膀胱癌P_（53）过度表达的临床意义

通过免疫组化ＡＢＣ法，对５０例手术切除或活检的膀胱癌标本石蜡切片进行Ｐ_（５３）基因表达的研究。结果表明：膀胱Ｐ_（５３）蛋白过度表达率为４２％（２１／５０），其中ＰＴ_２４０％（１２／３０），ＰＴ_３８２％（９／１１），ＰＴ_ａ，ＰＴ_１为０；Ｇ_２３２％（８／２５），Ｇ_３７２％（１３／１７），Ｇ_１为０。随访２５例患者，１３例Ｐ_（５３）阳性过度表达，其中有７６％（１０／１３）有复发转移，而单纯复发者只占２３％（３／１３）。１３例Ｐ_（５３）阳性表达者平均存活时间２２．６个月／例，１２例Ｐ_（５３）阴性表达者平均存活６３．７个月／例。Ｐ＜０．０１。     

外科危重患者的预后评估

为准确评估外科危重患者的预后，作者对外科３８６例危重患者进行了前瞻性研究，疾病的危重程度评价采用ＡＰＡＣＨＥⅡ评分系统。结果显示：ＡＰＡＣＨＥⅡ评分均值为１５．６±５．８（０～３８）；死亡患者（１０７例，占２７．７％）的ＡＰＡＣＨＥⅡ评分明显高于存活患者（２７９例，占７２．３％）的评分，差异有显著意义（１８．７±４．３ｖｓ。９．７±３．９，Ｐ＜０．０１）。随着ＡＰＡＣＨＥⅡ评分增高，死亡率从１．９％逐渐升高至１００％，两者之间垦显著相关（ｒ＝０．７５，Ｐ＜０．００１）。受试者工作特征曲线显示，随着危险度和ＡＰＡＣＨＥⅡ评分的增加，特异度从８９．２％增至９９．３％，而敏感度却从５９．８％下降至１８．７％。作者认为人ＰＡＣＨＥⅡ评分系统是评估外科危重患者预后的良好指标，值得临床上推广应用。     

臂丛根性损伤两种神经电图—肌电图检测方法的诊断符合率

目的比较两种神经电图－肌电图检测方法对臂丛根性损伤的诊断符合率。方法１９９７年前，对８２例臂丛根性损伤用上肢五大神经代表肌肉及肩胛带肌群肌电图（ＥＭＧ）、复合肌肉动作电位（ＣＭＡＰ）、运动神经传导速度（ＭＮＣＶ）、感觉神经诱发电位和传导速度（ＳＮＡＰ、ＳＮＣＶ）及体感诱发电位（ＳＥＰ）进行分析诊断。１９９７年起，对１１８例臂丛根性损伤加测颈椎旁肌ＥＭＧ、双侧膈肌的ＣＭＡＰ和斜方肌的ＥＭＧ、ＣＭＡＰ进行诊断。结果１９９７年至今，臂丛根性损伤神经电图－肌电图的诊断和术中发现相比，诊断完全符合率为８０％，完全及基本符合率为９５．４％，比１９９７年前分别提高１４．１％和１０．３％。结论臂丛神经根性损伤加测椎旁肌ＥＭＧ、膈神经、副神经肌电可提高臂丛根性损伤尤其是Ｃ５节后损伤的肌电诊断正确率。     

腹腔镜胆囊切除术中肺功能变化的临床研究

本文观察了１２例ＡＳＡ１级胆囊结石病人腹腔镜胆囊切除术中的肺功能变化。年龄为４０．７±９．４岁，体重６１．４±９．４ｋｇ。Ｍｉｄａｚｏｌａｍ－Ｆｅｎｔａｎｙｌ－Ｉｓｏｆｌｕｒａｎｅ－Ｔｒａｃｒｉｕｍ维持麻醉，控制呼吸，间歇正压通气。连续监测吸气气道峰压（ＰＩＰ），动态肺应性（ＬＣ），ＰＥＣＯ２，ＥＫＧ，ＮＩＢＰ和ＳｐＯ２。结果：体位改变对ＰＩＰ和ＰＥＣＯ２无明显影响（Ｐ＞０．０５），却使ＬＣ下降９．７％（Ｐ＞０．０５）。腹腔充气后３０分钟ＰＩＰ上升１７％（Ｐ＜０．０５），ＬＣ与麻醉后和充气前相比分别下降２５．８％和２０．８％（Ｐ＜０．０１），ＰＥＣＯ２增加１９．１％（Ｐ＜０．０１）；腹腔充气后６０分钟，ＰＩＰ和ＰＥＣＯ２未继续增加，但ＬＣ继续下降，比麻醉后和充气前下降３４．２％和２７．１％（Ｐ＜０．０１）。本文显示腹腔镜胆囊切除术中肺顺应性显著下降，气道压明显升高，ＰＥＣＯ２明显增加。     

