Management of major hemoptysis in patients with cystic fibrosis

Although bronchoscopy remains the best definitive method for localization of the site of hemorrhage in patients who have massive hemopytsis, angiography remains an important adjunct to this localization. When combined with embolization of the bleeding bronchial artery, it is an effective method of therapy for the management of massive hemoptysis in patients with cystic fibrosis.     

Rapid occurrence of pulmonary aspergillosis after pulmonary wedge resection

A 61-year-old man with diabetes mellitus undertook wedge resection of pulmonary tuberculoma in the left upper lobe. He was discharged uneventfully. However, he became febrile with productive cough five weeks after the discharge, and was readmitted. Imaging studies showed a cavitary lesion at the formerly resected site and multiple infiltrates in the other lobes. A diagnosis was rapidly deteriorating pulmonary aspergillosis. While medical treatments helped his general condition to improve, pulmonary shadows remained unchanged. Finally, we successfully treated him firstly, by performing left upper lobectomy and secondly, by treating multiple infiltrates with postoperative medical treatments. Multiple infiltrates improved gradually and diminished one month after surgery. He remains well without relapse for ten years after surgery.     

经导管支气管动脉栓塞术治疗肺部基础病变合并新型冠状病毒肺炎诱发咯血

目的 观察经导管支气管动脉栓塞术(BAE)治疗肺部基础病变合并新型冠状病毒肺炎(COVID-19)诱发咯血的价值。方法 纳入18例接受经导管BAE的肺部基础病变合并COVID-19咯血患者,观察其临床特征,根据临床转归分为治愈、显效、有效、无效及复发,评估BAE疗效。结果 首次BAE后治愈6例(6/18,33.33%)、显效3例(3/18,16.67%)、有效3例(3/18,16.67%),无效1例(1/18,5.56%)、复发5例(5/18,27.78%);5例复发者经二次BAE后均治愈。未见脊髓损伤及异位栓塞等严重并发症。结论 BAE治疗肺部基础病变合并COVID-19诱发咯血疗效确切,但短期内复发率较高。     

锥束CT在动脉栓塞治疗大咯血中的应用

目的探讨急诊经动脉栓塞术中应用锥束CT判定DSA疑似责任动脉是否为大咯血责任动脉的价值。方法回顾性分析接受动脉栓塞治疗的31例大咯血患者的资料。急诊栓塞术中对DSA疑似责任血管行锥束CT成像,根据锥束CT图像判断其是否为肺内靶病灶的供血动脉,从而判定其是否为大咯血责任血管。对经锥束CT判定的责任血管及锥束CT难以确定的疑似责任血管进行栓塞,对经锥束CT判定的非责任血管不予栓塞。结果 31例均于急诊动脉栓塞治疗后24 h内停止咯血。37条动脉为DSA疑似责任动脉;其中29例(29/31,93.55%)患者34条(34/37,91.89%)疑似责任动脉经术中锥束CT可明确鉴定其是否为大咯血责任动脉,包括责任动脉11条(11/37,29.73%)、非责任动脉23条(23/37,62.16%),另2例(2/31,6.45%)患者3条(3/37,8.11%)DSA疑似责任动脉经术中锥束CT仍未明确判定其是否为大咯血责任动脉。结论大咯血急诊经动脉栓塞术中应用锥束CT有助于准确判定DSA疑似责任动脉是否为真正的责任动脉。     

肾移植术后侵袭性肺曲霉感染15例临床诊治

目的：探讨肾移植受者术后侵袭性肺曲霉（ IPA）感染的诊治。方法回顾性分析济南军区总医院泌尿外科2008年7月至2013年5月肾移植术后15例IPA感染受者的临床资料。结果15例受者均为首次肾移植,均为肾移植术后半年内发生IPA感染,最早于术后16 d发现。经半乳甘露聚糖试验（ GM试验）检出IPA 9例,肺部CT检查检出4例,血培养检出3例,痰培养检出5例。9例合并CMV或细菌感染,2例合并假丝酵母菌属感染,4例为单纯性IPA感染。13例IPA感染受者给予伏立康唑注射液治疗（3例为确诊病例,10例为临床诊断病例）,其中2例合并或序贯给予米卡芬净;另2例临床诊断病例给予伊曲康唑注射液治疗。共有9例受者治愈,6例死亡。结论 GM试验、肺部CT检查等对肾移植术后IPA感染具有一定的诊断价值,结合临床表现,能够较早诊断IPA感染,有助于及时进行早期治疗,提高患者生存率。     

