两种化疗方案超选择动脉灌注治疗颅内恶性肿瘤的疗效及并发症比较

目的：比较表阿霉素（组）、长春新碱（组）分别联合卡铂、VP16超选择动脉灌注化疗治疗脑恶性肿瘤的疗效及并发症。方法：超选择动脉灌注化疗治疗脑恶性肿瘤30例，随机使用表阿霉素（组）、长春新碱（组）分别联合卡铂、VP16治疗并比较其疗效。结果：两组有效率（CR＋PR）分别为55．6％（10／18）和58．3％（7／12）(P＞0．05），均无严重并发症。结论：两组联合治疗方案的疗效相当，但表阿霉素组脱发更为明显，且价格昂贵，临床应用受一定限制。     

Chemotherapy of malignant brain tumours: principles, difficulties, results and strategies (author's transl)

Long-lasting therapeutic results have not yet been reached in brain tumour chemotherapy. Mean survival rates in patients with malignant gliomas (glioblastoma multiforme, astrocytoma III-IV) can only be increased for a few months, even with the administration of alkylating nitrosourea derivatives which are in common use these days. In addition to general difficulties of chemotherapy, the well-protected site of the target organ, the brain, is responsible for that fact. This organ has special barrier mechanisms which reduce environmental influences; furthermore the kinetics of brain tumour cells and the interaction of pharmacological agents and tumourous cells are only scarcely known. Finally there are difficulties in the comparison of different samples because criteria of sampling are not always identical and an unequivocal terminology is not used in brain tumour classification. Nevertheless there has been some therapeutic progress after the introduction of urea derivatives into brain tumour chemotherapy, be it as single agent, combination or adjuvant chemotherapy. There is apparently an increase in long-time survivors indicating the effectiveness of the chemotherapeutic scheme in use. Own results with 5 different protocols confirm this tendency. Certain cases with correlations between Ct and post mortem findings are presented. Results and conclusions are discussed.     

Polycystic ovary (Stein-Leventhal) syndrome: etiology, complications, and treatment.

Polycystic ovary syndrome (PCOS) occurs in approximately 3% to 5% of the female population and may be the leading cause of infertility in those of reproductive age. PCOS presents clinically with a variety of signs and symptoms; the most common being menstrual irregularities, hyperandrogenism, infertility, and obesity. The true pathophysiology has not been clearly elucidated; however, there is growing agreement that gonadotropin dynamic dysfunction, hyperandrogenism, and insulin resistance are key features. The diagnosing of PCOS involves radiologic and laboratory studies. Radiologic studies typically include pelvic ultrasound; laboratory data should be obtained regarding pertinent gonadotropins and other hormone levels. PCOS is not a benign condition. It may lead to complications involving glucose metabolism, dyslipidemias, cardiovascular disease, and cancer. The goals of treatment should focus on restoring menstrual regularity, decreasing androgen excesses, and decreasing insulin resistance.     

Interstitial laser photocoagulation under ultrasound guidance of liver tumors: results in 104 treated patients.

Objective: To evaluate the efficacy and complications of interstitial laser photocoagulation (ILP) under ultrasound (US) guidance as a technique for focal ablation of liver tumors in patients with normal and impaired hepatic function. Patients and Methods: A total of 104 patients, 77 with 85 nodules of hepatocellular carcinoma on cirrhosis (29 in Child-Pugh A class, 43 in B e 5 in C class) and 27 patients with hepatic metastases (25 from colon, two from lung carcinoma) underwent ILP under US guidance. Depending on tumor size up to four needles were inserted in the tumor and multiple laser illuminations were performed in one or multiple sessions. Necrosis of the nodules was evaluated with triphasic contrast-enhanced CT. Results: Ninety-four patients underwent a single ILP session and nine patients two sessions. CT showed complete necrosis in 70 out of 85 HCC nodules in 65 treated patients and in 24 out of 31 patients with metastases. Three Child C class patients dropped out the control of efficacy by CT because of severe liver failure associated in one case with transient paralytic ileum. One of these patients died 2 months after treatment. Two patients with metastasis dropped the completion of the treatment because of complication occurred after the ILP session (one paralytic ileum, one gastric haemorrage). Conclusions: ILP under US guidance is effective in inducing complete necrosis in small and large liver tumors. Nevertheless, ILP can cause severe derangement of liver function in patients with advanced cirrhosis.     

Intrinsicality: reconsidering spirituality, meaning(s) and mandates.

