化疗期不同时间服用甲羟孕酮改善肺癌患者的生活质量

目的 观察肺癌患者不同时间服用甲羟孕酮后对改善化疗期所致的食欲减退、恶心、体质量改变等生活质量的作用。并进行对比研究。方法 全组102例肺癌患者均经细胞学或病理学明确诊断。分为3组：第1组：化疗前≥3d开始服用甲羟孕酮(32例)；第Ⅱ组：化疗同一天或化疗前&;lt;3d开始服用甲羟孕酮(37例)；第Ⅲ组：化疗结束服用甲羟孕酮(33例)。甲羟孕酮25mg。3次／d，连服10—14d；化疗选用以长春地辛、顺伯、异环磷酰胺为主的方案，辅助5—羟色胺受体拮抗剂控制化疗引起的胃肠道反应。结果 在化疗期间食量不减或增加者69例，Ⅰ组为91％(29／32)，Ⅱ组为68％(25／37)，Ⅲ组为45％(15／33)；Ⅰ组与Ⅱ组、Ⅲ组相比较差异有显著性(P&;lt;0．05，tⅡ=2．28；tⅢ=4．22)。食量减少者33例，Ⅰ组发生率9％(3／32)，Ⅱ组发生率32％(12／37)，Ⅲ组发生率55％(18／33)，其中Ⅰ、Ⅱ组减少幅度轻，恢复时间快。接受化疗时50％未发生恶心，其中Ⅰ组(63％)明显优于Ⅱ组(49％)Ⅲ组(39％)。体质量不变或增加者70例，其中Ⅰ组为88％(28／32)；Ⅱ组为70％(26／37)；Ⅲ组为48％(16／33)。Ⅰ组与Ⅲ组相比较差异有显著性(P&;lt;0．05，t=3．58)。结论 化疗前提前服用甲羟孕酮更能发挥其抗胃肠道反应，改善生活质量的作用。     

研究妇康片联合醋酸甲羟孕酮对单纯型子宫内膜增生症患者症状改善及子宫内膜厚度变化的影响

目的研究妇康片联合醋酸甲羟孕酮对单纯型子宫内膜增生症患者症状改善及子宫内膜厚度变化的影响。方法选取2015年11月~2017年10月新密市中医院单纯型子宫内膜增生症患者84例,依照治疗方案不同分为观察组和对照组各42例。对照组采用醋酸甲羟孕酮治疗,观察组采用妇康片联合醋酸甲羟孕酮治疗,两组均持续用药3个月。比较两组疗效、不良反应发生率、治疗前后月经量、血红蛋白(Hb)水平、子宫内膜厚度及生活质量变化。结果观察组治疗总有效率95.24%(40/42)高于对照组73.81%(31/42),不良反应发生率33.33%(14/42)低于对照组71.43%(30/42),差异有统计学意义(P0.05);治疗后观察组Hb水平、健康状况简明量表(SF-36)评分高于对照组,子宫内膜厚度小于对照组,月经失血评估表(PBAC)评分低于对照组,差异有统计学意义(P0.05)。结论妇康片联合醋酸甲羟孕酮治疗单纯型子宫内膜增生症疗效显著,能有效改善患者症状,减小子宫内膜厚度,提高生活质量,降低不良反应发生率。     

甲羟孕酮减轻化疗患者骨髓抑制临床观察

目的观察消化道肿瘤患者服用甲羟孕酮（medroxyprogesterone acetate,MPA）对化疗后骨髓抑制的影响。方法 2008年11月2009年8月,将接受化疗的消化道肿瘤患者共100例随机分为治疗组（MPA加化疗组,54例）及对照组（单纯化疗组,46例）,2周期化疗后评价骨髓抑制状况和生活质量变化。结果治疗组和对照组化疗后白细胞、血红蛋白和血小板Ⅰ～Ⅱ度骨髓抑制发生率没有差异（P〉0.05）,但治疗组Ⅲ～Ⅳ度骨髓抑制发生率低于对照组,KPS评分改善率高于对照组（P〈0.05）。未见明显不良反应。结论 MPA可有效减轻化疗后骨髓抑制。     

