胰肾联合移植手术方式的选择

目的：探讨胰肾联合移植的手术方式及移植疗效。方法：10例I型糖尿病合并尿毒症患者施行了胰肾联合移植,最初2例为胰液膀胱引流（BD）术式,另8例为改进的胰液空肠引流（ED）术式。BD术式为移植物十二指肠的侧面与膀胱右侧壁作双层吻合;ED术式为移植物十二指肠的侧面与受者空肠作侧－侧吻合（不作Roux-en-Y)。术后早期采用皮质激素＋霉酚酸酯（MMF）＋他克莫司（FK506）＋抗淋巴细胞球蛋白（ALG）或赛尼哌四联诱导治疗,以后改为三联维持。结果：10例胰肾联合移植手术均获得成功,移植胰和移植肾功能术后1－5d恢复正常,停用胰岛素。术后未发生排斥反应和血栓形成,1例死于消化道出血和败血症,死亡时胰肾功能良好,其余9例均无其它外科并发症。随访3－27个月,目前移植胰和移植肾功能均正常,一般情况良好。2例BD术式患者术后长期伴有镜下血尿,其中1例发生2次反流性移植物胰腺炎和肉眼血尿,经保守治疗好转。结论：BD术式与改进的ED术式（不作Roux-en-Y吻合）均安全、可行,是治疗I型糖尿病并发尿毒症的有效方法;ED术式更符合患者生理功能,远期并发症,优于BD术式,可作为首选术式。     

肾茶对尿路结石的治疗作用

目的 评价肾茶治疗尿路结石的疗效。方法 小鼠随机分为肾茶治疗组和对照组。家兔做为输尿管动作电位改变的动物模型。临床上观察６６例尿路结石患者使用肾茶治疗疗效,６０例患者作为对照组。结果 肾茶在动物急性毒性试验中表明无毒性,家兔输尿管动作电位的频率和幅度增加,有排石利尿、抗菌止血作用。肾茶治疗组痊愈率（８４％）和总有效率与安慰剂组比较差异有非常显著性意义（Ｐ〈０．０１）。能茶是一种治疗尿路结石的无毒副     

Drug-induced acute interstitial nephritis: report of 10 cases.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.     

儿童药源性血尿36例临床分析

目的探讨药源性血尿的诱因、临床表现及预后。方法将2000-01~2003-12收治的36例药源性血尿的病因、临床表现及治疗等方面归纳总结。结果由头孢类药物引起的占50%,感冒通占19.4%,其他为30.6%。结论提示临床医生要提高对药物引发血尿的认识,尽量少用此类药物或在安全剂量、浓度下使用。     

Agranulocytosis associated with sulphasalazine therapy

A case report of a patient with agranulocytosis associated with sulphasalazine therapy is described. Recovery followed supportive therapy and withdrawal of the drug. Investigations including tests for leucocyte antibodies, the presence of which might have suggested an immunological cause for the drug reaction, were negative; an acetylation study, however, characterized the patient as a ‘slow’ acetylator phenotype, suggesting that the drug reaction was more likely to have been toxic in nature. It is suggested that acetylation studies be performed in patients who have previously shown serious side effects to sulphasalazine to assess the incidence of ‘slow’ acetylators.     

临床药师在导管接触性溶栓联合抗凝治疗急性下肢深静脉血栓的用药分析与药学监护中的作用

目的 探讨临床药师在急性下肢深静脉血栓患者个体化治疗中的作用。 方法 对南京鼓楼医院血管外科2018年8月收治的8例急性下肢深静脉血栓患者的治疗过程进行分析，结合临床药学知识制定导管接触性溶栓及抗凝用药方案，对患者实施全程药学监护。 结果 溶栓治疗期间，患者血浆纤维蛋白原水平呈明显下降趋势，血浆D-二聚体水平呈先升高后降低的趋势，血小板未见明显下降趋势；8例患者在溶栓治疗过程中，2例出现轻微牙龈出血后自行止血，1例出现血尿，停止溶栓治疗后改为口服抗凝药，血尿现象消失。患者预后改善明显，血栓完全溶解，静脉恢复畅通，用药安全得到有效保障。 结论 临床药师在导管接触性溶栓联合抗凝治疗急性下肢深静脉血栓患者的个体化用药监护方面发挥了积极作用。     

Cyclosporine-induced deterioration in patients with AIDS.