Canadian occupational therapists have placed spirituality as the central core of their theoretical Model, depicting inner and outer selves that contradict simultaneous declarations concerning the integration of mind/body/spirit. Even the word spirituality has discrepant meanings and failure to articulate one chosen meaning leads to ambiguity. This paper argues that occupational therapists must agree upon a single definition of spirituality that is congruent with our professional mandate and philosophical perspective; and that prevention of misunderstandings between and amongst clients and other health care professionals demands recourse to our own terminology. It is proposed that intrinsicality be employed to articulate the personal philosophy of meaning with which we interpret our lives. Influenced by environmental context and in homeostatic relationship with the body and mind, intrinsicality constitutes the essence of the self and informs occupational choices based upon personal values and priorities. Acknowledgement of intrinsicality respects the uniqueness of individuals' meanings.     

嘧啶核苷磷酸化酶在恶性肿瘤中的表达及意义

目的　观察嘧啶核苷磷酸化酶 (PyNPase)在胃癌和乳腺癌组织中的表达 ,并探讨其与肿瘤病理类型、转移及预后的关系。方法　应用免疫组化方法观察胃癌组织 4 0例、乳腺癌组织 4 4例及正常组织 12例 (6例胃黏膜组织、6例乳腺组织 )中PyNPase的表达。结果　PyNPase在胃癌及乳腺癌组织中表达的阳性率为 10 0 % ,明显高于正常胃黏膜及乳腺组织中的表达 (33 3%和 16 7% ) (P <0 0 1) ;在不同病理类型肿瘤中PyNPase的表达差异不显著 (P>0 0 5 ) ;在发生淋巴结转移的胃癌及乳腺癌组织中 ,PyNPase的强阳性表达率分别为 5 0 %和 5 7 9% ,而在未发生转移的癌组织中强阳性表达率分别为 13 6 %和 8% ,二者差异显著 (P <0 0 5 ) ;在术后生存 <5年的病例中 ,PyNPase的强阳性表达率为 5 4 5 % ,生存 >5年的病例为 7 8% ,两者差异极显著 (P <0 0 1)。结论　PyNPase在肿瘤组织中表达明显增高 ,与肿瘤的转移及预后密切相关。     

Imaging of gynecological disease (2): clinical and ultrasound characteristics of Sertoli cell tumors, Sertoli-Leydig cell tumors and Leydig cell tumors.

OBJECTIVE: To describe the clinical history and ultrasound findings in women with ovarian Sertoli cell, Sertoli-Leydig cell and Leydig cell tumors. METHODS: Women with a histological diagnosis of Sertoli cell tumor, Sertoli-Leydig cell tumor or Leydig cell tumor who had undergone preoperative ultrasound examination were identified from the databases of each of three participating ultrasound centers. The tumors were characterized on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions published by the International Ovarian Tumor Analysis (IOTA) group. In addition, all images were reviewed and described using pattern recognition. RESULTS: Of 22 patients identified, 15 had Sertoli-Leydig cell tumors, two had Sertoli cell tumors and five had Leydig cell tumors. Four patients were postmenopausal, one 48-year-old woman had undergone hysterectomy, 16 were of fertile age and one was a 4-year-old girl. Most patients (82%, 18/22) had endocrine symptoms, the most common being bleeding disturbance (64%, 14/22) and hirsutism (32%, 7/22). Twenty-two (96%) of 23 tumors (one woman had bilateral tumors) contained a solid component; 16 (70%) were purely solid. Pattern recognition showed that the Leydig cell tumors were small solid tumors (four of five had a largest diameter of 1-3 cm) and the two Sertoli cell tumors were somewhat larger solid tumors (4 cm and 7 cm); the Sertoli-Leydig cell tumors were either small (3-4 cm) or medium-sized (6-7 cm) solid tumors, or multilocular solid tumors of any size (3-18 cm) with purely solid areas mixed with areas of innumerable closely packed small cyst locules. CONCLUSIONS: On the basis of endocrine symptoms, the woman's age and ultrasound findings, it should be possible to suggest a correct preoperative diagnosis of Sertoli cell, Sertoli-Leydig cell or Leydig cell tumors in many cases.     

