肝泡状棘球蚴病

肝泡状棘球蚴病 (Ａｌｖｅｏｌａｒｅｃｈｉｎｏｃｏｃｃｏｓｉｓ ,Ａ ｅ .)是一种对人体危害极大的人畜共患的寄生虫病 ,由多房棘球绦虫的幼虫寄生于肝脏并不断增殖芽生 ,似癌样浸润扩散 ,造成肝组织不可逆的进行性损害。临床上具有慢性隐袭进行性的特点 ,常伴有肺及脑等重要器官转移。由于Ａ ｅ .具有一定的地区分布性 ,易于引起误诊 ,因此复习有关文献 ,提高Ａ ｅ .的全面认识 ,对临床诊治工作必将有所裨益。1　流行病学[1- 5]泡球蚴病主要流行于北半球高纬度地带。我国主要在西北地区流行。　　多房棘球绦虫的主要终宿主是狐及狼等野生…     

复杂性肝棘球蚴病外科治疗策略研究进展

肝棘球蚴病是一种由棘球属绦虫幼虫所致的人畜共患性疾病。我国主要致病绦虫类型为细粒棘球绦虫和多房棘球绦虫,分别引起细粒棘球蚴病和多房棘球蚴病。目前,棘球蚴病治疗已经取得重大进展,但对于部分就诊时已出现一种或多种并发症以及病灶侵及肝门、重要血管及胆管的复杂性棘球蚴病病例的治疗仍存在一定困难。本文根据近年来文献报道,结合临床经验,对复杂性肝棘球蚴病的外科治疗策略进行综述。［关键词］     

羊棘球蚴囊液抗原B诊断早期实验棘球蚴病鼠的研究

采用两种抗原（抗原Ｂ和粗抗原）通过ＥＬＩＳＡ法检测感染细粒棘球蚴和多房棘球蚴２－３月的小鼠,正常鼠以及棘球蚴病人,非棘球蚴病人和健康人血清抗体。结果表明,抗原Ｂ和粗抗原检测２月细粒棘球蚴鼠血清抗体阳性率分别为９５％和１００％。检测３月细粒球蚴病鼠血清抗体均为１００％,检测正常血清的假阳性率分别为０和５％。     

PAIR用于治疗人体囊性棘球蚴病

本报道了在超声波引导定位下，经皮肤治疗人体肝脏囊性棘球蚴病的经验。ＰＡＩＲ即穿刺，抽吸，注射，再抽吸的治疗方法，疗后对病人的长期随访结果说明，ＰＡＩＥ是肝脏棘球蚴病的首选治疗方法。     

79例肝棘球蚴病患者影像学分析

目的 回顾性分析79例肝棘球蚴病患者的影像学表现,为该病诊断与鉴别诊断提供参考。方法 收集2014-2017年在青海省人民医院行影像学检查并经病理检查证实的79例肝棘球蚴病患者病历资料,对其影像学表现进行回顾性分析。结果 79例肝棘球蚴病患者中,细粒棘球蚴病57例,多房棘球蚴病22例;细粒棘球蚴病患者中,单囊型21例,多子囊型16例,内囊塌陷型9例,实变型4例,钙化型7例。79例患者中,62例为常见影像学征象。单囊型细粒棘球蚴病表现为肝内囊性水样病灶,囊壁薄厚均匀、无强化;多子囊型表现为“囊中囊”、“玫瑰花瓣”、“轮辐征”等;当内囊塌陷分离时表现为“飘带征”、“双环征”等征象;囊壁钙化时呈弧线状、蛋壳状,囊内容物呈现絮状或者整个病灶钙化。多房棘球蚴病表现为肝内实性肿块,密度及信号不均匀,边缘不规则;病灶强化不明显,病灶内散在或者群簇状分布的“小囊泡”,常伴有钙化,整个病灶呈“地图样”外观。另外17例患者表现为复杂少见的影像征象;其中6例细粒棘球蚴病囊内含脂肪,影像表现为囊内单发或多发脂肪密度结节灶,CT值为-28～-84 HU;4例病灶破入胆管,邻近胆管密度增高,胆管壁增厚,周围胆管扩张;4例合并原发性肝癌,影像表现为肝内细粒或多房棘球蚴病合并实性强化肿块,增强呈“快进快出”表现;3例合并感染,影像学表现为囊壁明显增厚且强化明显,其中2例囊内见气体影,1例囊肿合并感染并侵及腹壁。结论 肝棘球蚴病影像学表现复杂多样,在临床工作中需认真分析,做好鉴别诊断。     

