脑干肿瘤切除术中听诱发电位的监护

脑干是生命中枢所在部位,也是神经中枢的“中枢””’,该部位肿瘤手术风险大,治疗效果差。随着显微外科和影像学等技术的发展,现在脑干肿瘤手术取得很大的进展。如何在尽可能切除脑干肿瘤的同时,及时察觉和避免损伤正常脑干组织,使手术更加安全,除了应用显微外科等...     

石杉碱甲类似物的研究II.N-甲基吡啶酮石杉碱甲类似物的合成

石杉碱甲(1)是从中草药石杉属植物千层塔(Lycopodium serratum Thunb.)中分得的一种高效可逆的乙酰胆碱酯酶抑制剂,临床试验证实它对早老性痴呆症有显著疗效。本文报道N-甲基吡啶酮石杉碱甲类似物2和3的合成。2-甲氧基-5-甲氧羰基-11-亚甲基-5,9-甲撑环辛-7-烯并吡啶(9)在乙腈中用三甲基氯硅烷和碘化钠选择性脱保护以定量的产率得吡啶酮10,再用甲醇钠和碘甲烷甲基化得N-甲基吡啶酮11,11经碱性水解,Curtius重排和氨基的脱保护得N-甲基吡啶酮石杉碱甲类似物2。通过类似的途径从中间体2-甲氧基-5-甲氧羰基-7-甲基-11-酮-5,9-甲撑环辛-7-烯并吡啶(14)合成了类似物3。类似物2和3的乙酰胆碱酯酶抑制活性均低于天然石杉碱甲。     

石杉碱甲类似物的研究Ⅲ．N－甲基吡啶酮石杉碱甲类似物的合成

石杉碱甲（１）是从中草药石杉属植物千层塔（ＬｙｃｏｐｏｄｉｕｍｓｅｒｒａｔｕｍＴｈｕｎｂ．）中分得的一种高效可逆的乙酰胆碱酯酶抑制剂，临床试验证实它对早老性痴呆症有显著疗效。本文报道Ｎ－甲基吡啶酮石杉碱甲类似物２和３的合成。２－甲氧基－５－甲氧羰基－１１－亚甲基－５，９－甲撑环辛－７－烯并吡啶（９）在乙腈中用三甲基氯硅烷和碘化钠选择性脱保护以定量的产率得吡啶酮１０，再用甲醇钠和碘甲烷甲基化得Ｎ－甲基吡啶酮１１，１１经碱性水解，Ｃｕｒｔｉｕｓ重排和氨基的脱保护得Ｎ－甲基吡啶酮石杉碱甲类似物２。通过类似的途径从中间体２－甲氧基－５－甲氧羰基－７－甲基－１１－酮－５，９－甲撑环辛－７－烯并吡啶（１４）合成了类似物３。类似物２和３的乙酰胆碱酯酶抑制活性均低于天然石杉碱甲。     

Efferent detoxification therapy in the complex treatment of diffuse suppurative peritonitis]

Upon the analysis of efferent combined therapy for diffuse purulent peritonitis in 130 patients, it was found that efferent detoxication promotes elimination of intoxication, correction of homeostasis abnormalities, recovery of basic systems of the body, a decrease of postoperative lethality and complications. The choice of the optimal detoxication method should be individual and adjusted for a peritonitis stage and a concrete clinical purpose.     

Koilocytosis in precancerous conditions and cancer of the vulva

The incidences of combination of koilocytosis and dysplasias of squamous epithelium of skin-mucous integument of vulva in 120 patients with kraurosis and leukoplakia and 166 patients with carcinoma of external genitalia (at the distance of 3-4 cm from the tumour) are studied. Vulva tissue of 100 women of the same age dying from non-tumourous conditions served as control. The increase of the koilocytosis incidence was observed at various stages of carcinogenesis (slight dysplasia--mild dysplasia--severe dysplasia--preinvasive carcinoma). koilocytes are not found in the invasive carcinoma. It is suggested to consider koilocytosis as one of additional morphologic signs of the risk of vulva carcinoma. The disappearance of koilocytes which are markers of the viral cell alteration in invasive carcinomas allows one to regard a viral damage of the vulva epithelium as one of the cocarcinogenic influences responsible for the development of squamous cell carcinoma.     

Breaking of distractors of the Harrington type after surgical treatment of scoliosis]

180 patients with scoliosis (aged 12-29 years) were subjected to the correction of deformation by means of the Harringtone type distractors and spondylodesis with utilization of osseous transplants. In 24 of them (13,3%) the distractor has been broken in different terms after the operation. The danger of the break increases with the age of the patients and abruptly increases in case of scoliosis of the V degree (in excess of 90 degrees) and in case of necessity to bend the distractor to correct the kyphoscoliosis. The distractor break is associated not with the material structure but with the rod design.     

The role of the complement system in the origin of respiratory insufficiency in patients on hemodialysis]

A study was made of changes in functional status of complementary system in 42 patients with chronic renal failure on programmed hemodialysis. Early stages of hemodialysis were accompanied by short-term and reversible activation of complementary system. 100 sessions were followed by complement depression. Complement system was found to be involved in two pathogenetic mechanisms of respiratory insufficiency: block of pulmonary microcirculation by leukocytic aggregates and DIC syndrome associated with microthrombosis of the lesser circulation vessels. To manage the above complications, plasmapheresis is advocated.