全身(全淋巴)照射后100例医源性急性放射病的临床分析

在造血干细胞移植治疗肿瘤过程中用全身照射（ＴＢＩ）或全淋巴照射（ＴＬＩ）预处理，研究受照不同剂量患者发生医源性急性放射病严重程度，治疗方法和造血恢复及相关合并症。方法１００例患者（白血病９１例，其他肿瘤９例）接受５００～１０００ｃＧｙＴＢＩ或ＴＬＩ和超大剂量化疗作预处理。结果均发生医源性急性放射病，白细胞降至（０～０．１５）×１０９／Ｌ，骨髓空虚，合并各种感染和出血。经造血干细胞移植，抗感染，应用ＧＭ－ＣＳＦ或Ｇ－ＣＳＦ积极支持治疗及保护隔离措施，９２例造血恢复，８例死于不同感染和出血。结论造血干细胞的移植起主要治疗作用，不同造血因子用于治疗急性放射病，可能是一种有希望的方法     

Intra-operative radiation therapy for malignant brain tumours: Rationale,method, and treatment results of cerebral glioblastomas

Summary In radiation therapy for malignant brain tumours, the dose of radiation that can be safely delivered to a tumour is limited by the radiation tolerance of the adjacent normal brain tissue. Among various radiation modalities to produce local tumour eradication without unacceptable complications, we chose a large, single irradiation dose during the operation (intra-operative radiation therapy, IORT). In contrast to X-ray or Cobalt-60 gamma ray irradiation, IORT with a high-energy electron beam delivered by the Shimadzu 20 MeV betatron provides acceptable dose homogeneity with rapid fall-off of the radiation dose beyond the treatment volume. Thus, IORT has the advantage of precise demarcation of the target volume, minimum damage to surrounding normal tissues, and a high absorbed target dose (15–25 Gy in 5–10 min).On the basis of our experience with 170 patients treated by IORT, we established the treatment indications and method in patients with malignant brain tumours. IORT with a dose of 15–25 Gy was delivered to widely resected tumours followed by external radiation therapy. No acute or subacute complications were observed. Treatment results of 30 patients with glioblastoma treated by IORT (mean 18.3 Gy) combined with external radiation therapy (mean 58.5 Gy) resulted in a median survival of 119 weeks and a 2-year survival rate of 61%.Supported by a Research Grant for Cancer (3–46, 4–23) from the Ministry of Health and Welfare, and by a Grant-in-Aid for Scientific Research (03454343) from the Ministry of Education, Science and Culture of Japan.     

The Decline in Serum Albumin after Conversion to High Flux, High Efficiency Dialysis

Abstract: Hypoalbuminemia among chronic hemodialysis patients is recognized as a poor prognostic sign. We observed that many of our chronic patients had a progressive decrease in their plasma albumin concentrations after they were converted to high flux, high efficiency dialysis from conventional dialysis mode. This change occurred in the absence of changes in the KTIV and protein catabolic rate (per) normalized to body mass. When nitrogen losses were measured, we found no difference in the dialysate concentrations of urea, alpha amino nitrogen, uric acid, or total nitrogen when high flux polysulfone was compared with high efficiency Cuprophan. While urea was the predominant nitrogen solute in all dialysate samples, there were some with a large gap between total and urea nitrogen. Alpha amino nitrogen losses, expressed as leucine equivalents, were substantial, ranging from 8. 4 to 9. 8 g/3. 5 h dialysis treatment. We believe that the increased losses of nitrogen experienced by patients after their conversion to a more efficient method of dialysis and not compensated for by a spontaneous increased intake of protein led to the observed fall in plasma albumin. Both urea and amino acid nitrogen losses need to be accounted for when achievement of higher KTIV dialysis is pursued.     

羊膜负载骨髓间充质干细胞与表皮细胞对放创性皮肤损伤促愈合研究

目的探讨治疗放创性全厚皮肤缺损创面的方法及效果. 方法贵州小香猪8只,每只背部脊柱两侧均有放创性全层皮肤缺损圆形创面(Ф3.67cm)各3个,共48个创面.将经处理的人羊膜(human amniotic mambrane, HAM)分别负载自体骨髓间充质干细胞(mesenchymal stem cells, MSCs)和表皮细胞,移植到其左侧24个创面作为实验组(A组);以单纯无种植细胞的HAM敷盖其右侧前16个创面(B组);以单纯油纱布敷盖其右侧后8个创面(C组).B、C作为对照组.观察移植后1～3周内各组创面愈合、肉芽组织生长及上皮化等情况,并进行创面组织HE染色及vWF免疫组织化学检测.用图像分析法测算各组各时间点创面平均面积(cm2),并计算其愈合百分率. 结果 C组于伤后 22～23天愈合,B组于伤后19～21天愈合;A组于伤后15～17天愈合,较B、C组分别提前6～7天和5～6天,愈合质量好.移植15～17天,A组与B、C组创面平均残留面积及愈合面积百分率比较,差异有统计学意义(P＜0.01). A组创面的新生上皮已完全覆盖整个创面,肉芽组织生长旺盛,肉芽组织中vWF、成纤维细胞和毛细血管含量丰富,可见胶原沉积;B、C组创面仍见许多炎性细胞浸润,肉芽组织中vWF、成纤维细胞和毛细血管含量少,胶原沉积不明显. 结论 HAM负载自体MSCs和表皮细胞植入对放创性全厚皮肤缺损创面有较好的促愈合作用,愈合质量较高.     

