前列腺癌骨转移性疼痛的综合治疗

目的 :探讨晚期前列腺癌骨转移性疼痛的综合治疗方法。　方法 :16例确诊为前列腺癌且有多个部位骨转移病灶伴有疼痛的患者 ,采用口服抗雄激素药物治疗的同时 ,辅以核素89Sr静脉内注射治疗和部分病灶放射治疗。　结果 :治疗后 ,疼痛缓解率 3个月为 75 .6 % ,6个月为 80 .5 % ,9个月为 6 3.4 % ;骨转移病灶数量明显减少。结论 :经过综合治疗后 ,本组晚期前列腺癌伴骨转移性疼痛的患者疼痛获得较为满意的缓解、甚至消失 ,从而改善了患者的生活质量。     

前列腺癌骨转移疼痛的^89锶（Sr）治疗

目的：探讨前列腺癌骨转移疼痛的^89锶（Sr）治疗。方法：本组11例明确诊断为前列腺癌，并有多个部位骨转移病灶伴有疼痛的病例，采用核素^89锶静脉内注射治疗。结果：^89Sr治疗后，疼痛缓解率3个月为78.6％；6个月为82.1％；12个月为75.0％。骨转移病灶数量也明显减少。结论：应用核素^89锶治疗中晚期前列腺癌伴骨转移性疼痛是一个比较有效的方法，其能够使患者的疼痛获得较得较为满意的缓解，甚至消失，从而改善他们的生活质量。     

紫杉醇周剂量治疗前列腺癌骨转移性疼痛的近期疗效观察

目的 探讨晚期前列腺癌骨转移性疼痛的治疗方法。方法 2004年～2005年对12例确诊为前列腺癌且有多个部位骨转移灶伴有疼痛的患者，采用国产紫杉醇周60mg／m^2，静脉注射，每周一次，连用3周，休息1周，共使用6周。结果 治疗后疼痛缓解率3个月为85％：6个月为74％。骨转移性病灶减少或缩小，可评价毒副反应8例，均可耐受。结论 本组病例经紫杉醇周剂量化疗后疗效肯定，疼痛缓解较满意，且不良反应轻，患者生活质量明显改善，值得扩大病例进一步研究。     

前列腺癌骨转移疼痛的~(89)锶(Sr)治疗

目的　探讨前列腺癌骨转移疼痛的89锶 (Sr)治疗。方法　本组 11例明确诊断为前列腺癌 ,并有多个部位骨转移病灶伴有疼痛的病例 ,采用核素89锶静脉内注射治疗。结果　89Sr治疗后 ,疼痛缓解率 3个月为 78.6% ;6个月为 82 .1% ;12个月为 75 .0 %。骨转移病灶数量也明显减少。结论　应用核素89锶治疗中晚期前列腺癌伴骨转移性疼痛是一个比较有效的方法 ,其能够使患者的疼痛获得较为满意的缓解 ,甚至消失 ,从而改善他们的生活质量     

~(153)Sm-EDTMP治疗前列腺癌骨转移的疗效观察

目的:通过对比研究153Sm-EDTMP和唑来膦酸治疗前列腺癌骨转移,以了解153Sm-EDTMP治疗前列腺癌骨转移的疗效。方法:确诊前列腺癌骨转移患者55例,分两组,一组31例用153Sm-EDTMP按37.0 MBq/kg体重静脉注射治疗,一组24例用唑来膦酸4 mg加入0.9%氯化钠注射液100 ml中缓慢静滴。治疗前及治疗后1～2个月行99mTc-MDP骨扫描检查。结果:153Sm-EDTMP组疼痛缓解有效率为83.9%,骨代谢改变有效率为64.5%。唑来膦酸组疼痛缓解有效率为58.3%,骨代谢改变有效率为33.3%。经χ2检验,两组疼痛缓解有效率比较χ2=4.448,P=0.035,骨代谢改变有效率比较χ2=5.263,P=0.022,均有显著性差异。结论:153Sm-EDTMP是治疗前列腺癌骨转移较理想的药物。     

