New ultrasound techniques for lymph node evaluation

Conventional ultrasound(US)is the recommended imaging method for lymph node(LN)diseases with the advantages of high resolution,real time evaluation and relative low costs.Current indications of transcutaneous ultrasound and endoscopic ultrasound include the detection and characterization of lymph nodes and the guidance for LN biopsy.Recent advances in US technology,such as contrast enhanced ultrasound(CEUS),contrast enhanced endoscopic ultrasound(CE-EUS),and real time elastography show potential to improve the accuracy of US for the differential diagnosis of benign and malignant lymph nodes.In addition,CEUS and CE-EUS have been also used for the guidance of fine needle aspiration and assessment of treatment response.Complementary to size criteria,CEUS could also be used to evaluate response of tumor angiogenesis to anti-angiogenic therapies.In this paper we review current literature regarding evaluation of lymphadenopathy by new and innovative US techniques.

Endoscopic ultrasonography-guided endoscopic treatment of pancreatic pseudocysts and walled-off necrosis:New technical developments

In the last decades,the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic interventions.Surgical procedures can be avoided in many cases by using endoscopically placed,Endoscopic ultrasonography-guided techniques and drainages.Endoscopic ultrasound enables the placement of transmural plastic and metal stents or nasocystic tubes for the drainage of peripancreatic fluid collections.The development of selfexpanding metal stents and exchange free delivering systems have simplified the drainage of pancreatic fluid collections.This review will discuss available therapeutic techniques and new developments.

How to perform gastrointestinal ultrasound: anatomy and normal findings

Gastrointestinal ultrasound is a practical, safe, cheap and reproducible diagnostic tool in inflammatorybowel disease gaining global prominence amongst clinicians. Understanding the embryological processes of the intestinal tract assists in the interpretation of abnormal sonographic findings. In general terms, the examination principally comprises interrogation of the colon, mesentery and small intestine using both lowfrequency and high-frequency probes. Interpretation of findings on GIUS includes assessment of bowel wall thickness, symmetry of this thickness, evidence of transmural changes, assessment of vascularity using Doppler imaging and assessment of other specific features including lymph nodes, mesentery and luminal motility. In addition to B-mode imaging, transperineal ultrasonography, elastography and contrast-enhanced ultrasonography are useful adjuncts. This supplement expands upon these features in more depth.

HIV感染和艾滋病的预防——感染途径和潜在受害人群

获得性免疫缺陷综合征(艾滋病,AIDS)是从人传播给人的病毒性(HIV)疾病,感染的危险性与病原体的数量有关,在感染的第一周和严重艾滋病的晚期病原体数最高。带有大量病原体的感染性血液具有高度危险性(>90％)。精子在感染性来源中占第二位,性接触是全世界最主要的传播途径。同性恋男性是最受危害的人群,但是,在全球的许多地区异性间的传播正在增长。静脉药瘾可因共用注射用具传播疾病。血液和血液制品在一些严格管理的国家已经不是疾病传播的主要来源,只是在极其例外的情况下才是感染的原因,医疗机构如果在护理上严格遵守消毒措施,传播疾病的危险性很小。昆虫并无感染性。人与人日常生活接触实际上不存在感染危险性,共用衣物、茶杯、在同一游泳池游泳或浴室蒸气浴和接吻也无危险性小心的应用阴茎套可以预防HIV感染。

急性心肌梗塞的溶栓治疗

<正> 本世纪中期以来,心血管疾病已成为西方国家最常见的死亡原因,其中又以急性心肌梗塞(AMI)为首。60年代中期,由于建立了重症监护病房,心律失常得以及时发现和治疗,使AMI的早期死亡率有所下降;70年代,由于药物能降低心肌氧耗,AMI的死亡率又有所下降;80年代,由于静脉溶栓的广泛应用,AMI的死亡率再次下降;目前,急诊PTCA又使AMI的早期死亡率有所下降,而各种药物的最佳组合又使其进一步下降。 AMI的治疗方法很多,下面着重介绍溶栓治疗。

妊娠期和围生期肝素诱导的Ⅱ型急性血小板减少症的处理

In pregnancy and in puerperium heparin is prescribed only for acute thromboembolism and/or for female patients with a clearly increased risk of venous thromboembolism. Since treatment changed from unfractionated heparin to lowmolecularweight heparin, the incidence of heparininduced thrombocytopenia type II (HIT type II) is therefore a rare event in this collective. HIT type II is a life threatening side effect of heparin which must immediately lead to the stop of heparin administration. Experiences with alternative anticoagulation in pregnancy and puerperium are limited. Oral anticoagulation with coumarin (vitamin K antagonists) is contraindicated for the initial therapy of HIT II. The treatment with these substances is dangerous, especially in the phase of organogenesis, because it can cause malformation and because of the elevated maternal and the child intraand peripartal bleeding risk in the 2nd half of the third trimenon. Danaparoid Sodium and recombinant Hirudin represent treatment options, whereby because of the better data and the intravenous and especially the subcutaneous application form the application of Danaparoid in the therapy of HIT typ II in pregnancy would appear to be more favourable. In the puerperium Warfarin or Phenprocoumon represent the therapy of choice. Breastfeeding is possible with this option. We report on a female patient with an acute thrombosis of the cerebral sinus vein during early pregnancy who developed a HIT type II under heparin treatment. The longterm anticoagulation with Danaparoid Sodium and the peripartale management are presented.

