微导管脑动脉超选灌注BCNU与ACNU治疗脑恶性肿瘤临床研究

目的：本文报告了28例脑恶性肿瘤应用不同化学药物和方法．延长病人生存期．改善生存质量以及并发症防治。材料与方法：将28例脑恶性肿瘤病人随机分二组，施行微导管脑动脉超选灌注化学药物BCNU与ACNU．每次剂量分别为100～200mg／m2和2～3mg／kg。结果：近期疗效，应用BCNU组有效率85．1％；应用ACNU组有效率100％。三年生存率：BCNU组42．8％；ACNU组64．3％，并发症；ACNU组明显低于BCNU组。结论；采用微导管脑动脉超选灌注化学药物治疗脑恶性肿瘤方法，疗效优于静脉及其它给药方法。药物ACNU疗效高于BCNU，并且药物ACNU的毒副作用小并发症少。     

Long-term intraduodenal infusion of a water based levodopa-carbidopa dispersion in very advanced Parkinson's disease

Objective – To evaluate the effects of continuous duodenal infusion of levodopa over time on the disabling fluctuations in motor performance in advanced parkinsonian patients. It has earlier been demonstrated that these fluctuations can be reduced by keeping the plasma concentration of levodopa constant. Material and methods – In view of the low water solubility of levodopa a stable dispersion of the drug was developed and used for continuous intraduodenal infusion in patients with advanced Parkinson's disease. Nine patients were evaluated with respect to an optimal oral treatment, during nasoduodenal infusion by a portable pump and then followed for 6 months to 2½ years when treated via transabdominal infusion. Upon each test occasion, over 2 non-consecutive days, objective movement analysis by means of an opto-electronic system was applied every 15-20 min and video recordings performed twice every h. On several test occasions plasma levodopa concentrations were analysed every 15 min. Results – The patients showed improvement and decreased variance of their motor function. In the 2 patients followed over a period of 2½ years levodopa plasma concentration showed reduced fluctuations on infusion and the levodopa consumption as well as mean levodopa plasma concentration decreased. Conclusion – Continuous duodenal infusion of levodopa is an alternative treatment strategy for patients with advanced Parkinson's disease when conventional therapy has failed.     

Morphine consumption and respiratory depression in children receiving postoperative analgesia from continuous morphine infusion or patient controlled analgesia

Thirty children, aged between five and 15 years, were randomly allocated to receive postoperative analgesia from continuous morphine infusion (CMI) or patient controlled analgesia (PCA), also using morphine. The children's morphine consumption, respiratory rates, oxygen saturations and observation points during which they were sleeping were recorded during two periods, one on the day of operation and one the following day. The median dose of morphine consumed by the children using PCA was significantly larger than that consumed by the children having continuous infusions. Children aged between nine and 15 years using PCA had significantly lower minimum respiratory rates and minimum oxygen saturations than similarly aged children receiving continuous infusions. There was no significant difference between the PCA and CMI groups in the number of observation times that the children were asleep or in the minimum respiratory rates and minimum oxygen saturations in the awake and sleeping children.     

Measuring the predictive performance of computer-controlled infusion pumps

Current measures of the performance of computer-controlled infusion pumps (CCIPs) are poorly defined, of little use to the clinician using the CCIP, and pharmacostatistically incorrect. We propose four measures be used to quantitate the performance of CCIPs: median absolute performance error (MDAPE), median performance error (MDPE), divergence, and wobble. These measures offer several significant advantages over previous measures. First, their definitions are based on the performance error as a fraction of the predicted (rather than measured) drug concentration, making the measures much more useful to the clinician. Second, the measures are defined in a way that addresses the pharmacostatistical issue of appropriate estimation of population parameters. Finally, the measure of inaccuracy, MDAPE, is defined in a way that is consistent with iteratively reweighted least squares nonlinear regression, a commonly used method of estimating pharmacokinetic parameters. These measures make it possible to quantitate the overall performance of a CCIP or to compare the predictive performance of CCIPs which differ in either general approach (e.g., compartmental model driven vs. plasma efflux approach), pump mechanics, software algorithms, or pharmacokinetic parameter sets.     

Micro-Drop Size and Intravenous Administration of Sedative-Anaesthetic Solutions

The variation in micro-drop size was studied for a series of sedative-anaesthetic solutions administered via a standard paediatric infusion set in combination with an infusion pump and drop counter. Of the solutions tested, only Diazemuls 20 mg% failed to alter micro-drop size. Solutions containing Ketalar, Apozepam, Hypnomidate and Althesin all caused a decrease in drop size and therefore in administered volume. The largest error (37%) occurred with a solution containing althesin 20% (v/v).     

