Six patients with moderate to advanced primary carcinoma of the liver were treated in this hospital with perfusion chemotherapy and embolization through the regional portal vein under the guidance of B-ultrasongraph rather than (with) operatie catheteization of the portal vein. The results show that all the tumor masses were reduced in size after the treatment (1.2-3.2cm, average value 1.9cm). It might be a new way for treating the primary carcinom of liver. The detailed procedure is descibed and the effects are also discussed in this article.
Objective To investigate and evaluate prevention and treatment of seroma by transposition of tissue flaps and Arista hemostatic powder after regional lymph node resection in patients with malignant tumors. Methods Twelve patients (6 males, 6 females; aged 31-81 years, with metastatic tumors underwent prevention and treatment of seroma with the tissue flaps and Arista hemostatic powder spray after regional lymph node resection. The metastatic tumors involved the axilla in 1 patient with breast carcinoma, the iliac and inguinal regions in 2 patients with carcinomas of theuterine cervix and the rectum, and the inguinal region in 9 patients, including4 patients with malignant fibrous histiocytoma（3 in the thigh, 1 in the leg）,2 patients with squamous carcinomas in the leg, 1 patient with synovial sarcomain the knee, 1 patient with epithelioid sarcoma in the leg, and 1 patient with malignant melanoma in the foot. As for the lymph node removal therapy. 1 patientunderwent axillary lymph node removal, 2 palients underwent lymph node removal in theiliac and inguinal regions, and 9 patients underwent lymph node removal inthe inguinal region. Meanwhile, of the 12 patients, 6 patients underwent transpostion of sartourius flaps with Arista hemostatic powder, 3 patients underwent transposition of the rectus abdominis myocutaneous flaps (including 2 patients treatedwith Arista spray befor the wound closure and 1 patient treated by transposition of local skin flaps with Arista spray used again),and 3 patients underwent only the suturing of the wounds combined with Arista. At the same time, of the 12 patients,only 4 patient underwent the transplantation of artificial blood vessels. Results The follow-up for 2-10 months after operation revealed that 10 patients, who had received the transposition of tissue flaps and the spray of Arista hemostatic powder, had the first intention of the incision heal with seroma cured. Nine patients were given a preventive use of Arista hemostaticpowder and therefore no seroma developed. The combined use of the transpositionof tissue flaps and Arista hemostatic powder spray achieved a success rate of 100% in the prevention or treatment of seroma. However, 1 patient developed microcirculation disturbance 24 hours after operation and underwent disarticulation of the hip; 1 patient developed pelvic cavity hydrops and died 10 months after operation. Conclusion The combined use of transposition of tissue flaps and Arista hemostatic powder spray can effectively prevent or treat seroma after regional lymph node removal in a patient with malignant tumor.
ObjectiveTo observe the blood perfusion changes of peripapillary and macular vessels in patients with nonarteritic anterior ischaemic optic neuropathy (NAION).MethodsRetrospective cohort study. Thirty-six eyes (19 affected eyes and 17 fellow eyes) of 19 patients with NAION diagnosed in People’s Hospital of Wuhan University from November 2017 to January 2019 were included in this study. There were 10 males and 9 females, with the mean age of 55.05±7.11 years. Forty eyes of 20 normal subjects matched with NAION patients were included as controls. BCVA, fundus color photography, SD-OCT and OCT angiography were performed in normal controls and repeated in NAION affected eyes at 1-2 weeks, 1-2 months, 3-5 months intervals. OCT quantitative measurements: average retinal nerve fiber layer thickness (aRNFL) of the disc and its superior values (sRNFL) and the inferior values (iRNFL), average ganglion cell complex thickness (aGCC) in macular region and its superior values (sGCC) and the inferior values (iGCC). OCTA quantitative measurements: average radial peripapillary capillary density (aRPC) and its superior values (sRPC) and the inferior values (iRPC), average vascular density of superficial retina (aSVD) in macular region and its superior values (sSVD) and the inferior values (iSVD), average vascular density of deep layer retina (aDVD), areas of foveal avascular zone (FAZ). The differences of OCT and OCTA quantitative measurements between NAION eyes and the fellow eyes and normal controls were comparatively analyzed. Independent sample t test, paired sample t test or nonparametric rank sum test were performed for comparison among three groups. Pearson or Spearman correlation analysis were used to analyze the correlation between RNFL and RPC, GCC and SVD, RNFL and GCC, RPC and SVD.ResultsAt baseline, the aRNFL, aRPC and aDVD of NAION patients were significantly higher than those of normal controls. Compared with the fellow eyes, the aRNFL increased significantly and the aRPC decreased significantly in NAION affected eyes. The overall differences of aRNFL, aRPC, aGCC and aSVD at four intervals within NAION affected eyes were statistically significant (P＜0.05). The average sRNFL, sRPC, sGCC and sSVD at 1-2 months interval were significantly lower than the average iRNFL, iRPC, iGCC and iSVD (P＜0.05). Correlation analysis: at 1-2 months interval, aGCC was positively correlated with aSVD (r=0.482, P=0.037); at 3-5 months interval, aRNFL was positively correlated with aRPC (r=0.631, P=0.037).ConclusionThere is a sectorial reduction of vascular density of peripapillary RPC and macular SVD with the disease progression of NAION.
