改良FAM方案治疗晚期胃癌临床观察

目的增加FAM方案治疗胃癌疗效．方法我们自1989－04／1997－03用5－FU＋ADM＋MMC方案治疗晚期胃癌共73例．其中标准FAM方案治疗42例（对照组）；改良FAM方案治疗31例，用药的剂量及方法进行了调整（治疗组）．73例均为初治病例．两组临床资料对比无统计学差异（P＞0．05）．对照组治疗方案：5－FU600ms／m2，静脉滴注，d1，d8，d29，d36；ADM30mg／m2，静脉注射，d1，d29；MMC10mg／m2，静脉注射，d1，每56d为一疗程，用1～3疗程．治疗组治疗方案：5－FU600mg／m2，静脉滴注（6h～8h），d1～d5；ADM50mg／m2，静脉注射，d1；MMC10mg／m2，静脉注射，d1，每28d为一疗程，用2～6疗程．结果治疗组有效率58．1％（8／3）优于对照组33．3％（1／42），（X2=4．4，P＜0．05）．对照组中位生存期9mo，治疗组为16mo（P＜0．05）．两组有效病例的中位生存期比较无显著差异（P＞0．05）．两组病例的毒副反应均不严重，患者能耐受，因此治疗组化疗方案优于标准FAM方案，值得推广应用．结论改良FAM方案疗效优于标准FAM方案，毒副作用无明显加重．     

HP方案治疗晚期非小细胞肺癌临床疗效观察

目的研究HP方案治疗晚期非小细胞肺癌（NSCLC）的临床疗效及毒副作用。方法38例晚期非小细胞肺癌患者应用HCPT 10mg／m^2／d，静脉滴注，第1天至第5天；DDP 20mg／m^2／d，静脉滴注，第1天至第5天；21d为1个周期，连用3个周期。结果38例CR 13．2％（5／38），PR 39．5％（15／38），SD 36．8％（14／38），PD 10．5％（4／38），总有效率52．6％（20／38）。结论 HCPT联合DDP的HP方案治疗晚期NSCLC为较有效方案，毒性低，值得临床推广研究。     

羟基喜树碱联合5-FU／LV治疗晚期大肠癌

目的 观察羟基喜树碱(HCPT)联合氟脲嘧啶(5-FU)、醛氢叶酸(LV)组成的HLF方案对晚期大肠癌的疗效及毒副作用。方法 治疗组30例HLF方案HCPT6--8mg／m2静滴，第1～5天；LV100mg静滴，第1～5天；5-FU500mg静滴，第1～5天。对照组28例5-FU／LV方案，LV与5-FU用法同治疗组，以上方案4周重复。结果 HLF方案与5-FU/LV方案有效率分别为36．6％及21．4％，主要不良反应为消化系统、血液系统毒性，多为Ⅰ～Ⅱ度，能耐受。结论 HLF方案治疗晚期大肠癌能提高疗效，稳定病情，改善症状。     

甲孕酮联合IEP与单用IEP方案治疗非小细胞肺癌的对比研究

目的 比较甲孕酮联合IEP方案与单用IEP方案治疗晚期非小细胞肺癌的疗效及毒副作用。方法：54例晚期非小细胞肺癌患随机分成两组,联合组：口服甲孕酮600mg／天,IFO1．5mg/m^2静脉滴注第1－5天,EP15mg/m^2持续深静脉滴注第1－5天,PDD15mg/m^2静脉滴注第1－5天;单化疗组：同上IEP方案。两组均以每28天为一周期,至少重复3个周期。结果：联合组有效率（CR＋PR）：48．1％,单化组有效率（CR＋PR）：44．4％,P＞0．05;中位生存期：联合组36周,单化组30周,P＜0．01;骨髓抑制、恶性呕吐等反应联合组均较单化组轻,P＜0．01;体重：用药12周后,联合组平均增加2．75kg,单化组平均减轻1．85kg,P＜0．05。结论：甲孕酮联合IEP方案与单化IEP方案治疗晚期非小细胞肺癌有效率无明显差异,但前中位生存期长,毒副反应轻,患生活质量明显提高。     

奥沙利铂联用氟脲嘧啶／醛氢叶酸治疗晚期大肠癌的临床研究

目的 观察奥沙利铂(OXA)与醛氢叶酸(LV)，氟脲嘧啶(5-FU)组成的OXA-LF方案对晚期大肠癌的疗效及不良反应。方法 治疗组36例予OXA-LF方案化疗，OXA130mg/m^3，第1天静滴；LV200mg／m^2，第1～5静滴；5-FU，425mg／m^2，第1～5天静滴。对照组32例给予LFP方案化疗，DDP16mg/m^2，第1～5天静滴；LV、5-FU用法同治疗组。以上方案每3周重复。结果 OXA-LF方案和LFP方案有效率分别为52．78％、40．63％，临床受益反应分别为83．3％、59．375％。主要不良反应为血液系统、消化系统及神经系统毒性，多为Ⅰ～Ⅱ度，患者耐受性良好。结论 OXA-LF方案治疗晚期大肠癌疗效较高，不良反应轻而且安全性。     

