Neoadjuvant intra-arterial infusion chemotherapy followed by surgery in patients with locally advanced cervical cancer

Objective： The aim of this study was to investigate the role of preoperative neoadjuvant intra-arterial infusion chemotherapy （NAIC） in treating locally advanced cervical caner. Methods： Nineteen locally advanced cervical cancer （LACC） patients from November 2003 to November 2005 were analyzed retrospectively. NAIC was administrated 2 courses every 2 weeks using a combination of 30 mg/m^2 bleomycin and 50 mg/m^2 cisplatin via bilateral femur artedes. The response to NAIC was assessed by pelvic examination and imaging diagnostics and histological analysis. Two weeks after NAIC radical hysterectomy with pelvic lymphadenectomy was performed. Results： Radical hysterectomy with pelvic lymphadenectomy were performed in 18 patients successfully. The mean tumor reduction rate was 73.04%. The overall clinical response rate of NAIC was 84.2% with 2 complete responses and 16 partial responses. Only 1 nonresponder. Six of 7 cases who had parametrial infiltration had a absence after chemotherapy, no significant change was observed in 1 case who followed by radiotherapy. Multivariate logistic regression analysis indicated that tumor volume prior to treatment was determining factor affecting the efficacy of NAIC in LACC. Conclusion： pre-operative NAIC inhibited the growth of LACC, minimized the size, eliminate effectively the pathologic dsk factors in the pelvic cavity, to improve the operability in cervical cancer patients with stage lib or above, considered inoperable.

Effect of local massage on prevention and treatment of intra-arterial polymethyl methacrylate embolism complications:An experimental animal study

Background:Massage is generally believed to be a simple and effective method for preventing necrosis when intravascular injection emboli are suspected.Due to its good dispersive properties,polymethyl methacrylate(PMMA)was used as the test filler.The main purpose of this study was to observe whether local massage as a simple remedial measure can promote the diffusion of filler and reduce the necrosis rate for intra-arterial embolism.Methods:Rabbit ears with the central ear artery(CEA)main trunk totally or segmentally obstructed 5 min after PMMA injection were studied.In order to simulate the massage effect of the fingers,the massage group was treated with a small beauty massage bar with a fixed vibration frequency along the direction of the blood flow.CEA blood flow and skin lesions were also analyzed.Results:The baseline data were similar between the control and massage groups.Compared to the control group,the recanalization rate of the CEA trunk in the treatment group increased significantly after massage.However,there was no significant difference in the visible rate of transparent embolus on the 1st day after treatment,nor in the necrosis degree or area of soft tissue damage on the 7th day after treatment.Further analysis showed that massage tended to have a positive effect on segmentally obstructed cases at 5 min after injection but a negative effect on totally obstructed ears at 5 min.Conclusion:Local massage cannot reduce the complications of tissue necrosis after intra-arterial PMMA injection.Prevention is key to reducing complications.

Localized Administration of Tissue Plasminogen Activator through the Ophthalmic Artery in the Setting of Central Retinal Artery Occlusion

Treatment of central retinal artery occlusion (CRAO) has been an ambiguous entity in the medical community. Many interventions have been explored;however, a standard of care has yet to be defined. Recent studies have suggested localized intra-arterial fibrinolysis as a promising method;however, a timeframe for optimal treatment initiation continues to be investigated. This case demonstrates an instance of CRAO treated with local fibrinolysis, however, what could be due to delayed time-to-treat, final visual outcomes were unfavorable. In conjunction with supporting literature, we believe optimization of thrombolytic protocols should be sought after to facilitate successful treatment outcomes. In addition, we encourage community awareness of the signs and symptoms of CRAO in hopes that earlier patient presentations will lead to swifter interventions and overall preservation of ocular function.

自发性脑室出血的直接纤溶治疗

目的 :探讨脑室内直接纤溶治疗对自发性脑室内出血的疗效、治疗机理、并发症和治疗措施的选择。方法 :对 42例自发性脑室内出血直接纤溶治疗的结果进行统计和分析 ,并用统计学方法对某些结果进行评估。结果 :康复 34例 ,死亡 8例 ,病死率为 19%。平均血块消溶时间为 7.2 d。统计学评估显示病人预后和脑实质内血肿量有关 ,而和脑室内积血程度无关。结论 :直接纤溶疗法是治疗自发性脑室内出血有效的方法。脑实质内血肿量大小对病人预后有较大的影响。

动脉内接触性溶栓治疗急性脑梗死的临床研究

目的 观察动脉内接触性溶栓治疗急性脑梗死的临床疗效 ,评价其在神经功能障碍恢复和脑血管再通疗效。方法 选择急性脑梗死发病均在 6h以内 ,采用动脉内接触性溶栓进行治疗 ,溶栓药为尿激酶。结果 共有 9例患者入选 ,有 3例闭塞血管完全再通 ,5例部分再通 ,1例无再通 ,溶栓后患者神经功能缺损明显改善 ,治疗前后患者欧洲脑卒中评分有明显差异 (P <0 0 5) ,溶栓前后患者纤维蛋白原、凝血时间有明显差异 (P <0 0 5) ,1例出现消化道出血 ,1例伴有皮下出血 ,1例发生再灌注损伤。结论 动脉内接触性溶栓治疗急性脑梗死可以提高闭塞血管的再通率 ,明显促进神经功能障碍的恢复 ,改善血液高凝状态 ,副作用少 。