经尿道前列腺汽化电切术后膀胱痉挛性疼痛防治方法探讨

目的:探讨经尿道前列腺汽化电切术(TUVP)后膀胱痉挛性疼痛防治方法.方法:TUVP患者60例,术后病人按不同的解痉镇痛方法随机分成三组,Ⅰ组(对照组),当膀胱痉挛疼痛时肌注哌替啶1 mg/kg,阿托品0.01 mg/kg;Ⅱ组术后保留硬膜外导管,间隔硬膜外腔注药镇痛,Ⅲ组术后行硬膜外自控镇痛(PCEA),所有病人治疗时间为3 d,术后以疼痛视觉模拟评分法(VAS)间接评估镇痛效果,定时记录膀胱内压、膀胱痉挛次数及病人术后恢复情况.结果:术后膀胱痉挛性疼痛发生率Ⅲ组、Ⅱ组、Ⅰ组分别为20%、45%、75%(P＜0.05);术后36 h三组病人膀胱痉挛性疼痛发生次数为Ⅲ组＜Ⅱ组＜Ⅰ组(P＜0.05),术后镇痛效果Ⅲ组＞Ⅱ组＞Ⅰ组(P＜0.05);Ⅰ组病人术后3 d膀胱内压明显高于Ⅱ组和Ⅲ组病人,术后2 dⅡ组明显高于Ⅲ组(P＜0.05);Ⅱ组和Ⅲ组病人术后尿液转清、拔尿管时间均明显早于Ⅰ组(P＜0.05),Ⅰ组有2例病人因术后出血再手术.结论:TUVP后膀胱痉挛性疼痛临床防治方法中,硬膜外注药的效果明显优于传统的肌注用药,应用PCEA模式效果更佳.     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除的手术进路选择与疗效分析

目的探讨鼻内镜下切除鼻腔鼻窦内翻性乳头状瘤手术进路的选择及其与疗效的关系。方法回顾性分析1996年8月～2008年2月经鼻内镜手术治疗的鼻腔鼻窦内翻性乳头状瘤91例患者的临床资料。按照Krouse分类法分为4级:Ⅰ级18例,Ⅱ级45例,Ⅲ级25例,Ⅳ级3例。其中采用单纯鼻内镜手术组(A组)Ⅰ级18例、Ⅱ级33例、Ⅲ级13例;鼻内镜联合改良柯-陆术式手术组(B组)Ⅱ级12例、Ⅲ级12例;鼻内镜联合鼻外进路手术组(C组)Ⅳ级3例。结果术后随访18～90个月,平均37个月,有15.4%(14/91)复发,其中A组Ⅰ级5.6%(1/18)、Ⅱ级6.1%(2/33)、Ⅲ级53.8%(7/13);B组Ⅱ级16.7%(2/12),Ⅲ级8.3%(1/12);C组Ⅳ级33.3%(1/3),统计结果提示Ⅱ级病例,A组和B组复发率无差异,而Ⅲ级病例,A组和B组复发率有差异,A组复发率高。复发病例行再次手术,均随访24个月未再复发。结论鼻内镜手术是治疗鼻内翻性乳头状瘤的安全有效方法,大部分可以通过单纯鼻内镜径路术式完成,但对于肿瘤涉及上颌窦、额窦等病变广泛的Ⅲ、Ⅳ级患者,采用联合进路可以避免手术盲区,减少肿瘤残留,降低复发率。     

女性急性心肌梗死患者入院时血糖水平与预后关系的研究

目的 探讨入院时高血糖对女性急性心肌梗死(AMI)患者住院期间预后的影响.方法 对我院心脏内科1988年1月至2007年12月接诊的171例无糖尿病史的女性急性AMI患者根据其入院时血糖水平分为3组.第Ⅰ组:69例,血糖水平<6.1 mmol/L;第Ⅱ组:49例,血糖水平6.1～7.8 mmol/L;第Ⅲ组:53例,血糖水平>7.8 mmol/L.对3组患者的一般临床情况、梗死部位、主要并发症发生率和病死率进行比较.结果 ①3组患者在一般临床情况、梗死部位方面差异无统计学意义(P均>0.05);②第Ⅲ组患者住院期间心力衰竭、心源性休克、严重心律失常发生率明显高于第Ⅰ组、第Ⅱ组患者[心力衰竭发生率:第Ⅰ组30.43%(21/69),第Ⅱ组32.65%(16/49),第Ⅲ组58.49%(31/53);心源性休克发生率:第Ⅰ组5.80%(4/69),第Ⅱ组8.16%(4/49),第Ⅲ组24.53%(13/53);严重心律失常发生率:第Ⅰ组24.64%(17/69),第Ⅱ组30.61%(15/49),第Ⅲ组54.72%(29/53)],差异均有统计学意义(P均<0.05).第Ⅲ组患者院内病死率[28.30%(15/53)]显著高于第Ⅰ组[13.04%(9/69)]患者,差异有统计学意义(P<0.05).结论 女性AMI患者入院血糖水平增高时,住院期间心力衰竭、心源性休克、严重心律失常的发生率及病死率均明显增加.     

