Physiologic Effect of Stent Therapy for Inferior Vena Cava Obstruction Due to Malignant Liver Tumor

Purpose To understand systemic the influence of stent therapy for inferior vena cava (IVC) obstruction due to advanced liver tumor. Methods Seven patients with symptomatic IVC obstruction due to advanced primary (n = 4) or secondary (n = 3) liver tumor were subjected to stent therapy. Enrollment criteria included high IVC pressure over 15 mmHg and the presence of edema and ascites. Z-stents were deployed using coaxial sheath technique via femoral venous puncture. Physiologic and hematobiochemical parameters were analyzed. Results All procedures were successful, and the stents remained patent until patient death. Promptly after stent placement, the IVC flow recovered, and the venous blood pressure in the IVC below the obstruction level showed a significant decrease from 20.8 ± 1.2 mmHg (mean ± SE) to 10.7 ± 0.7 mmHg (p < 0.01). Transient mild increase of right atrial pressure was observed in 1 patient. During the following week prominent diuresis was observed in all patients. Mean urine output volume in the 3 days before the stent therapy was 0.81 ± 0.09 l/day compared with 2.1 ± 0.2 l/day (p < 0.01) in the 3 days after. The edema and ascites decreased in all patients. The caval pressure change correlated well (r > 0.6) with the urine volume increase, and with the decreased volume of edema and ascites. The urine volume increase correlated well with the decrement of edema, but not with that of ascites. Improvements for various durations in the levels of blood urea nitrogen, serum creatinine, lactate dehydrogenase, fibrinogen, and platelet count were found (p < 0.05). These hematobiochemical changes were well correlated with each other and with the decrement of ascites. Two patients showed a low blood sodium level of 128.5 mEq/l after intensive natriuresis, and one of them died on day 21 with hepatic failure, which was interpreted as maladaptation aggravation. The mean survival time was 94.1 ± 34.1 days (mean ± SD), ranging from 21 to 140 days after stent treatment. Conclusion The stent therapy for IVC obstruction due to malignant liver tumors was followed by a series of physiologic and hematobiochemical consequences, most of them favorable but some possibly unfavorable. Rational interpretations and predictions of sequelae based on physiologic science including cardiology, hepatology, and nephrology would facilitate the best management of stent therapy for malignant IVC obstruction.     

Dynamics of cerebral edema and the apparent diffusion coefficient of water changes in patients with severe traumatic brain injury. A prospective MRI study

The distinction between intracellular (ICE) and extracellular edema (ECE) has a crucial prognostic and therapeutic importance in patients with severe traumatic brain injury (STBI). Indeed, ICE usually leads to cellular death, and maintenance of a cerebral perfusion pressure (CPP) above 70 mmHg is still under debate since this practice may increase ECE. The purpose of this study was to describe the ECE and ICE kinetics associated with STBI using quantitative diffusion MRI. Twelve patients were prospectively studied. The initial ADC in ICE measured on day 1.3±0.7 is significantly reduced compared to normal-appearing parenchyma (0.51±0.12 * 10⁻³ mm²/s vs. 0.76±0.03 * 10⁻³ mm²/s, n=12, P<0.0001) and reaches normality on MRI 3 performed on day 14.2±3.3. In patients presenting an extension of ICE on MRI 2 performed on day 6.7±1.4 (ADC_MRI2=0.40±0.11 * 10⁻³ mm²/s), ADC values in the extension area at the first MRI were slightly, but not significantly reduced compared to normal parenchyma (0.69±0.05 * 10^-3 mm²/s, P=0.29). Normalization occurred equally by day 14. ADC in ECE (1.34±0.22 * 10⁻³ mm²/s) was elevated and stable with time under CPP therapy. Therefore, ECE is not worsened by CCP therapy, and ICE appears more relevant than ECE in STBI.     