侵袭性肺部曲霉菌病生物标志物研究进展

侵袭性肺部曲霉菌病（IPA）主要影响免疫抑制宿主,该类宿主包括血液病患者和干细胞移植受者。过去十年中,易感人群数量急剧增加,在非粒细胞减少患者中IPA发病率为0.33%～5.8%。诊断为IPA的非粒细胞减少患者预后差,主要是因诊断延迟,病死率超过80%。IPA诊断仍面临困难,尤其在非粒细胞减少的患者中,主要原因是缺少特异临床表现、微生物和影像学方法等检测敏感性较低,于定植菌中鉴别感染十分困难;故获得新的特异性生物标志物十分必要。     

Improved outcome of pulmonary aspergillosis in heart transplant recipients with early diagnosis and itraconazole treatment

Pulmonary aspergillosis is a severe complication in heart transplant recipients. The drug of choice for this infection is amphotericin B, but its use is limited because of its side effects. We observed six cases of pulmonary aspergillosis in a group of 200 patients who had received heart transplants from January 1988 to January 1999. Predisposing factors such as previous rejection, neutropenia and/or cytomegalovirus reactivation were present in all patients. The clinical presentation was characterized by fever and a non-productive cough. X-rays showed monolateral or diffuse infiltrate with or without nodular lesions. The median interval between symptoms and diagnosis was 5 d (range 4–7). Diagnosis was made by culturing trans-tracheal aspirate samples. Aspergillus fumigatus was isolated in 3 patients and A. niger in the other 3. All patients were treated with itraconazole at 200–400 mg/day for 20–60 d and all recovered. One patient treated with the lowest dosage for the shortest term had a recurrence after 1 month and needed a second 30-day course of itraconazole at a higher dosage. No significant side effects were registered. Itraconazole is effective in the therapy of pulmonary aspergillosis, particularly when an early diagnosis is made.     

不明原因咯血的临床特点及治疗

目的探讨不明原因咯血（CH）的发生率、治疗方法及效果。方法回顾性分析231例咯血患者,根据临床检查、胸片、支气管镜及胸部CT结果筛选CH患者,对其临床资料及治疗方法进行分析。结果本组CH的发生率为22.94%（53/231）。对45例（45/53,84.91%）CH患者进行内科保守治疗,对8例（8/53,15.09%）进行支气管动脉栓塞术。20例胸部HRCT可见磨玻璃影。8例支气管动脉造影示支气管动脉增粗、纡曲,3例出现支气管动脉-肺动脉分流。随访1~8年,无咯血复发。结论大部分CH经内科保守治疗能够取得良好止血效果,少部分咯血量较大者需接受介入栓塞治疗,两者均能够取得良好的近远期效果。     

支气管动脉栓塞治疗大咯血

目的探讨支气管动脉栓塞治疗大咯血方法及临床效果。方法采用Seldinger技术．对35例大咯血患者用明胶海绵颗粒栓塞支气管动脉。35例病人中,支气管扩张症29例,肺结核6例。栓塞靶血管39支,其中栓塞1支者31例,栓塞2支者4例（1例支气管动脉＋内乳动脉同时供血）。结果35例患者于栓塞治疗后,获得即刻止血效果,止血成功率达100％。经2-7年的随访,32例未复发,3例于栓塞术后分别5个月、10个月、18个月又出现咯血,行第2次介入治疗．栓塞材料由明胶海绵改为PVA颗粒,明胶海绵＋真丝线段栓塞,随访4年后无再次咯血。结论支气管动脉栓塞是治疗大咯血的有效方法,效果确切,止血迅速。     

肝衰竭患者并发肺曲霉病八例临床分析

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小鼠侵袭性肺曲霉菌病模型的建立

目的建立小鼠侵袭性肺曲霉菌病(IPA)的动物模型。方法将90只小鼠随机分为5组,模型组:于接种前4天和接种前1天腹腔注射环磷酰胺200 mg/kg,通过鼻腔吸入浓度为1×1011/L烟曲霉菌孢子悬液40μl。非环磷酰胺对照组:除以0.9%氯化钠注射液(NS)代替环磷酰胺外,其余操作同模型组。环磷酰胺对照组:以NS代替烟曲霉菌滴鼻,其余操作同模型组。空白对照组:用NS代替环磷酰胺行腹腔注射,以NS代替烟曲霉菌孢子,其余操作同模型组。重组人粒细胞集落刺激因子(G-CSF)组:在模型组基础上,接种真菌孢子1天后皮下注射G-CSF 20μg kg-1 d-1。通过肺组织病理、肺组织真菌培养和血清半乳甘露聚糖测定(GM试验)等确定肺侵袭性曲霉菌病模型是否构建成功。结果肺曲霉菌培养、血清GM试验和病理切片等结果均表明,模型组和G-CSF组均发生了IPA,其余各组均无IPA发生。结论成功建立了小鼠肺曲霉菌模型。     