Eight patients with AIDS (acquired immune deficiency syndrome) but free of life-threatening infection were treated with the immunosuppressive drug cyclosporine for a mean of 53.9 days. The serum cyclosporine levels were maintained in the desired therapeutic range. All eight patients experienced severe toxic symptoms, which necessitated discontinuation of cyclosporine therapy in six. The serum levels of creatinine, urea and potassium rose during treatment and fell after therapy was stopped. The total leukocyte count, hemoglobin level, platelet count, total T-cell count, and T4- and T8-cell counts all fell markedly during treatment. The total leukocyte count, platelet count, and T4- and T8-cell counts rose after therapy was stopped, but the hemoglobin level remained low. No patient experienced resolution of symptoms during therapy, and the condition of all patients improved after treatment was stopped. The results of this pilot study indicate that cyclosporine does not alleviate, and may worsen, the symptoms and laboratory findings in patients with AIDS.     

Acute pneumonitis caused by inhalation of mercury vapor--report of a case

Two characteristics, volatility and biotransformation, make mercury somewhat unique as environmental toxicant, and make mercury poisoning as one of occupational diseases in the industry. Acute mercury vapor poisoning is a rare event. It often occurs during industrial accident or ignorant experiment. We report a case, a 28-year-old male waterworks technician, who developed dyspnea, cough, chest pain, metallic taste and ache in the whole body three hours after heating approximately 30 ml of liquid mercury during an experiment. Diarrhea with tarry stool occurred the next day. Chest roentgenogram revealed diffuse pulmonary infiltrates similar to pulmonary edema in both lungs, and was complicated by pneumomediastinum and subcutaneous emphysema later. The concentration of mercury in the plasma was over the toxic level. The urinary excretion of mercury greatly exceeded normal value. During hospitalization, the patient's liver and renal function tests were both normal. He was treated with penicillamine, 300 mg every six hours orally for 10 days in addition to a support treatment and oxygen therapy. He was discharged on the 15th hospital day with partial resolution of pulmonary infiltrates and was free of symptom.     

Metabolic Studies on Patients with Resistant Heart Failure Treated by Spironolactone

Metabolic balance studies were carried out on five patients with resistant heart failure treated with spironolactone and other diuretics. Spironolactone alone had little effect. When it was used in a daily dose of 400-600 mg. in combination with hydrochlorothiazide 100 mg. daily, the results were excellent in two patients. One of these was still free of failure after 12 months on combined therapy. In the other patient the serum potassium became elevated after a good diuresis, though on subsequent intermittent therapy with the drug the patient remained well for 12 months. In two other patients administration of spironolactone had to be discontinued because of elevation of the serum potassium before a good diuresis could take place. The fifth patient died.

Spironolactone can be a useful adjunct to the therapy of resistant heart failure, but there appears to be a real danger of causing the serum potassium to rise to toxic levels in patients so treated.

     

与甘露消毒丸相关的泌尿系肿瘤十例分析

目的:探讨与服用甘露消毒丸相关的泌尿系肿瘤患者的临床病理特点.方法:分析长期服用甘露消毒丸并存在泌尿系恶性肿瘤的10例患者的临床病理特点,并比较服药导致的尿毒症患者与同期住院的其他尿毒症患者的肿瘤发生率.结果:10例患者主要表现为反复发作的全程均一性肉眼血尿,病理检查确诊为泌尿系移行上皮细胞癌:7例膀胱癌、2例肾盂癌及1例肾盂输尿管癌,都伴慢性间质性肾炎,9例患者处于尿毒症终末期,1例肾功能正常.服药人群的肿瘤发生率明显高于普通尿毒症组(分别为32.1%和2.6%),差别有高度统计意义(P＜0.001).结论:长期服用甘露消毒丸者泌尿系恶性肿瘤发生率高,可能与其中所含的马兜铃酸成分有关.对存在正常形态血尿的服药患者,尤其是合并慢性间质性肾炎患者,必须高度警惕肿瘤可能.     

小儿血尿75例临床分析

[背景]分析小儿血尿的临床特点.[病例报告]回顾性分析小儿肉眼及镜下血尿75例临床资料,观察显微镜尿涂片染色红细胞形态学变化,鉴别肾性及非肾性血尿.75例小儿血尿中肾性血尿为46例(61.3%),其中急性肾小球肾炎为10例,肾炎型肾病为1例,单纯性血尿为20例,IgA肾病为2例,过敏性紫癜性肾炎为12例,急性肾盂肾炎为1例;非肾性血尿为29例(38.7%),其中尿路感染为6例,特发性高钙尿症为3例,左肾静脉受压综合征为2例,药物性血尿为18例.[讨论]小儿血尿病因复杂,大致分为肾性血尿和非肾性血尿,需早期诊断并治疗.     

