A modified technique to perform para-aortic lymphadenectomy up to the renal vein

ObjectiveTo investigate the safety and feasibility of our modified technique to perform lymph node excision up to the renal vein in cases of gynecological cancer.Materials and methods87 patients with endometrial or ovarian neoplasms underwent laparoscopic para-aortic lymphadenectomy (LPAL) up to the left renal vein were enrolled prospectively. During surgery, the surgeon was positioned to the right side of the patient and an additional trocar was introduced into the upper right abdomen. The laparoscopic video screen was placed to the side of the patient's head. Three-fan retractor forceps were used to hold up the duodenum and small bowel. The rest of the procedure was the same as conventional LPAL.ResultsThe median operating time for LPAL was 72 min (range: 40–115 min) and the median estimated blood loss was 45 ml (range: 15–1000 mL). There were two cases of intra-operative vascular injury. The median number of retrieved para-aortic lymph nodes (PALNs) was 18 (range: 10–37). Of the 87 patients, 11 patients had positive PALNs. None of the cases required laparotomy.ConclusionOur findings demonstrate that our modified LPAL technique is feasible, reproducible, can achieve good exposure and reduces surgical difficulty.     

新生儿及婴儿完全型肺静脉异位引流的外科治疗

目的　回顾性探讨新生儿及婴儿完全型肺静脉异位引流 (TAPVC)的早期外科手术效果。方法　 2 0 0 1年 3月～ 2 0 0 3年 4月 ,共收治 8kg以下完全型肺静脉异位引流患儿 13例 ,男 11例 ,女 2例。体重 (3.5～ 8)kg ,平均体重 (5 .0 3± 1.15 )kg。年龄 2 0d～ 11个月 ,平均年龄 (3.73± 3.30 )个月。心上型 6例 (4 6 .15 % 6 /13) ,心内型 4例 (30 .77% 4 /13) ,心下型 2例 (15 .38% 2 /13) ,混合型 1例 (7.6 9% 1/13)。所有患儿均在全麻低温体外循环下行矫治术。结果　术后早期死亡 2例(15 .38% ) ,均为心上型 ,2例心下型全部存活 ,随访 9例 ,时间为 2个月～ 2年 ,心功能均良好。结论　完全型肺静脉异位引流早期矫治效果良好 ,心下型肺静脉异位引流一旦确诊应急诊手术 ,不增加手术死亡率。     

Surgically important variations of the jugular veins

Knowledge of variations of veins of head and neck in relation to external jugular, anterior jugular, internal jugular, and facial veins is important to surgeons doing head and neck surgery as well as to radiologists doing catheterization and to clinicians in general. In the current case, multiple variations in the veins of the left side of neck are reported. The anterior division of retromandibular vein was absent. The facial vein continued as anterior jugular vein. The internal jugular vein was duplicated above the level of hyoid bone. There was a large communicating vein between the anterior jugular vein and anterior division of internal jugular vein. Lingual vein drained into the communicating vein. Jugular venous arch was abnormally large, doubled, and highly placed. The veins of the right side were normal.     

肝铸型标本肝静脉吻合的观测及临床意义

目的：观察肝静脉之间的吻合情况；方法：观察88个铸型标本中肝静脉侧支吻合的出现率，并对一例有丰富吻合支的肝脏用游标卡尺测量吻合中点处的直径；结果：88个肝铸型标本中有侧支吻合22例，显示率25％；1例丰富吻合标本，其中有17处吻合，最大直径为2．28mm，最小直径为0．62mm。副肝静脉与肝静脉吻合3处；结论：在肝静脉结扎或病理变化后，侧支循环开放、增多，受累肝段与未受累肝段间发生浅表和深部肝静脉侧支吻合，使得肝内血管解剖变得异常复杂而完全不同于正常解剖结构，为肝外科手术中处理肝静脉提供了解剖学依据。     

Markers of early endothelial dysfunction in intrauterine growth restriction-derived human umbilical vein endothelial cells revealed by 2D-DIGE and mass spectrometry analyses

Intrauterine growth restriction (IUGR) associates with fetal and placental vascular dysfunction, and increased cardiovascular risk later on life. We hypothesize that endothelial cells derived from IUGR umbilical veins present significant changes in the proteome which could be involved in the endothelial dysfunction associated to this conditions. To address this the proteome profile of human umbilical endothelial cells (HUVEC) isolated from control and IUGR pregnancies was compared by 2D-Differential In Gel Electrophoresis (DIGE) and further protein identification by MALDI-TOF MS. Using 2D-DIGE 124 spots were identified as differentially expressed between control and IUGR HUVEC, considering a cut-off of 2 fold change, which represented ∼10% of the total spots detected. Further identification by MALDI-TOF MS and in silico clustering of the proteins showed that those differentially expressed proteins between control and IUGR HUVEC were mainly related with cytoskeleton organization, proteasome degradation, oxidative stress response, mRNA processing, chaperones and vascular function. Finally Principal Component analysis of the identified proteins showed that differentially expressed proteins allow distinguishing between control and IUGR HUVEC based on their proteomic profile. This study demonstrates for the first time that IUGR-derived HUVEC maintained in primary culture conditions present an altered proteome profile, which could reflect an abnormal programming of endothelial function in this fetal condition.     

