The effects of thermochemotherapy using cyclophosphamide plus hyperthermia on the malignant pleural mesothelioma in vivo

The human malignant pleural mesothelioma is related to the use of asbestos in the majority of cases. Though the use of asbestos has been prohibited since the 1990s, the incidence of pleural mesothelioma is still increasing because of a latency period of at least 20 years. This study investigated the benefit of single therapy with cyclophosphamide or hyperthermia or the combination of both on cells of a human pleural mesothelioma cell line, xenotransplanted subcutaneously in the paw of mice. A CONTROL group received the same volume of physiological saline. The oxygenation of tumours was measured, tumour growth was followed over 3 weeks, immunohistochemical studies and a light and electron microscopic evaluation were performed. Chemotherapy or hyperthermia alone was only temporarily effective. The greatest benefit was achieved using combined thermochemotherapy consisting of cyclophosphamide plus hyperthermia: 50% of this group had partial remissions, and 67% responded to this therapy. After 3 weeks tumours grew again. Superior effects could be achieved by performing additional cycles of chemotherapy or adding another drug or radiation for instance. This study shows promising results in the treatment of malignant pleural mesothelioma.     

Alignment in Medial Fixed-Bearing Unicompartmental Knee Arthroplasty: The Limb Has a Leg Up on the Component

BackgroundTo assess how implant alignment affects unicompartmental knee arthroplasty (UKA) outcome, we compared tibial component alignment of well-functioning UKAs against 2 groups of failed UKAs, revised for progression of lateral compartment arthritis (“Progression”) and aseptic loosening (“Loosening”).MethodsWe identified 37 revisions for Progression and 61 revisions for Loosening from our prospective institutional database of 3351 medial fixed-bearing UKAs performed since 2000. Revision cohorts were matched on age, gender, body mass index, and postoperative range of motion with “Successful” unrevised UKAs with minimum 10-year follow-up and Knee Society Score ≥70. Tibial component coronal (TCA) and sagittal (TSA) plane alignment was measured on postoperative radiographs. Limb alignment was quantified by hip-knee-ankle (HKA) angle on long-leg radiographs. In addition to directly comparing groups, a multivariate logistic regression examined how limb and component alignments were associated with UKA revision.ResultsIn the Progression group, component alignment was similar to the matched successes (TCA 3.6° ± 3.5° varus vs 5.1° ± 3.5° varus, P = .07; TSA 8.4° ± 4.4° vs 8.8° ± 3.6°, P = .67), whereas HKA angle was significantly more valgus (0.3° ± 3.6° valgus vs 4.4° ± 2.6° varus, P < .001). Loosening group component alignment was also similar to the matched successes (TCA 6.1° ± 3.7° varus vs 5.9° ± 3.1° varus, P = .72; TSA 8.4° ± 4.6° vs 8.1° ± 3.9°, P = .68), and HKA was significantly more varus (6.1° ± 3.1° varus vs 4.0° ± 2.7° varus, P < .001). Using a multivariate logistic regression, HKA angle was the most significant factor associated with revision (P < .001).ConclusionIn this population of revised UKAs and long-term successes, limb alignment was a more important determinant of outcome than tibial component alignment.Level of EvidenceLevel III case-control study.     

高频超声引导下胸腔积液置管引流

胸腔积液临床常见,少量积液常无症状,中大量积液可致患者出现呼吸困难、无法平卧等表现,需通过胸腔穿刺置管引流及时加以缓解。胸腔积液穿刺引流不仅可用于临床治疗,还可辅助诊断不明原因胸腔积液。在超声直视下操作置管可提高穿刺成功率[1-2]。本研究观察高频超声在辅助引导置管引流胸腔积液中的效果。     

