NONMEM法分析临床病人静脉输注阿米卡星的群体药代动力学

收集52例呼吸科感染病人静脉输注阿米卡星(amikacin,AMK)的临床数据,用荧光偏振免疫法(FPIA)测定临床病人AMK的血清浓度275点,按二房室开放模型,用NONMEM程序一步估算出AMK的群体药代动力学参数,并定量地分析病人的体重、肌酐清除率、长期用药和病理状况(慢性阻塞性肺病,COPD)等固定效应对药代动力学参数的影响。经统计分析病人的肌酐清除率和COPD对AMK的药代动力学参数的影响有显著意义,而体重对表观分布容积Vc的影响无显著意义。由最终回归模型估算出AMK的群体药代动力学参数。     

Cavernous hemangioma of the liver: detection with single-photon emission computed tomography

The roles of single-photon emission computed tomography (SPECT) and planar imaging with technetium-99m-labeled red blood cells in the diagnosis of cavernous hemangioma of the liver were evaluated. The study group consisted of 26 consecutive patients referred for evaluation of liver lesions. A total of 23 cavernous hemangiomas were found, all of which showed decreased or normal flow and delayed uptake of the radiotracer. SPECT demonstrated 13 hemangiomas that were not detected with planar imaging; both modalities demonstrated the other ten lesions. Lesions that were not cavernous hemangiomas showed either normal (n = 6) or increased (n = 4) flow; none had delayed increased uptake on either planar or SPECT images. SPECT with labeled red blood cells is an accurate method for the detection of cavernous hemangiomas of the liver and is more sensitive than planar imaging in depicting small lesions.     

Pleural and chest wall invasion in bronchogenic carcinoma: CT evaluation

CT scans of 47 patients who had peripheral bronchogenic carcinoma contiguous to the pleural surface and who had undergone thoracotomy were retrospectively reviewed. The CT features of the primary neoplasm that were analyzed included the angle and amount of contact with the adjacent pleural surface, associated pleural thickening, fat plane between the tumor and chest wall, rib destruction, and chest wall mass. CT was of limited predictive value in separating those patients who had parietal pleural/chest wall involvement from those who did not. The combination of two or three CT findings (obtuse angle, greater than 3 cm contact with pleural surface, associated pleural thickening) resulted in a sensitivity of 87% and a specificity of 59%. The clinical symptom of focal chest pain, while not as sensitive (67%) as CT, was much more specific (94%) for parietal pleura/chest wall invasion.     

Urachal remnants: sonographic demonstration in children

On 62 of 100 pediatric bladder sonograms a small, elliptical, hypoechoic structure was observed on the middle of the anterosuperior surface of the urinary bladder. One of the these structures was removed surgically, and pathologic examination disclosed a normal urachal remnant. Since it is a common sonographic finding in children, it should not be mistaken for a pathologic process unless it is accompanied by signs and symptoms of infection or bladder obstruction.     

Preparation of packed red cells suitable for intravascular transfusion in utero

Intra-cardiac transfusion in utero is a recent development in the treatment of erythroblastosis foetalis. As with intra-umbilical cord transfusion, the procedure has been described as having a high risk of complication characterized by bradycardia and cardiac-arrest. Intra-coronary hyperkalemia was suspected as being a major contributing factor towards the complications experienced, particularly by the intra-cardiac delivery. The procedure is warranted, however, in cases where intra-umbilical cord transfusion is not possible. Therefore, studies comparing various methods of preparing packed cells for intravascular transfusion were initiated. The plasma potassium levels of gravity sedimented packed cells and saline washed red cells resuspended in either Ringer's lactate, pooled donor plasma or saline were measured. Products of saline washed/resuspended packed red cells transfused within 2 hours of preparation were found to have low potassium levels while exposing the fetus to minimal risk of transfusion transmitted infection and were therefore selected to be the most suitable product. Using this product, a significant decrease in the incidence of severe bradycardia resulting in cardiac-arrest, following intravascular transfusion (32 procedures) was observed.