β受体阻滞剂治疗婴幼儿血管瘤的研究进展

婴幼儿血管瘤（IH）是婴幼儿期最常见的良性肿瘤,大部分病变可自然消退,多以随访观察为主,但对可引起严重并发症或功能障碍的中、高风险IH仍主张尽早干预及治疗。普萘洛尔为非选择性β受体阻滞剂,自2008年开始应用于IH治疗后经大量临床实验及系列研究疗效得到验证,目前已成为IH治疗的一线药物。随着人们对IH认识的进一步深入及普萘洛尔相关治疗机制的探索,近年来其他β受体阻滞剂类药物治疗IH的报道逐渐增多,其在IH的应用范围逐渐扩大,药物选择相应增多。本文简要综述目前β受体阻滞剂应用于IH治疗的相关进展,进一步探究其疗效及安全性,为IH临床治疗提供更多选择及参考依据。     

溃疡分枝杆菌皮肤溃疡的临床病理观察

溃疡分枝杆菌皮肤溃疡（Buruli溃疡）由溃疡分枝杆菌引起,是皮肤除结核病及麻风病以外抗酸染色阳性的最常见的分枝杆菌感染性疾病。Buruli溃疡是一种危害公共卫生健康的疾病,现我们报道在东莞市发现的10例Buruli溃疡,并结合文献对其临床病理特点进行讨论。[第一段]     

上皮样血管瘤七例临床病理观察

目的 探讨上皮样血管瘤的临床病理学特征、诊断及鉴别诊断.方法 对7例分别发生于皮肤、骨及静脉的上皮样血管瘤进行临床病理学分析.结果 男性4例,女性3例,年龄14～54岁(平均34岁).其中发生于皮肤和皮下者3例,骨2例,静脉血管2例.临床表现:发生于皮肤者为暗红色丘疹或结节,质软或韧,部分伴瘙痒,病程长者可相互融合;发生于骨者表现为溶骨性破坏,境界清楚;发生于静脉内者,表现为软组织内境界清楚的灰白灰红质韧结节.组织学上,病变以增生的小血管伴内皮细胞上皮样改变为特征,多数病例血管有明确的腔隙形成,部分病例局部可见内皮细胞实性片状生长,并见胞质空泡化,提示原始管腔形成.间质可伴有多少不等的炎性细胞浸润,以嗜酸性粒细胞、淋巴细胞和浆细胞为主.免疫组织化学上均表达血管内皮标志物CD31、CD34,上皮标志物细胞角蛋白阴性.6例患者获得随访结果,随访时间为5个月至3年,均未见发生复发及转移.结论上皮样血管瘤是一种罕见的可以发生于皮肤、软组织及骨的肿瘤/病变,可单发或多发,是良性的、可成功治愈的.其形态学谱系广泛,易与木村病、上皮样血管内皮瘤等混淆.     

32P敷贴联合普萘洛尔治疗儿童大面积皮肤毛细血管瘤

目的 探讨32P敷贴联合普萘洛尔治疗儿童大面积皮肤毛细血管瘤的临床疗效.方法 将45例大面积毛细血管瘤患儿分为两组,进行前瞻性研究.对照组20例,其中≤3岁儿童草莓状血管瘤10例、＞3岁儿童鲜红斑痣10例,接受常规32P敷贴治疗.观察组25例,其中≤3岁儿童草莓状血管瘤10例、＞3岁儿童鲜红斑痣15例,接受32P敷贴联合普萘洛尔治疗.对比两组不同类型血管瘤、≤3岁儿童与＞3岁儿童的治疗效果及不良反应.统计计数资料采用x2检验和零反应检验,以P ＜0.05为差异有统计学意义.结果 对照组与观察组总有效率分别为80.0％与88.0％(P＞0.05);两治疗组中≤3岁儿童血管瘤有效率分别为90.0％与100.0％(尸＞0.05);但两治疗组中＞3岁儿童鲜红斑痣有效率分别为40.0％与80.0％,差异有统计学意义(P＜0.05).对照组单用32P敷贴在≤3岁儿童与＞3岁儿童有效率分别为90.0％与40.0％,差异有统计学意义(P＜0.05),观察组用32P敷贴联合普萘洛尔在≤3岁儿童与＞3岁儿童有效率分别为100.0％与80.0％,差异无统计学意义(P＞0.05).两组发生湿性皮炎分别为25.0％与40.0％,发生色素脱失分别为75.0％与84.0％,差异均无统计学意义(P＞0.05);发生心率减慢在≤3岁儿童与＞3岁儿童分别为50.0％与40.0％,差异无统计学意义(P＞0.05).结论 32P敷贴联合普萘洛尔治疗难治性大面积血管瘤,治疗方法简单、安全,疗效较好.但要密切注意32P、普萘洛尔两者不良反应的发生及处理.     

