脑状态指数在七氟醚或丙泊酚诱导时的变化

目的 观察七氟醚或丙泊酚麻醉时脑状态指数(CSI)的变化.方法 30例腹腔镜手术患者随机均分成七氟醚组(S组)和丙泊酚组(P组).麻醉诱导:S组吸入2%的七氟醚,每隔1分钟增加1%;P组每隔1分钟重复给予15 mg丙泊酚,直至患者意识消失.记录患者诱导期的CSI数值,并对患者的镇静程度采用警觉/镇静评分(OAA/S)标准评分.结果 S组与P组术前CSI基础值差异无统计学意义,随着麻醉的加深,两组的CSI数值均明显下降(P<0.01),至OAA/S 1分时S组与P组的CSI数值较OAA/S 5分时明显下降(P<0.05或P<0.01),S组与P组的CSI与OAA/S的相关系数r分别为0.843和0.812.结论 CSI监测可反映七氟醚或丙泊酚麻醉时的麻醉深度.     

术毕应用芬太尼对丙泊酚-雷米芬太尼麻醉恢复的影响

目的探讨术毕应用芬太尼对丙泊酚-雷米芬太尼麻醉恢复的影响。方法45例实施腹腔镜胆囊切除术患者随机均分成F1、F1.5和F2三组,手术结束前10min分别给予芬太尼1、1.5和2μg/kg,评定拔管后疼痛和镇静程度,记录呼吸恢复、意识恢复和拔管时间以及拔管后的不良事件。结果F2组的VAS显著低于F1、F1.5组[(0.2±0.4)分vs.(2.1±1.2)分和(1.2±1.2)分](P<0.05);F2组Ramsay评分显著高于F1和F1.5组[(4.5±0.5)分vs.(3.1±0.3)分和(3.2±0.6)分](P<0.01)。F2组的呼吸恢复、意识恢复和拔管时间分别为(21.5±0.5)min,(19.5±1.5)min和(24.0±2.1)min,显著延长于F1组的(10.9±3.1)min,(12.2±3.1)min和(15.2±4.8)min和F1.5组的(11.9±3.2)min,(14.3±4.4)min和(16.7±4.5)min(P<0.01)。结论在腹腔镜胆囊切除术手术结束前10min应用1或1.5μg/kg芬太尼可减轻雷米芬太尼停药后的疼痛反应,但不显著延长苏醒和拔管时间。     

舒芬太尼或芬太尼复合丙泊酚对喉显微手术血流动力学和应激反应的影响

目的 比较芬太尼复合丙泊酚与舒芬太尼复合丙泊酚用于喉显微手术患者的血流动力学和应激激素变化.方法 200例患者行支撑喉镜下声带手术,患者随机均分为芬太尼复合丙泊酚组(F组)和舒芬太尼复合丙泊酚组(S组).F组、S组分别静脉注射芬太尼3.0μg/kg或舒芬太尼0.3μg/kg、丙泊酚2.0mg/kg、琥珀胆碱1.5mg/kg实施麻醉诱导.记录和测定两组诱导前(T0)、插管即刻(T1)、插管后1min(T2)、置支撑喉镜后1min(T3)及拔管后1min(T6)的SBP、DBP、HR、去甲肾上腺素(NE)、皮质醇(Cor)、血糖(Glu)的变化和丙泊酚用量、麻醉恢复情况及不良反应.结果 F组T1、T2、T3时SBP、DBP高于、HR快于T0和S组(P<0.05).F组T1～T3时NE、Cor、Glu分别显著高于T0和S组(P<0.05).术中丙泊酚追加量和总用药量F组显著高于S组(P<0.05),麻醉恢复时间S组稍长于F组,但差异无统计学意义.结论 舒芬太尼复合丙泊酚麻醉对血流动力学和应激反应影响小,是喉显微手术中比较理想的麻醉配伍组合.     

依托咪酯和丙泊酚对罗库溴铵插管条件和起效时间的影响

目的 比较依托咪酯和丙泊酚对罗库溴铵插管条件和起效时间的影响。方法 60例ASA Ⅰ～Ⅱ级拟行择期上腹部手术的病人,随机均分为依托咪酯诱导组(E组)和丙泊酚诱导组(P组)。两组术前及其他术中用药相同,采用TOF-WATCH加速度仪监测肌松,并记录诱导前后的血压、心率。结果两组的插管条件无显著性差异(P>0.05)。E组的起效时间明显快于P组(P<0.05),P组诱导后的MAP明显低于E组(P<0.05)。结论 依托咪酯和丙泊酚均可提高罗库溴铵的插管条件。相对于丙泊酚,依托咪酯可缩短罗库溴铵的起效时间。     

Measurement of axial edge lift of rigid corneal lenses*

A simple but reliable method was used to measure the axial edge lift at the total diameter over a range of back optic zone radii of several proprietary designs of rigid gas-permeable corneal lens. One of these was found to have a constant axial edge lift construction.     

Phenotypic and Genotypic Lineage Switch of a Lymphoma with Shared Chromosome Translocation and T-Cell Receptor γ Gene Rearrangement

A case of non-Hodgkin's lymphoma showed a phenotypic and genotypic cell lineage switch twice during nine years of his clinical history; first, T-cell type, pleomorphic small cell lymphoma developed, followed by B-cell type, diffuse centroblastic/centrocytic lymphoma, and finally T-zone lymphoma without follicles again developed, from which AST-1 cultured cell line was established. Karyotype analysis demonstrated a shared abnormal chromosome, der(1)t(1;?)(p36;?), among the first relapsed B-cell tumor, the second relapsed T-cell tumor and AST-1 cell line. Furthermore, T-cell receptor (TCR) γ gene rearrangement bands of the same size were observed in the first relapsed B-cell tumor and the second relapsed T-cell tumor as well as AST-1 cell line. These results suggested that both relapsed tumors of different cell lineages are derived from a common malignant clone, presumably a committed lymphoid stem cell. A unique translocation, t(2;14)(q37;q11.2), which may involve TCR δ/α gene complex, was observed in the second relapsed tumor and AST-1 cells. To attempt to isolate the breakpoint of this translocation, the configuration of TCR δ/α gene complex was studied. The result showed that two rearrangements of TCR α gene detected with J_α probes were the products of the normal TCR rearrangement process, and were not involved in the translocation at this region. This patient, together with the AST-1 cell line, provided us a unique opportunity to study the development and clonal evolution of malignant lymphoma.     

