肾母细胞瘤69例临床分析

目的探讨肾母细胞瘤的诊断和治疗方案,以提高患儿存活率。方法回顾性分析1995年1月～2005年8月我院69例肾母细胞瘤病例的诊治过程。Ⅰ期25例,Ⅱ期23例,Ⅲ期17例,Ⅳ期4例。术前均经彩超,静脉尿路造影,CT及增强检查。均行手术治疗,完整切除瘤体肾60例,部分切除瘤体2例,7例行组织活检。术前化疗30例,所有病例术后均予化疗。结果本组病例2年存活率为81%。结论根治性切除是治疗肾母细胞瘤的关键,术前化疗有利于提高手术成功率,术后化疗可提高存活率。     

Effects of PEEP and tolazoline infusion on respiratory and inert gas exchange in experimental meconium aspiration

Meconium aspiration syndrome often produces respiratory failure in the neonate. We utilized the multiple inert gas elimination technique to study the effects on respiratory and inert gas exchange of the application of positive end expiratory pressure or continuous infusion of tolazoline HCl. The application of PEEP, with the optimal level of PEEP defined for each animal, produced a decrease in AaDO2 and pulmonary shunt, without an increase in blood flow to low VA/Q areas, or an increase in dead space. Tolazoline infusion, at 2 mg/kg/hour, had no apparent effect on AaDO2 or shunt, or magnitude of low VA/Q regions. Tolazoline therapy was associated with an increase in heart rate and a decrease in systemic blood pressure. We conclude that immediate postaspiration application of PEEP, but not of tolazoline, will diminish pulmonary shunt without creating low VA/Q areas, and therefore will improve gas exchange in MAS.     

Fetal blood lead values in a rural area

Lead levels were determined from neonatal samples of blood collected at a general-care hospital. The cord blood lead values of babies from urban maternal residences were significantly higher than those from rural environments. The over-all cord blood lead value was (mean +/- S.D.) 9.4 +/- 3.7 micrograms of lead per 100 ml. of whole blood. This level represented a considerably lower value than others previously reported and suggests a lower "normal" value for our population.     

Comparison between bone marrow transplantation and antithymocyte globulin in treatment of young patients with severe aplastic anemia

Fifty-seven patients younger than 25 years with severe aplastic anemia underwent either bone marrow transplantation or antithymocyte globulin therapy (ATG) to ascertain which approach should be used in young patients. Thirty-five patients who had an HLA-identical sibling donor underwent bone marrow transplantation after conditioning with cyclophosphamide and low-dose total-body radiation. Twenty-two patients who did not have an HLA-identical donor received ATG. The 2-year actuarial survival of patients after transplant is 72% (95%, CI 64% to 80%), versus 45% (95%, CI 29% to 61%) in those given ATG therapy (P = 0.18). In those patients surviving 6 months after treatment, return of peripheral blood counts to normal values was more common in patients who received marrow transplant compared with those given ATG therapy (P less than 0.001). Furthermore, 24 of 26 transplant survivors had Karnofsky performance scores greater than 90%, compared with only five of 13 ATG survivors. These data suggest that bone marrow transplantation is the preferred therapy for severe aplastic anemia in young patients who have an HLA-identical sibling donor. ATG should be reversed for those young patients with severe aplastic anemia who do not have a histocompatible marrow donor.     

SEM-dissection of a human embryo derived from an ectopic pregnancy

A 6.5-week-old human embryo with an approximate crown-rump length of 13.2 mm was obtained from a tubal pregnancy. Two hours before surgical removal, the embryo was imaged with real time ultrasound and was noted to have rhythmic cardiac motion. Subsequent to surgical removal, the embryo was dissected free from the placenta and prepared for routine scanning electron microscopic (SEM) studies. Progressive stages of dissection with microsurgical instruments followed by SEM photography elucidated the three-dimensional aspects of embryonic development of many structures, including the lens placode, tongue bud, Rathke's pouch, atrial and ventricular foramina, primitive intestinal loop and undifferentiated external genitalia. Almost certainly, such clear views of dissected structures can contribute to our understanding of human embryonic development.     

Early versus delayed initiation of continuous negative pressure in infants with hyaline membrane disease.

Twenty-three infants with HMD of similar severity, who were less than 24 hours of age and who were breathing spontaneously, were divided by random numbers into early and delayed CNP groups. The infants who were treated with CNP before their PaO2 was less than 50 mm Hg while breathing 70% oxygen experienced a significantly greater increase in PaO2 in response to the initiation of CNP, required less time with O2 therapy, required no mechanical ventilation, and had fewer complications. Based on these results, it is suggested that CNP be initiated in infants with HMD, who are less than 24 hours of age and are breathing spontaneously, before the PaO2 becomes less than 50 mm Hg on 70% O2.