完全型雄激素不敏感综合征的临床特征与变异

目的　总结中国完全型雄激素不敏感综合征 (CAIS)患者的基本特征和不同变异。方法　回顾性研究了 1976年 3月至 2 0 0 2年 2月北京协和医院收治的 2 8例CAIS患者的临床表现、激素测定和性腺病理结果 ,并与中国正常人群和国外文献报道的CAIS患者进行比较分析。结果　CAIS患者为女性表型 ,成年身高 (16 6 6 7±3 81)cm ,阴毛、腋毛稀少或缺如 ,有乳房发育 ,女性外阴 ,阴道呈盲端 ,深度为 (5 76± 1 6 4 )cm ,无宫颈 ;2 6 1%合并存在睾酮水平下降 ;19 2 %出现睾丸肿瘤 ,11 5 %有较大的睾丸鞘膜积液 ,19 2 %存在有发育不良的子宫。结论　CAIS临床表现较为特异 ,但仍存在异质性 ,包括存在发育不良的子宫、合并存在睾酮水平下降 ;中国CAIS患者肿瘤的发生率高于国外的报道。     

颈前路带锁钢板内固定治疗下颈椎骨折脊髓损伤病人的护理

目的探讨颈前路带锁钢板内固定治疗下颈椎骨折脊髓损伤病人的护理。方法随机选取1999年7月￣2003年7月22例下颈椎骨折脊髓损伤拟行前路带锁钢板内固定手术的病人,进行回顾性分析。结果21例获随访6￣24个月,按Frank分析法评价。4例完全恢复正常(占18.18%),上升1级9例(占40.90%),上升2级6例(占27.27%),无改善2例(占9.09%),死亡1例(占4.55%)。结论加强颈椎骨折脊随损伤病人围手术期护理,可有效预防术后并发症的发生,提高手术成功率。     

微波治疗耳廓假性囊肿的疗效观察

目的 探讨微波治疗耳廓假性囊肿的疗效.方法 对82例耳廓假性囊肿采用微波治疗,观察其疗效.结果 82例总有效率100%,其中痊愈78例,显效4例,随访3～6个月无复发.结论 微波治疗简单易行,术中不易出血,术后反应轻,费用低廉,治疗效果确切,易被患者接受,值得推广使用.     

贺普丁、卡提素、复方益肝灵联合治疗慢性乙肝36例观察

目的 探讨贺普丁、卡提素、复方益肝灵联合应用治疗慢性乙肝的疗效。方法 对确诊为慢性乙肝的患者随机分 为治疗组和对照组,治疗组采用贺普丁、卡提素、复方益肝灵联合用药。贺普丁50mg,口服,每日1次;卡提素0．5mg,穴位注 射,每半月1次;复方益肝灵2片,每日3次,口服。疗程半年。而对照组采用聚肌胞4mg,穴位注射,每周1次;乙肝疫苗 30μg,肌肉注射,每半月1次;护肝片2片,每日3次,口服。疗程半年。结果 治疗组各项指标明显优于对照组。结论 贺普 丁、卡提素及复方益肝灵合用治疗慢性乙肝疗效确切。     

Insights into oxazaphosphorine resistance and possible approaches to its circumvention.

The oxazaphosphorines cyclophosphamide, ifosfamide and trofosfamide remain a clinically useful class of anticancer drugs with substantial antitumour activity against a variety of solid tumors and hematological malignancies. A major limitation to their use is tumour resistance, which is due to multiple mechanisms that include increased DNA repair, increased cellular thiol levels, glutathione S-transferase and aldehyde dehydrogenase activities, and altered cell-death response to DNA damage. These mechanisms have been recently re-examined with the aid of sensitive analytical techniques, high-throughput proteomic and genomic approaches, and powerful pharmacogenetic tools. Oxazaphosphorine resistance, together with dose-limiting toxicity (mainly neutropenia and neurotoxicity), significantly hinders chemotherapy in patients, and hence, there is compelling need to find ways to overcome it. Four major approaches are currently being explored in preclinical models, some also in patients: combination with agents that modulate cellular response and disposition of oxazaphosphorines; antisense oligonucleotides directed against specific target genes; introduction of an activating gene (CYP3A4) into tumor tissue; and modification of dosing regimens. Of these approaches, antisense oligonucleotides and gene therapy are perhaps more speculative, requiring detailed safety and efficacy studies in preclinical models and in patients. A fifth approach is the design of novel oxazaphosphorines that have favourable pharmacokinetic and pharmacodynamic properties and are less vulnerable to resistance. Oxazaphosphorines not requiring hepatic CYP-mediated activation (for example, NSC 613060 and mafosfamide) or having additional targets (for example, glufosfamide that also targets glucose transport) have been synthesized and are being evaluated for safety and efficacy. Characterization of the molecular targets associated with oxazaphosphorine resistance may lead to a deeper understanding of the factors critical to the optimal use of these agents in chemotherapy and may allow the development of strategies to overcome resistance.     