多西他赛联合奥沙利铂治疗晚期转移性胃癌近期疗效观察

74例晚期胃癌患者随机分为观察组31例和对照组43例。观察组多西他赛65mg／m^2，静脉滴注，第1天；奥沙利铂120mg／m^2，静脉滴注，持续2h，第1天；21d为一周期。对照组给予多西他赛75mg／m^2，静脉滴注，第1天；顺铂75mg／m^2，分5次静脉滴注，1次／d，21d为一周期。两组均治疗2—8个周期。结果观察组完全缓解率（CR）0，部分缓解率（PR）38．7％，总缓解率（RR）38．7％；对照组分别为2．3％、37．2％、39．5％。两组疗效比较差异无统计学意义（P〉0．05），Ⅲ、Ⅳ度不良反应发生率观察组低于对照组。认为多西他赛联合奥沙利铂方案治疗晚期胃癌安全、有效。     

滋养细胞肿瘤外阴阴道转移瘤治疗体会

1982～1994年，我们收治滋养细胞肿瘤外阴阴道转移瘤患者27例，经单纯全身化疗均愈。一般资利：本组年龄24～51岁。转移灶位于阴道前壁下1／3处20例（其中1例在阴道口外尿道口下方），阴道侧壁7例（包括阴道残端2例，1例伴右侧大阴唇下方转移）。合并肺、脑转移2例，单独肺转移25例。转移瘤直径1～10cm。化疗方案及结果：本组采用住院治疗方案5－Fu＋KSM（5－Fu1000～1250mg／d＋KSM350～400vg／d静济，8天）或同步序贯1（VCR1～1．5mg第1天晚10点静滴，5－Fu1000～1250mg／d第2～5天静滴，KSM350～400vg／d第2～5天静滴，CTX0．2或…     

腹腔温热灌注化疗治疗腹腔恶性肿瘤临床观察

将86例腹腔恶性肿瘤患者随机分为两组，腹腔温热灌注化疗（IHCP）组给予顺铂（DDP）80～100mg、氟尿嘧啶（5-FU）1．5～2．0g、羟基喜树碱（HCPT）40～50mg，注入43℃温热生理盐水1500ml中，单药、两药或三药交替腹腔灌注，每2周1次；常规静脉化疗（IC）组给予5-FU 2000mg／m^2、HCPT 30mg／m^2、DDP 60mg／m^2，分5d静脉漓注，1次／月，共6次。IHCP组近期总有效率为58．0％，明显高于IC组的36．1％；IHCP组消化道和骨髓抑制的全身毒副反应明显低于IC组，肝、肾功能损害两组间无明显差异。     

榄香烯乳加联合化疗治疗难治性急性非淋巴细胞白血病疗效观察

目的：评价榄香烯乳联合化疗治疗难治性急性非淋巴细胞白血病（ANLL）的疗效。方法：将28例ANLL患者随机分为治疗组和对照组,治疗组使用榄香烯乳300mg加入5％GS500ml中静脉滴注,持续用药14d,同时加联合化疗：高三尖杉酯碱4－6mg静脉滴注,持续7d,阿糖胞苷100－200mg/m^2,第1－7天;对照组单用化疗,方案用量用法同治疗组。结果：治疗组总有效率为75．0％,对照组总有效率为41．7％,两组差异有显著性意义（P＜0．05）。结论：榄香烯乳对难治性ANLL有肯定疗效,比单用联合化疗效果好,且不良反应少,无血常规和骨髓抑制。     

DP和NP方案治疗晚期非小细胞肺癌临床比较

38例晚期非小细胞肺癌（NSCLC）患者随机分为两组。DP组18例,静滴国产多西他赛（DOC）40mg／m^2,第1、8天;静滴顺铂（DDP）30mg／m^2,第2～4天;NP组20例,静推长春瑞滨（NVB）25mg／m^2,第1、8天;DDP用法同DP组。28d为1周期,2周期后评价疗效。结果：总有效率（CR＋PR）DP组38．9％,NP组30％,两组比较无统计学差异（P〉0．05）。两组主要不良反应为胃肠道反应、骨髓抑制、脱发及静脉炎。认为DP与NP方案对晚期NSCLC均有确切疗效,均可作为一线治疗方案应用。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.