Bandage contact lens augmentation of 5-fluorouracil treatment in glaucoma filtration surgery

The use of 5-Fluorouracil (5-FU) to inhibit scarring following filtration surgery has been hampered by corneal epithelial defects and their accompanying inflammation. This toxicity, which occurs during the crucial period in which the risk of bleb failure is highest, has previously been a relative contraindication to further 5-FU use. We have found the early placement of a therapeutic bandage contact lens permits extended administration of 5-FU during this period, minimizing discomfort and inflammation as well as enhancing bleb survival.     

Subconjunctival injection of 5-fluorouracil following trabeculectomy for congenital and infantile glaucoma.

Trabeculectomy and subsequent subconjunctival injections of 5-fluorouracil (5-FU) were performed in four eyes (two children) with congenital glaucoma. Each of these eyes had previously undergone either goniotomy, trabeculotomy, or both; these procedures, however, had failed to control intraocular pressure (IOP) and progressive optic nerve damage. Sixteen and a half months (+/- 1.5 months) after the trabeculectomy and 5-FU treatments, the IOP in these eyes was in the low teens and there was no evidence of further optic-nerve or visual-field deterioration. Although trabeculectomy has been shown to be unsuccessful in managing congenital glaucoma, when it is done with the adjunct of subconjunctival injections of 5-FU, it may be advisable in these cases after previous surgery has failed.     

Erbium:YAG Laser Pretreatment Accelerates the Response of Bowen''s Disease Treated by Topical 5-Fluorouracil

BACKGROUND: Topical 5-fluorouracil (5-FU) is a standard treatment for Bowen's disease. However, its efficacy may be limited by the presence of stratum corneum. The Er:YAG laser has shown a dramatic enhancement effect on the delivery of 5-FU in vitro by ablation of the stratum corneum. The efficacy of laser-assisted delivery of 5-FU has not been tested in human. OBJECTIVE: To see whether Er:YAG laser pretreatment can improve the efficacy of topical 5-FU in the treatment of Bowen's disease. METHODS: Three target lesions from a patient with multiple Bowen's disease were selected for a half-side comparison study. The Er:YAG laser was used to remove the cornified layer on one side of each lesion, followed by twice-daily application of 5-FU cream to both sides. Clinical and histologic responses were compared. RESULTS: Lesions pretreated with the Er:YAG laser showed more rapid clinical and histologic responses to topical 5-FU than those treated with 5-FU alone. Evaluation at 9 months after treatment showed no recurrences of lesions on both sides. CONCLUSIONS: Our preliminary study demonstrates that this Er:YAG laser-assisted modality is effective and shows accelerated clinical response and shortened treatment time compared with topical 5-FU as a single treatment.     

Complications of subconjunctival 5-fluorouracil following glaucoma filtering surgery

The antimetabolite 5-fluorouracil (5-FU) has been used to inhibit fibroblastic growth to increase the success rate in glaucoma filtration surgery. Subconjunctival 5-FU can have adverse side effects. This paper describes two cases in detail of the ocular side effects of 5-FU. The first case is representative of the ocular surface problems. The second case deals with bleb leaks. Relative contraindications to 5-FU treatment are pre-existing ocular surface problems, early postoperative bleb leaks and fornix-based conjunctival flaps in filtering procedures. New drug delivery methods are presently being investigated to help decrease the adverse side effects and increase the efficacy of 5-FU.     

介孔硅纳米颗粒负载氟尿嘧啶用于肝癌和乳腺癌治疗的研究

目的 为了提高抗肿瘤药物的治疗效果,有效降低毒副作用。方法 利用溶胶-凝胶法合成介孔硅纳米颗粒（MSN）,负载抗癌药物氟尿嘧啶（5-FU）,得到MSN@5-FU载药纳米材料。首先对MSN@5FU的物理特性进行表征,接下来考察MSN@5FU的载药量,生物相容性以及药物释放情况,最后研究体外杀死肿瘤细胞的效果。结果 电镜图可以清晰地观察到,合成的MSN是纳米级尺寸,大小均一,孔径分布明显。同时,合成的MSN具有很强的负载5-FU的能力。此外,该载药系统在溶液中可以长期稳定存在,对正常细胞无毒副作用。重要的是,在微酸环境下可以大量释放5-FU。活死细胞实验结果说明该纳米载药系统具有良好的杀死肿瘤细胞能力。结论 MSN@5FU纳米载药系统在肝癌和乳腺癌治疗中可以发挥重要作用。     