摩托车排气管烫伤60例诊治分析

目的:寻求摩托车排气管烫伤后的理想治疗流程。方法:回顾性分析我科诊治的60例摩托车排气管烫伤患者的临床资料。结果:60例患者共分成两组,伤后<24h[平均(8.19±6.35)h]就诊者为Ⅰ组(共27例),其中浅Ⅱ度6例,深Ⅱ度19例,Ⅲ度2例;伤后>24h[平均(7.35±9.08)d]就诊者为Ⅱ组(共33例),其中浅Ⅱ度3例,深Ⅱ度20例,Ⅲ度10例;两组Ⅲ度创面所占比例比较,差异有显著性(P<0.05)。Ⅰ组来院时创面相对较清洁,伤后第3～16d(平均7.12d)的创面培养阳性率为11%(3/27);Ⅱ组来院时创面渗出较多,甚至流脓,来院时的创面培养阳性率为39%(13/33),两者差异有显著性(P<0.05)。Ⅰ组切削痂植皮者1例,Ⅱ组切削痂植皮者6例;仅予换药而未作植皮的创面愈合时间,Ⅰ组为6～31d[平均(16.96±5.85)d],Ⅱ组为7～39d[平均(21.93±7.23)d],两者差异有显著性(P<0.01)。结论:患者的不重视和早期处理不当是延误治疗、加重伤情的主要原因。即时冷疗、及时去正规医院烧伤科诊治、对Ⅲ度面积>3cm×3cm的创面早期切削痂植皮、注意合并伤的及时正确处理是摩托车排气管烫伤较理想的治疗流程。     

不同分期肺癌患者术后下肢深静脉血栓形成发生率及凝血指标水平比较

目的探讨不同分期肺癌患者术后下肢深静脉血栓形成(deep vein thrombosis,DVT)发生情况及凝血指标水平变化。方法肺癌患者289例,其中国际抗癌联盟Ⅰ期及原位癌85例(Ⅰ期组),Ⅱ期145例(Ⅱ期组),Ⅲ期59例(Ⅲ期组),均行根治性切除术。3组术后7 d内均行下肢深静脉彩超检查,记录DVT发生率;分别于术前及术后7 d采集静脉血,检测血小板计数、纤维蛋白原、凝血酶原时间(prothrombin time,PT)、D-二聚体(D-dimer,DD)水平。结果289例术后发生DVT 21例,发生率为7.27%;Ⅲ期组DVT发生率(16.95%)高于Ⅰ期组(1.18%)、Ⅱ期组(6.90%),且Ⅱ期组高于Ⅰ期组(P<0.05);Ⅰ、Ⅱ、Ⅲ期组术后7 d血小板计数[(224.8±11.7)×10^9/L、(214.5±10.6)×10^9/L、(224.8±12.2)×10^9/L]、纤维蛋白原[(4.0±1.2)、(3.7±1.5)、(4.1±1.3)g/L]、PT[(11.9±3.2)、(10.5±1.1)、(11.0±1.6)s]与术前[血小板计数:(211.4±8.7)×10^9/L、(204.5±9.5)×10^9/L、(221.1±10.2)×10^9/L;纤维蛋白原:(3.8±1.0)、(3.5±1.1)、(3.6±1.2)g/L;PT:(11.8±2.1)、(10.8±1.6)、(10.7±1.5)s]比较差异无统计学意义(P>0.05),且3组组间术前、术后7 d比较差异均无统计学意义(P>0.05);Ⅰ、Ⅱ、Ⅲ期组术前血清D-D[(0.5±0.4)、(0.5±0.3)、(0.5±0.1)g/L]比较差异无统计学意义(P>0.05),术后7 d[(1.2±0.1)、(2.8±0.2)、(4.5±0.6)g/L]均高于术前(P<0.05),且术后7 dⅢ期组高于Ⅰ、Ⅱ期组(P<0.05),Ⅰ期组与Ⅱ期组比较差异无统计学意义(P>0.05)。结论肺癌患者UICC分期越高,术后DVT发生率越高,检测血清D-D水平有助于评估肺癌患者术后DVT发生风险。     