Benefit of surgical resection of invasive pulmonary aspergillosis in pediatric patients undergoing treatment for malignancies and immunodeficiency syndromes

Purpose: The aim of this study was to evaluate the outcome of children undergoing treatment for malignancy and immunodeficiency syndromes in whom invasive pulmonary aspergillosis (IPA) developed.Methods: The authors reviewed the medical records of all patients treated at their institution from January 1990 to August 1999 for culture-proven pulmonary aspergillus infection.Results: Among the 43 patients studied, the median age at the time of diagnosis of IPA was 13.1 years. The most common primary diagnoses were acute myelogenous leukemia (n = 18) and acute lymphoblastic leukemia (n = 14); 27 patients (63%) had received a bone marrow transplant (BMT). Of the 18 patients who underwent surgical intervention for IPA, 14 (78%) had one operation, whereas the remaining 4 patients had 2. The 4 patients alive at the time this report was written had undergone surgical intervention 2, 10, 23, and 44 months previously respectively. Surgical resection of the involved lung parenchyma was significantly prognostic for survival (P < .001). Other factors that influenced outcome were the extent of pulmonary invasion, steroid use, and the timing of bone marrow transplantation (BMT) in regard to the diagnosis of IPA.Conclusions: The overall mortality rate of children treated for malignancies and immunodeficiency syndromes in who IPA develops remains high, and antifungal therapy alone may not be curative. Surgical resection may provide a small but possibly the only chance for survival. Therefore, we would advocate for resection of all involved tissue, even if it requires reoperation.     

Arterial embolization hyperthermia in porcine renal tissue

BACKGROUND: Arterial embolization hyperthermia (AEH) consists of arterially embolizing tumors with ferromagnetic particles that generate hysteretic heating on exposure to an alternating magnetic field. It was the objective of this study to evaluate AEH using the kidney of a large animal as a tumor model. METHODS: Between 50 and 400 mg of ferromagnetic microspheres (32 microm in diameter) was arterially infused into the kidneys of three pigs. Temperature probes were inserted into renal tissue, skin, and subcutaneous fat. Each subject was then exposed to an alternating magnetic field for 5 min, while under a general anesthetic. A femoral artery catheter was used to monitor the cardiac pulse. Three days after treatment the renal tissue was chemically analyzed for iron content, which was then correlated with tissue heating rates. RESULTS: There was a linear relationship between heating rate and iron concentration (N = 18, correlation = 0.72, P < 0.001) that suggested tissue iron concentrations in the range of 1.55 to 4.05 mg/g would yield tissue heating rates of 0.5 to 1.0 degrees C/min. No temperature increases were detected in control renal tissue (N = 6). The median increase in skin temperature after 5 min of heating was 0.8 degrees C (N = 6, min = 0.7 degrees C, max = 1.3 degrees C), and that in subcutaneous fat was 1.1 degrees C (N = 6, min = 0.8 degrees C, max = 1.2 degrees C). There was no detectable stimulation of cardiac or skeletal muscle or peripheral nerves during treatment. All subjects had uneventful 3-day posttreatment survivals. CONCLUSION: This study has shown that AEH can target deep-seated, vascularized tissue in a large animal with therapeutic temperatures (> 42 degrees C), and that the treatment is safe and well tolerated. Further assessment of treatment schedules should allow for a human trial in the near future.     

伏立康唑联合小剂量高三尖杉酯碱和格列卫治疗慢性粒细胞白血病急变期合并肺曲霉菌感染的疗效评价

目的研究伏立康唑联合小剂量高三尖杉酯碱和格列卫治疗慢性粒细胞白血病（CML）转变为急性白血病（急变期CML）合并肺曲霉菌感染（IPA）的疗效。方法选取CML急变期合并肺曲霉菌感染患者98例,随机分为观察组（49例）和对照组（49例）,两组均给予小剂量高三尖杉酯碱（HHT）和格列卫治疗;对照组加用氟康唑,观察组加用伏立康唑。结果恶性血液病疗效方面,观察组患者有效率为95.92%,对照组有效率为91.84%,两组差异无统计学意义（χ^2=0.952,P〉0.05）;IPA感染疗效方面,观察组患者有效率为81.63%,对照组有效率为65.31%,两组差异具有统计学意义（χ^2=5.137,P〈0.05）;对照组和观察组患者的不良反应发生率分别为55.10%和57.14%,差异无统计学意义（χ^2=1.037,P〉0.05）。结论伏立康唑联合小剂量的HHT和格列卫可作为治疗急变期CML合并IPA感染者一线用药方案,高效且安全。     

