Liver Transplantation for Cystic Fibrosis in Adults

Purpose To expand our knowledge on liver transplantation for cirrhosis associated with cystic fibrosis in adults. Methods Five patients who underwent a liver transplantation due to cystic fibrosis were reviewed. The outcome of the patients in terms of age, immunosuppression regimen, patient and graft survival, and pre- and post-transplant complications were investigated. Results Five adult liver transplant patients had cystic fibrosis (0.2%). These included 4 men and 1 woman with a mean age of 31 ± 10, ranging from 22 to 52 years old at the time of transplantation. All patients had lung problems. Four patients had exocrine and two had endocrine pancreatic insufficiency. Two are currently alive with a follow-up of 5.8 years and 4 months after transplantation, respectively. There were three deaths from pulmonary embolism at 4.5 years, myocardial infarction with cyclosporine nephrotoxicity at 10.7 years, and lymphoproliferative disorder at 5 months after transplantation. No deaths occurred from lung infection. Only one patient had postoperative pulmonary infectious complications, which were successfully treated with antibiotics and did not result in mortality. Conclusion Adult liver transplantation for end-stage liver disease associated with cystic fibrosis offers encouraging results with a rapid general improvement after surgery and it is now considered to be a safe and acceptable treatment for this disease population.     

Effectiveness of postural and instrumental reduction in the treatment of thoracolumbar vertebra fracture

We compared the effectiveness of postural reduction and instrumental reduction in the treatment of thoracolumbar and lumbar vertebra fracture in 40 patients. Under general anaesthesia, postural reduction in a stretching prone position was first performed. Instrumental reduction and fixation were then conducted. Radiographs were made after each reduction. Comparisons between the two films and the fracture films were made based on the changes in prevertebral height of both the fractured vertebra and the adjacent superior and inferior intervertebral spaces. It was found that the recovery of the prevertebral height in postural and instrumental reductions was basically identical. The recovery of the prevertebral height in the intervertebral spaces was more significant in instrumental reduction. Both reductions were ineffective in patients whose compression of the diseased vertebra was more than two-thirds of the normal. In cases of lower lumbar vertebra fractures, the effect of both reductions was unsatisfactory. Our findings indicated that the effectiveness of the reduction of vertebra fracture depends on the quantitative change of the spongy bone of the injured vertebra. Instrumental reduction only exerts an indirect tension. Postural reduction is effective in reducing thoracolumbar vertebral fracture, while instrumental reduction exerts only a relatively weak effect but it is particularly useful to maintain the result of postural reduction.     

ICOS-Dependent and -Independent Functions of Memory CD4 T Cells in Allograft Rejection

Donor-reactive memory T cells undermine the survival of transplanted organs through multiple pathways. We have previously reported that memory CD4 T cells resist treatment with anti-CD154 antibody and donor-specific transfusion (DST/MR1) and promote cardiac allograft rejection via generation of effector CD4 T cells and alloantibody. We hypothesized that the helper functions of memory CD4 T cells are independent of T-cell costimulation through CD154 but instead are regulated by alternative costimulatory pathways. This study investigated how blocking ICOS/B7RP-1 interactions affects functions of donor-reactive memory CD4 T cells. Treatment with blocking anti-ICOS mAb synergized with DST/MR1 and prolonged mouse cardiac allograft survival despite the presence of donor-reactive memory CD4 T cells. While blocking ICOS did not diminish the expansion of preexisting memory CD4 T cells or the induction of allospecific effector T cells, it did inhibit recruitment of the activated memory and effector T cells into the graft. In addition, anti-ICOS mAb treatment in combination with DST/MR1 prevented help provided by memory CD4 T cells for production of donor-specific IgG antibody. These results demonstrate the potential efficacy of ICOS blockade in sensitized transplant patients and provide the foundation for rational use of ICOS blockade in combination with other graft-prolonging strategies.     

Essential Role of Sphingosine-1-Phosphate Receptor 1-Bearing CD8+CD44+CCR7+ T Cells in Acute Skin Allograft Rejection

A subset of naturally formed sphingosine‐1‐phosphate receptor 1 (S1P1)‐bearing CD8⁺CD44⁺CCR7⁺ memory T cells has been identified in transplant recipient BALB/c (H‐2^d) mice. The frequency of this subset of memory T cells is significantly increased in the spleen, lymph nodes and skin grafts in the recipient BALB/c mice during acute skin allograft rejections. The immune‐reconstitution with CD8⁺CD44⁺CCR7⁺S1P1⁺ memory T cells facilitates acute skin allograft rejection in SCID mice. Being Th1‐polarized and cytotoxic, CD8⁺CD44⁺CCR7⁺S1P1⁺ memory T cells proliferate and differentiate immediately into effectors upon encountering allo‐antigens. A siRNA against S1P1 inhibits CD8⁺CD44⁺CCR7⁺S1P1⁺ memory T cell‐mediated acute skin allograft rejection in SCID mice by means of knocking‐down S1P1‐expression. CCL21 mutant (CCL21‐ΔCT) has been used to compete with wild‐type CCL21 in the course of binding to CCR7. Combined administration of siRNA S1P1 and CCL21‐ΔCT significantly prolongs the survival of skin allograft in the recipient BALB/c mice by means of inhibiting accumulation of CD8⁺CD44⁺CCR7⁺S1P1⁺ memory T cells in the spleen and the skin grafts. Our data provide direct evidence that S1P1 and CCR7 are involved in the proliferation and trafficking of CD8⁺CD44⁺CCR7⁺S1P1⁺ memory T cells. S1P1 may serve as a functional marker for CD8⁺CD44⁺CCR7⁺ memory T cells. Targeting CD8⁺CD44⁺CCR7⁺S1P1⁺ T cells may be a useful strategy to prolong the survival of allograft transplant.     

