6例特重烧伤患者的营养支持治疗

营养支持是烧伤患者综合治疗的重要组成部分,尤其是在特重烧伤患者的抢救与治疗中起着重要作用.我们应用营养支持配合临床抢救,治疗了6例特重烧伤患者,效果满意,现报道如下.     

青光眼常用药物不良反应及护理措施

青光眼是眼科重要的致盲眼病之一。治疗手段主要包括药物治疗、激光和手术治疗。其中药物治疗对青光眼,特别是原发性开角型青光眼的治疗具有重要的作用。抗青光眼的药物治疗是以减少房水生成,促进房水排出,其主要通过促进房水从小梁网通道或巩膜葡萄膜通道的外流或通过眼外渗透     

对肿瘤细胞免疫治疗临床及科研规范化管理的思考

生物治疗是继手术、放疗、化疗后的第4种肿瘤治疗模式,细胞免疫治疗是肿瘤生物治疗的重要方法。常用的细胞免疫治疗包括细胞因子诱导的杀伤细胞(CIK)、树突状细胞(DC)、自然杀伤细胞(NK)等。近年来,肿瘤的细胞免疫治疗取得了重要进展,如前列腺癌     

支气管镜引导下经鼻气管插管救治急危重症合并呼吸衰竭的护理

呼吸衰竭是急危重症患者的常见并发症,也是导致急危症患者死亡的重要原因之一。迅速建立人工气道,进行机械通气治疗是提高急危重症合并呼吸衰竭患者抢救成功率的重要治疗措施之一。     

肿瘤核素靶向治疗新进展

利用靶向分子将放射性核素定向导入肿瘤组织实现核素靶向治疗是肿瘤治疗的重要方法。利用单克隆抗体或小分子肽携带治疗性放射性核素,分别与肿瘤细胞表面表达丰富的抗原或受体特异性结合而开展放射免疫治疗或受体介导的核素治疗是靶向治疗的主要策略。近年来,这两种靶向治疗取得较大进展,部分已进入临床应用。随着靶向分子的不断出现、分子靶向技术的不断完善,肿瘤核素靶向治疗终将成为肿瘤治疗的重要方法。     

营养医师在疾病治疗中的重要作用

营养治疗是临床治疗过程中不可缺少的重要组成部分,也是临床治疗中最基本的内容之一.只有通过科学评价患者个体营养需求,才能及时提出促进其疾病康复、避免不良饮食危害、科学合理的饮食医嘱,而这正是营养医师充分发挥专业特长的舞台.因此,营养医师在临床营养治疗中具有不可或缺的重要作用.     

创新是介入放射学可持续发展的动力——论食管内照射支架技术治疗食管癌

食管癌的治疗仍然是目前临床所面临的难题之一.虽然,金属食管支架技术为缓解食管癌所致食管梗阻的重要技术,能快速、安全缓解食管癌所致的食管梗阻,但是对原发肿瘤无治疗作用.将支架作为放射性粒子载体,同时对肿瘤行近距离放射治疗,无疑将开创食管癌治疗的新模式,延伸了支架治疗的意义,是食管癌治疗乃至支架技术的重要突破.介入放射学的...     

中国冠心病抗栓治疗的探索与展望

抗栓治疗是冠心病治疗的重要基石.实现冠心病抗栓治疗的优化,是心血管医师持续努力的目标之一.目前国内冠心病抗栓领域尚缺少高质量的随机对照临床研究,成为中国冠心病抗栓治疗亟待解决的重要问题.针对我国心血管抗栓治疗大数据研究的现状和东西方人群的差异,笔者所在中心于2012年进行了一些初步探索.本文在总结笔者多年临床研究经验的基础上,从冠心病抗栓治疗的热点、现状及策略探索等方面进行述评.     

营养医师在疾病治疗中的重要作用

营养治疗是临床治疗过程中不可缺少的重要组成部分,也是临床治疗中最基本的内容之一。只有通过科学评价患者个体营养需求,才能及时提出促进其疾病康复、避免不良     

加强多学科合作提高甲状腺疾病放射性核素治疗水平

甲状腺疾病足最常见的内分泌疾病,治疗手段包括内科、外科和核医学治疗方法.131Ⅰ是甲状腺功能亢进症的重要治疗方法之一,重视多学科密切合作,可获得理想的治疗效果.     

