44例脓胸的外科治疗

目的：探讨脓胸的治疗方法。方法：根据已出院的44例脓胸患者的治疗资料进行分析。结果：胸腔闭式引流、胸腔灌洗是治疗中不可缺少的手段。结论：在全身治疗的基础上,配合胸腔闭式引流、胸腔灌洗、必要的外科手术可望取得较为理想的治疗结果。     

经尿道电切术联合吡柔比星膀胱灌注治疗腺性膀胱炎26例报告

目的：探讨经尿道电切术联合吡柔比星治疗腺性膀胱炎的方法及疗效。方法：对26例腺性膀胱炎患者经尿道电切后行THP膀胱灌注。结果：26例中，复发2例，临床症状完全消失18例，好转6例。结论：电切术联合吡柔比星是治疗腺性膀胱炎的一种可行有效的方法。     

132例膀胱内灌注吡柔比星预防浅表性膀胱癌术后复发

目的:评价吡柔比星膀胱内灌注预防浅表性膀胱癌术后复发的有效性及安全性.方法:符合入选标准的患者于手术后2周内开始行吡柔比星膀胱灌注,每次30mg,每周1次共8次,以后每月1次共1年,定期膀胱镜检查进行随访.结果:132例浅表性膀胱移行细胞癌患者,术后平均随访时间12.2±5.74个月.肿瘤复发22例,总复发率16.7%.其中复发性肿瘤的复发率明显高于初发肿瘤(P=0.003),而不同肿瘤分期、分级及单发与多发肿瘤患者间的复发率未见明显差异.不良反应主要为尿路刺激症状和尿常规异常.结论:吡柔比星膀胱灌注预防浅表性膀胱癌术后复发的效果明确,疗效满意,患者耐受性好,是较为理想的膀胱灌注化疗药物.     

RESTORATION OF INVOLUNTARY TONIC CONTRACTION OF THE LEVATOR MUSCLE IN PATIENTS WITH APONEUROTIC BLEPHAROPTOSIS OR HORNER SYNDROME BY APONEUROTIC ADVANCEMENT USING THE ORBITAL SEPTUM

Müller's muscle can be thought of as a large serial type of muscle spindle of the levator muscle. Effective stretching of the mechanoreceptor in the proximal part of Müller's muscle by voluntary phasic contraction of the levator muscle for initial opening of the eye induces involuntary tonic contraction of the levator muscle as a stretch reflex via the mesencephalic trigeminal nucleus, to maintain an adequate visual field. After disinsertion of the levator aponeurosis from the tarsus by habitual rubbing, elongation of Müller's muscle secondary to thinning (aponeurotic blepharoptosis) or paralysis (Horner syndrome) desensitises the mechanoreceptor of Müller's muscle, resulting in blepharoptosis. Shortening of the elongated and thinned Müller's muscle by instillation of phenylephrine, and surgical shortening, and fixation of the disinserted, elongated, and thinned aponeurosis using the orbital septum, restored involuntary tonic contraction of the levator muscle in nearly all of 2000 patients with aponeurotic blepharoptosis and in 11 patients with Horner syndrome.     

The Effect of Age on the Efficacy of Maintenance Bacillus Calmette-Guérin Relative to Maintenance Epirubicin in Patients with Stage Ta T1 Urothelial Bladder Cancer: Results from EORTC Genito-Urinary Group Study 30911

Background

Although maintenance bacillus Calmette-Guérin (BCG) is the recommended treatment in high-risk non–muscle-invasive bladder cancer (NMIBC), its efficacy in older patients is controversial.

Objective

To determine the effect of age on prognosis and treatment outcome in patients with stage Ta T1 NMIBC treated with maintenance BCG.

Design, setting, and participants

A total of 957 patients with intermediate- or high-risk Ta T1 (without carcinoma in situ) NMIBC were randomized in European Organization for Research and Treatment of Cancer (EORTC) trial 30911 comparing six weekly instillations of epirubicin, BCG, and BCG plus isoniazid followed by three weekly maintenance instillations over 3 yr.

Outcome measurements and statistical analysis

Cox multivariate proportional hazards regression models were used to assess the relative importance of age for recurrence, progression, overall survival, and NMIBC-specific survival with adjustment for EORTC risk scores.

Results and limitations

Overall, 822 eligible patients were included: 546 patients in the BCG with or without INH arms and 276 in the epirubicin arm. In patients treated with BCG with or without INH, 34.1% were >70 yr of age and 3.7% were >80 yr. With a median follow-up of 9.2 yr, patients >70 yr had a shorter time to progression (p = 0.028), overall survival (p < 0.001), and NMIBC-specific survival (p = 0.049) after adjustment for EORTC risk scores in the multivariate analysis. The time to recurrence was similar compared with the younger patients. BCG was more effective than epirubicin for all four end points considered, and there was no evidence that BCG was any less effective compared with epirubicin in patients >70 yr.