中晚期肝癌治疗途径的探讨

本院自１９８６年～１９９９年１２月,采用肝动脉栓塞化疗（ＴＡＣＥ）、肝动脉结扎（ＨＡＬ）、无水酒精瘤体内注射（ＰＥＩ）、二期切除、复发癌再切除等综合治疗的手段,取得了显著的疗效,改变了对中晚期肝癌持消极态度的观点。 临床资料 １９８６年６月一１９９９年１２月,我院共收治２０５６例原发性肝癌行外科治疗,其诊断均为手术证实。其中不能切除的原发性肝癌１０８１例,占５２．７％。男８９５例,女１８６例,年龄２３～７６岁,平均４６岁; ＨＢｓＡｇ阳性８４３例,占７８％; ＡＦＰ阳性者７７８例,占７２％;伴肝硬化…     

胃肠外科重症APACHEⅡ评分的临床意义（附244例分析）

采用前瞻性研究对１９９２年１２月至１９９５年９月期间胃肠外科入院需要进入ＳＩＣＵ监护和治疗的２４４例病人进行了急性生理学和慢性健康状况评分（ＡＰＡＣＨＥⅡ）。ＡＰＡＣＨＥⅡ评分统一在入ＳＩＣＵ第一个２４小时进行，所有病例随访至出院或死亡，记录每例转归，并与ＡＰＡＣＨＥⅡ总分作相关性分析。结果显示，全组２４４例ＡＰＡＣＨＥⅡ总平均分值为１１．２分，最低为５分，最高为３７分。存活病例共２１６例，平均分值为９．７分。死亡共２８例，病死率为１１．５％，死亡２８例的ＡＰＡＣＨＥⅡ评分平均为２２．６分（Ｐ＜０．００１）。全组ＡＰＡＣＨＥⅡ１０分以下共１５２例，１例死亡（０．７％）；１０～２０分６９例，死亡１０例（１４．５％）；２０～３０分２０例，死亡１４例（７０．０％）；３０分以上３例，全部死亡。病死率高低与ＡＰＡＣＨＥⅡ分值有密切的关系。本组风险病死率与实际病死率作回归分析，其ｒ＝０．９０５，Ｐ＜０．００１。从ＲＯＣ曲线可发现，其风险预测的准确性较高。急诊手术病人的ＡＰＡＣＨＥⅡ平均分值高于选择性病人，其手术死亡率也明显高于选择性手术病人。     

52例尿毒症患者肾移植前后脑电图、脑地形图的对比分析

对５２例尿毒症患者作肾移植前后脑电图（ＥＥＧ）、脑电地形图（ＢＥＡＭ）检查对比分析。术前ＥＥＧ异常率５５．８％，术后降至４０．４％，术前ＢＥＡＭ异常率６９．８％，术后降至５１．９％，且异常程度改善，但病程长，术前尿素氮＞３５．７ｍｍｏｌ／Ｌ者恢复慢，分析术前异常率高，其中一个原因亦与血透治疗有关。值得注意的是肾移植术后广泛应用环孢素，致术后ＥＥＧ、ＢＥＡＭ恢复与肾功能的恢复不呈正相关。提示应用ＥＥＧ、ＢＥＡＭ观察患者脑损害状况以及药物的神经毒性作用，可为临床提供简便有价值的参考。     

