Ultrastrukturelle Veränderungen am Nierenparenchym durch ESWL unter Acetylsalicylsäure (ASS)

BACKGROUND: The risk of hemorrhagic complications after extracorporeal shock-wave lithotripsy (ESWL) increases in patients with aspirin intake, but the hematoma-inducing mechanism has not been understood completely at the ultrastructural level. METHODS: The effect off shock-waves on the kidneys of male Wistar-rats (n=24) was investigated in an experimental setting using a special ESWL device. Ultrastructural examination was performed by light-, transmission electron- and scanning electron microscopy. RESULTS: Shock-wave induced tissue damage appeared in all kidneys independently of aspirin intake. Endothelial detachment, lethal cell injury, gaps and mechanical disruption of the glomerular basement membrane were regularly found. After 1 week, repair processes were completed with evidence of permanent fibrosis in some cases. CONCLUSIONS: ESWL can induce modest as well as fatal damage to renal tissue cells. Therefore, after an ESWL-induced hematoma a second ESWL should not be performed within 1 week of the first treatment.     

Transfusion Transmitted Infections in Armed Forces: Prevalence and Trends

Background

This study presents data on the prevalence rate of infectious markers among voluntary and replacement donors in the blood transfusion service in Armed Forces from 2000 to 2004.

Methods

39,646 units of blood were collected from donors during the period from 2000 to 2004. All the samples were screened for hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV) 1&2, hepatitis C virus (HCV), and by venereal disease research laboratory test (VDRL).

Results

24,527 (61.9%) were voluntary donations and 15,119 (38.1%) replacement donations. Prevalence of HBsAg had decreased, amongst voluntary donors from 1.67% to 0.77% but the positivity rate has not showed significant change. Seropositivity of HIV had decreased both in voluntary and replacement donors to 0.22% and 0.86% respectively. The seropositivity for anti-HCV showed steady decrease amongst voluntary donors from 0.46% to 0.20% in 2004, but in replacement donors, there was an increase in reactivity rate from 0.43% to 0.65%.

Conclusion

The increased seropositivity for HCV, HIV and HBsAg could be decreased by introduction of nucleic acid amplification testing (NAT) in minipools for HCV and HIV and introduction of anti-HBcAg (IgM) for hepatitis B virus (HBV) infection. But this may not be possible in near future in developing countries due to financial constraints. At present implementation of strict donor criteria and with use of sensitive laboratory screening tests it is possible to reduce the incidence of transfusion transmitted infections (TTI) in Indian scenario.Key Words: Transfusion transmitted infections, Human immunodeficiency virus, Hepatitis C virus, Hepatitis B virus     

射频毁损治疗肝脏肿瘤

肝脏肿瘤包括肝原发性肿瘤和肝转移瘤,其治疗目前仍首选手术切除,但确诊时85％～95％的患者已失去手术切除时机,对难以手术治疗的患者已有多种介入治疗方法,如肝动脉栓塞化疗(TAE)、经皮无水酒精注射、微波、激光、冷冻、高功率超声聚焦等。射频毁损(radiofrequency ablation,RFA)是近年国外刚用于肝脏肿瘤治疗的新技术,具有安全性高、并发症少、患者易耐受、肿瘤复发可重复治疗等优点,具有良好的应用前景。 1 射频治疗仪及治疗机制 1868年法国的d'Arsonval发现高于10KHz的高变电流通过活体组织时,并不引起神经肌肉的应激,但局部产热造成组织毁损,自此射频毁损术在神经及心血管领域得以应用并     

高能体外冲击波治疗慢性足底筋膜炎

目的:观察高能体外冲击波对慢性足底筋膜炎的临床治疗效果。方法:选择2004-12/2005-12在深圳市第六人民医院疼痛科门诊就诊的足底筋膜炎患者167例,均自愿参加观察。按奇偶序列随机分为2组,治疗组84例,对照组83例。①治疗组采用HKSW-O冲击波治疗机进行标准治疗,工作电压7～10V,冲击波频率60次/min,治疗时间15min。②对照组除机器探头未与治疗部位充分有效接触外,定位及治疗参数设置同治疗组。两组患者均治疗3次,间隔5d治疗1次。①治疗前及治疗结束3个月后对两组患者进行简式McGill疼痛问卷测评:包括感觉类评分(0～33分)、情感类评分(0～12分)、疼痛总分(0～45分)、目测类比疼痛评分(0～10分)及现有疼痛强度评分(0～5分),以上各项分值越高,表示疼痛强度越大。②治疗后3个月对两组患者进行疗效评估:显效为疼痛明显减轻;好转为疼痛略减轻;无效为症状较治疗前无改变或加重。③患者治疗后第3天复诊时进行副作用观察,包括皮肤发红、疼痛、肿胀及其他(如恶心、眩晕、异感等)。结果:167例足底筋膜炎患者全部进入结果分析,无脱落。①两组患者治疗前及治疗3个月后简式McGill疼痛问卷评分比较:治疗3个月后,治疗组感觉类、情感类、疼痛总分、目测类比疼痛评分及现有疼痛强度评分均显著低于治疗前(t=2.639～3.416,P<0.01)。除现有疼痛强度评分外,治疗3个月后治疗组患者的感觉类、情感类、疼痛总分及目测类比疼痛评分均显著低于对照组(t=2.467～3.487,P<0.01)。②治疗3个月后两组患者的临床疗效比较:治疗组患者的显效率显著高于对照组(χ2=112.33,P<0.01)。③治疗后第3天复诊时治疗组患者的副作用发生情况:治疗组患者有少部分病例会出现皮肤发红和局部疼痛,而肿胀和其他副作用几乎不出现。结论:高能体外冲击波对慢性足底筋膜炎的临床治疗效果确切,具有安全、有效、简易和快速等特点。     

