中毒性脑白质病

颅脑照射和抗癌化疗是中毒性脑白质病非常确定的病因。对肿瘤放化疗引起中毒性脑病的临床及其研究进展加以综述。     

氯乙烯中毒性肝病和乙型肝炎染色体畸变分析

本文对２１例氯乙烯中毒性肝病、９例乙型肝炎患者及１０例正常人外周血淋巴细胞染色体Ｇ显带分析表明：中毒性肝病组、乙肝组染色体数目畸变率和结构畸变率均明显高于对照组（Ｐ＜０．０１）．其中氯乙烯中毒性肝病组染色体结构畸变率还高于乙肝组（Ｐ＜０．０１）。对结构畸变中断裂点的分析表明，两种肝病的断裂点分布不同，同时还发现染色体上某些位点断裂频率较高，并初步探讨了这些位点和肿瘤发生之间的关系。     

柔红霉素致中毒性心肌炎1例报告

柔红霉素致中毒性心肌炎１例报告王国经，段金梅，师建红，李莉柔红霉素属蒽醌类抗癌药，能抑制细胞ＤＮＡ和ＲＮＡ合成，用于急性白血病等的治疗。不良反应有骨髓抑制、心肌及肝功能损害等。现将我科收治的柔红霉素中毒性心肌炎１例报告如下：患者女，２２岁，住院号：１...     

肿瘤病人化疗相关中毒性肠麻痹的治疗探讨(附10例报告)

目的　对使用长春碱类药物或化疗后产生粒缺并发肠道感染而导致中毒性肠麻痹的治疗进行探讨。方法　对 10例中毒性肠麻痹在禁食、胃肠减压、补充电解质、纠正酸碱失衡、肛管排气、抗生素等使用的基础上 ,加用NS 15 0ml+阿拉明 10mg +酚妥拉明10～ 2 0mg快速静滴 ,每日 1～ 2次 ,连用数天。为加强疗效 ,在静滴完上述溶液后半小时 ,可加肌注新斯的明 0 5～ 1mg。结果　本组中 ,使用该方法治疗 9例 ,其中 7例有效。结论　应用阿拉明 +酚妥拉明配合新斯的明对使用长春碱类药物或化疗后产生粒缺并发肠道感染等导致中毒性肠麻痹疗效好 ,值得进一步研究。     

肿瘤病人化疗相关中毒性肠麻痹的治疗探讨（附10例报告）

目的 对使用长春碱类药物或化疗后产生粒缺并发肠道感染而导致中毒性肠麻痹的治疗进行探讨。方法 对10例中毒性肠麻痹在禁食、胃肠减压、补充电解质、纠正酸碱失衡、肛管排气、抗生素等使用的基础上，加用NS 150ml 阿拉明10mg 酚妥拉明10～20mg快速静滴，每日1～2次，连用数天。为加强疗效，在静滴完上述溶液后半小时，可加肌注新斯的明0．5～1mg。结果 本组中，使用该方法治疗9例，其中7例有效。结论 应用阿拉明 酚妥拉明配合新斯的明对使用长春碱类药物或化疗后产生粒缺并发肠道感染等导致中毒性肠麻痹疗效好，值得进一步研究。     

五味子提取物对CCl4中毒大鼠肝超微结构的保护作用

目的：探讨五味子提取物对CCl4中毒大鼠肝细胞超微结构的保护作用。方法：Wistar大鼠25只,随机分为对照组、CCl4中毒24h组及10d组、五味子24h组及10d组,共5组,每组5只。CCl4中毒组大鼠用生理盐水（0.5ml/100g）灌胃3d,对照组和治疗组大鼠用五味子提取液（0.5ml/100g）灌胃3d后,中毒组和五味子组大鼠按0.2ml/100g体质量用量经腹腔一次性注射200ml/LCCl4致毒,对照组大鼠腹腔注射同体积植物油。然后,五味子组每天按0.5ml/100g体质量用量给予五味子提取液灌胃,而对照组、中毒组以等量生理盐水灌胃。不同时间点处死大鼠,透射电镜下观察肝脏超微结构的改变。结果：CCl4中毒24h组大鼠肝组织超微结构发生改变,表现为胞质基质疏松、空泡化;肝细胞线粒体肿胀,嵴断裂或消失;内质网呈片层状;核膜皱缩、断裂,染色质边集于核膜下,CCl4中毒10d组肝细胞核形态仍呈明显异型性。与CCl4中毒组大鼠相比较,五味子组大鼠肝细胞超微结构的病理性改变减轻。结论：五味子提取物对CCl中毒大鼠肝细胞的超微结构具有保护作用。     

