Simultaneous cardiac surgery with pulmonary resection

IntroductionCombined heart surgery and lung resection remain a controversial issue. This method facilitates the treatment of two major problems with one intervention, reducing hospitalization cost with acceptable outcomes. On the other hand, skepticism exists related to the effects of cardiopulmonary bypass on malignancy, proper extent of lung resection from non-standard approach and to a possible greater risk of perioperative bleeding.MethodsBetween November 2010 and April 2014 ten patients (male 9, female 1) underwent simultaneous cardiac surgery and pulmonary resection (mean age 69 ± 7 years). Pathological findings were as follows: primary carcinoma 4, benign lesion 4, metastasis 1, and carcinoid 1. Surgery at right lung was done in five cases and on left lung in five cases (lobectomy 5, extraanatomical resection 1, enucleation 3). In one case, because of the extent of malignant process, exploration only was done via sternotomy and pneumonectomy was performed later through thoracotomy. Cardiac procedures were as follows: coronary artery bypass grafting 5, aortic valve replacement 3, mitral valve replacement 1, ascending aorta replacement 1, and MAZE procedure 3. Sternotomy was performed in eight patients; in two of them left lateral thoracotomy was used and coronary artery revascularization was performed with MIDCAB principle. Off-pump surgery was used four times.ResultsThere was no hospital mortality. There was no reexploration because of bleeding. Cardiac part of procedures was in all cases without complications. Prolonged air-leak was found in one case. All patients with benign pathology are alive. In the malignant group, one patient with staged approach died in terminal phase of disease and the second patient deceased because of disease-non-related reasons one year after surgery. The rest of them are followed up regularly by pneumo-oncology outpatient department.ConclusionCombined heart surgery and lung resection can be performed without increased mortality and/or morbidity. The synchronous treatment avoids the necessity of a second intervention with good results and economic benefits.     

干法消化-原子荧光光谱法同时测定螺旋藻粉中砷和锑

目的建立干法消化和氢化物发生—原子荧光光谱法同时测定螺旋藻粉中砷和锑的方法。方法将螺旋藻粉干法消化后,利用氢化物发生—原子荧光光谱法同时测定砷和锑。对仪器条件进行了优化,比较了不同还原剂的增敏效果,考察了常见干扰离子对测定的影响。结果采用本方法测定,砷的线性范围为0～10μg/L,γ=0.9992,DL=0.16μg/L,回收率为96.0%～111.2%,精密度(RSD%)为2.37;锑的线性范围为0～10μg/L,γ=0.9998,DL=0.11μg/L,回收率为90.2%～109.0%,精密度(RSD%)为5.91。结论测定方法简单快捷,省时省力省试剂,结果准确,满足测定要求。     

局部晚期非小细胞肺癌放疗剂量提升研究进展

局部晚期非小细胞肺癌的RTOG0617研究显示进一步提高放疗剂量并没有带来生存获益,这促进了剂量提升策略的改变。目前多项研究通¹⁸FDG高摄取区域局部加量、同步加量调强放疗、改变剂量分割模式等探索更为有效的剂量提升手段,并取得一系列进展。PET-CT技术及调强放疗技术的广泛应用,为放疗剂量优化和提升提供了广阔空间。     

移植胰腺病理学诊断标准及其进展

胰腺移植和胰肾联合移植是治疗1型糖尿病和部分2型糖尿病及其并发症导致的肾衰竭的最佳治疗方法。胰腺移植的类型主要包括同期胰肾联合移植（SPK）、肾移植后胰腺移植（PAK）和单纯胰腺移植（PTA）。在所有的胰腺移植类型中,对移植胰腺的活组织检查（活检）仍然是明确诊断其排斥反应并与其他并发症进行鉴别的最佳方法。本文对移植胰腺活检的方法及其相关的研究进展、移植胰腺活检排斥反应诊断标准及其进展、移植胰腺主要的并发症及其病理学表现进行阐述,旨在为指导临床对上述并发症予以准确诊断,良好地保障移植胰腺和受者的长期存活提供参考。     

Short-term study of the effect of speech coding strategy on the auditory performance of pre- and post-lingually deafened adults implanted with the Clarion CII®

Objective The auditory performance of cochlear implantees is linked to numerous variables, such as audiological characteristics, age and type of speech coding strategy. In recent years, many different ways of processing sounds have been developed, with possible implications for auditory performance. The purpose of this study was to evaluate the intra-individual differences of patients for speech perception tasks in quiet and in noise as a result of switching from a standard strategy [Continuous Interleaved Sampling (CIS)/Simultaneous Analog Strategy (SAS)] to Hi-Resolution (HiRes).

Material and Methods A total of 14 post-lingual adults implanted with the Clarion CII® were selected for trials. At switch-on, six patients chose a CIS strategy and eight an SAS strategy. After an average period of 9.3 months, all patients were switched over to HiRes. All patients were tested (open-set mode) with bisyllabic words and sentences, in both quiet and noise [speech/noise ratio (SNR)=+10]. Testing was carried out after an initial period with the CIS/SAS strategy and 3 months after switching over to HiRes.

Results After switch-over a significant improvement was seen for both speech in quiet (words +25.2%, sentences +10.8%) and speech in noise (words 44.8%, sentences 45.4%).