Conclusions

In intermediate- and high-risk Ta T1 urothelial bladder cancer patients treated with BCG, patients >70 yr of age have a worse long-term prognosis; however, BCG is more effective than epirubicin independent of patient age.

Patient summary

Intravesical bacillus Calmette-Guérin for non–muscle-invasive bladder cancer is less effective in patients >70 yr of age, but it is still more effective than epirubicin.

Trial registration

This study was registered with the US National Cancer Institute clinical trials database (protocol ID: EORTC 30911; http://www.cancer.gov/clinicaltrials/search/view?cdrid=77075&version=HealthProfessional&protocolsearchid=12442243#StudyIdInfo_CDR0000077075).     

人工真皮支架联合灌洗式负压封闭引流在肌腱或骨外露创面修复中的应用

目的探讨人工真皮支架联合灌洗式负压封闭引流修复肌腱或骨外露创面的疗效。 方法选择2018年1月至2020年1月安徽医科大学第一附属医院烧伤科收治的肌腱或骨外露创面39例,其中急性创面26例(外伤10例,烧伤11例,热压伤4例,虫咬伤1例);慢性创面13例(糖尿病足皮肤溃疡2例,烧伤后期创面7例,瘢痕溃疡4例)。在全身麻醉或神经阻滞下行创面清创,在肌腱或骨外露处植入加强型人工真皮支架,外加负压封闭引流敷料覆盖,术后使用不同冲洗液进行间歇性灌洗,直至组织红润,达到二期植皮手术要求。观察并记录人工真皮支架使用次数,清创后人工真皮支架植入与二期植皮间隔时间和植皮成活情况。 结果39例肌腱或骨外露的急慢性创面经清创后覆盖人工真皮支架,术后经不同冲洗液间歇性灌洗式负压封闭引流治疗,均形成新鲜肉芽组织,二期经刃厚皮片植皮手术,植皮均100%成活,未出现感染等并发症。 结论人工真皮支架植入联合灌洗式负压封闭引流可有效地覆盖外露的肌腱和骨,是急慢性创面合并肌腱、骨外露的有效修复方式之一。     

Sudden sensorineural hearing loss – A contemporary review of management issues

Sudden sensorineural hearing loss (SSNHL) is an enigmatic entity, with obscure pathophysiology and debatable efficacy of the treatment agents used. An underlying cause is identified in only 10–15% of cases. The management of the remaining patients, classified as ‘idiopathic’, is empirical, and is conventionally with systemic steroids, vasodilator therapy, rheological agents, and antioxidants, to list a few amongst the host of the agents employed for the treatment. The availability of conflicting outcomes and lack of conclusive evidence has resulted in the propagation of consensus-based treatment protocols. In the present review, we discuss the various controversial issues and newer developments in the management of idiopathic SSNHL. The current review aims to present a narrative outlook of the updated evidence base available from PUBMED, augmented with relevant designated publications.     

吡柔比星膀胱灌注预防膀胱癌术后复发的观察

目的：探讨浅表性膀胱癌行经尿道膀胱肿瘤电切术或膀胱部分切除术后应用吡柔比星(THP)膀胱灌注化疗预防复发的预期疗效和安全性。方法：32例浅表性膀胱癌行经尿道膀胱肿瘤电切术或膀胱部分切除术后,应用THP(40mg)膀胱灌注．每周1次,共8次;以后每月1次,共8次。结果：随访6～40个月,其中3年以上无复发28例。结论：THP用于膀胱灌注预防浅表性膀胱癌术后复发有满意疗效,体内应用安全性好。     

Experimental Zygomycosis Due to Rhizopus spp. Infection by Various Routes in Guinea-Pigs, Rats and Mice

