肝癌介入治疗药动学及其临床意义探讨

本研究通过测定血清阿霉素浓度,分析了原发性肝癌阿霉素肝动脉灌注(A 组)、阿霉素碘油乳化后栓塞(B 组)及阿霉素微囊栓塞化疗(C 组)后药动学变化及其临床意义。A 组药动学变化与静脉给药相似,但峰值浓度高。B 组峰浓度低,半衰期延长,显示缓释和降低血浓度的作用。C 组峰浓度不明显,表现为长时、稳定的释放,血浓度低,具有保持局部长时间高浓度作用。结果揭示了肝癌介入治疗不同给药方法疗效差异的药动学依据。     

Periventricular- intraventricular hemorrhage in the premature infant- A historical perspective

The objective of this chapter is to trace the evolution of intraventricular hemorrhage in the premature infant highlighting the importance of the germinal matrix, a critical role for cerebral blood flow changes in the genesis of hemorrhage, clinical factors that increase the bleeding risk, and potential preventative strategies. In 1976, neuropathological studies demonstrated capillary rupture within the germinal matrix as the precursor of hemorrhage. In 1980, introduction of cranial ultrasound facilitated diagnosis of intraventricular hemorrhage. In 1979, loss of cerebral autoregulation in sick newborn infants was demonstrated. In the 1980’s, studies demonstrated the importance of intravascular factors in provoking hemorrhage. In 1983, the association of cerebral blood flow velocity fluctuations and subsequent hemorrhage was demonstrated. In 1994, antenatal steroids use to accelerate lung development was recommended. This was associated with an unanticipated reduction in hemorrhage. In the mid 1990’s early indomethacin administration was associated with a reduction of severe hemorrhage.     

白及微球的研制及其肝动脉栓塞实验研究

用乳化－冷凝技术首次制备出白及微球,并通过正交实验,确定了制备特定粒径微球的最佳工艺条件。对微球的外观、粒径与分布、溶胀度及血液相容性等进行了研究。微球平均粒径为５４．３６μｍ,粒径范围５０～９０μｍ,占总数的７８．３７％;微球在ｐＨ＝７．４的缓冲液中有一定的溶胀性;血液相溶性良好。实验小猪微球栓塞后的肝动脉造影表明白及微球可致肝右动脉一级、二级分支完全栓塞;病理检查表明梗死区可见肝组织呈肝硬化改变,大量的假小叶形成。微球栓塞后,ＧＰＴ有一过性升高,３周后恢复正常。实验结果表明,以白及胶为材料制备的微球将为癌症的治疗提供一种新型的栓塞治疗剂     

ITP患者脾动脉栓塞前后血小板的检测及其临床意义

应用自动血细胞计数仪检测ＩＴＰ患者脾动脉栓塞前后不同时期血小板的变化。结果栓塞后患者血小板计数（ＰＬＴ）和平均血小板体积（ＭＰＶ）的变化呈负相关,但ＰＬＴ恢复正常后,ＭＰＶ仍高于正常。提示脾动脉栓塞后血小板计数增高的机理不同于激素治疗。     

Aortopulmonary collateral artery embolization during postoperative extracorporeal membrane oxygenation after arterial switch procedure

Aortopulmonary collateral arteries sometimes complicate cyanotic congenital heart defects. Combined with a relevant left-right shunt, this could result in massive airway bleeding during and after corrective surgery. A preoperatively diagnosed 1.2 mm small aortopulmonary collateral artery in a newborn suffering from transposition of the great arteries caused life-threatening airway bleeding during surgery. Postoperative extracorporeal membrane oxygenation (ECMO) was necessary, and coil embolization was performed on ECMO to terminate pulmonary bleeding.     

New aspects in the treatment of priapism

Recent advances in the understanding of erectile physiology have improved the prompt diagnosis and treatment of priapism. During initial assessment, the physician must distinguish between veno-occlusive low flow (ischemic) and arterial high flow (nonischemic) in order to choose the correct treatment option for each type of priapism. Patient history, physical examination, penile haemodynamics and corporeal metabolic blood quality assist the distinction between static and dynamic priapism. Normally, priapism is effectively treated with intracavernous vasoconstrictive agents or surgical shunting. However, when these two methods fail, subsequent treatment procedures are a matter for debate. Alternative options, such as intracavernous injection of methylene blue or selective penile arterial embolization, for the management of high and low flow priapism are described and a survey of current treatment modalities is presented.     

