心脏肿瘤的外科治疗

目的探讨23例心脏肿瘤临床特点,总结外科诊断和治疗的经验。方法自2002年6月至2009年12月手术治疗心脏肿瘤患者23例,其中心脏粘液瘤13例,原发性心脏恶性肿瘤4例,右心下腔静脉平滑肌瘤5例,肝癌右心房转移性癌栓1例。所有病例术前均查心脏彩超,怀疑恶性者行CT或核磁共振检查,除1例患者因右心房肿瘤广泛侵犯右房室环及心包而仅做活检外,其余22例均在全麻低温体外循环辅助下行肿瘤切除术。结果住院期间全组病例无死亡,13例黏液瘤患者平均随访2年无复发转移。5例心脏恶性肿瘤患者中除1例因患者无法联系外,余4例均在2年内死亡。右心下腔静脉平滑肌瘤患者中有1例于术后1.5年经MRI证实复发。结论原发性心脏良性肿瘤以黏液瘤多见,彻底切除肿瘤是防止复发的关键。心脏恶性肿瘤预后差,早期手术治疗并辅以综合治疗可望改善预后。     

心脏肿瘤的外科治疗

目的探讨23例心脏肿瘤临床特点,总结心脏肿瘤的外科诊断和治疗的经验。方法自2002年6月至2009年12月手术治疗23例心脏肿瘤患者,其中心脏黏液瘤13例,原发性心脏恶性肿瘤4例,右心下腔静脉平滑肌瘤5例,肝癌右心房转移性癌栓1例。所有病例术前均查心脏彩色多普勒超声,怀疑恶性者行CT或核磁共振成像(MRI)检查,除1例患者因右房肿瘤广泛侵犯右房室环及心包而仅做活检外,其余22例均在全麻低温体外循环辅助下行肿瘤切除术。结果住院期间全组病例无死亡,13例黏液瘤患者平均随访2年无复发转移。5例心脏恶性肿瘤患者中除1例因患者无法联系外,余4例均在2年内死亡。右心下腔静脉平滑肌瘤患者中有1例于术后1年半经MRI证实复发。结论原发性心脏良性肿瘤以黏液瘤多见,彻底切除肿瘤是防止复发的关键。心脏恶性肿瘤预后差,早期手术治疗并辅以综合治疗可望改善预后。     

原发性心脏肿瘤的外科治疗

目的：总结原发性心脏肿瘤的诊断与治疗经验，探讨其诊断、治疗措施。方法：回顾性分析121例心脏肿瘤患的诊断、治疗和随访资料。结果：94例左房粘液瘤中痊愈86例，死亡5例，复发3例，5例右房粘液瘤均痊愈；4例心脏良性肿瘤，2例恢复良好；8例恶性心脏肿瘤患，3例未能手术切除2例死亡，1例自动出院，5例分别死于术后5－25个月。10例心包间皮瘤患，6例手术，5例痊愈，1例术后死亡，其中有1例肿瘤复发并广泛转移。结论：原发性心脏肿瘤临床少见，一旦明确诊断应尽早手术治疗，心脏良性肿瘤切除后预后好，但有复发的可能；原发性心脏恶性肿瘤预后差，手术目的在于改善患心脏的血液动力学状态，以改善患的症状，提高生活质量，延长生存期。     

心脏肿瘤的外科疗效分析

目的探讨心脏肿瘤的特点和外科疗效。方法手术治疗53例心肿瘤中,粘液性肿瘤38例(71.69%),左房粘液性肿瘤35例,右房粘液性肿瘤3例;非粘液性良性肿瘤8例(15.09%),左房脂肪瘤1例,左室脂肪瘤1例,左房海绵状血管瘤2例,左房纤维瘤3例,右房横纹肌瘤1例;原发性恶性肿瘤5例(9.44%)。均为肉瘤,包括左房、左室横纹肌肉瘤1例,左室血管肉瘤2例,右房粘液肉瘤1例,右房、右室间皮肉瘤1例。右心转移癌2例(3.77%),46例良性肿瘤均完整切除;7例恶性肿瘤中,完整切除4例,大部切除2例,因广泛侵润转移者只行活检1例。同期行二尖瓣成形术12例,二尖瓣替换术3例,房间隔缺损修补术3例。三尖瓣成形术3例,三尖瓣生物瓣替换术1例。结果手术后死亡3例(5.66%),平均随访(33.43±12.38)个月,2例粘液瘤于3年内复发并再手术,恶性肿瘤3例术后3个月～2年复发或转移死亡(6%)。结论心脏肿瘤的疗效与病理性质和肿瘤生长位置密切相关。     

