周剂量乐沙定联合低剂量5-氟脲嘧啶持续输注治疗消化道恶性肿瘤

目的　观察周剂量乐沙定 (L -OHP)联合低剂量 5 -氟脲嘧啶 (5 -FU)方案持续输注治疗消化道恶性肿瘤的疗效与毒副作用。方法　乐沙定 10 0mg/周 ,加入 5 %GS 5 0 0ml中静脉输注 3小时 ,5 -FU 2 5 0mg/(m2 ·d) ,持续深静脉输注 2 1天。以上方案连用 2周期为 1疗程 ,化疗后休息 1个月评定疗效。结果　全组 16例 ,总有效率 3 6 3 % ,其中CR 1例 ,PR 3例。主要毒性反应为感觉神经毒性。结论　认为周剂量乐沙定联合低剂量 5 -氟脲嘧啶持续输注方案治疗消化道恶性肿瘤是一有效、低毒的方案     

持续静滴小剂量肝素治疗新生儿弥散性血管内凝血的临床研究

目的探讨持续静滴小剂量肝素在弥散性血管内凝血中的疗效和安全性。方法对诊断明确的弥散性血管内凝血的患儿双盲、随机分为治疗Ⅰ组（31例）、Ⅱ组（36例）,两组皆建立专用通道。治疗Ⅰ组给予肝素每次62.5～125 u/kg,每4～6小时一次;治疗Ⅱ组给予持续静滴小剂量肝素每24小时60～90 u/kg,其他治疗两组相同。根据病情每日或隔日复查血常规、网织红细胞、凝血系统、3P试验和D-二聚体以指导治疗,为防止肝素所致的出血,及时加用鱼精蛋白。结果两组在住院时间（天）、肝素应用时间（天）、PC恢复时间、D-二聚体恢复时间、治愈（率%）和死亡（率%）比较,治疗Ⅱ组明显优于治疗Ⅰ组,经t检验,P〈0.001,差异显著。结论持续静滴小剂量肝素在弥散性血管内凝血中疗效肯定,有较高的安全性。     

Intermittent low-dose finasteride is as effective as daily administration for the treatment of hirsute women

In a prospective randomized study 38 women with idiopathic hirsutism or polycystic ovary syndrome (PCOS) received 2.5 mg of finasteride every day or every 3 days. Intermittent low-dose administration of finasteride was as effective as continuous administration in reducing hirsutism score and was accompanied by a lower incidence of side effects.     

Effects of oral and transdermal low-dose estrogen therapy on echocardiographic parameters of cardiac function

OBJECTIVE: To investigate the effects of transdermal 17 beta-estradiol (E(2)) compared with oral unopposed as well as opposed E(2) on echocardiographic parameters of left ventricular (LV) systolic and diastolic function. DESIGN: A prospective, randomized, double-blind, placebo-controlled, multi-center study. SETTING: Gynecologic and cardiologic outpatient departments. PATIENT(S): One hundred fifty-two healthy hysterectomized postmenopausal women. INTERVENTION(S): Participants received daily placebo (n = 49) or transdermal E(2) (50 microg; tE(2) group, n = 33), or oral E(2) (1 mg; oE(2) group, n = 37), or oral E(2) (1 mg) combined with gestodene (25 microg; oE(2)+G group, n = 33) for thirteen 28-day treatment cycles. MAIN OUTCOME MEASURE(S): M-mode, quantitative two-dimensional, and Doppler echocardiographic measurements were performed at baseline and after 1 year. RESULT(S): Compared with placebo, tE(2) and oE(2) showed no statistically significant changes in LV function. oE(2)+G resulted in a statistically significant favorable increase in peak flow velocity, flow velocity integral, and mean acceleration. Furthermore, a favorable decrease was observed in interventricular septum thickness and ejection time. CONCLUSION(S): After 1 year of unopposed E(2), LV function remained unchanged. The oE(2)+G treatment showed a potential beneficial influence on LV systolic function.     

Use of creatinine clearances to monitor the effect of low-dose dopamine in critically ill surgical patients

INTRODUCTION: Despite uncertain evidence of its efficacy, "low-dose dopamine" (2-5 microg/kg/min) has often been used to augment renal perfusion in critically ill surgical patients. The 2-h creatinine clearance (CC) has been shown to be a monitor of renal function in critically ill patients. We therefore studied the use of sequential CC determinations to monitor the effect of low-dose dopamine (LDD) in surgical intensive care unit (SICU) patients. We hypothesized that sequential CC measurements could demonstrate whether individual patients had positive responses in renal function to LDD. METHODS: Data were prospectively collected for patients on LDD in a university SICU. CC were recorded for these patients immediately before and after the institution of LDD or before and after the cessation of LDD. APACHE II scores, gender, urine creatinine, age, blood pressure, heart rate, and urine output (UO) were also recorded for these patients; P < 0.05. RESULTS: Twenty-four pairs of CC values were observed during the study. The mean APACHE II score for the patients was 15.1. In 10 cases after initiation of LDD, the mean CC increased from 52.5 +/- 23.7 ml/min to 68.1 +/- 33.8 ml/min (P = 0.056). UO also increased from 48.0 +/- 27 to 75.9 +/- 49 ml/h (NS). In 14 cases after discontinuation of LDD, CC decreased from 85.6 +/- 36.3 ml/min to 63.6 +/- 45.5 ml/min (P = 0.044) and UO decreased from 105.1 +/- 73.9 to 89.6 +/- 76.7 ml/h (NS). Overall, 13 of the 24 patients had a 25% change or more in CC upon initiation or cessation of LDD. CONCLUSIONS: LDD institution increased CC in individual patients in the SICU population. Because using LDD in the absence of a discernable improvement in renal function is costly and may harbor risks, we recommend following CC in patients on LDD to determine which patients derive benefit from the intervention.     

Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 microg for outpatient knee arthroscopy with tourniquet

BACKGROUND: Combination of local anesthetic and opioid enables the use of less spinal anesthetic and increases the success of anesthesia. Intrathecal opioid does not prolong motor recovery and thus should not delay discharge home. We hypothesized that 3 mg of hyperbaric bupivacaine with 10 microg of fentanyl permits fast-tracking or shorter stay in post anesthesia care unit (PACU), and earlier discharge home, compared with 4 mg of hyperbaric bupivacaine. METHODS: In this double-blind study, 100 outpatients undergoing knee arthroscopy received randomly either 4 mg of bupivacaine (B4) or 3 mg of bupivacaine + 10 microg fentanyl (B3F) intrathecally. The volume of 0.8 ml was injected at the L2/3 interspace over a 2-min period. A lateral decubitus position was maintained for 10 min. The sensory block was recorded by using thermal stimuli, and motor block was assessed according to a modified Bromage scale. Fast-tracking criteria were complete recovery of motor block, sensory block Th12 or lower and stable vital signs. RESULTS: One block (1%) failed. Motor recovery was faster in the B3F group: 60% of the patients recovered in 80 min or less compared with 28% in group B4 (P = 0.002). The PACU-time was shorter: 36 (10-103) vs. 55 (10-140) min, respectively (P = 0.005). Seventeen (B3F) vs. nine patients (B4) could bypass PACU (NS). Time to discharge home was similar in both groups. In the B3F group, 75% of the patients developed pruritus. CONCLUSION: Both solutions produced reliable spinal anesthesia for outpatient knee arthroscopy. The PACU-time was shorter in the bupivacaine-fentanyl group, but both groups reached home-readiness equally.     

Adjuvant interferon-alpha for melanoma revisited: News?from?old?and?new?studies

Currently the data from 12 randomised phase III trials investigatingthe role of interferon-alpha (IFN-2a) in patients with stageII–III high-risk melanoma are available. The most prominentdifferences between these trials concern the dose of IFN-2a, theduration of IFN-2a administration, and the stage of disease. Some ofthese trials have not yet reached maturity, but despite this thepositive results from some immature trials have attracted considerableattention. When only data from mature trials is considered, one mayconclude that the use of high-dose IFN-2a does prolong disease-freesurvival (DFS) but not overall survival (OS). Combined data fromlow-dose IFN-2a trials does not suggest a benefit in either DFS or OS.A trial with intermediate-dose IFN-2a is still immature. Thereforecurrently the routine use of IFN-2a cannot be recommended outside thescope of clinical trials.     

Treatment of myelodysplastic syndromes with retinoic acid and 1 alpha-hydroxy-vitamin D3 in combination with low-dose ara-C is not superior to ara-C alone. Results from a randomized study. The Scandinavian Myelodysplasia Group (SMG)

63 evaluable patients with myelodysplastic syndromes (MDS) and 15 with acute myelogenous leukemia (AML) were randomized between low-dose ara-C (arm A) and low dose ara-C in combination with 13-cis-retinoic acid (13-CRA) and 1 alpha-hydroxy-vitamin D3 (1 alpha D3) (arm B). 69 patients were evaluable and 18 (26.1%) responded to therapy. The addition of 13-CRA and 1 alpha D3 had no positive influence on survival of the patients, remission rates or duration of remissions. 12/27 patients in arm A and 6/29 patients in arm B progressed from MDS to AML during the course of the study (p = 0.0527). Arm B gave significantly more side-effects than arm A (p = 0.005). Therapeutic effects of 13-CRA and 1 alpha D3 on MDS is not supported by this study. However, an inhibiting effect on AML development in some MDS subgroups cannot be excluded.     

低剂量短疗程抗胸腺细胞球蛋白治疗肾移植耐激素排斥反应

目的探讨低剂量、短疗程的抗胸腺细胞球蛋白(ATG)治疗肾移植后早期激素耐受性排斥反应的疗效。方法15例肾移植后早期发生的激素耐受性排斥反应患者给予ATG 1 mg.kg-1.d-1,qod,总疗程4~10 d,观察其排斥反应逆转率、术后6mo内排斥反应再次发生率和感染发生率。结果ATG治疗(3.4±1.5)次后,15例患者中12例逆转(80%),肾功能良好;2例(13.3%)治疗有效,未行肾切除;1例(6.67%)无效,血透维持。术后6 mo内3例(20%)再次发生排斥反应,3例(20%)术后40d内发生肺部感染。随访期内受体存活率100%。结论低剂量、短疗程的ATG治疗能有效地逆转肾移植后早期激素耐受性排斥反应,且减少了感染及严重并发症的发生机会。