肝移植患者术后白蛋白的应用

目的:低白蛋白血症是肝移植患者的常见并发症,也是患者预后的重要影响因素。肝移植术后选择合理的白蛋白应用方案将有益于提高肝移植患者术后近远期疗效。方法:选择2000-10/2005-06于北京大学第三医院行肝移植并且随访时间大于6个月的患者80例,对治疗方案均知情同意。医院自2003年8月开始改变了肝移植术后白蛋白的输入方案:①方案改变之前患者即白蛋白输入方案未改变组(n=50),术后早期常规输入白蛋白剂量大于60g/d。②方案改变之后患者即白蛋白输入方案改变组(n=30),适当减少术后早期白蛋白输入的常规剂量至0￣20g/d。统计分析两组患者的一般情况、术后白蛋白使用情况、预后情况及住院费用。另外,对于两组中术后存在低白蛋白相关严重并发症的患者进行进一步的比较分析。结果:80例患者全部进入结果分析。①两组患者术前及术中一般情况差异无显著性意义(P>0.05)。②白蛋白输入方案改变组术后早期白蛋白的使用量及其费用/总住院费用比例显著低于白蛋白输入方案未改变组(P<0.01)。但两组患者术后第3天肝功能情况、白蛋白水平、早期并发症发生率、早期死亡率、半年生存率及呼吸机时间等情况差异均无显著性意义(P>0.05)。③两组中术后出现低白蛋白相关严重并发症患者术后第3天肝功能情况、白蛋白水平、早期死亡率、半年生存率及呼吸机应用时间等情况差异均无显著性意义(P>0.05)。结论:肝移植术后过多输入白蛋白不能改善患者预后;适当减少术后白蛋白的常规输入剂量,同时根据血白蛋白水平及并发症情况随时调整白蛋白的输入量能够减少白蛋白的用量,对患者预后因素亦无明显影响。     

Familial amyloidotic patients' experience of the disease and of liver transplantation

Liver transplantation is a new treatment for familial amyloidotic polyneuropathy (FAP). No qualitative study examining these patients' experiences of the disease and the treatment has been published. The purpose of this study was to explore and describe the experience of the disease and the liver transplantation from the FAP patient's perspective. In-depth interviews with 11 liver transplant FAP patients were performed. The process of the FAP disease and a liver transplantation was found to involve the following categories: going downhill, defence and denial, a chance of surviving, the decision — no choice, waiting powerless and uncertain, the first few steps after surgery, freed from the death sentence, still disabled, mastering up strength to recover, and the need for support and help.     

Development of a marrow transplant regimen for acute leukemia using targeted hematopoietic irradiation delivered by 131I-labeled anti-CD45 antibody, combined with cyclophosphamide and total body irradiation

In an attempt to decrease the relapse rate after bone marrow transplantation (BMT) for advanced acute leukemia, we initiated studies using 131I-labeled anti-CD45 antibody (BC8) to deliver radiation specifically to hematopoietic tissues, followed by a standard transplant preparative regimen. Biodistribution studies were performed in 23 patients using 0.5 mg/kg trace 131I-labeled BC8 antibody. The BC8 antibody was cleared rapidly from plasma with an initial disappearance half-time of 1.5 +/- 0.2 hours, presumably reflecting rapid antigen- specific binding. The mean radiation absorbed doses (cGy/mCi131I administered) were as follows: marrow, 7.1 +/- 0.8; spleen, 10.8 +/- 1.4; liver, 2.7 +/- 0.2; lungs, 2.1 +/- 0.1; kidneys, 0.7 +/- 0.1; and total body, 0.4 +/- 0.03. Patients with acute myelogenous leukemia (AML) in relapse had a higher marrow dose (11.4 cGy/mCi) than those in remission (5.2 cGy/mCi; P = .001) because of higher uptake and longer retention of radionuclide in marrow. Twenty patients were treated with a dose of 131I estimated to deliver 3.5 Gy (level 1) to 7 Gy (level 3) to liver, with marrow doses of 4 to 30 Gy and spleen doses of 7 to 60 Gy, followed by 120 mg/kg cyclophosphamide (CY) and 12 Gy total body irradiation (TBI). Nine of 13 patients with AML or refractory anemia with excess blasts (RAEB) and two of seven with acute lymphocytic leukemia (ALL) are alive disease-free at 8 to 41 months (median, 17 months) after BMT. Toxicity has not been measurably greater than that of CY/TBI alone, and the maximum tolerated dose has not been reached. This study demonstrates that with the use of 131I-BC8 substantially greater doses of radiation can be delivered to hematopoietic tissues as compared with liver, lung, or kidney, which may improve the efficacy of marrow transplantation.