Video-assisted thoracoscopic bronchoplasty/pulmonary arterial angioplasty

Thoracoscopic bronchoplasty combined with pulmonary arterial angioplasty can be particularly challenging. In the past, it was often done by using a conventional incision or hybrid video-assisted small incision. In recent years, anecdotal articles have described the application of thoracoscopic bronchoplasty/pulmonary arterial angioplasty. This chapter will describe the details associated with thoracoscopic bronchoplasty/pulmonary arterial angioplasty.     

Patient with inoperable pheochromocytoma

Malignant pheochromocytoma is a tumour with a very low incidence that occurs sporadically or in the presence of multiple endocrine neoplasia. We present the case of a woman with a sporadic occurrence of pheochromocytoma diagnosed in the phase of multiple dissemination in the abdominal cavity and overexpressing adrenaline, noradrenaline, and dopamine. Local transarterial chemoembolization and systemic treatment with lanreotide resulted in a very good response, a decrease in the production of catecholamines for 12 months and a partial decrease for another 8 months, with stabilization of disease determined by imaging.Systemic treatment with tegafur resulted in disease stabilization lasting 50 months, after which the drug was discontinued because of adverse effects. Maintenance therapy with lanreotide continues, and no disease progression has been observed for 4 months.The treatment algorithm for such patients is multidisciplinary and must always take into account the current scope of the disease, intercurrence, and the general condition of the patient.     

超早期超选择性动脉溶栓治疗急性脑梗死的临床疗效

目的探讨超早期超选择性动脉溶栓治疗急性脑梗死临床效果,以期提高临床诊治水平。方法选取2010-01—2015-01 82例急性脑梗死患者为研究对象,分成2组,均经超早期选择性动脉溶栓治疗,观察组41例,超早期(6h)治疗,对照组41例,在6~24h治疗,观察治疗后在相关指标变化。结果对照组显效率34.15%,总有效率78.05%,血管再通率51.22%,出血转化率29.27%;观察组显效率51.22%,总有效率90.24%,血管再通率82.93%,出血转化率9.76%,2组比较差异有统计学意义(P0.05)。2组治疗后较治疗前在血液流变学高切、低切和Fib、ADL均有改善,治疗前后比较差异均有统计学意义(P均0.05),治疗后2组间以上指标差异有统计学意义(P均0.05)。2组治疗前NIHSS评分比较差异无统计学意义(P0.05),治疗后2h、24h、1周、2周较治疗前有改善,治疗后2h、24h、1周、2周比较差异均有统计学意义(P均0.05)。结论超早期超选择性动脉溶栓治疗急性脑梗死临床效果显著,能提高血管再通,降低出血转化。     

In vivo quantification of hyperoxic arterial blood water T1

Normocapnic hyperoxic and hypercapnic hyperoxic gas challenges are increasingly being used in cerebrovascular reactivity (CVR) and calibrated functional MRI experiments. The longitudinal arterial blood water relaxation time (T_1a) change with hyperoxia will influence signal quantification through mechanisms relating to elevated partial pressure of plasma‐dissolved O₂ (pO₂) and increased oxygen bound to hemoglobin in arteries (Y_a) and veins (Y_v). The dependence of T_1a on Y_a and Y_v has been elegantly characterized ex vivo; however, the combined influence of pO₂, Y_a and Y_v on T_1a in vivo under normal ventilation has not been reported. Here, T_1a is calculated during hyperoxia in vivo by a heuristic approach that evaluates T₁‐dependent arterial spin labeling (ASL) signal changes to varying gas stimuli. Healthy volunteers (n = 14; age, 31.5 ± 7.2 years) were scanned using pseudo‐continuous ASL in combination with room air (RA; 21% O₂/79% N₂), hypercapnic normoxic (HN; 5% CO₂/21% O₂/74% N₂) and hypercapnic hyperoxic (HH; 5% CO₂/95% O₂) gas administration. HH T_1a was calculated by requiring that the HN and HH cerebral blood flow (CBF) change be identical. The HH protocol was then repeated in patients (n = 10; age, 61.4 ± 13.3 years) with intracranial stenosis to assess whether an HH T_1a decrease prohibited ASL from being performed in subjects with known delayed blood arrival times. Arterial blood T_1a decreased from 1.65 s at baseline to 1.49 ± 0.07 s during HH. In patients, CBF values in the affected flow territory for the HH condition were increased relative to baseline CBF values and were within the physiological range (RA CBF = 36.6 ± 8.2 mL/100 g/min; HH CBF = 45.2 ± 13.9 mL/100 g/min). It can be concluded that hyperoxic (95% O₂) 3‐T arterial blood T_1aHH = 1.49 ± 0.07 s relative to a normoxic T_1a of 1.65 s. Copyright © 2015 John Wiley & Sons, Ltd.     

