脊髓血管畸形的DSA分析及血管内栓塞治疗

目的：评价血管造影对脊髓血管畸形的诊断及栓塞治疗价值。方法：16例脊髓血管畸形病人做了选择性脊髓血管造影检查，确诊后进行血管内栓塞治疗。结果：根据DSA显示的异常血管的部位、形态、分布和供血动脉及引流静脉情况将其分为三型：髓内动静脉畸形4例；髓周动静脉瘘4例；硬脊膜动静脉瘘8例。栓塞治疗后，13例获得较满意效果，2例无变化。在2个月至3年的随访期间，13例临床症状有改善。结论：脊髓血管造影是诊断脊髓血管畸形的可靠依据，可清晰显示畸形血管及供血动脉和引流静脉。栓塞治疗是一种创伤小、并发症少的方法。     

头颈部静脉畸形的经皮硬化治疗

目的 探讨经皮穿刺酒精硬化技术在头颈部静脉畸形治疗中的安全性和价值。方法 9例头颈部静脉畸形患者，均采用经皮穿刺酒精硬化治疗。结果 9例患者共接受治疗16次，初次治疗的技术成功率为100％。7例患者术后症状明显改善，随访2～12个月，未见病变复发。结论 经皮穿刺酒精硬化技术是治疗头颈部静脉畸形的有效方法。     

Implementing Routine Palliative Care Consultation Before LVAD Implantation: A Single Center Experience

Context

Left ventricular assist devices (LVADs) are increasingly used to improve quality of life for end-stage heart failure patients. The Joint Commission now requires preimplantation palliative care assessment; however, many palliative care teams have little experience providing this service.

Fetal MRI: Head and Neck

Abnormalities of the fetal head and neck may be seen in isolation or in association with central nervous system abnormalities, chromosomal abnormalities, and syndromes. Magnetic resonance imaging (MRI) plays an important role in detecting associated abnormalities of the brain as well as in evaluating for airway obstruction that may impact prenatal management and delivery planning. This article provides an overview of the common indications for MRI of the fetal head and neck, including abnormalities of the fetal skull and face, masses of the face and neck, and fetal goiter.     

腹腔镜下经肛提肌外腹会阴联合直肠癌切除术的单中心经验

  目的  探索腹腔镜下完成经肛提肌外腹会阴联合直肠癌切除(extralevator abdominoperineal excision, ELAPE)手术的可行性。  方法  回顾性分析本院2012年6月至2013年8月实施的12例腹腔镜下ELAPE手术的围手术期特点, 手术过程中侧方完全切除肛提肌组, 后方切除其在尾骨的附着点, 前方根据肿瘤分期和位置决定是否行周围脏器的扩大切除。术中不更换体位, 会阴切口缝合皮下和皮肤, 缝闭盆底腹膜。从手术时间、术中出血、淋巴结获取数目、术后并发症等方面判断手术的可行性。  结果  患者平均年龄(65.2±12.5)岁, 体重指数21.6±3.1;肿瘤下缘距肛缘(3.3±0.7)cm; 手术时间(176.1±27.5)min, 术中出血(49.6±38.2)ml; 淋巴结获取数目(18.3±7.8)枚, 所有肠管断端及侧切缘均阴性; 2例发生尿潴留, 9例患者会阴切口达到甲级愈合。  结论  据手术短期效果, 术中不更换体位, 根据个体情况选择性行周围脏器的扩大切除, 在腹腔镜下完成ELAPE手术是可行的。     

Sacral Neuromodulation for the Treatment of Chronic Functional Anorectal Pain: A Single Center Experience

Introduction:   Treatment of functional anorectal pain disorders remains a challenge. The purpose of this study is to describe a single center experience with sacral neuromodulation for the treatment of chronic functional anorectal pain.
Methods:   This is a retrospective study based on prospectively collected data of patients treated with sacral neuromodulation for functional anorectal pain from April 2005 to August 2008. Symptoms were analyzed using a visual analog scale pain score (0 to 10). A 7-point Likert scale was used to rate global perceived effect. All patients had a percutaneous nerve evaluation and subsequent test stimulation to assess sacral neuromodulation outcome prior to permanent implantation. Patients were eligible for permanent sacral neuromodulation in case of a pain score <3 during test stimulation and/or >50% decrease in the pain score compared to baseline.
Results:   Nine patients (2 males) were included in this study. Mean age was 53.8 years (27.6 to 74.0). Four patients (1 male) had successful test stimulation and were eligible for permanent implantation. Median pain score decreased from 8.0 (6.0 to 9.0) to 1.0 (0 to 2.0). All patients experienced a lasting improvement during the follow-up till 24 months. Global perceived effect in successful patient was 1 (completely recovered) in one patient and 2 (much improved) in three patients.
Conclusion:   This study showed that sacral neuromodulation can be a successful treatment for functional anorectal pain not responding to other treatments. Improvement obtained during test stimulation is a good predictor (diagnostic) for sustained success of permanent sacral neuromodulation.     

Adjuvant Ozonetherapy in Advanced Head and Neck Tumors: A Comparative Study

Advanced head and neck (H&N) tumors have a poor prognosis,and this is worsened by the occurrence of hypoxia and ischemiain the tumors. Ozonetherapy has proved useful in the treatmentof ischemic syndromes, and several studies have described apotential increase of oxygenation in tissues and tumors. Theaim of this prospective study was to evaluate the clinical effectof ozonetherapy in patients with advanced H&N cancer inthe course of their scheduled radiotherapy. Over a period of3 years, 19 patients with advanced H&N tumors who were undergoingtreatment in our department with non-standard fractionated radiotherapyplus oral tegafur. A group of 12 patients was additionally treatedwith intravenous chemotherapy before and/or during radiotherapy.In the other group of seven patients, systemic ozonetherapywas administered twice weekly during radiotherapy. The ozonetherapygroup was older (64 versus 54 years old, P = 0.006), with ahigher percentage of lymph node involvement (71% versus 8%,P = 0.019) and with a trend to more unfavorable tumor stage(57% versus 8% IVb + IVc stages, P = 0.073). However, therewas no significant difference in overall survival between thechemotherapy (median 6 months) and ozonetherapy (8 months) groups.Although these results have to be viewed with caution becauseof the limited number of patients, they suggest that ozonetherapycould have had some positive effect during the treatment ofour patients with advanced H&N tumors. The adjuvant administrationof ozonetherapy during the chemo–radiotherapy for thesetumors merits further research.     

头颈部副神经节瘤的遗传学研究进展

头颈部副神经节瘤(head and neck paraganglioma,HNPGL)是一种少见的神经源性肿瘤,遗传因素在其发病过程中起一定作用。到目前为止,发现与HNPGL发病相关的基因共10个,包括SDHA、SDHB、SDHC、SDHD、SDHAF2、VHL、HIF2A、RET、NF1和TMEM127,其中SDHB、SDHC、SDHD、SDHAF2和VHL是常见致病基因。不同基因突变的临床表型不尽相同,SDHD、SDHC和SDHAF2突变几乎100%表现为HNPGL,SDHD和SDHAF2突变倾向于形成多发性副神经节瘤,且遗传方式具有明显母亲印记; 而SDHB突变有交感性副神经节瘤及恶变倾向。明确副神经节瘤的分子机制及基因型-表型之间的关系,可为HNPGL患者的遗传咨询、诊治和随访策略制订等提供帮助。