Determinants of plasma concentrations of nicotine and cotinine during cigarette smoking and transdermal nicotine treatment

Objective: Interindividual variability in plasma concentrations of nicotine and its proximate metabolite, cotinine, is considerable during smoking and transdermal nicotine treatment, even among individuals taking in nominally similar doses of nicotine. This report explores the determinants of this variability and the utility of baseline (smoking) plasma concentrations to predict concentrations during transdermal nicotine treatment. Methods: Data were analysed from a smoking cessation study (n = 466), and from a pharmacokinetic study (n = 12). Multiple regression models examined the relationships of plasma concentrations to individual characteristics such as smoking pattern, absorbed dose of nicotine, and pharmacokinetic parameters. Results: Plasma concentrations of nicotine and cotinine were highly variable in both studies. Indirect estimates of plasma clearance (baseline plasma concentration divided by cigarettes per day) together with other factors could account for 18 to 33% of the variability during transdermal nicotine treatment in the smoking cessation study. In contrast, 75 to 99% was accounted for by direct measurements of plasma clearances and systemic dose of nicotine in the pharmacokinetic study. Conclusion: Plasma concentrations of nicotine and cotinine during transdermal nicotine treatment are poorly predicted by clinical history or baseline plasma concentrations. This is a result of inadequate characterisation of highly variable individual pharmacokinetic parameters and absorbed dose of nicotine. Considering the interindividual variability of plasma nicotine and cotinine concentrations together with the lack of clinical end-points for transdermal nicotine dosing, it seems logical to investigate the utility of a therapeutic drug monitoring approach for transdermal nicotine treatment – particularly for high dose regimens (> 22 mg per 24 hours). Received: 7 May 1996 / Accepted in revised form: 21 August 1996     

MANAGEMENT OF SEMINOMA OF THE TESTIS: RECOMMENDATIONS BASED ON TREATMENT RESULTS

Background : The results of management of seminoma of the testis at the Department of Radiation Oncology St Vincent's Hospital, Sydney were evaluated retrospectively to: (i) establish that outcomes were in keeping with published results from centres in Australia and overseas; (ii) assess the impact of chemotherapy on management; and (iii) to determine ‘best practice’ management protocols based on our results and a review of the relevant literature. Methods : (i) Assessment of treatment results for stage I and II seminoma of the testis treated by post-orchidectomy radiotherapy and/or chemotherapy at St Vincent's Hospital between 1979 and 1993; (ii) literature review of published data from Australian and overseas centres on the management of seminoma of the testis, and in particular the use of surveillance or chemotherapy either alone, at time of relapse or combined with radiotherapy; and (iii) development of recommendations for use as management protocols in our department. Results : Our data and a review of the literature suggest that post-orchidectomy radiotherapy with chemotherapy for relapse in stage I and IIA disease results in long-term cure rates approaching 100%. Treatment with chemotherapy either routinely or selectively or using a surveillance policy is unlikely to show any improvement in outcome and may be less cost-effective and/or produce increased morbidity and the risk of secondary leukaemia. For stage IIB disease (5–10 cm) the use of initial combination chemotherapy with or without subsequent radiotherapy did not appear to give better outcomes than initial radical radiotherapy alone, reserving chemotherapy or further radiotherapy for relapse. For bulkier stage IIB disease (> 10cm). the use of initial chemotherapy plus consolidation radiotherapy appeared to be an appropriate treatment. Conclusions : Management protocols for seminoma of the testis at St Vincent's Hospital, Sydney Department of Radiation Oncology currently are (i) stage I, IA and IIB (5–10 cm): post-orchidectomy radiotherapy alone with chemotherapy or further radiotherapy for relapse; and (ii) stage IIB (> 10 cm) disease: initial chemotherapy post-orchidectomy followed by radiotherapy to sites of initial disease involvement.     

异丙酚在无抽搐电休克治疗麻醉中的应用

目的 :研究异丙酚在无抽搐电休克治疗 (MECT)麻醉中的应用效果及安全性。方法 :34例首次住院的精神分裂症患者随机分为异丙酚组和硫喷妥钠组 ,每组 17例 ,每例完成 1个疗程 6次MECT治疗 ,每组完成 10 2人次治疗 (n =10 2 )。每次治疗时 ,异丙酚组给予异丙酚静脉麻醉 ,硫喷妥钠组给予硫喷妥钠静脉麻醉 ,全麻诱导后皆静注琥珀酰胆碱 ,待肌肉松弛后行MECT治疗。全程监测患者心电图、血氧饱和度、血压、心率、脉搏 ,并观察记录自主呼吸恢复时间。苏醒时间和不良反应 ,进行前瞻性研究。结果 :与硫喷妥钠组相比 ,异丙酚组自主呼吸恢复快 ,苏醒快 ,无咳嗽 ,呃逆 ,呕吐等不良反应 ,两组差异显著。而异丙酚组注射点疼痛发生率显著高于硫喷妥钠组。结论 :在MECT中应用异丙酚静脉麻醉是一种更安全、有效的方法。