水飞蓟宾构象的理论研究

目的 水飞蓟宾RRRR对映体分子中存在多个可变的二面角，可以产生许多立体构象，旨在从理论上寻找其合理构象。方法 采用二面角系统搜索后，结合AM1方法确定主要构象，以B3LYP／6—31G*方法优化构型后，在B3LYP／3—21G水平计算了振动频率和热力学参数。结果 得到了各二面角的分布情况，找出了主要的局部构象，明确了C9-C11和C18-C22旋转主要引起分子构象变化，4种主要构象能量差异较小，都有存在的可能性，二面角C19-C18-C22-C32和C8-C9-C11-C16变化的能量曲线表明，C9-C11旋转的能垒很小，受C19的羟甲基影响，C18-C22旋转能垒较大。结论 水飞蓟宾RRRR对映体主要以4种构象的形式存在。     

综合治疗尖锐湿疣200例临床疗效观察

目的:观察局部冶疗加口服中药对尖锐湿疣的治疗效果。方法:将200例病人按随机分组法分成治疗组及对照 组,治疗组采用局部治疗加口服中药的方法治疗,对照组仅采用局部治疗方法,治疗期为3个月,随访半年。结果:在治疗尖锐 湿疣方面治疗组有效率为86.6％,对照组有效率为57.89％,治疗组疗效明显优于对照组(P<0.05);治疗组复发率(24.74%) 明显低于对照组(42.11%)。结论:采用局部治疗加口服中药的方法治疗尖锐湿疣效果明显,其复发率显著降低。     

丁卡因凝胶剂的研制与药效测定

 目的：研究各种透皮促进剂对丁卡因经皮渗透的影响，找出一种起效时间较短的丁卡因凝胶剂。方法：配制不同处方的丁卡因凝胶剂，采用Franz扩散小池，HPLC检测药物浓度进行离体皮肤渗透实验，然后采用针刺法进行在体药效测定。结果：月桂氮酮使丁卡因透皮速率提高，但滞后时间延长，在体麻醉效果不佳；单用乙醇不延长滞后时间，在体麻醉起效时间缩短。结论：含乙醇的丁卡因凝胶剂局麻效果最好，可以开发利用。     

Seven-year survivor with malignant melanoma of the anus without radical surgery

We report a case of a long-term survivor with malignant melanoma of the anus who did not undergo radical surgery. A 71-year-old woman who presented with anal bleeding and anal tumor underwent an excisional biopsy in September 1985. The biopsy specimen was a lobulated, polypoid, pigmented mass 2 cm in diameter, that had been located on the anterior wall of the anus. A satellite nodule 7 mm in diameter was found on the left wall of the anus at the level of the dentate line. Both tumors were histologically diagnosed as malignant melanoma. The primary tumor was 6 mm thick. Melanoma cells were present microscopically at the cut end of the rectum. Because of her history of ischemic heart disease, the patient rejected our recommendation that she undergo radical surgery, and received 10 courses of carboplatin 20 mg intramuscularly and OK-432 10 K.E. (Klinische Einheit) intradermally every week. A single, pigmented metastatic inguinal lymph node developed and was excised in June 1987. A recurrent tumor was detected in the rectum in October 1992, so again we recommended radical surgery. The patient rejected radical surgery again, and received 12 courses of carboplatin 10 mg intramuscularly every 2 weeks. She died of disease at home in July 1993 after surviving for 7 years and 10 months. An autopsy was not performed. This case shows that local excision of the primary lesion may be appropriate to preserve the quality of life of patients with early-stage malignant melanoma of the anus.     

Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer

Purposes: The study evaluates prognostic factors for dissemination and survival in patients with local or regional recurrence of breast cancer. Furthermore, the aim was to define subgroups of patients at different risk of developing metastases in specific anatomical sites. Patients and methods: The study included 140 patients with isolated local or regional node recurrence, who entered a prospective study for staging of patients with first recurrence of breast cancer in the period 1983–85. The primary treatment was a simple mastectomy; node positive patients received adjuvant radiotherapy and chemotherapy or tamoxifen.If possible, the locoregional recurrence was treated with surgery and/or radiotherapy, otherwise by systemic therapy. Results: Median follow up was 10.4 years; 78 patients developed distant metastases (soft tissue, 32%; bone, 45%; viscera 40%). Median time to dissemination was 4.4 years, and the ten year dissemination rate was 72%. Median time to dissemination was 3.7 years for patients with recurrence in the regional nodes compared to 6.5 years for patients with chest wall recurrence only, p = 0.05. No specific time sequence (temporal pattern) was observed in the anatomical distribution of metastases, and the anatomical site of recurrence could not be predicted by any of the prognostic factors. At follow up, 93 patients had died. The median survival was 5.6 years and 30% were alive after 10 years. Forty-three of the 99 patients who received local therapy only did not develop metastases. Fifteen of these patients died without evidence of metastatic disease while 28 patients were still alive without distant recurrence after a median follow up time of 9.3 years (range, 6.5–11.9 years). Level of LDH and the number of positive regional nodes (NPOS) at primary diagnosis were significant independent prognostic factors for survival after recurrence. Conclusions: Approximately one third of the patients receiving local treatment only, were alive and without distant metastases up to ten years after locoregional recurrence, indicating that there is a subset of patients which may be long term survivors after local treatment only (surgery or radiotherapy). The duration of survival can be estimated by LDH and NPOS, but the model needs validation in a separate data set before clinical use.     

