Sonographically guided small-bore chest tubes and sonographic monitoring for rapid sclerotherapy of recurrent malignant pleural effusions.

OBJECTIVE: To evaluate the role of sonographically guided small-bore chest catheters and sonographically based monitoring of fluid evacuation in rapid sclerotherapy of malignant pleural effusions. METHODS: In 50 patients with recurrent malignant pleural effusions, a 9F catheter was inserted into the pleural space under sonographic guidance. When sonography documented complete fluid evacuation, bleomycin (0.75 mg/kg) was injected via the tube. Fluid drainage was monitored for 12 hours; if fluid output was less than 100 mL, the pleural catheter was removed; otherwise, a second dose of bleomycin was administered after 24 hours. If loculations or fluid reaccumulations due to tube malfunctioning were detected, they were evacuated by sonographically guided thoracentesis, and bleomycin (1.5 mg/100 mL of fluid) was injected through the thoracentesis needle. All patients were monitored for fluid recurrence with thoracic sonography. RESULTS: Twenty-nine patients received 1 dose of bleomycin, and 21 received 2 doses. In 11 patients with residual loculations, sonographically guided thoracentesis was performed, and bleomycin was injected into the loculations. In 29 patients, pleurodesis was completed within 24 hours; in 21, it was completed within 48 hours. The 30-day response was 84%; the long-term response was 60%. No complications or serious side effects were observed. CONCLUSIONS: Rapid pleurodesis can be accomplished within 24 to 48 hours, with good short- and long-term responses. Thoracic sonography plays a pivotal role. It guides placement of the pleural catheter and is valuable in the monitoring of fluid evacuation for determining the right time for sclerosing agent administration and in the detection and treatment of loculations or residual pleural fluid due to tube malfunctioning.     

平阳霉素碘油乳剂动脉内栓塞治疗原发性大肝癌初探

目的回顾性评价平阳霉素碘油乳剂（PLE）经肝动脉化疗栓塞治疗原发性大肝癌的安全性、技术成功率及临床疗效，以期提高患者生活质量及生存率。方法对20例原发性大肝癌患者实施超选择性肿瘤滋养动脉PLE栓塞治疗。随机抽取前期用丝裂霉素碘油乳剂（MLE）治疗的24例原发性大肝癌患者作为对照组，比较两组病例治疗后肿瘤大小、肿瘤血管的改变及生存率等变化。结果研究组较对照组术后肿瘤缩小更明显（X^2=7．51，P〈O．05），甲胎蛋白水平下降显著（X^2=8.290，P〈0．05）。研究组6、12、24、36个月生存率分别为95％（19／20）、70％（14／20）、30％（6／20）和20％（4／20），对照组6、12、24、36个月生存率分别为80％（19／24）、54％（13／24）、21％（5／24）和13％（3／24），两组生存率比较，差异有统计学意义。结论PLE超选择性肿瘤滋养动脉栓塞治疗原发性大肝癌安全，治疗效果明显，其疗效明显优于MLE栓塞治疗。     

��ɽͪ�Կ�ǻ�Ĥ����ά�Ա�SD����ģ�Ϳ���ά�������о�

??Objective??To investigate the pharmacological effects of halofuginone ??HF?? on rat models of oral submucous fibrosis ??OSF?? induced by bleomycin ??BLM??. Methods??Forty SD rats were randomly divided into control group??20?? and model group??20??. Rats in the model group were treated with 1mg / mL BLM in the bilateral buccal submucosa anesthetized by isoflurane once a day for eight weeks. The control group was given saline instead of BLM. The mouth opening of each rat was measured at 2 weeks, 4 weeks, 6 weeks, and 8 weeks, respectively, and the mean value was drawn after measuring three times for each rat. After 8 weeks??5 rats from the model group were killed and all the rats from the control group were killed, and bilateral buccal mucosa tissues of each killed rat were taken and then fixed in paraformaldehyde. The remaining OSF rats from the model group were randomly divided into control group and HF group??six in each group. Rats from HF group were treated with 200 μL of 1μg/mL halofuginone once a day for six weeks??which was administered in the same way as BLM. The control group were given the same dose of saline. The mouth opening of each rat was measured at 2 weeks, 4 weeks, and 6 weeks with the above-mentioned methods, respectively. After 6 weeks??all the left rats were killed, and bilateral buccal mucosa tissues of each killed rat were taken and then fixed in paraformaldehyde. HE staining was used to detect the histopathological changes in the buccal mucosa of rats. Results????1??Local injection of BLM for 8 weeks in the buccal mucosa of 20 SD rats induced 17 SD rat models which had clinically and pathologically similar change to human OSF.??2??Halofuginone locally injected for 6 weeks relieved the fibrosis in OSF model rats. Conclusion??Halofuginone can improve the situation of oral submucous fibrosis of SD rats induced by 1 mg/mL BLM??and prevent its further development.     

Respiratory papillomas: presentation before six months

The prognosis of respiratory papillomatosis (RP) in newborns appears to be less favorable than in infants and older children. In this series of four patients who developed symptoms of the disease within the first 6 months of life, the mortality was 100%. In these premature and term newborn infants, endoscopic laser surgery and medical and immunologic therapy were unable to control the growth of RP. Meticulous local removal of the airway lesions is the most reliable form of management.     

