激素药源性股骨头坏死及骨质疏松50例分析

目的探讨应用糖皮质激素的剂量和时间与发生股骨头坏死及骨质疏松的关系。方法通过采用对比分组的方法，分析对武警医学院附属医院因特殊情况需大量应用糖皮质激素而发生股骨头坏死及骨质疏松的患者，了解激素应用剂量及应用时间与发病结果之间的关系。结果在所选病例中，全部出现不同程度的骨质疏松，但发生股骨头坏死的病例仅占总数的30％，且激素应用总量小于2000mg的病例中，短期股骨头坏死的发生率为0；2000-5000mg的病例中，短期股骨头坏死的发生率为17．6％；激素用量在5000mg以上的病例中，股骨头坏死的发生率为43．5％；激素用量在10000mg以上的病例，股骨头坏死的发生率为80％。结论股骨头坏死发生率与糖皮质激素的总用量有关，与激素应用时间长短无关。     

细胞因子在胎儿生长受限中的作用及相关性研究

目的:探讨在胎儿生长受限(FGR)母血及脐血中的表皮生长因子(EGF)与肿瘤坏死因子α(TNF-α)水平及相关性。方法:采用放射免疫分析法(R IA)测定足月正常体重儿(对照组)25例,FGR组20例的母血及脐血EGF、TNF-α浓度。结果:FGR组母血、脐血EGF浓度与对照组比较均明显降低(P均<0.01),TNF-α均明显增高(P均<0.05)。EGF、TNF-α浓度呈负相关。结论:母血、脐血EGF减少、TNF-α增加可能与FGR的发生有关,EGF可能通过某种途径抑制TNF-α的细胞毒作用而促进胎儿生长发育。     

Scrotal fat necrosis after skiing

Fat necrosis in the scrotum is a rare lesion seen only before the age of puberty. The authors add one case of their own to three earlier reports. Common to most patients reported are the strict age limits between 9 and 12 years at the onset, exposure to cold, a tender mass in close connection with one or both testicles, and difficulties in differentiating this condition preoperatively from other forms of acute scrotum. Microscopic similarities with cold panniculitis are discussed. Offrint requests to: J. Viljanto     

Brachytherapy for T1-T2 floor-of-the-mouth cancers: the Gustave-Roussy Institute experience

: In a retrospective analysis, we evaluated the Gustave-Roussy Institute’s experience of locoregional control, survival, and complications of low-dose rate brachytherapy for carcinoma of the floor of the mouth.

: Between 1970 and 1985, 160 patients with previously untreated carcinoma of the floor of the mouth received interstitial brachytherapy as definitive treatment. Of the 160 patients, 79 (49%) had T1 and 81 (51%) had T2 lesions, and 127 (79%) had N0 and 33 (21%) had N1; 84% of tumors arose from the anterior floor of the mouth. Brachytherapy was performed with ¹⁹²Ir wires, according to the Paris system rules, followed by neck dissection (T2 or N1) or follow-up (T1N0).

: With a follow-up period of 9–19 years, the observed survival rates were 89% at 2 years and 76% at 5 years, and the local control rates were 93% in T1 and 88% in T2 tumors. A low rate of distant metastases was noticed (5%); 31% of patients developed a second primary cancer. Severe mucosal necrosis was observed in <10% of patients. Any grade of bone necrosis was seen in 18% of cases (only 2.5% had G3 necrosis). This complication occurred more frequently in patients with poor dental status and in those treated without dental protection during implantation (p <0.001).

: Radical brachytherapy offers excellent local control (89%) and an acceptable rate of complications (<10% severe necrosis) that may be significantly decreased with dental care and the use of protective devices. The high incidence of second malignancies remains a major concern in these patients.     