Pharmacokinetics of tacrolimus and mycophenolic acid are altered, but recover at different times during hepatic regeneration in rats.

Hepatic regeneration is very critical to the success of living donor liver transplantation, which allows a reduced size liver to grow in size to accommodate the requirements of both the donor and the recipient. The objectives of this study were to evaluate 1) the hepatic metabolism of the two immunosuppressive drugs, tacrolimus and mycophenolic acid (MPA), and 2) the pharmacokinetics of tacrolimus and mycophenolic acid at various time points after initiation of hepatic regeneration by partial hepatectomy in rats. The hepatic intrinsic clearance of tacrolimus was decreased to 70% and 51% of the control level at the 24th h and the 6th day, respectively, but returned to normal level by day 14. The total body clearance of tacrolimus was reduced transiently but recovered completely by day 18. The hepatic intrinsic clearance of MPA was decreased to 52% and 51% of that in control rats at the 24th h and the 6th day, respectively, but recovered to normal level by day 14. The total body clearance of MPA was reduced at the 24th h but recovered by day 6. The magnitude of reduction in the clearance of tacrolimus and MPA was much smaller than what was predicted from in vitro data. The elimination clearance of MPA glucuronide was also impaired during hepatic regeneration but recovered to normal level with time. In conclusion, the pharmacokinetics of tacrolimus and mycophenolic acid were altered during hepatic regeneration but recovered completely at different rates over time. Caution must be exercised in extrapolating in vitro data to in vivo conditions during hepatic regeneration.     

米非司酮致子宫内膜简单型增生二例临床分析

近年来，随着米非司酮应用的日趋广泛，其并发症亦不断增加，尤其是一些少见的以及一些始料未及的并发症，更应引起注意。我院2004年门诊诊治的二例病例，1例为子宫肌瘤剜除术后，1例为子宫腺肌症，在连续口服米非司酮4～6个月后，出现不规则的阴道多量流血，后经诊断性刮宫，二例病理检查均提示为子宫内膜简单型增生。现报道如下：     

三叉神经痛的辨证施治略述

三叉神经痛是指三叉神经分布范围内反复出现的阵发性短暂剧烈疼痛。罹患此病，轻者影响正常生活，重者痛不欲生。患者自觉痛如刀割、锥刺、火灼、电击、常伴有同侧面部肌肉抽搐，一般无感觉缺失等神经传导功能障碍。并常见到有激发点（扳机点）的存在，即如在刷牙、洗脸、进食、言语等动作时，接触三叉神经分布区某一部皮肤或粘膜等，均可激发疼痛发作。     

Prediction of Hidden Blood Loss During Posterior Spinal Surgery

Objective Identification of the risk factors for extraordinary hidden blood loss (HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in spinal surgery.     

保罗青光眼植入物治疗青光眼的初步观察

目的：初步评估保罗青光眼植入物在青光眼治疗中的有效性和安全性。

方法：回顾性分析2022-03/2023-01接受保罗青光眼植入物治疗的青光眼患者10例10眼的临床资料。至少随访12 mo,观察手术前后视力、眼压和抗青光眼用药数量等指标的变化。

结果：纳入患者末次随访时视力较术前无明显变化; 术前眼压19-60(中位数28)mmHg,末次随访时眼压为10-18(中位数14)mmHg。术前所有患者均需使用2-4种抗青光眼药物,末次随访时仅1例患者需使用。4例患者末次随访时角膜内皮细胞密度较术前明显下降,未发生角膜相关并发症。截至末次随访,10例患者均获得手术成功。

结论：保罗青光眼植入物具有显著的降眼压疗效,角膜内皮细胞损害可能是其存在的隐患。