Preoperative risk stratification using gated myocardial perfusion studies in patients with cancer.

Cancer patients frequently have anemia or an altered coagulation state that may affect their risk stratification for perioperative cardiac events. We performed this study to investigate the incidence of perioperative cardiac events in cancer patients who had abnormal stress myocardial perfusion imaging (MPI) results versus cancer patients with normal MPI results. METHODS: We included 394 consecutive cancer patients with normal (n = 201) or abnormal (n = 193) results on MPI studies performed for preoperative risk stratification. MPI was performed within 6 mo before each patient's scheduled operation. All the patients had surgical procedures requiring general anesthesia, except for 18 who had endoscopic or colonoscopic procedures. We retrospectively reviewed their data for the incidence of major cardiac events intraoperatively and for 1 mo postoperatively. We collected data on their cancer type, risk factors for coronary artery disease, MPI findings, risk of operation, and intraoperative or postoperative major cardiac events, which included death, myocardial infarction (MI), and congestive heart failure (CHF). RESULTS: The patients with abnormal MPI results included 97 with ischemia, 80 with scarring, and 16 with mixed scarring and ischemia. The mean left ventricular ejection fraction and end-diastolic volume were 63.8% +/- 9.8% and 82.0 +/- 53.5 mL in the normal MPI group versus 52.1% +/- 13.1% and 118.1 +/- 53.4 mL in the abnormal-MPI group (P < 0.001). There were 9 major intraoperative or postoperative cardiac events (4.7%) in the patients with abnormal MPI results and none in the patients with normal MPI results (P = 0.001). These major events consisted of 3 deaths, 2 acute MIs, 1 non-Q-wave MI, and 3 cases of CHF. Four of these patients had only scarring on their MPI studies, 3 had ischemia, and 2 had scarring and ischemia. CONCLUSION: Normal MPI results have a high negative predictive value for perioperative cardiac events in cancer patients. Abnormal MPI results, whether demonstrating scarring or ischemia, should prompt appropriate perioperative management in patients with cancer to minimize major cardiac events.     

Clinical Significance of an Early Protocol Biopsy in Living-Donor Renal Transplantation: Ten-Year Experience at a Single Center

We report here our 10-year experience of a biopsy performed at day 14 after transplantation in 304 patients with stable graft function. The factors that may have influenced subclinical rejection were analyzed according to histology. The incidence of subclinical rejection was 13.2%. Addition of mycophenolate mofetile (MMF) as a primary immunosuppressant significantly decreased the incidence of subclinical rejection compared with patients without such treatment (odds ratio, 0.23; p < 0.05). On the other hand, HLA-DR antigen mismatch (odds ratio, 2.39) and unrelated donor (odds ratio, 2.10) were also significantly associated with decreased subclinical rejection (p < 0.05). The incidence of acute rejection in patients with normal findings was lower than in those with borderline changes or subclinical rejection (0.23 +/- 0.05 vs. 0.48 +/- 0.07 and 0.60 +/- 0.11, respectively; p < 0.05). The graft survival rates in patients with subclinical rejection were lower than in patients with normal or borderline changes at 1 (88.4% vs. 97.9% and 99.1%; p < 0.05), 5 (77.8% vs. 96.2% and 95.9%; p < 0.05) and 10 (62.3% vs. 96.2% and 93.7%; p < 0.05) years. Thus, a protocol biopsy performed on day 14 after transplantation is useful for predicting graft survival. Triple therapy including MMF, related donor and HLA-DR antigen match are important factors for reducing subclinical rejection in living-donor renal transplantation.     

Treatment of congenital cystic adenomatoid malformation-does resection in the early postnatal period increase surgical risk?

OBJECTIVE: The recent development of fetal ultrasonography has allowed for an increasing number of prenatal diagnoses for congenital cystic adenomatoid malformation (CCAM). However, the appropriate surgical timing of these patients has not been studied as of yet. The aim of this study is to suggest a safe strategy for the treatment of CCAM by identifying the relationship between the timing of surgery and postoperative outcome. METHODS: Between 1987 and 2003, 40 patients (28 males, 12 females) underwent surgical resection for CCAM. The mean age was 38.6+/-9.1 (2 days-13 years) months. CCAM was diagnosed by prenatal ultrasonography in eight patients. Early operations were performed in four out of the eight. Operation was deferred until 2-12 months of age for the remaining four patients. RESULTS: Type I CCAM was found in 20 patients, type II in 20 and no patient exhibited type III. Five patients had associated pectus excavatum anomaly. There were no cases of operative mortality. Seventeen minor postoperative complications developed in 16 patients (40.0%): prolonged chest tube drain in 10, wound infection in 4, and 1 case of pneumonia, empyema and pleural space, respectively. The average hospital stay was 11.8 (6-29) days. During the mean follow-up period of 67.5 months, one patient died of accidental aspiration 7 months after operation during the postoperative recovery course of Ravich operation for pectus excavatum. The remaining patients reported doing well with normal physical activity. All five patients who underwent surgery at the age of under 1 month did not exhibit increased postoperative morbidity. CONCLUSIONS: We concluded that surgery for CCAM could be safely performed in all age groups with satisfactory long-term outcomes. It is suggested that early elective surgical correction can be recommended for a patient whose diagnosis was made in utero.     