Objective To observe the histopathological changes of tumor tissue after intraoperative regional chemotherapy of rectal cancer. Methods After the treatment of intraoperative regional chemotherapy with 5-FU (15 mg/kg)， the histopathological changes of tumor tissue were detected. Results Slight changes with cancer cells in all the cases accepted intraoperative regional chemotherapy were found under light microscope such as karyopyknosis, nuclear swelling, coagulation and necrosis of cytoplasm, hydropsia of intercellular substance, invasion of inflammatory cells, and 9/15 cases with slight inflammation of vessels were observed; While those changes were found in individual cells of the cases without regional chemotherapy. The more enlarged intercellular space of cancer cell was observed under electron microscope in the case with regional chemotherapy. Conclusion The intraoperative regional chemotherapy of rectal tumor can change the histopathological appearance of tumor tissue, that is significant in preventing cancer cells diffusing during operation and relapsing after operation.
A 7.1-magnitude earthquake hit china again, 702 days after Wenchuan Earthquake at Yushu prefecture of Qinghai province, 4000 meters above sea level. Up to April 19th, the death toll climbed to 1706, with 256 missing and 12128 injured. West China Hospital, as a regional state-level hospital of Ministry of Health, organized the first batch of medical team with relief supplies at the first day after Yushu earthquake and rushed to Yushu taking part into the rescue effort in golden seventy-two hours. The second day after Yushu earthquake, medical apparatus and drugs valued 5,000,000 RMB were delivered to the rescue site and the second batch of medical team were positioned. Within thirty three hours after the earthquake, 102 people, including 93 earthquake related injuries and 9 armed police with severe altitude illness, were sent to our hospital by air in four batches successively. Based on the first-hand experience of medical rescue in Wenchuan Earthquake, a series of diagnosis and treatment criteria which were built and developed with evidence-based method, and “four concentration principles”, namely concentrating the wounded, concentrating the experts, concentrating resources, and concentrating treatments, our medical rescue in Yushu earthquake were carried out appropriately. Up to 12 am., April 19th, 93 cases from the disaster area have been treated, of whom 54 seriously wounded, 58 underwent operations and none death. The experience learnt from Wenchuan Earthquake have been used, improved and sublimated more rapidly, more appropriately, more effectively in the Yushu earthquake medical rescue.
