Primary synovial sarcoma of the left heart with large amount of necrotic tissue

We present a case of primary synovial sarcoma arising from the left heart, an extremely rare occurrence, with a large amount of necrotic tissue, which suggested a poor prognosis. After incomplete tumor resection, chemotherapy and radiation therapy were performed; however, PET/CT findings at 26 months after the operation revealed local recurrence. Although we performed two additional operations following chemotherapy, the patient died from local recurrence at 36 months after the initial operation. In this case of synovial sarcoma arising from the left heart, even though aggressive multimodality therapy was performed, the prognosis was still poor.     

Intracellular cytokines in cells of necrotic tissue from patients with acute pancreatitis.

OBJECTIVE: To determine the alterations in intracellular cytokine responses in necrotic pancreatic tissue obtained on debridement from patients with acute pancreatitis. DESIGN: Laboratory study. SETTING: Teaching hospital, India. MATERIAL: Necrotic tissue obtained at necrosectomy from 34 patients with alcohol-induced or biliary pancreatitis (n = 17 in each) and at autopsy from 12 controls. INTERVENTIONS: Histopathological evaluation; measurement of intracellular content of the cytokines interleukin (IL)-2, IL-4, IL-10 and IFN-gamma in CD4+ and CD8+ T lymphocytes and IL-6 and IL-12 in CD14+ monocytes. MAIN OUTCOME MEASURES: Intracellular content of the measured cytokines. RESULTS: CD4+ and CD8+ T cells and CD14+ monocytes responded to in vitro stimulation of mitogens and synthesised cytokines to varying degrees in the three groups. The heterogeneous cytokine response pattern did not show a typical type 1/type 2 polarised model. CONCLUSIONS: This profile suggests that the cells retain the capacity to modulate their phenotype in response to local conditions at the effector site. These results could be taken into consideration when designing new and specific treatments for modifying the immune inflammatory response.     

Removal of the subchondral plate in acetabular preparation

Retention of the subchondral plate during acetabular preparation in total hip replacement is believed to be an important part of modern cementing techniques. We have constructed a two-dimensional finite element analysis to assess the effect of retention and removal of this relatively stiff structure. The finite element analysis demonstrates increased stiffness and stress concentrations at the bone-cement interface that may have an adverse effect. Although further study is required, it may be that subchondral bone retention is not advantageous.

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Résumé   On crois que la conservation de l’os subchondral au cours de la préparation acetabulaire pour le rémplacement-total de l’hanche est importante en les techniques modernes de ciment. Nous avon construit une analyse ”finite element” a deux dimensions pour évaluer l’effet de la conservation ou de l’enlèvement de cette structure raide. L’analyse ”finite element” démontrer l’intensification de concentration de la raideur et de la pression à l’interface de l’os-ciment qui peut produire un effet hostile. Bien que les études supplementaires sont necessaires, c’est possible que la conservation de l’os subchondral n’est pas adavantageux.

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Accepted: 11 January 2000     

胆道镜联合肾镜辅助经皮窦道清除重症急性胰腺炎胰周坏死组织

目的 介绍经皮窦道胆道镜联合肾镜辅助下清创、引流治疗重症急性胰腺炎胰周坏死组织的方法及优势。方法 回顾性分析2013年1月至2017年12月在湖州市第一人民医院接受经皮穿刺胆道镜联合肾镜辅助下清创、引流治疗的15例重症急性胰腺炎合并胰腺周围组织坏死及渗出的患者临床资料。置8 F引流导管引流1周后,用扩张器扩张窦道至26 F。用胆道镜联合肾镜经窦道对胰周坏死组织进行反复多次清创,直到感染组织通过引流彻底清除。结果 15例患者各接受胆道镜治疗1～4次,人均2.3次,单次清创引流的操作时间为24～45 min,平均（33.6±5.5）min。15例患者均好转出院,平均住院时间（45.5±5.0）d,1例（6.7%）因脓肿复发行腹腔镜下假性囊肿-空肠内引流术,其余均未出现清除手术并发症。结论 胆道镜联合肾镜清除重症急性胰腺炎胰周坏死组织可在局麻下操作,减少全麻及气腹的影响;该法简单易行,直视下操作,可避免出血及脏器损伤的发生,安全可靠;该法兼具清除坏死组织、冲洗、引流 的作用,并可多次清创,效率高、效果好。     

A review on the nonoperative removal of necrotic tissue from burn wounds

The study of nonoperative debridement of burns got underway during the Second World War. A large number of substances such as enzymes of plant origin, acids and proteolytic enzymes of bacterial origin were examined since. The proteolytic enzymes derived from filtrates of C. histolyticum and B. subtilis have attracted the greatest interest. Although enzymatic debridement would seem at first sight to be an attractive form of treatment, unfortunately the results are highly variable.     

