慢性移植肾失功后的移植肾切除手术分析

目的:分析总结因慢性移植肾失功而行移植肾切除手术患者的临床治疗经过,进一步探讨这类手术的安全性和适应证。方法:以慢性移植肾失功患者76例为研究对象,年龄23~72(36.6±13.5)岁,以上患者发生慢性移植肾失功的时间为术后11~91(35.8±24.6)个月,转入血液透析的时间为3~33(10.4±6.2)个月。76例患者均实施了移植肾切除手术,移植肾切除术后随访时间为6个月~5年。结果:平均手术时间50(35~180)min;术中平均出血量450(200~2 600)ml,平均输血量300(400~2 400)ml,其中67例进行了自体血液回收后输血。术后平均引流量250(20~1 100)ml,平均住院时间11(5~23)d。术后主要并发症:切口血肿8例,切口感染10例,消化道出血7例,心衰7例,肺部感染5例,肾上腺危象2例,下肢跛行2例。死亡4例。多数患者的体重指数、血红蛋白及血清白蛋白含量较术前有所提高。结论:慢性移植肾失功后的移植肾切除手术为高风险手术,应积极做好术前准备,同时加强围手术期护理,以降低手术并发症的发生率;积极适时地切除已经完全失功了的移植肾,有助于改善患者身体素质,避免免疫抑制的不良反应,同时有利于减轻患者本人及社会的经济负担。     

Purification of hemopoietic progenitor cells from human marrow using a fucose-binding lectin and cell sorting

Human peripheral blood granulocytes, but not lymphocytes, erythrocytes, or monocytes, bound the fucose-binding lectin from Lotus tetragonolobus (FBP), and this binding was competitively inhibited by the sugar alpha- L-fucose. The fluorescence-activated cell sorter was used to study the appearance of this receptor on human marrow cells during granulocyte differentiation and to prepare fractions enriched for granulocyte- macrophage progenitor cells (granulocyte-macrophage colony-forming cells--GM-CFC). Cell binding of fluoresceinated FBP increased for bone marrow cells in the sequence--lymphocytes, blast cells, promyelocytes and myelocytes, monocytes, and polymorphonuclear cells. Selection of cells with appropriate low-angle or high-angle light scatter characteristics achieved a 10-fold or 2-3-fold enrichment of progenitor cells, respectively. By selecting cells with intermediate fluorescence intensity, a further 2-3-fold enrichment for GM-CFC was obtained. Cell sorting using the optimal selection of these three parameters produced up to 36-fold enrichment of the progenitor cells from human bone marrow. The most enriched fraction was composed of 23% progenitor cells (colony- and cluster-forming cells) with a yield of 36%. In populations most highly enriched by GM-CFC, immature cells (blast cells, promyelocytes, and myelocytes) made up 95% of the cells present.     

Sebaceous carcinoma of the lip: Comparing normal lip and cheek anatomy with the imaging features of a rare cutaneous malignancy

Sebaceous carcinoma is a rare cutaneous malignancy, commonly affecting the eyelids. This case highlights a patient who presented with sebaceous carcinoma of the right upper lip with extensive involvement of the soft tissues of the head and neck. As part of the initial investigation, ultrasound was requested. This case demonstrates the ultrasound features of sebaceous carcinoma as well as revising the normal ultrasound anatomy of the upper lip and muscles of the cheek.     

Establishing and managing a periodontal biobank for research: the sharing of experience

Periodontal bio‐repositories, which allow banking of clinically validated human data and biological samples, provide an opportunity to derive biomarkers for periodontal diagnosis, prognosis and therapeutic activities which are expected to improve patient management. This article presents the establishing of the Malaysian Periodontal Database and Biobank System (MPDBS) which was initiated in 2011 with the aim to facilitate periodontal research. Partnerships were established with collaborating centres. Policies on specimen access, authorship and acknowledgement policies were agreed upon by all participating centres before the initiation of the periodontal biobank. Ethical approval for the collection of samples and data were obtained from institutional ethics review boards. A broad‐based approach for informed consent was used, which covered areas related to quality of life impacts, genetics and molecular aspects of periodontal disease. Sample collection and processing was performed using a standardized protocol. Biobanking resources such as equipment and freezers were shared with the Malaysian Oral Cancer Database and Tissue Bank System (MOCDTBS). In the development of the MPDBS, challenges that were previously faced by the MOCDTBS were considered. Future challenges in terms of ethical and legal issues will be faced when international collaborations necessitate the transportation of specimens across borders.     

介入封堵与外科手术治疗主动脉窦瘤破裂的疗效及安全性

目的比较介入封堵与外科手术治疗主动脉窦瘤破裂(RSVA)的疗效及安全性。方法选取RSVA患者22例,介入封堵治疗10例(介入组),外科手术治疗12例(手术组)。术后随访6—24个月,比较两组临床症状、是否存在残余分流、有无瓣膜反流、封堵器有无移位、肺动脉压变化及心功能状态。结果介入组均完全封堵;与术中比较,术后肺动脉收缩压、肺动脉平均压均降低,差异均有统计学意义(P均0.05);术后即刻造影示少量残余分流1例。手术组完全封堵率为91.67%(11/12);术后出现较大的残余分流和严重低心排量综合征各1例。两组随访期内均未发生右心衰竭、栓塞、感染性心内膜炎、主动脉瓣反流、溶血和死亡等。结论介入封堵治疗主动脉窦瘤破裂与外科修补疗效相当,且具有较好的安全性。     

前哨淋巴结活检判断口腔癌颈部淋巴结转移的系统评价

目的:系统评价前哨淋巴结活检(SLNB)预测口腔癌颈淋巴结转移的临床价值。方法:通过计算机检索CENTRAL、Medline、EMBASE、IFCC、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(CQVIP)、万方数据库等,收集应用前哨淋巴结活检判断口腔癌颈淋巴转移的诊断试验,应用统计软件Meta-DiSc 1.4进行数据分析。结果:纳入分析的文献9篇,前哨淋巴结活检判断口腔癌颈淋巴转移的敏感度、特异度、阳性似然比(+LR)、阴性似然比(-LR)、诊断优势比(DOR)及系统接收操作特性曲线(SROC)下面积分别为84%(95%CI 73%～92%)、100%(95%CI97%～100%)、19.16(95%CI 7.65～47.77)、0.22(95%CI 0.10～0.51)、97.72(95%CI 29.69～321.61)和0.99。结论:前哨淋巴结活检可作为临床上判断口腔癌颈淋巴结转移有效可行的方法。     

头颈部侵袭性纤维瘤9例及文献复习

目的:探讨头颈部侵袭性纤维瘤的临床表现、病理特征、治疗方式及预后.方法:根据2005年世界卫生组织的肿瘤类指导原则,回顾性分析2008 ～ 2012年间收治9例头颈部侵袭性纤维瘤的临床资料并复习相关文献.结果:发病部位以颈部(3例)、下颌下区(2例)最为常见,其次是上颌骨、颧部、眶下区、腮腺各1例,对9例患者都实施手术切除,4例患者因肿瘤已侵犯头颈部重要结构,无法获得阴性切缘,其中1例患者发生恶变,接受放射治疗,另2例术后未接受综合治疗,术后复发,所有病例无远处转移,随访时间为6 ～51个月.结论:头颈部侵袭性纤维瘤诊断主要依靠术后病理,彻底手术切除是治疗并减少复发的主要手段,对于复发或难以完整切除的病例可配合放化疗,且术后长时间密切随访.