ObjectiveTo observe the changes of choriocapillary blood flow area (CBFA) and diameter of ellipsoid zone absence (DEZA) of eyes with idiopathic macular hole (IMH) before and after surgery and its correlation with visual function.MethodsA prospective study. From May 2019 to January 2020, 23 IMH patients (IMH group and fellow eyes group) diagnosed in the Department of Opthalmology of The First Affiliated Hospital of Bengbu Medical College, and 30 age and gender-matched normal controls (30 eyes, control group) were included in this study. All patients were examined the best corrected visual acuity (BCVA) before and after surgery. The BCVA examination was performed using the international standard Snellen visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. CBFA and DEZA were obtained by optical coherence tomography angiography (OCTA). CBFA was measured on the choriocapillary with a circle of 1.0 mm radius centered in the fovea. DEZA was the diameter of ellipsoid zone absence horizontally. The differences of CBFA and logMAR BCVA in the three groups, and the changes of CBFA, DEZA, logMAR BCVA in IMH group before and after surgery were analyzed. The measurement data between the three groups were compared by one-way analysis of variance, and the independent samples t test was used for the comparison between the two groups. Pearson correlation analysis was used for the correlation between the index, multiple linear regression analysis were performed between postoperative visual acuity and preoperative parameters.ResultsBefore and 6 months after surgery, the logMAR BCVA in IMH group were 1.26±0.7 and 0.48±0.22, CBFA were 1.49±0.30 and 1.92±0.17 mm2, DEZA were 1 080.22±576.98 and 433.78±423.04 μm, respectively. Compared with those before surgery, BCVA and CBFA were significantly improved, DEZA obviously decreased and the differences were statistically significant (t=5.53, 7.77, 6.58; P＜0.01). CBFA in IMH group was lower than fellow eyes group and control group, the difference was statistically significant (F=14.13, P＜0.01). After surgery, CBFA in IMH group increased similar to that of fellow eyes group (t=4.32, P=0.37), but lower than that of control group with the significant difference (t=4.07, P＜0.01). The results of Pearson correlation analysis showed that logMAR BCVA and DEZA were positively correlated (r=0.69, 0.75; P＜0.01), CBFA and DEZA were negatively correlated (r=?0.49, ?0.89; P＜0.05) before and after surgery. Multivariate linear regression analysis showed that the postoperative logMAR BCVA was positively correlated with DEZA (t=2.32, P=0.02).ConclusionsAfter surgery, BCVA and CBFA of IMH eyes are significantly increased, DEZA is obviously reduced. Before and after surgery, logMAR BCVA is positively correlated with DEZA, and CBFA is negatively correlated with DEZA.
ObjectiveTo observe the changes of microperimeter and OCT angiography (OCTA) in idiopathic macular hole (IMH) before and after operation, and to explore the correlation between the changes and visual acuity.MethodsFrom January 2018 to January 2019, 41 patients (41 eyes) with IMH who underwent pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) flap surgery in Tianjin Eye Hospital were included in this study. Among them, 8 patients (8 eyes) were male and 33 patients (33 eyes) were female. The average age was 64.02±6.46 years. The average course of disease was 7.00±8.85 months. BCVA, microperimeter and OCTA were performed. The retinal mean sensitivity (RMS) at 10 ° and fovea 2 ° fixation rate (P1) and binary contour ellipse area (63% BCEA) were measured by macular integrity assessment instrument. The central retinal thickness (CRT), choroidal blood flow area (CFA), superficial and deep retinal blood flow density (FAVD, FDVD), foveal avascular zone (FAZ) and blood flow densitywithin the width of FAZ 300 μm (FD-300) were measured by OCTA. Twenty one and 19 eyes with or without ILM flap operation were treated with 25G standard three incision PPV. The follow-up time was more than 6 months. Paired t-test was used to compare the indexes before and after operation. Pearson correlation analysis was performed for the correlation between logMAR visual acuity and microperimeter variables and OCTA variables. Nonparametric test was performed for paired comparison between affected eyes and contralateral eyes before and after operation.ResultsAt 6 months after operation, logMAR visual acuity (t=－12.33), RMS (t=7.94), P1 (t=3.21), 63% BCEA (t=－3.98), CRT (t=－9.17), CFA (t=8.14), FSVD (t=3.75), FDVD (t=3.88) were significantly improved compared with those before operation (P＜0.001). The difference of FAZ area (t=－1.40) and FD-300 (t=1.95) before and after operation were not statistically significant (P＞0.05). The results of correlation analysis showed that logMAR visual acuity 6 months after surgery was correlated with preoperative logMAR visual acuity, MIN, RMS, P1, 63% BCEA, FSVD, FDVD and FAZ (r=0.432、0.527、－0.410、－0.383、0.349、－0.406、－0.373、0.407; P＜0.05). At 6 months after operation, the indexes of the affected eyes were significantly improved compared with those before operation, but worse than those of the contralateral eyes (P＜0.05).ConclusionsPPV for IMH can effectively improve the visual acuity, retinal function and foveal microvascular circulation. Retinal function and blood circulation changes have a significant impact on postoperative visual acuity.
Objective To determine whether regional arterial infusion (RAI) of 5-Fu and imipenem could decrease infection and mortality of acute necrotic pancreatitis (ANP) or not. Methods Fifty three patients with ANP were devided into three groups, group A, 16 patients who received intravenous 5-Fu and imipenem, group B, 22 patients who received 5-Fu by RAI and imipenem intravenously, and group C, 15 patients who received both 5-Fu and imipenem by RAI. Results The incidence of infection of ANP in group C (0%) was significantly lower than that in group A (50.0%) and B (27.2%), and the mortality rates in group B (18.1%) and C (13.3%) were significantly reduced as compared with group C (43.8%). Conclusion RAI of 5-Fu and imipenem was effective in reducing ANP infection and mortality rates.
