软X线治疗皮肤基底细胞癌和鳞状细胞癌

背景：作者制定了一个应用软X线治疗表皮恶性肿瘤的计划，该计划虑及临床已诊断的肿瘤在治疗下的退化现象。目标：根据治愈率和后期溃疡形成来评价本计划的有效性。方法：对1988-1992年间接受连续照射的1267例基底细胞癌和鳞状细胞癌患者进行随访（平均随访77个月）。结果：肿瘤复发率5．1％，与其大小、厚度及时间-剂量分次因子有关。溃疡形成率6．3％，取决于照射野大小、X线的硬度，在一个较小照射野（直径≤4cm）内则与总的照射剂量和时间-剂量分次因子有关。82．5％的溃疡能适当治愈。局限性：尚无证据表明本方案优于其他文献报道的方案。结论：软X线对表皮恶性肿瘤是有效的。     

Value of laparoscopic staging for Hodgkin disease

Because of the potential for complications with laparotomy and splenectomy, and the widespread use of combination chemotherapy as first-line treatment, surgical staging is now performed in only 30% of patients with Hodgkin disease. Laparoscopic staging has rarely been reported. Three patients with the nodular sclerosis cell type of Hodgkin disease underwent laparoscopic staging. Mean operative time was 207 minutes. No conversion to laparotomy was necessary. There were no peri- or postoperative complications and no deaths. Mean blood loss was negligible. The pathologist deemed all liver and lymph nodes biopsies adequate for histologic analysis. Stage IA and IIA were confirmed in two patients: one patient with stage IIA was upstaged to IIIA after surgery. Performed by an experienced team, laparoscopy is the procedure of choice for abdominal staging of patients with Hodgkin disease.     

Phase II trial and pharmacokinetic assessment of intravenous melphalan in patients with advanced prostate cancer

Summary Alkylating agents have been reported to yield response rates of up to 20% in hormone-refractory prostate cancer. Melphalan was studied in four small trials in which the drug was given orally. In this phase II trial, melphalan (30 mg/m²) was given intravenously every 28 days to 27 patients with hormone-refractory prostate cancer. Pharmacokinetic sampling was performed so as to describe the clearance of melphalan in this population and in an attempt to carry out pharmacodynamic modeling for toxicity and response. Prostate-specific antigen (PSA) was also assessed prospectively. No objective responses to this regimen were documented. The median survival for patients on this trial was 11.5 months. There was no correlation between drug clearance and measured creatinine clearance and no relationship between systemic exposure and toxicity. A decrease of >50% in serum PSA that was sustained for >6 weeks was documented in two patients, most notably in one patient who has survived for more than 29 months. Intravenous melphalan is not an active agent in hormone-refractory prostate cancer.Supported in part by grants 5T32-CA-09307, P30-A-14236-18, and U10-CA-44691 from the NIH, by the Burroughs-Wellcome Corporation, by the Don Monti Memorial Researc Foundation, and by the P. B. Cohen Fund for Urologic Cancer Research. One of the authors (D. I. J.) is a recipient of a Cancer Research Campaign (United Kingdom) Travelling Fellowship     

Diuretics and vitamin B1: are diuretics a risk factor for thiamin malnutrition?

Despite modern pharmacologic agents in the therapy of heart failure, the prevalence of heart failure is increasing worldwide. In the vitamin B1 deficiency disease beriberi, cardiac symptoms may represent the central feature. Two new studies confirmed that all diuretics lead to increased urinary thiamin excretion depending on the urinary flow rate. In a subject at risk, such as an elderly patient, chronic diuretic treatment may lead to a subclinical thiamin deficiency. Whether subclinical thiamin nutriture is a modulator of the prevalence and/or severity of heart failure is not known; however, it seems to be plausible from the metabolic point of view.     

Loss of NKX3.1 expression in human prostate cancers correlates with tumor progression

NKX3.1 is a prostate-specific homeobox gene located on chromosome 8p21. In the mouse, Nkx3.1 has growth-suppressive and differentiating effects on prostatic epithelium. Mutations of the coding region of NKX3.1 were not found in human prostate cancer, failing to support the notion that NKX3.1 was a tumor suppressor gene. To study the expression o NKX3.1 protein in human tissues and prostate cancer, we derived a rabbit antiserum against purified recombinant NKX3.1. Among normal human tissues, NKX3.1 expression was seen in testis, in rare pulmonary mucous glands, and in isolated regions of transitional epithelium of the ureter. NKX3.1 was uniformly expressed in nuclei of normal prostate epithelial cells in 61 histological sections from radical prostatectomy specimens. We analyzed 507 samples of neoplastic prostate epithelium, most of which were contained on a tissue microarray that contained samples from different stages of prostatic neoplasia. We observed complete loss of NKX3.1 expression in 5% of benign prostatic hyperplasias, 20% of high-grade prostatic intraepithelial neoplasias, 6% of T1a/b samples, 22% of T3/4 samples, 34% of hormone-refractory prostate cancers, and 78% of metastases. Our data show that NKX3.1 expression is highly, but not exclusively, specific for the prostate. Loss of NKX3.1 expression is strongly associated with hormone-refractory disease and advanced tumor stage in prostate cancer (P < 0.0001).     