囊性棘球蚴病免疫发病机制研究进展

本文从宿主对棘球蚴感染的先天性抵抗、早期免疫、包囊形成期免疫、影响CD4⁺ T细胞分化因素、细胞因子在细粒棘球绦虫(Eg)感染中的作用、Eg感染与变态反应、Eg感染的逃避机制等7个方面进行了综述。     

棘球蚴病流行因素研究进展

棘球蚴病是一种严重危害人民健康和畜牧业发展的人兽共患寄生虫病,在世界范围内是一个重要的公共卫生和经济问题。该文概述了细粒棘球蚴病和多房棘球蚴病在全球的流行情况,从自然、宿主和社会三个方面,综述了细粒棘球蚴病和多房棘球蚴病的流行因素研究进展。遥感和地理信息系统作为疾病研究的新手段,已被应用到探索多房棘球蚴病自然因素的研究中。     

The seroprevalence of cystic hydatidosis in Oman

The presence of antibodies against Echinococcus granulosus in sera from 306 humans and 390 camels in Oman was investigated by indirect haemagglutination assays. Only one of the human and five of the camel sera gave positive reactions. The reactivities of the human sera were confirmed by ELISA. These results, together with isolated reports of hydatid cysts, indicate that E. granulosus is endemic in Oman, although with a low prevalence.     

Single-stage VATS and thoracotomy in multiple organ hydatidosis

We report a case of hydatidosis of the bilateral lung and of the left lobe of the liver which we treated by cystotomy and capitonnage via right video-assisted thoracoscopy, left posterolateral thoracotomy, and diaphragm incision in a single-stage operation. The patient developed a right pleural infection in the ninth postoperative month and underwent exploratory thoracotomy and recapitonnage. Thoracoscopic cyst extirpation can be safely performed alone or in combination with thoracotomy to reduce the operative inconvenience for patients.     

The limited use of ultrasound in the detection of abdominal abscesses in patients after colorectal surgery: compared with gallium scan and computed tomography

BACKGROUND/AIMS: Ultrasound has been suggested to be a first-line test for the detection of intra-abdominal abscess (IAA). However, according to our experience, ultrasound seemed not so effective when applied to the patients after colorectal surgery. Computed tomography (CT) and gallium scan have also been suggested as very useful for the detection of IAA. The purpose of this study was to evaluate the efficacy of sonography and gallium scan in diagnosing intra-abdominal abscess after colorectal surgery and to compare these results with CT. METHODOLOGY: Twenty-three patients with suspected IAA after colorectal surgery at our institution were eligible for the study. A positive IAA was verifed only if pus was drained or on postmortem examination. Negative reports of abscesses were verified by adequate outpatient review following hospital discharge that indicated the clinical absence of an abscess. Within 4 days of the clinical suspicion of abscess, all patients were evaluated by three techniques: sonography, CT and gallium scan. We compared the sensitivity, specificity and accuracy of these modalities. RESULTS: Fourteen of the 23 patients (60.9%) were verified as IAA. We found the sensitivity, specificity, and accuracy of CT scan for the detection of LAA in the patients with colorectal surgery to be 92.9%, 100%, and 95.7%, respectively. The sensitivity, specificity and accuracy of gallium scan were 100%, 77.8% and 91.3%, respectively. Ultrasound had a 42.9% sensitivity, 100% specificity, and 65.2% overall accuracy for diagnosing IAA. CONCLUSIONS: Sonography plays a small role in the detection of IAA in the patients after colorectal surgery. CT and gallium scan are more helpful than sonography for the detection of IAA.     

心腔内超声在心房颤动射频消融中的应用

随着射频消融技术的发展 ,根治房室结和房室折返性心动过速、心房扑动、房性心动过速以及特发性室速有了成熟的经验 ,但作为最常见的心房颤动临床治疗上却显得举步维艰。 90年代中期 ,随着外科迷宫手术的简化及导管射频仪器的改进 ,临床上开始了导管心房线性消融房颤的探索 ,但房颤的消融治疗无论从治疗效果还是并发症的防治方面均未取得突破性进展 ,从而使房颤的射频消融成为心电生理领域最困难的堡垒和最热门的研究课题。近年来 ,由房性早搏引起的房颤“局灶性房颤”概念的提出 ,使得射频消融根治部分房颤成为可能 ,也使我们在房颤的治疗…     

Osteoclastogenesis during infective exacerbations in patients with cystic fibrosis

