Distribution of lithium elimination rates in a selected population of psychiatric patients

Summary Chronic treatment with conventional lithium carbonate was interrupted in a selected group of 40 psychiatric patients of mixed sex and race. All patients had normal renal function. Serum samples were taken 12, 24, 36 and 48 h after the last dose and lithium was assayed by atomic absorption spectrophotometry. Decay rates calculated for the 12–24 h and 36–48 h periods yielded different values. This was ascribed to the presence of an incomplete redistribution phase during the earlier period. The distribution of elimination rates determined during the later period gave a more symmetrical spread and approximated a normal distribution. The mode, median, mean and standard deviation of the lithium elimination half-lives were 12.5, 14, 18.2 and 7.3 h and 22.5, 24.5, 29.8 and 10.1 h for the two periods, respectively. The results contrast sharply with another report of the distribution spread of elimination half-lives in a much larger sample. The current values have implications for dosage prediction, serum level monitoring and dosage formulation, especially sustained-release preparations. The evidence was against the possibility that some individuals retain lithium.     

Auditory toxicity effects of long-term cis-dichlorodiammineplatinum II therapy in genitourinary cancer patients

To determine the auditory toxicity effects of long-term cis-dichlorodiammineplatinum II therapy, pure tone hearing thresholds were measured prior to therapy and repeated before each subsequent treatment. CDDP was given by a slow intravenous drip method at a low dose of 1 mg/kg body weight, with 37.5 gm mannitol, once a week for six treatments and every 3 weeks thereafter. From a group of 173 genitourinary cancer patients treated, 50 male patients were selected who received at least 12 months of CDDP with no active conductive ear pathology, and whose audiograms obtained at baseline, 6th weeks, 26th weeks, and 52nd weeks of treatment were all available for comparison. Pure tone threshold levels deteriorated across time particularly by the 52nd week and at the higher frequencies. Threshold differences across time were statistically significant and within a linear trend. Of the 50 cases, 30% showed suspect or no ototoxicity, 26% mild, 32% moderate, 2% marked, and 4% showed severe ototoxic changes. Of the two cases who developed severe ototoxicity, one showed complete recovery. There was partial recovery in 26% and no recovery in 54%. Individual variability in susceptibility to and recovery from ototoxicity necessitates systematic audiometric monitoring throughout the therapy.     

In vivo evaluation of cell mediated immunity against human melanoma

Evaluation of cell mediated immunity against human melanoma target cells was performed in an in vivo model using human tumor xenografts growing in Balb/c athymic mice. Intraperitoneal inoculation of 1 × 10⁷ human melanoma cells produced peritoneal carcinomatosis which lead to death of the animals at 23.8 ± 2.6 days (N = 12). Peripheral blood lymphocytes (PBL) from normal donors were administered to tumor bearing mice, and survival times of 22.0±2.3 days were observed (N = 8). Peripheral blood lymphocytes from four of five normal donors which had been presensitized on monolayers of melanoma tissue culture cells in vitro failed to prolong host survival times. In contrast, PBL obtained from 15 of 20 melanoma patients were found to prolong survival of the tumor bearing nude mice. Of these 15 patients, 8 were undergoing specific active immunotherapy, while 7 had not been sensitized except by the disease process. The ability of PBL obtained from patients to prolong survival of tumor bearing animals did not appear to correlate with either the stage of the disease or the patient's clinical course. The possible mechanisms for the prolonged survival and usefulness of this model are discussed.     

Incidence of Chromosomal Abnormalities from a Morphologically Normal Cohort of Embryos in Poor-Prognosis Patients

Purpose: Preimplantation genetic diagnosis of aneuploidy was performed on the embryos yielded by 70 poor-prognosis patients, with the aim of transferring those with a normal chromosomal complement, thus possibly increasing the chances of pregnancy. Methods: Multicolor fluorescence in situ hybridization (FISH) was applied for the simultaneous detection of chromosomes X, Y, 13, 16, 18, and 21. Inclusion criteria were (1) a maternal age of 36 years or older (n = 33), (2) three or more previous in vitro fertilization cycles (n = 20), and (3) an altered karyotype (n = 17). Results: A total of 412 embryos underwent FISH, resulting in 234 (57%) that were chromosomally abnormal. Euploid embryos were available for transfer in 59 patients, generating 19 pregnancies (32%), with an implantation rate of 19.9%. Conclusions: High rates of chromosomally abnormal embryos in poor-prognosis patients can determine repeated in vitro fertilization failures when embryo selection is performed on the basis of morphological criteria alone. Hence, the FISH analysis could represent the prevailing approach for the identification of embryos possessing full potential for developing to term.     