Co(ii), Ni(ii), Cu(ii) and Cd(ii)-thiocarbonohydrazone complexes: spectroscopic,DFT, thermal,and electrical conductivity studies

New and stable coordinated compounds have been isolated in a good yield. The chelates have been prepared by mixing Co(ii), Ni(ii), Cu(ii), and Cd(ii) metal ions with (1E)-1-((6-methyl-4-oxo-4H-chromen-3-yl)methylene)thiocarbonohydrazide (MCMT) in 2 : 1 stoichiometry (MCMT : M²⁺). Various techniques, including elemental microanalyses, molar conductance, thermal studies, FT-IR, ¹H-NMR, UV-Vis, and XRD spectral analyses, magnetic moment measurements, and electrical conductivity, were applied for the structural and spectroscopic elucidation of the coordinating compounds. Further, computational studies using the DFT-B3LYP method were reported for MCMT and its metal complexes. MCMT behaves as a neutral NS bidentate moiety that forms octahedral complexes with general formula [M(MCMT)₂Cl(OH₂)]Cl·XH₂O (M = Cu²⁺; (X = ½), Ni²⁺, Co²⁺; (X = 1)); [Cd(MCMT)₂Cl₂]·½H₂O. There is good confirmation between experimental infrared spectral data and theoretical DFT-B3LYP computational outcomes where MCMT acts as a five-membered chelate bonded to the metal ion through azomethine nitrogen and thiocarbonyl sulphur donors. The thermal analysis is studied to confirm the elucidated structure of the complexes. Also, the kinetic and thermodynamic parameters of the thermal decomposition steps were evaluated. The measured optical band gap values of the prepared compounds exhibited semiconducting nature. AC conductivity and dielectric properties of the ligand and its complexes were examined, which showed that Cu(ii) complex has the highest dielectric constant referring to its high polarization and storage ability.

New and stable coordinated compounds have been isolated in a good yield.     

An HPLC-ECD procedure for measuring total phenolsulfotransferase (PST) activity in human liver, platelets and blood

The phenolsulfotransferase (PST) activity in human liver, platelets and blood was measured under saturating concentrations of the conjugating agent, 3'-phosphoadenosine-5'-phosphosulfate (PAPS). Conventional PST assays employ PAP35S at suboptimal concentrations. In addition, the sulfate conjugate formed, namely N-acetyldopamine-sulfate (NADA-sulfate) was quantified directly by high-pressure liquid chromatography cum electrochemical detection (HPLC-ECD). NADA, the biogenic amine acceptor used in this study appeared from kinetic data to be a substrate of both the P and M forms of PST when used in micromolar concentration. Two apparent Km values of 4.2 mumol/l and 22.6 mumol/l were observed. In contrast, only one apparent Km value was evident when the assay was carried out in the presence of 2,6-dichloro-4-nitrophenol (DCNP), a selective inhibitor of the P form of PST or after heat treatment under specified conditions which inactivates the M form of PST. Thus measurement of PST activity with NADA as the acceptor substrate permits the determination of total PST activity and a parallel assay with the inclusion of DCNP would distinguish the two variants of PST, both of which appear to be present in all human tissues.     

A new procedure for the visualization of multiple forms of gamma-glutamyl transferase (GGT) results in normals, patients receiving enzyme-inducing drugs and patients having liver parenchymal lesions

The activity of gamma-glutamyl transferase (GGT, EC 2.3.2.2) in sera of 68 healthy individuals, of 38 patients receiving anti-epileptic drugs, and of 27 patients having liver parenchymal lesions, was visualized after electrophoresis on cellulose-acetate gel using the $\text{substrate}\text{γ-}\text{l}\text{-}\text{glutamyl}\text{-p-}\text{nitroanilide}$ as a new colour reagent.The liberated p-nitroaniline was converted in situ into a lilac-coloured product using the Bratton-Marshall reaction.In most samples two bands were demonstrated, one located between albumin and α₁-globulin, called GGT 1, the other located in the α₂-globulin region, GGT 2. In a few samples a third band, GGT 3, with far less activity than the other bands, occurred in the β-globulin region.When it occurred, an increase in total GGT activity was mainly due to an increase of GGT-1 activity.The possible role of the determination of GGT-1 activity as a monitor of microsomal enzyme induction is discussed.     