护理干预联合氟哌噻吨美利曲辛片对癌症抑郁焦虑患者生活质量的影响

目的研究护理干预联合氟哌噻吨美利曲辛片对癌症抑郁焦虑患者生活质量的影响。方法选取2013年3月到2014年3月黄冈市中心医院收治的癌症抑郁焦虑患者120例,分为Ⅰ、Ⅱ和Ⅲ组,每组40例,Ⅰ组给予传统护理,Ⅱ组给予护理干预和安慰剂,Ⅲ组给予护理干预联合氟哌噻吨美利曲辛片治疗。采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评价患者抑郁和焦虑情况,比较3组临床疗效、HAMD评分、HAMA评分、生活质量改善情况。结果治疗后Ⅱ组和Ⅲ组HAMD评分和HAMA评分分别为(19.8±0.3)、(15.4±0.2)、(14.9±0.5)、(11.4±0.1)分,与治疗前比较差异有统计学意义(t=12.032、11.895,P=0.013、0.014;t=12.752、13.029,P=0.011、0.009),Ⅲ组明显低于Ⅱ组,两组比较差异有统计学意义(t=10.032、9.893,P=0.023、0.029);Ⅰ组总有效率为17.5%(7/40),Ⅱ组总有效率为67.5%(27/40),Ⅲ组总有效率为92.5%(37/40),3组比较差异有统计学意义(F=49.782,P=0.024);3组生活质量改善有效率分别为12.5%(5/40)、67.5%(27/40)、95.0%(38/40),差异有统计学意义(F=49.621,P=0.017)。结论护理干预联合氟哌噻吨美利曲辛片能显著改善患者抑郁和焦虑情况,改善患者生活质量。     

甲羟孕酮改善晚期肺癌化疗不良反应的临床探究

目的探讨甲羟孕酮在改善晚期肺癌化疗患者的不良反应的应用价值。方法回顾性分析我院于2011年12月~2013年01月收治的70例晚期肺癌患者的临床资料,根据用药的不同将其分为观察组(35例)和对照组(35例)。其中对照组给予单纯化疗,观察组患者则在化疗期间加用甲羟孕酮辅助治疗,观察对比两组患者食欲、体重、胃肠道反应、骨髓抑制以及全身状况等不良反应的变化情况。结果甲羟孕酮组患者有91.43%的患者食欲增加,85.71%的患者体重增加,91.43%的患者骨髓抑制处于0~Ⅱ级,34.29%的患者卡氏评分≥30分,而只有8.57%的患者出现消化道反应,较单纯化疗组差异显著,有统计学意义(P0.05)。结论甲羟孕酮辅助晚期肺癌化疗效果显著,可明显改善食欲、增加体重、减轻胃肠道反应,不良反应得到全面改善,患者的生活质量也得到提高,值得在临床上推广应用。     

醋酸甲孕酮改善晚期癌症患者化疗期生活质量的临床研究

目的 :观察患者口服 5 0 0mg醋酸甲孕酮改善化疗期生活质量疗效。方法 :2 33例各种肿瘤患者随机分成两组。治疗组 117例 ,化疗期联用甲孕酮 5 0 0mg/日 ,6～ 8周为一观察周期。对照组 116例 ,采用单独化疗。结果 :治疗组中 10 1例 (86 2 % )食欲增加 ,73例 (6 2 4 % )体重增加 ,91例 (77 8% )疼痛缓解 ,明显优于对照组 ,P <0 0 0 5。结论 :醋酸甲孕酮在改善晚期癌症患者生活质量方面有较好的疗效 ,且毒副作用不明显。     