Mechanisms of bFGF and NT-4 potentiation of necrotic neuronal death

The effects of neurotrophic factors on necrotic neuronal death are controversial. In this study we found that both neurotrophin-4 (NT-4) and basic fibroblast growth factor (bFGF) potentiated necrotic neuronal death caused by exposure to oxygen-glucose deprivation or iron-citrate (Fe) in cortical cultures. However, there were significant differences in the actions of the two neurotrophic factors. Neurotrophin-4 protected against apoptotic neuronal death, while bFGF had no effect on apoptotic death in these cultures. Furthermore, potentiation of oxygen-glucose deprivation induced necrotic death by NT-4 required pretreatment (24 h), while pretreatment with bFGF had no effect. However, acute treatment with bFGF during oxygen-glucose deprivation did potentiate neuronal death. Both neurotrophic factors potentiated free radical mediated necrotic neuronal death induced by exposure to Fe. However, the RNA synthesis inhibitor, actinomycin-D, blocked the injury potentiation by NT-4, but not that caused by bFGF. Also, NT-4, but not bFGF, potentiated Fe induced necrotic death in pure neuronal cultures. Expression of mRNA for FGF receptors FGFR1 and FGFR2 was observed at high levels in astrocytes. The results indicate that the injury enhancing effects of bFGF are acute, while those of NT-4 require prolonged exposure and new protein synthesis. Furthermore, the effects of bFGF appear to be mediated through actions on astrocytes, while NT-4 appears to act directly on neurons. The fact that neurotrophic factors from two distinct families can potentiate neuronal death by two different mechanisms suggests that such injury potentiation may be a common concern regarding the use of neurotrophic factors.     

高压氧对兔激素性股骨头坏死的血液流变学影响

目的:通过检测兔激素性股骨头坏死造模及高压氧治疗过程中的血液流变学变化,探讨激素性股骨头坏死的发病机理。方法:健康日本成年大耳白兔48只,随机分模型组(36只)及对照组(12只)。模型组每周2次肌肉注射醋酸泼尼松龙10 mg/kg,对照组每周2次肌肉注射生理盐水2 m l,共6周。随后将模型组随机分高压氧治疗组(12只)及对照组(12只),治疗组行高压氧治疗,对照组呼吸常压新鲜空气。检测试验后2周、4周、6周、8周、10周、12周兔血液流变学参数变化、观察组织形态学变化。结果:模型组实验2、4、6周全血粘度、血浆粘度均显著高于对照组;股骨头骨质疏松,镜下空骨陷窝数和脂肪细胞数逐渐增多,骨细胞体积缩小,核固缩。高压氧治疗后全血粘度、血浆粘度均低于对照组,坏死的骨细胞有修复现象,并可见新生骨细胞。结论:大剂量激素可造成兔血流变学特性恶化,可能是兔股骨头坏死的重要原因之一;高压氧可使恶化的血液流变学趋向好转,对股骨头坏死有一定治疗作用。     

股骨头坏死治疗仪对股骨头坏死患者骨结构修复及髋关节功能的影响

目的:探讨股骨头坏死治疗仪对股骨头坏死患者髋关节功能及骨结构修复的影响。方法:2000-01/2002-12随机抽取股骨头坏死患者90例,治疗组60例采用股骨头坏死治疗仪配合口服中药治疗,对照组30例单纯口服中药治疗。评估两组患者治疗前后的髋关节疼痛评分、生活能力评分,髋关节活动度评分,行走距离评分。结果:髋关节疼痛评分治疗前治疗组为(15.47±3.25)分,治疗后为(26.80±6.56)分,对照组治疗前为(15.20±4.38)分,治疗后为(28.00±6.21)分,两组治疗前后差异均有显著性意义(t=12.30,8.35,P<0.01)。生活能力评分治疗组治疗前为(11.75±2.73)分,治疗后为(18.17±3.44)分,对照组治疗前为(10.00±4.38)分,治疗后为(28.00±6.21)分,两组治疗前后比较差异均有显著性意义(t=25.17,8.35,P<0.01)。髋关节活动度评分治疗组治疗前为(9.67±2.88)分,治疗后为(13.87±3.57)分,对照组治疗前为(8.80±3.04)分,治疗后为(12.13±3.23)分,两组治疗前后比较,差异有显著性意义(t=24.24,5.76,P<0.01)。行走距离评分治疗组治疗前为(6.80±1.73)分,治疗后为(10.25±1.66)分,对照组治疗前为(5.10±1.79)分,治疗后为(8.90±2.78)分,两组治疗前后比较差异有显著性意义(t=32.91,6.67,P<0.01)。结论:“股骨头坏死治疗仪”对股骨头坏死患者的髋关节疼痛、髋关节活动度、行走距离均有切实的改善作用。     

