手指恶性黑色素瘤的临床特征与疗效分析

目的 探讨手指恶性黑色素瘤的临床特征及治疗效果.方法 回顾性分析1995年2月-2007年10月收治并经病理检查证实的22例手指恶性黑色素瘤的临床资料,其中拇指12例,示、中指各3例,环、小指各2例.手指黑斑及疼痛为共同的首发症状,15例有甲下病变,12例有外伤史,2例X线片显示指骨有溶骨性改变.主要采用手术、全身化疗及免疫治疗.所有患者均采用截指术,其中13例行同侧腋窝淋巴结清扫术.结果 22例患者获得随访,其中3例2年后失访.随访时间为1～10年,平均4.5年.1年生存率为86.4%(19/22),3年生存率为63.2%(12/19),5年生存率为31.6%(6/19).结论 手指恶性黑色素瘤临床少见,治疗应以手术、化疗、免疫治疗等综合方法为主.其预后与肿瘤大小、浸润深度及临床分期有关.     

手指恶性黑色素瘤的临床特征与疗效分析

目的 探讨手指恶性黑色素瘤的临床特征及治疗效果.方法 回顾性分析1995年2月-2007年10月收治并经病理检查证实的22例手指恶性黑色素瘤的临床资料,其中拇指12例,示、中指各3例,环、小指各2例.手指黑斑及疼痛为共同的首发症状,15例有甲下病变,12例有外伤史,2例X线片显示指骨有溶骨性改变.主要采用手术、全身化疗及免疫治疗.所有患者均采用截指术,其中13例行同侧腋窝淋巴结清扫术.结果 22例患者获得随访,其中3例2年后失访.随访时间为1～10年,平均4.5年.1年生存率为86.4%(19/22),3年生存率为63.2%(12/19),5年生存率为31.6%(6/19).结论 手指恶性黑色素瘤临床少见,治疗应以手术、化疗、免疫治疗等综合方法为主.其预后与肿瘤大小、浸润深度及临床分期有关.     

3例肾脏原始神经外胚层肿瘤临床分析

目的：提高临床上对肾脏原始神经外胚层肿瘤的认知。方法：回顾性分析2004年1月～2008年4月收治的3俩肾脏原始神经外胚层肿瘤患者的临床资料。结果：3例术前均未明确诊断,皆为术后病理证实。其中2例接受术后辅助性化疗,随访无瘤生存达3年,1例未行术后辅助治疗,失访。结论：。肾脏原始神经外胚层肿瘤临床上极为少见,应结合影像学检查、病理及遗传学特点明确诊断,治疗以根治性手术为首选,综合治疗为主。     

阴茎恶性黑色素瘤1例报告并文献复习

目的认识阴茎恶性黑色素瘤的生物学行为和临床病理特征。方法回顾分析1例阴茎恶性黑色素瘤病例,结合文献分析其发病情况、临床病理特征、诊断和治疗。结果患者行阴茎部分切除术,术后1年死于肺转移。免疫组化染色(S-P法):HMB45( ),S-100( ),Vimentin( ),Actin(SM)(-),Cytokeratin(-)。结论阴茎恶性黑色素瘤治疗主要采用手术切除,辅以放疗、化疗及免疫治疗,但预后差。     

阴茎原发恶性黑色素瘤4例

目的 探讨阴茎原发恶性黑色素瘤的临床症状、病理特点及诊断治疗.方法 对4例阴茎原发恶性黑色素瘤的病理和临床资料进行回顾性分析.结果 4例均行阴茎部分切除,双侧腹股沟淋巴结清扫术.术后4例均行化疗,其中2例化疗联合生物学治疗.结论 阴茎原发恶性黑色素瘤临床罕见,确诊依靠病理,手术为主要治疗手段,术后行化疗联合生物学治疗可提高生存期,但因其恶性程度高,预后不佳.     

