超声介入无水酒精瘤内注射治疗肝癌48例

目的回顾性总结无水酒精瘤内注射治疗肝癌的疗效。方法对48例肝癌患者共70个结节在超声引导下细针穿刺经皮瘤内注射无水酒精,使瘤体药物浓度极高,致肿瘤细胞及其血管内皮细胞迅速脱水,蛋白凝固,癌细胞变性坏死。肿瘤直径0.9~3.9cm,每个病灶每次注射酒精2~6ml,或每次1~3ml。每周2次共4~6次为1疗程。结果治疗后9个瘤灶消失,36个缩小,25个未增大。直径缩小或不变的肿瘤,影像学上呈囊性化趋向,CT增强扫描动脉期无强化,原血清甲胎蛋白(AFP)值升高者显著下降,经组织学检查的瘤灶证实完全坏死。注射过的瘤灶无局部复发,肝内远膈部位复发14例。治疗副作用仅见短暂的局部烧灼痛、低热、一过性转氨酶轻度升高。结论本疗法最显著的优点是安全性高,是目前治疗肝癌确实有效、安全、微创的方法。     

Maternal transmission of interstitial 8p23.1 deletion detected during prenatal diagnosis

We report on the first prenatally diagnosed interstitial 8p23.1 maternally inherited deletion. At 20 weeks of gestation (WG) the fetus was diagnosed with a complete atrioventricular canal. In infancy, the mother underwent a two‐step cardiac surgery for an interrupted aortic arch type A associated to an inlet ventricular septal defect (VSD). A straddling of the tricuspid valve type B was confirmed during surgery. The outcome showed no cardiac failure or conduction anomalies. However, she presented with moderate intellectual disability. Classical and molecular cytogenetic studies on amniotic and maternal lymphocytes cells showed a nearly identical interstitial deletion of the 8p23.1 region encompassing the GATA4 gene locus (Mother: nt 6,913,337–12,580,828, fetus: nt 7,074,449–12,580,828) with no modification of the telomeric region. The relevance of our report is not only the maternal syndromic interstitial 8p23.1 deletion, but also maternal transmission which has never been reported before. The maternal and fetal phenotypes were not identical, however, even though they had the same cellular and molecular background: an alteration of the epithelial mesenchymal transition of the atrioventricular valvulo‐septal complex where GATA4 plays a positive role in the regulation. We reviewed all cases of interstitial 8p23.1 deletions diagnosed either prenatally or postnatally. © 2012 Wiley Periodicals, Inc.     

Distinct immunohistochemical findings in columnar epithelium of esophageal inlet patch and of Barrett's esophagus

Immunohistochemistry was performed on biopsies of columnar mucosa from 11 patients with Barrett's esophagus and 11 patients with columnar mucosa in the cranial esophagus, the inlet patch. Both epithelia contained endocrine cells, immunoreactive to antisera against serotonin, glucagon, somatostatin, and pancreatic polypeptide; the specialized mucosa of Barrett's esophagus contained, in addition, neurotensin-immunoreactive cells, and in the mucosa of an inlet patch we found a gastrin cell. These findings are not compatible with some of the current theories on the origin of these epithelia. The mucosa of the inlet patch has been considered to consist of heterotopic gastric mucosa. The mucosa of the adult human stomach, however, does not contain glucagon cells. These cells are only present in the early embryonic stomach, and they disappear during embryonogenesis. According to our findings, the mucosa of the inlet patch therefore represents embryonic gastric mucosa. The specialized columnar epithelium of Barrett's esophagus has been considered to have evolved from gastric mucous neck cells. However, although glucagon cells are a feature of the embryonic stomach, neurotensin-immunoreactive cells have not been found in the gastric mucosa. Our study suggests that the specialized columnar epithelium of Barrett's esophagus originates from a very immature multipotent gastrointestinal stem cell.This investigation was supported by a grant of the Deutsche Forschungsgemeinschaft Fe 127/5-7.     

