局部应用丝裂霉素C对大鼠坐骨神经运动功能的影响

目的 观察局部应用不同浓度的丝裂霉素C (mitomycin C,MMC)对大鼠坐骨神经运动功能的影响.方法 30只健康SD大鼠,随机分为5组,每组6只.充分显露大鼠右侧坐骨神经,术中各组分别以棉片浸透生理盐水(A组,对照组)或0.1 mg/mL(B组)、0.3 mg/mL(C组)、0.5 mg/mL(D组)、0.7 mg/mL(E组)的MMC,包裹于暴露的坐骨神经周围5 min.术后3d通过斜板实验及足迹分析实验结果来评价坐骨神经运动功能的变化.结果 a)斜板试验:术后3d,各剂量MMC组及对照组斜板试验角度比较,差异无统计学意义(P＞0.05);b)足迹分析实验:术后3d,各剂量MMC组及对照组坐骨神经功能指数比较,差异无统计学意义(P)＞0.05).结论 局部应用浓度不超过0.7mg/mL的MMC不会对大鼠坐骨神经的运动功能产生明显影响.     

Treatment of Airway Complications Following Lung Transplantation

ObjectiveTo describe our experience in airway complications following lung transplantation and to suggest a management strategy using different interventional bronchoscopic techniques.MethodRetrospective analysis of all airway complications following lung transplantation from January 1999 to July 2007.ResultsDuring this period, 223 patients underwent lung transplantation, with a total of 345 airway anastomoses. In 70 (20.23%), there were complications requiring endoscopic intervention. A total of 631 procedures were carried out in 52 patients. Thirty-three patients presented a combination of bronchial stenosis and bronchomalacia, 18 patients had bronchial stenosis alone and 1 patient presented dehiscence of the anastomosis. In most cases, pneumatic balloon dilatation was effective, although temporarily, and ultimately 47 patients required endobronchial stent placement. The most common complication associated with the use of stents was granulation tissue formation, seen in 57.3% of patients. After stent placement, forced expiratory volume in one second (FEV₁) improved significantly.ConclusionAirway complications after lung transplantation are frequent. Balloon dilatation was effective in only a few patients with bronchial stenosis, requiring stent placement in most. Airway permeabilization after endobronchial stent placement improved FEV₁ in these patients. Based on our experience, we propose a management strategy for airway complications after lung transplantation.     

Effect of Topical Mitomycin C on the Healing of Surgical and Laser Wounds: A Hint on Clinical Application

OBJECTIVES: Mitomycin C (MMC) is used in otolaryngological surgery to reduce complications from postoperative scarring. However, the effects of MMC on wound healing at different doses and on different wound types have not been fully described. The aim of this study was to evaluate the effects of topical MMC at 2 different doses on the healing of surgical and laser wounds. STUDY DESIGN AND SETTING: This was a randomized study using 20 rabbits. Six full-thickness wounds were made by excision or laser vaporization on the flank skin. The wounds were randomly treated by topical MMC of 0.4 or 1.0 mg/mL or saline for 5 minutes. RESULTS: Re-epithelialization and contraction of the original wounds were significantly delayed by the use of MMC (P < 0.01). The delayed healing effect of MMC was more prominent in the laser wounds than in the excision wounds. MMC inhibited collagen deposition and fibroblast proliferation of wounds on histological analysis. The 2 different concentrations of MMC showed no difference in gross or histological wound healing characteristics. CONCLUSION: Our results showed that MMC delays the healing of wounds as a result of the inhibition of fibrosis, especially for laser wounds.     

经纤支镜气管置入支架术后并发症患者的护理

总结101例气管狭窄和食管-气管瘘经纤支镜置气管镍钛记忆合金支架术后并发症的护理经验。结果101例患者术后呼吸困难、咳嗽、咯血症状均得到改善，术后发生并发症20例（19．8％），经临床治疗、护理均好转。提出加强术前心理护理及术后璃情观察。及时进行对症处理是减少并发症发生的关键。     

Airway Obstruction and Perioperative Complications in Smokers Undergoing Abdominal Surgery

Background: The goal of this study was to determine whether airway obstruction determined by preoperative spirometry predicts perioperative complications in smokers undergoing abdominal surgery whose treatment is managed according to current clinical practice.