不育男性精子数及活动率与体液表皮生长因子的相关性

为了分析体液表皮生长因子（ＥＧＦ）含量与不明原因男性不育之间的相关性，本研究分别收集了３７例男性不育患者的血液、精液和唾液，根据精子计数将患者分成３组：Ａ组：＜２１×１０６／ｍｌ，Ｂ组：２１４０×１０６／ｍｌ，Ｃ组：＞４０×１０６／ｍｌ。根据精子活动率将患者分成４组：Ｉ组：０２０％，Ｉ组：２１％～４０％，ＩＩ组：４１％～６０％，ＩＶ组：６１％～８０％。用放射免疫法测定血浆、精浆和唾液ＥＧＦ浓度。结果：各组血浆ＥＧＦ含量与对照比较无显著差异，Ａ、Ｂ和Ｃ组的唾液ＥＧＦ浓度均显著高于对照（Ｐ＜０．０５），而且Ａ组精浆ＥＧＦ也显著高于对照（Ｐ＜０．０５）。Ｉ、ＩＩ和ＩＶ组的唾液ＥＧＦ浓度都显著高于对照（Ｐ＜０．０５）。对照组的唾液ＥＧＦ含量与精子数量呈显著负相关（ｒ＝－０．８７５，Ｐ＜０．０５）。唾液ＥＧＦ（主要来自颌下腺）与精子发生有相关性。唾液ＥＧＦ浓度异常与不明原因男性不育的关系值得重视。     

42例外科危重患者高渗性脱水临床分析

１９９５年５月至１９９８年１１月我院外科ＩＣＵ共收治危重患者４４６例,其中４２例发生高渗性脱水,发生率９－４１％。１．临床诊断：本组４２例患者中,男性２８例,女性１４例,平均年龄为６６岁。ＡＰＡＣＨＥＩＩ：１３～２９分,平均１７－６分。根据病史、临床表现及患者失水多于失钠,失液后血钠大于１５０ｍｍｏｌ／Ｌ,血浆渗透浓度大于３１０ｍｍｏｌ［１］确诊为高渗性脱水。其中轻、中度缺水者３５例（８３－３３％）,重度缺水者７例（１６－６７％）。其中血钠１５０～１６０ｍｍｏｌ／Ｌ者３２例;＞１６０ｍｍｏｌ／…     

抗胸腺淋巴细胞球蛋白预防肾移植后排斥反应的临床研究

本实验分别给予１００例肾移植术后患者预防性应用抗胸腺淋巴细胞球蛋白（ＡＴＧ）和１００例肾移植术后常规应用环孢素Ａ（ＣｓＡ）组进行了持续三个月的临床研究。结果表明：应用ＡＴＧ组肾功能恢复快（３￣１０天，ＣｓＡ组７￣１５天）；急性排斥率低（ＡＴＧ组１８％，ＣｓＡ为４７％）；肾中毒ＡＴＧ组无，而ＣｓＡ组１５例（Ｐ〈０．００１），有显著差别；肝中毒及感染发生率无显著差别（Ｐ〉０．０５）。在应用ＡＴＧ过程中     

胆囊结石合并胆心综合征的外科治疗

目的　 评价胆囊结石合并胆心综合征的外科治疗效果。 方法　 回顾性分析 14 9例胆囊结石术前合并心血管症状和心电图异常者的临床资料。结果　本组胆心综合征发生率为 39.4% ( 14 9/378)。 14 9例均行胆囊切除 ,无严重并发症或手术死亡。术后 3月随访率 82 .6 % ( 12 3/14 9) ,其中10 2例 ( 82 .9% )心电图恢复正常或明显改善 ,自觉症状消失 ;15例 ( 12 .2 % )心电图无明显改变 ,但自觉症状明显减轻。 结论　 胆囊切除术是治疗胆心综合征的根本方法。对无症状胆囊结石合并心血管症状者 ,如患者心功能能耐受手术 ,也应行胆囊切除术     

急性胰腺炎血脂、脂蛋白及载脂蛋白的变化及临床意义

目的分析急性胰腺炎血脂、脂蛋白及载脂蛋白的变化并探讨其临床意义。方法总结我院2001年6月至2003年6月112例急性胰腺炎病人(轻症96例,重症16例,其中死亡4例)血脂、脂蛋白及载脂蛋白的变化。结果轻症胰腺炎时28.1%HDL-C和33.3%apoA1的起始值轻度降低。重症胰腺炎时这两项指标起始值分别有81.3%和75%降低,随后检查全部病例均降低。轻症胰腺炎和重症胰腺炎HDL-C和apoA1起始值比有显著差异(P<0.01)。apoB在轻症胰腺炎中31.3%异常,其中27.1%轻度升高。重症胰腺炎中有25%升高。T-CHO在轻症胰腺炎时变化不明显,在重症胰腺炎12.5%明显升高,56.3%明显降低,18.8%开始正常随后明显降低。Trig在轻症胰腺炎有6.3%轻度升高,在重症胰腺炎18.1%明显升高(>6 mmol/L)。LDL-C和Lp(a)在轻症胰腺炎和重症胰腺炎无明显变化。结论HDL-C和apoA1的起始值和(或)随后明显减少提示胰腺炎病情严重。T-CHO的显著变化与胰腺炎严重程度密切相关。Trig显著升高的胰腺炎可能为重症。LDL-C、Lp(a)及apoB对判别急性胰腺炎的严重程度无明显意义。     