成人包皮环套术中结扎强度与相关并发症的关系

目的：探讨成人包皮环套术后包皮水肿和内外板分离的主要病阂。方法：选择300例门诊患者,予以前瞻、对照性研究。随机分两组,一组为强结扎作用（弹力线＋大套环）,一组为弱结扎作用（普通丝线＋小套环）,观察两组术后包皮水肿和内外板分离的发生率。结果：强结扎作用组出现72例中度以上包皮水肿,17例内外板分离,弱结扎作用组出现37例中度以上包皮水肿,5例内外板分离,前组发病率高于后组,差别均有显著性意义。结论：结扎作用过强是导致成人包皮环套术后皮水肿和内外板分离的主要病因。控制好两个作用力结扎线弹力和套环张力,为伤口创造一个良好的张力环境是降低术后上述两个并发症的关键。     

21例囊性肾癌的诊治和随访结果分析

目的：增加对囊性。肾癌真实发病率和生物学行为的认识，提高术前诊断准确性。方法：回顾性分析1997年5月～2007年5月收治的所有。肾癌中存在囊性成分病例的临床特点、影像学表现、手术治疗方式的选择、病理特点以及随访的情况。结果：以囊性成分所占体积不少于肿瘤总体的75％为入选标准，筛选出21例囊性肾癌（22个病灶，其中病例17为双侧病变），占所有肾癌总数（312例）的6．7％，患者平均年龄为47．3岁（30岁到77岁）．4处病灶行。肾部分切除术（18．2％）．18处病灶行肾癌根治术（81．8％）；按病理分期T1期16例（76．2％），T2期5例（23．8％），T3期1例（4．8％）；按Bosniak分类，Ⅱ类4例（18．2％），Ⅲ类12例（54．5％），IV类6例（27．3％）。术后随访平均39．0个月（2～110个月，中位数33个月），除1例因术后心脏合并症死亡外，余20例（95．2％）均生存，没有肿瘤复发和转移。结论：囊性肾癌是一种少见的临床病理亚型，Bosniak分类能在一定程度上提高术前诊断的准确性，手术切除特别是保留肾单位手术能有效地治疗囊性肾癌，临床预后很好。     

腹腔镜治疗老年萎缩性胆囊炎44例临床分析

目的:探讨老年萎缩性胆囊炎患者的腹腔镜治疗方法,并预防胆管损伤并发症的发生。方法:回顾分析腹腔镜治疗老年萎缩性胆囊炎44例患者的临床资料。结果:41例顺利完成手术,3例中转开腹,12例放置腹腔引流管,术后肝下积液1例,无其他并发症发生及死亡病例。结论:老年人萎缩性胆囊炎的腹腔镜治疗属于复杂手术,与术中操作技巧,把握好中转手术的时机,充分围手术期准备,熟练术中操作技巧,把握中转开腹的时机,合理使用器械等是预防和减少并发症的关键。     

腹部外科SIRS患者下丘脑-垂体-甲状腺轴的功能改变及机制探讨

目的：研究SIRS状态下下丘脑-垂体-甲状腺轴的功能改变并探讨其机制。方法：应用放射免疫分析方法测定25例病人的血清T3、T4、rT3、TSH、TRH水平,并与20例正常对照进行比较。结果：SIRS病人血清T3、T4水平低于对照组。TSH和TRH水平观察组高于对照组。结论：SIRS病人下丘脑-垂体-甲状腺轴的功能出现紊乱,其可能的机制是由于甲状腺本身的功能受到抑制以及应激刺激作用的结果。     

应用皮肤牵张带延期闭合骨筋膜室减张切口

目的观察应用皮肤牵张带延期直接缝合骨筋膜室减张切口的效果。方法因骨筋膜室综合征而行切开减压术导致皮肤缺损患者 21例,年龄 7～ 36岁,小腿皮肤缺损 17例、前臂皮肤缺损 3例、足部皮肤缺损 1例。缺损区最小 5 cm× 15 cm,最大 11 cm× 28 cm,合并骨外露和肌腱外露者各 1例。于骨筋膜室切开减压后第 4～ 7 d放置皮肤牵张带,此后 3～ 7 d天待牵拉至两侧皮缘靠近时延期缝合伤口, 2周后拆线。结果 21例患者, 20例伤口一期愈合,形成线状瘢痕; 1例在放置皮肤牵张带之前伤口红肿,有较多分泌物,置皮肤牵张带 2 d后分泌物仍较多,故拆除 3根硅胶带,伤口引流,遗留 2 cm× 5 cm创面,经换药、小块游离皮片植皮后伤口愈合。 2例合并骨外露和肌腱外露者伤口愈合良好。随访 3～ 15个月,患肢远端关节活动自如,无肌肉挛缩现象。结论急性骨筋膜室综合征切开减压后,使用皮肤牵张带延期缝合伤口,安全、有效。其优点 :(1)操作方法简便、快速,病程短,费用相对较低; (2)无需游离皮片植皮,愈合后形成线状瘢痕,局部皮肤质量较好,对美观影响小; (3)同样适用于伴骨外露和肌腱外露者,可避免施行皮瓣转移覆盖手术。     

42例椎管内髓外肿瘤外科治疗分析

目的 回顾性分析42例椎管内髓外肿瘤的临床表现、诊断和外科治疗效果。方法 对椎管内肿瘤的部位、类型、临床表现、影像学特点和手术方法进行分析比较。结果 随访时间平均16个月（6个月－3年）,无1例复发,手术优良为97％。结论 根据临床表现,MRI结合病理检查能够确诊,早期外科治疗是最佳的方法。