冷冻消融术和达芬奇机器人辅助手术对局限性前列腺癌患者术后凝血和纤溶功能的影响

目的比较冷冻消融术与达芬奇机器人辅助手术对局限性前列腺癌患者术后凝血功能和纤溶功能的影响,并探讨其可能的机制。方法收集2018年9月—2020年12月间上海交通大学医学院附属仁济医院收治的260例局限性前列腺癌患者的临床资料,根据手术方式将患者分为前列腺冷冻消融术组(冷冻组)和达芬奇机器人辅助前列腺癌根治术组(达芬奇组),每组130例。比较两组患者的一般情况(包括年龄、身高、体重)和手术情况(麻醉和手术时间、术中出血量),手术前后凝血指标[PT、APTT、凝血酶时间(TT)]、纤溶指标[D-二聚体、纤维蛋白原降解产物(FDP)]和炎症因子(IL-2、IL-6、TNF-α)水平,以及出院前血栓所致恶性临床事件的发生情况。结果冷冻组患者的麻醉时间、手术时间均显著短于达芬奇组(P值均<0.01),术中出血量显著少于达芬奇组(P<0.01)。两组患者术后APTT、PT、TT均显著短于同组术前(P值分别<0.01、0.05),D-二聚体、FDP水平均显著高于同组术前(P值均<0.01);冷冻组术后APTT、PT、TT均显著短于达芬奇组术后(P值分别<0.01、0.05),D-二聚体、FDP水平均显著高于达芬奇组术后(P值均<0.01)。两组患者术后血清IL-6水平均显著高于同组术前(P值均<0.01),TNF-α水平均显著低于同组术前(P值分别<0.01、0.05);冷冻组术后IL-2水平显著高于同组术前(P<0.01);达芬奇组术后IL-2水平显著低于冷冻组术后(P<0.01),IL-6水平显著高于冷冻组术后(P<0.05)。两组患者出院前均未发生血栓所致的恶性临床事件。结论冷冻消融术较达芬奇机器人辅助手术能显著缩短局限性前列腺癌患者的手术和麻醉时间,减少术中创伤和出血;但可引发机体高凝状态,增加静脉血栓栓塞风险,在制订患者围手术期预防血栓形成方案时应充分权衡。

局部应用氨甲环酸对脊柱手术患者凝血及纤溶功能的影响

目的探讨局部应用氨甲环酸对脊柱手术患者凝血及纤溶功能的影响。方法选取2017年10月-2018年10月于陆军军医大学大坪医院脊柱外科行多节段、胸腰椎后路植骨融合内固定术的患者96例,随机分为4组:对照组(用生理盐水冲洗切口),静脉滴注组(静脉滴注1%氨甲环酸注射液),0.5%氨甲环酸组(切口应用0.5%氨甲环酸注射液)和1%氨甲环酸组(切口应用1%氨甲环酸注射液),每组24例。测定各组术后第1、2、3天的切口引流量,术前和术后第1、2、3天的凝血五项[活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、国际标准化比值(INR)],采用免疫比浊法测定D-二聚体(D-D)水平;ELISA法检测组织型纤溶酶原激活物(t-PA)和纤溶酶原激活抑制物(PAI-1);血栓弹力图(TEG)法检测血栓最大幅度(MA)、反应时间(R)、凝固时间(K)、凝固角(Angle)和纤溶活动值(LY30)。于出院前1 d行双下肢B超检查。结果术后第1、2、3天,静脉滴注组、0.5%氨甲环酸组、1%氨甲环酸组引流量均少于同时相对照组,1%氨甲环酸组引流量少于0.5%氨甲环酸组及静脉滴注组,差异均有统计学意义(P<0.05)。4组间及组内不同时点的APTT、PT、TT、FIB和INR比较差异均无统计学意3义(P>0.05)。术后第1、2、3天,静脉滴注组、0.5%氨甲环酸组、1%氨甲环酸组D-D水平均低于对照组,0.5%氨甲环酸组、1%氨甲环酸组D-D水平均低于静脉滴注组,1%氨甲环酸组D-D水平最低,差异均有统计学意义(P<0.05)。4组间及组内不同时点的t-PA和PAI-1比较差异无统计学意义(P>0.05)。术后第1天,静脉滴注组、0.5%氨甲环酸组、1%氨甲环酸组MA均高于对照组,1%氨甲环酸组MA高于静脉滴注组和0.5%氨甲环酸组,差异有统计学意义(P<0.05);术后第2、3天各组间MA比较差异均无统计学意义(P>0.05)。4组间及组内不同时点的R、K、Angle和LY30比较差异均无统计学意义(P>0.05)。出院前1 d B超结果均未见双下肢深静脉血栓形成。结论在脊柱手术中局部应用相同剂量氨甲环酸的抗纤维蛋白溶解和止血作用优于静脉给药方式。