婴儿性血管瘤24例临床病理分析

目的探讨婴儿性血管瘤的临床病理、免疫组化特征以及鉴别诊断。方法采用HE及免疫组化技术对24例婴儿性血管瘤进行观察,并结合文献复习。结果17例呈增殖期图像：细胞丰富,增生的毛细血管排列成小叶状,血管内皮细胞肥胖,管腔不明显,内皮细胞周围为梭形的血管周细胞;7例呈消退期图像：皮下组织中纤维脂肪组织增生,血管减少,残留血管腔扩张,内皮细胞扁平,血管周细胞减少。血管内皮细胞GLUT1阳性,血管周细胞SMA阳性。结论婴儿性血管瘤是儿童期最常见的良性肿瘤,在年龄、性别、发病部位及病程上具有明显特点,组织学特点是肿瘤由血管内皮细胞及血管周细胞组成,内皮细胞特异性表达GLUT1。     

90Sr敷贴治疗358例皮肤血管瘤患儿疗效观察

毛细血管瘤是先天性血管病,是婴幼儿的常见良性肿瘤类疾病。起源于中胚叶,一般在出生或出生后不久出现,随着患儿的生长发育而增大。男女比例为1．2：1,新生儿发病率高。治疗方法很多,如局部注射硬化剂、激素、冷冻、激光及锶-90敷贴治疗。而锶-90敷贴治疗由于疗效显著,无痛苦,简便安全等优点而受患儿和家长欢迎。本科应用锶-90敷贴治疗358例皮肤血管瘤患儿,效果良好,报告如下：     

类固醇皮质激素局部注射治疗婴幼儿血管瘤疗效观察

血管瘤在婴幼儿中较常见。我院自1987年1月～1992年1月间应用类固醇皮质激素混合液局部注射治疗门诊41例婴幼儿血管瘤;有效率87.8%,治愈率为51.2%。注射后血管瘤消退快,无复发、感染及药物副作用。     

马来酸噻吗洛尔联合冷冻治疗婴幼儿皮肤血管瘤的临床研究

目的 探究马来酸噻吗洛尔联合冷冻治疗婴幼儿皮肤血管瘤的临床效果。方法 将240例皮肤血管瘤患儿随机分为对照组（120例）和联合组（120例）,其中对照组患儿给予马来酸噻吗洛尔治疗,联合组患儿给予马来酸噻吗洛尔联合冷冻治疗。比较2组患儿临床疗效、瘤体直径、血清基质金属蛋白酶-9(MMP-9)水平、血管内皮生长因子（VEGF）水平及不良反应发生情况。结果 联合组患儿治疗总有效率明显高于对照组（P<0.05）。与治疗前比较,治疗后3个月、治疗后6个月2组患儿瘤体直径均逐渐减小（P<0.05）,且联合组患儿治疗后3个月、治疗后6个月瘤体直径减小更明显（P<0.05）。与治疗前比较,治疗后3个月、治疗后6个月2组患儿血清MMP-9及VEGF水平均逐渐降低（P<0.05）,且联合组患儿治疗后3个月、6个月MMP-9及VEGF水平均明显低于对照组（P<0.05）。2组患儿湿疹、溃疡、糜烂及红肿等不良反应总发生率比较,差异无统计学意义（P>0.05）。结论 马来酸噻吗洛尔联合冷冻治疗婴幼儿皮肤血管瘤疗效显著,可有效降低血清MMP-9、VEGF水平,缩小瘤体,安全有效...     

伴皮肤溃疡的III期乳腺癌18例手术治疗体会

乳腺癌是严重威胁女性健康的恶性肿瘤之一。临床以乳腺肿块为主要表现,伴局部侵润,皮肤改变,远处转移。伴皮肤溃疡的乳腺癌属局部晚期乳腺癌,肿瘤破溃,有恶臭,经久不愈,严重影响患者的生活及生存质量。我院自2000年1月~2005年6月共收治伴皮肤溃疡的III期乳腺癌患者18例,均行乳腺癌改良根治术。现报道如下。1资料与方法1.1临床资料本组18例患者均为女性,年龄55~68岁,平均年龄58.6岁。原发灶均局限于乳房一个象限,直径3.0~4.8 cm,高出正常皮肤表面1.5~2.5 cm。肿瘤穿破皮肤,表面溃烂,有恶臭,仍可推动,无胸壁固定。乳头、乳晕均有不同程度受…     

Gastrectomy for the treatment of refractory gastric ulceration after radioembolization with 90Y microspheres

Transcatheter arterial radioembolization (TARE) with Yttrium-90 (⁹⁰Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.     