大剂量天然维生素C+电磁波联合吉西他滨和顺铂治疗32例蒽环类耐药性晚期乳腺癌

目的：观察大剂量天然维生素C 电磁疗联合吉西他滨(健择)和顺铂(DDP)治疗蒽环类耐药性晚期乳腺癌的疗效与安全性。方法：2001牟11月～2003年11月以本方法治疗蒽环类耐药性晚期乳腺癌32例。健择1200mg／m^2d1、d8静脉滴注DDP 300mg／m^2,d2、3、4同时水化利尿治疗。在化疗前5d开始口服大剂量天然维生素C1．0g tid,同时接受电磁波治疗,每天1次,至化疗结束后。中位化疗周期数3周期(2～4周)。结果：CR2例(6．3％),PR12例(37．5％),总有效率(CR PR)43．8％,中位肿瘤进展时间(TTP)4．5个月。主要毒性反应为恶心、呕吐与骨髓抑制。结论：大剂量天然维生素C 电磁疗联合健择和DDP治疗蒽环类耐药性晚期乳腺癌疗效较好,使用方便,毒副反应轻,是蒽环类耐药性乳腺癌的有效解救治疗方案。     

水化治疗对冠心病合并肾功能不全患者预防造影剂肾病的疗效观察

目的:探讨水化治疗对冠状动脉介入治疗(PCI)患者造影剂肾病(contrast-induced nephropathy,CIN)的防治作用.方法:选择102例接受PCI治疗的患者,随机分为口服水化治疗组与静脉水化治疗组,每组各51例.比较观察两组患者PCI术前,术后第2、3天的血肌酐变化水平.结果:口服水化治疗组与静脉...     

氨氯地平对脑梗死后遗症期的高血压患者颈内动脉血流动力学的影响

目的 研究氨氯地平对脑梗死后遗症期的高血压患者颈内动脉血流动力学的影响.方法 80例脑梗死后遗症期的高血压患者随机分为治疗组和对照组,每组40例.治疗组服用氨氯地平作降血压治疗,对照组不服药.采用彩色多普勒超声仪测定治疗组和对照组颈内动脉的血流动力学指标.结果 治疗1月时、6月时与治疗前比较,治疗组收缩压(SBP),舒张压(DBP)、颈内动脉收缩期峰值流速(PSV)、舒张末期流速(EDV)、波动指数(PI)、血流量(VOLUME)有显著差异.治疗6月时与治疗1月时比较,治疗组SBP、DBP、颈内动脉PSV、EDV、PI、VOLUME有显著差异.治疗组与对照组比较,在1月时、6月时SBP、DBP、颈内动脉PSV、EDV、PI、VOLUME有显著差异.对照组观察起始时、1月时、6月时SBP、DBP、颈内动脉PSV、EDV、PI、VOLUME无显著差异.结论 氨氯地平不仅能降低脑梗死后遗症期高血压患者的血压,而且显著改善颈内动脉血流动力学指标,增加颈内动脉血流量.     

Glomerular Disease Associated with Takayasu Arteritis： 6 Cases Analysis and Review of the Literature

Objective To evaluate the clinical features, renal histopathology and therapeutic response to glucocorticoid and immunosuppressive agents in patients with glomerular disease associated with Takayasu arteritis （TA）. Methods Patients with TA and renal biopsy-confirmed glomerular disease were investigated retrospectively. None of them had renal artery stenosis or occlusive changes.Results Six patients with glomerulopathy, accounting for 3.75% of the 160 TA patients admitted to our hospital at the same period, were analyzed. All of them were females with a mean age of 35.5 ± 10.0 years. Four cases presented with lower extremity edema. Laboratory tests showed that one was nephrotic syndrome, three were nephrotic range proteinuria, and two of them had mild renal dysfunction. The other two patients were asymptomatic microscopic hematuria and proteinuria. Renal pathology revealed mild immunoglobulin A nephropathy in two cases, mild mesangial proliferative glomerulonephritis （GN）, membranoproliferative GN, minimal change disease, and fibrillary GN in one case respectively. Five cases received glucocorticoids and cyclophosphamide therapy. Proteinuria and microscopic hematuria disappeared in 2 to 4 weeks after the initiation of therapy in three cases. The patient with membranoproliferative GN also reached complete remission of proteinuria and recovered renal function 6 months after the treatment. Conclusions TA may induce glomerular disease as a part of its histological spectrum. Apart from ischemic glomerular disease, glomerular disease should be suspected when TA patients have microscopic hematuria or proteinuria, that may be therapeutically responsive to glucocorticoids and immunosuppressive agent in relative early phase.     