Comparative studies on absorption patterns of the drug after intrarectal administration of 5-FU emulsion and 5-FU solution

Intrarectal administration of 5-fluorouracil (5-FU) emulsion was compared experimentally with that of 5-FU solution as to the degree of absorption and tissue distribution. For the 5-FU levels in the rectal wall, the levels in the emulsion group remained at high levels during the 6 hour period after administration while the levels in the solution group decreased rapidly. For the 5-FU levels in the lymph nodes, those in the emulsion group were significantly higher (more than four times) and remained at relatively high levels for a longer period than those in the solution group. In the thoracic lymph, 5-FU levels in the emulsion group remained more than two times higher throughout the experimental period. The results suggest that preoperative intrarectal administration of 5-FU emulsion may be effective as an adjunct to surgery for rectal cancer with lymph node metastasis, because of the long duration of high concentration resulting in the rectal lymphatics and rectal wall.     

Radiostereometric analysis of the double-coated STAR total ankle prosthesis: a 3-5 year follow-up of 5 cases with rheumatoid arthritis and 5 cases with osteoarthrosis

Background The designs of total ankle prostheses have changed in recent years in order to give better performance. Only a few studies of these ankle prostheses have been published, however, and none on micromotion.

Patients and methods We evaluated 5 patients with rheumatoid arthritis and 5 with osteoarthosis, 4 (3-5) yearsafter arthroplasty with the double-coated STAR prosthesis.

Clinical examination included AOFAS hindfoot score. Standardized a-p and lateral radiographs were taken and RSA analyses were done at regular intervals.

Results There was no difference in results between ankles operated on due to rheumatoid arthritis and due to osteoarthrosis. A rapid initial migration was observed for the tibial components at 6 weeks, but thereafter all but 1 implant seemed stable. The migration pattern for the talar component was similar.

Rotation around the 3 axes was observed for the tibial components at 6 weeks, but not thereafter. The talar components became stable for rotation around the longitudinal and sagittal axes, but not around the transverse axis. 8 out of 10 ankles were painless. The median total AOFAS score was 83 and the median range of motion was 32°. None of the 20 components had changed position and there were no signs of bone resorption.

Interpretation Provided the indication is adequate and the prosthesis has been implanted correctly, the double-coated STAR ankle prosthesis will have a satisfactory fixation to underlying bone.     

联合应用华蟾素与氟尿嘧啶对胃癌细胞增殖抑制及诱导凋亡的作用

目的 探讨单一华蟾素体外对人胃癌细胞的增殖抑制和诱导凋亡作用以及与5-氟尿嘧啶（5-FU）联合应用对胃癌细胞的影响.方法 实验分为对照组;华蟾素（cino）组;5-FU组和cino＋5-FU组.利用体外细胞培养、倒置显微镜和荧光显微镜、MTT比色技术及流式细胞仪等方法,观察细胞形态,检测cino和5-FU对人胃癌细胞株BGC823细胞抑制率、细胞凋亡和细胞周期.结果 cino对人胃癌细胞有显著的增殖抑制作用,呈时间剂量依赖性.cino＋5-FU对BGC-823细胞的增殖抑制率显著高于单独使用组（P＜0.05）.定量分析显示cino＋5-FU组的凋亡细胞发生率显著高于cino组和5-FU组（P＜0.05）.cino＋5-FU可使G0/G1期细胞比例降低,S期细胞比例升高,且大多数被阻滞于S期.结论 cino对胃癌BGC-823细胞具有增殖抑制和诱导凋亡作用,与5-FU联用可显著提高后者的化疗效果,且呈时间剂量依赖关系.     

