铋合剂与复方铋剂治疗胃溃疡的对比研究

经内窥镜证实的活动性胃溃疡的门诊病人76例(包括胃溃疡60例及复合溃疡16例)随机分成两组,分别给予铋合剂(MB)和复方铋剂(MBC)治疗,在6周疗程结束后2天内纤维内窥镜复查,判明疗效。结果发现胃溃疡MB组30例愈合者26例(86.7%),MBC组30例愈合者24例(80%);复合溃疡MB组8例愈合6例(75%),MBC组8例愈合5例(62.5%),两组疗效比较在统计学上均无显著性差异(P>0.05)。12例接受MB治疗的患者,在治疗前及疗程2周、6周末测试BUN、肌酐及PSP亦均无显著变化(P>0.05)。本文说明铋合剂治疗活动性胃溃疡与复方铋剂比较,同样有效;且铋合剂制备更简易,制剂稳定便于保存,未发现有副作用,值得推广。     

有针麻醉与无针麻醉在小儿包皮环切术中的对比研究

目的:探讨无针麻醉与有针麻醉运用盐酸利多卡因在小儿包皮环切术中的对比分析。方法:选择2012年11月至2013年8月在本院择期行包皮环切术的患儿60例,随机分成两组,每组各30例,对照组给予有针麻醉应用1%盐酸利多卡因后行包皮环切术,治疗组给予无针麻醉运用1%盐酸利多卡因后行包皮环切术,两组均采用传统包皮环切手术方法,采用视觉模拟疼痛评分方法(VAS)对疼痛进行评分,比较两组患儿的麻醉起效时间、麻醉维持时间、VAS、手术时间、术后水肿情况及术后1周切口愈合程度。结果:两组患儿VAS评分、麻醉起效时间、麻醉剂量差异有统计学意义(P0.05);两组手术时间、麻醉维持时间差异无统计学意义(P0.05);治疗组术后水肿情况及1周切口愈合程度显著优于对照组,两组差异有统计学意义(P0.05)。结论:无针麻醉运用盐酸利多卡因应用于小儿包皮环切术麻醉效果好,患儿耐受性好,有效缩短了手术时间,且术后恢复快,值得在基层医院推广使用。     

坐浴一号洗液抗炎镇痛药效作用研究

目的对坐浴一号洗液进行抗炎镇痛药效作用研究,以期为该制剂治疗肛瘘术后创面愈合的临床疗效提供现代药理学实验依据。方法采用二甲苯致小鼠耳廓肿胀炎症模型和醋酸致小鼠扭体疼痛模型,以金玄痔科熏洗散中成药制剂为阳性药物对照,分为高、中、低剂量组观察坐浴一号的抗炎和镇痛药理作用。结果坐浴一号与阳性药物组比较,其低剂量组无显著性差异,但中剂量组和高剂量组均有显著性差异,优于阳性药物组。结论坐浴一号洗液具有明显的抗炎和镇痛作用。     

3.0 T ~1H-MRS定量分析评估脂肪肝治疗效果的初步研究3.0 T^1H-MRS定量分析评估脂肪肝治疗效果的初步研究

目的探讨在3.0 T MRI中运用氢质子波谱成像（1 H-MRS）技术评估脂肪肝治疗效果的可行性。方法收集临床确诊并治疗的脂肪肝患者26例,分别于治疗前、治疗后3和6个月各行1次1 H-MRS检查,测得1 H-MRS的水峰峰值和脂肪峰峰值、水峰峰下面积和脂肪峰峰下面积,计算肝细胞相对脂肪含量1（RLC1）及相对脂肪含量2（RLC2）;同期测量患者的甘油三酯、γ-谷氨酰转肽酶、腹围及体重指数,将其拟合成临床脂肪肝指数（fatty liver index,FLI）。以FLI为参照标准,对不同时间点1 H-MRS所测得肝脏脂肪含量进行统计学分析。结果采用配伍设计的方差分析,治疗前、治疗后3和6个月的RLC1、RLC2值比较差异有统计学意义（P〈0.05）;用SNK法做两两检验,治疗前RLC1、RLC2值均分别明显高于治疗后3个月或治疗后6个月的RLC1、RLC2值（P〈0.05）。RLC1、RLC2与FLI进行秩相关性分析,均呈正相关性（r=0.476,P〈0.001;r=0.475,P〈0.001）。可靠性分析显示,治疗前的组内相关系数均≥0.75,可重复性好。结论 1 H-MRS定量分析评估脂肪肝治疗效果具有可行性,并且是一种无创的定量监测方法。 更多     

A simple technique ligating the corresponding inflow and outflow vessels during anatomical left hepatectomy