Emergency Treatment of Intractable Migraine

SYNOPSIS
The treatment of refractory or prolonged migraine is a difficult problem for the physician and patient. Treatment varieswith physician and location, but widely accepted is therapy with an injectable analgesic in combination with asedative/antimetic and/or ergotamine.Since prolonged migraine headache is said to be associated with cranial vascular inflammation, the addition ofcorticosteroids to treatment may enhance relief. An analysis was conducted of 162 patients who were treated with andwithout steroids for intractable migraine headache in the emergency department of a large community hospital.Patients were divided into three groups. Group I consisted of 73 patients treated with meperidine and promethazine;Group II, 32 patients treated with dihydroergotamine and meperidine; Group III, 57 patients treated with meperidine,promethazine and dexamethasone. All patients were telephoned 24 hours after treatment to determine the degree ofheadache relief. Twenty-one patients (29%) from Group I; 12 patients (37%) from Group II; and 41 patients (72%) fromGroup III reported marked relief.From this limited study, it appears that the inclusion of dexamethasone in the treatment of intractable migraineheadache is of benefit.     

Results of a dose-intense phase 1 study of a combination chemotherapy regimen with cisplatin and epidoxorubicin including medroxyprogesterone acetate and recombinant interleukin-2 in patients with inoperable primary lung cancer

Based on the role of cytokines in the pathogenesis of cancer-related anorexia-cachexia and the ability of progestins, such as medroxyprogesterone acetate, to reduce cytokine production and relieve cancer-related anorexia-cachexia symptoms, the authors designed an open, dose-finding phase I study of a combined chemotherapy regimen (cisplatin [CDDP], epidoxorubicin [EPI]), including recombinant interleukin-2 (IL-2) and medroxyprogesterone acetate for patients with stage IIIB to IV inoperable primary lung cancer. The end points were clinical response and toxicity with definition of dose-limiting toxicity and maximal tolerable dose; relief of cancer-related anorexia-cachexia symptoms; the assessment of patient serum levels of IL-1beta, IL-6, tumor-necrosing factor-alpha (TNF-alpha), and soluble IL-2 receptor (sIL-2R). From March to October 1997, 16 patients (M:F ratio, 14:2; mean age, 60.5 years; age range, 41 to 74 years) were enrolled. All patients were evaluable for toxicity and 14 of them for response. The patients were assigned to increasing dose levels of drugs according to a dose-escalation schedule. The weekly schedule consisted of a combination of CDDP given intravenously on day 1, EPI given intravenously on day 1, 1 g/day medroxyprogesterone acetate given orally on days 1 to 7, and recombinant IL-2 1.8 MIU administered subcutaneously on days 2 to 7 plus 300 microg granulocyte-colony stimulating factor support given subcutaneously on days 2 to 5. Administration of medroxyprogesterone acetate began 1 week before the first cycle. Dose escalation of the drugs was as follows: 30 mg x m2 x week(-1) CDDP and 25 mg x m2 x week(-1) EPI (first level, two patients); 30 mg x m2 x week(-1) CDDP and 33 mg x m2 x week(-1) EPI (second level, 2 patients); 40 mg x m2 x week(-1) CDDP and 33 mg x m2 x week(-1) EPI (third level, 6 patients); and 40 mg x m2 x week(-1) CDDP and 40 mg x m2 x week(-1) EPI (fourth level, 6 patients). Six cycles were planned for each patient. The actual dose intensity delivered was more than 80% of the projected dose intensity of all drugs. After six cycles, clinical response (according to World Health Organization criteria), toxicity (according to World Health Organization criteria), Eastern Cooperative Oncology Group (ECOG) performance status, body weight, appetite, and serum levels of cytokines were evaluated. After six cycles, 9 of 14 patients (64.3%) had partial response, 3 of 14 (21.4%) had stable disease, and 2 of 14 (14.3%) had progressive disease, and the objective response rate was 64.3%. ECOG performance status and body weight did not change significantly after treatment, whereas appetite showed an increase that was of borderline statistical significance. Toxicity was acceptable and only hematologic. Dose-limiting toxicity was established at the fourth dose level; consequently, maximal tolerable dose was assessed at the third dose level. Before treatment, the serum levels of IL-1beta, IL-6, and TNF-alpha were significantly greater in the patients than in healthy persons. The comparison between pretreatment and posttreatment serum values of IL-1beta, IL-6, TNF-alpha, and sIL-2R did not reveal significant differences in the patients. Similar results were obtained when the patients were considered as responders (partial response) or non-responders (stable or progressive disease) to therapy. Only IL-6 serum levels were increased (p = 0.014) after treatment.     