Cerebral edema attenuated inversion recovery MR sequence in low magnetic field: a feasibility study

RATIONALE AND OBJECTIVES: Minimally invasive neurosurgery requires methods to specify surgical boundaries of target tissue, such as brain tumors. This study investigated technical possibilities and clinical usefulness of adapting edema attenuated inversion recovery (EDAIR) pulse sequences to suppress magnetic resonance signal from cerebral edema in brain tumor patients. MATERIALS AND METHODS: A resistive 0.23-T magnetic resonance scanner with magnitude-encoded inversion recovery sequences was used. Twenty-eight separate scanning tests in 25 neurosurgical brain tumor patients were performed on the day before surgery. An inversion recovery sequence with several inversion times between 150 and 2,200 ms was tested. The same sequences were also used intraoperatively and postoperatively. RESULTS: T(1) relaxation time of brain edema varied from case to case. An inversion recovery sequence with an inversion time of 400-800 milliseconds attenuated brain edema and seemed to help in demarcating gross brain tumor for surgical resection. These features were helpful for the evaluation of resectable tumor tissue particularly using neuronavigation techniques. CONCLUSIONS: According to these preliminary findings, inversion recovery sequences supplement other imaging modalities and assist neurosurgeons in evaluating different surgical trajectories and in estimating brain tumor volume before craniotomy.     

Anti-inflammatory effect of O-methylated flavonol 2-(3,4-dihydroxy-phenyl)-3,5-dihydroxy-7-methoxy-chromen-4-one obtained from Cassia sophera Linn in rats

Ethnopharmacological relevance

Cassia sophera Linn (Family Caesalpiniaceae), popularly known as kasundi, is used both in the Indian traditional system and folk medicine to treat several inflammatory pathologies such as asthma, arthritis and pains. The aim of the present study was to evaluate the scientific basis of anti-inflammatory activity of Cassia sophera ethanol extracts and of an isolated constituent of Cassia sophera.

Materials and methods

The anti-inflammatory activity of Cassia sophera was studied using the carrageenan, dextran induced rat paw edema, and cotton pellet induced granuloma in rats. The ethanol extract was administered at the concentrations of 200 and 400 mg/kg body weight whereas rhamnetin (RN) was administered at a dose of 10 and 15 mg/kg, b.w. Indomethacin was used as standard drug.

Results

The HPLC analysis revealed that good amounts of rhamnetin (0.18%) was present in Cassia sophera.The ethanol extracts at 400 mg/kg, showed maximum inhibition of inflammation induced by carrageenan (44%), dextran (40%), cotton pellets (37.47%). On the other hand rhamnetin (15 mg/kg) exhibited maximum anti-inflammatory effect, that is 79 and 33% at the end of 3 h with carrageenin, and dextran-induced rat paw edema, respectively. In a chronic test rhamnetin (15 mg/kg) showed 43.32% reduction in granuloma weight.

Conclusion

The marked inhibitory effect on paw edema and granuloma showed that Cassia sophera possess remarkable anti-inflammatory activity which may be due to rhamnetin at least in part, supporting the folkloric usage of the plant to treat various inflammatory diseases.     

刘渡舟《经方临证指南》治验七则

伤寒大家刘渡舟教授熟读经典,擅用经方,认为每一首经方,都因其内在病机而有相应临床表现,或因其临床表现把握其内在病机,选择相应经方,以抓主症为要,对临床表现类似的患者,仔细观察,辨证入微,选择经方。选择《经方临证指南》中浮肿、上热下寒、房劳伤阳等验案七则,展现刘渡舟洞悉病机,深悟经方药性,始终牢牢把握方证相应原则,取效快且效果显著。     

李志明治疗慢性肾小球肾炎

李志明教授认为慢性’肾炎发病多与肺、脾、肾、三焦及膀胱等脏腑功能失调有关,病机为本虚标实,本虚为肺、脾、肾等脏腑虚损,标实为湿热、血瘀互结为患。灵活运用中药,调理脾胃,平补阴阳,清热利湿,凉血止血,化瘀止痛,治疗效果显著,副作用小。     