血液病患者侵袭性肺曲霉菌病研究进展

侵袭性肺曲霉菌病(IPA)是恶性血液病患者,尤其是接受异基因造血干细胞移植人群真菌感染死亡的主要原因,早期诊治对于降低该类患者发病率和改善预后至关重要。然而,尽管IPA的诊治已有实验室生物学指标、病理及影像学多重证据支持,并已形成较为完善的诊治体系,但因受限于病变部位标本难以获取、非特异性的临床特征及预防性抗真菌药物的积极使用,早期诊断仍然具有挑战性。本综述从曲霉菌对恶性血液病患者的致病机理、临床表现、诊断标准、影像学及实验室检测等现有技术以及下一代基因测序(NGS)应用发展入手,探讨对恶性血液病患者发生IPA的认知及相关研究进展。     

先天性冠状动脉瘘94例治疗体会

目的 总结94例先天性冠状动脉瘘治疗体会。方法 1964年3月至2000年12月共治疗冠状动脉瘘94例，男54例，女40例。年龄9个月－63岁。76例为单纯先天性冠状动脉瘘，18例合并其他心脏畸形。94例中65例冠状动脉瘘起自右冠，29例起自左冠。瘘入右室、右房、左室、肺动脉、左房者依次占41．5％、24．5％、18．1％、11．7％、4．2％。介入栓堵治疗5例；手术治疗89例，其中6例全麻常温下行病变冠状动脉结扎或切断缝合，83例行低温体外循环下直视手术闭合瘘口。结果 死亡1例，为早年常温手术结扎病变的冠状动脉后室颤死亡。23例术后残余瘘，其中1例再次手术。72例随访3个月至23年，无远期死亡。结论 先天性冠状动脉瘘外科手术或介入治疗均安全、有效，远期效果良好。     

聚乙烯醇颗粒子宫动脉栓塞治疗子宫腺肌病

目的观察PVA(聚乙烯醇)颗粒子宫动脉栓塞(UAE)治疗子宫腺肌病的临床效果。方法对26例根据临床症状、彩色超声或磁共振成像检查诊断为子宫腺肌病的患者行UAE治疗。术后观察月经量、痛经程度及子宫体积等变化。结果26例患者子宫动脉栓塞均一次成功，UAE治疗后平均观察5个月，21例患者术后痛经完全消失，3例明显缓解，2例缓解7～9个月后复发；临床显效率达92．3％；月经量明显减少，而月经周期及经期无变化；术后疼痛评级比术前明显降低，彩色超声或．MR检查显示子宫体积明显缩小。结论PVA栓塞剂子宫动脉栓塞治疗子宫腺肌病是一种近期疗效显著、安全有效的治疗途径。     

Arterial switch operation using aortic homograft for transposition of the great arteries with pulmonary regurgitation

We report a case of a 15 month-old boy who underwent the arterial switch operation using cryopreserved aortic homograft for transposition of the great artries with pulmonary regurgitation, with coexisting right ventricular outflow tract obstruction precluding atrial switch operation. Follow-up echocardiography at 6 months showed trivial neoaortic valve regurgitation, no significant systemic outflow obstruction, with good cardiac function. In small children, the choice of material for left ventricular outflow tract reconstruction is one of the most crucial issues. Cryopreserved homograft has been one of the primary options for the aortic valve replacement in small children because of the ease of suturing and excellent hemostasis.     

非小细胞肺癌伴对侧肺内结节的外科治疗

目的 探讨非小细胞肺癌伴对侧肺结节的诊断及治疗.方法 24例获明确诊断的非小细胞肺癌患者伴对侧肺结节,均接受手术治疗,术后辅助放、化疗,并定期跟踪随访14～21个月.结果 24例患者中,其中6例有原发或转移癌;肺结节的大小,原发癌的病理类型和分期与结节性质之间无联系.结论 非小细胞肺癌患者伴对侧肺结节,如果不能取得病理...