肝癌的冷冻治疗

冷冻疗法已成为治疗不能手术切除肝癌的重要手段.冷冻方法可选择手术中冷冻,切除或不切除肿瘤、腹腔镜下冷冻,或在超声、cT或MRI监测下,经皮冷冻.作为一局部治疗,冷冻具有超越其他治疗方法的若干优点:仅消融肝内肿瘤组织,而少伤及正常组织;由于大血管流动血流的温热作用,冷冻可安全地治疗临近大血管的肝肿瘤:冷冻比之手术更适宜治疗肝多发性肿瘤.冷冻联合肝动脉化学栓塞(TACE)、酒精注射或125碘粒子植入,有相辅相成的作用.对于冷冻在肝癌治疗中应用,可归结如下:(1)小于5 cm,尤其小于3 cm的肝癌,数目不超过3个,可以手术中冷冻或经皮冷冻.(2)大于5 cm的肝癌,先作TACE,再给予经皮冷冻.(3)大于5 cm,边缘不整,预计冷冻不完全的肝癌,可予手术中或经皮冷冻,同时在冷冻区周边部注射酒精或植入125碘粒子.     

比索洛尔和依那普利对高血压病治疗的比较观察

对１４５例原发性高血压患者分组应用比索洛尔（Ｂｉｓｏｐｒｏｌｏｌ）与依那普利（Ｅｎａｌａｐｒｉｌ）治疗，以观察各自疗效。结果显示：①比素洛尔总有效率８７．５％，依那普利总有效率７８．７％，两者疗效有明显差异。②对心率、血脂、血糖、血清电解质、血像和肝肾功能观察期间均无不良影响。③比索洛尔每晨只服１次即可维持疗效，使用方便，副作用小，耐受性好。     

先天性胆总管扩张症38例分析

目的 研究胆总管扩张症的正确诊断与治疗方法。方法 回顾性分析1985年1月至2004年1月我科手术治疗的38例先天性胆总管扩张症患者的资料，术后平均随访50个月。结果 行胆总管十二指肠吻合术2例，胆总管空肠Roux—Y吻合术9例，行胆总管扩张部切除加肝总管空肠Roux—Y吻合术27例；术后胆瘘3例，胰瘘并腹腔出血各1例，无手术死亡。结论 胆总管扩张部切除加胆肠Roux—Y吻合是本病的主要治疗方法，疗效好，局限性肝内胆管扩张可行部分肝叶切除术。     

Intervertebral focal surgery for the treatment of non-contiguous multifocal spinal tuberculosis

Purpose

The purpose of this study was to assess the clinical efficacy of intervertebral focal surgery by complete debridement, deformity correction, graft fusion, and internal fixation for patients with non-contiguous multifocal spinal tuberculosis.

Methods

A total of 29 cases with non-contiguous multifocal spinal tuberculosis admitted to the hospital from January 2000 to January 2007 were treated by intervertebral focal surgery. There were 63 foci in 29 cases, averaging 2.2 foci per case, and 146 affected vertebral bodies, averaging 2.3 vertebral bodies per focus. Three cases had one normal intervertebral disc between two foci, and the other 26 cases had two or more normal intervertebral discs between two foci.

Results

All cases were followed-up for an average of five years. The kyphosis showed a mean correction rate of 67.7% after surgery. A mean loss rate of correction of 8.2% was observed at the final follow-up. The levels of erythrocyte sedimentation rate and C-reactive protein returned to normal in 27 cases on average at 5.8 months and bone union could be observed at five months after surgery. Eleven cases with nerve damage recovered to E grade at the final follow-up.

Conclusions

Intervertebral focal surgery by complete debridement, deformity correction, graft fusion, and internal fixation for patients with non-contiguous multifocal spinal tuberculosis was feasible and effective.     

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia

Objective

Laparoscopic simple prostatectomy for large volume benign prostatic hyperplasia (BPH) has been reported in the literature and may be a viable alternative to open surgery for large prostate glands. While previous publications have shown comparable outcomes between laparoscopic and open simple prostatectomy, there have been few publications describing improved laparoscopic operative technique to further improve these outcomes. The authors describe a novel technique of prostatic urethra preservation during laparoscopic simple prostatectomy.

Materials and methods

From January 2006 to September 2009, laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 51 patients with symptomatic BPH. This technique included extraperitoneal insufflation of the retropubic space by balloon dilation, placement of five trocars in an inverted U shape, transverse prostatic capsular incision, development of a subcapsular plane, and removal of prostatic adenoma with preservation of the prostatic urethra followed by suturing of the prostatic capsule. Demographic, perioperative and outcome data were recorded.