光气急性中毒机制的深入研究

光气是一种经典的化学战剂,也是化学恐怖袭击的重点选择对象。同时光气又是一种重要的化工原料,广泛应用于高分子材料、农药、医药、香料和染料等领域,在生产、储存、运输过程中的意外事故造成的光气泄漏,极大威胁人民生命财产安全,这些使得光气一直是各国学者的研究热点。光气中毒主要引起难治性肺水肿,死亡率极高,目前世界上没有有效的救治方法和药物,主要是由于对其中毒机制不清楚。我们实验室多年来一直从事窒息性毒剂肺损伤机制研究,近年来取得了一些发现性的成果,提出了光气的酸烧伤理论,同时就氧化损伤-呼吸爆发等机制进行了一定的研究,本文将就光气部分最新研究进展做一综述。     

信迪利单抗致晚期鳞状细胞肺癌患者致死性中毒性表皮坏死松解症1例

中毒性表皮坏死松解症(TEN)是免疫治疗中一种罕见不良反应,其进展快、死亡率高。本文报道1例晚期鳞状细胞肺癌在使用信迪利单抗免疫治疗后出现TEN致死亡的病例。TEN需引起临床医生广泛关注,做到早期诊断、规范治疗。     

恶性肿瘤与肾功能损害(附34例报告)

分析恶性肿瘤诊治过程中发生肾功能损害的发病机理。方法　就我院 1995～ 1998年住院病病中发生肾功能损害的病因加以分析。结果　恶性肿瘤患者诊治过程中发生肾功能损害的原因可能有 :①造影剂性肾病。②中毒性肾病。③免疫相关性肾损害。④溶解综合征伴急性肾损害。⑤肝肾综合征。结论　肾功能损害是恶性肿瘤诊治中常见并发症之一 ,有时危及生命 ,应引起医务人员高度重视。     

燃煤砷污染对人体血细胞DNA合成、DNA损伤及修复的影响

目的与方法：采用液体闪烁计数法及＾１２５Ｉ后标记法检测燃煤型砷中毒人群血细胞ＤＮＡ自发合成、ＤＮＡ－蛋白质交联物（ＤＰＣ）水平及非程序外ＤＮＡ合成（ＵＤＳ）反应,以探讨燃煤砷污染以人体ＤＮＡ合成、ＤＮＡ损伤及修复的影响。结果：病区非病人及中毒病人的ＤＮＡ合成明显降低,ＤＰＣ水平随病情加重而升高;而ＵＤＳ反应则只在中毒病人体内增强,差异均有显著性。结论：燃煤砷可在早期致人体内ＤＰＣ形成,引起严重的Ｄ     

Necrotizing leukoencephalopathy following CHOP chemotherapy

Toxic leukoencephalopathy syndromes are rare disorders of cerebral injury characterized by changes in the white matter and accompanying neurologic dysfunction. They have been reported in association with a variety of clinical etiologies, most commonly including severe hypertension, cranial irradiation, and environmental toxins. However, they have also been described in conjunction with immunosuppressive and chemotherapeutic agents. There has been one case of fatal leukoencephalopathy reported following CHOP chemotherapy for non-Hodgkin lymphoma. We report a second case of fatal necrotizing leukoencephalopathy following the administration of CHOP chemotherapy.     

Reversible Posterior Leukoencephalopathy Syndrome Associated with Concurrent Bevacizumab,Gemcitabine, and Oxaliplatin for Cholangiocarcinoma

Introduction  

Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare disorder characterized by altered mental status, seizure, hypertension, and symmetrical white matter edema (leukoencephalopathy) typically in the posterior cerebral hemispheres on brain imaging. It is often linked to certain medication use, in particular, chemotherapeutic agents. Here, we present a case of chemotherapy-related RPLS and review the current literature on this topic.     

Treatment-related white matter changes in cancer patients

Forty cancer patients with bilateral diffuse cerebral white matter hypodensities on computerized tomography (CT) scan were reviewed. Brain irradiation and/or chemotherapy were considered responsible for the CT abnormalities in all patients but one, whose changes were presumably due to demyelination related to the aging process. Among these 39 patients, 7 had clinical symptoms of leukoencephalopathy. Two patients had acute transient leukoencephalopathy, and one of them experienced permanent neurologic changes after continuing treatment. Six additional patients had delayed leukoencephalopathy. The interval between whole-brain irradiation (WBXRT) alone and the CT detection of white matter hypodensities was almost always longer than 1 year. This interval was shortened to less than 1 year in a significant number of patients when WBXRT was followed by various chemotherapeutic protocols. More importantly, there was an increased incidence of clinical leukoencephalopathy. A higher incidence of clinical leukoencephalopathy in patients receiving intracarotid chemotherapy in the treatment of brain tumors and in patients receiving combination chemotherapy for central nervous system relapse of adult leukemia suggests a need for further investigation.     