Methods: A pulmonary function database identified patients undergoing abdominal surgery who met the following criteria for airway obstruction (n = 135): a forced expiratory volume less than 40% of predicted normal value, a forced expiratory volume:forced vital capacity ratio less than the lower limit of predicted normal, a smoking history of more than 20 pack-years, and an age older than 35 yr. A group of patients without airway obstruction (n = 135) was matched for gender, surgical site (upper vs. lower abdominal), smoking history, and age. Medical records were reviewed by an abstractor to identify perioperative complications that occurred within 30 days after surgery.

Results: The forced expiratory volume values were 0.9 +/- 0.2 l (mean +/- SD) and 2.9 +/- 0.6 l in patients with and without airway obstruction, respectively. When analyzed by conditional logistic regression using the 1:1 matched-pairs feature, including age, pack-year smoking history, site of incision, and current smoking status as covariates, in patients with airway obstruction bronchospasm was more likely to develop (odds ratio, 6.9 [95% confidence interval, 1.2 to 38.4]) but the patients were not more likely to need prolonged endotracheal intubation (odds ratio, 1.1 [95% confidence interval, 0.4 to 3.2]). They were also no more likely to need prolonged intensive care admission or readmission. The frequency of other complications was less than 5%.     

经纤支镜气管置入支架术后并发症患者的护理

总结101例气管狭窄和食管-气管瘘经纤支镜置气管镍钛记忆合金支架术后并发症的护理经验.结果101例患者术后呼吸困难、咳嗽、咯血症状均得到改善,术后发生并发症20例(19.8%),经临床治疗、护理均好转.提出加强术前心理护理及术后病情观察,及时进行对症处理是减少并发症发生的关键.     

Effect of Mitomycin C on recurrence of plantar fibromas

Although certainly not the first line treatment for plantar fibromas, surgical resection is a treatment option for some patients with have failed exhaustive non‐surgical treatment. The use of topical Mitomycin C has been recently shown to reduce the recurrence rate of other fibrous lesions. The purpose of this study was to determine the impact of topical application of Mitomycin C on recurrence rate of plantar fibromas. A retrospective analysis was done from a prospectively gathered database with a total 50 consecutive patients over a 16‐month study period. The control group (n = 29) consisted of patients who underwent only surgical resection, while the study group (n = 21) consisted of patients who underwent surgical resection with adjuvant therapy using Mitomycin C. The primary endpoint was local recurrence after the procedure. Secondary end points included complications and toxicity associated with this medication. No patients were lost to follow up. Of the 29 patients in the control group, there were 17 patients (17/29, 58.6%) had recurrence of the plantar fibroma at a mean follow‐up of 9.1 months. In contrast, in the experimental study group, all patients were free from local recurrence. No complications or side effects were associated with Mitomycin C use. The results demonstrate that the topical application of Mitomycin C to the tumor bed after surgical resection of plantar fibromas reduced the recurrence rate. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2554–2561, 2018.

     

Mitomycin C bladder instillation therapy for bladder tumors.

Patients with bladder tumors underwent a course of topical bladder instillation of 20 mg. mitomycin C in 20 ml. sterilized distilled water 3 times weekly for a total of 20 procedures. In 22 of the 50 patients (44 per cent) the tumors disappeared completely, while in 16 patients (32 per cent) there was partial disappearance and in 12 patients (24 per cent) there was no affect. Therefore, the total effective rate was 76 per cent. We concluded from our studies that mitomycin C topical therapy could be applied to low stage and low grade bladder tumors less than 1 cm. in diameter, without regard to the number of tumors. We now use mitomycin C topical therapy in all cases of bladder tumors. Local bladder reaction was noted in 3 cases but a complete course of therapy was accomplished in each case--in 2 cases without interruption of treatment and in 1 case by delaying treatment for 1 week. Abnormal values of hematocrit, white blood cells and platelets in blood were not observed during therapy.     