Neck masses due to internal jugular vein phlebectasia: Frequency in Menkes disease and literature review of 85 pediatric subjects

Classic Menkes disease is a rare X‐linked recessive disorder of copper metabolism caused by pathogenic variants in the copper transporter gene, ATP7A. Untreated affected individuals suffer failure to thrive and neurodevelopmental delays that begin at 6–8 weeks of age and progress inexorably to death, often within 3 years. Subcutaneous injections of Copper Histidinate (US Food and Drug Administration IND #34,166, Orphan product designation #12‐3663) are associated with improved survival and neurological outcomes, especially when commenced within a month of birth. We previously identified internal jugular vein phlebectasia (IJP) in four Menkes disease subjects. This feature and other connective tissue abnormalities appear to be consequences of deficient activity of lysyl oxidase, a copper‐dependent enzyme. Here, we report results from a prospective study of IJP based on 178 neck ultrasounds in 66 Menkes subjects obtained between November 2007 and March 2018. Nine patients met the criterion for IJP (one or more cross‐sectional area measurements exceeding 2.2 cm²) and five subjects had clinically apparent neck masses that enlarged over time. Our prospective results suggest that IJP occurs in approximately 14% (9/66) of Menkes disease patients and appears to be clinically benign with no specific medical or surgical actionability. We surveyed the medical literature for prior reports of IJP in pediatric subjects and identified 85 individuals and reviewed the distribution of this abnormality by gender, sidedness, and underlying etiology. Taken together, Menkes disease accounts for 16% (15/94) of all reported IJP individuals. Neck masses from IJP represent underappreciated abnormalities in Menkes disease.     

大隐静脉射频消融术与大隐静脉高位结扎剥脱术治疗静脉曲张的疗效对比

目的比较大隐静脉射频消融术和大隐静脉高位结扎剥脱术治疗静脉曲张的临床疗效。方法回顾性分析2018年9月至2019年5月江苏省中医院收治的70例(93条患肢)下肢大隐静脉曲张患者的临床资料,将行大隐静脉射频消融术和高位结扎剥脱术治疗的患者分别设为观察组和对照组,每组35例(对照组43条患肢,观察组50条患肢)。对比分析2组患者手术时间、恢复时间、切口数量、术后VAS疼痛评分等手术相关情况,比较2组患者手术前后CEAP分级、临床疗效、术后并发症、术后生活质量和满意度评分。结果与对照组相比,观察组所需手术时间、术后首次下床时间、住院时间及恢复时间较短,术中出血量、切口数量较少,术后VAS疼痛评分较低;2组患者CEAP分级构成在术后均比术前显著降低;观察组患者术后并发症总发生率显著低于对照组;观察组患者术后生活质量总评分及各项评分均显著高于对照组;观察组患者对治疗方法的整体评价高于对照组,以上差异均具有统计学意义(P<0.05)。结论大隐静脉射频消融术与大隐静脉高位结扎剥脱术疗效相当,但射频消融术有操作简单、创伤小、恢复快、并发症少且美观等优势,同时可减轻患者痛苦,显著改善术后生活质量,提高患者满意度。     

SPP对人脐静脉内皮EA.hy926细胞表达粘附分子的作用

目的:通过研究在N,N-二甲基鞘氨醇(DMS)作用下,人脐静脉内皮EA.hy926细胞株(EA株)表达粘附分子CD54(ICAM-1)和CD62p(PS)的变化,探讨第二信使1-磷酸鞘氨醇(SPP)参与动脉粥样硬化(AS)粘附过程的机制。方法:采用流式细胞仪分群作用衡量EA细胞株和单核细胞之间的粘附率,用细胞免疫组化法检测DMS作用于EA株后引起的粘附分子的表达。结果:随着DMS作用剂量或作用时间的增加,CD54与CD62p的表达均减少,同时粘附率也相应地下降。结论:AS早期的粘附过程可能是通过SPP来转导信息,以促进粘附分子表达。     

彩色多普勒超声对小腿三头肌内静脉扩张的诊断价值

目的探讨彩色多普勒超声对小腿三头肌内静脉扩张的诊断价值。方法选择72例疑为下肢深静脉病变的患者,其中男性32例,女性40例;年龄28-92岁,平均年龄56岁。应用彩色多普勒超声检查小腿三头肌内静脉（包括比目鱼肌静脉及腓肠肌静脉）,测量其管径,观察管腔内透声及血流情况,探查其交通支的情况。结果共检出小腿三头肌内静脉受累患肢72条,单纯小腿三头肌内静脉扩张32例（44．4％）,合并血栓16例（22．2％）,合并交通静脉扩张24例（33.3％）。结论彩色多普勒超声能够有效地检出小腿三头肌内静脉扩张及血栓、其交通支情况。是超声检查下肢深静脉时不容忽视的重要内容。