Results of percutaneous transluminal angioplasty

Percutaneous transluminal angioplasty (Dotter technique) was used in 2,942 cases of iliofemoral atheromatous disease. Results varied with the characteristics of the obstructing lesion (length and location) and the clinical stage of ischemia (claudication, rest pain, gangrene). Based on the foregoing, angioplasty is done either as the preferred primary treatment or for the relief of clinically advanced disease in patients unsuitable for high risk surgery. Success is favored by the use of aggregation inhibitors and single-use Teflon or balloon catheters; complications are few.     

Dynamic probabilistic model for determination of optimal timing of surveillance chest radiography in pediatric Hodgkin disease

A dynamic probabilistic model based on hazard rate analysis, Monte Carlo modeling, and lead-time estimation techniques was developed to determine the optimal timing and frequency of chest radiography in the monitoring for relapse of children with treated Hodgkin disease. The analysis incorporates the performance characteristics of chest radiography, the natural history of the disease process, and therapeutic efficacy as a function of earliness of detection in the determination of optimal strategy. Examples of the model applied to the experiences of Stanford Medical Center and St. Jude Children's Research Hospital illustrate the utility of such a model in customizing an optimal monitoring strategy for a specific institution and clinical experience. The results suggest that monitoring protocols significantly overutilize chest radiography in the evaluation for recurrent Hodgkin disease in children.     

L-精氨酸对5/6肾大部切除大鼠残余肾代偿性增生的影响

目的观察１％Ｌ－精氨酸（Ｌ－ａｒｇ）饮食对５／６肾大部切除大鼠（ＳＮｘ）残余肾代偿性增生（ＣＲＧ）的影响。方法实验分组：（１）假手术（ｓｈａｍ）组；（２）ｓｈａｍ＋Ｌ－ａｒｇ组；（３）ＳＮｘ组；（４）ＳＮｘ＋Ｌ－ａｒｇ组。大鼠于术后３０天处死，观察Ｌ－ａｒｇ对残余肾湿重（ＫＷ）、肾重／体重比（ＫＷ／ＢＷ）、ＣＲＧ、残余肾蛋白质、ＤＮＡ含量、细胞增生以及平均肾小球体积（ＶＧ）的影响。结果Ｌ－ａｒｇ明显增加ＫＷ（Ｐ＜０．０５）、ＫＷ／ＢＷ（Ｐ＜０．０５）、ＣＲＧ（Ｐ＜０．０５）以及残余肾蛋白质、ＤＮＡ含量（Ｐ分别＜０．０１，０．００１）。免疫组化显示，残余肾小管、间质增殖细胞核抗原（ＰＣＮＡ）阳性细胞数明显增加（Ｐ＜０．０５）。此外，ＳＮｘ＋Ｌ－ａｒｇ组ＶＧ较ＳＮｘ组增加１６％。结论Ｌ－精氨酸可能刺激残余肾代偿性增生，此为限制Ｌ－精氨酸饮食治疗慢性肾衰提供了理论依据     

中草药库房管理的现状分析及经验探讨

为了探讨和分析中草药库房管理的现状以及经验,在谷歌学术、中国知网、万方医学网等网站以中草药库房管理、现状及经验为关键词进行检索,然后结合本院中草药库房管理的实际经验,对近年来有关中草药库房管理的文献进行分析、总结,探讨和分析中草药库房管理的现状及经验。通过总结分析发现,在入库时对药品的质量进行验收,在储存时控制储存药材的条件,对库房进行微机化管理,能够有效保证中草药的质量和中草药的临床用药安全。加强对中草药库房的质量安全管理,可以保证患者的临床用药安全,更好的服务于临床。     

Long-term outcomes of liver transplant patients with human immunodeficiency virus infection and end-stage-liver-disease: single center experience

Objective

Orthotopic-liver-transplantation (OLT) in patients with Human-Immunodeficiency-Virus infection (HIV) and end-stage-liver-disease (ESDL) is rarely reported. The purpose of this study is to describe our institutional experience on OLT for HIV positive patients.

Material and methods

This is a retrospective study of all HIV-infected patients who underwent OLT at the University Hospital of Essen, from January 1996 to December 2009. Age, sex, HIV transmission-way, CDC-stage, etiology of ESDL, concomitant liver disease, last CD4cell count and HIV-viral load prior to OLT were collected and analysed. Standard calcineurin-inhibitors-based immunosuppression was applied. All patients received anti-fungal and anti-pneumocystis carinii pneumonia prophylaxis post-OLT.

