Individualized Mycophenolate Mofetil Dosing Based on Drug Exposure Significantly Improves Patient Outcomes After Renal Transplantation

Efficacy and safety of mycophenolate mofetil (MMF) may be optimized with individualized doses based on therapeutic monitoring of its active metabolite, mycophenolic acid (MPA). In this 12-month study, 137 renal allograft recipients from 11 French centers receiving basiliximab, cyclosporine A, MMF and corticosteroids were randomized to receive either concentration-controlled doses or fixed-dose MMF. A novel Bayesian estimator of MPA AUC based on three-point sampling was used to individualize doses on posttransplant days 7 and 14 and months 1, 3 and 6. The primary endpoint was treatment failure (death, graft loss, acute rejection and MMF discontinuation). Data from 65 patients/group were analyzed. At month 12, the concentration-controlled group had fewer treatment failures (p = 0.03) and acute rejection episodes (p = 0.01) with no differences in adverse event frequency. The MMF dose was higher in the concentration-controlled group at day 14 (p < 0.0001), month 1 (p < 0.0001) and month 3 (p < 0.01), as were median AUCs on day 14 (33.7 vs. 27.1 mg*h/L; p = 0.0001) and at month 1 (45.0 vs. 30.9 mg*h/L; p < 0.0001). Therapeutic MPA monitoring using a limited sampling strategy can reduce the risk of treatment failure and acute rejection in renal allograft recipients 12 months posttransplant with no increase in adverse events.     

脊柱侧凸翻修手术

目的探讨脊柱侧凸手术失败原因及翻修手术的处理方法。方法回顾性分析我院自1997年以来收治的脊柱侧凸矫形术后需要进行翻修手术患者33例。男10例，女23例。翻修时距初次手术时间平均为13．4个月(0．5．66个月)。33例患者共行43次翻修手术，其中29例进行1次翻修手术，2例进行3次翻修手术，2例进行4次翻修手术。另有4例患者增加脊柱矫形和融合，同时行脊柱前路松解、支撑植骨手术。结果翻修手术时间平均3．9h(1．5—7．3h)，手术中平均出血601ml(50—2000ml)，平均输血量643．3mk(0-2000ml)。术后随访平均27个月(3—67个月)，未出现畸形加重、内固定失败等并发症。结论脊柱侧凸翻修手术是脊柱畸形矫形术后的一种补救手术。术前完善的手术策略和良好的手术技术是翻修手术的关键。     

葛根素治疗2型糖尿病周围神经病变53例疗效观察

目的　观察葛根素对糖尿病周围神经病变的临床疗效。方法　在治疗糖尿病的同时 ,用0 9%氯化钠注射液 30 0mL 葛根素 0 4g静脉滴注 ,每天 1次 ,10d为 1疗程 ,共 3个疗程。结果　用葛根素治疗糖尿病周围神经病变 5 3例 ,显效 31例 ,有效 12例 ,总有效率达 81% ,无明显副作用。结论　葛根素治疗糖尿病周围神经病变效果较好 ,副作用小 ,值得推广运用     

子宫动脉栓塞治疗子宫肌瘤89例报告

目的 评价子宫动脉栓塞术治疗子宫肌瘤的近期疗效。方法 89例子宫肌瘤患者，采用Seldinger技术分别作左右子宫动脉主干插管检查和栓塞治疗，栓塞剂采用聚乙稀醇颗粒(PVA)或白芨混合颗粒。结果 72例(80．9％)完成随访，随访时间1～28个月。有94．1％(64／68)的患者月经复常；治疗后瘤体缩小25．2％～76．8％(M=41．3％)。除了术中术后疼痛(65例)和发热(16例)外，有2例因肌瘤坏死行子宫切除术，1例出现卵巢早衰。结论 子宫动脉栓塞术治疗子宫肌瘤的近期疗效满意，远期疗效尚待进一步观察。     

236例无痛人工流产术的疗效观察

目的:探讨异丙酚和芬太尼混合液静脉麻醉、笑气吸入麻醉及2%利多卡因宫颈局部浸润麻醉三种镇痛方法在人工流产手术中的疗效比较。方法:自2003年8月至2004年1月对236例妇科门诊早孕要求终止妊娠的妇女实施无痛人工流产术。随机分成3组。A组:异丙酚+芬太尼静脉麻醉(85例);B组:N2O(笑气)吸入麻醉(88例);C组:2%利多卡因宫颈局部浸润麻醉(63例),观察人流术中其镇痛效果并对疼痛进行分级。结果:A组85例100%可达到完全不痛(疼痛分级为0级);B组65.90%可达到完全不痛,Ⅰ级23.86%,Ⅱ级9.09%,Ⅲ级1.15%;C组0例可达到完全不痛,Ⅰ级63.49%,Ⅱ级30.16%,Ⅲ级6.35%。结论:受术者如无心肺疾患及人流禁忌证,无痛人工流产术应选择异丙酚+芬太尼静脉麻醉可达到完全无痛,痛苦最小。     