Summary: Streptozotocin-diabetes was induced in Swiss mice and in Wistar rats. Hematological examination was performed before streptozotocin was administered, and for 5 weeks afterwards. Leukocytosis was present in all animals. Severe diabetes was found, and it persisted during the 13-week follow-up period. Serum glucose levels were controlled weekly. Nondiabetic animals infected by inhalation or by intranasal instillation with Rhizopus microsporus var. rhizopodiformis remained negative as well as diabetic animals infected by inhalation. In the intranasally instilled mice and rats, 33% and 67% respectively contracted severe zygomycosis. Non-compromised guinea-pigs and mice were infected intravenously or intraperitoneally with Rhizopus microsporus var. rhizopodiformis or Rh. oryzae. The guinea-pig infected with small inocula was more sensitive than the mouse, and developed fatal zygomycosis with invasion of almost all organs and production of erythematous ulcerative skin eruptions. Fatal disease was also obtained in mice infected intravenously, but not intraperitoneally. Anatomopathology of the various organs and lesions revealed profuse invasion of various organs including brain, lungs, blood vessels, etc. Large coenocytic hyphae were present. In the lungs and the spleen of the guinea-pig and in the pelvic cavity of the mouse, various forms of large vesicles and sporangium-like elements were observed. The hyphae were in general distorted, broad, irregular and rarely septated. The infection of guinea-pigs with Rhizopus spp. is proposed as a model for the study of the infection. It presents all aspects of zygomycosis that may occur in man and animals, especially in compromised or largely exposed individuals. Zusammenfassung: Streptozotocin-Diabetes wurde bei Schweizer Mäusen und Wistar-Ratten erzeugt. Hämatologische Prüfungen wurden vor und 5 Wochen nach der Streptozotocin-Verabreichung durchgeführt. Bei allen Tieren lag Leukozytose vor. Es wurde ein schwerer Diabetes erzielt, der während der 13wöchigen Beobachtungsperiode anhielt. Die Serumglucosespiegel wurden wöchentlich kontrolliert. Nichtdiabetische Tiere blieben nach Inhalation oder intranasaler Instillation von Rhizopus microsporus var. rhizopodiformis negativ genau so wie die diabetischen Tiere, die durch Inhalation infiziert wurden. Nach intranasaler Instillation zeigten 33% der Mäuse und 67% der Ratten eine schwere Zygomykose. Immunkompetente Meerschweinchen und Mäuse wurden i.v. oder i.p. mit Rhizopus microsporus var. rhizopodiformis oder Rh. oryzae infiziert. Die mit kleinen Inokula infizierten Meerschweinchen erwiesen sich als empfindlicher als die Mäuse. Sie entwickelten eine tödliche Zygomykose unter Invasion fast aller Organe und Bildung erythematöser ulzerativer Hauteruptionen. Durch i.v., nicht jedoch durch i.p. Injektion ließen sich bei Mäusen tödliche Erkrankungen erzeugen. Die Anatomopathologie ergab schwere Invasion verschiedener Organe, z. B. Gehirn, Lungen, Blutgefäße. Große coenozytische Hyphen waren anwesend. In Lungen und Milz der Meerschweinchen und im Beckenhohlraum der Mäuse wurden verschiedene Formen großer Vesikeln und schwammartiger Elemente beobachtet. Die Hyphen waren im allgemeinen verzerrt, breit, unregelmäßig und zeigten selten Trennwände. Die Infektion mit Rhizopus spp. beim Meerschweinchen wird als Modell zur Untersuchung dieser Infektionsart vorgeschlagen, da sie alle Aspekte der Zygomykose, die bei Tier und Mensch, insbesondere bei immunkompromittierten oder stark exponierten Individuen auftreten kann, zeigt.     

Alternating mitomycin C and BCG instillations versus BCG alone in treatment of carcinoma in situ of the urinary bladder: a nordic study

OBJECTIVES: To evaluate whether, in patients with carcinoma in situ (CIS) of the urinary bladder, alternating instillation therapy with mitomycin C (MMC) and bacillus Calmette-Guerin (BCG) was more effective and less toxic than conventional BCG monotherapy. METHODS: Patients were stratified prospectively for primary, secondary, and concomitant CIS and randomized to one of two regimens. Patients in the alternating group received six weekly intravesical instillations of MMC 40 mg, followed by alternating monthly instillations of BCG 120 mg and MMC for one year. In the monotherapy group, only BCG was instilled on the same schedule. RESULTS: Of 323 enrolled patients, 304 were eligible for analysis. After an overall median follow-up of 56 months, the Kaplan-Meier disease-free estimate for BCG monotherapy was significantly better than that for alternating therapy (p=0.03; log rank test). Risk for progression appeared lower in the BCG monotherapy group (p=0.07), but no differences existed in survival. Besides the regimen, CIS category also predicted outcome to some extent. BCG monotherapy caused significantly more local side-effects and premature cessation of instillation treatment than did the alternating therapy. However, no differences were observed in the number of serious side-effects. CONCLUSION: One-year BCG monotherapy was more effective than the alternating therapy for reducing recurrence and compared well with the best regimens reported from substantially smaller series. The alternating therapy was better tolerated.