Basic experiments on oral administration of 5-fluorouracil emulsion as adjuvant chemotherapy to surgical treatment for gastric cancer

Oral administration of 5-fluorouracil (5-FU) emulsion was compared experimentally with that of 5-FU aqueous solution as to the degree of absorption and tissue distribution. After oral administration of both the 5-FU emulsion and the 5-FU solution, 5-FU was detected at the highest level in both the stomach and the duodenum. This seems to suggest that 5-FU is strongly affinitive to the tissues of the gastrointestinal tract. As to the relative concentration of these two forms of the drug, the oral administration of the 5-FU emulsion resulted in a maximum value 1.5 times higher than that of the 5-FU solution. An appreciable concentration of 5-FU was maintained for a considerably long time with the administration of 5-FU emulsion. In the lymph, the maximum level of the 5-FU emulsion was three times higher than that of the 5-FU solution. The drug concentration of the 5-FU emulsion remained higher than that of the 5-FU solution through the entire duration of the experiment. Regarding the drug concentration in the regional lymph nodes, the pattern demonstrated was almost the same as in the lymph itself. It is expected that the oral administration of 5-FU emulsion may be useful as an adjuvant to the surgical treatment of gastric cancer, because of the high drug concentration resulting both in the gastrointestinal tract and in the regional lymph nodes.     

Basic experiments on oral administration of 5-fluorouracil emulsion as adjuvant chemotherapy to surgical treatment for gastric cancer

Oral administration of 5-fluorouracil (5-FU) emulsion was compared experimentally with that of 5-FU aqueous solution as to the degree of absorption and tissue distribution. After oral administration of both the 5-FU emulsion and the 5-FU solution, 5-FU was detected at the highest level in both the stomach and the duodenum. This seems to suggest that 5-FU is strongly affinitive to the tissues of the gastrointestinal tract. As to the relative concentration of these two forms of the drug, the oral administration of the 5-FU emulsion resulted in a maximum value 1.5 times higher than that of the 5-FU solution. An appreciable concentration of 5-FU was maintained for a considerably long time with the administration of 5-FU emulsion. In the lymph, the maximum level of the 5-FU emulsion was three times higher than that of the 5-FU solution. The drug concentration of the 5-FU emulsion remained higher than that of the 5-FU solution through the entire duration of the experiment. Regarding the drug concentration in the regional lymph nodes, the pattern demonstrated was almost the same as in the lymph itself. It is expected that the oral administration of 5-FU emulsion may be useful as an adjuvant to the surgical treatment of gastric cancer, because of the high drug concentration resulting both in the gastrointestinal tract and in the regional lymph nodes.     

Ankle arthrodesis in rheumatoid arthritis: 30 cases followed for 5 years

We have reviewed the results of 30 ankle arthrodeses performed on 26 patients with rheumatoid arthritis. This procedure was associated with a high morbidity, with wound breakdown and infection occurring in 12 cases. Eighteen ankles had fused, six had pain-free fibrous union, and six required further surgery for nonunion. Clinical evaluation, at an average follow-up of 5 years, was based on a modified ankle-grading system with good or excellent results in 14, fair results in nine, and poor in two. Only 4 patients had some residual pain in the ankle, and so, despite the high complication rate, arthrodesis is an effective method of treating the painful, rheumatoid ankle.     

Ankle arthrodesis in rheumatoid arthritis: 30 cases followed for 5 years

We have reviewed the results of 30 ankle arthrodeses performed on 26 patients with rheumatoid arthritis. This procedure was associated with a high morbidity, with wound breakdown and infection occurring in 12 cases. Eighteen ankles had fused, six had pain-free fibrous union, and six required further surgery for nonunion. Clinical evaluation, at an average follow-up of 5 years, was based on a modified ankle-grading system with good or excellent results in 14, fair results in nine, and poor in two. Only 4 patients had some residual pain in the ankle, and so, despite the high complication rate, arthrodesis is an effective method of treating the painful, rheumatoid ankle.     

