鞘内药物输注系统永久植入术治疗顽固性疼痛病人18例

鞘内药物输注系统(IDDS)永久植入术治疗顽固性疼痛病人18例,其中晚期癌痛病人13例,非癌痛病人5例.首先行筛选试验,随后行IDDS永久植入术.癌痛病人采用视觉模拟评分(VAS评分)及QLQ-C30生活质量评分(QLQ-C30)法,非癌痛病人采用VAS评分法,评价疼痛程度,记录副作用及并发症的发生情况,癌痛病人随访至死亡,非癌痛病人均获得随访至今.术后所有病人经短期鞘内给药量调整后,VAS评分降低,癌痛病人QLQ-C30评分升高.部分病人出现恶心呕吐、便秘、尿潴留、皮肤瘙痒、镇静过度等,约1周均明显缓解,无持续残留症状.术中拔除穿刺针时误割断鞘内导管1例;导管与泵的金属接口过度磨擦至导管破裂,出现渗液1例;术后出现低颅压2例,脑脊液渗漏1例,右小腿后外侧持续性神经病理性疼痛1例,无伤口感染、裂开、愈合不良,无导管渗漏、破裂、异位、折叠、被结扎或肉芽肿形成,无泵翻转、位置异常等,设备本身无故障出现.

Abstract：

From November 2003 to May 2010, intrathecal drug delivery system (IDDS) was implanted in 18 patients with chronic intractable pain. Analgesia was provided with morphine. Thirteen patients suffered from late stage cancer and 5 from diseases other than cancer. VAS score was used to measure intensity of pain in all 18patients. QLQ-C30 score was used to evaluate quality of life in cancer patients. The patients were followed up for 3-62 months in 5 non-cancer patients. All 13 cancer patients died at 57 days-10 months after operation. VAS scores were significantly decreased and QLQ-C30 scores increased by intrathecal administration of morphine. Side effects developed in all patients to some extent including nausea, vomiting, constipation, urinary retention, pruritus and over-sedation and vanished in a week. Intrathecal catheter was cut while being pulled out of the needle in 1 patient. Two patients developed low intracranial pressure after operation. Cerebrospinal fluid leakage occurred in 1 patient. One patient developed neuropathic pain in the posterolateral side of right leg.     

重组组织型纤溶酶原激活剂治疗脑室内出血

目的 探讨利用重组组织型纤溶酶原激活剂(rt-PA)脑室内给药治疗脑室出血的疗效和安全性. 方法 对自2005年11月至2007年10月收入我院的10例脑室出血患者CT确诊后,进行(单侧或双侧)脑室穿刺置管,4～6 h后经弓l流管缓慢注入rt-PA 4～8 mg,12～24 h重复1次,每24～48小时复查CT了解脑室内血肿清除情况,直至头颅CT扫描显示脑室内高密度影像消失.于脑室出血后30 d时对患者情况利用GOS评分进行评估. 结果 每个患者应用rt-PA总剂量为13～24 mg,30 d后GOS评分为良好4例,中残3例,重残2例,植物生存1例,无患者死亡,无出血、颅内感染等并发症,未发生引流管被血块堵塞情况. 结论 选择适宜剂量和方法的rt-PA脑室内给药能够加速脑室内血块溶解,保持脑室引流管通畅,减少血块占位效应.该方法能够安全有效地改善患者的预后.     

序贯性应用肝动脉化疗栓塞与瘤内无水酒精注射治疗巨块型肝癌144例

 目的 观察经皮肝动脉化疗栓塞（TACE）和CT引导下经皮穿刺瘤内无水酒精（PEI）序贯性治疗巨块型原发性肝癌的疗效。方法 144例无远处转移巨块型原发性肝癌先经TACE术治疗，2周后再进行4 ~ 6次PEI治疗。结果 PR 96例（66.7 %），MR 33例（22.9 %），SD 15例（10.4 %），二期可切除69例，手术切除率47.9 %。随访结果显示：6个月、1、2、3年生存率分别为：93.8 %、75.0 %、59.0 %、31.9 %。结论 TACE与PEI序贯性治疗中晚期巨块型肝癌疗效较显著，使原不能手术切除的肝癌可以适应手术治疗，延长了患者的生存期，提高了患者生活质量     

光动力疗法联合玻璃体腔曲安奈德注射治疗脉络膜新生血管

目的观察光动力疗法(PDT)联合玻璃体腔曲安奈德(TA)注射治疗老年黄斑变性和病理性近视引起的脉络膜新生血管(CNV)的近期疗效和安全性。方法16例经过视力、眼压、荧光素眼底血管造影(FFA)以及光相干断层扫描(OCT)等检查确诊的CNV患者的16只患眼进行PDT联合玻璃体腔TA注射治疗。其中,渗出型老年黄斑变性14例14只眼,病理性近视2例2只眼。16只眼中,12只眼在PDT治疗后72 h行玻璃体腔TA注射,4只眼在PDT 3个月~1年(平均9个月)后行玻璃体腔TA注射。第1年的平均治疗次数为1.1次。联合治疗后,采用与治疗前相同的条件和检查方法进行随访观察,随访时间3~18个月,平均随访时间18.6个月。对比观察治疗前后患者的最佳矫正视力、眼压、CNV病灶渗漏情况以及黄斑区视网膜厚度变化。结果16只眼中,7只眼视力提高,占43.8%;9只眼视力稳定,占56.2%。FFA显示CNV病灶在联合治疗后渗漏停止或减轻,OCT显示黄斑区视网膜水肿消退或减轻。1只眼暂时性眼压升高,占6.3%。经药物短期治疗后恢复正常。结论PDT联合玻璃体腔TA注射可以安全有效地治疗CNV,延缓视力下降,并且可以减少重复治疗的次数。     