MDCT evaluation of intimal defects in intramural hematoma of the aorta: initial findings and follow-up

The purpose of this study is to assess the incidence and type of intimal defects in acute stage of the intramural hematoma (IMH) of the aorta using multi-detector CT (MDCT), and to see whether there was any difference in disease progression according to the presence and types of intimal defects. A retrospective analysis of 37 patients with following inclusion criteria was performed: (1) DeBakey type III IMH, (2) CT scans using 16-/64-channels MDCT within 24 h from symptom onset, and (3) no previous history of acute aortic syndrome. IMH patients were classified into 3 groups according to the initial MDCT findings: Group I included those patients without any intimal defects, Group II included those patients with ulcer-like projections, and Group III included those patients with atherosclerotic plaque ulcers. Thirty-four patients who underwent follow-up CT scans were assessed for changes in intimal defect size and hematoma thickness. For the initial CT studies, Group I included 6 patients, Group II included 7 patients, and Group III included 24 patients, In Group I, all patients showed regression of IMH without development of de novo intimal defects. However, in Groups II and III, intimal defect size was increased in 5 (83.3%) and 16 (72.7%) patients (P = 0.595), respectively. IMHs were complicated in 0 (0.0%), 1 (16.7%), and 4 (11.8%) patients in Groups I, II, and III, respectively (P = 0.587). Intimal defects are very common findings in the acute stage of IMH, and most of are associated with atherosclerotic plaque. Intimal defects have a tendency to increase in size in patients with ulcer-like projections or atherosclerotic plaque ulcers. However, IMHs improved with medical treatment, as shown by the decrease in hematoma thickness in all groups following treatment.     

Hyperprolactinaemia in patients with heart failure: clinical and immunogenetic correlations

BACKGROUND: Prolactin represents a stimulatory link between the neuroendocrine and immune systems, but its involvement in the neurohumoral adaptations to heart failure (HF) has not been explored. METHODS: We prospectively studied 55 patients (45 males, 10 females, age 48 +/- 7 years) with NYHA Class II/III HF due either to dilated cardiomyopathy (CMP) (n = 33) or ischemic heart disease (IHD) (n = 22). Serum prolactin levels were determined by radioimmunoassay, soluble interleukin-2 receptor (sIL-2R) levels by enzyme-linked immunoassay and HLA-DQ genotyping with PCR. Left ventricular ejection fraction (LVEF) and end-diastolic diameter (LVEDd) were assessed echocardiographically. RESULTS: Hyperprolactinaemia (17.3 +/- 4 ng mL-1 [Group I] vs. 4.64 +/- 2 ng mL-1 [Group II], P < 0.01) was found in 14 patients (8 with IHD, 6 with CMP). The distribution of HLA-DQB1 alleles was compared in the two groups and showed a significant increase in the frequency of *0301 (86% in Group I vs. 45% in Group II, P < 0.05). Histidine at position 30 of the HLA-DQB1 gene was found in 22% of Group II but in none of Group I patients. Furthermore, there was an inverse correlation between the presence of histidine at position 30 and the levels of serum prolactin. Both sIL-2R levels, a marker of T-cell activation, and concanavalin A-stimulated lymphocyte proliferation were lower in Group I patients (561 +/- 106 vs. 804 +/- 109 pg mL-1 and 20.8 +/- 4 vs. 37.3 +/- 5 cpmX103 [3H] thymidine, respectively). LVEF was significantly higher (32 +/- 5%) and LVEDd smaller (62.0 +/- 6 mm) in Group I compared to Group II (25 +/- 4% and 68.0 +/- 5 mm, respectively, P < 0.01) patients. CONCLUSION: Hyperprolactinaemia presents in 25% of patients with HF and may reflect decreased activation of T-lymphocytes associated with relatively preserved LV systolic function which is under immune-genetic control at the HLA-DQ locus.     