感染性胰腺坏死精准化坏死组织清除术的现状与思考

感染性胰腺坏死是重症急性胰腺炎病程晚期发生的一种死亡风险极高的疾病状态,针对其治疗一直是十分棘手的问题,且其治疗方式及时机仍存争议。近年来,随着微创技术的不断发展,多种微创方式的精准化坏死组织清除术成为学界倡导的主流,更加强调个体化、精准化、多学科的治疗模式,有效地控制了患者的局部及全身感染症状,并降低了其病死率,改善了患者预后。本文总结近年文献报道的关于坏死组织清除术在感染性胰腺坏死中的应用进展,为其精准化和个体化治疗提供参考。     

Effect of cerulloplasmin on natural factors of defense in patients with an acute necrotic pancreatitis

In 81.25% patients with an acute necrotic pancreatitis and in 50% of healthy persons the blood neutrophils are sensitive to cerulloplasmin in metabolic activity. In 62.5% of patients the phagocytic index have had reduced in addition of cerulloplasmin. Phagocytic number in addition of cerulloplasmin have constituted over 1,5 conditional units, in 75% of patients, without such addition - in 84%. The conclusion was made about necessity of individual selection of immunomodulators in patients with an acute necrotic pancreatitis.     

经腹膜后入路胰腺坏死组织清除引流术治疗胰腺坏死感染

目的:探讨胰腺坏死并感染采用经腹膜后入路胰腺坏死组织清除引流术治疗的临床效果与安全性。方法:选择2013—2015年采取经腹膜后入路胰腺坏死组织清除引流术治疗的44例胰腺坏死并感染患者为观察组、既往采用经腹部切口入路清除坏死组织后持续闭合冲洗治疗56例胰腺坏死并感染患者为对照组,对比两组患者的手术效果。结果:两组术前一般资料及各项实验室指标差异均无统计学意义(均P0.05)。治疗后,观察组的血淀粉酶、尿淀粉酶、血糖、降钙素原、肿瘤坏死因子α、白细胞介素8值均明显低于对照组患者(均P0.05);观察组患者的手术时间、住院时间均明显短于对照组(均P0.05),两组患者的再次手术率、死亡或放弃治疗率无统计学差异(均P0.05);观察组有效率高于对照组(75.0%vs.58.9%)、手术并发症发生率低于对照组(15.9%vs.33.9%),但均无统计学差异(均P0.05)。结论:胰腺坏死并感染采用经腹膜后入路胰腺坏死组织清除引流术效果可靠,且较开腹手术恢复快、创伤小。     

Applying negative pressure therapy to deep pressure ulcers covered by soft necrotic tissue

Negative pressure therapy was applied to 39 deep pressure ulcers covered by soft necrotic tissue. All of the wounds were so deep that there were bones or ligaments just beneath the soft necrotic tissue. They had already received several types of conservative therapy including a necrotomy for periods ranging from 1 to 72 months. The wounds were minimally debrided and put in an adequately wet environment with negative pressure. This environment was established by the application of a suction‐dressing. All of these wounds showed clear wound beds within only 1 month. All of the wounds were successfully cured, either with or without a musculocutaneous flap. Negative pressure wound therapy is thus considered to be one of the choices for the management of non healing deep pressure ulcers covered by soft necrotic tissue.     

应用皮肤软组织扩张术修复坏死性筋膜炎后遗瘢痕

坏死性筋膜炎是一种少见的严重软组织感染,常后遗瘢痕,好发于腰骶部,应用传统的瘢痕切除全厚植皮方法修复效果不佳。自１９８７年我科应用皮肤软组织扩张术修复坏死性筋膜炎后遗腰骶部瘢痕６例,其中１例采用术中即时扩张术,余５例采用常规扩张术,整复效果满意。此方法具有一次可修复较大面积;与周围皮肤色泽,质地相似,外观佳;耐磨、耐压、不牺牲供区等优点。本文就其手术方法及其优缺点进行了讨论。     

Pathogenesis and treatment of hemocoagulation disorders in an acute necrotic pancreatitis

Results of investigation of content of activated protein C, Intercellular Adhesion Molecule -1 (ICAM-1) and interleukin (IL)--18 in the patients with an acute pancreatitis were presented. At the hospital attendance the concentration of IL-18, ICAM-1 increase and the activated protein C level lowering were noted. The strict immediate correlation connection between serum blood level of IL-18, ICAM-1 and hematocrit and the reverse one--between these mediators concentration and the activated protein C content--were noted during all period of observation.     

Antibacterial therapy of patients with inflammatory necrotic pancreatitis

The infectionized necrotic pancreatitis (NP) course, complicated by localized and diffusive peritonitis, abscess and retroperitoneal phlegmon in 86 patients, was analyzed. Severity of state of patients according to the APACHE II scale was estimated. Recommendations for application of empirical and purposeful antibacterial therapy was elaborated. Total mortality for infectionized NP with complicated course was 25.5%.     

Intensive therapy of patients with infected necrotic pancreatitis

In 70 patients the course of infected forms of necrotic pancreatitis was analyzed. Severity degree of the patients conditions was estimated according to APACHE II scale. Practical recommendations about management of such patients were elaborated.