氩氦冷冻治疗系统对犬脑冷冻范围的超导刀直径变量和时间相关性研究

目的 探讨氩氦冷冻治疗系统(简称氩氦刀)在超导刀直径及冷冻时间变量下,正常犬脑组织冷冻坏死范围及超微组织病理学变化. 方法用直径2mm、3mm氩氦冷冻超导刀插入犬脑一侧右额叶,分别冷冻3min、5min,重复一次,48h后灌注取脑组织,在光镜和电镜下观察组织病理学变化,测量冷冻坏死区直径.结果 冷冻后48h,冷冻区脑组织均呈出血坏死状,可明显分为中央坏死区、炎性反应带、出血水肿带和交界线,冷冻边缘未发现存活的脑细胞结构.结论 采取2次冻融循环,冷冻时间为3min、5min,足以导致冷冻区脑组织死亡.     

Development of a visual inspection programme for cervical cancer prevention in Bangladesh

Cervical cancer is the most common reproductive cancer in women in Bangladesh, and most women come for diagnosis and treatment when it is too late. To support early detection of pre-cancerous conditions and prevent cervical cancer, Bangladesh undertook a screening programme using visual inspection of the cervix with acetic acid (VIA) and cryotherapy through a public sector programme. The programme was launched in 2004−05 in a phased manner, starting with a pilot programme in 16 of the 64 districts in the country and scaled up to 44 districts as of the end of 2007. Evaluation of the pilot programme's performance showed that VIA can be carried out by trained doctors, nurses, and paramedical workers in Bangladesh, even though the level of resources is poor, and women, their partners and families are often not aware of the disease and its consequences. The programme now needs to move from opportunistic screening to population-based, systematic screening of women over age 30. More providers need to be trained, and clinics better equipped. The links between screening, diagnosis and treatment need to be improved and the false-positive rate of VIA tests greatly reduced. It is only when we have achieved high coverage that reduced rates of cancer can be ensured.     

调Q激光与液氮冷冻治疗扁平疣疗效比较

目的：比较调Q激光与液氮冷冻治疗扁平疣的疗效。方法：120例扁平疣患者随机分为调Q激光治疗组和液氮冷冻治疗组,每组60例,观察治疗效果。结果：调Q激光治疗组痊愈率93．3％,平均治疗次数1．3次。液氮冷冻治疗痊愈率73．3％,平均治疗次数2．3次,两组比较均有显著性差异（P〈0．05）。结论：调Q激光治疗扁平疣疗效优于液氮冷冻。     

氦氩冷冻治疗癌性疼痛的临床观察

目的探讨氩氦刀冷冻治疗癌性疼痛的疗效及安全性。方法 67例肿瘤患者在CT引导下行经皮穿刺氩氦刀冷冻治疗疼痛相关性瘤灶,观察术后患者疼痛缓解状况及瘤灶影像学改变。结果 67例患者在术后24小时、1周、1个月和3个月时疼痛缓解有效率分别为74.6%、86.6%、86.6%和73.1%,CT复查提示冷冻瘤灶呈坏死样改变,PET/CT提示病灶无活性或活性明显降低。全组术中、术后未出现严重并发症,主要不良反应包括寒战、血压波动、气胸或胸腔积液、术后发热、伤口渗血和周围神经损伤。结论氩氦刀冷冻治疗能有效缓解晚期肿瘤患者的癌性疼痛,改善生活质量,且安全性高,值得临床推广。     

Comparison of cryotherapy with curettage in the treatment of Bowen's disease: a prospective study

