鼻内镜手术切除治疗38例鼻腔鼻窦恶性肿瘤的临床疗效

目的：对鼻内镜手术切除治疗鼻腔鼻窦恶性肿瘤的临床疗效进行探讨。方法对我院2010年1月至2013年1月收治的在鼻内镜下切除38例鼻腔鼻窦恶性肿瘤患者的临床资料进行回顾性分析。结果术中出血100～350mL,平均220mL,无术中死亡,无严重并发症。术后鼻内镜检查及鼻窦CT或MRI检查证实38例患者肿瘤全部切除,手术成功率100％。所有患者随访14～38个月,2例筛窦鳞状细胞癌中1例6个月后因心肌梗死死亡,1例16个月后脑转移死亡;2例恶性黑色素瘤患者中1例术后13个月死于脑转移,1例10个月后出现局部复发,再次鼻内镜手术,随访至今未见复发;1例腺样囊性癌患者术后19月个后复发、1例秀神经母细胞瘤术后29个月复发、1例软骨肉瘤14个月后局部复发,均再次鼻内镜下手术,随访至今未复发,其余31例随访至今未见复发。结论鼻内镜手术治疗鼻腔鼻窦恶性肿瘤有效、创伤小、恢复快,对提高患者生存质量有重要意义,但应注意手术适应症。     

鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎65例疗效分析

目的探讨鼻内镜下鼻腔泪囊造孔术的手术方法和临床效果。方法对65例(68眼)患者采用鼻内镜下泪囊鼻腔造口术治疗慢性泪囊炎,同期行鼻内镜下手术治疗鼻腔疾病,随诊观察6个月以上。结果 58例治愈,5例好转中有2例术后1年后息肉复发。治愈率为89%,总有效率100%。结论鼻内镜下鼻腔泪囊造孔术是治疗慢性泪囊炎的切实可行的手术方法。     

鼻内镜下切除鼻腔鼻窦内翻性乳头状瘤的临床分析

目的探讨经鼻内镜手术切除鼻腔鼻窦内翻性乳头状瘤的疗效。方法对2002年6月～2007年6月笔者所在医院在鼻内镜下切除鼻腔鼻窦内翻性乳头状瘤11例患者和同期行鼻侧切开术治疗鼻腔鼻窦内翻性乳头状瘤11例患者进行回顾性比较研究。所有患者系Ⅰ期和Ⅱ期病例。结果在鼻内镜下治疗的11例患者中,10例一次性手术完全切除,1例15个月复发再手术治愈。在鼻侧切开术下治疗的11例患者中1例恶变,6例一次性手术完全切除,2例术后发现残留,予以微波处理,2例分别手术后6个月和12个月复发,均再手术治愈。所有病例均随访3年,均未再复发。结论内镜下切除鼻腔鼻窦内翻性乳头状瘤,具有视野清晰、损伤小、面部无瘢痕、患者康复快,术后换药方便等特点。     

手术防粘连液预防小儿经鼻内镜腺样体切除术后鼻腔粘连的疗效观察

目的 探讨手术防粘连液预防小儿经鼻内镜腺样体切除术后鼻腔粘连的临床效果.方法 选择患小儿腺样体肥大,经鼻内镜腺样体切除术患儿118例,随机分为观察组63例和对照组55例,观察组术后予鼻用糖皮质激素加用手术防粘连液,对照组仅予鼻用糖皮质激素,随访6个月,比较2组术后出现鼻腔粘连的情况.结果 观察组出现鼻腔粘连2例（3.2％）,对照组出现鼻腔粘连8例（14.5％）,2组比较差异有统计学意义（P＜0.05）.结论 手术防粘连液能有效预防小儿经鼻内镜下腺样体切除术后出现鼻腔粘连.值得临床推广应用.     

