反应停治疗难治性多发性骨髓瘤25例

1临床资料我院2001-02/2004-01接受2个疗程卡氮芥 环磷酰胺 马法兰 泼尼松 长春新碱或2个疗程长春新碱 阿霉素 地塞米松方案化疗无效或复发的难治性多发性骨髓瘤患者25(男16,女9)例,年龄42～80(中位年龄57.2)岁.单用反应停口服治疗,起始剂量200 mg/d,如无不良反应,每周增加100 mg,根据患者耐受情况,最高剂量为600 mg/d,3 mo为1疗程.服药期间禁止使用糖皮质激素类药物及细胞毒药物.     

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Background  

Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.     

Effect of aldosterone on cyclic-AMP metabolism in the urinary bladder of the toad

Recent studies regarding the mechanism by which adrenal steroid hormones influence the transport and permeability effects of cyclic-AMP (c-AMP) in the toad urinary bladder are summarized. Aldosterone increases the sodium transport and the water-permeability response of the toad urinary bladder to antidiuretic hormone and to its intracellular mediator, c-AMP. This action of the steroid appears to involve inhibition of the degradation of c-AMP. In response to vasopressin, or to theophylline, c-AMP levels are higher in aldosterone-treated tissue; and the activity of cyclic nucleotide phosphodiesterase—the enzyme that catalyzes the degradation of c-AMP—is depressed.     

IgE Multiple Myeloma: A Report of the Third Case

The third known case of IgE multiplemyeloma is described. The patient wasa 65-yr-old woman who died 11 moafter a diagnosis of multiple myelomawas made by a surgical biopsy of theleft iliac crest. Her serum containedapproximately 2.7 g/100 ml of a paraprotein of mid- mobility. The isolatedanomalous protein gave a reaction ofidentity with the IgE myeloma proteinof the second reported case when reacted with a specific IgE antiserum.The light-chain type of the myelomaprotein was in contrast to of theother two IgE myeloma proteins. Herclinical manifestations differed fromthe two previously reported cases inseveral respects. She had neitherplasma cell leukemia nor overt BenceJones proteinuria and developed rapidly progressive widespread osteosclerotic lesions that were associated withbone pain.

Submitted on June 7, 1971 Revised on August 9, 1971 Accepted on September 1, 1971     

Home glucometer monitoring markedly improves diagnosis of post renal transplant diabetes mellitus in renal transplant recipients

BACKGROUND: Definitions of de novo posttransplant diabetes mellitus (PTDM) have varied widely in the renal transplant literature, and most have not used the American Diabetes Association (ADA) definition of diabetes (fasting plasma glucose [FPG] > or = 126 mg/dl on two occasions, or a casual plasma glucose level >200 mg/dl). Most patients are monitored for PTDM by 12-hour FPG levels drawn for clinic visits. In contrast, we describe the diagnosis of PTDM by home glucometer monitoring METHODS: We screened 89 consecutive nondiabetic renal transplant recipients for PTDM by ADA criteria and home glucometer monitoring during the first 3 months posttransplant RESULTS: Of 23 patients with impaired fasting glucose levels of 111-126 mg/dl, 14 (61%) met ADA criteria for diabetes mellitus of based on home glucometer monitoring. The incidence of de novo PTDM was 31% during this period. Predictors of PTDM in a Cox proportional hazards model were race and acute rejection, with a trend towards BMI. Clinic visit FPG levels did not differ between PTDM and non-PTDM patients. All diagnoses were made based on prelunch or supper FPG >200 mg/dl. CONCLUSIONS: Overnight FPG are inadequate for diagnosis of PTDM. All renal transplant recipients with impaired FPG should, at minimum, have home FPG testing.     

Criteria for selection of patients for emergency portacaval shunt

A computer program analysis of the effect on survival of 74 preoperative factors was performed as part of a prospective study of the emergency portacaval shunt in 146 unselected patients with bleeding esophageal varices due to alcoholic cirrhosis. Only ascites, a serum glutamic oxalacetic transaminase level of 100 units or more, and a requirement for 5,000 ml or more of blood transfusion were associated with a statistically significant decrease in survival. However, none of these factors are contraindications to operation because their presence permits a survival rate of 37 to 40 per cent. The only contraindication to emergency portacaval shunt is the combined presence of ascites, jaundice, encephalopathy, and severe muscle wasting, a constellation that was incompatible with survival beyond one year.     

Hypophosphatemia after 95 right-lobe living-donor hepatectomies for liver transplantation is not a significant source of morbidity

BACKGROUND: Hypophosphatemia appears to be a universal event after right hepatic lobectomy for live-donor adult liver transplantation according to one report. Because hypophosphatemia appears to contribute to increased postoperative complications, routine hyperalimentation with supratherapeutic levels of phosphorus was advocated. METHODS: From July 2000 to May 2002, we performed 95 right-lobe living-donor hepatectomies for 95 adult liver-transplant recipients, the largest single institutional experience. We reviewed our data that were collected prospectively. RESULTS: We did not find profound hypophosphatemia (<1.0 mg/dL) to be prevalent in our donors. At least six (6.3%) donors did not have postoperative hypophosphatemia. In addition, there appears to be no increased morbidity related to hypophosphatemia when aggressively corrected with intravenous or oral phosphates in our group of donors that underwent right-lobe hepatectomies. CONCLUSIONS: We, therefore, cannot endorse the routine administration of hyperalimentation with supratherapeutic phosphorus because of its potential morbidity.     

Survival of some medically important fungi on hospital fabrics and plastics

Tests of the survival of Candida spp., Aspergillus spp., a Fusarium sp., a Mucor sp., and a Paecilomyces sp. on hospital fabrics and plastics indicated that viability was variable, with most fungi surviving at least 1 day but many living for weeks. These findings reinforce the need for appropriate disinfection and conscientious contact control precautions.