自体造血干细胞移植不同预处理方案治疗恶性淋巴瘤100例临床观察

本研究比较大剂量化疗联合或不联合大面积照射预处理方案对恶性淋巴瘤(ML)患者行自体造血干细胞移植(AHSCT)的疗效、预后及安全性的影响。回顾性分析1992年9月至2010年8月在解放军307医院行AHSCT的100例ML患者,根据AHSCT预处理方案不同,分为高剂量化疗组和高剂量放、化疗组,分析3、5、10年的总生存(OS)率、无进展生存(PFS)率和不良反应。结果表明,截止至2011年2月,中位随访时间33.5个月,所有患者造血功能均获重建。高剂量化疗组和高剂量放、化疗组患者白细胞计数恢复至1.0×109/L的中位时间为(6.0±0.4)d、(8.2±0.4)d,血小板恢复至20.0×109/L的中位时间为(7.1±0.8)d、(11.4±2.5)d,差异均具有统计学意义(P0.05)。高剂量化疗组和高剂量放、化疗组OS率分别为3年67.3%、68.9%,5年62.8%、60.6%,10年57.6%、56.2%;PFS率分别为3年63.6%、63.2%,5年59.4%、58.3%,10年50.8%、55.3%,差异均无统计学意义(P0.05);两组患者发热、感染、出血差异无统计学意义(P0.05)。结论:自体移植预处理方案中的高剂量放、化疗组较高剂量化疗组造血重建晚,但两组疗效及预后无统计学差异。     

Comparison of a Shortened Isosorbide Dinitrate-Potentiated Head-Up Tilt Testing with the Conventional Protocol: Tolerance and Diagnostic Accuracy

Background: The head-up tilt test (HUT) is widely used to investigate unexplained syncope; however, in clinical practice, it is long and sometimes not well tolerated. Objectives: To compare the sensitivity, specificity, accuracy, and patients' tolerance of a conventional and shortened HUT. Methods: Patients with a history of vasovagal syndrome (VVS) were randomized to a conventional HUT (group I) consisting of 20-minute passive tilt followed by 25 minutes after administration of sublingual isosorbide dinitrate (ISDN), or a shortened HUT (group II) where ISDN was given immediately after tilt and observed for 25 minutes. The control group consisted of age- and gender-matched subjects without VVS symptoms. A specific questionnaire to evaluate tolerance was applied. Results: Sixty patients (29 ± 10 years, 82% female) were included. In group I, 22/30 patients had a positive HUT compared to 21/30 in group II (73% vs 70%, P = 0.77). There was also no difference in the accuracy between the two protocols (63% vs 73%, P = 0.24). The time to positivity was shorter in group II (13.2 minutes vs 30 minutes, P < 0.001). Within the control group (n = 60), the frequency of false-positives was 47% and 23% for the conventional and shortened HUT, respectively (P = 0.058). After conventional HUT, 65.2% subjects reported that the test was too long compared to 25% subjects after the shortened HUT (P = 0.002). Conclusion: In this study, the HUT without passive phase was not inferior to the conventional HUT regarding sensitivity, specificity, and accuracy. Furthermore, the shortened ISDN-potentiated protocol allowed faster diagnosis and was better tolerated. (PACE 2012; 35:1005-1011).     

不同咽喉入路方式在声门上型喉癌手术中的应用

目的分析声门上型喉癌保留喉功能手术中进入咽喉腔的合理入路。方法对21例行声门上喉部分切除术的患者分别采用会厌谷入路、声带前连合上方入路及咽侧入路进入咽喉腔,完整切除肿瘤并行相应修复方式,保留喉功能。结果所有患者手术顺利,术中进入咽喉腔及肿瘤切除的过程中符合肿瘤切除的"无瘤"原则,术后病理未出现手术切缘阳性,无咽瘘。全部患者均于术后10～30 d拔除鼻饲管经口进食,20例患者于术后14～60 d拔除气管套管,所有患者均发音成功。结论声门上型喉癌行保留喉功能手术时,根据肿瘤原发部位及局部浸润情况,采取不同入路进入咽喉腔既获得了满意的手术视野及疗效,同时遵循了肿瘤切除的"无瘤"原则。     