吉西他滨治疗高龄晚期非小细胞肺癌

目的:观察吉西他滨治疗高龄晚期非小细胞肺癌的疗效,并与同期单纯支持治疗的患者比较,以探讨高龄晚期非小细胞肺癌的治疗方案。方法:吉西他滨组21例,采用吉西他滨单药化疗,剂量为1250mg/m2,静脉滴注,第1、8天用药,每21天为1周期,共4周期。对照组23例不用任何化疗,单纯支持对症治疗。结果:吉西他滨组总有效率为28.6%,其中PR6例,SD12例,PD3例。对照组无CR和PR者。吉西他滨组中位缓解期6.3个月。吉西他滨组和对照组中位肿瘤进展时间分别为5.8和2.6个月,中位生存时间分别为12.8和4.6个月(P<0.01);1年生存率分别为46.6%和9.2%(P<0.01)。吉西他滨组KPS、体重增加和临床症状改善情况均显著高于对照组(P<0.01)。毒副反应方面吉西他滨组12例(57.1%)出现Ⅰ、Ⅱ级血小板减少,7例(33.3%)出现Ⅰ、Ⅱ级白细胞下降,未见Ⅲ、Ⅳ级毒性反应。少数患者血红蛋白下降Ⅰ度,恶心呕吐Ⅰ/Ⅱ度。结论:吉西他滨单药治疗高龄晚期非小细胞肺癌是安全有效的。     

氯沙坦和非洛地平治疗中老年高血压合并高尿酸血症的疗效观察

[目的 ]　比较氯沙坦和非洛地平对中老年高血压合并高尿酸血症的疗效。　 [方法 ]　 60例中老年高血压合并高尿酸血症患者随机分成两组 ,分别服用氯沙坦 (氯沙坦组 ,n =3 0例 )和非洛地平 (非洛地平组 ,n =3 0例 ) ,分别测定两组患者治疗前后的血压、2 4h动态血压、血尿酸、空服血糖、血脂和肝肾功能。　 [结果 ]　氯沙坦和非洛地平均有明显的降压效果 (P <0 .0 1) ,两组的降压效果相似 (P <0 .0 5 ) ,但氯沙坦降低血尿酸的效果优于非洛地平 (P <0 .0 0 1) ,对血糖、肝肾功能、血脂均无明显作用 ,未发生明显不良反应。　 [结论 ]　氯沙坦治疗中老年高血压安全、有效 ,与非洛地平相似 ,并且有降低高血尿酸作用     

老年食管癌围手术期的处理要点与体会

目的:提高老年人食管癌手术治疗成功率及降低其围术期死亡率。方法:对30例老年食管癌实行开胸手术患者的围手术期准备、术前检查、处理、手术方法及术后并发症的防治等进行分析。结果:本组手术切除率为100%,无死亡病例,无吻合口瘘。出现呼吸衰竭、窒息各1例。结论:选择好手术适应症,充分准备围手术期各项指标及术后预防呼吸、循环衰竭是手术成功的关键。     

老年肺癌外科治疗体会

目的探讨老年肺癌的外科治疗体会。方法回顾性研究68例65岁以上老年肺癌的临床资料和治疗情况。结果术前ECG异常21例（30．9％），肺功能异常25例（36．8％）。手术切除66例（97．1％）。术后心肺并发症23．5％，死亡率0。结论老年不应是手术禁忌证，加强围手术期管理，采取适当的手术方式，可以提高老年肺癌患者的生存率。     

不孕不育者对人工授精技术的伦理态度调查研究

目的：研究不孕不育者对人工授精技术的伦理态度,促进该项技术更好地为患者服务.方法：自制问卷调查了223名不孕不育者.结果：不孕不育者对AIH、AID的态度存在显著差异（P＜0.05）;对婚姻家庭生活选择相对宽容;精子的商品化趋向值得关注;必须采取一定措施以保证精子和人工授精儿的质量.结论：AID会引发许多伦理问题,临床应用时更应遵循有利于患者、知情同意等伦理原则和相关法律规定,以减少纠纷,造福社会.     

脑外伤病人的临床伦理问题探讨

脑外伤病人占外科病人很大一部分比例,其治疗过程艰难而复杂,而且在治疗过程中涉及很多伦理学问题,值得探讨和研究.本文作者通过多年来诊治脑外伤病人的经验,从伦理学的角度对脑外伤治疗过程中的一些问题进行了探讨,以期更有利于保障患者和医务工作者的合法权益、减少医疗纠纷,摆正医生与患者位置关系,使脑外伤患者得到更好的治疗.