Effects of subinhibitory concentrations of moxifloxacin in an in-vitro dynamic model

The postantibiotic effect (PAE), sub-MIC effect (SME) and postantibiotic sub-MIC effect (PASME) of moxifloxacin were investigated in an in-vitro dynamic model reproducing in-vivo elimination kinetics of the antibiotic. The PAE was induced by exposing strains of Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli and Klebsiella pneumoniae to 5 x MIC of the antibiotic for 1.5 hours. After induction, cultures were washed to eliminate the antibiotic and resuspended into the dynamic model either in the presence or absence of a subinhibitory concentration of the antibacterial agent of 0.5 x MIC. Unexposed controls were treated similarly. PASMEs were constantly longer than corresponding SMEs, but differences between them were not statistically significant. Both PASMEs (mean 11:17 hours, range from 8:17 to 14:57) and SMEs (mean 9:23 hours, range from 6:03 to 12:34) had an initial bactericidal effect and were significantly longer than PAEs (mean 1:31 hours, range from 0:21 to 2:14). The primary effect of moxifloxacin sub-MICs appears to be prevalent in PAE. The possibility of once-daily dosing of the drug is strengthened.     

Gaining uniform active muscle function by "in situ tendon transplant" in surgical rehabilitation of the upper extremity of tetraplegic patients. A case report]

The results of tendon transfers in the tetraplegic upper limb are encouraging. In contrast to the cases with peripheral nerve injury or polio, the availability of active muscles for transfers is very limited in tetraplegics. In both hands of a tetraplegic patient with Group 4 according to the international classification the brachioradialis was transferred to FPL and ECRL to FDP 2-5. The Zancolli-Lasso-procedure was performed in both hands as well as tenodesis of EPL proximally to the wrist. On the right side stabilisation of the thumb was achieved by CMS-1-fusion and on the left side the thumb got control by an abductor transfer using pronator teres and an interpositional tendon graft of the paralysed FDS 2. The result is described. Grip strength and Sollerman test were measured. Advantages and disadvantages of the two different procedures for thumb control are discussed, and the different abilities of gripping are shown.     

Calcium-independent increases in pericellular plasminogen activator activity in pemphigus vulgaris*

Abstract Intracellular free calcium ([Ca²⁺]_i), an important second messenger, plays a crucial role in a variety of biochemical reactions leading to cell activation and protein secretion. This study examines the potential role of (Ca²⁺)_i in mediating increases in pericellular plasminogen activator activity of canine keratinocytes observed upon binding of human pemphigus vulgaris IgG (hPV IgG). Using the calcium-sensitive fluorescent probe fura-2 and digital video fluorescence imaging microscopy, [Ca²⁺]_i levels were determined in individual keratinocytes for up to 29 minutes after addition of 0.1–5 mg/ml hPV IgG to monolayers of subconfluent and confluent cultures. Extracellular ATP (a known [Ca²⁺]_i-agonist in canine keratinocytes) and normal human IgG (nh IgG) served as positive and negative controls, respectively. HPV IgG and nh IgG failed to induce significant increases in [Ca²⁺]_i whereas 500 μM ATP induced a rapid, 3- to 12-fold transient increase above resting levels. Binding of hPV IgG to these keratinocyte cultures was demonstrated by immunoflurescence at the end of selected experiments. ATP stimulation of cultures previously treated with hPV IgG showed normal responsiveness and more than 90% of the cells were still viable at the end of [Ca^2plus;]_i imaging, thus demonstrating that failure to respond to hPV IgG was not due to an experimental artifact. Plasminogen activator activity in supernatants of confluent cultures incubated with 0.1– 1 mg/ml hPV IgG or nh IgG and harvested at various time intervals was dependent on the IgG dose used and increased steadily over time. Increases in activity were 47–92% higher in cultures treated with hPV IgG than those incubated with the same dose of nh IgG. Taken together, these results suggest that hPV IgG-mediated increases in pericellular uPA activity occur via pathways independent of Ca²⁺ mobilization.