Hepatocarcinoma invasion of the portal vein: detection using lipiodol computed tomography. Apropos of 2 cases

Portal vein involvement is a major complication of hepatocellular carcinoma and has an important impact on management and prognosis. Iodized-oil computed tomography is a well-established imaging technique for the pretherapeutic assessment of hepatocellular carcinoma because it allows detection of the primary tumor site and any daughter nodules. We report two cases of hepatocellular carcinoma extending to the portal vein which was documented by iodized-oil computed tomography. In both cases, tumor thrombus demonstrated marked retention of the iodized-oil on computed tomography. Our two cases demonstrate that iodized-oil computed tomography can depict portal vein extension of hepatocellular carcinoma. In addition, these two cases suggest that iodized-oil retention within the portal vein is a clue to the diagnosis of hepatocellular carcinoma.     

64层螺旋CT血管成像对TACE治疗原发性肝癌的临床价值

目的:探讨64层螺旋CT血管成像对于肝癌(HCC)供血动脉的显示价值。方法:100例HCC患者在肝动脉化疗栓塞术(TACE)前后行MSCT扫描和血管成像。结果:100例患者的HCC供血血管被充分显示;TACE治疗效果与HCC供血动脉有密切关系,规则性供血类型与变异性血管类型差异有统计学意义(P=0.034)。结论:64层螺旋CT血管成像是一种评价HCC供血动脉的重要方法,为术式的选择及预后提供了重要信息。     

Fibrolamellar carcinoma of the liver: radiologic-pathologic correlation.

Fibrolamellar carcinoma is a malignant hepatocellular tumor with distinct clinical and pathologic differences from hepatocellular carcinoma. It differs from hepatocellular carcinoma in demographics, condition of the affected liver, tumor markers, and prognosis. Fibrolamellar carcinoma characteristically manifests as a large hepatic mass in adolescents or young adults (without gender predominance). Cirrhosis; elevated alpha-fetoprotein levels; and typical risk factors for hepatocellular carcinoma such as viral hepatitis, alcohol abuse, and metabolic disease are typically absent. Fibrolamellar carcinoma is characterized pathologically by cords of tumor cells surrounded by abundant collagenous fibrous tissue arranged in a parallel or lamellar distribution. Fibrotic lamellae often coalesce to form a central scar. Fibrolamellar carcinoma characteristically appears on radiologic images as a lobulated heterogeneous mass with a central scar in an otherwise normal liver. Radiologic evidence of cirrhosis, vascular invasion, or multifocal disease--findings typical of hepatocellular carcinoma--is uncommon in fibrolamellar carcinoma. Imaging features of fibrolamellar carcinoma overlap with those of other scar-producing lesions including focal nodular hyperplasia (FNH), hepatocellular adenoma and carcinoma, hemangioma, metastases, and cholangiocarcinoma. FNH, in particular, may simulate fibrolamellar carcinoma, since both have similar demographic and clinical characteristics. Because some believe that radiologic diagnosis of FNH is possible, it is important to understand the imaging appearance of fibrolamellar carcinoma to avoid misdiagnosing this malignant tumor as a FNH.     

原发性肝细胞癌放疗抗拒分子机制研究进展

原发性肝细胞癌放疗疗效差异与肿瘤的放疗抗拒密切相关。多种基因及分子通路参与调控原发性肝细胞癌对放疗的抗拒,对原发性肝细胞癌放疗抗拒分子标志物的研究可预测放疗敏感性,对放疗抗拒的逆转研究有重要意义。     

Ferucarbotran-enhanced MRI versus triple-phase MDCT for the preoperative detection of hepatocellular carcinoma

OBJECTIVE: We compared ferucarbotran-enhanced MRI with triple-phase MDCT for the preoperative detection of hepatocellular carcinoma. SUBJECTS AND METHODS: Seventy-three consecutive patients with 121 hepatocellular carcinomas underwent ferucarbotran-enhanced MRI, including a dynamic study, and triple-phase MDCT before hepatic resection. The diagnosis of hepatocellular carcinoma was confirmed in all patients by means of pathologic examination after surgical resection. Three experienced radiologists independently reviewed the MR and CT images on a segment-by-segment basis. The accuracy of these techniques for the detection of hepatocellular carcinoma was assessed by conducting a receiver operating characteristic (ROC) analysis of the observations of 88 resected hepatic segments with at least one hepatocellular carcinoma each and 121 resected hepatic segments without hepatocellular carcinoma. RESULTS: The mean values of the area under the ROC curve (A(z)) for ferucarbotran-enhanced MRI and triple-phase MDCT for all observers were 0.947 and 0.949, respectively; the difference between these two values was not statistically significant (p = 0.799). The mean sensitivities of MRI and triple-phase MDCT were 90.2% and 91.3%, respectively, and their mean specificities were 97.0% and 95.3%, respectively. The differences in the mean sensitivities and specificities of these two imaging techniques were not statistically significant (p > 0.05 in each case). CONCLUSION: Ferucarbotran-enhanced MRI seems to be as accurate as triple-phase MDCT for the preoperative detection of hepatocellular carcinoma.     

