异环磷酰胺为主的联合方案治疗晚期复发鼻咽癌

[目的]观察比较异环磷酰胺(IFO)、顺铂(DDP)、5-氟尿嘧啶(5-Fu)联合方案(IPF方案)与DDP,5-Fu(PF方案)治疗晚期复发鼻咽癌(Ⅲ-Ⅳ期)的近期疗效及毒副反应。[方法]136例均经病理证实为晚期复发鼻咽癌患者,随机分为IPF组69例,PF组67例(对照组)[结果]IPF组和PF组有效率分别为69.56％(48/69)和43.3％(29/67),两组间差异有显著性(X2=8.519,P<0.01)。中位生存期:IPF组16个月(8-34个月),PF组为6.5个月(4-21个月),两组间差异有显著性(X2=22.36,P<0.05)。毒副作用主要为骨髓抑制,Ⅲ-Ⅳ度白细胞下降率IPF组为49.4％,PF组为5.97％,两组差异有显著性(X2=29.54,P<0.01)。Ⅲ-Ⅳ度血小板下降率IPF组为29.18％,PF组为0％(X2=30.29,P<0.01);Ⅲ-Ⅳ度消化道反应两组的发生率分别为15.94％和11.94％(x2=0.234,P>0.01).且以Ⅲ度为主。[结论]以IFO为主的方案联合治疗晚期复发鼻咽癌疗效好,毒副反应能耐受,可作为一线方案。     

奥美拉唑静脉给药治疗上消化道大出血的疗效观察

本文阐述了奥美拉唑（Ｏｍｅｐｒａｚｏｌｅ）治疗急性上消化道大出血８０例与法莫替丁（Ｆａｍｏｔｉｄｉｎｅ）治疗上消化道大出血５０例比较，前者有效率明显高于后者。提示奥美拉唑治疗急性上消化道大出血效果好，无副作用，减少了手术率、死亡率，是一种有效的止血药物。     

药物浓度和病因对三磷酸腺苷治疗阵发性室上性心动过速的影响

本文报告23例次ATP治疗PSVT的效果,总有效率56.5％,9例次高浓度快速注射者8例转复。器质性心脏病者副作用较多,1例冠心速注高浓度ATP后,发生心室颤动和阿-斯氏综合征。这一结果提示:药物浓度和注射速度是影响疗效的主要因素,PSVT伴AVB者疗效也很低;病因和药物浓度是决定副作用的因素。因此,对于器质性心脏病者,尤其冠心病人,应避免高浓度快速静脉注射ATP。     

Optimising Hormone Therapy in Advanced Disease

Although most prostate cancer (PCa) patients nowadays are diagnosed at an early stage of disease, unfortunately still a significant number of patients will develop advanced PCa or will be diagnosed at an advanced (or metastatic) stage of disease. The group of patients showing the highest increase in incidence are those with rising prostate specific antigen (PSA) after radical therapy.In the last quarter of 2004, a Medline search has been performed targeting publications on patients diagnosed with advanced PCa, as well as with PSA relapse after previous radical therapy. This review aims at providing guidance to optimise hormone therapy in those selected groups of patients by addressing three pivotal questions; (i) who should receive hormonal treatment, (ii) what type of hormonal therapy should the patient be offered and (iii) what is the best timing of starting hormonal treatment.In patients relapsing after radical therapy, the PSA doubling time (PSA DT) has become a critical instrument to distinguish patients to have innocuous PSA evolution from patients at high risk for disease progression. A PSA DT of 3 months seems to be the cut-off point for identifying patients at risk. Therefore patients with a PSA DT of less than 3 months should be advised to initiate hormonal therapy. Antiandrogen monotherapy may be considered in this setting as it has been shown to delay progression; however, significant survival data are not yet available. Whether luteinising hormone releasing hormone (LHRH) agonists should be given continuously or intermittently (IHT) remains subject of debate.Surgical castration has been the standard of care in patients diagnosed with advanced PCa. Currently, LHRH agonists have become the preferred way of suppressing testosterone.Combination of an antiandrogen and a LHRH agonist (CAB) shows a modest benefit over LHRH agonist monotherapy. As CAB leads to increased side effects and costs, LHRH agonist monotherapy is preferred in the majority of patients.Conflicting data have been published concerning the optimal timing of LHRH agonist therapy. So it is not clear whether LHRH agonist therapy should be started immediately or deferred until appearance of symptoms. When initiating continuous hormone therapy, patients should be carefully monitored for the risk of long term androgen deprivation (anaemia, osteopenia and osteoporosis).     