丙种球蛋白和维生素C对实验性自身免疫性心肌炎作用的研究

目的：探讨丙种球蛋白（IVIG）和不同剂量维生素C（VitC）对实验性自身免疫性心肌炎（EAM）的保护作用。方法：Balb／c小鼠52只，随机分为6组：空白组不予任何处理；其余小鼠分别于第1天和第7天在双测腹股沟皮下注射充分乳化的猪心肌肌凝蛋白，剂量为每次每只100μg；从免疫的当天开始给每只小鼠腹腔注射所给药物。小剂量VitC组：150mg／kg&#183;d^-1 VitC；大剂量VitC组：300mg／kg&#183;d^-1 VitC；IVIG组：1g／kg&#183;d^-1 IVIG；IVIG＋VitC组：1g／kg&#183;d^-1 IVIG和150mg／kg&#183;d^-1 VitC；对照组：与干预组等量的生理盐水。小鼠于第21天给予称重，麻醉后处死，并摘眼球取血，用Elisa法测定血清肿瘤坏死因子α（TNF—α）水平；取心脏、脾脏和肾脏分别称重，得心脏、脾脏和肾脏与体重之比（C／W、S／W、R／W）；脾脏在肉眼观察后作病理切片和H—E染色。心脏分为三部分：一部分作病理切片和H—E染色，一部分作冰冻切片，在荧光显微镜下用直接免疫荧光法测定心肌组织中沉积的IgG水平，一部分作电镜检查。结果：（1）心脏的病理改变：大、小剂量VitC组心肌炎性细胞的浸润及心包钙化有所减轻；IVIG组和IVIG＋VitC组心肌偶有淋巴细胞浸润，无心包钙化。（2）脾脏的病理改变：除空白组外，其余脾脏均明显增大，IVIG组和IVIG＋VitC组更是明显，镜检表现为红髓充血和白髓增生。（3）心脏、脾脏、肾脏与体重之比：各干预组C／W明显低于对照组；各干预组和对照组S／W明显高于空白组，IVIG组和IVIG＋VitC组S／W明显高于大、小剂量VitC组；R／W各组无差异。（4）TNF—α水平：大、小剂量VitC组的TNF—α水平略低于对照组，IVIG组和IVIG＋VitC组的TNF—α水平明显低于对照组。（5）心肌的免疫荧光检测：对照组比较粗的荧光条带主要集中在心肌间质，大、小剂量VitC组荧光的密度和强度有所降低，而IVIG组和IVIG＋VitC组的荧光条带增宽，在心肌间质中呈宽大的条索状分布，亮度明显增强。（6）心肌的电镜检测：对照组心肌肌丝排列紊乱，肌节断裂严重，线粒体肥大，并出现空泡变性；大、小剂量VitC组病变比对照组有所减轻；IVIG组和IVIG＋VitC组肌丝排列紊乱明显减轻，肌节断裂比对照组减少，线粒体基本正常。结论：IVIG和VitC对EAM都有一定的保护作用，可以减轻心脏的病理改变，抑制TNF—α的产生；但IVIG或IVIG＋VitC作用更为明显，并可刺激机体的免疫反应，增加心肌中IgG的沉积。