前哨淋巴结显像剂99Tcm-IT-Rituximab的制备及其定位性能

目的研究前哨淋巴结（SLN）显像剂^99Tc^m-亚氨基噻吩（IT）．美罗华（Rituximab）的标记方法及其定位效应。方法采用2-IT作为双功能连接剂，制备^99Tc^m-IT-Rituximab，确定最佳反应条件，评价标记抗体分子完整性及生物活性。观察比较^99Tc^m-IT-Rituximab及^99Tc^m-硫胶体（SC）2种示踪剂在小鼠淋巴结中的定位性能。将^99Tc^m—IT—Rituximab作为显像剂，对10例乳腺癌患者行乳腺癌SLN动态显像。结果2-IT与Rituximab连接的最佳物质的量比为10：1，4℃反应45min后，每分子抗体螯合上的游离巯基数平均为2．1个。IT—Rituximab分子保持完整、免疫活性保留完全。^99Tc^m-IT-Rituximab的标记率〉90％，其与B淋巴瘤细胞株Raji细胞的结合率为69．4％。动物显像结果显示^99Tc^m—IT—Rituximab可清晰定位小鼠SLN，注射后30min～24h SLN均可显影，2h后SLN显影清晰，至24h未见次级淋巴结显影。动物体内分布数据显示^99Tc^m-IT-Rituximab定位性能明显优于^99Tc^m-SC，24h时SLN百分注射剂量率（％ID）为4．49％，次级及第3级淋巴结基本无摄取，24h注射点滞留率为22．14％。结论该标记方法简单，标记率高；^99Tc^m—IT—Rituximab在SLN中定位性能良好，是一种潜在的新型SLN显像剂。     

Diazepam and atropine as premedicants: no discrimination by monoamine metabolite and catecholamine measurements in cerebrospinal fluid and plasma

The relationships between self-reported assessments of the quality of the preoperative night's sleep, preoperative anxiety, and several biochemical and physiological indicators of stress reaction were investigated in pregnant women at term receiving no premedication (n = 15), a placebo tablet (n = 15), diazepam 5 mg p.o. (n = 15), or atropine 0.01 mg/kg i.m. (n = 15), in connection with spinal analgesia for elective caesarean section. In the patients receiving no premedication, the subjective estimate of the quality of the preoperative night's sleep was negatively associated with concentrations of noradrenaline (NA) and its metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG) in CSF, and with plasma adrenaline. The anxiolytic effect of diazepam was reflected as significantly lower plasma levels of another metabolite of NA, 3,4-dihydroxyphenylglycol (DHPG). Placebo and diazepam, and to a lesser extent atropine, confounded the statistical relationships between the clinical and biochemical responses found in the patients with no premedication. On the whole, the biochemical monoamine measurements were of little use in determining the clinical effects of different kinds of premedicants.     

小儿术中输糖量的实验观察

选择手术时间≥２ｈ的小和手术５８例，按输糖量，麻醉方法和年龄分为５组。甲组输５％糖，乙组不输糖，其他组输２．５％糖。丙组＜６岁，丁组≥６岁，其他随机分组。戊组用硫喷妥钠基础＋神经阻滞，其他组分离麻醉。术中均按７ｍｌ／ｋｇ．ｈ匀速滴入。麻醉开发１ｈ，２ｈ各测血糖１次。结果：（１）各组血糖均升高，甲组最显著。（２）各组等１ｈ血糖升高明显，第２ｈ不再继续升高。（３）分离麻醉组血糖升高比硫妥钠基础组显著。     

Detection of muscular ventricular septal defect by the phase image

A case of muscular ventricular septal defect shown by the phase image derived from Fourier analysis of gated equilibrium radionuclide angiocardiography is presented. The diagnostic feature of the defect on the phase image was a marked phase delay localized mainly in the trabecular portion of the right ventricle. This characteristic finding seemed to be caused by the left to right shunt flow through the defect located in the muscular portion of the interventricular septum.     