Inhibition of water intake by ouabain administration in sheep

Intracarotid infusion of ouabain (1280 ng/min) over $\text{4}\text{1}\text{2}\text{hr}$ virtually abolished water intake of sheep in response to intracarotid infusion of either angiotensin II (800 ng/min) or 4 M NaCl (1.6 ml/min for 20 min). Ouabain treatment did not affect mean arterial pressure either before or during infusion of angiotensin. Neither ouabain nor angiotensin administration affected plasma [Na] or [K] or CSF [K]. During ouabain, but not during control infusion, angiotensin administration significantly decreased CSF [Na]. Ouabain administration also decreased water intake after $\text{23}\text{1}\text{2}\text{or}\text{48}\text{hr}$ water deprivation. In the $\text{23}\text{1}\text{2}\text{hr}$ deprivation experiments, food was made available immediately prior to water presentation and the ingestion of food appeared to ameliorate the reduction in water intake. Food intake itself, was decreased in some animals, during ouabain treatment. Ouabain infused at 960 ng/min resulted in significant, but smaller, reductions in water intake induced by angiotensin, 4 M NaCl, and 48 hr water deprivation. It was concluded that ouabain treatment affected water intake by influence on Na transport either in the thirst receptors or at some other level in the neural system between receptor and effector.     

Urinary insulin excretion rate: an index of free insulinaemia in insulin-dependent diabetics

In 25 insulin-dependent diabetics, 14 managed by conventional insulin injection treatment (CIT) and 11 treated by continuous subcutaneous insulin infusion (CSII), there was a highly significant correlation between urinary insulin excretion rate (IER) per 1.73 m2 and mean serum free insulin concentration (r = 0.73, p less than 0.001), measured over a 24 h period. Urinary IER and mean daily serum free insulin levels were significantly higher in diabetics than in non-diabetics. CSII-treated patients had significantly lower mean 24 h plasma glucose levels than CIT-treated patients despite similar values of urinary IER and mean daily serum free insulin in the two groups. Urinary IER may be a useful indicator of average insulinaemia in large scale studies, avoiding the problems of multiple blood sampling and immunoassay in the presence of anti-insulin antibodies.     

The occurrence of low insulin response to glucose infusion in children

Summary Insulin response to glucose infusion was studied in 42 children with a normal intravenous glucose tolerance, 7–16 years of age. The majority of these children had at least one first degree relative with diabetes mellitus. Low and delayed insulin response similar to the one found in 15–20% of healthy adult subjects also occurred in 15–20 per cent of the children in this material. These findings support our previous suggestion that the low and delayed insulin response to glucose is probably genetically determined.

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Das Vorkommen von verringerter Insulinausschüttung nach Glukoseinfusion bei Kindern

Zusammenfassung Die Insulinausschüttung nach Glucoseinfusion wurde bei 42 Kindern, 7–16 Jahre alt, mit normaler intravenösen Glucosetoleranz untersucht. Die Mehrzahl dieser Kinder hatte einen diabeteskranken Eltern-oder Geschwisterteil. Eine verzögerte und verringerte Insulinfreisetzung, ähnlich denen, die bei 15–20% von gesunden Erwachsenen gefunden worden waren, war bei 7 von 42 Kindern zu sehen. Dieser Befund stützt unsere frühere Ansicht, daß die verzögerte und verringerte Insulinausschüttung bei Hyperglykämie wahrscheinlich genetisch bedingt ist.

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L'existence de réponse insulinique réduite à la perfusion de glucose chez l'enfant

Résumé La réponse insulinique à la perfusion de glucose a été étudiée chez 42 enfants âgés de 7 à 16 ans et ayant un test de tolérance au glucose normal. Chez la plupart des enfants au moins un des parents ou frères et surs avait le diabète. Une réponse insulinique réduite et retardée, similaire à celle observée chez 15 à 20% des adultes en bonne santé, a été démontrée chez 7 enfants sur les 42. Ces résultats confirment notre suggestion que ce type de réponse insulinique réduite et retardée est probablement déterminée par des facteurs héréditaires.

     

The follow up study of intra-arterial infusion chemotherapy with local vein blocking as a surgical neo-adjuvant treatment for locally advanced breast cancer

Preoperative intra-arterial infusion neo-adjuvant chemotherapy, in combination with local vein blocking, was administered to thirtyone patients with locally advanced stage III breast cancer. The anti-cancer drugs and dosages used were 500 mg of 5-Fluorouracil (5FU), which was infused daily for 7–14 days, and 20 mg of Adriamycin (ADM), which was administered as a bolus dose twice into the subclavian and internal mammary arteries. The response rate of this method on the primary tumor was 48.4 per cent, and, histologically it was found to be as high as 90.3 per cent. The response rate of the clinical effects on the regional lymph nodes was 50.0 per cent, however, histologically, it was found to be lower than that of the primary tumor. In the long-term follow up study the 5-year survival rate was 72.2 per cent. Thus, this method seems to be effective as a combined modality in cases of locally advanced stage III breast cancer.