胃代膀胱术远期疗效观察

目的 探讨胃代膀胱术的远期疗效。方法 对1991年5月至2003年10月30例胃代膀胱术患者的临床资料进行统计分析。其中膀胱肿瘤28例，结核性膀胱挛缩2例。结果 随访8～13年，平均10年。30例全身健康情况良好，日间排尿满意，3例偶有夜间尿失禁。1例术后19个月发生代膀胱穿孔，经抗酸和手术治疗痊愈。30例肾功能正常，无电解质紊乱；24例排尿前后胃泌素及尿液pH检查正常；4例有无症状菌尿。13例代膀胱黏膜活检为慢性炎症，壁细胞减少；9例免疫组化检查G细胞较正常减少。尿动力学检查代膀胱容量及顺应性正常，排尿期贮尿囊压力低于正常。10例行排尿期膀胱造影无输尿管返流，5例B超示肾集合系统轻度扩张。1例低压胃膀胱成形术，1例胃与后尿道逆蠕动吻合，剩余尿分别为150ml和250ml。1例出现血尿尿痛综合征，经抗酸及碱化尿液治疗后缓解。结论 胃代膀胱术远期疗效满意，是一种较好的尿流改道方法。     

经皮腘静脉插管造影术临床应用研究

自1990年起，对38条静脉病变的下肢，通过静脉向近侧插管，将导管置于每对瓣膜下方注入造影剂，观察屏气时造影剂的泄漏量和程度。结果证明，本检测方法能清晰显示下腔静脉和髂静脉，更能定位检测深静脉中各对瓣膜的功能，从而为探讨发病机理、明确诊断和手术方法选择，提供可靠的依据。     

Cortical Thinning Correlates with Cognitive Change in Multiple Sclerosis but not in Neuromyelitis Optica

Objectives

To compare spatial patterns of cortical thickness alterations in neuromyelitis optica (NMO) and multiple sclerosis (MS); and to investigate the correlations between cortical thinning and clinical variables in NMO and MS.

Methods

We studied 23 patients with NMO, 27 patients with MS and 26 healthy controls (HCs). The global, brain region and vertex-based cortical thickness (CTh) were analysed and compared among the three groups. A general linear model was used to investigate the correlations between cortical thinning and clinical measures.

Results

A limited number of cortical regions in visual cortex were found to be significantly thinner in NMO patients than in HCs. The MS patients exhibited more widespread cortical thinning compared with HCs, and significantly greater cortical thinning in the insula and the parahippocampus compared with NMO. The extent of cortical thinning in several brain regions correlated with cognitive measures in MS, but not in NMO.

Conclusions

Neocortical thinning in NMO mainly affects visual cortex, while MS patients show much more extensive cortical thinning. Cognitive changes are correlated with cortical atrophy in MS not in NMO. The substrates of cognitive changes in MS and NMO could therefore be different.

Key Points

? MS patients show much more extensive cortical thinning than NMO. ? Cortical thinning of insula and parahippocampus particularly distinguishes MS from NMO. ? Cognitive changes are correlated with cortical atrophy in MS but not in NMO.     

Laparoscopic repair of hiatus hernia: Does mesh type influence outcome? A meta-analysis and European survey study

Background

Synthetic mesh (SM) has been used in the laparoscopic repair of hiatus hernia but remains controversial due to reports of complications, most notably esophageal erosion. Biological mesh (BM) has been proposed as an alternative to mitigate this risk. The aim of this study is to establish the incidence of complications, recurrence and revision surgery in patients following suture (SR), SM or BM repair and undertake a survey of surgeons to establish a perspective of current practice.

Methods

An electronic search of EMBASE, MEDLINE and Cochrane database was performed. Pooled odds ratios (PORs) were calculated for discrete variables. To survey current practice an online questionnaire was sent to emails registered to the European Association for Endoscopic Surgery.

Results

Nine studies were included, comprising 676 patients (310 with SR, 214 with SM and 152 with BM). There was no significant difference in the incidence of complications with mesh compared to SR (P = 0.993). Mesh significantly reduced overall recurrence rates compared to SR [14.5 vs. 24.5 %; POR = 0.36 (95 % CI 0.17–0.77); P = 0.009]. Overall recurrence rates were reduced in the SM compared to BM groups (12.6 vs. 17.1 %), and similarly compared to the SR group, the POR for recurrence was lower in the SM group than the BM group [0.30 (95 % CI 0.12–0.73); P = 0.008 vs. 0.69 (95 % CI 0.26–1.83); P = 0.457]. Regarding surgical technique 503 survey responses were included. Mesh reinforcement of the crura was undertaken by 67 % of surgeons in all or selected cases with 67 % of these preferring synthetic mesh to absorbable mesh. One-fifth of the respondents had encountered mesh erosion in their career.

Conclusions

Both SM and BM reduce rates of recurrence compared to SR, with SM proving most effective. Surgical practice is varied, and there remains insufficient evidence regarding the optimum technique for the repair of hiatal hernia.

