经尿道等离子汽化电切术治疗浅表膀胱肿瘤57例效果观察

Objective To evaluate the clinical efficacy of the bipolar plasmakinetic system in transurethral resection for bladder tumors (TURBt). Methods 57 patients aged 38 to 82 (42 male and 15 female; mean age, 58.2 years) with bladder tumors were treated by the bipolar plasmakinetic system. Single tumor was noted in 38 patients and multiple tumors in 19. Results All the patients received only one TURBt. The mean operation time was 22 min and mean hospital stay was( 5 ± 0.36 )days. 55 patients were followed up and 2 were lost. 12 patients relapsed within 24 months of follow-up. 8 had to receive second transurethral resection and 4 required radical cystectomy. Conclusions The bipolar plasmakinetic system in TURBt is minimally invasive, effective and safe.     

经尿道前列腺电汽化术

Forty-four cases of benign prostate hyperplasia were underwent using transurethral electrovaporization of prostate (TUVP). The average age of the patients was 71.3,and the mean operation time was 55min. The mean indwelling catheter time was 54h, capable of voiding fredy after the removal of the catheter. International prostate symptom score(I-PSS) dropped from 28.9 before the procedure to 7.2 postoperatively. Q_max increased from 4.9ml/s to 18.3ml/s. Neither transurethral resection syndrome nor severe bleeding occurred in the patients. TUVP was daimed to be effective and safe with less bleeding and few complications and less trauma to the patients     

Influence of renal failure,rheumatoid arthritis and old age on the pharmacokinetics of diflunisal

Summary The single-dose plasma kinetics of diflunisal was studied in healthy young and old subjects, in patients with rheumatoid arthritis, and in patients with renal failure. The plasma and urine kinetics of the glucuronidated metabolites of diflunisal were studied in the healthy elderly subjects and in the patients with renal failure. In addition, the multiple-dose plasma kinetics of diflunisal was assessed in healthy volunteers and in patients with rheumatoid arthritis. After a single dose of diflunisal the terminal plasma half-life, mean residence time and apparent volume of distribution were higher in elderly subjects than in young adults. No difference was observed in any pharmacokinetic parameter between age-matched healthy subjects and patients with rheumatoid arthritis. The elimination half-life of unchanged diflunisal was correlated with the creatinine clearance (r=+0.89) and its apparent total body clearance exhibited linear dependence on creatinine clearance (r=+0.78). In patients with renal failure, the terminal plasma half-life and mean residence time of diflunisal were prolonged. The renal and apparent total body clearances were lower, the mean apparent volume of distribution was higher and the mean area under the concentration-time curve extrapolated to infinity (AUC) was greater in the renal failure patients than in controls. The plasma concentration of the glucuronidated metabolites rapidly rose to levels above those of unchanged drug in renal patients, whereas they were lower than those of unchanged diflunisal in controls. The AUC (0–96 h) of diflunisal glucuronides in the patients was four-times that in controls, and the terminal elimination half-life of the glucuronides was prolonged in them. The renal excretion and clearance of diflunisal glucuronides were reduced when renal function was impaired. After multiple dosing, the pre-dose steady-state plasma-concentration increased with decreasing creatinine clearance (r=-0.79). When the plasma concentration exceeded 200 μmol·1⁻¹, the elimination half-life was doubled, due to partial saturation of diflunisal conjugation. This finding suggests that lower doses could be used in long-term treatment. Thus, old age and arthritic disease appear to have little influence on the kinetics of diflunisal in the absence of renal functional impairment. Ordinary doses can be given for short term treatment of elderly patients with or without RA. In patients with renal failure, however, reduced doses of diflunisal are recommended.     

经尿道钬激光膀胱部分切除术与膀胱肿瘤电切术的护理比较

目的 对比经尿道钬激光膀胱部分切除术与膀胱肿瘤电切术的护理.方法 将膀胱肿瘤需行手术治疗的88例患者按手术方法不同分为钬激光肿瘤治疗组(钬激光组)45例和经尿道膀胱肿瘤电切术(TURBt组)43例,统计并分析手术时间、术后持续膀胱冲洗时间、膀胱痉挛发生次数、手术后住院日等.结果 钬激光组患者术中出血量、术后住院天数、持续膀胱冲洗时间、术后留置尿管时间和膀胱痉挛发生次数等方面均优于TURBt组患者[分别为(4.8±4.6)ml比(10.2±4.9)ml;(1.1±1.0)d比(1.8±1.1)d;(3.1±1.2)d比(6.0±1.3)d;(5.0±1.6)d比(5.9±1.4)d;(1.5±1.1)次比(5.0±2.4)次].结论 经尿道钬激光膀胱部分切除术具有创伤小、出血少、恢复快等优势,在治疗效果相近的前提下减轻了患者的痛苦,降低了护理难度,提高了医疗护理工作效率.

