关于小剂量胰岛素治疗糖尿病酮症酸中毒的几个问题

本文总结1980～1981年期间采用小剂量胰岛素治疗44例糖尿病酮症酸中毒的经验。本组全部采用小剂量胰岛素2.4～12u/h加入生理盐水中持续静滴、直至血糖下降至250mg/dl。该法疗效良好、治愈43例(97.73%)、血糖降至250mg/dl平均需6.19±5.29h、胰岛素平均用量为31.9±23.7u,血糖每小时平均下降66.45mg/dl。本文着重讨论以下四点:1.本疗法对多数用过胰岛素治疗和胰岛素抗体存在者仍有效。2.分析了重症病人酮症纠正延迟的原因,并提出处理方法。3.指出糖尿病酮症酸中毒高渗性昏迷的处理方法。4 游离脂肪酸测定可作为糖尿病酮症酸中毒的诊断指标,有助于同非酮症高渗性昏迷的鉴别。     

Low-dose arabinosyl cytosine in acute leukemia after a myelodysplastic syndrome and in elderly leukemia

Low-dose arabinosyl cytosine (ARA-C) was tested in 15 patients with acute leukemia after a myelodysplastic syndrome (MDS) and in six elderly patients with acute nonlymphoid leukemia (ANLL). The drug was given subcutaneously at 10 mg/m2, every 12 hr for 2 weeks, every 28 days. The overall response rate was 19% (one complete remission, three partial responses), and the median duration of response was 4 months. No particular features at diagnosis were predictive of response. Pancytopenia and marrow hypoplasia occurred after 44 (78%) of 56 courses of therapy and were more severe in nonresponders. Four patients died during the aplasia following ARA-C therapy. Subcutaneous low-dose ARA-C was of limited benefit and bore a noticeable hematologic toxicity.     

Ovarian function during low-dose oral contraceptive use

Lowering the total steroid dose in modern oral contraceptives (OCs) has been connected with a higher incidence of ovarian follicle and cyst formation. To investigate the presence of ovarian follicles and cysts by means of vaginal ultrasonography and serum hormone determinations during use of two low-dose OCs, 65 volunteers were randomized to receive either 20 μg ethinylestradiol (EE) + 150 μg desogestrel (group A) or 35 μg EE + 250 μg norgestimate (group B) for a 2-month study period. At baseline, 39% of women in group A and 31% in group B exhibited at least one follicle <35 mm in diameter. By the end of the second treatment cycle, the frequency of these follicles had decreased to 14% in each group. Only one subject in the higher estrogen group developed an ovarian cyst >35 mm. One subject in each group demonstrated hormone levels characteristic of ovulation; no pregnancy occurred in either group. The 20 μg EE preparation was not found to lead more often to ovarian follicles or cysts when compared with a 35 μg EE preparation, possibly because of the type and dose of the progestogen used.     

小剂量阿糖胞苷治疗急非淋──骨髓内白血病原细胞的动态观察

综合早期的文献报道，小剂量阿糖胞苷诱导急非淋（ＡＮＬＬ）完全缓解，其缓解率达５０％～８０％之高，且认为此疗法无明显骨髓抑制和血液学毒性。综合近期的报道，此疗法的完全缓解率只有２２％～２３％，且常见血液学毒性、缓解期亦短。动态观察治疗前后骨髓原细胞的变化，解答了各家疗效如此悬殊和有关的问题。     

Effective treatment of anal cancer in the elderly with low-dose chemoradiotherapy

Chemoradiotherapy (CRT) is accepted as the standard initial treatment for squamous cell anal cancer. However, frail elderly patients cannot always tolerate full-dose CRT. This paper reports the results of a modified regimen for this group of patients. In all, 16 patients with biopsy-proven squamous cell carcinoma of the anal canal or margin and performance status or co-morbidity precluding the use of full-dose CRT were included in this protocol. The median age was 81 (range 77-91). Patients received a dose of 30 Gy to the gross tumour volume plus 3 cm margin in all directions. Concurrent chemotherapy comprised 5-fluorouracil 600 mg m(-2) given over 24 h on days 1-4 of radiotherapy. The treatment was well tolerated. All 16 patients completed treatment as planned. Only one patient experienced any grade 3 toxicity (skin). The local control at a median follow-up of 16 months was 73% (13 out of 16). The overall survival was 69% and disease-specific survival 86%. This is a well-tolerated regimen for elderly/poor performance patients with anal cancer, which can achieve high rates of local control and survival. Longer follow-up will determine whether these encouraging results are maintained.     