敲减FGFR1基因表达对婴幼儿血管瘤内皮细胞生物学特性的影响

目的:研究敲减成纤维细胞生长因子受体1(FGFR1)基因的表达对婴幼儿血管瘤内皮细胞(HemECs)活力、凋亡、侵袭和迁移的影响。方法:经转染FGFR1小干扰RNA(si-FGFR1)下调FGFR1表达,研究FGFR1对HemECs生物学特性的影响,以CCK-8法检测细胞活力的变化,流式细胞术检测细胞的凋亡水平, Transwell实验检测细胞侵袭和迁移能力的改变;Western blot法检测磷脂酰肌醇3-激酶(PI3K)、蛋白激酶B(AKT)和磷酸化AKT(p-AKT)的蛋白水平。结果:转染si-FGFR1进入HemECs能够显著抑制细胞的活力(P0.05),促进其凋亡(P0.05),降低细胞的侵袭和迁移能力(P0.05);Western blot结果显示,下调细胞中FGFR1基因的表达可降低PI3K和p-AKT的蛋白水平(P0.05),但对AKT蛋白水平无显著影响。结论:敲减HemECs细胞内FGFR1的表达可通过影响PI3K/AKT信号通路调节婴幼儿血管瘤内皮细胞的生物学特性。     

The comparison of esophageal variceal ligation plus propranolol versus propranolol alone for the primary prophylaxis of esophageal variceal bleeding

Background/Aims

To investigate the efficacy and longterm outcome of esophageal variceal ligation (EVL) plus propranolol in comparison with propranolol alone for the primary prophylaxis of esophageal variceal bleeding.

Methods

A total of 504 patients were retrospectively enrolled in this study. 330 patients were in propranolol group (Gr1) and 174 patients were in EVL plus propranolol group (Gr2). The endpoints of this study were esophageal variceal bleeding and mortality. Association analyses were performed to evaluate bleeding and mortality between Gr1 and Gr2.

Results

EVL was more applied in patients with high risk, such as large-sized varices (F2 or F3) or positive red color signs. Total 38 patients had bleeds, 32 in Gr1 and 6 in Gr2. The cumulative probability of bleeding at 120 months was 13% in Gr1 versus 4% in Gr2 (P=0.04). The predictive factors of variceal bleeding were red color signs (OR 2.962, P=0.007) and the method of propranolol plus EVL (OR 0.160, P=0.000). 20 patients died in Gr1 and 12 in Gr2. Mortality rates are similar in the two groups compared, 6.7% in Gr1 and 6.9% in Gr2. The cumulative probability of mortality at 120 months was not significantly different in the two groups (7% in Gr1, 12% in Gr2, P=0.798). The prognostic factors for mortality were age over 50 (OR 5.496, P=0.002), Child-Pugh class B (OR 3.979, P=0.001), and Child-Pugh class C (OR 10.861, P=0.000).

Conclusions

EVL plus propranolol is more effective than propranolol alone in the prevention of the first variceal bleeding in patients with liver cirrhosis.     

Clinical trial of allogeneic cultured dermal substitutes for intractable skin ulcers of the lower leg

The efficacy of allogeneic cultured dermal substitute (CDS) on wound healing was evaluated in six patients with intractable skin ulcers on the lower extremities. Allogeneic CDS was repeatedly applied to wounds at intervals of 4-7 days to prepare a wound bed acceptable for skin grafting or to induce resurfacing through the granulation tissue formation associated with epithelialization. In one patient with a leg ulcer, the wound size decreased to 32% of the original size within 10 weeks and skin grafting was conducted. In the other five patients with leg, ankle, or foot ulcers, the wound size decreased to 9%-25% of the original size within 6 weeks.     

Ruptured hemangioma of the umbilical cord and intrauterine fetal death, with review data

A case of intrauterine fetal death with rupture of a hemangioma in the umbilical cord is presented. Hemangiomas are uncommon tumors of the umbilical cord, and their clinical significance is not entirely clear, but associations with polyhydramnios, fetal disseminated intravascular coagulation, and fetal hydrops have been described. In a high proportion of the umbilical cord hemangiomas reported in the literature (32 cases), the fetus had died in utero as in the present case and only ten cases were vital and completely normal infants. Associated malformations and complications of the umbilical cord hemangioma are reviewed.     

雷贝拉唑三联法治疗幽门螺旋杆菌阳性消化性溃疡的临床疗效观察

目的观察雷贝拉唑、克拉霉素及阿莫西林三联法治疗幽门螺旋杆菌阳性消化性溃疡的临床效果。方法将150例消化性溃疡患者随机分成治疗组和对照组,治疗组75例接受雷贝拉唑三联法,对照组75例接受奥美拉唑、克拉霉素及阿莫西林三联法;用药均为7 d,疗程结束4周及半年后复查内镜及快速尿素酶实验检查,观察幽门螺旋杆菌根除率、溃疡治愈率和复发率。结果经过治疗后两组幽门螺旋杆菌根除率分别为84.0%和81.3%,差异无统计学意义（P〉0.05）;总有效率分别为94.7%和81.3%,复发率分别为为7.7%和16.1%,差异有统计学意义（P〈0.05）。结论采用雷贝拉唑三联法和传统的奥美拉唑三联疗法治疗Hp阳性消化性溃疡均能快速缓解临床症状,但雷贝拉唑三联疗法疗效更显著,幽门螺旋杆菌根除率、溃疡治愈率更高,而复发率较低。