Recognition and management of phaeochromocytoma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in preoperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before, during and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

哈乐在良性前列腺增生伴急性尿潴留中的应用

目的 :探讨α1A肾上腺素能受体阻滞剂哈乐 (tamsulosin)对良性前列腺增生 (BPH)伴急性尿潴留病人的治疗作用。方法 :对 72例BPH伴急性尿潴留病人采用随机、对照研究 ,分为治疗组和对照组。病人均行保留导尿 ,口服抗生素治疗。治疗组加用哈乐 0 .4mg ,1次 /d ,连续服用 3次。 72h后拔除导尿管。　结果 :拔除导尿管后 4 4 % (32 / 72 )的病人能自行排尿。有效率治疗组为 6 1% (2 2 / 36 ) ,对照组为 2 8% (10 / 36 ) ,两组比较差异有显著性 (P <0 .0 1)。　结论 :对BPH伴急性尿潴留应用哈乐治疗 ,可提高早期拔除导尿管后病人自行排尿的成功率 ,且疗效与前列腺体积大小无关。     

α核素非均匀微观分布对细胞微剂量的影响

目的探讨放射免疫治疗中α核素在细胞水平上非均匀微观分布对细胞S因子的影响。方法利用蒙特卡罗方法随机模拟α粒子的发射;基于连续慢化近似模型,根据α粒子剩余射程-能量的关系,采用插值法计算α粒子入射动能和出射动能,得到其在靶区内的能量沉积。以213Po为例,计算了不同细胞大小及核素不同微观分布（均匀分布、中心分布、随核素距细胞中心的距离线性递增、线性递减、指数递增、指数递减）下细胞对细胞的S因子。结果213Po均匀分布下的S（C←C）与Hamacher给出的结果符合得很好;不同微分布下的S（C←C）有显著差别。分析表明,核素不同微观分布所造成的α粒子在靶区内运动的平均弦长的显著变化,以及由此产生的α粒子平均碰撞阻止本领的变化,是造成细胞S因子有显著差别的主要原因。结论放射性核素非均匀微分布类型显著影响细胞S因子的大小,在估算细胞吸收剂量时应予以重视。     

Lung function, smoking and survival in severe alpha 1-antitrypsin deficiency, PiZZ

Lung function, smoking, age and mortality data in 158 adult severe alpha₁-antitrypsin deficient, PiZZ individuals, followed from 1963 to 1982 were analyzed. Low initial FEV₁ value was significantly associated with increased mortality (p < 0.005). A 3 yr mortality rate of 40% was found in individuals whose initial FEV₁ values were less than 30% of that predicted. In contrast, the corresponding 3-yr mortality among those whose initial FEV₁ values were between 30 and 65% of that predicted was only 7%. Smokers were found to have significantly lower FEV₁ levels (p = 0.008) and higher mortality (p < 0.005) than non-smokers. The difference between current and ex-smokers in mortality and FEV₁ level were not statistically significant (p = 0.9 and p>0.25, respectively). Cross-sectional analysis of the initial FEV₁ values indicated a significant decline (p < 0.005) of FEV₁ with increasing age. This decline was greater among smokers than non-smokers. Longitudinal analysis of FEV₁ rates of decline in 80 cases with follow-up FEV₁ measurements failed to detect any significant differences between smokers and non-smokers, but was performed late in the disease process. The application of these results to the planning of studies on replacement therapy, smoking intervention strategy and longitudinal follow-up is discussed.     

原发性肝细胞癌患者血清AFP,CEA和CA50的研究

为研究原发性肝细胞癌(PHC)血清一些肿瘤标志的变化及临床意义,本文用放射免疫法测定PHC31例,非胰岛素依赖性糖尿病(NIDDM)24例患者血清甲胎蛋白(AFP)、癌胚抗原(CEA)和糖类抗原50(CA50)含量,并以23例正常人作对照,同时测定一些相关指标。PHC肿瘤大小用B超确定,个别患者用CT确定。结果PHC患者血清AFP(332.8±126.11对10.75±5.47ng/L),CA50(42.85±19.28对20.94±6.20U/ml),均明显高于正常对照(P<0.01),AFP升高与CA50呈正相关,而AFP和CA50含量与PHC的肿瘤大小也呈正相关(P<0.05),但与Child分级无关(P>0.05)。AFP阳性例数29例,敏感性93％,特异性87％,正确性88％。CA50阳性18例分别为58％、78％和76％。NIDDM患者仅CA50升高(25.22±5.16U/ml,P<0.05),且与血糖浓度(11.65±1.94mmol/L)无关(P>0.05)。研究提示联合测定血清AFP、CA50对诊断PHC是敏感、特异而正确的。     

Cerebrospinal fluid-filtration reduces TNF alpha in bacterial meningitis-CSF

A 37 year old male was admitted with the diagnosis of bacterial meningitis. Pneumococci were seen in the Gram stain of the cerebrospinal fluid. The clinical condition did not suggest severely raised intracranial pressure, there were no localizing signs and symptoms. CSF was turpid, with 20.100/3/mm³, mainly polymorphonuclear cells. Tumor necrosis factor alpha in CSp was greatly increased with 813 pg/ml. Parallel to the application of intravenous Penicillin G a CSF filtration was carried out. Within 214 h 225 ml CSF were filtrated through a Pall-filter, using a bidirectional pump. Cell count dropped to 720/3 cells/mm³, TNF-alpha to 39 pg/ml. The clinical course was uneventful, on day 12 the patient could be discharged without sequelae. CSF filtration may be a highly effective method to reduce from the CSF pathogenetically important cytokines, such as TNF-alpha, being responsible for intrathecal/meningeal inflammatory processes and triggered by cell-wall components of bacteria, e.g. pneumococci.     

Trichloroethanol is not a metabolite of alpha chloralose

Head space capillary gas chromatography was used to detect alpha chloralose and its potent metabolite, trichloroethanol in clinical and forensic cases. Although alpha chloralose was identified in blood and urine in all cases, trichloroethanol was never detected. In a fatal case the alpha chloralose concentration in blood was 151.3 mg/l. It was concluded that trichloroethanol is not a metabolite of alpha chloralose.     

A method for reducing background tracks in plastic detectors

The purpose of the present study was to reduce background tracks by removing a given surface layer of the 250 μm thick lexan polycarbonate foils before exposure to alpha particles. Ethylenediamine solution was used for taking layers from the surface of the foils.