灯盏花治疗椎-基底动脉缺血性眩晕64例

灯盏花治疗椎－基底动脉缺血性眩晕６４例吕云利，傅学锋，姚向荣，廖军，路逵自１９９５年１１月～１９９６年７月，我们用云南灯盏花注射液治疗椎一基底动脉缺血性眩晕（ＶＢＩＶ），并与传统中药丹参注射液作对照观察，疗效满意，报告如下。临床资料诊断接文献（中风与...     

Is local anaesthesia actually beneficial in flexible fibreoptic nasendoscopy?

Although the application of a topical local anaesthetic before fibreoptic nasendoscopy is routine practice in many otolaryngological outpatients, the actual benefit to the patient of this procedure remains in doubt. Eighty-two patients were recruited in this double-blind randomized control trial which compared the patients’ experiences of fibreoptic nasendoscopy with nasal preparations of Xylocaine^® (lidocaine), normal saline, and no spray to the nose and throat. A visual analogue scoring system was used to determine scores for the overall unpleasantness of procedure, receiving a spray, and taste of the spray, and pain. This study has shown significantly worse overall experience (P = 0.001) and pain (P = 0.048) scores for Xylocaine^® spray versus no spray. It is concluded that the routine use of topical local anaesthetics within the nose before routine fibreoptic nasendoscopy is not only of no value, but actually makes the experience worse for the patient.     

原发性气管肿瘤的外科治疗

 自1991年6月至1996年11月, 我们对原发性气管肿瘤23例进行手术治疗, 其中良性肿瘤2例, 恶性肿瘤21例, 施行气管节段切除11例, 侧壁切除6例, 气管腔内肿瘤刮除加电灼术6例。 术后无发生气管瘘、无手术死亡。 术后1、3、5年生存率分别是86％、53％和21％。 作者认为应根据气管肿瘤的病理性质, 病变范围和外侵程度, 酌情使用气管节段切除、侧壁切除和肿瘤刮除加电灼术。     

区域注射磷—32玻璃微球对裸鼠移植性人肝细胞癌的形态学影响

目的：研究－３２玻璃微球（３２Ｐ－ＧＭＳ）区域注射对裸鼠移植性人肝细胞癌的形态学影响及其意义。方法：应用光镜、免疫组织化学及电镜观察对照组及治疗组的肿瘤组织学和超微结构特征。结果：对照组中，瘤体长径约３ｃｍ，瘤细胞排列紧密，呈小梁状，富于血窦，约５％瘤细胞坏死。治疗组中，瘤体长径为０．４～２ｃｍ，其中少部分瘤体边缘细胞排列紧密，大部分瘤细胞排列松散，呈网状或假腺样且被纤维血管束分割成巢。４０％～８０％的瘤细胞呈凝固性坏死。７５％以上排列紧密的瘤细胞ＰＣＮＡ阳性，而排列松散的ＰＣＮＡ阳性瘤细胞不足２５％。松散排列的瘤细胞较紧密排列的瘤细胞，桥粒显著减少、细胞变性坏死增多。结论：本研究提示局部内放射３２Ｐ－ＧＭＳ明显具有杀伤癌细胞和抑制肿瘤生长的作用。这为３２Ｐ－ＧＭＳ对肝癌治疗的实验研究和临床应用提供形态学依据。     

18F-FDG符合线路SPECT显像在胃肠道恶性肿瘤术后的应用

目的探讨^18F—FDG符合线路SPECT显像在探测胃肠道恶性肿瘤术后复发和远处转移中的应用价值。方法24例胃肠道恶性肿瘤术后患者，其中食管癌4例，胃癌7例，结肠癌6例，直肠癌7例，运用SIEMENS ECAM^deut SPECT仪进行^18F—FDG显像。结果^18F—FDG显像诊断胃肠道恶性肿瘤术后转移和复发的灵敏度为94．7％，特异性80．0％，准确性91．7％。在^18F—FDG显像真阳性18例中，2例为局部复发，5例为局部复发伴转移，11例为远处转移。在有复发的7例患者中，5例^18F—FDG显像结果与CT检查结果一致，2例CT检查局部未见异常，在有转移的16例患者中，共检出转移灶55处。结论符合线路SPECT仪^18F—FDG显像是检测胃肠道恶性肿瘤术后复发和转移的敏感而有效的方法。