椎管手术脑脊液漏的处理

本文重点介绍了椎管手术并发脑脊液漏的术中术后处理，认为术中对硬脊膜缝合修补针距应小于０．３ｃｍ，对术后出现脑脊液漏采用压、堵、输和体位调节的办法。同时对脑脊液漏的原因进行了讨论。     

A quantitative approach to technetium-99m hexamethylpropylene amine oxime

A non-invasive, simple method for the quantitative evaluation of brain perfusion is presented using intravenous radionuclide angiography with technetium-99m hexamethylpropylene amine oxime (^99mTc-HMPAO). Graphical analysis was employed for the evaluation of the unidirectional influx constant (k _u of the tracer from the blood to the brain. The k _u values were standardized to provide objective and comparable values, brain perfusion indices (BPI), among studied subjects by setting the ratio of ROI_brain size to ROI_aorta size at 10. The wholebrain BPI values for the normal control subjects showed a significant negative correlation with advancing age (r = -0.632, P =0.0204, n =13). The mean of the wholebrain BPI of 7.0 (SD =1.4) in 20 patients with cerebrovascular disorders was significantly lower than that of 10.6 (SD =1.5) in 13 normal control subjects. The BPI measurements showed only minimal intra- and interobserver variability. Changes of the ratio of ROI_aorta size and ROIbmin size did not significantly influence the BPI values. Hemispherical BPI values in 19 subjects (n =38) showed highly significant correlations with the hemispherical mean cerebral blood flow values obtained from Xenon-133 single photon emission tomography (SPET) (r =0.926, P =0.0001 for the early picture method and r =0.932, P =0.0001 for the sequential picture method). This technique is easy to apply as an adjunct to SPET and may be helpful in the quantitative evaluation of brain perfusion in routine clinical studies. Offprint requests to: H. Matsuda     

CSF drainage in patients with posterior fossa tumours

Summary The management of hydrocephalus secondary to a posterior fossa tumour is controversial. We audited recent practice with a retrospective analysis of 287 consecutive patients undergoing posterior fossa exploration for tumour. 85 shunts and 112 external ventricular drains (EVD) were placed. The overall CNS infection rate in the series was 6%. There was a significantly higher (p < 0.01) infection rate in patients who had a drainage procedure, and a trend towards higher infection rates in patients with two drainage procedures. Early infection rates with EVDs and shunts were the same (7%). One third of patients with hydrocephalus had pre-operative drainage, a third had per-operative drainage but only a quarter required a permanent shunt.The majority of patients will not require a permanent shunt and where temporary CSF diversion is required EVD is reasonable.     

Cerebrospinal fluid concentrations of the complement MAC inhibitor CD59 in multiple sclerosis and patients with other neurological disorders

Rodent oligodendrocytes have a unique susceptibility among glia to the lytic effects of complement, due in part to a deficiency in CD59 (protectin), a key surface inhibitor of the complement membrane attack complex (MAC). The possibility that shedding of CD59 by human oligodendrocytes contributes to complement-mediated oligodendrocyte injury in inflammatory demyelinating disease has been investigated by estimating levels of CD59 in cerebrospinal fluid samples from 12 patients with demyelinating disease of the central nervous system and 13 with other neurological diseases. No significant differences were found between patients and controls, or between patients with active and those with clinically inactive demyelinating disease, providing no direct support for oligodendrocyte shedding of CD59 in multiple sclerosis.     

Drug transport across the blood — brain barrier II. Experimental techniques to study drug transport

This is part II of a review on the transport of drugs across the blood-brain barrier. In this part, the emphasis is on the various experimental techniques that can be used to characterize the blood — brain barrier transport of drugs. Generally speaking, three approaches can be distinguished:in vitro techniques using isolated brain capillaries, cerebrovascular endothelial cells in primary culture or endothelium-derived cell lines;in vivo techniques (both single-passage and multi-passage techniques) andin situ perfusion techniques. Each of these techniques has specific advantages and disadvantages associated with it. Therefore, in many instances, a combination of different approaches is needed to study the fundamental aspects of drug transport across the blood-brain barrier.     

小儿脑脊液中生长抑素含量的测定及其临床意义

本文在国内首次应用RIA法测定了43例患神经系统疾病的患儿和23例正常小儿CSF中SS水平。结果表明,正常小儿CSF SS含量为141.63±8.77Pg/ml;癫痫和炎性疾病组SS含量无明显改变。而在脑实质损害组,SS含量明显升高。GSF中SS含量与蛋白含量呈明显正相关。