Cervical inlet patch-optical coherence tomography imaging and clinical significance

AIM: To demonstrate the feasibility of optical coherence tomography (OCT) imaging in differentiating cervical inlet patch (CIP) from normal esophagus, Barrett’s esophagus (BE), normal stomach and duodenum.METHODS: This study was conducted at the Veterans Affairs Boston Healthcare System (VABHS). Patients undergoing standard esophagogastroduodenoscopy at VABHS, including one patient with CIP, one representative patient with BE and three representative normal subjects were included. White light video endoscopy was performed and endoscopic 3D-OCT images were obtained in each patient using a prototype OCT system. The OCT imaging probe passes through the working channel of the endoscope to enable simultaneous video endoscopy and 3D-OCT examination of the human gastrointestinal (GI) tract. Standard hematoxylin and eosin (H and E) histology was performed on biopsy or endoscopic mucosal resection specimens in order to compare and validate the 3D-OCT data.RESULTS: CIP was observed from a 68-year old male with gastroesophageal reflux disease. The CIP region appeared as a pink circular lesion in the upper esophagus under white light endoscopy. OCT imaging over the CIP region showed columnar epithelium structure, which clearly contrasted the squamous epithelium structure from adjacent normal esophagus. 3D-OCT images obtained from other representative patients demonstrated distinctive patterns of the normal esophagus, BE, normal stomach, and normal duodenum bulb. Microstructures, such as squamous epithelium, lamina propria, muscularis mucosa, muscularis propria, esophageal glands, Barrett’s glands, gastric mucosa, gastric glands, and intestinal mucosal villi were clearly observed with OCT and matched with H and E histology. These results demonstrated the feasibility of using OCT to evaluate GI tissue morphology in situ and in real-time.CONCLUSION: We demonstrate in situ evaluation of CIP microstructures using 3D-OCT, which may be a useful tool for future diagnosis and follow-up of patients with CIP.     

Atypical post burn oedema presenting with obstruction of veins at the thoracic inlet

A case of atypical oedema of the non-burned area following electrical burns over the back and buttocks causing venous obstruction at the thoracic inlet is reported.     

Double inlet left ventricle–ventriculoarterial discordance without surgical treatment

Univentricular heart is a rare congenital defect that consists, in nearly 80% of cases, of double inlet left ventricle, to which both atrioventricular valves connect. A 31‐year‐old male patient was diagnosed with single ventricle at the age of 9. He had not received any surgical intervention and was not on any medication. Functional capacity was assessed as New York Heart Association class III. Both atrioventricular valves were found to open into the morphological left ventricle, which was located on the right; the hypoplasic right ventricle was on the left side of the left ventricle, the posteriorly located aorta emerged from the right ventricle, and the anteriorly located pulmonary artery emerged from the left ventricle. There was significant subvalvular and valvular stenosis in the pulmonary valve site. The disease is complex and it is very rare that untreated patients reach adulthood.     

Dextrocardia,situs solitus,inlet ventricular septal defect (VSD), and iatrogenic tricuspid regurgitation (TR)―A surgical perspective

Dextrocardia with situs solitus is a rare congenital anomaly, often associated with intra- or extracardiac malformations. A clear understanding of the spatial orientation of the chambers of the heart for planning surgical approach, is imperative. Access to the right side of the heart, especially for repair of the tricuspid valve can be challenging. We describe a case of dextrocardia, situs solitus, inlet ventricular septal defect (VSD) with iatrogenic tricuspid regurgitation (TR) in an adult patient, highlighting the surgical aspects essential for a successful outcome.     

H2O/CO2污染对煤油燃料超声速燃烧影响数值研究

在纯净空气与H₂O/ CO₂污染空气来流对比试验结果基础上,采用数值计算方法和化学动力学方法,研究了H₂O和CO₂污染组分对煤油燃料超声速燃烧的影响,获得了试验手段难以得到的燃烧室流场参数和性能数据。完成了相应的煤油燃料超声速燃烧室二维数值计算,其中匹配了进口总温、总压、马赫数、氧气摩尔分数和工作当量油气比。将数值计算结果与相应试验测量值进行了对比分析,并结合燃烧室流场数据、性能参数分析了H₂O和CO₂污染的动力学影响、以及对燃烧室性能的影响。研究表明:(1)数值计算结果与实验测量值总体上吻合,两种手段均体现了纯净空气来流时不同煤油当量油气比的燃烧室性能,并反映了一致的“污染效应”影响趋势;(2) H₂O污染、H₂O+ CO₂污染的存在降低了煤油燃料超声速燃烧室性能,体现在燃烧诱导压升、燃烧效率、流向冲量增量的下降,而且随着污染组分含量的增加,燃烧室性能下降越加显著。 