胸水细胞端粒酶活性检测对良恶性胸腔积液的鉴别诊断价值

目的：探讨胸水细胞端粒酶活性对良、恶性胸腔积液的鉴别诊断价值。方法：用改良的PCR-ELISA法检测37例恶性、32例良性胸水细胞端粒酶活性,并与胸水细胞学、癌胚抗原（CEA）诊断结果进行比较。结果：37例恶性胸腔积液中有26例端粒酶活性阳性（26/37）,阳性率为70.27%,高于良性胸腔积液中端粒酶海性表达（2/32,P＜0.01);端粒酶活性检测诊断恶性胸水敏感性为70.27%,特异性为93.75%,与胸水细胞学诊断符合率为54.05%;其敏感性高于胸水CEA诊断结果（敏感性为51.35%)。结论：胸水细胞端粒酶活性检测作为细胞学检查的辅助手段能提高恶性胸水的诊断率,有助于良、恶性胸腔积液的鉴别诊断。     

高聚金葡素联用顺铂治疗恶性胸水64例疗效观察

目的 :观察生物反应调节剂高聚金葡素 (HASL)加顺铂 (DDP)联用治疗恶性胸水的疗效。方法 :将 64例恶性胸水患者男 4 0例 ,女 2 4例 ,随机分为 2组 ,治疗组选用HASL +DDP ,对照组单用DDP进行比较。结果 :胸水减少 ,治疗组有效率 82 .3 % ,对照组有效率 60 %。结论 :HASL联用DDP能有效控制恶性胸水 ,提高患者生存质量 ,减轻化疗药物毒副作用 ,值得临床推广应用。     

非感染性肺底积液的X线诊断分析

目的 :探讨肺底积液X线诊断的准确性。方法 :回顾性分析 42例非感染性肺底积液的X线征象。结果 :肺底积液的主要X线表现是假膈征、心淹征、双膈影征和变换体位液体弥散征象。结论 :熟悉肺底积液的X线诊断和鉴别诊断 ,对肿瘤患者胸膜转移的早期诊断、及时治疗有重要意义。     

Tumor-associated lymphocytes (TAL) are competent to produce higher levels of cytokines in neoplastic pleural and peritoneal effusions than those found in sera and are able to release into culture higher levels of IL-2 and IL-6 than those released by PBMC

This work was designed to study the proliferative response of tumor-associated lymphocytes (TAL) from neoplastic effusions against autologous tumor cells and the immunophenotype pattern of TAL from neoplastic effusions and that of PBMC of the same patients. We also compared the serum levels of the cytokines interleukin (IL) 1, 2 and 6, tumor necrosis factor- (TNF) and soluble IL-2 receptor (sIL-2R) with those present in neoplastic effusions of the same patients. Moreover, we examined the ability of TAL and peripheral blood mononuclear cells (PBMC) to produce and release the cytokines and sIL-2R and to express membrane CD25 following their stimulation with phytohemagglutinin (PHA) in vitro. Finally, we compared the cytokines/sIL-2R production and membrane CD25 expression by PHA-stimulated PBMC of the patients with neoplastic effusions with a series of 90 cancer patients without neoplastic effusions and 20 normal healthy subjects. Thirteen neoplastic pleural and eight peritoneal effusions were collected from 11 patients with primary lung cancer, 7 with primary epithelial ovarian cancer, 1 with breast cancer, 1 with pleural mesothelioma, and 1 with pancreatic cancer. The proliferative response of TAL from neoplastic effusions against autologous tumor cells was lower than the response to PHA, IL-2, and anti-CD3, but significant. The percentage distribution of CD3⁺ and CD8⁺ lymphocyte subpopulations was higher in peritoneal than in pleural effusions, while the CD16⁺ subset was higher in pleural than in peritoneal effusions. The percentage distribution of CD16⁺ was significantly lower in pleural effusions than in PBMC of patients with pleural effusions. The CD39 antigen was higher on TAL from peritoneal effusions than on PBMC of the same patients. The levels of IL-1 and sIL-2R in peritoneal effusions did not differ from those measured in the sera of the same patients, while the levels of IL-2, IL-6, and TNF were higher in the peritoneal effusions. The levels of IL-2, IL-6, TNF, and sIL-2R, but not IL-1, in pleural effusions were significantly higher than those found in the sera of the same patients. The amounts of IL-2 and IL-6 produced by TAL were generally higher than those released by PBMC. The secretion of cytokines IL-1, IL-2, and sIL2R by PHA-stimulated PBMC was lower, but IL-1 and IL-6 secretion was higher in cancer patients with neoplastic effusions than in either cancer patients without neoplastic effusions or normal subjects. The CD25 expression on PHA-stimulated PBMC derived from cancer patients with neoplastic effusions was in the same range as that of cancer patients without neoplastic effusions and normal subjects. These findings suggest that TAL may be able to produce cytokines and may be amenable to immune manipulation.Abbreviations FITC Fluorescein-isothiocyanate - IL Interleukin - mAb Monoclonal antibody - MHC Major histocompatibility complex - NK Natural killer - PBMC Peripheral blood mononuclear cells - PHA Phytohemagglutinin - TAL Tumor-associated lymphocytes - TIL Tumor-infiltrating lymphocytes - TNF Tumor necrosis factor- - sIL-2R Soluble interleukin-2 receptor     