21例鼻内翻性乳头状瘤手术治疗效果观察

目的：探讨手术治疗鼻和鼻窦内翻性乳头状瘤的效果及术式选择。方法：回顾性分析在鼻内镜下功能性鼻腔、鼻窦手术或者柯-陆手术＋鼻内镜下鼻腔鼻窦手术联合径路行鼻内翻性乳头状瘤切除的资料。结果：21例中6例失访,其余病例随访观察6—36个月,除1例因放疗后出现鼻腔粘连,其余均无复发。结论：彻底切除肿瘤,减少对邻近部位侵袭的发生。术后密切随访是降低术后复发率的重要措施。     

气管、支气管腺样囊性癌4例临床分析

目的 探讨气管、支气管腺样囊性癌的临床特征、诊断和治疗方法.方法 回顾性分析4例气管、支气管腺样囊性癌的诊治过程,均为女性,年龄37～65岁.2例为气管腺样囊性癌,2例为支气管腺样囊性癌.结果 4例均在我院明确诊断,并进行了包括内镜下介入、手术、放疗等有效的治疗,存活至今.结论 大气道腺样囊性癌是临床少见病,诊断时需要提高警惕,采用多种联合治疗可提高存活率.     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术临床分析

目的探讨鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术的方法及效果。方法回顾分析65例患者的临床资料。结果本组65例患者均完整切除肿瘤,症状消失,术后无明显并发症发生。本组患者术后经病理诊断均为内翻性乳头状瘤。于术后6个月内按鼻内镜常规要求换药,并定期复查。全部患者随访1~4年,其中6例在随访期第3年复发,均为侵犯上颌窦肿瘤,再次手术后未有复发。2例在第4年复发,手术切除病理报告为肿瘤恶变,行鼻侧切开术切除肿瘤,术后配合放疗,目前患者状况较好。结论鼻内镜下切除肿瘤创伤小,并发症少,可同时处理鼻腔及鼻窦的其他病变,术后随访简单易行。单纯采用鼻内镜手术时,要选择好适合病例,对病变范围广泛,手术难度大,鼻内镜下联合其他方法治疗是较好的选择。     

经鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的临床研究

目的：观察经鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的临床疗效。方法：选择2010年4月-2011年4月收治的经常规治疗方法无效的慢性泪囊炎患者36例（41眼）,在局麻鼻内镜下行泪囊鼻腔造口术。随访6～12个月。结果：本组36例（41眼）手术均顺利完成,其中治愈33例,好转2例,无效1例,总有效率为91．67％。均未出现明显手术并发症。结论：经鼻内镜下鼻腔泪囊造口术对慢性泪囊炎治疗有较高的疗效,术中准确定位泪囊在鼻内的解剖部位是鼻内镜下鼻腔内造口术手术成功的关键。     

头颈部腺样囊性癌患者的预后及其影响因素分析

目的分析头颈部腺样囊性癌患者的预后及其影响因素。方法回顾性分析2004-2012年我院收治的55例头颈部腺样囊性癌患者的临床资料,其中单纯手术30例,手术加术后放疗22例,放化疗1例,单纯放疗2例,接受化疗15例。接受化疗的15例患者中初治后发生转移行化疗12例,术后同步化放疗2例,同期放化疗1例。采用Kaplan-Meier法和Logrank检验分析其临床疗效和预后情况。结果 55例患者的随访率为96%,中位随访时间46个月。3年、5年总生存率分别为89.8%、77.3%,无远处转移生存率分别为81.8%、35.9%,无局部区域失败生存率分别为79.1%、56.3%。单因素分析显示T分期、术后放疗和手术切缘与总生存率相关(P<0.05),手术切缘和术后放疗与无局部区域失败生存率相关(P<0.05)。多因素分析显示T分期是总生存率的独立影响因素(P=0.005),手术切缘是无局部区域失败生存率的独立影响因素(P=0.047)。结论头颈部腺样囊性癌治疗应尽量手术根治切除,局部晚期推荐手术及放疗综合治疗。     

青少年腺样体及下鼻甲肥大微创治疗的临床研究

目的:探讨青少年腺样体及下鼻甲肥大微创治疗的方法及疗效.方法:对32例患者在鼻内镜下行腺样体及下鼻甲肥大的等离子消融治疗,随访6个月,观察患者的临床症状、鼻内镜及CT榆查情况.结果:32例患者全部治愈,总有效率100%,无任何并发症.结论:鼻内镜下行腺样体肥大及下鼻甲肥大的等离子消融手术直观、清晰、微创,术后并发症少,能最大限度保护鼻腔鼻咽黏膜及生理功能,值得推广应用.     

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.     

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.     

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.