舌下含服硝酸甘油倾斜试验诊断儿童血管迷走性晕厥的价值

目的 探讨舌下含服硝酸甘油倾斜试验(SNHUT)对儿童血管迷走性晕厥(VVS)的诊断价值。 方法 2001年3月至2005年5月在中南大学湘雅二医院儿童晕厥专科就诊或住院的不明原因晕厥(UPS)患儿143例，年龄4~18(12.10±3.03)岁，男58例，女85例。电动倾斜床直立倾斜70°行基础直立倾斜试验(BHUT)，并对其阴性者中的64例在同一角度直接给予舌下含服硝酸甘油片0.2mg，再次评价试验结果。用SPSS 11.0软件进行微机统计学处理。 结果 (1)BHUT阳性率29.4%(42/143)，其中女性占73.8%(31/42)；SNHUT 64例，阳性44例，阳性率为68.7%。SNHUT显著地提高了VVS的检出率。(2)出现阳性结果的时间：BHUT为(21.31±13.24)min，SNHUT为(5.41±4.23)min。(3)反应类型：BHUT及SNHUT阳性患儿共86例，血管抑制型83.7%(72/86)，女性占53.5%(46/86)；心脏抑制型7.0%(6/86)，均为女性；混合型9.3%(8/86)，女性占62.5%(5/8)。(4)副反应：舌下含服硝酸甘油64例，未见明显不耐受现象或其他副反应。 结论SNHUT能提高儿童VVS诊断阳性率，副反应小，使用方便，可在儿科临床推广。

The evaluation of superselective bilateral anterior branches of internal iliac arteries infusion neoadjuvant chemotherapy and embolism for treatment of advanced ovarian epithelial carcinoma

Objective To evaluate the role of neoadjuvant bilateral anterior branches of internal iliac arteries chemotherapy and embolization in patients with advanced ovarian epithelial carcinoma. Methods Forty-two patients with advanced ovarian epithelial cancer were treated with neoadjuvant bilateral anterior branches of internal iliac arteries chemotherapy and embolization followed cytoreductive surgery and adjuvant combination chemotherapy. Primary cytoreductive surgery was performed in the control group, and then followed by adjuvant combination chemotherapy started from operation day in the control group 1 and started from the third day after operation in the control group 2 . The rate of optimal cytoreductive surgery, survival, blood loss and operative time were investigated in three groups. Results The rate of residual focus debulking to less than 2 cm after bilateral anterior branches of internal iliac arteries platinum-based chemotherapy and embolization was 71.43%(P<0.001), and 21% had no gross residual focus after surgery. Blood loss and operative time were significantly decreased in neoadjuvant chemotherapy followed by cytoreductive surgery compared to that of control group (P<0.01). The median overall survival was 26 months .The median disease-free interval was 18.2 months. Conclusions Neoadjuvant bilateral anterior branches of internal iliac arteries platinum-based combination chemotherapy and embolization are an alternative treatment for patients with advanced ovarian epithelial cancer in whom the chance of optimal cytoreductive surgery is low. The mode of treatment for advanced ovarian epithelial cancer can reduce blood loss and decrease operative time, and increase the rate of optimal cytoreductive surgery. Early chemotherapy after operation may help to improve the survival of patients with advanced ovarian epithelial cancer.