对西汉帛画《导引图》和竹简《引书》中的器械治疗导引式的比较研究

1973-1984年,中国湖南省和湖北省出土了2000年前的帛画《导引图》和竹简《引书》。通过资料查阅、文物资料复原、对比研究等方法,解明了帛画《导引图》和竹简《引书》中使用器械等术式治疗的疾病名称、术式名称、动作过程等问题,为正确解读汉代器械导引术,丰富古代医疗体操内容提供参考。

Review of dynamic contrast-enhanced ultrasound guidance in ablation therapy for hepatocellular carcinoma

Local ablative techniques-percutaneous ethanol injection, microwave coagulation therapy and radiofrequency ablation (RFA)-have been developed to treat unresectable hepatocellular carcinoma (HCC). The success rate of percutaneous ablation therapy for HCC depends on correct targeting of the tumor via an imaging technique. However, probe insertion often is not completely accurate for small HCC nodules, which are poorly def ined on conventional B-mode ultrasound (US) alone. Thus, multiple sessions of ablation therapy are frequently required in diffi cult cases. By means of two breakthroughs in US technology, harmonic imaging and the development of second-generation contrast agents, dynamic contrast-enhanced harmonic US imaging with an intravenous contrast agent can depict tumor vascularity sensitively and accurately, and is able to evaluate small hypervascular HCCs even when B-mode US cannot adequately characterize the tumors. Therefore, dynamic contrast-enhanced US can facilitate RFA electrode placement in hypervascular HCC, which is poorly depicted by B-mode US. The use of dynamic contrast-enhanced US guidance in ablation therapy for liver cancer is an effi cient approach. Here, we present an overview of the current status of dynamic contrast-enhanced US-guided ablation therapy, and summarize the current indications and outcomes of reported clinical use in comparison with that of other modalities.

Electrocorticography-Guided Surgical Treatment of Solitary Supratentorial Cavernous Malformations with Secondary Epilepsy

Objective To evaluate the efficacy of electrocorticographic(ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy. Methods This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years(mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated. Results Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I(75.00%), 5 were class II(13.89%), 2 were class III(5.56%), and 2 were class IV(5.56%), thus the total effective rate(class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes(P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes(P=0.041). Conclusions Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes.

Image-guided conservative management of right colonic diverticulitis

AIM： To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS： The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed tomography, ultrasonography, or operative findings were retrospectively reviewed. RESULTS： Of the 189 patients hospitalized for right colonic diverticulitis, the stages of diverticulitis by a modified Hinchey classification were 26 patients （13.8%） in stage 0, 139 patients （73.5%） in stage I a, 23 patients （12.2%） in stage I b, and 1 patient （0.5%） in stage Ⅲ. Medical therapy was undertaken in 185 of 189 patients （97.9%）. One hundred and eighty three of 185 patients were successfully treated with bowel rest and antibiotics. Two patients in stage I b required a resection or surgical drainage because of an inadequate response to conservative treatment. Recurrent diverticulitis developed in 15 of 183 patients （8.2%） who responded to medical therapy. All 15 patients who suffered a second attack had uncomplicated diverticulitis, and were successfully treated with medical therapy.CONCLUSION： Our results indicate that right colonic diverticulitis is essentially benign and image-guided conservative treatment is primarily required.

Image-guided radiation therapy: basic concepts and clinical potentials

The adaptation and integration of imaging into the process of cancer detection, diagnosis, and intervention is an area of medicine that is undergoing extremely rapid development. Radiation therapy is a prime example of this change. While the objectives of these developments are clear, they raise numerous issues regarding the skills and resources that assure these technologies are appropriately integrated and applied. We will explore the basic concepts related to image guidance in various radiotherapy-related procedures with special emphasis on the clinical potentials of this impressive technology.

COMPARISON OF CT-GUIDED LESS INVASIVE SURGERIES WITH WIDE SURGICAL EXCISION IN TREATMENT OF OSTEOID OSTEOMAS

Objective To report the results of treatment of osteoid osteomas with wide surgical excision and CT-guided less invasive surgeries.Methods Forty-two patients were entered into this prospective study between Jan.1998 and Jan.2008.Nineteen patients underwent wide surgical excision.The lesions were in the femur(n=9),tibia(n=7),and humerus(n=3).The mean lesion diameter was(9.2±2.3)mm(range,7-16mm).Twenty-three patients(15 males and 8 females)underwent CT-guided less invasive surgeries procedures.The lesions were in the femur(n=9),tibia(n=6),acetabulum(n=4)and humerus(n=4).The mean lesion diameter was(8.1±2.7)mm(range,6-15mm).Among these 23 patients,20 patients were performed by core drill excision.Three patients were performed by radiofrequency ablation.Follow-up ranged from 16 to 68 months(mean,35 months)to assess pain,neurovascular damage,pathological fracture,movement,and recurrence.Results were categorized as success(persistent complete relief of pain)and failure(absent or incomplete relief of pain,requiring additional treatment).Results The success rates were 89%(17/19)after wide surgical excision and 96%(22/23)after less invasive surgeries,respectively,and the difference was not significant(P>0.05).Patients were hospitalized for average 8.3 d(5-15d)after wide surgical excision and 3.2d(3-5d)after less invasive surgeries(P<0.05).There were no complications such as sepsis,pathological fracture,or neurovascular damage.No further recurrences were observed during follow-up.Conclusion Less invasive surgeries has obvious advantages such as reduced cost,shorter stay in hospital and rapid convalescence.Core-drill excision can obtain sufficient material for pathologic examination.

肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导下对肿瘤靶向定位,用物理或化学的方法杀死肿瘤细胞;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种.局部消融治疗的特点：一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用.局部消融治疗在过去20年左右发展迅速,已经成为继手术切除、介入治疗后的第三大肝癌治疗手段,而且由于其疗效确切,特别是在小肝癌的治疗方面,射频消融治疗的疗效与手术切除相近,因此,被认为是小肝癌的根治性治疗手段之一.