肝血管瘤治疗中不同介入栓塞方法的比较

目的 探讨不同介入栓塞方案治疗肝血管瘤的疗效及安全性.方法 收集2010年8月-2013年4月在济宁市第一人民医院介入放射科接受治疗的肝血管瘤患者的临床资料.入组患者根据栓塞方法不同分为明胶海绵微粒＋平阳霉素碘化油乳剂组（观察组）和单纯的平阳霉素碘化油乳剂组（对照组）,比较两组患者的治疗效果、术后并发症、下床时间、住院时间以及治疗前后总胆汁酸（total bile acid,TBA）的变化.结果 本研究共纳入研究对象60例,其中观察组和对照组各30例.观察组患者治疗有效率和显效率均优于对照组（x^2=6.734,P=0.034）;两组并发症发生率差异无统计学意义（x^2=0.098,P=0.75）,观察组下床时间（t=19.39,P＜0.01）、住院时间（t=7.257,P＜0.01）均显著少于对照组;治疗前两组患者TBA水平差异无统计学意义（t=0.073,P=0.94）,治疗后3d观察组TBA水平低于对照组（t=3.195,P＜0.01）.两组患者的谷丙、谷草转氨酶、白蛋白、总胆红素、凝血酶原时间等指标均无统计学差异（P均＞0.05）.结论 明胶海绵微粒加平阳霉素碘化油乳剂相对于单纯平阳霉素碘化油乳剂治疗肝血管瘤,不仅有效、安全,而且患者术后恢复速度更快.     

布洛芬抑制博莱霉素诱导的肺纤维化小鼠一氧化氮生成的机制研究

 目的研究布洛芬对博莱霉素诱导的肺纤维化小鼠一氧化氮（NO）生成的影响及可能机制。方法通过气管内滴注博莱霉素复制小鼠肺纤维化模型,治疗组经腹腔注射给予不同剂量的布洛芬。用NO化学法试剂盒测定血清NO水平;用免疫组织化学法检测肺组织核因子-κB;用Westernblot法检测各组肺组织诱导性NO合成酶（iNOS）蛋白表达水平。结果与正常对照组比较,模型组血清NO水平、肺组织核因子κB（NF-κB）含量和iNOS的表达显著增加（P<0.01）,布洛芬5mg/kg治疗组未见明显变化,而布洛芬10mg/kg和20mg/kg治疗组则明显降低（P<0.05,P<0.01）。布洛芬20mg/kg治疗组血清NO含量、肺组织NF-κB含量和iNOS的表达明显低于布洛芬5mg/kg和10mg/kg治疗组。结论布洛芬可抑制由博莱霉素引起的iNOS和NF-κB的上调,降低肺纤维化小鼠NO水平,可能是降低肺纤维化机制之一。     

卡托普利对实验性肺间质纤维化的干预作用

目的 :观察血管紧张素转换酶 (ACE)活性在博莱霉素 (BLM)所致大鼠肺间质纤维化过程中的动态变化 ,了解ACE抑制剂卡托普利 (CPT)对大鼠肺纤维化模型的影响。方法 :4 5只SD大鼠随机分为 3组 :对照组、模型组和用药组。模型组和用药组经气管内注入BLM诱导肺纤维化 ,随即分别每日胃管内灌注生理盐水和CPT(6 0mg·kg- 1·d- 1 )进行干预 ;对照组气管和胃管内灌注均以生理盐水代替。各组动物均于气管内灌药后 7,14 ,2 8d分别处死 5只 ,测动物体重及肺湿重 ,取肺组织做HE染色 ,Ⅰ、Ⅲ型胶原的免疫组化 ,并行图像分析 ;心腔内取血测ACE的活性。结果 :血清ACE活性在气管内灌注BLM后迅速上升 ,第 7d达到高峰 (与对照组比P <0 .0 1) ,随后下降 ,到第2 8d基本恢复正常。CPT能显著降低血清中ACE的活性 ,减少肺内胶原的表达 ,减轻肺泡炎和肺纤维化的程度。结论 :CPT能减轻BLM诱导的大鼠肺泡炎和肺纤维化     

Bleomycin therapy and Anaesthesia

Bleomycin is a cytotoxic drug used in the treatment of teratoma of the testis. This drug appears to sensitize the lungs so that acute lung damage occurs with concentrations of oxygen normally considered free from toxic effects. Two anaesthetics administered to the same patient undergoing thoracotomy are reported. No postoperative lung damage was produced on either occasion.     

博来霉素A_6对小鼠肺毒性的电子显微镜观察

用电子显微镜观察比较博来霉素A_6和目前临床使用的博来霉素(复合物)对小鼠的肺毒性。博来霉素A_6和博来霉素分别以相当于1/40、1/20和1/10 LD_(50)剂量给小鼠ip 7d或10 d。病变表现为肺毛细血管的损伤,内皮细胞胞浆空泡、皂泡样变、网状化、伪足样突起、血小板粘着和微血栓形成等最为常见。博来霉素A_6引起的肺病变明显地较博来霉素为轻,提示博来霉素A_6有可能成为肺毒性较低的博来霉素类抗癌药物。