Bone histomorphometry is still the golden standard for diagnosing renal osteodystrophy

AIM: The clinical picture of renal osteodystrophy (RO) is very uncharacteristic. The diagnosis is made by means of biochemical indicators, intact parathormone (iPTH) concentration, bone X-rays, bone densitometry and particularly bone histomorphometry. The aim of our study was to establish whether a combination of non-invasive methods can bring us closer to the diagnosis as to avoid bone biopsy. PATIENTS AND METHODS: We chose 30 patients treated by chronic hemodialysis. Only 4 of them had no symptoms of RO. Biochemical parameters (Ca, P) and iPTH concentrations were determined. bone X-rays were taken (the parathyroid series), bone mineral density was measured by quantitative digital radiography (QDR), and bone biopsy specimens were taken for bone histomorphometry. The data were analyzed by the Statistica by StatSoft and SPSS computer programs. RESULTS: With respect to bone histomorphometry, 10 patients had osteitis fibrosa (OF), 15 had mixed osteodystrophy (MO), 5 adynamic bone disease (ABD). There was a good correlation of iPTH and alkaline phosphatase (AP) concentrations with histomorphometric parameters. There was also a correlation between radiological changes and histomorphometric parameters. After the analysis of discrimination using the SPSS computer program, taking only iPTH into consideration, 36.6% of patients were correctly classified according to their diagnosis. Considering iPTH and densitometry, 46.6% were classified correctly. Considering iPTH and radiological changes, 60% of patients were classified correctly. CONCLUSION: To diagnose 73.3% of patients correctly, it was necessary to consider the above mentioned non-invasive parameters, as well as AP, P, concentrations and the patient age. Histomorphometry remains the "golden standard" for diagnosing RO.     

A comparison of methods for the detection of myocardial ischemia during noncardiac surgery: automated ST-segment analysis systems, electrocardiography, and transesophageal echocardiography.

Clinicians often fail to detect intraoperative ischemic electrocardiographic (ECG) changes when viewing oscilloscopes. Automated ST-segment monitors promise to increase the detection of such ECG changes. We investigated the capacity of two commercially available ST-segment monitors to detect intraoperative myocardial ischemia in patients at high risk for developing intraoperative myocardial ischemia during vascular and other noncardiac procedures. The ST-segment monitors were compared with two reference monitors: (a) printed eight-lead ECGs, as interpreted by a cardiologist, and (b) the presence of segmental wall motion abnormalities and thickening abnormalities detected by transesophageal echocardiography (TEE). We also examined the capacity of the printed ECG to diagnose myocardial ischemia when compared with TEE. We studied 44 patients who underwent TEE, printed multilead ECG, oscilloscope monitoring of leads V5 and II, and measurement of ST-segment deviation from the baseline using an automated Hewlett Packard ST-segment device. The sensitivities for the Hewlett Packard system were 40% for TEE-diagnosed myocardial ischemia and 75% for ECG-diagnosed ischemia. Comparison of the printed ECG with TEE revealed that ST-segment changes in the printed ECG, as analyzed by a cardiologist, were 25% sensitive and 62% specific for the detection of TEE-diagnosed myocardial ischemia. When T-wave inversions were added to ST-segment depression as a criterion for the diagnosis of myocardial ischemia by the printed ECG, the sensitivity of ECG for the detection of intraoperative myocardial ischemia, as determined by TEE, was 40% and specificity was 58%. Twenty-three of the 44 patients were simultaneously monitored in leads I, II, and V5 with an automated Marquette ST-segment monitor.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical treatment of congenital valvular aortic stenosis.