脊髓前动脉损伤致脊髓缺血性损伤模型的MRI评价

目的：研究经脊髓前动脉损伤，致脊髓缺血性损伤模型的高场强MRI信号表现特征。方法：选用12只家犬经颈前手术入路，切断脊髓前动脉，经高场强MRI扫描，对照病理分析脊髓前动脉损伤后脊髓的MRI信号变化特征。结果：脊髓前动脉损伤后脊髓MRI表现出异常T2WI高信号，且出现在脊髓前动脉损伤节段的前2／3，多表现为一例受累及或偏向一例。结论：MRI能确定脊髓缺血性损伤的部位及信号特征。     

High-dose contrast-enhanced computed tomography (CECT) with iopamidol in the detection of cerebral metastases

Summary Intravenously admistered iodinated contrast media have been demostrated, since early experience with computed tomography of the brain, to improve clinical value of the procedure for detecting intracranial lesions. There is no universal agreement about the amount and the method of administration of the contrast medium. Many authors maintain that the use of large doses gives better results for the diagnosis of tumors and metastases. The purpose of this paper is to evaluate the tolerance of iopamidol administered by rapid intravenous infusion in a large number of patients undergoing contrast enhanced computed tomography to detect brain metastases. The authors examined 969 consecutive adult patients suffering from lung cancer, brain metastases have been detected in 17% of cases. Adverse reactions to contrast media occurred in 3 patients. Non ionic contrast media are recommended in this diagnostic procedure.     

High-frequency ventilation (HFV) in hyaline membrane disease —a preliminary report

Eight premature babies affected by hyaline membrane disease and needing mechanical respiratory support were ventilated by means of a VDR 1 (Bird Space Technology) respirator at 10 Hz during a mean time of 51 h. Before HFV 7 infants had been on conventional mechanical ventilation (CMV) and one on nasal CPAP. The values of mean airway pressure (MAP) and oxygenation index (PaO₂/FIO₂) on CMV and HFV were (mean and range): 1. CMV: MAP 15 (4–29) mm Hg, ox. index 15.47 (5.07–23.19) kPa; 2. HFV after 1 h: MAP 15 (10–19) mm Hg, ox. index 24.13 (9.07–46.12) kPa. Improved oxygenation allowed rapid reduction of FIO₂ in the following hours. Only 3 infants were weaned directly from VDR 1, 5 were switched back to CMV mainly because of technical failures of the respirator. The change from HFV to CMV was associated with a fall of PaO₂/FIO₂ from 35.99 (15.86–74.52) to 22.39 (7.33–31.46) kPa. The mean time of artificial ventilation (CMV+HFV) was 121 h (range 46–166). Except for 1 pneumothorax no medical complications were seen during HFV, and all patients survived. Despite impressive improvements in oxygenation it is cautioned against the use of the VDR 1 because of the high incidence of technical problems.     

高肺容积部分平均通过时间的测定方法和临床意义

介绍了用力呼气肺量图高肺容积部分平均通过时间(MTTp-h)的测定方法,并对100例正常人和94例气道阻塞疾病(支气管肺癌、喉癌和慢性支气管炎)患者进行了测定。初步认为MTTp-h对检测大气道和上气道阻塞敏感性较高,可作为协助临床诊断的实验室指标。     

Route of lymphocyte migration through the high endothelial venule (HEV) in human palatine tonsil

Eleven palatine tonsils were collected from subjects who underwent tonsillectomy in Christian Medical College Hospital and the route of migration of lymphocytes through the high endothelial vessel was studied under EM. In the interendothelial route, migration of a lymphocyte through HEV wall began with the adhesion of a lymphocyte to the surface of endothelial cells by means of a short cytoplasmic projection in the vicinity of intercellular space. The projection extended into the cleft between adjacent endothelial cells. The lymphocyte migrated through HEV by diapedesis. After the lymphocyte had traversed the interendothelial space, it occupied the subendothelial space. In the transendothelial route, migration of a lymphocyte through HEV was initiated by adherence of the lymphocyte to the endothelial cell. The adherent lymphocyte compressed or invaginated into the cytoplasm of the endothelial cell, entered the endothelial cell, was completely enclosed within the endothelial cell cytoplasm, and emerged from the endothelial cell to occupy the subendothelial space. Evidence is presented from static transmission electron microscopic pictures for the migration of lymphocytes by both interendothelial and transendothelial routes through the high endothelial venule.     

淋巴细胞亚群微核表达的辐射效应研究

简述了淋巴细胞亚群微核检测方法、淋巴细胞亚群自发微核率和影响因素，以及关于电脑射效应的研究现状，为微核法用于辐射生物剂的未来发展提供了有益信息。