Clinical response to statins: Mechanism(s) of variable activity and adverse effects

Abstract

Statins represent a major advance in the treatment of hypercholesterolemia, a significant risk factor for atherosclerosis. There is, however, notable interindividual variation in the cholesterolemic response to statins, and the origin of this variability is poorly understood; pharmacogenetics has attempted to determine the role of genetic factors. Myopathy, further, has been reported in a considerable percentage of patients, but the mechanisms underlying muscle injury have yet to be fully characterized. Most statins are the substrates of several cytochrome P450s (CYP). CYP polymorphisms may be responsible for variations in hypolipidemic activity; inhibitors of CYPs, e.g. of CYP3A4, can significantly raise plasma concentrations of several statins, but consequences in terms of clinical efficacy are not uniform. Pravastatin and rosuvastatin are not susceptible to CYP inhibition but are substrates of the organic anion-transporting polypeptide (OATP) 1B1, encoded by the SLCO1B1 gene. Essentially all statins are, in fact, substrates of membrane transporters: SLCO1B1 polymorphisms can decrease the liver uptake, as well as the therapeutic potential of these agents, and may be linked to their muscular side-effects. A better understanding of the mechanisms of statin handling will help to minimize adverse effects and interactions, as well as to improve their lipid-lowering efficiency.     

Clinical response to statins: mechanism(s) of variable activity and adverse effects

Statins represent a major advance in the treatment of hypercholesterolemia, a significant risk factor for atherosclerosis. There is, however, notable interindividual variation in the cholesterolemic response to statins, and the origin of this variability is poorly understood; pharmacogenetics has attempted to determine the role of genetic factors. Myopathy, further, has been reported in a considerable percentage of patients, but the mechanisms underlying muscle injury have yet to be fully characterized. Most statins are the substrates of several cytochrome P450s (CYP). CYP polymorphisms may be responsible for variations in hypolipidemic activity; inhibitors of CYPs, e.g. of CYP3A4, can significantly raise plasma concentrations of several statins, but consequences in terms of clinical efficacy are not uniform. Pravastatin and rosuvastatin are not susceptible to CYP inhibition but are substrates of the organic anion-transporting polypeptide (OATP) 1B1, encoded by the SLCO1B1 gene. Essentially all statins are, in fact, substrates of membrane transporters: SLCO1B1 polymorphisms can decrease the liver uptake, as well as the therapeutic potential of these agents, and may be linked to their muscular side-effects. A better understanding of the mechanisms of statin handling will help to minimize adverse effects and interactions, as well as to improve their lipid-lowering efficiency.     

Defecography: I. Description of a new procedure and results in normal patients

To solve frequently encountered clinical problems in the anorectal area, we have developed a simplified dynamic method of defecography. A radiopaque substance, the consistency of normal stools, is introduced into the rectum and the patient is then seated on a specially designed seat composed of superposed air chambers which, for technical reasons, are filled with water. The movements induced by evacuation of the rectum are recorded using 100-mm ampliphotography. After recording findings in 56 normal patients, we are able to define 5 criteria for “normal”: increase in anorectal angulation, obliteration of the impression of the puborectal muscle, wide opening of the anal canal, total evacuation of the rectal contents, and normal resistance of the pelvic floor. The mean value of the anorectal angle (ARA) was 91.96° (±1.52 SEM) at rest and 136.76° (±1.51 SEM) during straining. The increase of ARA during straining is 44.8°.     

Spinal cord stimulation in chronic pain: evaluation of results, complications, and technical considerations in sixty-nine patients.

Sixty-nine patients undergoing spinal cord stimulation (SCS) were studied for a period of up to 8 years. Indications, implantation techniques, and stimulation systems are presented in this article. Pain-suppressor effects of SCS are reviewed, assessing the clinical efficacy over time as well as complications with the stimulation device. Immediately following implantation, inadequate pain relief was noted in 20% of the patients. Decrease of the efficacy of pain alleviation occurs during the first 3 years after implantation. Most failures are noted in patients presenting with failed back surgery. This study also demonstrates that SCS systems should offer the capability of both monopolar and bipolar stimulation modes by the use of multipolar electrodes.     

空回肠交界处巨大憩室恶性间质瘤临床病理观察

目的探讨小肠憩室恶性间质瘤的影像学和临床病理学特征。方法对1例小肠憩室恶性间质瘤进行影像学、临床病理及免疫组化观察,并进行文献复习。结果患者男性,33岁。手术标本呈囊实性,与肠腔相通。组织形态镜下瘤细胞主要由梭形和少许上皮样细胞组成。梭形瘤细胞排列呈束状、编织状、栅栏状;上皮样瘤细胞呈小巢片状分布在梭形瘤细胞之间。免疫组化CD117、CD34、S-100、desmin、SMA和NSE均为( )。结论胃肠间质瘤(GIST)可发生于从食管至肛门的胃肠道全长范围内,但是小肠憩室伴发恶性间质瘤十分罕见,临床症状无特殊规律性,极易误诊,诊断有赖于影像学、临床病理和最具特征的免疫组化检查。