New perspectives in the evolution of prognosis and treatment of chronic lymphocytic leukaemia

Chronic lymphocytic leukaemia is a disease with a variable clinical course and prognosis. New prognostic factors like immunoglobulin gene mutational status, cytogenetic abnormalities, CD38 and ZAP70 expression of malignant cells have been described recently. Conventional and biological prognostic factors allow to identify patients with unfavorable prognosis at early stage. Purin analogues, fludarabine and fludarabine based combinations can achieve complete hematological remission in approximately one third of patients with chronic lymphocytic leukaemia. Chemoimmunotherapy (most experience is obtained by combination of fludarabine + cyclophosphamide + rituximab) can increase not only complete remission rate, but also induce molecular remission in some cases. Stem cell transplantation as well as early and effective chemotherapy are curative choices of treatment in patients with chronic lymphocytic leukaemia.     

瞬目反射对Bell氏麻痹预后判断的作用

目的：观察Ｂｅｌ氏麻痹患者瞬目反射（ＢＲ）的特点,探讨其判断预后的临床意义。方法：检测３６例Ｂｅｌ氏麻痹患者及３０名健康人ＢＲ,并对３２例患者进行随访。结果：ＢＲ反应电位潜伏期患者均较健康人延长,波幅较健康人低;在临床恢复过程中波幅,潜伏期有恢复趋势;病情预后差者潜伏期比预后好者延长更明显,波幅比预后好者下降更明显。结论：ＢＲ检测对估计Ｂｅｌ氏麻痹预后有判断价值。     

Esophageal perforation after fiberoptic endoscopic injection sclerotherapy for esophageal varices

Esophageal perforation is a rare major complication of fiberoptic endoscopic injection sclerotherapy for bleeding esophageal varices. This complication occurred in 1% (two) of our patients. Both patients recovered with conservative treatment. Although mild symptoms continued for a long period after the procedure, esophageal stenosis did not occur.     

危重症护理技术协作网络的构建

为了提高医院的危重症患者的护理质量和抢救成功率及生命质量。采用前瞻性的实践方法构建了护理技术协作网络。通过组织危重症患者的护理技术培训、查房与会诊和扩大危重症护理技术协作网范围、将量化手段引入管理，还应用重症病人评估积分网络管理病人，应用危重症护理技术训练测评系统管理护理人员，提高了护理人员的素质，使人力资源得到合理配置，促进了医疗质量和两个效益的明显提高。由此不难看出，危重症护理技术协作网络有应用推广价值。     

A decade of experience with TCu200

This paper summarizes ten years of experience with 2766 interval insertions of the TCu200 device. One hundred and twenty months of use were completed by 572 patients and the cumulative woman-months of use were 159 664. For evaluating the overall performance, gross cumulative and yearly specific life-table termination and continuation rates were calculated as suggested by Tietze [2]. The cumulative pertinent rates at the end of the ten-year follow-up period were as follows: pregnancy 10.2; expulsion 6.3; bleeding/pain 32.3; and removal for other medical reasons 19.4. The gross annual rates for the same conditions at the end of the first year of use were: 1.8, 2.4, 4.2, and 2.0, while in the tenth year they were: 0.6, 0.1, 4.4, and 2.8, respectively. The continuation rate was 89.1 at the end of the 12th month and 33.2 at the end of the 10th year. Based on this evaluation, the TCu200 IUD has a good overall performance and a longer lifespan than was previously expected.     

Regional pharmacokinetics of amifostine in anesthetized dogs: role of the liver, gastrointestinal tract, lungs, and kidneys.

Amifostine is a prodrug in which selectivity is largely determined by the preferential formation and uptake of its cytoprotective metabolite, WR-1065, in normal tissues as a result of differences in membrane-bound alkaline phosphatase activity. In this study, we characterized the sites and extent of organ-specific activation by the liver, gastrointestinal tract, lungs, and kidneys after systemic administrations of amifostine. A total of 10 dogs were infused via the cephalic vein using sequential dose rates of drug at 0.125, 0.500, and 1.00 micro mol/min/kg. Infusion of each dose rate lasted 2 h, at which time steady-state plasma concentrations were obtained (i.e., portal vein, carotid artery, hepatic vein, pulmonary artery, and renal vein). The hepatic arterial, portal venous, and renal arterial blood flows, and cardiac output, were measured. The hepatic and splanchnic extraction of amifostine remained high at 90%, whereas gastrointestinal extraction decreased from 43 to 12 to 15% with increasing dose. Pulmonary extraction of amifostine was low at 7%, whereas renal extraction was intermediate at 57%. Because blood flow measurements were relatively constant during the drug infusions, clearance parameters paralleled that of organ extraction. As a result, saturability was observed in the gastrointestinal blood clearance (i.e., from 9.8 to 2.8-3.3 ml/min/kg) and total body plasma clearance of amifostine (i.e., from 52.6 to about 37.3 ml/min/kg), as the doses increased. Due to the drug's high activation in liver, these findings suggest that amifostine may offer good protection of this organ against the toxicities of chemotherapy and radiation.     

南柴胡化学成分的研究

从南柴胡（Bupleurum scorzonerifolium Willd.)根的乙醇提取物中分离得到7个化合物，根据波谱数据和理化性质鉴定为：柴胡皂甙元F（1），柴胡次皂甙F（2），3″－O－乙酰柴胡皂甙d(3),6″-O-乙酰柴胡皂甙d(4),4″-O-乙酰柴胡皂甙d(5),a″－菠甾醇（6），二十四碳酸（7）。均为首次从该植物中得到。     

The association of biliary and pancreatic anomalies with periampullary duodenal diverticula. Correlation with clinical presentations

Fifty-eight symptomatic patients with periampullary duodenal diverticula (PDD) were examined for pancreatic and biliary anomalies using endoscopic retrograde cholangiopancreatography (ERCP), ultrasonography, and other imaging modalities. The pathologic findings in these patients were compared with those in a matched group of 58 patients without PDD, who were simultaneously undergoing a similar investigation for the same clinical presentations. Pathologic findings in the pancreas and/or biliary tree were detected in 70.7% of all patients with PDD, compared with 39.7% in the control group. In patients with PDD, pancreatobiliary anomalies were detected in all patients who presented with jaundice, 85% of patients with pancreatitis, and 27.8% of patients with abdominal pain, as compared with 60%, 40%, and 17%, respectively, in the control group. In 23 patients, ERCP findings demonstrated pancreatobiliary abnormalities that were not detected by other imaging modalities. Fifteen of the patients with PDD and pancreatobiliary anomalies had undergone cholecystectomy between six months and five years previously. We conclude that ERCP is essential in the investigation of all patients with PDD, especially those presenting with jaundice or pancreatitis. Biliary surgery in patients with PDD and a dilated bile duct should include a biliary drainage procedure to prevent recurrence of pancreatobiliary disease.     

原发性高血压合并室性早搏患者的临床特征

目的 观察原发性高血压患者室性早搏(简称室早)的发生特点,为临床治疗提供依据.方法 选取住院时同步接受动态心电图和动态血压监测的200例原发性高血压患者,观察室早与24 h血压、血压昼夜节律变化、左心室肥厚、心肌缺血以及心功能间的关系.结果 ① 伴和不伴室早的原发性高血压患者,其24 h血压差异无统计学意义;室早Low...