介入化疗栓塞治疗32例宫颈癌合并出血的临床疗效分析

目的探讨介入化疗栓塞治疗宫颈癌合并出血的临床意义。方法对３２例宫颈癌合并出血的患者采用子宫动脉灌注５－氟尿嘧啶（５－Ｆｕ）、顺铂（ＰＤＤ）、丝裂霉素（ＭＭＣ）加碘油行子宫动脉化疗栓塞,再用明胶海绵栓塞止血。结果①盆腔动脉造影能清楚显示肿瘤血管及范围,明确出血部位,经化疗栓塞后全部病例得以止血。②介入治疗能够短时间内控制巨大肿瘤,但难以使肿瘤完全坏死。结论介入化疗栓塞能够取得满意的止血效果,是其他治疗手段不可比拟的。介入治疗能够提高宫颈癌的近期疗效,但单纯用介入治疗难以根治,必须配合手术治疗或放射治疗。     

Long-term lowering of blood pressure after carotid and vertebrobasilar ischemic stroke

We followed up 107 patients experiencing a first-ever ischemic stroke after having been affected by essential hypertension for at least one year, in order to analyze the phenomenon of post-stroke blood pressure lowering. Of the 82 patients still surviving after three months of follow-up, 44 (54%) had normal arterial blood pressure values. There were no significant differences between these normotensive patients and the 38 with high blood pressure in terms of cerebrovascular risk factors or disability, but blood pressure normalized in 34 of the 54 patients experiencing a carotid stroke (63%) and in only 10 of the 28 experiencing vertebrobasilar stroke (36%) (p=0.035). These data may offer a starting point for further studies of the neurogenesis of arterial hypertension.

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Sommario Al fine di analizzare il fenomeno della normalizzazione della pressione arteriosa dopo ictus cerebrale in pazienti prima ipertesi, abbiamo osservato 107 soggetti con primo ictus ischemico, che erano già precedentemente affetti da ipertensione arteriosa da almeno un anno. Degli 82 (77%) sopravvissuti a tre mesi di follow-up, 44 (54%) hanno mostrato una normalizzazione della pressione arteriosa. L'incidenza di fattori di rischio per malattia cerebrovascolare e disabilità grave non è risultata significativamente diversa nel gruppo degli ipertesi rispetto ai normotesi. Tuttavia la normalizzazione della pressione arteriosa è stata osservata in 34 dei 54 pazienti con ictus carotideo (63%) e solo in 10 dei 28 con ictus vertebrobasilare (36%) (p=0.035). Riteniamo che tali dati offrano uno spunto per ulteriori ricerche sulla genesi neurogena dell'ipertensione arteriosa essenziale.

     

Selective arterial embolization in the treatment of aneurysmal bone cyst and angioma of bone

Nineteen aneurysmal bone cysts and five angiomas of bone were treated by selective arterial embolization. The median follow-up was 22 months. In 17 patients healing occurred with complete relief of symptoms; in 11 of these almost complete ossification of the lesion resulted. In the remaining cases, little or no ossification was apparent but ossification may take 1 year or more to occur. No recurrence was observed in any of these cases. Recurrence occurred only in two cases. In one, growth of the recurrence stopped after a second embolization, and the X-rays showed no change. Selective arterial embolization represents a treatment of choice in aneurysmal bone cyst and angioma of bone especially of the spine, sacrum, or pelvis. In these sites embolization replaces surgery which might be hazardous due to intraoperative bleeding.Supported in part with Rizzoli Research Funds     

Biventricular Bypass: Alternative to Univentricular Bypass and Total Artificial Heart–Bridge

Left ventricular and biventricular bypasses (LVBs, BVBs) were performed in 102 experiments in sheep, goats, and donkeys. Biventricular bypass was performed in the assisted circulation mode or in the paracorporeal artificial heart bridge (PCAHB) mode when the natural heart fibrillates. During implantation of artificial ventricles instead of a heart-lung bypass, counterpulsation was used. Several types of connective conduits were developed and tested in experiments. The conduits included bifurcational connective pipes that permit "intake" of blood into artificial ventricles from atria and ventricles of the natural heart simultaneously and consequently provide effective blood flow through shunts not depending on the state of the natural heart (acute cardiac weakness or asystole). Monitoring gas content (PO2, PCO2, and pH) in the myocardium of both ventricles suggested development of right ventricular failure under conditions of LVB before hemodynamic changes occurred and confirmed the preferability of BVB over other methods of assisted circulation, as it is most effective and capable of normalizing short-term cardiac disturbances in the course of the 1st 2 days. Survival time of experimental animals (2-3 days for dogs, 5-12 days for sheep, goats, and donkeys) is sufficient to overcome acute cardiac insufficiency. This suggests that BVB in the assisted circulation mode or PCAHB mode can serve as a bridge for cardiac transplantation for the time of search for the available organ.