎格雷治疗冠心病心绞痛临床观察

目的观察银杏达莫注射液联合奥扎格雷中西医结合治疗冠心病心绞痛的效果。方法将60例冠心病心绞痛病人随机分为两组,观察组28例给予银杏达莫注射液15 mL加5%葡萄糖或0.9%氯化钠,静脉滴注,1次/d,连用14 d;奥扎格雷80 mg,静滴,1次/d,连用14 d。对照组22例常规服用阿司匹林、硝酸酯类。结果观察组临床总有效率为93.4%,对照组总有效率为71.3%;观察组心电图总有效率为70.1%;对照组总有效率为57%。结论银杏达莫注射液联合奥扎格雷能明显减少心绞痛的发作次数及减轻胸闷、胸痛的症状。     

C型臂引导下等离子髓核低温消融术联合臭氧治疗包容性腰椎间盘突出症的对比观察

目的:观察在C型臂引导下,应用等离子髓核低温消融术联合注射臭氧治疗包容性腰椎间盘突出症的临床疗效.方法:回顾性分析90例包容性腰椎间盘突出症,随机分为A、B、C三组,每组30例.A组采用等离子髓核低温消融术联合臭氧治疗,B组采用等离子髓核低温消融术治疗,C组采用腰椎间盘注射臭氧治疗.采用VAS视觉模拟疼痛评分作为疼痛水平评价指标,改良Mac-Nab标准评估治疗效果.观察三组患者术后9天、18天、1个月的临床疗效.结果:术后1个月A组治疗优良率为96.6%(29/30例),B组治疗的优良率为76.6%(23/30例),C组治疗后优良率为70%(21/30例).A组优良率高于B组和C组(P<0.05).结论:等离子髓核低温消融术联合臭氧治疗包容性腰椎间盘突出症疗效优于单独应用等离子髓核低温消融术或单独应用注射臭氧治疗包容性腰椎间盘突出症.     

氟比洛芬酯和利多卡因联用缓解异丙酚注射痛的随机对照研究

目的 探讨联合应用氟比洛芬酯和利多卡因做静脉预处理缓解异丙酚注射痛的效果.方法 将160例拟行择期手术的ASI 1～2级全麻患者随机分为对照组、利多卡因组(Lc组)、氟比洛芬酯组(FA组)和氟比洛芬酯和利多卡因联用组(联用组),每组各40例.所有患者在给药前均先以橡胶止血带阻断其局部静脉回流,随后分别给予对照组0.9％ NS7 mL,FA组氟比洛芬酯注射液5mL(50 mg)+0.9％ NS 2 mL,Lc组2％利多卡因2mL(40 mg)+0.9％ NS 5 mL,联用组氟比洛芬酯注射液5mL (50 mg) +2％利多卡因2mL (40 mg);2 min后撤止血带,在5s内给入0.5 mg/kg的异丙酚.给药同时由另一位麻醉师以相同的方式及问题询问患者注射部位情况,采用VRS评分.结果 4组间一般情况比较无明显差异.Lc组、FA组、联用组的异丙酚注射痛发生率明显低于对照组(P＜0.05),联用组疼痛发生率低于其余3组.在注射痛强度评分方面,Lc组和联用组的疼痛强度明显低于对照组.术后24 h随访,患者注射部位无红肿、静脉炎或药疹等不良反应情况,亦无预期的胃肠刺激症状.结论 氟比洛芬酯和利多卡因联用做静脉预处理可有效缓解异丙酚注射痛,且不会增加不良反应.     

骨髓间充质干细胞关节腔注射治疗胶原诱导性关节炎的实验研究

目的 观察骨髓间充质干细胞(BMSCs)关节腔注射治疗胶原诱导性关节炎(CIA)的疗效.方法 体外扩增原代间充质干细胞至P2代.大鼠胶原二次免疫后第7天,将等量0.9％氯化钠注射液及P2代细胞分别注射至CIA不同侧足踝关节处.2,4,8,12周后观测关节炎指数和足爪关节X线分析及指数评估;12周处死动物进行组织学观察.采用配对t检验进行统计学分析.结果 在不同观察时间点间充质干细胞治疗组与对照组的关节炎指数为:(第2周)3.18±0.62与3.84±0.35,(第4周)3.45±0.28与4.06±0.38,(第8周)3.86:±0.23与6.75±0.36,(第12周)4.23±0.43与7.86±0.66;X线放射学指数为:(第2周)2.04:±0.21与2.72:±.0.15,(第4周)2.52±0.47与4.06±0.38,(第8周)3.56±0.29与4.35±0.36,(第12周)3.73±0.43与4.86±0.62;组织学评分为:(第12周)2.34±0.22与3.52±0.55.结论 骨髓间充质干细胞关节腔注射治疗可以抑制CIA大鼠的病情发展,有望成为一种新的临床治疗手段.     

Pain on injection of propofol: a comparison of methylene blue and lidocaine

Study Objective

To investigate whether methylene blue, given before injection of propofol, was effective in reducing the frequency and severity of pain associated with propofol injection.

Design

Prospective, randomized, double-blinded clinical study.

Setting

Operating room of a university hospital.

Patients

90 adult, ASA physical status 1 and 2 patients undergoing elective surgery.

Interventions

Patients were randomly allocated to one of three groups of 30 patients each. Group I received 50 mg of methylene blue, Group II received 40 mg of lidocaine, and Group III, the control group, was given normal saline. All drugs were given as a 2.0 mL bolus 45 seconds before propofol administration.

Measurements

Injection pain using vocal responses, facial grimacing, arm withdrawal, tears, and questioning of the patient were noted. A 4-point scale was used for documenting pain.

Main Results

Pain frequency was 90% in the saline group, whereas the frequencies were significantly lower in the lidocaine and methylene blue groups (26.7% and 40%, respectively).

Conclusions

Intravenous pretreatment with methylene blue appears to be effective in reducing the pain during propofol injection.