Results

The mean operative time was 126±51.98 min and the estimated blood loss was 232.55±199.54 mL. Significant improvements were noted in the International Prostate Symptom Score (IPSS), quality of life (QOL) questionnaires and maximum flow rate (Q_max) of patients three months after surgery. No incontinence was reported in any patient. Moreover, there was no significant difference in the 5-Item International Index of Erectile Function (IIEF-5) score pre- and post- operatively in patients who had erectile function before surgery and no patient complained of retrograde ejaculation during the postoperative follow-up period.

Conclusions

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia is feasible and reproducible. With this technique, postoperative morbidity can be reduced and antegrade ejaculation preserved.KEY WORDS : Benign prostatic hyperplasia, laparoscopy, prostate, prostatectomy     

慢性移植肾损伤的组织弥散定量分析与血肌酐水平的相关性研究

目的 探讨实时组织弹性成像(RTE)技术的组织弥散定量分析在慢性移植肾损伤的应用及与血肌酐水平的相关性.方法 同种异体肾移植患者69例,均行常规超声检查和实时组织弹性检查,按血肌酐水平及术后时间分为三组:术后3个月内肌酐正常组(A组,25例)、术后3个月以上高肌酐组(B组,23例)、术后3个月以上肌酐正常组(C组,21例),并对结果进行对比分析.结果 ①A组与B组比较,血肌酐、组织弥散定量分析参数应变均值(MEAN)、蓝色领域(％AREA)、复杂度(COMP)、峰度(SKEW)、相关性(CO RR)差异有统计学意义(P＜0.05).②B组血肌酐与组织弥散定量分析参数(MEAN、％AREA、SKEW)之间有相关性(r=0.682,P＜0.05;r=-0.628,P＜0.05;r=-0.481,P＜0.05).③对组织弥散定量分析参数作ROC曲线,MEAN敏感性较高(90.9％),COMP特异性、准确性较高(68.0％,81.8％).④将结果三所得截点应用到C组,结果显示21例中有4～5例高于或低于截点.结论 RTE的组织弥散定量分析与血肌酐水平有良好的相关性,可以间接反映慢性移植肾损伤,是超声评价移植肾功能的新方法.     

Deletion of Myeloid Interferon Regulatory Factor 4 (Irf4) in Mouse Model Protects against Kidney Fibrosis after Ischemic Injury by Decreased Macrophage Recruitment and Activation

BackgroundAKI is characterized by abrupt and reversible kidney dysfunction, and incomplete recovery leads to chronic kidney injury. Previous studies by us and others have indicated that macrophage infiltration and polarization play key roles in recovery from AKI. The role in AKI recovery played by IFN regulatory factor 4 (IRF4), a mediator of polarization of macrophages to the M2 phenotype, is unclear.MethodsWe used mice with myeloid or macrophage cell–specific deletion of Irf4 (MΦ Irf4 ^−/−) to evaluate Irf4’s role in renal macrophage polarization and development of fibrosis after severe AKI.ResultsSurprisingly, although macrophage Irf4 deletion had a minimal effect on early renal functional recovery from AKI, it resulted in decreased renal fibrosis 4 weeks after severe AKI, in association with less-activated macrophages. Macrophage Irf4 deletion also protected against renal fibrosis in unilateral ureteral obstruction. Bone marrow–derived monocytes (BMDMs) from MΦ Irf4 ^−/− mice had diminished chemotactic responses to macrophage chemoattractants, with decreased activation of AKT and PI3 kinase and increased PTEN expression. PI3K and AKT inhibitors markedly decreased chemotaxis in wild-type BMDMs, and in a cultured macrophage cell line. There was significant inhibition of homing of labeled Irf4 ^−/− BMDMs to postischemic kidneys. Renal macrophage infiltration in response to AKI was markedly decreased in MΦ Irf4 ^−/− mice or in wild-type mice with inhibition of AKT activity.ConclusionsDeletion of Irf4 from myeloid cells protected against development of tubulointerstitial fibrosis after severe ischemic renal injury in mice, due primarily to inhibition of AKT-mediated monocyte recruitment to the injured kidney and reduced activation and subsequent polarization into a profibrotic M2 phenotype.     

皮肤血管平滑肌脂肪瘤一例

患者男,26岁,左面部皮下包块1年于2019年5月9日至宿迁市第一人民医院皮肤科就诊。1年前患者触及左面部有一黄豆大小皮下包块,生长缓慢,随气温变化其大小略有改变。既往体健,无结节性硬化症、神经纤维瘤病家族史……