单纯内分泌与内分泌加内照射治疗晚期前列腺癌的疗效对比分析

目的：研究核素内照射改善前列腺癌骨转移引起的疼痛及对骨转移治疗的疗效，并与内分泌治疗进行比较。方法：对52例前列腺癌骨转移患者均采用双侧睾丸切除加氟他胺（250mg,3次／d)治疗。所有患者均于术前不同时间出现明显的疼痛症状，其中15例接受^89锶内照射治疗（148MBq静脉注射），8例接受^153Sm-EDT-MP内照射治疗（37MBq/kg静脉注射，1次／月）；29例未接受内照射治疗者作为对照组。结果：^89锶治疗组有14例患者疼痛明显缓解，占93．3％（14／15）；^153Sm-EDTMP治疗组有6例疼痛明显缓解，占75．0％（6／8）；单纯内分泌治疗组经调整药物剂量或结构后，疼痛明显缓解者仅9例，占31．0％（9／29）。^99Tcm-MDP全身骨显像示骨转移病灶出现不同程度的好转，其中^89锶治疗组有11例，占73．3％（11／15）；^153Sm-EDTMP治疗组有5例，占62．5％（5／8），而单纯内分泌组有7例，占24．1％（7／29）。^89锶治疗组3例、^153Sm-EDTMP治疗组有2例出现血白细胞和血小板明显下降，经对症治疗后恢复。结论：核素内照射治疗能改善前列腺癌骨转移引起的疼痛，并可不同程度地抑制肿瘤骨转移灶的生长，但必须密切观察血红蛋白、白细胞及血小板的变化。     

89锶、唑来膦酸及99锝-亚甲基二膦酸盐治疗老年前列腺癌骨转移的临床观察

［摘要］ 目的 观察和比较89Sr、唑来膦酸及99锝-亚甲基二膦酸盐（云克）在老年前列腺癌骨转移患者治疗中的临床价值。方法 回顾性分析2017年01月至2018年01月我科收治的老年前列腺癌骨转移患者，分为89Sr治疗组、唑来膦酸治疗组及云克治疗组。比较三组患者治疗后骨痛缓解、骨转移灶控制及不良反应情况，并行统计学分析。结果 本研究共纳入53例患者，镇痛疗效：89Sr组较唑来膦酸组、云克组治疗早期止痛效果好，差异有统计学意义（P<0.05），但治疗6个月后差异减小，12个月后三组间差异无明显统计学意义（P>0.05）。89Sr组及唑来膦酸组对重度疼痛组缓解优于中度疼痛组，无明显统计学差异（P>0.05），云克组对重度疼痛组缓解明显差于中度疼痛组，有统计学差异（P<0.05）。转移灶疗效：89Sr组较唑来膦酸组、云克组治疗效果好，但无明显统计学差异。骨转移灶数目，89Sr组及唑来膦酸组、云克组对≥10组的治疗效果优于<10组，但均无明显统计学差异。不良反应：89Sr的骨髓抑制、唑来膦酸的发热反应，较另两种药物有明显统计学差异（P<0.05），其余不良反应无明显统计学差异（P>0.05）。结论 89Sr、唑来膦酸、云克均有较好的缓解骨痛、控制骨进展作用。89Sr针对老年患者，易出现骨髓抑制，需密切随访。云克不良反应少，连续长期静脉输液，增加老年患者的痛苦。唑来膦酸易出现发热，但给予对症后可缓解。     