Comparison of standard-dose and low-dose gemcitabine regimens in pancreatic adenocarcinoma patients: a prospective randomized trial

Background A prospective, randomized study was performed to determine whether gemcitabine infusion at a low dose (250 mg/m²) is comparable or superior to the standard-dose infusion (1000 mg/m²) in terms of the survival period, clinical benefit, and frequency of adverse effects in patients with advanced pancreatic adenocarcinoma. Methods Twenty-five patients who were histologically proven to have locally advanced pancreatic cancer or pancreatic cancer with distant metastases were initially enrolled in the present study. They were treated with gemcitabine infusion at either a dose of 1000 mg/m² over 30 min (the standard regimen) on days 1, 8, and 15 of every 4-week cycle or at a dose of 250 mg/m² over 30 min every week. Survival time, response rate, time to treatment failure, clinical benefit response, and adverse effects were compared between the two groups. Results Twenty-one patients received gemcitabine for more than 1 month. The median survival period was 7.2 months for patients who received the low-dose infusion regimen, in contrast to 5.2 months for patients administered the standard-dose infusion regimen. The time to treatment failure was 5.6 months for patients in the low-dose infusion regimen, in contrast to 3.4 months for patients in the standard-dose infusion regimen. There were no significant differences in either survival time to time to treatment failure or clinical benefits between the two groups, but the incidence of adverse reactions in patients administered the low-dose therapy was significantly lower than that in patients receiving the standard-dose therapy (P < 0.05). In particular, patients in the standard infusion regimen group experienced more hematologic toxicity than those in the low-dose regimen. Conclusions These findings suggest that the low-dose gemcitabine infusion regimen can be continuously administered to patients with locally advanced and systemically spreading pancreatic cancer because of its reduced toxicity, resulting in better quality of life and an improved safety profile as compared to the standard infusion treatment regimen.     

麻仁软胶囊对便秘的疗效及其安全性考察

目的 观察麻仁软胶囊对便秘的疗效和对结肠黏膜的影响。方法 结肠慢传输型及混合型便秘的门诊患者208例随机分为治疗组及对照组。治疗组患者每日口服麻仁软胶囊1次,每次2粒,连续服用10个月;对照组患者每日口服番泻叶5 g（沸水100 mL浸泡后顿服）1次,连续服用10个月。根据排便次数和胃肠传输实验（GITT）判断治愈率、总显效率（治愈率＋显效率）、总有效率（总显效率＋有效率）。依据腹胀、腹痛等判断不良反应。治疗10个月后肠镜观察结肠黏膜黑变情况。结果 治疗组的治愈率略低于对照组,总显效率、总有效率与对照组无显著差异,治疗组患者服药后10个月后镜检未发现结肠黑变,而对照组26.9%患者结肠黑变。结论 低剂量麻仁软胶囊治疗便秘有效,并具有较高安全性。     

生血丸对小鼠低剂量辐射损伤的预防与修复作用及机制

目的 探讨生血丸对低剂量辐射致小鼠肝、脾、骨髓细胞、外周血淋巴细胞损伤的预防与修复作用及机制。方法 将小鼠随机分为5组：对照组、生血丸预防给药组（预防给药组）、生血丸治疗给药组（治疗给药组）、模型1组（对应治疗给药组）、模型2组（对应预防给药组）。ELISA法检测肝、脾细胞中羟自由基、超氧阴离子自由基、鸟氨酸脱羧酶（ODC）的活性。高倍镜下观察骨髓细胞及外周血淋巴细胞的微核率。结果 与对照组相比,2个模型组小鼠肝细胞内羟自由基、超氧阴离子自由基的量显著增加;与各自模型组相比,治疗给药组、预防给药组上述指标显著减小。与对照组相比,2个模型组小鼠肝细胞内ODC活性显著增强,外周血淋巴细胞与骨髓细胞的微核率显著增加;与各自模型组相比,预防给药组和治疗给药组ODC活性显著减弱,外周血淋巴细胞与骨髓细胞的微核率显著降低。各组小鼠脾细胞中各指标间未见明显差异。结论 生血丸能有效预防和改善小鼠肝细胞、外周血淋巴细胞和骨髓细胞由于低剂量辐射所造成的损伤。     

Antiangiogenic (metronomic) chemotherapy for brain tumors: current and future perspectives

Significant advances in the diagnosis and treatment of brain tumors have been made through better imaging, surgical techniques and advances in radiation therapy. However, the cure rate for most adult and pediatric brain tumor patients has not mirrored this success. Angiogenesis, the development of neovascularization, provides the required nutrients and oxygen to an expanding tumor and is controlled by a complex balance of proangiogenic cytokines and antiangiogenic factors. A series of new inhibitors of angiogenesis are now in clinical trials. Most of these rely on inhibiting tumor cell-mediated cytokines or blocking the activation of their cognate receptors. Cytotoxic chemotherapy, by contrast, targets dividing cells but can be modulated to attack dividing endothelial cells. This review will focus on the use of low-dose antiangiogenic (also called metronomic) chemotherapy to inhibit endothelial cell function and resultant neovascularization in the treatment of adult and pediatric brain tumors. By examining the biology and preclinical findings that led to the development of antiangiogenic/metronomic chemotherapy, clinical studies have been undertaken that support the role of this approach in the clinic, and have led to the introduction of a number of markers being used to better predict active combinations and appropriate patient populations.