血浆置换治疗ABO血型不合异体外周血干细胞移植后纯红再生障碍性贫血

目的;观察血浆置换治疗ＡＢＯ血型不合异体外周血干细胞移植后出现红系再生障碍的疗效。方法：ＣＳ ３０００Ｐｌｕｓ血浆置换,回输“ＡＢ”型健康人血浆及７０６代血浆。结果：置换后１０ｄ Ｈｂ上升,３周后上升为９４ｇ／Ｌ。结论：血浆置换是治疗ＡＢＯ血型不合异体外周血干细胞移植后纯红再障比较好的方法。     

结核病小鼠病理学与T_H1/T_H2细胞动力学及iNOS表达关系的研究

目的　从分子病理学角度探讨结核病小鼠病理学与免疫学的相关性。方法　将BALB c小鼠随机分为两组 :结核病模型组 (A)和正常对照组 (N)。经尾静脉注射H37RV 建立结核病小鼠模型。采用免疫组化染色和常规HE染色 ,探讨IFN γ、IL 4、iNOS表达与肺脏组织损伤的类型和程度的关系。免疫组化结果采用图象分析计算阳性细胞面密度。结果　结核病小鼠病程中可观察到两个阶段 :感染 2周内为急性炎症期 ,以肺泡 毛细血管间质内和血管周围炎性渗出为特征 ,可观察到明显的TH1细胞占优势 ,免疫组织化学染色结果显示 ,在炎性渗出区内IFN γ阳性细胞较IL 4阳性细胞明显增多 ;感染第 4周到实验结束为慢性进展期 ,以肺实质内广泛肺炎伴灶性干酪坏死为特征 ,免疫反应表现为TH0平衡 ,在肺损伤组织中IFN γ和IL 4阳性细胞基本相当。iNOS表达在急性期增多慢性期减少。结论　结核病感染过程中TH1/TH2细胞动力学和iNOS表达的变化与组织损伤的类型和程度关系密切。     

对截石位手术床腿架装置的改进与制作

目的针对目前手术室使用的截石位手术床腿架存在调节费力、螺丝松脱会造成病人大腿受伤的问题,笔者设计了一种可以通过前后移动来调整高度的截石位手术床腿架。方法手术床腿架主干采用不锈钢材质制作,由主撑、滑套、斜撑、撑杆和腿托5个部分组成,主撑和斜撑分别固定于手术床床尾同一侧的上下选定部位,滑套套装在主撑上,与斜撑相连;斜撑为气弹簧组件,其长度可调,用来调节腿架的高度,腿托通过可以左右两个自由度活动的撑杆固定在滑套上。结果它操作方便,升降平缓安全,解决了操作费力及存在安全隐患的问题。结论较之原先未改进的手术床腿架,缩短了手术摆位时间,更易于调整双腿分开角度,提高了腿位放置的舒适度,医生、护士使用操作更加灵活、方便、可靠。     

Intravenous infusion of propofol for induction and maintenance of anaesthesia during endoscopic carbon dioxide laser ENT procedures with high frequency jet ventilation

Fourteen patients of ASA grades 1 3 were anaesthetised with continuous infusions of propofol and alfentanil for endoscopic carbon dioxide laser ENT microsurgery. Their lungs were ventilated with an oxygen-air mixture using a high frequency jet ventilator. Propofol was given at an initial rate of 120 μg/kg/minute for 10 minutes after a bolus dose of 2.6 mg/kg, and then at 80 fig μg/kg/minute. Alfentanil was given at a rate of 0.5 μg/kg/minute. Arterial pressure decreased significantly after the bolus dose. It increased significantly for a few minutes after laryngoscopy and returned to baseline values during maintenance of anaesthesia. Heart rate increased significantly during induction and until laryngoscopy was performed but it decreased below its initial value after 5 minutes of maintenance. Platelet count and the degree of aggregation did not change during infusion of propofol.