阴茎原发性恶性黑色素瘤1例报告并文献复习

目的探讨阴茎原发恶性黑色素瘤的生物学行为、临床病理特点、诊断治疗方法及其预后。方法报告1例阴茎原发恶性黑色素瘤的诊断治疗、随访情况并结合国内外文献进行分析。结果本例患者肿瘤分期为I期,行阴茎全切尿道会阴造口＋双侧腹股沟淋巴结清扫术,术后行化疗并结合免疫治疗,于术后18个月出现远处转移,术后30个月因全身多发转移、多器官功能衰竭死亡。结论阴茎原发恶性黑色素瘤临床罕见,恶性程度高。其确诊依靠病理,外科手术为主要治疗手段,对于Ⅰ期、Ⅱ期的患者,阴茎全切术式较之部分切除术后生存期明显延长,对于Ⅲ期患者手术范围则对于术后生存期并无明显影响。术后结合化疗以及免疫治疗可提高生存期,但总体预后差。     

隐睾恶变6例诊治分析

目的：探讨隐睾恶性肿瘤的诊断与治疗方法。方法：回顾性分析6例隐睾恶变的临床资料。结果：平均年龄31．8岁;4例发生于腹腔内隐睾,2例发生于腹股沟区隐睾。5例行B超和CT检查,术前确诊为隐睾恶变;1例拟行腹内隐睾复位固定,术中发现睾丸萎缩变硬,切除后病理检查发现恶变。所有患者均行手术治疗,术后给予放疗或化疗或免疫治疗;病理类型为精原细胞瘤4例,胚胎性癌1例,未成熟型畸胎瘤伴胚胎性癌及卵黄囊瘤1例。随访5例,随访时间2～5年,2例死亡,3例无瘤生存。结论：隐睾患者盆腔或腹股沟进行性增大的肿块应高度怀疑隐睾恶变,B超和CT是诊断隐睾恶变的重要手段,手术加放疗或化疗或免疫治疗相结合的综合治疗可改善预后。     

原发性食管恶性黑色素瘤二例

病例 1 男,62岁.患者进行性吞咽障碍伴哽噎、胸骨后疼痛1个月,行上消化道X线钡餐检查示:食管下段可见一4 cm×4 cm的充盈缺损,伴桥行黏膜,病灶表面可见龛影,食管下段有占位性病变.胃镜检查示:距门齿34～37 cm处食管前壁见一肿物,表面有结节状突入腔内,占据近食管半边.病理检查提示:食管低分化恶性肿瘤.于2007年8月21日,在全身麻醉下行食管下段恶性肿瘤根治术,术中探及食管下段肿块,长约4.0 cm,食管旁见大小为0.5 cm×0.5 cm的淋巴结数枚,质韧.切下肿块后,食管内有一3.5 cm×2.5 cm×2.5 cm息肉样物突入食管腔.术后病理检查示:食管恶性黑色素瘤已侵入肌层,食管旁6枚淋巴结均未见肿瘤细胞转移.     

肛管直肠恶性黑色素瘤34例治疗与预后分析

目的探讨肛管直肠恶性黑色素瘤（ARMM）的预后影响因素。方法回顾性分析1993年3月至2011年11月问解放军总医院收治的34例肛管直肠恶性黑色素瘤患者的临床资料．分析临床病理因素与预后的关系。并采用Cox比例风险模型进行多因素预后分析。结果34例ARMM患者中,26例行腹会阴联合切除手术（APR）,8例行局部扩大切除术（wLE）;术后行辅助治疗者20例,其中化疗14例,放疗2例。中医中药治疗4例,免疫治疗16例。术后均接受随访,中位随访时间27个月。1、3和5年的总生存率分别为76.3％、39．6％和20．6％,1、3和5年的无病生存率分别为60．6％、30-8％和12．8％。APR和WLE术后局部复发率分别为0（0／26）和5／8,行和未行术后免疫治疗者局部复发率分别为0（0／16）和27．8％（5／18）,差异均有统计学意义（均P〈0．05）。单因素预后分析显示,肿瘤大体分型、浸润程度、淋巴结转移和临床分期与术后总体生存有关,淋巴结转移、术后免疫治疗和辅助治疗与术后无病生存有关（均P〈0．05）。多因素预后分析显示,肿瘤浸润程度和临床分期是术后总体生存的独立预后因素（均P〈0．05）,而术后无病生存的独立预后因素未获证实（均P〉0．05）。结论合理选择手术方式和术后免疫治疗是提高ARMM患者治疗效果的关键。     

异位甲状腺癌的诊断和治疗

目的　探讨异位甲状腺癌的发病特点、诊断和治疗方法。方法　对 2 9例异位甲状腺癌的临床及病理资料进行回顾性分析。结果　 2 9例均行手术治疗 ,术后辅以放、化疗。术后随访 ,5年存活率为 5 2 .0 % ,最长 1例已存活 2 4年。结论　早期发现并及时手术治疗是提高异位甲状腺癌患者生存率的关键 ,术后给予辅助性放、化疗有助于提高生存率。     

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.     

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.     

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.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.