晕可消胶囊治疗椎—基底动脉缺血性眩晕疗效观察及其对红细胞膜流动性的影响

目的:较大样本观察晕可消胶囊治疗椎-基底动脉缺血性眩晕疗效及其对红细胞膜流动性的影响。方法:符合入选标准的门诊病例203例随机分为观察组(晕可消组)102例,对照组(维脑路通组)101例,治疗10d后行疗效评定并以荧光偏振法检测红细胞膜流动性的变化。结果:观察组疗效优于对照组,并显著改善了红细胞膜的流动性。结论:晕可消胶囊具有改善红细胞膜流动性作用,用于治疗椎-基底动脉缺血性眩晕疗效肯定,值得推广。     

云克治疗类风湿关节炎临床疗效观察

目的:观察云克 (99Tc- MDP)治疗类风湿关节炎 (RA)的疗效。 方法:对 80例类风湿关节炎 (RA)患者应用云克进行静脉治疗 2 1d,并对治疗前后的相关指标进行对照分析。结果 :治疗前与治疗后相比 ,患者晨僵持续时间、握力、ESR、CRP、RF有统计学意义 (P <0 .0 5 ) ,患者关节压痛数及关节肿胀数差异无统计学意义 (P >0 .0 5 )。 结论:云克治疗类风湿关节炎能改善临床症状及实验室指标 ,远期疗效好 ,而且毒副作用小。     

132例男性不育患者遗传学病因分析

目的：对男性不育患者进行遗传学病因分析，并探讨其遗传效应。方法：采取132例男性不育患者外周血进行染色体核型分析。结果：132例男性不育患者中，染色体异常24例，染色体变异22例。其中大Y20例，47，XXY18例，45．XY，t(13；14)3例，小Y和46，XY，inv(9)各2例，46，XY，t(9；22)1例。结论：染色体异常是男性不育的重要原因，并建议男性不育患者进行基因诊断，以便确诊是否属于遗传病，为生育提供指导，避免盲目治疗。     

射频消融治疗肝肿瘤315例报告

目的总结1999年6月至2003年8月用射频消融（radiofrequency ablation，RFA）治疗315例肝肿瘤病人的病例资料，探索RFA治疗肝肿瘤近远期疗效。方法采用了一次定位、多点穿刺，RFA联合肝动脉栓塞（TAE）、选择性门静脉栓塞（SPVE）治疗直径5～13cm的大肝癌，及经皮经肺经膈肌RFA治疗膈顶部肝癌。结果总并发症发生率为5．1％，无一例住院期间死亡。AFP阳性的169例肝癌病人中，RFA后有124例（73．6％）明显降低，其中有95例（56．2％）转阴。半年生存率为89．5％，1年生存率为80．1％，18个月生存率为61．4％，24个月生存率为48．3％，〉36个月生存率为35．6％。结论采用TAE、SPVE及RFA一次定位多点穿刺法治疗无手术切除指征的中晚期（含大肝癌）的病人，疗效明显，总并发症发生率低。     

Urological emergency in neonates with congenital hydronephrosis

OBJECTIVE: It is well described that unilateral pelviureteric junction obstruction (PUJO) is a benign condition, because the dilatation resolves spontaneously and the function does not decrease in most of the kidneys. However, there is exceptional PUJO that requires emergent treatment in neonatal periods. The aim of this article is to report the urological emergency and management in neonates with PUJO. MATERIALS AND METHODS: Nine children (seven boys and two girls) with PUJO who underwent neonatal emergent treatment during the last 13 years were reviewed. Renal function was evaluated according to decay curve of serum creatinine (SCr) levels corresponding to gestational age (GA) at delivery. Physical examination, ultrasonographic monitoring, and chest and abdominal plain radiographs were repeated in each neonate. RESULTS: Eight patients were detected prenatally. In five patients, multicystic dysplastic kidney (MCDK) was demonstrated on the contralateral side. Three patients underwent percutaneous puncture of fetal hydronephrosis. Decrease of amniotic fluid was evident in three fetuses. Indications for emergent treatment included mass effect from hydronephrosis in three patients, renal dysfunction in five, and severe urinary tract infection in one. During neonatal periods, a percutaneous nephrostomy tube was placed in seven, and open nephrostomy in one with anorectal malformation. Repeated punctures of the dilated renal pelvis were done in one patient. Renal function after pyeloplasty was stable in eight patients, while it was moderately decreased in one who was associated with oligohydramnios in utero. CONCLUSION: Indications for emergent treatment in neonates with PUJO included mass effect from giant hydronephrosis, renal dysfunction and severe urinary tract infection. At birth, respiratory and circulatory conditions must first be stabilized. In neonates with hydronephrosis of the solitary kidney or severe bilateral PUJO, serial SCr should be monitored to evaluate renal function. Decrease of amniotic fluid suggested renal functional compromise that would not recover after urological management.