Mitomycin C reused: an in vitro cost-effectiveness study

The use of mitomycin C, an effective agent in the intravesical treatment of superficial bladder cancer, is limited by its high cost. An in vitro study was done to determine whether mitomycin C could be recovered after intravesical administration and reused in the same patient. Cultured human transitional carcinoma cells from line 253-J were exposed to: medium alone; fresh mitomycin C (1 mg./ml.); mitomycin C stored for 1, 2 and 4 weeks; and mitomycin C recovered from patients after intravesical use, tested immediately and stored and tested after serial dilution after 1, 2, and 3 weeks. Results were assessed by cell counts 2 and 5 days after 2-hour exposure to the test solutions. With fresh mitomycin C and that stored up to 4 weeks, cell growth was less than 1 per cent of control (medium alone) at 2 and 5 days. Mitomycin C was also effective when recovered after intravesical use for up to 2 weeks, at which time cell growth was 9.7 and 3.1 per cent of control at 2 and 5 days, respectively. However, at 3 weeks, cell counts were 11.5 and 18.3 per cent of control at 2 and 5 days, suggesting that mitomycin C loses potency with dilution. We conclude that mitomycin C might be recovered, stored and reused for at least 2 weeks in individual patients, a practice that could result in a substantial reduction of treatment cost.     

Experimental intra-arterial infusion of Microencapsulated Mitomycin C into pelvic organs

Laboratory experience with the use of Mitomycin C encased in ethylcellulose microcapsules as an agent for transcatheter embolisation is described. Microencapsulated Mitomycin C (MMC-m.c.) was infused into the pelvic organs of dogs by arterial catheterisation and the distribution of MMC in plasma and tissue was examined. MMC levels in the circulating blood of the MMC-m.c. group were significantly lower than those of the non-encapsulated MMC group. The biological potential of MMC was retained for prolonged periods in the pelvic organs after intra-arterial infusion of MMC-m.c. On the other hand, MMC could not be detected in the tissue of the non-encapsulated MMC group 4 h after the infusion.     

Mitomycin C prevents strictures in caustic esophageal burns in rats

BACKGROUND: Caustic esophageal injuries lead to stricture formation. Although a number of agents have been tried experimentally to prevent strictures, few have gained clinical application. The purpose of this study was to investigate the effectiveness of Mitomycin C (MMC), which inhibits fibroblastic proliferation in preventing caustic esophageal strictures. MATERIAL AND METHODS: Fifty-six rats were allocated into four groups. Caustic esophageal burns were created as described by Gehanno. Group A was instilled only with saline. Group B was injured and untreated. Groups C and D were injured and received topical MMC at 0.02 and 0.04% concentrations, respectively. At 28 days, stenosis index (SI), collagen deposition, and hydroxyproline content (HP) were determined in distal esophageal segments. Statistical analyses were done. RESULTS: Mean SI in Group B was significantly higher than others (P < 0.05). Mean SI was statistically higher in Group C than A and D and similar between groups A and D. The greatest accumulation of collagen was found in Group B, followed by Group C, D, and A, respectively. Collagen deposition in Group D was statistically lower than Group B (P < 0.01) and similar to Group C. Mean HP in Group B was statistically higher than others (P < 0.05), significantly higher in Group C than Group D (P = 0.047), and similar between Groups A and D (P = 0.73). CONCLUSION: MMC was effective in preventing strictures following experimental caustic esophageal injury, in a dose-dependent manner. We consider that it can gain clinical utilization with the establishment of effective mode, dose, and timing of therapy.     

