晚期肝癌患者行介入治疗围手术期的护理

肝癌介入治疗是利用介入放射学进行肝动脉灌注化疗药物和血管栓塞,阻断肿瘤血供,使癌体严重缺血坏死而缩小,达到治疗肝癌的目的。我院对68例晚期原发性肝癌患者采用肝动脉栓塞化疗术（TACE）治疗,将护理体会报告如下。     

晚期肝癌患者行介入治疗围手术期的护理

肝癌介入治疗是利用介入放射学进行肝动脉灌注化疗药物和血管栓塞[1],阻断肿瘤血供,使癌体严重缺血坏死而缩小[2],达到治疗肝癌的目的.我院对68例晚期原发性肝癌患者采用肝动脉栓塞化疗术(TACE)治疗,将护理体会报告如下.     

肝动脉栓塞化疗术后并发上消化道出血的原因分析及护理

原发性肝癌是我国常见的恶性肿瘤之一，由于患者就诊时多为肿瘤中晚期，故已丧失外科手术的最佳时机，肝动脉栓塞化疗术（TACE）成为其主要有效治疗方法。其优点是化疗药物局部灌注可提高药物浓度，降低全身化疗的毒副反应，从而提高患者生活质量；碘油等栓塞剂可阻断肝癌组织的动脉血供，造成肿瘤组织的缺血坏死，可使部分患者肝癌明显缩小，从而获得手术切除机会。     

肝癌介入治疗中的护理管理

肝动脉化疗栓塞术（TACE）是目前介入治疗肝癌常采用的方法之一。正常肝脏组织具有门静脉及肝动脉的双重血供，其中门静脉供血占70％～75％，肝动脉供血仅占25％～30％，而肝肿瘤病灶的血供90％来自肝动脉，只有10％来自门静脉。因此，对肝癌进行肝动脉栓塞化疗，肿瘤内的药物浓度高于周围静脉给药，而肝的代谢作用使周围血管药物浓度不高，且栓塞阻断了肿瘤的营养供给血管而对正常肝组织供血影响不大。所以癌结节大部分坏死，而肝脏功能不受损或受损不严重。它的适应证是：各期原发性肝癌；转移性肝癌；减轻肝癌引起的疼痛和控制肿瘤破裂出血。     

肝癌介入化疗术的护理

肝动脉介入化疗能有效提高肝癌局部的药物浓度,通过冲击化疗和动脉栓塞,使肝癌细胞加速坏死。故广泛应用于中晚期肝癌的治疗。我院自１９９４年１０月～１９９９年１０月对１２０例中晚期肝癌病人采用动脉介入治疗,均取得良好效果,现将护理体会报告如下：１ 临床资料及方法１．１ 一般资料：病人年龄 ２５～７２岁,平均 ４８．５岁．其中男 ７０例,女５０例。１．２ 方法：采用Ｓｏｌｄｉｎｇｅｒ技术经皮股动脉穿刺送入多功能盘曲导管,插管至肝固有动脉．注入４０％～６０％泛影葡胺显影剂,根据病变部位及肿瘤的营养血管选定灌注动…     

靶向给药系统——甲氨蝶呤肝动脉栓塞微球特征及其对大鼠肝癌的实验治疗

本文介绍用乳化—冻凝技术制备甲氨蝶吟—明胶微球的方法。实验结果证实,包裹在微球内的MTX对⁶⁰钻幅射、温度和光照射是稳定的。微球的体外溶出试验、明胶微球在介质中不同时间的溶胀度试验也在文中介绍。微球肝动脉栓塞实验治疗用大鼠移植性肝癌进行,结果表明MTX微球治疗组的大鼠在肿瘤抑制率、促使肿瘤坏死程度以及延长荷瘤动物存活期方面比肝动脉灌注生理盐水、MTX溶液和明胶微球为佳.由于MTX微球具有阻断肿瘤血供和在其局部缓释化疗药物等双重功用,故治疗肝癌的效果明显优于动脉化疗或单纯栓塞方法。     

复方甘草酸苷联合舒肝宁对原发性肝癌肝动脉灌注化疗栓塞术后保肝作用的临床观察

原发性肝癌在我国是一种常见的恶性肿瘤,大多数患者被诊断为肝癌时已无外科手术指征.目前肝动脉灌注化疗栓塞（TACE）是公认的肝癌非手术疗法的首选方法.TACE是将营养肿瘤的肝动脉栓塞使癌结节局部缺血坏死或抑制肿瘤生长,在切断肿瘤供血的同时也会部分减少正常肝组织的血供,原发性肝癌多是在乙型肝炎、肝硬化基础上发生的,患者往往已经存在不同程度的肝细胞损害,TACE治疗又会进一步加重肝细胞损害,严重时可导致不可逆转的肝功能衰竭.因此肝癌患者在进行介入治疗的同时保护肝功能治疗是非常重要的.     

靶向给药系统——甲氨蝶呤肝动脉栓塞微球特征及其对大鼠肝癌的实验治疗

本文介绍用乳化—冻凝技术制备甲氨蝶吟—明胶微球的方法。实验结果证实,包裹在微球内的MTX对~(60)钻幅射、温度和光照射是稳定的。微球的体外溶出试验、明胶微球在介质中不同时间的溶胀度试验也在文中介绍。微球肝动脉栓塞实验治疗用大鼠移植性肝癌进行,结果表明MTX微球治疗组的大鼠在肿瘤抑制率、促使肿瘤坏死程度以及延长荷瘤动物存活期方面比肝动脉灌注生理盐水、MTX溶液和明胶微球为佳.由于MTX微球具有阻断肿瘤血供和在其局部缓释化疗药物等双重功用,故治疗肝癌的效果明显优于动脉化疗或单纯栓塞方法。     

肝动脉栓塞微球的动物药动学和药效学研究

肝动脉栓塞微球是用于治疗中晚期肝癌的新剂型。通过动脉插管即可将微球栓塞肝癌邻近的末梢动脉血管,起阻断血流和在局部缓释药物的双重作用。本文结合几年来对甲氨蝶吟(MTX),羟基喜树碱明胶微球和顺铂-乙基纤维素微球的基础研究工作,综述微球栓塞后在动物的体内过程和药效学。     

肝动脉栓塞微球的动物体内行为和药效学研究

肝动脉栓塞微球是用于治疗中晚期肝癌的新剂型。通过动脉插管即可将微球栓塞至肝癌邻近的末梢动脉血管,起阻断血流和在局部缓释药物的双重作用。本文结合几年来对MTX明胶微球和顺铂-乙基纤维素微球的基础研究工作,综述微球栓塞后在动物体内的行为和药效学,并介绍了初期临床结果。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.