Results

Eight transplanted HIV-infected patients with a median age of 46 years (range 35-61 years) were included. OLT indications were HCV (n = 5), HBV (n = 2), HCV/HBV/HDV-related cirrhosis (n = 1) and acute liver-failure (n = 1). At OLT, CD4 cell-counts ranged from 113-621 cells/μl, and HIV viral-loads from < 50-175,000 copies/ml. Seven of eight patients were exposed to HAART before OLT. Patients were followed-up between 1-145 months. Five died 1, 3, 10, 31 and 34 months after OLT due to sepsis and graftfailure respectively. Graft-failure causes were recurrent hepatic-artery thrombosis, HCV-associated hepatitis, and chemotherapy-induced liver damage due to Hodgkin-disease. One survivor is relisted for OLT due to recurrent chronic HCV-disease but non-progredient HIV-infection 145 months post-OLT. Two other survivors show stable liver function and non-progredient HIV-disease under HAART 21 and 58 months post-OLT.

Conclusions

OLT in HIV-infected patients and ESLD is an acceptable therapeutic option in selected patients. Long-term survival can be achieved without HIV disease-progression under antiretroviral therapy and management of the viral hepatitis co-infection.     

Large myelomeningocele repair

Background:

Wound closure is accomplished in most cases of myelomeningocele (MMC) by undermining of the skin edges surrounding the defect. However, large defects cannot be closed reliably by this simple technique. Due to the technical challenge associated with large MMC, surgeons have devised different methods for repairing large defects. In this paper, we report our experience of managing large defects, which we believe bears a direct relationship to decrease the incidence of wound complications.

Materials and Methods:

Forty children with large MMCs underwent surgical repair and represent our experience. We recommend using all hairy skin around the defect as a way to decrease the tension on the edges of the wound and the possible subsequent necrosis. It is our experience that vertical incision on one or two flanks parallel to the midline can decrease the tension of the wound. Moreover, ventriculo-peritoneal shunting for children who developed hydrocephalus was performed simultaneously, which constitutes another recommendation for preventing fluid collection and build up of pressure on the wound.

Results:

Patients in this study were in the age range of 2 days to 8 years. The most common location of MMC was in the thoracolumbar area. All but four patients had severe weakness in lower extremities. We used as much hairy skin around the MMC sac as possible in all cases. Vertical incisions on one or both flanks and simultaneous shunt procedure were performed in 36 patients. We treated children with large MMC defects with acceptable tension-free closure. Nonetheless, three patients developed superficial skin infection and partial wound dehiscence, and they were managed conservatively.

Conclusions:

We recommend using all hairy skin around the MMC defect for closure of large defects. In cases that were expected to be at a higher risk to develop dehiscence release incisions on one or two flanks towards the fascia were found to be useful. Simultaneous ventriculo-peritoneal shunting is also recommended in this cohort of patients, according to our experience. These recommendations neither prolong the time of surgery nor increase the cost, but facilitate a successful closure.     

Immunological effect of aqueous extract of Vernonia amygdalina and a known immune booster called immunace® and their admixtures on HIV/AIDS clients: a comparative study

Objective

To investigate the immunological effect of Vernonia amygdalina (V. amygdalina) leaf extract and immunace^® on HIV infected patients taking highly active antiretroviral therapy.

Methods

Fresh V. amygdalina leaves were collected within Nsukka area in Enugu State. The leaves were rinsed with distilled water. Two handful of cleaned fresh leaves were soaked in 200 mL water and squeezed gently by hand to a mixture. Clients were divided into four groups and each group was given different combination. They took the medication for four weeks. The immune effect was tested against marketed immune booster in some retroviral clients.

Results

The mean absolute CD4 count was increased in the client who took the extract or supplement. And the clients who took both the extract and supplement had a greater increase in the CD4 count. The increased CD4 was significant as compared with the control group (P<0.05). The skin rashes were also improved in the entire groups.

Conclusions

It can be concluded that the aqueous extract of V. amygdalina and immunace or both have immunological effect on HIV infected patients. Therefore, we suggest that the V. amygdalina extract or immunace or both could be used as adjuvant in the management of HIV/AIDS clients.