Pharmacokinetics of Mitomycin C Following Hepatic Arterial Chemoembolization With Gelfoam

Twelve mongrel dogs were randomly allocated into two groups using matched paired-design. Catheters were inserted into the hepatic artery, hepatic vein and the femoral vein, respectively. In the first group, gelfoam supplemented with mitomycin C (MMC) was injected into the hepatic artery, whereas the second group received a hepatic arterial injection of MMC solution alone. Simultaneous blood sampling from the hepatic and femoral veins at regular intervals was performed. MMC concentrations in plasma was determined using high performance liquid chromatography (HPLC) and the pharmacokinetics of MMC were determined. MMC concentrations in hepatic and femoral veins did not differ and no significant difference in pharmacokinetics was found when comparing MMC administration into the hepatic artery with or without gelfoam supplementation. Thus, our results revealed that gelfoam could not delay the clearance of MMC from the liver.     

Mitomycin C in superficial bladder cancer: 24-month follow-up

Twenty-three patients who were given intravesical Mitomycin C for treatment of superficial bladder cancer have been followed up for a further 12 and 24 months after an initial assessment 5 weeks after completing therapy. At 5 weeks 17 (74%) showed complete disappearance of tumour and 4 (17%) showed a partial response. Twelve months later 8 (35%) remained tumour-free and 15 (65%) had recurrences; 5 of these (22% of all patients) had progressed to invasive cancer. The results at 24 months were little different except that one further patient (27% in all) progressed to invasive cancer. Six patients with symptomatic carcinoma in situ became symptom-free after Mitomycin C, but despite remaining free of symptoms three have progressed to invasive cancer. This small series shows that involvement of large areas of bladder urothelium by tumour, carcinoma in situ and previous therapy for tumour are unfavourable prognostic indices.     

Mitomycin C as an adjuvant in resected gastric cancer.

As a result of their previous experience with mitomycin C at high discontinuous doses in advanced gastric cancer, the authors studied its role as an adjuvant for locally advanced cases after surgical complete resection. Results from 70 evaluable patients are presented. Patients were allocated randomly to receive mitomycin C, 20 mg/m2 I.V. direct once every 6 weeks, four courses, or a placebo. After a follow-up period of 250 weeks, seven patients of treatment arm and 23 controls have already relapsed (p less than 0.001). Toxicity was moderate and controllable by symptomatic measures. The authors consider this investigation a positive contribution in the field of adjuvant therapy of gastric cancer.     

Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy With Mitomycin C for Peritoneal Carcinomatosis from Nonappendiceal Colorectal Carcinoma

Background: Cytoreductive surgery (CS) and intraperitoneal hyperthermic chemotherapy (IPHC) are efficacious in patients with disseminated mucinous tumors of the appendix. We reviewed our experience using this approach for nonappendiceal colorectal cancer (NACC).Methods: We performed a retrospective chart review of a prospective database for patients undergoing CS and IPHC with mitomycin C for peritoneal carcinomatosis from colorectal primary lesions between December 1991 and April 2002.Results: There were 77 patients, with a median age of 54 years. Peritoneal carcinomatosis was synchronous and metachronous in 27% and 73% patients, respectively. Seventy-five percent of patients (n = 58) had received chemotherapy prior to IPHC. Complete resection of all gross disease was accomplished in 37 patients (48%). The mean carcinoembryonic antigen level decreased from a preoperative value of 31.2 to a postoperative value of 6.9 (P < .0001). Overall survival (OS) at 1, 3, and 5 years was 56%, 25%, and 17%, respectively. With a median follow-up of 15 months, the median OS was 16 months. Perioperative morbidity and mortality were 30% and 12%, respectively. Hematologic toxicity occurred in 15 patients (19%). Cox regression analysis identified poor performance status (P = .018), bowel obstruction (P = .001), malignant ascites (P = .001), and incomplete resection of gross disease (P = .011) as independent predictors of decreased survival. Patients with complete resection of all gross disease had a 5-year OS of 34%, with a median OS of 28 months.Conclusions: CS and IPHC with mitomycin C can improve outcomes for select patients with peritoneal spread from NACC. One third of patients who undergo complete resection of gross disease have long-term survival.