Preventing paclitaxel-induced peripheral neuropathy: a phase II trial of vitamin E supplementation

A randomized, controlled trial was performed to assess the efficacy and safety of vitamin E supplementation for prophylaxis against paclitaxel-induced peripheral neuropathy (PIPN). Thirty-two patients undergoing six courses of paclitaxel-based chemotherapy were randomly assigned to receive either chemotherapy with vitamin E (300 mg twice a day, Group I) or chemotherapy without vitamin E supplementation (Group II). A detailed neurological examination and electrophysiological study was performed during and 3 months after chemotherapy. The severity of PIPN was summarized by means of a modified Peripheral Neuropathy (PNP) score. The incidence of neurotoxicity differed significantly between groups, occurring in 3/16 (18.7%) patients assigned to the vitamin E supplementation group and in 10/16 (62.5%) controls (P=0.03). The relative risk (RR) of developing PIPN was significantly higher in controls than in vitamin E group patients (RR=0.3, 95% confidence interval (CI)=0.1-0.9). Mean PNP scores were 2.25+/-5.1 (range 0-15) for patients in Group I and 11+/-11.63 (range 0-32) for those in Group II (P=0.01). Vitamin E supplementation was well tolerated and showed an excellent safety profile. This study shows that vitamin E effectively and safely protects patients with cancer from the occurrence of paclitaxel-induced peripheral nerve damage. A double-blind, placebo-controlled trial is needed to confirm these results.     

Bi-phenotypic leukemia and hybrid leukemia]

Phenotypes of leukemic cells can be determined through dual staining with pairs of FITC-labeled and PE-labeled monoclonal antibodies using a laser flow cytometer. Hybrid acute leukemia (HAL) was diagnosed when leukemic cells expressed 2 or more lymphoid markers and at least one myeloid maker simultaneously. Based on this criteria, forty out of 111 cases with untreated acute leukemia were diagnosed as HAL, 16 of 41 (39%) patients with acute lymphoblastic leukemia and 15 of 70 (21%) patients with acute non-lymphocytic leukemia were diagnosed as having HAL. We classified these HAL cells into 4 types by the following items. Type I; leukemic cells expressed only CD33 and 2 or more B-cell antigens, type II; only CD33 and 2 or more T-cell antigens, type III; CD13 and/or CD33 and 2 or more B-cell antigens, and type IV; CD13 and/or CD33 and 2 or more T-cell antigens. There were 7 type I cases and 16 type III cases. The leukemic cells of these two types were thought to be ALL cells expressing one or several myeloid lineage-associated antigens. There were 4 type II cases and 10 type IV cases. Type II and IV were regarded as lymphoid-lineage associated antigens positive AMLs. At least in adults, the expression of myeloid-associated antigens of ALL cells seems to identify a high risk group of ALL patients with a poorer response to standard ALL therapy.     

Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

OBJECTIVES: Resuscitation studies of hypertonic saline using controlled and uncontrolled hemorrhage models yield conflicting results with regard to efficacy. These disparate results reflect the use of models and resuscitation regimens that are not comparable between studies. This study evaluated the effects of comparable and clinically relevant resuscitation regimens of 7.5% sodium chloride/6% dextran 70 (HSD) and 0.9% sodium chloride (NS) in a near-fatal uncontrolled hemorrhage model. METHODS: Thirty-six swine (14.2 to 21.4 kg) with 4-mm aortic tears were bled to a pulse pressure of 5 mm Hg (40-45 mL/kg). The animals were resuscitated with either NS or HSD administered in volumes that provided equivalent sodium loads at similar rates. Group II (n = 12) was resuscitated with 80 mL/kg of NS at a rate of 4 mL/kg/min. Group III (n = 12) received 9.6 mL/kg of HSD at a rate of 0.48 mL/kg/min. In both groups, crystalloid resuscitation was followed by shed blood infusion (30 mL/kg) at a rate of 2 mL/kg/min. Group I (controls; n = 12) were not resuscitated. RESULTS: One-hour mortality was significantly greater in group I (92%) as compared with group II (33%) and group III (33%) (Fisher's exact test; p = 0.004). Intraperitoneal hemorrhage was significantly greater in group II (34 +/- 20 mL/kg) and group III (31 +/- 13 mL/ kg) as compared with group I (5 +/- 2 mL/kg) (ANOVA; p < 0.05). There was no significant difference in hemodynamic parameters between groups II and III. CONCLUSION: In this model of severe uncontrolled hemorrhage, resuscitation with HSD or NS, administered in volumes that provided equivalent sodium loads at similar rates, had similar effects on mortality, hemodynamic parameters, and hemorrhage from the injury site.     

