Objective To elucidate the clinical features and treatment of parapneumonic effusions ( PPE) . Methods Ninety-seven patients were analyzed retrospectively in Guangzhou First Municipal People’s Hospital fromJanuary 2004 to July 2008. The data of 54 patients with complicated parapneumonic effusion ( CPPE) and 9 cases with empyema were compared with 49 patients with tuberculosis pleural effusions. Results Of 97 cases, 34 patients with uncomplicated parapneumonic effusion ( UPPE) were treated with antibiotics only, whose hospitalization time was ( 14. 8 ±7. 6) days, and 27 cases were cured ( 79. 4% ) . Of 54 CPPE patients, 42 were treated with antibiotics and pleural space drainage with central venous catheter, whose hospitalization time was ( 21. 7 ±13. 0) days, and 32 were cured ( 76. 2% ) . Another12 CPPE patients were treated with interapleural urokinase and drainage from the chest tube, whose hospitalization time was ( 22. 5 ±9. 3) days, and 8 were cured ( 66. 7% ) . Nine cases with empyema were rinsed the pleural with metronidazole solution, whose hospitalization time was ( 25. 7 ±17. 4) days, and 8 were cured( 89. 0% ) . Compared with the tuberculous pleurisy patients, most CPPE and empyema occurred in middle and old aged patients with an average age of ( 63. 3 ±19. 3) years. Polykaryocyte and lactate dehydrogenase increased significantly. Adenosine deaminase ( ADA) was lt; 45 U/L in most UPPE and empyema patients, but was gt; 45 U/L in 7 cases ( 11% ) . Conclusions UPPE is simple and preferably treated with antibiotics alone. While CPPE and empyema should be drainaged as early as possible, and the low-dose urokinase may be helpful. The level of ADA can not absolutely distinguish parapneumonic effusion from tuberculous pleural effusion.
Objective To summarize the recent studies on diagnosis and treatment for pregnancy-associated breast cancer （PABC） to provide evidence for diagnosis and treatment for PABC. Methods By PubMed， Medline， and CNKI retrieval system， with “pregnancy-associated breast cancer or PABC， diagnosis of pregnancy-associated breast cancer or PABC， treatment of pregnancy-associated breast cancer or PABC” as key words to retrieval for the recent researches about PABC. All of the publications about studies on diagnosis and treatment for PABC were reviewed and summarized. Results Diagnosis of PABC included ultrasound， mammography， magnetic resonance imaging， needle biopsy， and so on， and the treatment contained surgery， chemotherapy， endocrine therapy， radiation therapy， and targeted therapy. However， when diagnosis and treatment for PABC involved， the impact to patients with pregnancy and fetus must be considered in priority. Conclusions By reviewing the studies of relevant papers about diagnosis and treatment for PABC which can provide a clinical guidance for clinicians. Usage of bevacizumab and lapatinib still needs to further be studied.
Objective To evaluate the effect of regiono-perfusional chemotherapy of pancreatic adenocarcinoma, and to seek the management of its complications. MethodsThirty-six patients with unresectable pancreatic adenocarcinoma received selectively intra-arterial catheterization and perfused with 5-Fu, ADM, DDP. Results Six patients had complete response, 15 partial response, and one underwent radical resection subsequently. Cmplications occurred in 14 patients with 2 patients died of complications.Conclusion Regiono-perfusional chemotherapy of pancreatic adenocarcinoma is effective, but the complications can not be neglected.
Prevention and treatment of traumatic neuroma by implanting the proximal neural stump into the muscle were studied. Sixteen SD rats were used for the experimental study. The proximal stump of the left sciatic nerve was implanted into the nearby muscle as the experiment side, whereas the proximal stump of the right sciatic nerve was left untreated as the control side. The results were assessed with histological and electrophysiological methods. The experiment demonstrated that neuroma was formed in the control side one month postoperatively, whereas in the experimental side the nerve fibers were dispersed among the muscle fibers and no definite neuroma was formed. Implantation of neural stump into muscle could prevent and treat traumatic neuroma.
