Tumour necrosis factor inhibitors

The cytokine, tumour necrosis factor-alpha (TNF-alpha) plays a key role in the pathogenesis of many chronic inflammatory and rheumatic diseases, in particular, Crohn's disease, rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Controlled trials have shown that the TNF inhibitors (etanercept, infliximab and adalimumab) significantly reduce symptoms and signs, improve function and quality of life, and reduce radiologically evident damage in patients with rheumatoid diseases. For reasons that are not entirely clear, etanercept does not work in Crohn's disease. Injection site and intravenous reactions and increased risk of infection (in particular, reactivation of tuberculosis) are associated with the use of these agents. Increased risk of lymphoproliferative disease, the development of lupus-like syndromes and demyelination, including optic neuritis and reactivation of multiple sclerosis, are under evaluation in long-term follow-up studies. The TNF inhibitors are expensive (about $18 000 per year), and in some patients need to be given continuously to maintain benefit, even in the presence of other immunosuppressive therapy.     

血浆纤维蛋白原与肿瘤

近年来流行病学研究表明,血浆纤维蛋白原（fibrinogen,Fbg）水平变化不仅与凝血机制变化有关,而且与心血管病、血栓病、糖尿病、恶性肿瘤等有关,尤其是在恶性肿瘤的监测与预后判断上有着极其重要的意义。Fbg是所有凝血因子中含量最高的一种凝血蛋白,是凝血系统中的“中心”蛋白质。由肝细胞合成,经糖基化和部分磷酸化后释放人血,     

Askin瘤1例报道

本文报道 1例经手术、病理、免疫组化确诊的Ａｓｋｉｎ瘤 ,结合文献复习 ,讨论其临床特点、诊断及鉴别诊断要点和治疗原则。1　临床资料和方法患者　男 ,3 2岁 ,农民。因右胸壁肿块 2 0年 ,进行性增大 5年 ,切除后复发 1年于 2 0 0 0年 2月 2 0日入院。患者 2 0年前无意中发现右侧胸壁一个黄豆大小结节 ,质硬无疼痛。 5年前该结节增至拇指大小 ,无疼痛。在当地乡镇医院手术切开 ,发现内容物呈“豆腐渣样” ,未切除。 4年前该肿块增至核桃大 ,在当地医院手术切除 ,未作病理检查。术后愈合。大约 1年前在原肿块切除的手术疤痕附近又长出 2个肿…     

Awake Craniotomy for Tumour Excision

Background

Craniotomy and excision of tumours can produce neurological deficits if the tumour is located close to eloquent areas of the brain. One technique of overcoming this problem is to keep the patient ‘awake’ during surgery.

Methods

Eight patients with intra cranial space occupying lesions (ICSOL) were operated ‘awake’, using a combination of skull block with sedation and analgesia. A mixture of 0.125% bupivacaine and 0.5% lignocaine was used for various nerve and field blocks. Midazolam, fentanyl and propofol in titrated doses were used to achieve conscious sedation.

Result

The procedure was successful in all the patients. They tolerated the procedure well and were able to follow the commands intraoperatively as desired. There were no significant complications.

Conclusion

Awake craniotomy with skull blocks with sedation and analgesia is a well established procedure. It requires a good rapport between surgeon, anaesthesiologist and the patient.Key Words: Awake craniotomy, Skull block, Sedation, Analgesia