60例原发性纵隔肿瘤的外科手术治疗体会

目的分析原发性纵隔肿瘤的临床特点,探讨有效的手术治疗方法。方法选取我院2008年6月至2012年6月间收治的60例原发性纵隔肿瘤患者,所有患者均经胸部CT、X线检查以及病理检查确诊,总结外科手术治疗体会。结果本组60例原发性纵隔肿瘤患者中死亡1例,死于术后呼吸衰竭,病死率为1.7%。术后对患者进行4～6个月的随访发现,良性肿瘤患者恢复良好,未见复发,恶性肿瘤患者采用术后化疗或放疗后症状得到显著改善,其中发生脑部转移3例,肺部转移1例。讨论采用外科手术治疗原发性纵隔肿瘤是一种有效的治疗方法,手术应根据患者及肿瘤的具体情况选择合适的手术切口和手术方式,术中操作应仔细,以保证手术的安全性,提高临床治疗效果。     

29例腮腺肿瘤手术治疗分析

目的 探讨提高腮腺肿瘤诊断水平和临床治愈率的方法.方法 回顾性分析了2004年12月至2010年12月我科进行的29例腮腺肿瘤切除手术患者的临床资料,统计了病例资料的病理分类、临床治愈、术后复发及并发症情况.结果 本组29例腮腺肿瘤患者,其中良性肿瘤为24例,恶性肿瘤为5例,所有病例均行手术治疗.本组患者中有2例多形性腺瘤良性肿瘤术后复发,2例恶性肿瘤术后复发;本组患者术后出现暂时性面瘫7例;2例患者发生涎瘘;有1例患者因肿瘤破坏了面神经颊支.结论 手术治疗腮腺肿瘤的治愈率高,为首选治疗方式,术式选择可根据实际情况选决定.     

超声诊断心脏肿瘤的临床探析

目的探究心脏肿瘤采用彩色多普勒超声心动图诊断的临床价值。方法选取2012年8月至2014年1月收治的33例心脏肿瘤患者进行诊断研究,22例患者为原发性的良性肿瘤,5例患者为原发性的恶性肿瘤,6例患者为继发性的心脏恶性肿瘤,对上述患者进行临床表现、发病部位和多普勒超声诊断的分析和对比。结果原发性良性肿瘤和原发性恶性肿瘤,在二尖瓣前叶这一部位发病的所占比例差异大,有统计学意义(P<0.05)。且诊断的准确度为94.7%,效果显著。结论彩色多普勒超声诊断可准确判断心脏肿瘤患者的具体病情,分析肿瘤的情况,有较高价值。     

原发性小肠肿瘤30例手术治疗体会

目的：探讨原发性小肠肿瘤的临床特点、诊断及治疗方法。方法：对1998年1月～2009年1月收治的原发性小肠肿瘤30例的临床资料进行回顾性分析。结果：小肠肿瘤发病部位以回肠多见,其次为空肠、十二指肠;临床表现缺乏特异性,误诊率高,良性肿瘤行局部肠或肠段切除,恶性肿瘤行根治性切除或姑息性切除,无围手术期死亡病例,术后24例恶性肿瘤均得到1～5年的随访,术后1、3、5年的生存率分别为87．5％、62．5％和29．2％。结论：小肠肿瘤术前诊断困难,综合采用各项检查是提高术前诊断率的关键。手术治疗是主要的首选方法。     

75例腮腺肿瘤临床分析

目的探讨腮腺肿瘤的发病特点及诊断治疗中存在的问题。方法对2005年1月至2010年12月6年间收治的经组织病理学确诊的75例腮腺肿瘤患者病史进行回顾性分析。结果本组病例中,良性肿瘤72例,占96%,恶性肿瘤3例,占4%,术后6例出现暂时性面瘫,涎瘘1例,皮下积液2例。结论腮腺肿瘤中多为良性肿瘤,根据肿瘤的大小选用不同的手术方式,在根除肿瘤前提下尽可能保存功能,术后并发症取决于手术中细节方面的处理。     

原发性腹膜后肿瘤的诊治

目的：探讨总结原发性腹膜后肿瘤的诊断和治疗。方法对1997年1月～2009年10月收治的35例原发性腹膜后肿瘤的临床资料进行回顾性分析。结果原发性腹膜后肿瘤的临床表现以腹部肿物及腹部隐痛为主,检查手段主要为B超、CT、MRI。35例病例中,2例未手术,其余33例手术治疗。恶性肿瘤22例（66.7%）、良性肿瘤11例（33.3%）,完整切除27例（其中联合脏器切除1例）,部分姑息切除5例,手术探查活检1例。结论影像学检查可有效诊断原发性腹膜后肿瘤;外科手术治疗及肿瘤完整切除是治疗和预后的关键;术后提高随访率,及早发现复发病灶,复发者再次手术仍可获得临床疗效。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.