宫颈妊娠的诊断及治疗

目的探讨宫颈妊娠病因、诊断、鉴别诊断及处理。方法回顾性分析我院1983年3月至2007年5月收治的10例(A1～10)宫颈妊娠的临床资料。结果A1、A3、A4、A9出血较多的患者通过钳刮术止血,并在术后明确诊断。A2、A6例有合并症伴大出血患者行急诊全子宫切除术,其余4例通过超声早期诊断。A2、A10β-HCG水平较低,行MTX保守治疗成功,A7在MTX保守治疗β-HCG下降的情况下发生大出血,钳刮术未能止血,由于经济原因未行子宫动脉栓塞术而行全子宫切除术;A8行预防性子宫动脉栓塞后行钳刮术,疗效满意。结论(1)宫颈妊娠病情凶险,应慎重对待。(2)超声检查对宫颈妊娠的诊断有重要意义。(3)对于早期患者可根据孕周、β-HCG、胎芽大小、胎心有无选择氨甲蝶呤(MTX)全身或局部治疗或子宫动脉栓塞;对于MTX治疗无效或发生阴道大出血时,若有条件应首选子宫动脉栓塞;若无条件,可在有止血措施的情况下,选择钳刮术,迫不得已才行全子宫切除术。     

宫颈妊娠9例诊治分析

目的 探讨宫颈妊娠的诊治方法.方法 对9例宫颈妊娠患者的临床资料进行回顾性研究.结果 9例宫颈妊娠中,术前B超明确诊断3例,误诊6例,误诊率66.7%.1例入院后直接行全子宫切除术.1例因血、尿HCG正常,拟诊宫颈肌瘤直接行宫腔镜下宫颈妊娠物电切术.7例用MTX和(或)米非司酮保守治疗 宫腔镜下宫颈妊娠物电切术或宫颈搔刮术.其中5例行MTX全身化疗,有3例保守成功,另2例术中出血较多,血压下降,分行用消毒纱布填塞压迫止血和全子宫切除术.2例行MTX宫颈局部注射 全身化疗,其中1例因用药后阴道流血增加行子宫动脉灌注MTX 栓塞术.本文9例病理诊断均为宫颈管坏死机化组织中见蜕变的蜕膜、绒毛组织;均痊愈出院.结论 妊娠妇女如出现宫颈增大、子宫异常体征,应借助B超检查,考虑宫颈妊娠的可能,早期明确诊断.子宫颈妊娠只有少数需要切除子宫,大部分可采用全身、局部化疗,能够成功地治疗需要保留子宫和生育功能的患者.     

宫颈妊娠28例临床分析

目的探讨宫颈妊娠的早期诊断及保守性治疗方法。方法对收治的28例宫颈妊娠进行回顾性分析。结果18例经阴道B超早期诊断，10例为阴道大量流血或人工流产出血不止后经阴道B超确诊。28例经MTX加米非司酮联合化疗或用子宫动脉栓塞并局部加MTX化疗，均经保守治疗治愈，子宫得到保留。结论阴道B超是诊断宫颈妊娠的首选方法，联合化疗及子宫动脉栓塞加局部化疗使保守治疗成为可能。     

子宫动脉靶注入MTX加栓塞术联合清宫术治疗子宫瘢痕妊娠

目的探讨双侧子宫动脉靶注入甲氨喋呤（MTX）加栓塞术联合清宫术治疗瘢痕妊娠的可行性。方法回顾性分析收治的52例经子宫动脉靶注入MTX加栓塞术联合清宫术的瘢痕妊娠患者的病例资料。采用Seldinger法进行右侧股动脉穿刺成功后,将导管超选至双侧子宫动脉,于双侧子宫动脉内分别灌注MTX及行明胶海绵颗粒栓塞,栓塞术后24～48h内行B型超声（B超）引导下清宫术。结果 50例化疗栓塞后,行清宫术出血量少,血HCG下降显著。化疗栓塞后转开腹行切口瘢痕妊娠组织清除术及子宫修补术2例。结论子宫动脉靶注入MTX加栓塞术联合清宫术治疗瘢痕妊娠是目前安全、有效、防止大出血的有效方法。     

经子宫动脉化疗灌注栓塞治疗异位妊娠的疗效观察

目的探讨经子宫动脉灌注化疗栓塞术在治疗异位妊娠中的疗效。方法对65例异位妊娠患者行超选择性双侧子宫动脉插管,灌注甲氨蝶呤,后用聚乙烯醇颗粒栓塞双侧子宫动脉,l周后行刮宫手术。结果 65例患者均成功行双侧子宫动脉化疗灌注加栓塞术,术后l周行刮宫手术,手术顺利、出血量少,未出现严重并发症。结论子宫动脉灌注化疗栓塞术是保守治疗异位妊娠的一种安全、有效的微创方法。     