Ankle arthrodesis in rheumatoid arthritis. 30 cases followed for 5 years.

We have reviewed the results of 30 ankle arthrodeses performed on 26 patients with rheumatoid arthritis. This procedure was associated with a high morbidity, with wound breakdown and infection occurring in 12 cases. Eighteen ankles had fused, six had pain-free fibrous union, and six required further surgery for nonunion. Clinical evaluation, at an average follow-up of 5 years, was based on a modified ankle-grading system with good or excellent results in 14, fair results in nine, and poor in two. Only 4 patients had some residual pain in the ankle, and so, despite the high complication rate, arthrodesis is an effective method of treating the painful, rheumatoid ankle.     

Patellar Reconstruction Using Posterior Femoral Condyle: A 5-Year Follow-Up

A patient with rheumatoid arthritis presented to clinic with an increasingly painful knee. The patient had undergone patellectomy for patellofemoral arthritis 10 years previously. After knee arthroscopy showing extensive arthritic changes, it was decided to offer primary arthroplasty of the knee with patellar reconstruction using posterior lateral femoral condyle graft taken at the time of arthroplasty. The positive outcome from this case is encouraging and constitutes a further option in patients with prior patellectomy undergoing knee arthroplasty.     

氟尿嘧啶免疫聚乳酸纳米微粒抗肿瘤效应的研究

目的利用载氟尿嘧啶（5-FU）免疫聚乳酸（PEA）纳米微粒（NPs），观察其对严重联合免疫缺陷病（SCID）鼠人胃癌移植模型的治疗效应。方法超声乳化法合成的载5-FU的抗血管内皮生长因子（VEGF）单克隆抗体纳米微粒，建立SCID鼠人胃癌移植肿瘤模型，观察药物对高表达VEGF胃癌移植肿瘤模型的治疗效应及其不良反应。结果空白对照组、未载药空纳米微粒组、5-FU组（20mg／kg）、抗VEGF单克隆抗体-未载药空纳米微粒组、抗VEGF单克隆抗体组、载5-FU纳米微粒组、5-FU（20mg／kg）加抗VEGF单克隆抗体组及抗VEGF单克隆抗体-载5-FU纳米微粒组（20mg／kg）的抑瘤率分别为0、6．61％、24．26％、27．94％、35．29％、37．50％、39．71％和52．21％，且载5-FU的抗VEGF单克隆抗体纳米微粒组和未载药纳米微粒组的血白细胞数量及肝肾功能与空白对照组相比，差异无统计学意义（P〈0.05）；而含5-FU原药组血白细胞数量较空白对照组和抗VEGF单克隆抗体-载5-FU纳米微粒组下降34．43％和37．38％（P〈0.05）：而肝转氨酶升高93．17％和66．56％。治疗组与对照组癌细胞凋亡指数相比，以抗VEGF单克隆抗体．载5-FU纳米微粒组更为明显，差异有统计学意义（P〈0.05）；含抗VEGF抗体的实验组微血管密度明显低于含5-FU药组和对照组（P〈0.05）。结论载5-FU抗VEGF单克隆抗体纳米微粒可提高5-FU的抑瘤率，并通过抑制肿瘤的血管生成，诱导肿瘤细胞凋亡，增加疗效，有效降低5-FU的骨髓抑制和肝肾功能损害作用．是一种安全的新型药物纳米级靶向制剂。     