前列腺癌骨转移病人唑来膦酸不同给药间期疗效比较

目的比较唑来膦酸在前列腺癌骨转移病人不同给药间期(4周及12周)临床疗效的差异。方法前列腺癌骨转移病人52例,按治疗间期分为每4周1次组(A组)及每12周1次组(B组),给予4.0 mg唑来膦酸静滴1年。比较两组病人治疗后骨相关事件(SRE)发生率,首次SRE发生时间、骨发病率、肌酐纠正的尿N-末端肽、骨痛缓解、骨转移灶控制及不良反应相关情况。结果 A组中有64.0%、B组中有33.3%病人出现治疗拖延,两组间比较,差异有统计学意义(P0.05)。A组中5例(20.0%)、B组中6例(22.2%)出现了至少1个SRE,两组间首次SRE时间均在30周左右出现,差异无统计学意义(P0.05)。A、B组的平均骨发病率(SMR)值分别为0.46∶0.50,差异无统计学意义(P0.05)。疼痛数字量表(NRS)评分及及止痛药用量各监测时间点均无明显差异(P0.05)。肌酐纠正的尿N-末端肽(uNTX/Cr)率仅在48周时B组高于A组,其他时间两组未有明显差异。骨转移灶缓解:24周及48周时骨扫描显示两组骨转移灶控制情况无明显差异。A组消化道反应和低血钾发生率高于B组,但差异无统计学意义(P0.05)。结论唑来膦酸每12周1次在缓解骨痛,控制骨进展效果不次于每4周1次,是前列腺骨转移病人可接受治疗方案。     

^153Sm—EDTMP治疗前列腺癌伴骨转移的临床观察

目的：探讨＾１５３Ｓｍ－乙二胺四甲基膦酸盐（＾１５３Ｓｍ－ＥＤＴＭＰ）治疗前列腺癌伴骨转移的治疗效果。方法：对３９例前列腺癌伴骨转移的患者应用＾１５３Ｓｍ－ＥＤＴＭＰ进行治疗,并对其止痛效果、病灶变化和毒副作用进行观察。结果：骨痛完全缓解１２例（３０．８％）,部分缓解２２例（５６．４％）,总有效率为８７．２％,２～６个月Ｘ线和骨扫描复查,病灶消失４例,部分消失和变浅７例,有效率为２８．１％,治疗１周后,白细胞和血小板稍下降,停药４周后恢复至治疗前水平。结论：对前列腺癌伴骨转移的患者,尤其是有骨痛者,采用＾１５３Ｓｍ－ＥＤＴＭＰ治疗效果肯定,副作用小,安全可靠。     

89锶、唑来膦酸及99锝-亚甲基二膦酸盐治疗老年前列腺癌骨转移的临床观察

目的观察和比较89Sr、唑来膦酸及99锝-亚甲基二膦酸盐(云克)在老年前列腺癌骨转移患者治疗中的临床价值。方法回顾性分析2017年01月至2018年01月我科收治的老年前列腺癌骨转移患者,分为89Sr治疗组、唑来膦酸治疗组及云克治疗组。比较三组患者治疗后骨痛缓解、骨转移灶控制及不良反应情况,并行统计学分析。结果本研究共纳入53例患者,镇痛疗效:89Sr组较唑来膦酸组、云克组治疗早期止痛效果好,差异有统计学意义(P0.05),但治疗6个月后差异减小,12个月后三组间差异无明显统计学意义(P0.05)。89Sr组及唑来膦酸组对重度疼痛组缓解优于中度疼痛组,无明显统计学差异(P0.05),云克组对重度疼痛组缓解明显差于中度疼痛组,有统计学差异(P0.05)。转移灶疗效:89Sr组较唑来膦酸组、云克组治疗效果好,但无明显统计学差异。骨转移灶数目,89Sr组及唑来膦酸组、云克组对≥10组的治疗效果优于10组,但均无明显统计学差异。不良反应:89Sr的骨髓抑制、唑来膦酸的发热反应,较另两种药物有明显统计学差异(P0.05),其余不良反应无明显统计学差异(P0.05)。结论89Sr、唑来膦酸、云克均有较好的缓解骨痛、控制骨进展作用。89Sr针对老年患者,易出现骨髓抑制,需密切随访。云克不良反应少,连续长期静脉输液,增加老年患者的痛苦。唑来膦酸易出现发热,但给予对症后可缓解。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.