Objective To explore efficacy and safety of radiofrequency ablation (RFA) in the treatment of large hepatocarcinoma. MethodsFortythree cases of large hepatocarcinoma underwent RFA with the expandable cluster electrode,eight of all cases had undergone transcatheter artery chemoembolization (TAE) for 1-2 sessions within 2 months before RFA; the tumors were 5-10 cm in diameter, mean 7.5 cm. Hepatic function examination, alphafetoprotein, enhanced CT scans,color ultrasonography and needle biopsy were performed,pre and posttreatment. Complete necrosis was evaluated by dynamic enhanced CT scans and biopsy. Therapeutic time and sessions of RFA,length of stay in hospital and complications of RFA were observed; and thirtynine of 43 cases after RFA were followed up for 12-18 months.ResultsFortythree cases of large hepatocarcinoma received RFA for 67 sessions， 1-3 sessions per case，mean 1.6 sessions; therapeutic time 55-150 min,mean 75 min; length of stay in hospital 3-15 day， mean 8.7 day; major complications of RFA included local skin burn of electrode board in 2 cases （4.6%） and moderatetolarge right pleural effusion in 3 cases （7.0%），overall complications rate was 11.6%; complete necrosis was achieved in 41.0% of cases which were evaluated by dynamic enhanced CT scans at least 6 months followed RFA; of thirtyone cases of positive AFP, AFP level became negative in 3,decreased obviously in 5 within 6-12 months after RFA; in 12-18 months followup,oneyear survival rate was 69.2%.Conclusion RFA appears to be safe, effective and minor invasive for the treatment of large hepatocarcinoma.
Abstract： Sarcoidosis is a common systemic disease with noncaseating granulomatous epithelioid nodule and coexisting granulomatous inflammation. Although sarcoidosis can affect any organ of the body， more than 90% of the patients demonstrate thoracic involvement， which is often confusing with lung cancer and other diseases. Therefore, thoracic surgeons must have a clear understanding of sarcoidosis. Moreover， due to the special role of surgery in obtaining pathological specimens， thoracic surgeon plays an important role in the diagnosis and treatment of sarcoidosis. It is not difficult to make diagnosis for patients with typical clinical features of sarcoidosis. However， the majority of patients do not have specific manifestations of sarcoidosis. The cause of sarcoidosis remains unknown， and there is also no specific treatment strategy for it. But recent research has shown that annexin A11 gene may be involved in the pathogenesis of sarcoidosis， and tumor necrosis factor （TNF） inhibitor is effective in the treatwent of sarcoidosis.
The postictal state which describes changes in behavior, motor function, and neuropsychological performance that occur after a seizure and persist until these variables return to their normal baseline, which can take anywhere from a few seconds to a few hours to a few days. The degree and intensity of the postictal state significantly affects the patient's quality of life and is strongly associated with the patient's rating of the severity of the seizure, but receives little attention in the treatment of epilepsy, and anti-seizure medications prevent postictal events by making the patient seizures-free, or will attenuate or shorten the time after the seizure. Therefore, it is of great clinical significance to evaluate the efficacy of anti-seizure medications in the post-seizure state. This article reviews the effects of the main anti-seizure medications on the postictal state
In this series of 34 cases, 2 patients performed hepatic dect-jejunal anatomosis, 9 were PTCD external drainage, 8 were installation of internal drainage tubes through the PTCD, 9 were laparotories, 3 were cheemotherapeutic perfusison through artery and 3 were untreated. According to the follow-up results, the authors recommend that the internal drainage through PTCD is the better method to treat unresectable carcinoma of bile duct for proper patients.
Objective To present and summarize the data concerning the diagnosis and treatment of popliteal aneurysm in our hospital. Methods The data of popliteal aneurysm in our hospital from 1975 to 2004 were reviewed and analyzed. Eleven patients with 11 diseased limbs were treated, including 8 males and 3 females, age from 21 years to 64 years 〔(48.54±13.66) years〕. The combined diseases include syphilis, rheumatic heart disease and chronic obstructire pulmonary disease etc. Ten patients received operations, including endoaneurysmorrhaphy (n=4) and graft bypass after aneurysmal resection (n=6), through posterior approach (n=7) or medial approach (n=3). One patient, combined with advanced syphilis and heart failure, received conservative treatment because of his poor general condition. Results The common clinical manifestations included popliteal pulsating mass, claudication, difficulty in extension of the knee, pain etc. Acute ischemia occurred in 3 limbs. The diameter of popliteal aneurysms varied from 4-13 cm 〔（6.73±2.69) cm〕. There were 3 (27.3%) cases of ruptured aneurysms whose diameters were 7 cm, 7 cm and 11 cm respectively. Special examinations included arteriography and Doppler sonography. Pathological results of these patients were pseudoaneurysm (n=3), syphilitic aneurysm (n=3) and atherosclerotic aneurysm (n=4). Two patients were not followed up, and postoperative follow up of the other 8 patients ranged from 18 months to 30 years. In the group of endoaneurysmorrhaphy, postoperative gangrene of the affected limb occurred in one patient, and above-knee amputation was performed. One patient suffered from intermittent claudication in the group of endoaneurysmorrhaphy and of graft bypass respectively. No manifestations of limb ischemia were found in the other 5 patients during the time of follow up. Conclusion General utilization of Doppler sonography in screening high risk patients might be helpful to detect popliteal aneurysm. For symptomatic popliteal aneurysm or asymptomatic popliteal aneurysm with diameter larger than 3 cm, operation is indicated. Asymptomatic popliteal aneurysms no more than 3 cm in diameter could be monitored with care.