Twenty-two patients with congenital valvular aortic stenosis were surgically treated between 1967 and July 1975. Five (23%) were under 1 year of age (group I) and 17 (77%) were between 2 and 24 years (group II). All infants exhibited severe congestive heart failure and electrocardiographi (ECG) evidence of left ventricular hypertrophy (LVH) with strain pattern. In group II, angina was present in three cases, syncope and fatigue in two; the ECG indicated LVH in 10 cases (59%) with strain pattern in five (29%). A bicuspid aortic valve was present in 77% (17/22) of the cases; 32% had other cardiac anomalies. Aortic valvotomy was performed on cardiopulmonary bypass in 20 cases, and with deep hypothermia and circulatory arrest in two. Three infants under 1 month of age with associated anomalies died (hospital mortality 14%). Intraoperative average peak left ventricular-aortic systolic pressure gradient decreased from 86 to 21 mmHg (P less than 0.001). Late clinical (in all cases) and haemodynamic (26%) follow-up showed severe restenosis in two patients of group II; one of them had a second operation, the other one died three and a half years postoperatively. Results assessed on the basis of symptoms, ECG changes, aortic valve function, and/or haemodynamic findings were fair in the two surviving infants. Results in group II were excellent in three, satisfactory in seven, fair in four, and poor in two cases. In infants, aortic valvotomy is a palliative procedure which carries a high risk. In the older age group, early and late results are more gratifying.     

Electrocardiographic changes during microlaryngoscopy in practolol-pretreated patients under balanced anaesthesia

Electrocardiographic (ECG) changes were studied in 82 adult patients with a mean age of 49 years undergoing microlaryngoscopy. The patients were pretreated with practolol 0.15 mg/kg i.v. 5 min before induction of anaesthesia with thiopental. Anaesthesia was maintained with nitrous oxide in oxygen, fentanyl and suxamethonium-infusion. ECG changes occurred in 49% of the patients before anaesthesia and procedure. Pre-existing ECG changes increased or new changes occurred in 39% of the patients during intubation and in 38% during the procedure. The most common preanaesthetic ECG changes were flat or negative T-wave (18%), sinus tachycardia (13%), ischaemic S-T segment depression (8.5%) and intraventricular conduction disturbance (8.5%). ECG changes during intubation were sinus tachycardia (16%), ventricular ectopic beats (12%), supraventricular ectopic beats (10%) and ischaemic S-T segment depression (10%). The most common changes during microlaryngoscopy were supraventricular ectopic beats (16%), T-wave flattening or inversion (15%), ischaemic S-T segment depression (11%) and sinus bradycardia (10%). In all patients ECG changes disappeared without any special treatment. Unlike our earlier identical study without practolol pretreatment, neither sinus tachycardia nor junctional rhythm occurred during microlaryngoscopy in the present study. The results suggest that practolol pretreatment before microlaryngoscopy is especially useful when sinus tachycardia and junctional rhythm should be avoided.     

Potential harmful effect of iodinated intravenous contrast medium on the clinical course of mild acute pancreatitis

HYPOTHESIS: A worse clinical outcome might be expected in patients with acute pancreatitis (AP) who receive intravenous contrast medium for a nondynamic contrast-enhanced computed tomographic (CECT) study early during hospital admission. DESIGN: Cohort analytic study. SETTING: Tertiary care center. PATIENTS: Of 126 patients with mild AP, 52 patients underwent CECT to establish AP diagnosis (group 1), and the remaining 74 did not (group 2). MAIN OUTCOME MEASURES: Survival and development of local or systemic complications during the hospital stay. Potential confounders were demographic, clinical, and biochemical data, as well as therapeutic measures. The Atlanta classification was used to define local and systemic complications. RESULTS: Mean age, etiology of AP, prognostic score on admission, and pharmacologic treatment were similar between groups. Local and systemic complications were more frequently observed in patients who underwent CECT (odds ratio, 11.4; 95% confidence interval, 2.0-64.8; P =.008). Six patients, all in group 1, developed a pancreatic abscess (odds ratio, 20.8; P =.004). In 5 of them, a second CECT showed more severe AP changes. The association between CECT and abscess development was more apparent in patients with a body mass index of 25 or more and/or nasogastric suction. Six patients in group 1 and 1 in group 2 had systemic complications (odds ratio, 9. 5; P =.01). There were no deaths. CONCLUSIONS: The observed increased incidence of local and systemic complications in patients with mild AP who undergo CECT, particularly in those with a body mass index of 25 or more, suggests a potentially harmful effect of intravenous contrast medium. Until this issue is clarified, it seems reasonable to restrict the use of dynamic CECT to patients with severe AP, protracted clinical course, or suspected local septic complication.     