ESWL治疗泌尿系结石683例临床分析

目的:探讨体外震波碎石(ESWL)在治疗泌尿系结石中的治疗效果。方法:对1998～2004年在我院行ESWL的683例泌尿系结石患者资料进行总结。结果:596例2月内排净;63例6月内排净;11例未排净;13例无效,无效者在最后一次碎石后1月行开放性手术。ESWL治疗后肉眼血尿456例,镜下血尿71例,2d后消失;肾绞痛29例,经用解痉药得到缓解;“石街”形成3例,经及时对“石街”再次行ESWL治疗后,“石街”顺利排出;13例术后出现发热,其中8例体温在38～38.5℃之间,5例在38.5℃以上,经对症处理后治愈。无肝、肾等重要器官损伤。结论:ESWL是治疗泌尿系结石的有效方法之一。     

5-Fu区域化疗对大肠癌手术后肝转移影响的临床研究

目的 探讨5－FU区域化疗是否可以减少大肠癌手术后肝转移的发生率。方法 1994年4月至1998年7月我们将符合研究标准的117例患进行了研究，手术中按随机分组，治疗组57例，对照组60例。治疗组5－FU 500mg/m2，连续7d，对照组不插管。所有患至少随访4年。结果 门静脉插管化疗的不良反应与全身化疗一样，主要是消化道症状和造血功能抑制，但都较轻微，可以耐受。对照组肝转移13（13／60）例，治疗组肝转移3（3／57）例（X^=5．1，P＜0．05）。结论 大肠癌手术后门静脉插管化疗可减少肝转移的发生率，其不良反应是可以忍受的，它是值得广泛推广的治疗手段。     

Accidental inhalation of mercury vapour: respiratory and toxicologic consequences

Four adults, including a pregnant woman, and three children were admitted to hospital following accidental exposure to mercury vapour produced by heating mercury-gold amalgam. Initial symptoms and signs included a paroxysmal cough, dyspnea, chest pain, tachypnea, nausea, vomiting, fever and leukocytosis. Pulmonary function testing performed on the second day after exposure revealed air-flow obstruction and minor restrictive defects in three patients. The diffusing capacity of the lung for carbon monoxide was reduced in two of these patients. The mean initial blood mercury level (+/- one standard deviation) for the seven patients was 30.8 +/- 1.5 micrograms/dl. A computer analysis showed mercury to behave as a two-compartment system, the compartments having half-lives of 2 and 8 days. The four adults received chelation therapy with D-penicillamine, which did not affect the urinary excretion of mercury. The pregnant woman's infant, born 26 days after exposure, had no detectable clinical abnormalities. The levels of mercury in the blood of the mother and infant at birth and 6 days later were comparable, indicating free transfer of the metal across the placenta.     

VIP方案治疗晚期非小细胞肺癌

采用VIP联合化疗方案治疗晚期复治的非小细胞肺癌24例。结果：CR1例,PR9例,NC9例,PD5例。有效率41．67％（10／24）。毒性反应主要是骨髓抑制及消化道反应。加用Mesna后,全组未出现肉眼血尿。提示VIP方案治疗晚期复治的非小细胞肺癌有较好疗效,值得推广使用。     

Therapeutic management of small cell lung cancer. Fewer toxic reactions with lower chemotherapeutic drug dosages

A treatment protocol for small cell lung cancer used attenuated drug dosages in an attempt to reduce toxic reactions without compromising effectiveness. Treatment consisted of cyclophosphamide, 50 mg orally daily, methotrexate, 1.25 mg orally daily, procarbazine hydrochloride, 50 mg orally daily, and vincristine sulfate, 10 micrograms/kg intravenously weekly, and was continued until relapse or for two years. Patients with limited disease were given concurrent radiation (4,000 to 5,000 rad, using standard fractionation) to the primary lesion and draining nodes. Fifty patients were evaluable for toxic reactions and survival: 22 with limited and 28 with extensive disease. Fifty-four percent of the patients with extensive disease responded; one (4%) had a complete response. Median survival of the patients with extensive disease was 20 weeks. Ninety-five percent of the patients with limited disease responded; 57% had a complete response. Median survival of these patients was 55 weeks; one-year survival was 59%, and 18-month survival was 36%. Three patients have discontinued therapy without relapse for 48, 22, and seven months. One patient remains disease free after undergoing therapy for 84 weeks. There were no treatment-related deaths, and only 4% of patients experienced WBC count nadirs of less than 1,000/cu mm. Patients with limited disease had long-term survivals comparable with those of other more toxic protocols.