Adequate symptom relief justifies hepatic resection for benign disease

Background  

The purpose of this study was to evaluate the long-term results of partial liver resection for benign liver lesions.     

中医病案的特点及当代病案整理现状

中医病案是中医的重要组成部分之一，从开始的零星记载到病案专著、专科病案的出现，经历了漫长的时间。通过对近十几年有关中医病案发展及当代中医病案整理工作的文献进行总体回顾、分析、评价，基本从病案的概念、分类、时代特点及当代中医病案情况等角度总结了中医病案发展的概况。     

经导管介入治疗瓦氏窦瘤破裂的临床疗效及其安全性

目的 探讨经导管介入治疗瓦氏窦瘤破裂的临床疗效与安全性.方法 用导管法对1例瓦氏窦瘤(右冠窦)破人右心房患者进行封堵治疗.术后定期随访,复查心脏超声及心电图等,对封堵术前后心脏杂音、各心腔压力、心腔大小变化等进行回顾性分析研究.结果 用12/14 mm的国产PDA封堵器成功封堵.术后即刻心脏杂音消失,右心房、右心室及肺动脉压力分别由术前的21/10、52/2、50/14 mmHg下降为14/5、34/0、33/15 mmHg,左心室内径术前为57 mm,术后第3天复查为49 mm;无并发症发生.结论 经导管介入治疗瓦氏窦瘤破裂是一项安全、有效的新技术,对适合进行介入治疗的患者,可以取代外科手术治疗.     

Hepatitis C virus genotypes: clinical relevance and therapeutic implications

The incidence of hepatitis C virus (HCV) -related hepatocellular carcinoma (HCC) has been increasing in several countries including Taiwan. There are six main genotypes, each of which contains closely related subtypes. Molecular epidemiological studies have shown marked differences in the genotype distribution by geographical region and between patient groups. HCV genotype 1 may play a role in the development of HCC, although some studies have argued against this. A sustained virological response secondary to interferon monotherapy or interferon/ribavirin combination therapy may reduce the risk of HCC and improve survival in chronic hepatitis C patients. The HCV genotypes are associated with therapeutic response. Rapid virological response is also a predictor of therapeutic response. Although viral characteristics have consistently been shown to be important predictors of treatment response, identification of additional host immune and genetic factors involved in determining the outcome of antiviral therapy is necessary. Newly developed bio-techniques (microarray, proteomes, bioinformatics), drugs, and treatment strategies may elucidate the pathogenesis and improve the therapeutic response in HCV infection.     

Genetic Analyses of the Mouse Deafness Mutations Varitint-Waddler (Va) and Jerker (Espnje)

Genetic studies on spontaneous mouse mutants with hearing defects have provided important insights into the function of genes expressed in inner ear hair cells. Here we report on our genetic analyses of the deaf mutants varitint-waddler (Va) and jerker (Espnje). A high-resolution genetic map localizes VaJ to a 0.14 ± 0.08 cM region between D3Mit85 and D3Mit259 on distal chromosome 3. By comparative mapping, the human ortholog resides at 1p22.3 between markers D1S3449 and D1S2252. To study the effect of different genetic backgrounds on the hearing phenotype, Espnje and VaJ were crossed to various inbred strains. Auditory-evoked brainstem response tests on F2 progeny demonstrate that expression, inheritance, and penetrance of the hearing phenotype are solely controlled by the mutant allele. To test for a genetic interaction between Espnje and Cdh23v, auditory function was analyzed in double heterozygotes; no significant increases of thresholds of sound pressure levels were observed. The results establish the framework for cloning the Va gene and provide valuable insights into the genetics of deafness mutations in the mouse.     

Management of unilaterally deep impacted first, second, and third mandibular molars

Simultaneous impactions of first, second, and third permanent molars comprises a very rare clinical situation with diverse therapeutic approaches and is a difficult challenge for dentists. Early diagnosis and treatment of eruption disturbances contributes to optimal outcomes. This article reports the treatment of a teenager with severe impaction of right mandibular first, second, and third molars, which hinders the masticatory function and dental arch integrity. A decision-making process and a simple orthodontic technique are described. To shorten the treatment time and simplify the procedures, the impacted right mandibular third and second molars were orthodontically uprighted with an innovative tip-back cantilever. Subsequently, the deeply impacted right mandibular first molar was extracted with minimal obstacles. The combined surgical-orthodontic approach resolved a challenging clinical problem and eliminated the need for prosthetic or dental implant replacement of the impacted molars. Good occlusion, normal function, and a healthy periodontium of the patient were also achieved.     