前列腺素E1对脂肪所致犬呼吸窘迫综合征的治疗作用

采用同种脂肪提取液复制犬呼吸窘迫综合征模型,观察前列腺素E_1(PGE_1)对其治疗作用。结果表明,PGE_1可改善该模型的低氧血症,降低肺毛细血管通透性,减轻肺水肿,其减轻肺损伤的机理与其抑制多形核白细胞粘附、氧自由基产生及保护Ⅱ-型肺泡上皮细胞等有关。     

羟苯磺酸钙治疗糖尿病性皮肤溃疡的临床研究

[目的]评价羟苯磺酸钙治疗糖尿病性皮肤溃疡的疗效和安全性.[方法]采用双盲临床随机对照试验.76例糖尿病性皮肤溃疡患者,随机分为试验组和对照组.试验组38例服用羟苯磺酸钙;对照组38例服用安慰剂维生素C;疗程8周.[结果]试验组溃疡愈合的速度与程度均明显优于对照组.总有效率试验组为94.74%,对照组为52.63%,两者之间有显著差异(P＜0.01).服药期间肝肾功能无异常改变.[结论]羟苯磺酸钙是治疗糖尿病性皮肤溃疡有效安全的药物.     

手术联合丝裂霉素C治疗原发性翼状胬肉

目的 :观察原发性翼状胬肉单纯切除术中使用丝裂霉素C对预防复发的效果及安全性。方法 :对 1997年 10月至 1999年 3月门诊原发性翼状胬肉患者施行单纯切除术 ,并在翼状胬肉切除后立即用浸有 0 0 1%丝裂霉素C的棉片覆盖 5min。对照组仅施行单纯切除术 ,不使用丝裂霉素C。随访观察 6～ 12个月。结果 :72只单纯切除术联合应用丝裂霉素C的患眼有 9只眼复发 ,复发率为 12 5 0 % ,未发现任何严重并发症。对照组 198只眼有 76只眼复发 ,复发率为 38 38%。两者差异有显著性。结论 :在术中联合应用丝裂霉素C能够减少原发性翼状胬肉单纯切除术后的复发 ,并且安全。     

平阳霉素治疗血管瘤、血管畸形后组织学观察

目的 :观察平阳霉素治疗血管瘤、血管畸形后引起的组织学变化。方法 :13例不同类型的血管病变 ,分1～ 3次注射平阳霉素 4～ 2 4mg ,多次注射者间隔 10～ 12d .在末次注射后 12～ 15d切除治疗后的病变组织进行组织学观察。结果 :注射 1次的标本中血管壁增厚 ,管腔变狭窄 ;注射 2次的标本中管腔闭塞 ,管壁失去正常结构 ;注射 3次的标本中管壁结构消失 ,组织纤维化。结论 :平阳霉素瘤腔内注射后可引起血管内膜变化 ,致使管腔闭塞 ,从而治愈血管瘤及血管畸形     

激素局部注射治疗儿童瘢痕的疗效分析

目的 探讨肾上腺皮质激素(醋酸曲安奈德)局部注射对儿童增生性瘢痕、瘢痕疙瘩的治疗效果及预防瘢痕形成的疗效。方法 对增生性瘢痕、瘢痕疙瘩及预防性注射治疗的患儿473例，共行1514次醋酸曲安奈德局部注射，观察临床效果并进行回顾性分析、评价和总结。结果 增生性瘢痕治疗效果良好，有效率达100％，对关节部位瘢痕的挛缩有明显减轻和预防的作用。瘢痕疙瘩直接注射效果较差，手术切除术后，进行预防性注射可收到良好效果。其余手术后经预防性注射，无增生性瘢痕发生。注射期间28例出现早期Cushings综合征表现，停药半年后消失，随访5年以上，无生长发育异常。结论 小剂量激素局部注射是治疗和预防儿童增生性瘢痕、瘢痕疙瘩的较为安全、可靠、有效的非手术治疗方式之一。     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.