Activity of [des-Aspartyl1]-Angiotensin II in Primary Aldosteronism

This study describes the effects of [des-Aspartyl(1)]-angiotensin II ([des-Asp]-AII) on blood pressure and aldosterone production in patients with primary aldosteronism due to aldosterone-producing adrenal adenoma (APA) and idiopathic adrenal hyperplasia (IHA), and in normotensive control subjects. 10 patients with primary aldosteronism, 7 with APA and 3 with IHA, and 6 normotensive control subjects were placed on a constant 150-meq sodium diet for 4 days. [des-Asp]-AII was infused for 30 min at 6, 12, and 18 pmol/kg per min. Three groups of patients were identified on the basis of aldosterone response to [des-Asp]-AII. Group I, composed of normotensive control subjects, showed incremental increases in plasma aldosterone concentration from 6+/-1 to 14+/-3 ng/100 ml (P < 0.01) with [des-Asp]-AII infusion. Group II, composed of patients with primary aldosteronism, showed incremental increases in plasma aldosterone concentration from 33+/-8 to 65+/-13 ng/100 ml (P < 0.05) with 12 pmol/kg per min of [des-Asp]-AII. Group III, also composed of patients with primary aldosteronism, showed no increase of plasma aldosterone concentration with [des-Asp]-AII. Groups I and II showed similar percentage increases in plasma aldosterone concentration (P = NS). Group III showed significantly lower aldosterone responses than group I (P < 0.01). Group II included all patients with IHA and two patients with APA. Group III included only patients with APA. The blood pressure responses to [des-Asp]-AII of subjects in group I did not differ significantly from those of groups II or III.Thus, patients with IHA and a subgroup of patients with APA showed responsiveness to [des-Asp]-AII which was limited to adrenal cortical stimulation of aldosterone biosynthesis. This suggests that adrenal responsiveness to angiotensin is a major control mechanism in some forms of primary aldosteronism. The differential adrenal responsiveness to [des-Asp]-AII in patients with APA indicates either that there are two distinct subpopulations of APA, or that alteration in tumor response to angiotensin occurs during the natural progression of the disease history.     

短疗程、高强度化疗方案治疗儿童青少年B细胞非霍奇金淋巴瘤的疗效

目的评价德国NHL-BFM-90方案治疗中国儿童青少年B细胞非霍奇金淋巴瘤（BNHL）的疗效和毒性。方法20岁以下的儿童青少年B-NHL患者42例，其伯基特淋巴瘤18例，弥漫性大B细胞淋巴瘤16例，间变性大细胞淋巴瘤8例；早期病例（Ⅱ期）10例，晚期病例（Ⅲ，Ⅳ期）32例所有患者均接受NHL-BFM-90方案化疗根据临床分期、血清乳酸脱氢酶（LDH）的水平等预后因素，分为低、中和高危3组。低危组（Ⅱ期患者）接受A和B疗程交替化疗4个疗程：中危组（Ⅲ期和LDH〈500U／L的Ⅳ期患者）接受AA和BB疗程交替化疗6个疗程高危组[LDH〉500U／L的Ⅳ期患者和中危组两疗程AA、BB治疗后不能完全缓解（CR）的患者]接受AA、BB和CC疗程交替化疗6个疗程每个疗程间隔18～21d结果37例（88％）患者获得CR，5例（12％）患者获得部分缓解（PR），其中1例接受自体造血干细胞移植，3例行残留病灶放疗，1例观察，主要不良反应为骨髓抑制和黏膜炎，以AA、BB和CC疗程明显，但均可耐受中位随访20（4～89）个月，按Kaplan-Meier方法进行生存率统计，2年全组无事件生存（EFS）率为86．24％，早期患者为100％，晚期患者为80．95％。结论短疗程、高强度化疗结合中枢神经系统预防的治疗策略能明显改善儿童青少年B-NHL患者的疗效和生存率，特别是对晚期患者的疗效更明显。