ObjectiveTo survey and analyze the trend of congenital heart disease (CHD) of regions distribution and medical payment model in Children's Hospital of Gansu Province over the past 11 years, and to provide evidence for diagnosis and treatment strategies for CHD children.
MethodsMedical records of the CHD children hospitalized in the Children's Hospital of Gansu Province from 2001 to 2011 were completely collected. Regional distribution, year and other basic information of them were extracted. Data was then analyzed using the SPSS 16.0 software.
ResultsA total of 591 CHD children were included. Most of them came from Middle-Long, accounting for 68.87%; while the number of CHD children in the region of East-Long and He-xi had a tendency of growth by year, with average growth speed of 189.42% and 27.62%, respectively. Most of them came from the region which is economic class Ⅲ, accounting for 35.64% (highest) with average growth speed (203.45%). Most of the treatment costs were self-supported before 2005, and health insurance and other social aids were consistently increasing after 2005. Most of the institutions for initial visit were town-level hospitals, accounting for 55.50%, and with average growth speed of 170.18%.
ConclusionThe medical demand of CHD children in less-developed regions in Gansu province increases year by year. Government-guided healthcare system should be established and improved so as to basically guarantee the prevention and treatment of CHD in less-developed regions.
ObjectiveTo observe the blood perfusion of optic nerve and macular areas and investigate its relationship with visual field defect in nonarteritic anterior ischemic optic neuropathy (NAION).MethodsTwelve consecutive unilateral NAION patients (course of disease ＜3 months) and 12 healthy Chinese adults were enrolled in the study. The affected eyes and fellow eyes from 12 NAION patients were defined as group A and group B; 12 eyes from 12 healthy adults were defined as group C. Best corrected visual acuity (BCVA), intraocular pressure (IOP), indirect ophthalmoscope and computer optometry were performed on all of the three groups of patients. Visual field (VF) and optical coherence tomography (OCT) were performed on NAION patients. Logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. Compared to group B, logMAR BCVA, mean deviation (MD) and pattern standard deviation (PSD) in group A were significant decreased (t=3.278, ?4.909, 4.130, P＜0.05). There was no significant difference in spherical equivalent, IOP, peripapillary retinal nerve fibre layer (pRNFL) between group A and group B (t=0.000, 0.890, 1.215; P＞0.05). OCT angiography (OCTA) was used to measure the flow area (FA) at optic disc, flow area at radial peripapillary capillaries (RCFA) and FA, non-perfusion area (NFA), parafoveal vessel density (PVD) and parafoveal vascular index (PVI) in macular area. Pearson correlations between the deficiency of optic blood flow and visual field were analyzed.ResultsThe differences of FA at optic disc and peripapillary RCFA among 3 groups were significant (F=4.162, 3.357; P＜0.050). Compared to group B (t=?5.822, ?7.467; P＜0.001) and C (t=9.435, 4.615, P＜0.05), FA at optic disc and peripapillary RCFA in group A was significantly reduced. There is several NAION showed quadrantal FA decreased in optic nerve. However, there was no significant difference in optic disc FA and peripapillar RCFA between group B and C (F=0.004, 0.030; P＞0.050). There was no differences of FA, NFA, PVD and PVI among 3 groups (F=0.488, 1.107, 0.493, 1.086, 1.098, 0.093, 1.093, 1.221; P＞0.05). Positive correlation between optic disc FA, peripapillary RCFA and MD (r=0.542, 0.585; P＜0.05) were observed. However, there was no significant correlation between optic disc FA, peripapillary RCFA and PSD (r=?0.404, ?0.430; P＞0.05), and negatively correlated to BCVA (r=?0.617, ?0.596; P＜0.05). PRNFL was negatively correlated to optic disc FA (r=?0.643, P＜0.05), but not correlated to peripapillary RCFA (r=?0.377, P＞0.05).ConclusionsThe optic disc blood flow reduced in affected eyes of unilateral NAION whose disease course was less than 3 months, while the macular perfusion was normal. There was a positive correlation between optic disc flow and visual field.
