动脉化疗栓塞术对小儿肾母细胞瘤细胞凋亡和增殖的影响

目的探讨动脉化疗栓塞术(TACE)对肾母细胞瘤(WT)细胞凋亡指数(AI)和细胞增殖指数(PI)的影响,并评价其在临床治疗中的地位。方法将24例肾母细胞瘤患儿按临床分期、病理分型进行配对设计研究,设动脉化疗栓塞组12例,全身化疗组12例,采用TUNEL法和免疫组织化学超敏二步法测定标本的细胞凋亡指数和细胞增殖指数。结果动脉化疗栓塞组AI高于全身化疗组(P<0.05),PI低于全身化疗组(P<0.05),AI与PI成负相关(P<0.05),动脉化疗栓塞组术后瘤体缩小,坏死程度高于全身化疗组(P<0.05),而骨髓抑制少(P<0.05)。结论与全身化疗组相对比,术前采用动脉化疗栓塞法能更有效地诱导肿瘤细胞凋亡,抑制肿瘤细胞增殖,促使肿瘤缩小、坏死,有利于手术根治,取得更好的疗效,提高生存率。     

The adolescent thalassemic. The complicant rebel

Chronic hereditary conditions are expected to have a strong influence on the psychosocial development of the adolescent. Thalassaemia major is the commonest of these disorders in Mediterranean countries. In the past it was rarely seen in adolescence because the majority of patients died in childhood. The availability of treatment has allowed survival but the optimum treatment is difficult, especially chelation which consists of daily subcutaneous infusions of 10 hours duration. The adolescent patient must achieve social independence while he/she has a dependency on family, doctors and nurses and a need to strictly adhere to a difficult regime. Non-adherence will result in complications and possible fatality. Family and caretakers may become overprotective. Short stature, bone deformities and poor sexual development influence self image and self confidence. The purpose of this paper is to examine how various published studies have viewed the adolescent with Thalasaemia and to draw conclusions about the necessity for supportive services for the patients and their families. Earlier studies gave emphasis to negative psychosocial trends such as dysphoric moods, dependency, low self esteem, fears, anxiety etc. These were attributed to family stresses and over-protectiveness as well as the condition. Other studies from centers in Italy mainly, have demonstrated normal psychosocial development with better social adjustment than normal peers. Recently published data suggest that Italian patients are more compliant to treatment compared to Greek and Cypriot patients. This may be due to better psychosocial support. The need for such support is emphasized as is the need for training of doctors and nurses dealing with Thalassaemia major patients.     

The Guillain-Barré syndrome. The clinico-electrophysiological correlations

The authors refer about clinico-electrophysiological correlations in children with Guillain-Barré syndrome (GBS). The dates confirm the diagnostic and prognostic value of electrodiagnostic studies in GBS, so that the authors suggest an electrodiagnostic protocol. According to the authors, independently of the extent of electrophysiological abnormalities, young age has a favourable influence on the restoration of conduction abnormalities and on the evolution of damage to peripheral neurones.     

The interleukins

In this review we have summarized the large mass of information that has accumulated in recent years relative to the heterogeneous group of molecules known as the interleukins (IL), the lymphokines, and the cytokines that control the growth and differentiation of cells of the hematopoietic and lymphoid lineage and cells of other lineages. Our intent is to provide the informed generalist with a body of information with which to interpret and understand forthcoming studies of this important class of molecules, particularly those with clinical import.     

The glomerulonephritides

The glomerulonephritides are a group of conditions characterized by inflammation primarily within the renal glomerulus. The main clinical features are haematuria, hypertension and reduced renal function. Oedema and proteinuria are common. The severity varies from asymptomatic to catastrophic renal failure. Careful evaluation is required in order accurately to determine the correct diagnosis and treatment.     

The autopsy

In France, Caillavet's law sets the conditions required for autopsy and organ removal. Despite the liberal conditions of this law, the autopsy rate is becoming rare. Other obstacles exist, in particular, religious beliefs in the case of islamic and jewish people. The final decision rests with the family although this decision may be influenced by the physician, if the family can be convinced of the importance of such an examination.