Abstract：

Objective To compare the pest operative nursing outcomes between holmium laser resection and transurethral resection of bladder tumors. Methods Totally 45 cases were randomly assigned to undergo holmiam laser resection of bladder tumors (HoLRBT) and 43 cases had standard transurethral resection. The operationtime, duration of bladder rinse,frequency of vesical hyperkinesia, the time of post operational hospital stay were statistically analyzed.Results Peri-operative bleeding and postoperative hospitalization days,continuous bladderdouche time,postoperative placing a urinary catheter time and bladder seizure OCCUrs in holmium laser group were 1.0)d vs(1.8±1.1)d;(3.1±1.2)d vs(6.0±1.3)d;(5.0±1.6)d vs(5.9±1.4)d;(1.5±1.1)times vs and the difficulty of nursing,which may improve the working efficiency of medical treatment and nursing.     

老年人支气管哮喘危险因素和临床特点分析

Objective To explore the risk factors and clinical features of elderly asthma.Methods Clinical data of 221 patients with adult asthma were retrospectively analyzed.According to age,the patients were divided into the young group(15 ～59 years) and elderly group( ≥ 60 years).All indices were compared between the two groups to identify risk factors and clinical features.Results In 221 patients with asthma,the elderly patients was 64 patients (28.96% ) ,and their mean age was 73.4 years, of which 39 males(60.93% ) and 25 females (39.06% ).The number of smokers in the elderly group was significantly higher than the young group (x2 = 4.753, P < 0.05) , and infection and climate change was risk factors for asthma in the elderly(x2 =6.352,9.376,all P<0.05) ;The seasonal aspects of old age group was prone to winter and spring, and the young group was prone to winter and summer;The complications and underlying diseases in elderly patients was significantly higher than those in the young group( x2 = 126.270,P <0.01).Conclusion In elderly patients with asthma, male was more than female, and smoking rate was high.The infection and climate change was the main risk factors,which was prone in winter and spring and had more complications and underlying diseases.     

壶腹周围肿瘤外科姑息引流疗效分析

Objective To compare the clinical effects of palliative drainage to pancreatic and periampullary carcinoma which could not be excised with the operation.Methotis A retrospective study was accomplished on the palliative drainage treatment of 68 patients with pancreatic and petiampullary carcinoma hospitalized from 1996 to 2003.Results The disease course was two days to eight months.A definite preoperative diagnosis was made for 64 cases.Among them.single test diagnosed 24 cases and multiple tests diagnosed 40 cases.56 patients suffered from jaundice before operation.34 patients were treated by Roux-Y choledochojejunostomy.Choledochoduodenostomy was performed in 16 patients,cholecystduodenostomy for biliary by pass Was performed in 8 patients and stented internal drainage of the biliary duct in the liver and duodenostomy was performed in 10 patients.After reducing jaundice,12 patients was performed surgical resection.The second operation was performed in 4 patients because of postoperative jaundice and in 3 patients because of pylofic obstruction.The pefioperative compllcations include 4 cases of jaundice pyloric,3 cases of obstruction,2 cases of postoperative bleeding and 5 cases of infection of incisional wound.The aver-age stay in hospital waa 13.3 days(8～22 days).Conclusion Multiple tests were helpful to make a definite preoper-ative diagnosis.The selection of palliative drainage method based on the condition of patients had good curative effect in clinic.Surgocal exploration and reducing jaundice could set win conditions for second operation.     

壶腹周围肿瘤外科姑息引流疗效分析

Objective To compare the clinical effects of palliative drainage to pancreatic and periampullary carcinoma which could not be excised with the operation.Methotis A retrospective study was accomplished on the palliative drainage treatment of 68 patients with pancreatic and petiampullary carcinoma hospitalized from 1996 to 2003.Results The disease course was two days to eight months.A definite preoperative diagnosis was made for 64 cases.Among them.single test diagnosed 24 cases and multiple tests diagnosed 40 cases.56 patients suffered from jaundice before operation.34 patients were treated by Roux-Y choledochojejunostomy.Choledochoduodenostomy was performed in 16 patients,cholecystduodenostomy for biliary by pass Was performed in 8 patients and stented internal drainage of the biliary duct in the liver and duodenostomy was performed in 10 patients.After reducing jaundice,12 patients was performed surgical resection.The second operation was performed in 4 patients because of postoperative jaundice and in 3 patients because of pylofic obstruction.The pefioperative compllcations include 4 cases of jaundice pyloric,3 cases of obstruction,2 cases of postoperative bleeding and 5 cases of infection of incisional wound.The aver-age stay in hospital waa 13.3 days(8～22 days).Conclusion Multiple tests were helpful to make a definite preoper-ative diagnosis.The selection of palliative drainage method based on the condition of patients had good curative effect in clinic.Surgocal exploration and reducing jaundice could set win conditions for second operation.     