联合应用mTI-ASL和IVIM技术在鉴别高级别胶质瘤术后复发与假性进展中的应用价值

目的: 探讨应用多反转时间动脉自旋标记(multiple inversion time-pulsed arterial spin labeling,mTI-ASL)和体素内不相干运动(intravoxel incoherent motion,IVIM)技术在脑胶质瘤术后复发与假性进展中的鉴别价值。方法: 选择2018年01月至2020年01月就诊于我院高级别胶质瘤术后放化疗后首次复查常规MR增强扫描出现异常强化的患者,行mTI-ASL及IVIM序列扫描,将获取图像数据资料进行相关后处理分析,分别手动勾画感兴趣区,测量术后异常强化区各项定量参数,即真性扩散系数(true diffusion coefficient,D)、假性扩散系数(pseudo-diffusion coefficient,D*)及灌注分数(perfusion fraction,f)、脑血流量(cerebral blood flow,CBF)和动脉通过时间(arterial transit time,ATT)。分别采用独立样本t检验比较两组感兴趣区相关参数值,从而评估mTI-ASL和IVIM技术在两者鉴别诊断中的价值。结果: (1)脑胶质瘤术后复发组CBF值(6.413±0.438)、ATT值(0.198±0.033),比假性进展组CBF值(4.654±0.372)、ATT值(0.165±0.208)高,两者比较具有统计学意义(P＜0.01)。(2)脑胶质瘤术后复发组D值(1.118±0.178),比假性进展组D值(1.380±0.236)低,两者比较具有统计学意义(P＜0.01)。(3)脑胶质瘤术后复发组D*值(17.126±4.274)、f值(0.269±0.095),比假性进展组D*值(12.755±3.974)、f值(0.169±0.052)高,两者比较具有统计学意义(P＜0.01)。结论:应用 mTI-ASL和IVIM技术有助于脑胶质瘤术后复发与假性进展的鉴别诊断。     

CalliSpheres载药微球TACE联合微波消融治疗原发性大肝癌疗效评价

目的探讨CalliSpheres载药微球经导管肝动脉化疗栓塞术(TACE)联合微波消融治疗原发性大肝癌的临床疗效。方法23例直径5~10cm原发性肝癌患者施行了CalliSpheres载药微球TACE联合微波消融治疗。术后1、3、6、9、12个月及以后每3个月采用肝脏增强MRI随访。结果23例患者共行33次CalliSpheres载药微球TACE联合微波消融治疗,无肝脓肿、胆脂瘤等并发症发生。23例患者随访3~22(平均9.2±3.9)个月,术后1、3、6、9、12和15个月客观缓解率分别为86.9%、87%、93.8%、77.0%、63.6%、57.2%,疾病控制率分别为100.0%、95.7%、93.8%、92.3%、81.8%、85.7%。术后3、6、9、12和15个月生存率分别为100%、93.8%、84.6%、81.8%、71.4%。结论CalliSpheres载药微球TACE联合微波消融治疗原发性大肝癌安全可靠,近中期疗效较好。