原发性卵巢平滑肌肉瘤临床分析(附3例报告及国内20例综合分析)

目的 探讨原发性卵巢平滑肌肉瘤的临床特点、诊断、治疗方法，以及可能预后相关因素。方法 对3例原发性卵巢平滑肌肉瘤综合国内近10年报道20例进行分析。结果 原发性卵巢平滑肌肉瘤可发生于任何年龄，主要为绝经后妇女。临床表现不典型，诊断主要依靠病理，同时结合免疫组化Desmin( )，Vimentin( )诊断。结论 原发性卵巢平滑肌肉瘤恶性度高，预后差，并且可能与分化程度及其微血管相关。治疗以手术为主，辅以合适的放疗和化疗综合治疗。     

Lymphangioma of the spermatic cord

We report a new case of spermatic cord lymphangioma in a infant 2 years old. The initial diagnosis was funicular hydrocele. The treatment was the local excision of tumor and the diagnostic was histological. Postoperative course was excellent. Must be explored the transillumination of the mass which would have led us to think other the diagnosis different from that of the cord hydrocele before the operation since it would have given negative. During the operation, must the assured that the cystic anomaly is limited to spermatic cord, to evite recurrences in the postoperative course.     

Randomized parallel study of doxorubicin plus paclitaxel and doxorubicin plus cyclophosphamide as neoadjuvant treatment of patients with breast cancer.

PURPOSE: This randomized, noncomparative, parallel-group study was designed to evaluate the pathologic complete response (pCR) rate of combined doxorubicin plus paclitaxel (AP) and doxorubicin plus cyclophosphamide (AC) as neoadjuvant chemotherapy in patients with previously untreated breast cancer who were unsuitable for conservative surgery. PATIENTS AND METHODS: A total of 200 patients with T2-3, N0-1, M0 disease were randomly assigned in a 2:1 ratio to receive preoperative chemotherapy with either doxorubicin 60 mg/m(2) plus paclitaxel 200 mg/m(2) as a 3-hour infusion (AP) or doxorubicin 60 mg/m(2) plus cyclophosphamide 600 mg/m(2) (AC) every 3 weeks for 4 courses followed by surgery. RESULTS: A pCR (eradication of invasive carcinoma in tumor and in axillary lymph nodes) was found in 16% and 10% of patients in the AP and AC arms, respectively, by study center pathologists, and in 8% and 6% of patients, respectively, by independent pathologists. Patients with pCRs tended to have unifocal disease, tumors with negative hormonal receptor status, and less differentiation (Scarff, Bloom, and Richardson scale grade 3). Breast-conserving surgery was performed in 58% and 45% of patients in the AP and AC arms, respectively. An objective clinical response was achieved in 89% of patients in the AP arm and 70% in the AC arm. At a median follow-up of 31 months, disease-free survival (DFS) was higher in patients who reached pCR versus those without pCR (91% v 70%). CONCLUSION: The encouraging pathologic and clinical responses of patients with breast cancer after neoadjuvant chemotherapy with doxorubicin plus paclitaxel warrant additional investigation of paclitaxel in the neoadjuvant setting of breast cancer management.     

Phase II study of neoadjuvant carboplatin and paclitaxel followed by radiotherapy and concurrent cisplatin in patients with locoregionally advanced nasopharyngeal carcinoma: therapeutic monitoring with plasma Epstein-Barr virus DNA.

PURPOSE: To assess the efficacy of neoadjuvant paclitaxel and carboplatin (TC) followed by concurrent cisplatin and radiotherapy (RT) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) and to monitor treatment response with plasma Epstein-Barr virus (EBV) DNA. PATIENTS AND METHODS: Thirty-one patients with International Union Against Cancer stages III and IV undifferentiated NPC had two cycles of paclitaxel (70 mg/m2 on days 1, 8, and 15) and carboplatin (area under the curve 6 mg/mL/min on day 1) on a 3-weekly cycle, followed by 6 to 8 weeks of cisplatin (40 mg/m2 weekly) and RT at 66 Gy in 2-Gy fractions. Plasma EBV DNA was measured serially using the real-time quantitative polymerase chain reaction method. Results All patients completed planned treatment. Response to neoadjuvant TC was as follows: 12 patients (39%) achieved partial response (PR) and 18 achieved (58%) complete response (CR) in regional nodes; five patients (16%) achieved PR and no patients achieved CR in nasopharynx. At 6 weeks after RT, one patient (3%) achieved PR and 30 patients (97%) achieved CR in regional nodes, and 31 patients (100%) achieved CR in nasopharynx; 29 patients (93%) had EBV DNA level of less than 500 copies/mL. Neoadjuvant TC was well tolerated, and the most common acute toxicity of cisplatin plus RT was grade 3 mucositis (55%). At median follow-up of 33.7 months (range, 7 to 39.3 months), six distant and three locoregional failures occurred. Plasma EBV DNA level increased significantly in eight of nine patients who experienced treatment failure but did not increase in those who did not. The 2-year overall and progression-free survival rates were 91.8% and 78.5%, respectively. CONCLUSION This strategy was feasible and resulted in excellent local tumor control. Serial plasma EBV DNA provides a noninvasive method of monitoring response in NPC.     