Schizotypal disorder and schizophrenia: a profile analysis of neuropsychological functioning in Japanese patients.

This study compares neuropsychological functioning in a Japanese schizophrenia spectrum disorder group and a group of healthy Japanese volunteers. Participants were 37 patients diagnosed with schizophrenia, 28 schizotypal patients, and 99 psychiatrically-normal volunteers. A wide range of cognitive measures were examined. All participants completed a Japanese version of a neuropsychological battery assessing executive function, working memory, processing speed, language, verbal memory, and spatial organization. Comparisons of neuropsychological function demonstrated similarities and differences between patients diagnosed with schizotypal disorder and those diagnosed with schizophrenia. Impairments in verbal memory, language, and processing speed were common to both patient groups and may represent a vulnerability to schizophrenia. Impairments in aspects of working memory, spatial organization and executive function were preferentially observed in schizophrenia and may be features of the overt manifestation of psychosis. Possible differences in the contributions of prefrontal and temporo-limbic structures provide direction for further studies.     

增殖细胞核抗原在口腔鳞状细胞癌中的表达

采用鼠抗ＰＣＮＡ单克隆抗体，ＡＢＣ法，对１１例正常口腔粘膜及２９例口腔鳞癌进行了染色。结果表明：正常粘膜仅在基底层中有少量的ＰＣＮＡ阳性细胞，其阳性分级为１级。而鳞癌阳性分级主要是３～４级，随着组织学分级的升高，ＰＣＮＡ阳性表达率也相应增高。经统计学分析，正常组织与鳞癌之间及鳞癌各级均有非常显著差异（Ｐ＜００１）。提示：ＰＣＮＡ的表达与口腔鳞癌组织学分级有关。     

实验性视网膜光化学损伤中的蛋白激酶C

目的：研究实验性视网膜光化学损伤中蛋白激酶C(protein kinase C，PKC)活性的改变；探索地塞米松(dexamethasone，DXM)对视网膜中PKC活性的影响。 方法；48只SD大鼠分为对照组和DXM组，后者于光照前3天开始，连续5天腹膜腔注射DXM 1mg/(kg·d)。经(1 900±106.9)Ix的绿色荧光灯(λ＝510nm～560nm)连续照射24小时后的6小时和1、3、7、14天，进行视网膜PKC活性检测。 结果：光化学损伤后视网膜中的PKC活性在短暂的上升后即出现持续性的下降；DXM对PKC的活性改变无明显作用。 结论：光化学损伤中的视网膜功能障碍可能与PKC活性的持续降低有关。 （中华眼底病杂志，1997，13：78-80）     

复合维生素对抗体形成细胞的影响

单独一种维生素缺乏对免疫功能的影响已有较多研究报道,但维生素缺乏一般不会单独发生,为此本实验研究了维生素A、E、B_2、B_6及叶酸供给不足(1/3生理需要量)、加倍补充(2倍和3倍生理需要量)后对小鼠抗体形成细胞的复合效应。动物喂养6周(不足纠正组喂8周),结果显示,不足组抗体形成细胞显著低于对照组,而2倍、3倍组则显著升高,不足组补充正常量维生素后,抗体形成细胞升高超过对照组,与2倍量组无显著差异;另外,该几种维生素对肝脏RNA、脾脏DNA、RNA及肝脏蛋白质均有明显影响,且抗体形成细胞的变化与核酸、蛋白质含量改变相平行,提示后者可能是维生素作用于体液免疫系统的生化机制。     

磺胺噻二嗪硫酮衍生物的合成及其抑菌活性

利用药物化学骈合原理设计并合成了一系列新的３，５－二取代１，３，５－噻二嗪－２－硫酮类化合物，其结构经红外光谱，紫外光谱及元素分析证实，抑菌活性试验显示了良好的抑菌活性。     

洁尔阴体外抑菌作用的实验研究

用国产恩威牌洁尔阴对阴道常见七种细菌进行抑菌试验,结果该药对其中五种细菌有明显抑菌作用,本文为洁尔阴治疗细菌性阴道炎提供了实验依据。     

中医治疗妊娠重复性疾病

在中医妇科门诊工作中 ,经常可以遇到这样情况 ,在一个人的多次妊娠过程中会出现重复性疾病 ,以致因此而导至胎动不安、堕胎、滑胎、甚至出现畸胎。对此我们可以称之为“妊娠重复性疾病”。“优生、优育”是每一位孕妇及其家属的愿望 ,更是我国的一项基本国策。故我们对此类疾病应予以重视、研究 ,以提高临床疗效 ,解除患者的病痛、确保胎儿的健康出生。在自己三十多年的临床工作中 ,遇到数例这类疾病 ,从中摸索出了一些规律、有一定的认识、掌握了一定经验、取得了一定临床疗效。现将一些资料整理成文 ,以供同道参考。病例一、李桂娥 ,女 ,…