A case of fibrolamellar hepatocellular carcinoma.

Fibrolamellar hepatocellular carcinoma is an uncommon histologic subtype of hepatocellular carcinoma, comprising 3.5% of all hepatocellular carcinomas in one large study (Brandt et al 1988). It usually occurs in young people, the average age being 18 years (Farhi et al 1983). It is not associated with cirrhosis and the serum alphafetoprotein is usually normal (Craig et al 1980). Fibrolamellar hepatocellular carcinoma has a more favourable prognosis than the usual hepatocellular carcinoma, with an average survival of 32 months from onset of symptoms, compared to 6 months for the usual type. The resectability rate and 5 year survival figures are also much better (Craig et al 1980). Hence distinguishing this histological subtype is important for surgical management and survival prognosis. This report describes a full radiological evaluation of such a case, covering the wide spectrum of relevant imaging modalities.     

Hepatocellular carcinoma and gastroenteropancreatic neuroendocrine tumors: potential role of other positron emission tomography radiotracers

18F-Fluorodeoxyglucose avidity for gastroenteropancreatic neuroendocrine tumors and hepatocellular carcinoma is variable, depending on the underlying tumor biology. Experience with non-fluorodeoxyglucose (FDG) tracers (eg, 18F-labeled amine precursors l-dihydroxyphenylalanine and 68Ga-DOTA-peptides for gastroenteropancreatic neuroendocrine tumors and radiolabeled acetate or choline for hepatocellular carcinoma) is evolving and expanding rapidly. This article reviews the role of FDG and non-FDG radiotracers in the imaging evaluation of patients with gastroenteropancreatic neuroendocrine tumors or hepatocellular carcinoma.     

液化碘油混合无水乙醇栓塞治疗小肝癌的临床研究

目的分析超液化碘油与无水乙醇混合后栓塞治疗小肝癌的临床疗效,探讨治疗小肝癌的新方法。方法对经彩超CT或MRI检查发现并经病理证实的小肝癌患者88例共126个病灶,进一步行肝动脉造影,经数字减影血管造影(DSA)证实后,对小肝癌供血动脉行超选择性插管,并以超液化碘油混入无水乙醇(1:0.5)对发现的126个小肝癌病灶充分栓塞。结果 88例患者共126个小肝癌病灶全部行超选择性插管栓塞术,术后无严重并发症发生.术前病灶直径0.8～3.0 cm,平均直径2.75 cm,术后3月复查,肿瘤完全消失16例,72例肿瘤不同程度缩小,肿瘤平均直径1.45 cm。术后1、3、5年复发率分别为17%(15/88)、25%(22/88)、36%(32/88)。术后1、3、5年生存率分别为100%(88/88)、86%(76/88)、68%(60/88)。结论超液化碘油混合无水乙醇栓塞治疗小肝癌疗效显著,术后并发症少,术后复发率低于外科手术治疗,可作为治疗小肝癌的选择方法之一。     

原发性肝癌与血清中HBxAg和抗—HBx的关系

用病例对照的方法，研究了原发性肝癌与血清中HBxAg和抗-HBx的关系。结果表明，肝癌病人与非肝癌的其他肿瘤病人（所有两组病人皆有乙型肝炎感染标记），他们血清中HBxAg和抗-HBx的阳性率差别都不显著，提示HBxAg或抗-HBx与肝癌的关系不密切，二者都不适于作为肝癌的早期诊断指标。     

Ultrasound in hepatoma-can specific diagnosis be made?

The ultrasound appearances of primary hepatocellular carcinoma in 32 patients are described. Attempts to correlate the appearances with serological, histological, and arteriographic findings revealed no consistent pattern. There appears to be no great difference in the range of ultrasound appearances in primary hepatocellular carcinoma when compared with that reported for metastatic disease. The findings suggest that in patients with cirrhosis, ultrasound is a sensitive method for the detection and accurate location of hepatocellular carcinoma, but that in these patients the echo pattern provides little help in the differentiation of primary from secondary carcinoma. Our study has revealed four different echo patterns in patients with hepatocellular carcinoma: echofree (47%), echogenic (23%), mixed (175) and diffuse infiltration 13%).