RATIONALE: Adults with cystic fibrosis (CF) are at increased risk of developing osteoporosis. During infective exacerbations, increased production of proinflammatory cytokines and markers of bone resorption have been reported. OBJECTIVE: The aim of this study is to investigate the growth and proliferation of potential osteoclast precursor cells before, during, and after intravenous antibiotic treatment of infective exacerbations in patients with CF. METHODS: Hematopoietic precursor cell growth was examined using colony formation assays using Methocult culture medium. Circulating potential osteoclast precursors were identified using four-color flow cytometry by CD14, CD33, CD34, and CD45 expression. RESULTS: At the start of an infective exacerbation increases in hematopoietic precursor colony formation (15.42 colonies/10(5) cells plated, p = 0.025), proliferation (28.5%, p < 0.001), and the numbers of circulating potential osteoclast precursors (6.5%, p < 0.001) were seen in comparison with baseline levels. These increases declined after treatment with intravenous antibiotics to a level close to baseline. CONCLUSIONS: The results demonstrate an increase in the production of potential osteoclast precursors in the peripheral blood during CF infective exacerbations. This may result in increased bone resorption and contribute to bone loss in patients with CF.     

Frequency of pulmonary embolism in patients with low-probability lung scan and negative lower extremity venous ultrasound

STUDY OBJECTIVES: To define the prevalence of pulmonary embolism (PE) in patients who are undergoing pulmonary arteriography because of a high clinical suspicion for PE but who have had a low-probability lung scan and a negative lower extremity venous ultrasound examination. DESIGN: A retrospective review of the medical records of 365 consecutive patients who underwent pulmonary arteriograms for suspected PE was undertaken. RESULTS: Of the 365 pulmonary arteriograms, 62 were performed in patients with suspected PEs despite a low-probability lung scan and a negative lower extremity venous ultrasound examination. In the latter group, five patients (8%; 95% confidence interval, 2.7% to 18%) had PEs revealed on the arteriogram. CONCLUSIONS: In patients whose presentation provokes a high clinical suspicion for PE despite having had a low-probability lung scan, a negative lower extremity venous ultrasound examination is insufficient to preclude proceeding to pulmonary angiography.     

Early detection by ultrasound scan of severe post-chemotherapy gut complications in patients with acute leukemia

BACKGROUND AND OBJECTIVE: Acute leukemia patients may develop life-threatening gut complications after intensive chemotherapy. We evaluated the role of abdominal and pelvic ultrasound (US) examination in early detection of these complications. DESIGN AND METHODS: A cohort of twenty adult acute leukemia patients undergoing intensive chemotherapy for remission induction entered the study. All chemotherapy regimens included cytarabine by continuous i.v. infusion for several days. RESULTS: Three patients had severe gut complications: 2 cases of enterocolitis and 1 case of gall bladder overdistension in the absence of calculi. In all cases the abnormality was documented by US examination: US scan showed thickening of the intestinal wall (two cases), and gall bladder overdistension with biliary sludge (one case). Immediate medical care included bowel rest, a broad-spectrum antibiotic, antimycotic treatment, and granulocyte colony-stimulating factor. All patients recovered from the complication. INTERPRETATION AND CONCLUSIONS: We believe that the favorable outcome obtained in our small series can be attributed to early diagnosis followed by appropriate treatment. Early recognition by US and immediate medical management can lead to complete recovery of severe intestinal complications in patients with acute leukemia undergoing intensive chemotherapy.     

A new "Perforator Grinder-Aspirator Apparatus (PGAA)" for the minimal access surgery of cystic liver hydatidosis

Despite that minimal access surgery is a feasible, effective and viable option for radical surgical treatment of cystic hydatidosis, the laparoscopic approach is not widely accepted because of the risk of recurrence and the risk of severe complications, such as anaphylaxis and/or contamination of the peritoneal cavity related with the spillage. To overcome these difficulties, several techniques and devices are described in the literature. In our center (ISTEM), we have designed and developed a new generation "Perforator-Grinder-Aspirator Apparatus (PGAA: patent no. TR-2004/02916)" which evacuates cyst contents in a more secure, effective and easy way. By using PGAA, we are able to perform the laparoscopic approach while keeping the necessary pneumoperitoneum pressure to evacuate the cyst contents of liver hydatidosis securely and effectively, with wider indications even in difficult locations, after testing its safety and efficacy in some ex-vivo animal livers with hydatid cysts. PGAA is made up of four main units including puncture-irrigation needle, perforator-grinder pipe, aspiration cannula and, electric motor. One of the most important specialties of this new PGAA is having the automatically retractable rotary blade on the distal edge to grind and evacuate all the contents of the cavity including germinal layer and scolices. Having the retractable rotary blade allows the operator to avoid any intracystic parenchymal damage after perforating the outer layer. After taking out the perforator-grinder pipe, the aspiration cannula allows the laparoscopic visualization of the inner surface of the cystic cavity through its 10-mm internal diameter. In this article, the author describes the technical aspect and specifications of PGAA, and its applications in some cases with awkwardly located liver hydatid cysts, underlying its superiority over the classical aspirators and other devices.