反相高效液相色谱法测定莪术油注射液中莪术醇和牛儿酮的含量

目的利用反相高效液相色谱法同时测定莪术油注射液中莪术醇和牛儿酮含量。方法采用AgilentTC ODS色谱柱(4.6 mm×15 cm,5μm),流动相A:乙腈-甲醇-水-磷酸(550∶225∶225∶1);流动相B:甲醇,梯度洗脱,流速1.0 mL/min,柱温:35℃,检测波长:210 nm。结果在该条件下,莪术醇、牛儿酮浓度分别在0.940 6~94.06μg/mL和1.333~133.2μg/mL范围内与峰面积呈良好的线性关系;回收率分别为100.70%和100.37%,RSD分别为0.86%和0.92%。结论本法可用于同时测定莪术油注射液中莪术醇和牛儿酮的含量,方法简便、结果准确。     

曲安奈德玻璃体内注射治疗黄斑水肿对眼压的影响观察

目的:评价曲安奈德玻璃体内注射治疗糖尿病性黄斑水肿在眼压方面的安全性。方法:将双眼糖尿病性黄斑水肿患者分别采用4m g和8m g不同剂量的曲安奈德玻璃体内注射,观察最佳矫正视力维持时间和眼压升高情况的差异。结果:两种剂量的曲安奈德玻璃体内注射均可使黄斑水肿消退,最佳矫正视力维持时间两组有显著性差异(P<0.05),4m g和8m g两种剂量曲安奈德玻璃体内注射引起眼压升高无显著性差异(P>0.05)。结论:4m g和8m g曲安奈德玻璃体内注射均可引起眼压升高,可尝试应用8m g剂量替代4m g曲安奈德玻璃体内注射以维持最佳矫正视力和减少玻璃体内注射次数带来的风险。     

自体骨髓注射治疗单纯性骨囊肿的影像学变化与临床意义

目的观测自体骨髓注射治疗单纯性骨囊肿的影像学改变，分析其临床意义。方法自体骨髓注射治疗单纯性骨囊肿患儿27例，获随访25例，随访平均3．3年。以CR摄影判定影像学上的疗效；观测术后不同时期X线骨囊肿面积、皮质厚度的变化情况；分术前合并病理骨折组及无病理骨折组，测算术前囊肿纵径／最小皮质厚度，行组间比较。通过三维CT结合X线观察骨囊肿的基本愈合形式。结果1次注射后愈合10例，缺损愈合5例，持续存在7例（含2例无反应），复发3例。除外无反应者，术后3个月病灶内均有不同程度的密度增高；X线骨囊肿面积基本稳定，主要发生在术后649个月（21／23）；X线骨囊肿皮质厚度基本稳定，主要发生在术后9个月～1年（19／23）。除外下肢持重管状骨病变，术前合并病理骨折组及无病理骨折组囊肿纵径与最小皮质厚度比值差异显著。结论自体骨髓注射治疗单纯性骨囊肿术后随访至少1年；该法通过骨皮质增厚，囊腔内骨嵴及骨小梁向心性增生，分割包绕填塞囊腔而逐步愈合。     

The effects of intradermal vaccination with DNA encoding for the T-cell receptor on the induction of experimental autoimmune encephalomyelitis in B10.PL mice

Intradermal gene administration was found to induce a more profound immune response than direct intramuscular gene injection. We performed intradermal vaccination of B10.PL mice with DNA encoding for the V 8.2 region of the T-cell receptors (TCR). Three weeks later, these mice were immunized with rat myelin basic protein (MBP). Daily mean clinical scores and mortality rate were lower in this group compared with controls. The proliferative responses of lymph node cells to rat MBP were slightly less in the vaccination groups than in the control groups (p < 0.05). However, we detected no differences between the two groups with regard to the production of MBP-specific IgG, IgG1, & IgG2a antibodies. The levels of cytokine mRNA expression in the vaccination groups were observed higher than in the control groups without antigen-specific stimulation, but all of cytokine expressions between the vaccination and control groups after antigen-specific stimulation were identical. These results demonstrate that intradermal DNA vaccines encoding for TCR might prove to be useful in the control of autoimmune disease.     

Cervical facet joint injections in the neck and shoulder pain

The effects from cervical facet joint injections in those patients who have been complaining cervical zygapophyseal joint pain were compared. The patients were diagnosed originally as myofascial pain syndrome (MPS), cervical herniated nucleus pulposus (HNP), and whiplash-associated disorders (WAD). Patients with the zygapophyseal joints pain of C5-6 and C6-7 were classified by their pain origin as MPS, HNP, and WAD. All patients had been undergone cervical zygapophyseal joints injections with the mixture of lidocaine and triamcinolone unilaterally or bilaterally through the posterior approach under C-arm imaging guide. The therapeutic effects were compared with reduction of numeric rating scale (NRS) of pain before and immediately after blockade and symptom-free periods in each group after 12 months. Symptom durations before injections were 16.1+/-9.6, 4.6+/-1.9 and 4.1+/-1.1 months in each MPS, HNP, and WAD groups. The reductions of NRS immediately after the blockade among the three groups were not different. However, the symptom-free duration after blockade lasted longer in the HNP group than the other two groups. In patients with cervical zygapophyseal pain syndromes, the analgesic effect from cervical facet joint blocks lasted longer in cervical HNP than MPS or WAD.     

Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol

Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6-8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.