宫颈妊娠26例临床分析

目的探讨宫颈妊娠的早期诊断及合理有效的保守性治疗方法,提高对本病的诊治水平。方法回顾性分析笔者所在医院1992年1月～2011年1月共收治的26例宫颈妊娠患者的临床病历资料。结果 6例患者氨甲蝶呤保守治疗成功,20例子宫动脉灌注加栓塞治疗后5~7 d B超下清宫;均保守治疗成功。结论宫颈妊娠是严重的异位妊娠,应早诊断、早治疗,B超对宫颈妊娠早诊断有重要价值;宫颈妊娠大出血采取子宫动脉灌注加栓塞能迅速、有效杀灭胚胎并止血;MTX药物保守治疗是有效的。     

剖宫产术后子宫瘢痕处妊娠36例临床分析

目的探讨剖宫产术后瘢痕处妊娠(CSP)的临床特点、诊断及治疗方法。方法对36例CSP患者的临床资料进行回顾性分析。结果 36例患者均有剖宫产史,至少1次,HCG<2000mIu/ml者10例患者采用常规MTX保守药物治疗加刮宫术,均获成功。9例行B超引导下局部抽吸妊娠囊液+局部注入MTX,24～48小时后清宫成功7例,2例因在清宫术中大出血,均急诊行子宫动脉栓塞治疗;HCG>100000mIu/ml者17例有3例患者因为人工流产术而导致大出血急诊子宫动脉栓塞治疗,14例患者均行双侧子宫动脉栓塞+MTX灌注+刮宫术成功。结论应提高临床医生对CSP的认识,CSP一般超声检查可确诊,子宫动脉栓塞+刮宫术可做为首选治疗方案。     

超选择性插管栓塞治疗宫颈妊娠的应用研究

目的评价经导管超选择性插管至子宫动脉栓塞治疗宫颈妊娠的可行性和安全性。方法7例宫颈妊娠患者均采用Seldinger技术经皮胶动脉穿刺,行超选择性子宫动脉插管后灌注甲氨蝶呤（MTX）、明胶海绵颗粒栓塞后联合刮宫术进行治疗,所有患者术后均观察B．HCG值变化。结果7例患者双侧子宫动脉插管及栓塞成功率均为100％,3例术后3—5d内孕囊完全脱落自然排出,7例刮宫术中宫内组织易于剥离,出血仅为5—10ml。术后1周复查B-HCG下降,术后无严重并发症发生。结论经导管超选择性插管至子宫动脉栓塞治疗宫颈妊娠可明显降低子宫切除和丧失生育能力的风险,是一种微创、简便、安全有效的方法。     

两种方法治疗剖宫产术后子宫瘢痕处妊娠疗效观察

观察并比较两种方法治疗剖宫产术后子宫瘢痕处妊娠的疗效。方法：40例剖宫产术后瘢痕处妊娠患者分为两组,A组22例采用子宫动脉介入栓塞＋局部MTX化疗,B组18例采用全身应用MTX＋米非司酮。观察两组患者治疗后药物不良反应、阴道出血量、血人绒毛膜促性腺激素β（β-HCG）水平、B超监测包块以及治疗成功率等情况,并比较两组疗效。结果：A组治疗成功率、药物不良反应、B-HCG转阴时间、阴道出血量等指标均优于B组,差异有统计学意义（P〈0．05）。结论：介入双侧子宫动脉栓塞联合MTX灌注术治疗剖宫产术后瘢痕处妊娠安全、有效,疗效优于氨甲喋呤联合米非司酮。     

子宫动脉栓塞术及局部灌注化疗任剖宫产疤痕妊娠治疗中的应用

目的：探讨子宫动脉栓塞术（UAE）及局部灌注化疗在剖宫产疤痕妊娠治疗中的应用。方法：回顾性分析151例子宫剖宫产疤痕妊娠患者的临床资料。结果：151例子宫剖宫产疤痕妊娠患者行UAE及局部MTX灌注治疗均保留子宫成功,仅1例患者因术后远期出血行保守治疗成功,均未出现严重并发症。结论：对子宫剖宫产疤痕妊娠的治疗而言,UAE及局部MTX灌注化疗是一种安全,有效,微创的治疗方式,对要求保留子宫的患者而言可作为首选的治疗方式.     

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.