曾接受体外震波碎石的胆囊结石患者行胆囊切除术的预测及相关因素

Extracorporeal shock wave lithotripsy (ESWL) is effective in the treatment of symptomatic cholecystolithiasis in well- selected patients. We analyzed the predictors of cholecystectomy in a large series of gallstone patients after ESWL. This was a retrospective follow- up cohort- study of consecutive patients undergoing ESWL for symptomatic chole cystolithiasis over a 9- year period. It was possible to analyze a total of 297 patients; there were 211 women and 86 men, with a mean age of 52 years (range, 8- 81 years). Patients that had been cholecystectomized after ESWL were compare d to patients with their gallbladder still in situ and determinants of cholecyst emctomy in terms of clinical, stone, aid gallbladder parameters and symptoms ana lyzed. The mean duration of follow- up was 99 months (range, 27- 134 months). During follow- up, 106 (36% ) patients underwent a cholecystectomy at a mean o f 34 months (range, 0- 127 months) after ESWL. Histological data showed a norma l gallbladder wall in only 4 cases; 101 examinations revealed some kind of (chro nic) inflammation, which was not different from histological gallbladder results in patients without prior lithotripsy. Three gallbladder polyps were found, but no carcinoma. Cholecystectomy after ESWL of gallbladder stones was strongly ass ociated with persitent and/or renewed biliary symtoms. Nevertheless, only three of four patients became asymptomatic after CE. Thus, ESWL proved to be a valuabl e organ- preserving alternative to cholecystectomy in selected patients.

80岁以上老年人接受颈动脉支架治疗:来自ALKK颈动脉支架(CAS)注册研究的结果

目的：明确年龄对颈动脉支架置入（CAS）并发症发生率的影响。方法和结果：此注册研究共纳入了2780例CAS手术。患者的中位年龄为70．8岁，其中80岁以上老年人占11．2％，该比例自1996年至2005年显著增加（5．9％傩13．7％；P=0．002）。与80岁以下患者相比，80岁以上老年患者中有症状的颈动脉狭窄是更为常见的CAS指征（60．7％ vs 48％，P〈0．001），CAS术失败的比例更高（6．9％傩2．2％，P〈0．001），且手术操作的时间更长（中位时间为45min们40min。P=0．008）。年龄的增加会伴随院内死亡或卒中发生率的显著增加（P=0．001）。与80岁以下患者相比。80岁以上老年患者的院内死亡或卒中发生率也显著增加（5．5％似3．2％，P=0．032；0R1．79。95％CI1．04～3．06）。

免疫吸附疗法可降低扩张性心肌病患者的发病率

Background: In patients with dilated cardiomyopathy (DCM)-and severe congestive heart failure, immunoadsorption(IA) and subsequent IgG substitution leads to an acute and prolonged hemodynamic improvement. Goal of this study was to investigate the long-term effect of immunoadsorption on morbidity. Methods: In a retrospective analysis of 34 patients(17 patients who have received immunoadsorption therapy and 17 control patients) were included. Inclusion criteria were DCM, left ventricular ejection fraction less than 35%, NYHA classes II-III. The average time after immunoadsorption was 3.0 years (median 2.3 years). Both groups did not differ concerning sex, age, duration of disease, medication, baseline ejection fraction and NYHA class. Results: In patients who have received immunoadsorption(IA) the days of hospitalisation for congestive heart failure per year could be significantly reduced in contrast to the control patients(17.2 days prior to IA, 4.3 days after IA). Even if the procedural days for immunoadsorption were included there was still a significant reduction of hospitalisation if IA therapy was longer than 2.5 years ago. The days of hospitalisation increased gradually with time during the follow up period. IA induced an acute increase in EF(19.8-25.7%, p< 0.01 vs. baseline). Conclusion: IA not only leads to an acute hemodynamic improvement in patients with DCM but may also reduce morbidity in these patients during the next 3 years.

Effects of Different Right Ventricular Pacing Sites on QRS Duration in Patients Receiving Permanent Dual Chamber Pacemakers

ObjectiveTo explore the effects of exposure to aluminum（Al） on long-term potentiation（LTP） and AMPA receptor subunits in rats in vivo. 〈br〉 MethodsDifferent dosages of aluminum-maltolate complex[Al（mal）3] were given to rats via acute intracerebroventricular （i.c.v.）injection and subchronic intraperitoneal （i.p.） injection. Following Al exposure, the hippocampal LTP were recorded by field potentiation techniquein vivo and the expression of AMPAR subunit proteins （GluR1 and GluR2） in both total and membrane-enriched extracts from the CA1 area of rat hippocampus were detected by Western blot assay. 〈br〉 ResultsAcute Al treatment produced dose-dependent suppression of LTP in the rat hippocampus and dose-dependent decreases of GluR1and GluR2in membrane extracts; however, no similar changes were found in the total cell extracts, which suggests decreased trafficking of AMPA receptor subunits from intracellular pools to synaptic sites in the hippocampus. Thedose-dependent suppressive effects on LTP and the expression of AMPA receptor subunits both in the membrane and in total extracts were found after subchronic Al treatment, indicating a decrease in AMPA receptor subunit trafficking from intracellular poolsto synaptic sites and an additional reduction in the expression of the subunits. 〈br〉 ConclusionAl（mal）3obviously and dose-dependently suppressed LTP in the rat hippocampal CA1 region in vivo, and this suppression may be related to both trafficking and decreases in the expression of AMPA receptor subunit proteins. However, the mechanisms underlying these observations need further investigation.