Postoperative myocardial damage in patients with coronary artery disease undergoing major non cardiac surgery

A prospective study was carried out in a group of 50 patients with coronary artery disease, presenting for major non-cardiac surgery, to investigate the timing and incidence of further perioperative myocardial damage. A standardised anaesthetic was used. A standard 12-lead ECG was taken immediately before surgery and at 24, 48, and 72 hr after the start of anaesthesia. Blood samples were taken immediately preoperatively and at 6, 24, 48, and 72 hr after anaesthesia for total CK and CK-MB assay. Thirty-three patients (66%) showed ECG evidence suggestive of further infarction, and of these, two (4%) died in the immediate perioperative period. The first ECG change occurred in 27/31 (87%) by 24 hr, in 3/31 (10%) by 48 hr, and 1/31 (3%) by 72 hr. Twenty-nine patients (58%) including the two deaths showed CK-MB enzyme changes. The first elevation in CK-MB was nil at 6 hr and 72 hr, with 23/27 (85%) at 24 hr, and 4/27 (15%) at 48 hr. In 22/50 (44%) ECG and enzymes were correlative. Goldman and Cooperman risk indices were calculated for each patient. The Cooperman risk index was superior to the Goldman scale in the correlation of observed with predicted myocardial morbidity. Patients with ECG changes only before surgery were just as liable to further myocardial damage as those patients with ECG changes and a documented history of a previous infarct and/or symptoms. Myocardial damage is maximal in the first 24 hr after surgery, and may not be adequately predicted by current risk indices.     

Laparoscopic surgery: does it increase the probability of atrial and ventricular arrhythmias in children?

PURPOSE: Despite the minor physiologic changes those occur during laparoscopic procedures, pneumoperitoneum with CO2 insufflation may induce alterations in electrocardiographic (ECG) variables, which may predict severe atrial and ventricular arrhythmias. This study aims to assess QT dispersion (QTD) and P wave dispersion (PWD) changes in children who have undergone laparoscopic appendectomy. PATIENTS AND METHODS: Sixteen patients (12 males and 4 females) who had preoperative diagnosis of appendicitis were included in the study. As laparoscopic exploration revealed appendicitis in all patients, laparoscopic appendectomy was performed. Preinsufflation (ECG1), postinsufflation (ECG2), predesufflation (ECG3), and postdesufflation (ECG4) ECGs were achieved at a speed of 25 mm/s for QTD and PWD analyses. RESULTS: Although mean corrected QTD and PWD at ECG2 and ECG3 were significantly greater than ECG1 and ECG4, those changes induced by insufflation of CO2 were reversible. CONCLUSIONS: The clinical significance of pneumoperitoneum, which causes an increase in corrected QTD and PWD in children, remains to be determined with further studies.     

Evolving Pattern of Laparoscopic Gastric Band Access Port Complications

Laparoscopic gastric banding (LGB) is the commonest bariatric procedure in Australia. The commonest complication of LGB is access port or tubing (AP/T) problems, requiring revisional surgery. The aim of this study was to document the evolving pattern of AP/T complications. All patients whose LGB procedure (Allergan(TM) Bands) and AP/T revision (Allergan(TM) port revision sets) were performed by one surgeon (1999 to 2008) were included, giving 167 AP/T revisions in 124 patients out of a total 1,928 LGB patients. All patient follow-up details were prospectively recorded and retrospectively analysed. Incidence of LGB AP/T problems was 8.7%. Mean time to first AP/T revision was 2 years. Over the last 4 years of the series, the number of LGB insertions was constant, but the number of AP/T revisions progressively increased. Twenty-seven percent of AP/T revision patients required two or more AP/T revisions. Sixty-two percent of the AP/T complications were leaks. Half the AP complications were flipping of the AP. There was no correlation of AP/T problems with any changes to port design to date. Infection rate for LGB insertion was 0.67%. The incidence of LGB AP/T complications progressively increases with duration after LGB insertion. Occurrence of one AP/T problem appears to select a subgroup more likely to experience further AP/T problems. To date, revisions of port design do not appear to have solved AP/T problems. Recent introduction of a significantly redesigned port may reduce AP/T failures.