Early treatment of severe cystoid macular edema in central retinal vein occlusion with posterior sub-tenon triamcinolone acetonide

PURPOSE: To evaluate the clinical outcomes of posterior sub-Tenon (PST) injection of triamcinolone acetonide (TA) in the early treatment of severe cystoid macular edema (CME) in central retinal vein occlusion (CRVO). METHODS: In a noncomparative, prospective study, 18 eyes of 18 patients with severe CME (central macular thickness, CMT >450 microm) secondary to recent-onset CRVO (the onset of symptoms < or =4 weeks) and a decrease in visual acuity (< or =80 letters of Early Treatment Diabetic Retinopathy Study [ETDRS] scores, 20/50) were included. PST injection of 40 mg of TA was given under topic anesthesia. All patients received three biweekly injections and were evaluated at baseline and at 1 day, 1, 2, 4, 6, and 8 weeks, and 3, 6, and 9 months after injection. The main outcome measures were ETDRS scores, CMT, intraocular pressure (IOP), cataract progression, and frequency of complications. RESULTS: The mean age of the 18 patients was 61.17 years (range, 24-81 years) and the mean duration of symptoms was 15.28 days (range, 9-28 days). Eight eyes were diagnosed with ischemic CRVO and 10 eyes with nonischemic CRVO. Mean baseline ETDRS visual acuity (VA) score was 36.89 +/- 18.22 in all affected eye. There was a significant improvement in VA at 1, 3, 6, and 9 months of follow-up. The mean VA at these time points were 46.61 +/- 20.21, 58.11 +/- 22.19, 59.39 +/- 22.98, and 58.67 +/- 23.27 (all P < 0.001), respectively. Both nonischemic and ischemic eyes benefited with a statistically significant VA improvement at each time point. A comparison of the gain in VA between two subgroups was not significant at 1 and 3 months (P > 0.05), but was statistically significant at 6 and 9 months (P = 0.009 and 0.008, respectively). VA gain of 10 or more letters was found in all nonischemic eyes (10/10) and 3 ischemic eyes (3/8) at the 9-month follow-up. Two ischemic eyes were found to have no gain of letters in VA at the 9-month follow-up. The mean baseline CMT for all eyes was 566 +/- 42 microm. There was a 29% reduction with a mean CMT of 404 +/- 49 microm (P < 0.001) at 1 month, 51% reduction with a mean CMT of 278 +/- 40 microm (P < 0.001) at 3 months, 61% reduction with a mean CMT of 222 +/- 56 microm (P < 0.001) at 6 months, and 63% reduction with a mean CMT of 210 +/- 30 microm (P < 0.001) at 9 months. Both nonischemic and ischemic eyes demonstrated a statistically significant reduction in CMT (all P < 0.001). A comparison of the reduction in CMT between these two subgroups was not significant at each visit (all P > 0.05). For both subgroups, there was no statistically significant difference in IOP change at baseline, 1 week, 1, 3, 6, and 9 months of follow-up. Only two patients required topic antiglaucoma drops for elevated IOP. Three patients developed a recurrence of CME accompanied with visual decrease. No cataract progression or other complications were observed. CONCLUSIONS: PST injection of TA is effective in reversing CME and improving visual acuity in recent-onset CRVO in the first 9 months. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO. Early treatment may be better for visual improvement before longstanding macular edema results in irreversible photoreceptor damage. Further study with longer follow-up period is necessary.     

苏木精对人类膀胱癌T24细胞的杀伤及诱导凋亡作用

目的观察苏木精对人类膀胱癌T24细胞的杀伤及诱导凋亡的作用，探讨其对靶细胞杀伤的作用机制。方法将靶细胞培养于含药量分别为0、12．5、25、50、100、200μg／ml的RPMI1640培养基中，培养24h，倒置显微镜下观察细胞的形态学变化，收集靶细胞，采用锥虫蓝拒染法测定药物对靶细胞的杀伤作用。采用流式细胞术（FCM）检测不同药物质量浓度对靶细胞凋亡的影响。结果随着药物质量浓度的逐步增加，细胞发生形态学变化，且细胞死亡率逐步增加，对照组细胞死亡率为（2．63±0．29）％，各组细胞死亡率分别为（10．00±4．82）％、（21．88±3．42）％、（76．41±4．82）％、（92．27±7．62）％和（96．34±8．78）％。对照组细胞凋亡的自然发生率为0．47％；含药量为50μg／ml时，细胞凋亡率显著增高，达到43．18％，死细胞率为48．47％，活细胞率为8.35％；随着药物质量浓度的增大，细胞凋亡率逐渐降低。而死细胞率则逐渐上升。结论苏木精可通过诱导细胞凋亡和直接杀伤作用于靶细胞，在较低浓度下，可诱导靶细胞发生凋亡，药物浓度超过100μg／ml时，则能直接杀死靶细胞。