Background Massive bleeding remains one of main factors of morbidity and death in liver resections. For this reason, the Pringle maneuver or total vascular exclusion is commonly used during liver resection. However, ischemic damage is still a major problem. Some surgeons used the “glissonean” approach for bleeding control, but the technique is tedious and also time consuming, with high incidence of bile leaks in the postoperative period. The aim of this paper is to describe a new bleeding control technique, rapid ligation of the corresponding inflow and outflow vessels without hilus dissection before the parenchyma transection during anatomical left liver resection and to analyze the feasibility, blood loss, transfusion requirements, and postoperative complications. Materials and methods During the past 18 years, we used the new hemorrhage control technique in left liver resection in 630 patients with malignant or benign tumors. Results The median blood loss in all 630 patients was 110 ± 250 ml (range 50–750), and no patient required blood transfusion. The median total operative time was 77 ± 35 min (range 25–155). No bile leaks and liver failure of the patients occurred postoperatively. There was no death within 30 postoperative days. Conclusion The rapid ligation of the corresponding inflow and outflow vessels without hilus dissection before the parenchyma transection is a feasible, safe, and bloodless technique during the left liver resection. A commentary on this paper is available at     

Liver resection without hilus preparation and with selective intrahepatic hilus stapling for benign tumors and liver metastasis

Background Nowadays, liver resection is a routine operative procedure in surgical centers, and strategies must be aimed at avoiding additional risk factors. Extrahepatic isolation of portal vein, hepatic artery and hepatic duct, as well as lymphadenectomy of the liver hilum are generally accepted steps of liver resection, even for metastatic and benign indications. Our primary aim was to analyze the feasibility, blood loss, blood transfusion requirements, incidence of complications, and outcome using the approach for intrahepatic devascularization leaving the extrahepatic hilus untouched. Materials and methods Thirty-eight consecutive patients with resection for metastases and benign liver tumors were selected. After hilar examination, the extrahepatic structures remain intact, and during parenchyma dissection, the whole right or left or the appropriate bi-segmental pedicle is isolated intrahepatically and then transected using a stapler device. Results The used technique was feasible in all cases, and no intra- or postoperative surgical complications were observed. To date, no tumor recurrence was found in the hilum during the follow-up period. Conclusion The intrahepatic pedicle stapling technique appears to be feasible and safe in liver resection. Hilar dissection can, thus, be avoided in liver metastasis and benign liver tumors.     

Frequency of Human Leukocyte Antigens and Donor Specific Antibodies in Long-Term Living Donor Kidney Transplantation

PurposeHLA antibodies have been shown to be associated with late graft loss. In this study, we defined the incidence and profiles of anti-HLA antibodies and their impact on graft outcome in long-term kidney recipients.MethodsThe sera of 118 kidney transplant recipients were screened for anti-HLA antibody presence. The antigen specificity of the detected HLA class I and class II antibodies was identified using a Luminex assay (Luminex Corp, Austin, TX, United States). Presence of donor specific antibodies (DSA) was examined in individuals with anti-HLA antibodies using the Luminex method.ResultsAnti-HLA class I and/or class II antibodies were detected in serum of 16.1% of the kidney transplant patients. The antibodies were directed against HLA class I antigens in 4 patients (21.1%), HLA class II antigens in 9 patients (47.4%), and both class I and class II antigens in 6 patients (31.6%). The overall prevalence of DSA was 10.2%. Anti-HLA antibodies were significantly associated with higher rate of cyclosporine use. Presence of DSA was associated with a lower rate of tacrolimus use, a higher rate of cyclosporine use, and lower donor age. Presence of anti-HLA antibodies was associated with higher acute cellular rejection and higher chronic active humoral rejection rates. Presence of DSA was associated with chronic active humoral rejection.ConclusionThe presence of either HLA antibodies or DSA significantly correlated with lower graft survival, poor transplant function, and proteinuria.     

Successful Treatment for BK Virus Nephropathy by Leflunomide in a Kidney Transplant Patient: A Case Report

IntroductionThe immunosuppressant agents in kidney transplantation (KT) may lead to various complications such as opportunistic infections and malignancies. BK virus associated nephropathy is a significant complication following KT, and it can result in graft failure. BK virus causes tubulointerstitial nephritis, ureter stenosis, and even graft failure in KT recipients with impaired immune system. We described a 63-year-old woman, who was a hepatitis C carrier and on dialysis for 22 years before KT, who received cadaveric-donor KT 2 years previously. She reported decreasing urine output and general weakness. The serum creatinine level was slightly increased from 2.94 to 4.38 mg/dL.MethodsImmunosuppressant medications including prednisolone, everolimus, cyclosporin, and mycophenolate sodium were continued as maintenance therapy post KT. Kidney biopsy was performed due to deterioration of graft function.ResultsThe kidney biopsy showed consistent results with early-stage polyomavirus nephropathy, characterized by focal viral cytopathic changes with positive immunohistochemical signals and mesangial proliferative glomerulonephritis, immune-complex-mediated (Fig 1 and Fig 2). Negative C4d staining at peritubular capillary was reported. The dosage of mycophenolate sodium was tapered from 720 to 360 mg daily and that of everolimus increased from 0.5 to 1.0 mg daily due to BK viral infection with BK nephropathy. The serum creatinine level was 2.75 mg/dL after treatment.ConclusionEarly detection of BK nephropathy and decreasing immunosuppressant agents are the mainstay of treatment. Substituting leflunomide for mycophenolate sodium and increasing dosage of everolimus has been proposed to solve BK nephropathy. We presented that the use of leflunomide in such situation is in a timely manner.