抗血管生成药物Endostatin和SU6668联合氟尿嘧啶对结肠癌的影响

目的探讨血管生成抑制剂Endostatin和SU6668联合氟尿嘧啶（5-FU）对结肠癌生长和转移的抑制作用，并探讨其作用机制。方法建立人结肠癌裸鼠原位种植转移模型。将60只荷瘤鼠随机分为5组，每组12只。种植12d后分别自腹腔内注射生理盐水（对照组）、Endostatin（E组）、SU6668（S组）、Endostatin加SU6668（E加S组）、Endostatin加SU6668加5-FU（E加S加F组），1次／d，共4周。种植后第6周末处死动物，测量原位肿瘤瘤重、抑瘤率和肿瘤微血管密度（MVD），观察肿瘤肝腹膜和区域淋巴结转移及腹水出现情况。结果对照组、E组、S组、E加S组、E加S加F组抑瘤率分别为0、64．9％、63．5％、76．4％和88．2％；MVD分别为（18．10±5．65）、（2．75±0．75）、（3．17±0．58）、（0．94±0．42）和（0．36±0．45）；腹膜转移率分别为90％、16．7％、25％、0和0；区域淋巴结转移率分别为90％、0、0、0和0。E组、S组、E加S组、E加S加F组与对照组相比，结肠癌生长和转移受到明显抑制（P〈0．05）；尤以E加S加F组明显（P〈0．01）。结论Endostatin和SU6668联合5-FU具有协同作用，能更有效地抑制结肠癌的生长和转移。     

Efficacy of rapamycin in patient with juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis (JRA) is an immune-mediated disease characterized by articular inflammation and subsequent tissue damage that may result in severe disability. Several combinations of drugs, including immunosuppressive agents have been used to control disease progression. Although there is no information available on rapamycin efficacy in JRA, it has demonstrated a potential to inhibit inflammatory processes observed in adult rheumatoid arthritis (RA). We present a 21 years old renal transplant recipient with JRA, primarily treated with tacrolimus and steroids, who achieved a long-term disease remission after introduction of rapamycin. As long as pathogenesis of JRA and RA is similar, we conclude that rapamycin could be promising immunosuppressant for patients after renal transplantation suffering from both JRA and RA.     

Arthroscopic synovectomy of the wrist

Arthroscopic synovectomy is safe and reliable, with mild postoperative morbidity. The rationale of a surgical synovectomy is to excise inflamed synovium and thereby, remove as much effusion and inflammatory substrate as possible. In most cases, arthroscopic synovectomy is performed as an outpatient procedure. The technique has also been used for other diagnoses causing wrist arthritis, but very few results have been reported and the indications remain to be defined. In rheumatoid arthritis (RA), juvenile chronic arthritis (JCA), systemic lupus erythematosus (SLE), and postinfectious monoarthritis, a long period of increased comfort and improved function can be anticipated.     

Regional injection of 5-fluorouracil and starch microspheres in colorectal cancer

Experiments were undertaken to examine the effect of degradable starch microspheres (DSM) on the local distribution of 5-fluorouracil (5-FU) given by mesenteric arterial injection. Tritiated 5-FU (200 microCi) was injected into the inferior mesenteric artery of 8 perfused specimens of human large bowel containing adenocarcinoma and the concentration of 5-FU in local tissues and venous effluent was measured by scintillation counting. Metabolites of 5-FU were detected by radiochromatography. DSM (6 X 10(7)/mean diameter 40 micron) were injected in suspension with 5-FU (n = 7) and separately: before (n = 7) and after 5-FU (n = 7). Specimens given DSM retained 20% more cytotoxic than specimens given 5-FU alone (p less than 0.05). The concentration of 5-FU in tissues next to the primary tumour was increased when DSM were given in suspension with 5-FU, but higher concentrations were obtained when DSM were given last (p less than 0.05). Low concentrations were produced when DSM were given first. Concentrations in tumour tissue were not significantly increased by DSM.     

A synopsis of surgery for rheumatoid arthritis (excluding the hand)

Over the years, orthopedic surgery has become more involved in the care of the rheumatoid patient. A more active and aggressive attitude by orthopedic surgeons has thrown new light on the handling of the rheumatoid patient. Currently, the surgical treatment of rheumatoid arthritis is evaluated not only by the outcome of a procedure on a single skeletal part but also by the generalized effects of the disease on the activity of the patient and the function of neighboring joints. Soft-tissue procedures, such as synovectomy and release operations, have been beneficial. Prosthetic surgery yields satisfactory results, and every effort should be made to give the rheumatoid patient as long a period as possible with relief of pain and increased mobility.