实脾饮加减治疗水肿临床疗效分析

目的：观察实脾饮加减治疗肾病综合征水肿疗效。方法：选取96例肾病综合征水肿患者,随机分为对照组及治疗组。对照组给予标准激素治疗,治疗组在对照组基础上予实脾饮加减治疗。结果：治疗后与治疗前组内比较,两组的24h尿白蛋白及血白蛋白均明显下降（P＜0.01）,治疗后两组间比较,治疗组明显优于对照组（P＜0.05）;治疗后两组总有效率比较,治疗组明显优于对照组（P＜0.05）。结论：实脾饮加减治疗肾病肾病综合征水肿疗效确切。     

导致青脉性下肢溃疡的真皮水肿机制

目的观察静脉性下肢溃疡局部真皮组织内水肿的分布,探讨皮肤破溃的形成机制.方法临床确诊患静脉性下肢溃疡病人12人,共13侧下肢于小腿中下段患有皮肤溃疡7～18个月.应用20MHz高频二维超声波扫描仪,对患肢膝关节下5cm、踝关节上5cm、及两者之间的3个观察点的皮肤分别扫描记录;以同组病人健侧下肢相应点做为对照.获取的扫描图像行数字分析,分别对真皮厚度、真皮总超声强度中的低回声象素百分比(LEP/TEP%)、真皮浅层(乳头层)与深层(网状层)的低回声象素比(LEPP/LEPR)等进行定量.结果发生静脉性溃疡的肢体与健侧相比,膝下5cm处两侧真皮厚度、LEP/TEP%、LEPP/LEPR等均无明显差异.小腿中点及踝关节上5cm处,患侧真皮厚度分别增加了(0.40±0.01)mm和(0.80±0.02)mm(P＜0.01),LEP/TEP%增加了(29.0±6.4)%和(41.5±0.3)%(P＜0.01),显示患侧小腿中下段真皮内水肿,并以近踝关节处严重;LEPP/LEPR定量结果为患侧小腿中点及踝关节上5cm处分别增加了0.5及0.9±0.1(P＜0.05,P＜0.01),显示这些部位的真皮水肿以乳头层为主.结论患静脉性下肢溃疡的小腿中下段真皮水肿明显,且水肿易发生于表皮与真皮深层之间的乳头层内.结果提示表皮与真皮深层间形成限制性水肿带,这可能是造成表皮缺氧破溃,导致局部溃疡发生的关键性病理基础.     

玻璃体手术治疗视网膜中央静脉阻塞伴黄斑水肿

Objective To observe the clinical therapeutic effects of vitrectomy and radial optic neurotomy (RON) for macular edema secondary to central retinal vein occlusion (CRVO). Methods Thirty-six consecutive patients (36 eyes) were identified duration of macular edema secondary to ischemic CRVO. According to the time of surgery, these patients divided into two groups, the radial optic neurotomy (RON) group, the Pars Planna Vitrectomy/Panretianl Endophotocoagulation (PPV/PE) group. The average follow-up periods were 28.6± 6.3 months. The changes in visual acuity (VA), foveal thickness, visual fiPEd and the case of optic disc were observed and compared. Results The visual acuity (VA) of 4 eyes in the radial optic neurotomy (RON) group and 6 eyes in the Pars Planna Vitrectomy /Panretiani Endopbotocoagulation (PPV/PE) group improved at the first 1 month. Then clinical observation and follow-up more than 1 year, in the radial optic neurotomy (RON) group: visual acuity (VA) had improvement in 8 eyes, 4 remained the same, whereas 2 became worse. The Pars Planna Vitrectomy/Panretianl Endopbotocoagulation (PPV/PE) group: visual acuity (VA) had improvement in 12 eyes, 8 remained the same, whereas 4 became worse. None of both the groups were≥0.5 in BCVA, and 50% were ≥0.1. It was not statistically significant between the two groups which eyes were≥ 0.1 in BCVA at 1 month and 1 year of follow-up (P >0.05 ). OCT showed that all patients were improved at their last follow-up when compared with preoperative foveal thickness. However,4 eyes had optic atrophy in RON group. Conclusions The improvement in visual acuity and macular edema between RON group and PPV/PE group has no statistically significant differences. However, optic atrophy is a major postoperative complication in the RON group. It's better to choose PPV/PE first.