Carbamazepine and valproate monotherapy: feasibility, relative safety and efficacy, and therapeutic drug monitoring in manic disorder

Rationale: Search for alternatives to lithium therapy for mood disorders commenced with anticonvulsants, carbamazepine (CBZ) and valproic acid (VPA), in the late 1970s. The comparative safety and efficacy data of CBZ and VPA monotherapy in patients with bipolar disorder remain to be established. Objectives: The main objectives of the study were to assess the relative anti-manic efficacy and safety of CBZ and VPA; to study the feasibility of using either, as a first line anti-manic agent; to investigate and generate clinically relevant parameters involving therapeutic drug monitoring of the two drugs. Methods: After a 2-day screening period, suitable patients (n=30) were randomly assigned to treatment with CBZ or VPA. Both the drugs were started with an average dose of approximately 20 mg/kg body weight per day. Further increment in dose was carried out at weekly intervals, guided by clinical improvement, serum levels and treatment emergent adverse events. The primary efficacy measure in the protocol was defined as a change from baseline to endpoint in total score on the Young Mania Rating Scale. A favourable clinical response was defined a priori as a decrease of more than 50% from baseline in Young Mania Rating Scale total score. Results: Both CBZ and VPA were found to be efficacious as single first-line anti-manic agents, however VPA proved to be better. Using the intent-to-treat analysis, the VPA group showed a significant fall in YMRS total scores after week 1 while the CBZ group showed a significant fall after week 2. In the primary efficacy analysis, valproate group experienced significantly greater mean improvement in Young Mania Rating Scale total score than the CBZ group. Of the VPA treated patients, 73% showed a favourable clinical response while 53% of the patients on CBZ responded favourably. In the CBZ group, significantly more patients received rescue medication during the week 2 and the requirement was quantitatively more as compared to the VPA group. The steady state serum concentration (Css) of CBZ ranged from 3 to 9 μg/ml; however, it did not appear to correlate with the dose or clinical response. The Css of VPA ranged from 50 to 100 μg/ml; a linear correlation was found between the dose and serum levels of VPA as well as between weekly rise in serum levels and clinical response. Weekly dose escalations of VPA also correlated positively with corresponding rise in serum levels. Significantly more patients in the CBZ group reported adverse events, including nausea, vomiting and dizziness, than VPA. Conclusions: The findings from this study suggest that both CBZ and VPA monotherapy is feasible for treatment of acute mania; however, VPA is more efficacious in terms of its early onset of action, lesser requirement for rescue medication and better tolerability. Further work needs to be undertaken to characterise the manic patients in terms of their differential psychopharmacologic response profile. Received: 9 July 1999 / Accepted: 11 January 2000     

Factors responsible for interindividual differences in the dose requirement of phenprocoumon

Summary The total and unbound plasma concentrations of phenprocoumon and the prothrombin complex activity were determined in 51 patients on phenprocoumon. A 7-fold difference in the dosing rate (10–70 μg/kg/day) was required to maintain the prothrombin complex activity at 11–30% of normal. The variation in dosing requirement was mainly due to inter-individual differences in the intrinsic clearance of phenprocoumon and only to a minor degree to differences in sensitivity to it. On average patients with myocardial infarction required only 2/3 of the daily dose of phenprocoumon of post cardiac surgery patients and patients with thrombosis and emboli. That difference appeared to be due to higher clearance in surgical patients and to greater resistance to phenprocoumon in patients with thrombosis and emboli. The total clearance in patients varied approximately 5-fold. It was better predicted by the interindividual intrinsic clearance (r=0.84) than by the unbound fraction (r=0.15).     

2型糖尿病患者血浆内皮素测定及其意义初探

Objective This study aimed to determine the change of plasma endothelin (ET) in patients with diabetes meUitus .Methods 42 diabetic patients and 50 normal people were included in our study.The diabetic patients were divided into 2 groups, one group with vascular complications, and the other one without. The plasma ET, blood pressure,fasting blood glucose and other intems were measured in these people. Result The plasma ET level was found to be greatly elevated in diabetic patients comparing with the normal people and ET level of diabetic patients with vascular complication was much higher than patients without complications. The plasma ET level had positive correlation with systolic pressure in diabetic patients. Conclusion The result indicated that the high level of plasma ET might play an improtant role in the occurrence and development of vascular complication. The level of plasma ET should be routinely measured in diabetic patients. The patients with high - level plamsa ET should take therapeutic measures to prevent the occurrence of vascular complication.