     

A novel “cooled-wet” electrode for radiofrequency ablation

In the light of growing demands for improved applicability of radiofrequency ablation (RFA), recently we have developed a novel “cooled-wet” electrode by taking the advantages of both internally cooled and saline-enhanced electrodes. The efficacy of the electrode was evaluated in both ex vivo and in vivo liver RFA under both low and high power output levels. The ablation volume created with the “cooled-wet” electrode appeared to be much larger than that reported up to now with the use of other monopolar electrodes. The mechanisms on how this device optimizes the RF energy delivery are also discussed. Received: 3 December 1999; Accepted: 6 December 1999     

Study of telomerase activity in pleural lavage fluid specimens in patients with non-small-cell lung cancer and its clinical significance

Objective: To detect telomerase activity in pleural lavage fluid specimens in patients with non-small-cell lung cancer (NSCLC) and to evaluate its clinical value. Methods: From July 2005 to May 2007, 167 pleural lavage fluid specimens were obtained from 135 patients with NSCLC and 32 patients with benign lung tumour during operation. Telomeric repeated amplification protocol (TRAP)-enzyme-linked immunosorbent assay (ELISA) was performed to measure the telomerase activity in these specimens. Pleural lavage cytology (PLC) analysis of the pleural lavage fluid specimens was used for comparison. All the above specimens were examined within 3 h. Results: The positive rate of telomerase activity and PLC in pleural lavage fluid from patients with NSCLC was 25.2% (34/135) and 8.1% (11/135), respectively, with a significant difference (P < 0.05). Telomerase activity was detected in all 11 specimens with positive cytological examination. Telomerase activity was negative in all 32 patients with benign lung tumour. There was a significant relationship between telomerase activity and pleural extension, T level, N level as well as the clinical TNM (tumour, node, metastasis) stage of lung cancer. A significant association was found between positive telomerase activity and overall survival rate, even stage I survival rate. Multivariate Cox regression analysis demonstrated that telomerase activity, as well as PLC and the TNM stage were independent predictors of prognosis. Conclusion: Telomerase activity is a useful adjunct for cytological method in the diagnosis of pleural micro-metastasis and was related to prognosis in a patient with NSCLC.     

Inhibition of Autophagy by 3-MA Enhances the Effect of 5-FU-Induced Apoptosis in Colon Cancer Cells

Background  5-fluorouracil-(5-FU)-based adjuvant chemotherapy is widely used for the treatment of colorectal cancer. However, 5-FU resistance in the course of treatment has become more common. Therefore, new therapeutic strategies and/or new adjuvant drugs still need to be explored. Methods  Two colon-cancer-derived cell lines, colon26 and HT29, were used to investigate the effect of 5-FU, 3-methyladenine (3-MA, an autophagy inhibitor), or their combination on apoptotic cell death and autophagy. MTT assay, Hochest plus propidium iodide (PI) staining, and DNA fragmentation assay were used to observe apoptosis. Meanwhile, monodansylcadaverine (MDC) was used to detect autophagy. Finally, immunoblotting assay was used to explore the molecular change that occurred. Results  We observed the apoptosis induced by 5-FU in colon cancer cells. Meanwhile, autophagy was also stimulated. The combination treatment of 3-MA and 5-FU significantly increased the apoptotic cell death. By isolating the subcellular fractions of mitochondria and cytosol, we observed that the release of cytochrome c was increased in combination-treated cells. Cytochrome c resulted in the activation of caspase-3, thus activating PARP. Moreover, the anti-apoptotic protein, Bcl-xL, was significantly downregulated by 3-MA. Conclusions  Our results suggest that 5-FU-induced apoptosis in colon cancer cells can be enhanced by the inhibitor of autophagy, 3-MA. Autophagy might play a role as a self-defense mechanism in 5-FU-treated colon cancer cells, and its inhibition could be a promising strategy for the adjuvant chemotherapy of colon cancer.     

糖尿病重症脑梗死患者早期肠内营养的效果观察及护理

目的探讨早期肠内营养对2型糖尿病重症脑梗死患者身体功能恢复的效果。方法将84例患者随机分为观察组（42例）和对照组（42例）。对照组行肠外营养支持3～4d后予鼻饲流质,观察组行早期肠内营养,2周后评价效果。结果观察组营养状况、神经功能缺损程度评分显著优于对照组（均P〈0．05）。两组不良反应及并发症发生率（除外上消化道出血）比较,差异无统计学意义（均P〉0．05）。结论早期肠内营养能够保持2型糖尿病重症脑梗死患者正常营养状态并有利于神经功能的恢复,且安全。     

Successful use of posterior instrumented spinal fusion alone for scoliosis in 19 patients with neurofibromatosis type-1 followed up for at least 25 months

Introduction  Posterior instrumented fusion alone has been considered inadequate to correct scoliosis in most patients with neurofibromatosis type-1 (NF-1) because of their weak bone structure. This study was undertaken to evaluate whether the extension of fusion one level beyond the conventional fusion level would enable posterior instrumented fusion alone to be as effective as anterior–posterior fusion in treating patients with NF-1 and scoliosis who are more than 10 years old and whose scoliosis is <90°. Methods  Nineteen patients with NF-1 were treated surgically with long, posterior instrumented fusion for scoliosis from 1998 to 2004. Among the patients, 3 had nondystrophic curves, and 16 had dystrophic curves. Posterior fusions were performed that used abundant bone grafts, and included neutral and stable vertebrae in both the coronal and sagittal planes and any coronal curves of more than 40°. Results  The mean coronal and sagittal Cobb’s angles in the nondystrophic curves were 79° and 16° before surgery, 31° and 12° after surgery, and 37° and 15° at follow-up, respectively. In the dystrophic thoracic curves, the Cobb’s angles in the coronal and sagittal planes before and after surgery and at follow-up were 68° and 31°, 27° and 28°, and 33°and 30°, respectively. There were no cases of coronal or sagittal decompensation, neurologic complications, or infections. There were eight (42.1%) complications, three intraoperative and five late. Pseudarthrosis with instrumentation failure that required revision surgery occurred in one (5.2%) patient. Conclusions  These results demonstrate that a satisfactory stabilization of scoliosis can be achieved by posterior fusion with instrumentation alone in patients with NF-1 who are more than 10 years old, and whose scoliosis is <90°. Contributions of authors: All authors meet the criteria for authorship. All authors accept full responsibility for the study, had access to the data, analyzed the data, and made the decision to publish.