Conclusion Despite individual differences, all patients improved their performance with HiRes use, the greatest improvements being seen under unfavourable listening conditions (SNR=+10). Subjective improvements in speech discrimination and overall sound quality perception were reported even after the first week of HiRes use.     

适形调强放疗同期整合瘤床推量治疗肺癌脑转移瘤的可行性研究

背景与目的：肺癌脑转移的发生率呈上升趋势,适形调强放射治疗(intensity-modulated radiotherapy,IMRT)+瘤床同期整合推量(simultaneous integrated boost,SIB)技术对于脑转移患者是一种新的治疗选择。本研究旨在探讨全脑IMRT+瘤床SIB治疗合并1~4个肺癌脑转移灶患者的近期临床疗效及治疗相关不良反应,明确该方案的可行性。方法：前瞻性收集2014年6月-2015年6月在江门市中心医院确诊为肺癌脑转移(转移病灶数1~4个)的32例患者,所有患者均行全脑5野IMRT(40 Gy/20 f)+瘤床SIB(50 Gy/20 f),分别评价其靶区剂量分布、放疗总有效率、肿瘤局部控制率、1年生存率、各种急性及晚期不良反应。结果：所有患者均完成放疗。全组2级呕吐、恶心和癫痫发生率分别为9.4%、15.6%和12.5%,2例出现2级认知功能障碍,4例出现2级记忆力损伤,2例出现3级记忆力损伤,无4级急性及晚期不良反应。放疗总有效率为71.9%,肿瘤局部控制率为96.9%,1年生存率为44%。结论：全脑5野IMRT(40 Gy/20 f)+瘤床SIB(共10 Gy,即总量50 Gy/20 f) 治疗1~4个肺癌脑转移灶是可行的。     

Outcomes with bilateral cochlear implantation following sudden dual sensory loss after ethylene glycol poisoning

Abstract

Acute loss of vision accompanied by profound loss of hearing is fortunately rare, but has a catastrophic effect on both the patient and their family. Re-establishing communication and spatial awareness are high priorities. We describe the case of a 45 year-old man who presented as a result of poisoning by ethylene glycol. Following assessment by clinicians who learned the deaf-blind alphabet in order to communicate, he had his hearing successfully rehabilitated with simultaneous bilateral cochlear implants. The patient recovered the ability to understand speech near perfectly in quiet, to attend to the ear giving the clearer signal in noise, and to localise sources of sound. The patient reported that the latter skill facilitated mobility. This is the first reported case of a patient with acute dual sensory loss due to ethylene glycol poisoning benefiting from bilateral cochlear implants.     

Simultaneous thrombin and plasmin generation capacities in normal and abnormal states of coagulation and fibrinolysis in children and adults

Introduction

Thrombin and plasmin are the key enzymes involved in coagulation and fibrinolysis, respectively. Plasma coagulative and fibrinolytic potentials in normal children and adults, and in representative pathologically altered hemostatic states, were evaluated via simultaneous assessment of thrombin and plasmin generation.

Materials and Methods

An assay of Simultaneous Thrombin and Plasmin generation (STP) was developed to measure thrombin and plasmin in plasma using individual fluorometric substrates. Coagulation is initiated with dilute tissue factor, phospholipid, and calcium in platelet-poor plasma; fibrinolysis is accelerated via tissue plasminogen activator (tPA). Abnormal states of hemostasis were investigated.

Results

STP assay reproducibility and normal adult and pediatric values for measured and calculated parameters have been established. Onset of both thrombin and plasmin generation was significantly delayed in children relative to adults (p < 0.001) and the maximum amplitudes of thrombin and plasmin generation were less in children than adults (p < 0.01). No significant differences were measured among pediatric age groups. The most profound impairments in thrombin generation were observed for extrinsic and common pathway factor deficiencies, with the exception of afibrinogenemia. Plasmin generation was severely impaired in deficiencies of fibrinogen and plasminogen as well as with decreased tPA reagent concentration and addition of aminocaproic acid. Plasmin generation was greatly enhanced by alpha-2-antiplasmin deficiency and excess tPA reagent.

Conclusion

Simultaneous assessment of thrombin and plasmin generation in plasma shows promise for affording an enhanced understanding of overall coagulative and fibrinolytic functions in physiological and pathologically altered states of hemostasis in children and adults.     

Burn scar contractures of the feet: efficacy of bilateral simultaneous surgical correction

Children who sustain large total body surface area (TBSA) burns with involvement of the lower extremities frequently sustain injuries to the dorsum of the feet. Burn scar contractures of the feet can develop as a sequela of the burn injury. Such contractures frequently require surgical correction. Many surgeons proceed with staged unilateral corrections when both feet are equally in need of operative intervention. The purpose of the study is to determine if the morbidity for correction of bilateral dorsal foot contractures is different from that for the correction of unilateral dorsal foot contractures.

A retrospective review from January 1994 to July 1999 was undertaken. Forty-five patients with photographic record of burn scar contracture of the feet were identified. Twenty-five patients underwent staged unilateral surgical correction and twenty patients underwent simultaneous bilateral correction of the feet. All patients underwent surgical correction with split thickness skin grafts (STSG). No statistical difference was found in terms of mortality, development of contracture, or number of reconstructive procedures. However, the length of stay revealed the efficacy of the bilateral simultaneous release of the dorsal feet.