Interferon-related leukoencephalopathy in a patient with renal cell carcinoma.

A 75-year-old patient with metastatic renal cell carcinoma was treated with recombinant interferon alpha-C and thereafter developed a neurologic syndrome of dementia, ataxia, confusional state, loss of concentration ability and cortical blindness. CT scan findings were compatible with leukoencephalopathy, which is reported as being a toxic effect of interferon.     

Chemotherapy induced reversible posterior leukoencephalopathy syndrome

The reversible posterior leukoencephalopathy syndrome (RPLES) is a condition characterised by reversible neurological and radiological findings that has been associated with use of immunosuppressive, chemotherapeutic and more recently novel targeted therapies. We describe the case of a 50-year-old woman with advanced non-small cell lung cancer who developed status epilepticus shortly after receiving cisplatin and gemcitabine chemotherapy. The clinical, radiological and EEG findings during and post event are presented and are in keeping with a diagnosis of RPLES. Early recognition of this rare syndrome, supportive management and withdrawal of the offending agent appear to result in a reversal of the manifestations described.     

Molecular target therapy-associated CNS complications

Advances in cancer chemotherapy, particularly development of molecular target therapies based on cancer biology, have significantly improved survival for cancer patients. Targeted therapies display generally favorable toxicity profiles, but reports of severe toxicities as seen with previous chemotherapeutic drugs have been increasing recently. Antineoplastic drug-induced central nervous system injuries sometimes progress to life-threatening complications. In this article, progressive multifocal leukoencephalopathy and reversible posterior leukoencephalopathy syndrome, which have been reported in association with targeted therapies, are reviewed clinically, etiologically based on reports in the literature. Treating physicians should be aware of the importance of early recognition and institution of appropriate management for these complications to reduce the risk of permanent neurological sequelae.     

化疗药物对肿瘤细胞免疫原性的调变作用

目的 观察化疗药物对肿瘤细胞免疫原性的调变作用,探讨介导预处理化疗增效作用的机制.方法 MTT法筛选化疗药物5-氟尿嘧啶(5- Fluorouracil,5- FU)、顺铂(Cisplatin,DDP)、紫杉醇(Paclitaxel,PTX)、多西紫杉醇( Docetaxel,DTX)的体外高、中、低毒性浓度,将这些浓...     

Progressive multifocal leukoencephalopathy with detection of JC virus in a patient with chronic lymphocytic leukemia parallel to onset of fludarabine therapy

Along with the establishment of more intense chemotherapeutic regimens including fludarabine for the treatment of indolent lymphoproliferative diseases like chronic lymphocytic leukemia (CLL), an increasing amount of cases with progressive multifocal leukoencephalopathy (PML) due to JC virus have been observed. We report a patient with CLL who developed PML parallel to the onset of fludarabine therapy. Spinal fluid was tested positive for JC virus. Despite virostatic treatment with cidofovir, neurologic symptoms were progressive and the disease ultimately fatal. The present case suggests that immunosuppression caused by chronic lymphoproliferative malignancies alone may be a factor in the development of PML. Chemotherapy with fludarabine may act as an additional trigger. The question remains whether serologic screening for JC virus in patients with chronic lymphoproliferative disease undergoing intense chemotherapy might be valuable once sufficient antiviral treatment has been established.     

表阿霉素为主联合方案治疗非小细胞肺癌的临床观察

目的　观察表阿霉素为主的联合化疗方案治疗晚期非小细胞肺癌的疗效以及毒副反应。方法　应用含表阿霉素的EEP和CEP方案分别治疗晚期非小细胞肺癌。结果　 31例治疗的总有效率 41 9% ,不良反应主要为消化道和血液毒性 ,以及轻度的心脏毒性 ,老年病人及心电图轻度异常者仅 9 7%出现新的心电图异常改变。结论　含表阿霉素的联合化疗方案治疗晚期非小细胞肺癌的疗效较好 ,且较为安全 ,适合于老年患者及心电图轻度异常者。