BACKGROUND: In our departments, curettage and cautery (C&C) and liquid nitrogen cryotherapy are the preferred methods of treatment for Bowen's disease (BD). OBJECTIVES: We aimed to compare these two treatments with regard to efficacy, time to heal, morbidity and recurrence rate. METHODS: Cryotherapy was performed using a liquid nitrogen spray giving two freeze-thaw cycles, each freeze cycle being maintained for 5-10 s after the formation of an ice ball to the intended margin. Curettage was performed with a conventional disposable curette under local anaesthesia, and electrocautery was then used for haemostasis. RESULTS: Eighty lesions in 67 patients (55 female) were analysed. The mean age of the patients was 74 years (range 46-89). The most frequent site was the lower leg, below the knee (n = 59, 74%). The average time taken for complete healing after the procedure was 60 days. The mean size of the lesions was 336 mm(2) (range 30-1890). The patients were followed up for a mean of 22 months (range 6-24, median 2 years). In the cryotherapy group (n = 36 lesions), the median time to complete healing was 46 days (range 14-210; mean 69). Twelve lesions took more than 90 days to heal. Infection requiring antibiotics developed in four patients. Thirteen of the treated lesions had recurred by 24 months. In the C&C group (n = 44 lesions), the median time to healing was 35 days (range 14-330; mean 53). Six of the lesions took more than 90 days to heal. Infection developed in two patients. Recurrence occurred in four lesions over the follow-up period. Considering BD on the lower legs separately, lesions took on average 90 days to heal in the cryotherapy group (n = 23), whereas in the C&C group (n = 36) they took 39 days to heal (P < 0.001). During the procedure and the subsequent 24 h, patients were 10.4 times more likely to report pain of any degree for lesions treated by cryotherapy than by C&C (P < 0.001). CONCLUSIONS: This study suggests a superiority of C&C over cryotherapy in the treatment of BD, especially for lesions on the lower leg. Curettage of lesions of BD is associated with a significantly shorter healing time, less pain, fewer complications and a lower recurrence rate when compared with cryotherapy.     

Effectiveness, safety and acceptability of 'see and treat' with cryotherapy by nurses in a cervical screening study in India

We evaluated a 'see and treat' procedure involving screening, colposcopy, biopsy and cryotherapy by trained nurses in one-visit in field clinics in a cervical screening study in South India for its acceptability, safety and effectiveness in curing cervical intraepithelial neoplasia (CIN). Women positive on visual inspection with acetic acid (VIA) were advised colposcopy, directed biopsies and cryotherapy if they had colposcopic impression of CIN in one visit by nurses in field clinics supervised by a doctor. Side effects and complications were assessed and cure rates were evaluated with VIA, colposcopy and biopsy if colposcopic abnormalities were suspected. Cure was defined as no clinical or histological evidence of CIN at > or =6 months from treatment. Of the 2513 women offered 'see and treat' procedure, 1879 (74.8%) accepted. Of the 1397 women with histologically proved CIN treated with cryotherapy, 1026 reported for follow-up evaluation. Cure rates were 81.4% (752 out of 924) for women with CIN 1; 71.4% (55 out of 77) for CIN 2 and 68.0% (17 out of 25) for CIN 3. Minor side effects and complications were documented in less than 3% of women. 'See and treat' with cryotherapy by nurses under medical supervision is acceptable, safe and effective for cervical cancer prevention in low-resource settings.     

Depigmentation therapies for normal skin in vitiligo universalis

If vitiligo involves most of the body, it might be easier to depigment the normal remaining skin rather than to attempt repigmentation. We reviewed the literature to date regarding available therapies for depigmenting the normal skin in vitiligo universalis. Our review revealed that the threshold regarding what percentage of body surface area qualifies as depigmentation is variable among practitioners. Monobenzyl ether of hydroquinone (MBEH) is the most widely used depigmenting agent and has few side‐effects. Tretinoin in combination with MBEH is able to speed depigmentation of the skin. Monomethylether of hydroquinone has also been used successfully for depigmentation. Eighty‐eight per cent phenol is also effective in depigmenting the skin but its application on large areas is toxic for liver and kidney. Different types of lasers are also available to destruct the melanocytes selectively, but this technique can be painful and expensive. Cryotherapy is a cheap depigmenting therapy but, because of scarring risk, it should only be used by experienced dermatologists. No trials have compared the efficacy of the above‐mentioned well‐established depigmentation agents/techniques. Certain drugs such as imatinib, imiquimod and diphencyprone, which are used to treat other diseases, caused depigmentation as a side‐effect. Some depigmentation agents used for branding cattle can also serve as topical depigmentation agents. In conclusion, comparative clinical trials are needed to compare the efficacy of various depigmentation agents/techniques. In particular, topical imatinib, imiquimod and diphencyprone may be considered as potential depigmenting agents, which require further investigation. This review revealed that MBEH is safe and effective depigmenting agent.