正交试验法优选复方新霉素乳膏的制备工艺

目的:改进复方新霉素乳膏的制备工艺.方法:采用三因素三水平的正交试验法,筛选最佳工艺条件.结果:以吐温-80分散药物,将药物先溶于水相,在90℃条件下混合乳化所得的乳膏质量最优.结论:以正交试验法优选的复方新霉素乳膏的制备工艺,方法简单,效果满意.     

正交法探讨复方参仲口服液制备工艺

目的:优选复方参仲口服液的制备工艺。方法:采用L9(34)正交试验对制备工艺进行优选。结果:最佳提取工艺为8倍于生药量的水煎煮3次,每次1.0 h,醇沉浓度为70%。结论:该制备工艺合理、可行。     

Failed Caesarean Section: An Obstetrician's Nightmare

EDITORIAL COMMENT: In medicine, human judgment is fallible, but obstetrics is the discipline in which an error of judgment is most rapidly revealed, to the obstetrician, the patient and the labour ward staff, due to the unpredictability of the duration of labour and imminence of delivery in any individual patient. When the editor was a house officer he was called to the antenatal ward because a multipara, near term had abdominal pain. Vaginal examination revealed an undiluted cervix, but within the minute or so it took a walk to the handbasin to wash his hands the woman had delivered a live baby into the bed. It is always wise, and should be a routine. unless operating in haste for an emergency such as bleeding from placenta praevia, to perform a vaginal examination after anaesthesia is established before commencing Caesarean section in a woman in labour. The editor has performed many safe easy-forceps deliveries in this circumstance, in theatre, in women in whom Caesarean section was planned for cephalopelvic disproportion with or without fetal distress. This finesse is more important if the consultant has agreed to perform a Caesarean on the findings recorded by others, but the fact remains that labour and delivery can accelerate most unexpectedly. We accepted this case report for publication, not merely because it is the first such case reported, but also for the opportunity it provided to stress to readers the need for final evaluation of the stage of labour before Caesarean section, when the conditions are most favourable for assessment. Nonetheless, as this case tells us. it is possible for labour and delivery to proceed faster than the obstetrician can perform a Caesarean section.     

再次尿道成形术治疗先天性尿道下裂术后严重并发症

目的：了解先天性尿道下裂行各种尿道成形术失败后，利用膀胱粘膜行尿道成形术的疗效。方法：将严重狭窄和（或）无法修补的尿瘘瘢痕组织彻底切除，取膀胱粘膜片形成尿道，正位开口于龟头，新尿道内置多孔硅胶支架管作引流。结果：２８例中，２３例治愈，３例有小尿瘘需作尿瘘修补，２例完全失败，再次作粘膜尿道成形术治愈。结论：各种类型先天性尿道下裂尿道成形失败后，可用膀胱粘膜移植尿道成形，效果良好     

半边旗抗肿瘤有效成分6F对HL-60细胞周期的影响及体外增效作用

目的：研究半边旗抗肿瘤有效成分６Ｆ对ＨＬ－６０细胞周期的影响及对常用抗肿瘤药的体外增效作用。方法：应用流式细胞光度术（ＦＣＭ）测定细胞周期，应用噻唑蓝（ＭＴＴ）法测定药物对细胞的抑制率。结果：不同浓度６Ｆ作用６小时即可使ＨＬ－６０细胞Ｓ期及Ｇ２／Ｍ期比例升高，Ｇ１期比例下降，并呈一定的剂量效应关系，当作用到２４小时后，Ｓ期比例进一步升高，但Ｇ２／Ｍ期比例稍有回落。低浓度６Ｆ分别与２－氯代脱氧腺苷（２－ＣＬｄＡｄｏ），顺铂（ＣＤＤＰ），长春新碱（ＶＣＲ），氟尿嘧啶（５ＦＵ）合用可增强它们对ＨＬ－６０细胞的杀伤作用，ｑ值大于０．８５，与各药有相加或协同作用，６Ｆ对２－ＣｌｄＡｄｏ，ＣＤＤＰ，ＶＣＲ，５ＦＵ的增效倍数分别为１．５８，１．５３，１．５５，１．３８。结论：６Ｆ可明显阻断ＨＬ－６０细胞在Ｓ期及Ｇ２／Ｍ期；６Ｆ可增强上述药物对ＨＬ－６０细胞的杀伤作用。已知，２－ＣｌｄＡｄｏ阻断细胞在Ｓ期，ＣＤＤＰ和ＶＣＲ阻断Ｇ２／Ｍ期，５ＦＵ阻断Ｇ１期。鉴于所试药物对细胞周期的影响不同，提示６Ｆ的体外增效作用可能与此有关。     

毛细管电泳法测定氧氟沙星及左氧氟沙星在其制剂中的含量

建立制剂中氧氟沙星及左氧氟沙星毛细管电泳高频电导分析法，并用于片剂、滴眼液中氧氟沙星及左氧氟沙星含量的测定。对电泳介质的种类、浓度以及操作电压和进样量等影响因素进行了优化。实验采用5mmol／L乳酸为缓冲溶液，分离电压20．0kV，可在7min内实现对氧氟沙星及左氧氟沙星的分离和检测。在优化实验条件下，氧氟沙星的线性范围0．4～220μg／ml，检出限0．2μg／ml，回收率94．4％～102％；左氧氟沙星的线性范围0．6-200μg／ml，检出限0．3μg／ml，回收率95.4％～102％。