经导管灌注生物制剂治疗癌性胸腔积液

目的 观察生物制剂胸腔内灌注对癌性胸水的疗效。方法 采用胸腔穿刺硅胶导管灌注高聚金葡素和白细胞介素Ⅱ生物制剂或化疗药物对照。结果 高聚金葡素组２０例,有效率为８２．０％,对照组丝裂霉素组２０例,有效率为４５％,白细胞介素Ⅱ组１８例,有效率为８３．３％。对照组丝裂霉素组１８例,有效率为４４．４％。结论经导管灌注生物制剂高聚金葡素或白细胞介素Ⅱ,其疗效明显优于胸腔内化疗。     

Behaviour of glibenclamide on repeated administration to diabetic patients

Summary Six maturity onset diabetic patients took glibenclamide 5 mg by mouth, every morning 10 min before a standard breakfast. Serum levels of immunoreactive glibenclamide, glucose and immunoreactive insulin were measured repeatedly on the first and 15th days of treatment. Measured glibenclamide blood levels were in close agreement with an analogue computer simulation of data obtained from healthy volunteers: there was no accumulation of drug in the blood, but there was strong evidence for the existence of a slowly equilibrating deep compartment. Considerable insulin release and correction of the breakfast-induced hyperglycaemia were observed immediately after administration of the drug, as well as 5 h later, at lunch time. The clinical significance of blood levels of glibenclamide, as well as the correlation of pharmacokinetics with pharmacodynamics, are discussed in the light of these results.Glossary of symbols IR- immuno-reactive - GLI glibenclamide - IRI immuno-reactive insulin - GLU glucose - AK 1 values obtained with patient AK on the first day of treatment - AK 15 values obtained with patient AK on the 15th day of treatment - b serum level - b_max maximal serum level - t time after dose - t_max time of maximal serum level - G gastro-intestinal system - B central compartment (blood) - T peripheral compartment (tissue) - E excreta - M,N coefficients of the equation of a bi-exponential decay curve - µ, v exponents of the equation of a bi-exponential decay curve - e base of natural logarithms - K_BG K_EB K_TB K_BT first order rate constants (e. g. K_BG means: into B, from G) - K_BG first order rate constants - etc. not corrected for the volume of distribution     

预防肺泡胸膜漏临床分析（附110例恶性肺肿瘤肺叶切除）

目的 探讨恶性肺肿瘤行肺叶切除后影响住院时间的因素。方法 研究分析1995年11月至2002年10月我科收治的110例恶性肺肿瘤行肺叶切除患者的临床病理资料，相关因素数值化后，以Logistic回归分析得到对住院时间影响较大的因素。结果 术后并发症气胸和术前肺功能指标第一秒用力呼气量(FEVl)是较大的影响住院时间因素。结论 提高术前肺功能储备及预防术后气胸的发生是缩短住院时间的关键。