微创穿刺术治疗慢性硬膜下血肿198例回顾性分析

目的 探讨慢性硬膜下血肿微创治疗的方法 及其有效性、实用性和安全性.方法 采用YL-1型一次性穿刺针微创穿刺术治疗慢性硬膜下血肿1 98例,回顾性分析总结手术的优点和术中术后注意要点.结果 无死亡病例,无术后颅内感染及颅内血肿发生.平均住院6天出院.气颅l 0例.少量积气;头皮坏死3例;复发5例.结论 微创穿刺术治疗慢性硬膜下血肿具有操作简单、经济实用、安全有效等特点.

In vitro amplified human leukocyte antigen (HLA)-haploidentical donor immune cellinfusion (HDICI) is not commonly used in children. Therefore, our study sought to evaluate its safety for treating childhood malignancies. Between September 2011 and September 2012, 12 patients with childhood malignancies underwent HDICI in Sun Yat-sen University Cancer Center. The median patient age was 5.1 years (range, 1.7-8.4 years). Of the 12 patients, 9 had high-risk neuroblastoma (NB) [7 showed complete response (CR), 1 showed partial response (PR), and 1 had progressive disease (PD) after multi-modal therapies], and 3 had Epstein-Barr virus (EBV)-positive lymphoproliferative disease (EBV-LPD). The 12 patients underwent a total of 92 HDICIs at a mean dose of 1.6×108 immune cells/kg body weight: 71 infusions with natural kil er (NK) cells, 8 with cytokine-induced kil er (CIK) cells, and 13 with cascade primed immune cells (CAPRIs); 83 infusions with immune cells from the mothers, whereas 9 with cells from the fathers. Twenty cases (21.7%) of fever, including 6 cases (6.5%) accompanied with chil s and 1 (1.1%) with febrile convulsion, occurred during infusions and were al eviated after symptomatic treatments. Five cases (5.4%) of mild emotion changes were reported. No other adverse events occurred during and after the completion of HDIDIs. Neither acute nor chronic graft versus host disease (GVHD) was observed following HDICIs. After a median of 5.0 months (range, 1.0-11.5 months) of follow-up, the 2 NB patients with PR and PD developed PD during HDICIs. Of the other 7 NB patients in CR, 2 relapsed in the sixth month of HDICIs, and 5 maintained CR with disease-free survival (DFS) ranging from 4.5 to 11.5 months (median, 7.2 months). One EBV-LPD patient achieved PR, whereas 2 had stable disease (SD). Our results show that HDICI is a safe immunotherapy for childhood malignancies, thus warranting further studies.

Patients with late-stage cancer commonly have distant lymph node metastasis;however, poor health often contraindicates surgical treatment. Although the quality of life and overal survival for these patients are low, there is neither a consensus nor a guide for treatment. Ablation technique and surrounding tissue damage are two possible reasons for limited study of radiofrequency ablation in patients with superficial distant lymph node metastasis. Here, we report two patients treated successfully with ultrasound-guided radiofrequency ablation for superficial distant lymph node metastasis. In these patients, deionized water was injected to the surrounding tissues of the lymph node to decrease heat injury. Results from these patients suggest that radiofrequency ablation may play an important role in the treatment of patients with distant lymph node metastasis.

Purpose: To evaluate the clinical effect of 5-μm pore filter connected with three-way cock by removing the vehicle in triamcinolone acetonide (TA) suspension.Methods: Through 5-μm pore filter connected with three-way cock, TA suspension was replaced by intraocular irrigating solution. The new suspension has been applied to 60 cases of diabetic branch retinal vein occlusion, diabetic macular edema and agerelated macular degeneration patients through intravitreal injection. It was also been applied to 41 cases of diabetic retinopathy, epimacular membrane, proliferative vitreoretinopathy and idiopathic macular hole patients to assist pas plana vitrectomy (PPV). Whether TA particles can adhere to posterior hyaloid cortex, epiretinal membrane and internal limiting membrane during the surgery have been observed.During follow up, corrected visual acuity and intraocular pressure were recorded.Results: Fiveμm pore filter connected with three-way cock can remove the vehicle in TA suspension successfully and retain TA particles. When the new suspension was applied to assist PPV, it can adhere to posterior hyaloid cortex, epiretinal membrane, internal limiting membrane and visualized them clearly. In all the 41 cases that underwent PPV surgery, visual acuity of 30 cases increased or remained stable.Intraocular hypertension happened in 4 cases. Two cases of the 41 patients had cataract formation during follow up. In the 60 cases that underwent TA intravitreal injection,45 cases increased their visual acuity at least 2 lines. Intraocular hypertension happened in 17 cases and 4 patients had cataract formation. None of the 101 patients caught endophthalmitis or other serious complications.Conclusion: Filter connected with three-way cock can remove the vehicle in TA suspension effectively and this procedure can be applied to intravitreal injection or PPV. This manipulation is so simple that it deserves to be popularized for clinical use.