Allergic skin reactions to anticonvulsant medications in patients receiving cranial radiation therapy

PURPOSE: Erythema multiforme and Stevens-Johnson syndrome have been associated with anticonvulsant medications (AEDs) in patients with brain tumors receiving cranial irradiation. AEDs are also known to cause mild drug rashes. The incidence of these complications has not been well studied among patients with brain tumors. We reviewed the records of patients with brain tumors treated with cranial radiation and AEDs to assess the frequency of both severe and mild skin reactions. METHODS: Retrospective review of 289 radiotherapy records of consecutively treated patients from 1988 to 1993. RESULTS: Only one of 289 patients developed erythema multiforme. Milder rashes, however, occurred in 18% of exposures to AEDs including 22% of exposures to phenytoin, compared with the expected rate of 5-10%. Most of the mild drug rashes occurred before the initiation of radiotherapy, suggesting that radiation was not the cause of these reactions. CONCLUSIONS: Severe skin rashes are rare among patients with brain tumors receiving radiation therapy and AEDs. There is, however, an increased frequency of mild drug rashes among patients with brain tumors that does not appear related to radiation.     

Reliability and validity of ratings of signal hyperintensities on MRI by visual inspection and computerised measurement

Brain magnetic resonance imaging (MRI) scans on 98 elderly subjects, 62 with a diagnosis of schizophrenia and 36 healthy controls, were independently and blindly rated by two investigators using the visual rating methods of Fazekas et al. (Fazekas, F., Chawluk, J.B., Alavi, A., Hurtig, H.I., Zimmerman, R.A., 1987. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. American Journal of Neuroradiology 8, 421-426) and Victoroff et al. (Victoroff, J., Mack, W.J., Grafton, S.T., Schreiber, S.S., Chui, H.C., 1994. A method to improve interrater reliability of visual inspection of brain MRI scans in dementia. Neurology 44, 2267-2276) for periventricular, deep white matter and subcortical gray matter signal hyperintensities (SHs) on T2-weighted images. The hyperintense signal volumes were measured by manual delineation of the signals on a workstation using Analyze software (computerised method). The subjects also underwent a detailed neuropsychological assessment. There was a high correlation between two experienced raters for both visual ratings, and the correspondence between the two methods was high. The inter-rater reliability for the computerised method was modest but significant, and the association between the visual and computerised methods was good except for ratings for SHs in subcortical nuclei. The Fazekas and computerised methods, and to a lesser degree the Victoroff method, had modest but significant correlations with some neuropsychological test measures. In conclusion, we did not demonstrate a clear superiority in reliability or validity for one demanding computerised method of rating SHs. Visual ratings should therefore be considered adequate for most clinical and research purposes, but such ratings should be accompanied by adequate training and the provision of standard reference images.     

急性非淋巴细胞白血病中MGMT与p53基因突变的研究

目的 探讨肿瘤抑制基因ｐ５３、ＭＧＭＴ在急性非淋巴细胞白血病（ＡＮＬＬ）中的改变。方法 用聚合酶链反应－单链构象多态性（ＰＣＲ－ＳＳＣＰ）技术对３１例ＡＮＬＬ患者、２２例正常人ｐ５３基因第５、６、７、８外显子和ＭＧＭＴ基因第１、４外显子进行突变分析。结果 ３１例ＡＮＬＬ中５例存在ｐ５３基因突变、４例存在ＭＧＭＴ基因突变,其中２例ｐ５３与ＭＧＭＴ同时发生突变。结论 ｐ５３基因突变在白血病发生中起一定     

先天性胆总管囊肿并发肝功能异常的临床意义

目的 探讨先天性胆总管囊肿肝功能异常的病理基础及临床意义,方法 分析８０例先天性胆总管囊肿患者的肝功能结果,对其中的３６例进行肝病理观察及随访,结果 该病患儿肝功能异常的发生率为８０％,胆汗淤滞是其病理基础,手术后随胆汁淤滞的解除,肝功能均恢复正常,结论 及时手术解除明道梗阻是改善肝功能的根本途径。     

丁胺卡那霉素地塞米松复方脂质体在兔眼玻璃体内的药代动力学研究

目的 应用丁胺卡那霉素地塞米松(丁卡地塞)复方脂质体玻璃体内注射以延长两种药物的半衰期.方法 大白兔随机分4组,正常眼2组和眼内炎眼2组均分别注射复方脂质体和游离药物.结果 丁卡在正常眼复方脂质体的半衰期较游离药物延长1.8倍,在眼内炎眼延长3.4倍.地塞在正常眼复方脂质体半衰期较游离药物延长22.5倍,在眼内炎眼延长46.2倍.结论 丁卡地塞复方脂质体玻璃体内注射使丁卡和地塞两种药物的半衰期有明显延长.     

药流与负压吸宫法的效果和可接受性研究

研究的目的:比较RU486/Cytotec药物和负压吸宫术两种流产方法的效果,以及医学的和个人的可接受性.对象为通过咨询,介绍两种流产方法后,让对象自愿选择而组成.年龄在20～34岁.药物组100例,闭经35～42天,第1天口服RU486 600mg,第3天服Cytotec(PGE1)0.4mg,第17、43天回医院随访.手术组100例,闭经≤56天,负压吸宫术后第14、43天回医院随访.结果:完全流产率药物组为89%,手术组为100%.对象选择这两种流产方法的主要原因:药物组94%的人认为痛苦少,手术组的55%认为手术快、节省时间,而且手术同时可取出或放置宫内节育器(占45%).结论:RU486/Cytotec药物流产和负压吸宫术在各自适合的人群中都具有高度的可接受性.两种方法各具优缺点,不能相互取代,二者相辅相成,取长补短,将使终止妊娠的措施更为安全     

Unilateral comminuted and complicated fracture of the mandible due to dog attack

Fractures of the mandible and their management are discussed in detail in textbooks and articles dealing with facial trauma. This paper presents the management and treatment of a case of a unilateral comminuted and complicated fracture of the mandible due to dog attack on a geriatric patient. The attack also severed the patient's right arm. Due to the severity of the trauma, an emergency surgery was performed on the mandible and arm.     

Reduction of adrenocorticotropic hormone (ACTH) and cortisol in drug addicts treated by acupuncture and electrical stimulation (AES).

Forty-two heroin addicts and 31 normal persons were examined for the effect of acupuncture and electrical stimulation (AES) on plasma ACTH, cortisol and cyclic-AMP levels. Both ACTH and cortisol levels were reduced significantly in the addicts after treatment whereas no such significant reduction was observed in the normals. Plasma cyclic-AMP level was not affected in either group. Taken together, results from the present study suggest that the mechanism of AES in the treatment of addiction may have a neuroendocrinological basis. This hypothesis is particularly attractive in view of the isolation of opiate-like peptides from the brain.     

THE CHARACTERISTICS OF OVARIAN SEROUS TUMORS OF BORDERLINE MALIGNANCY

During 1948-1976, 363 cases of ovarian serous tumor were encountered in the hospital. Among them, 58 cases were pathologically compatible with the criteria of this tumor of borderline ma- lignancy proposed by the WHO classification. The purp8se of this paper is threefold: 1. To study the c!inical behavior and mode of de- velopment of pathologically documented bordcr- line malignant serous ovarian tumors. 2. To compare the difference between benign, border- line malignant and malignant serous tumors. 3. To assess the value of making such a "borderline malignant" subgroup.