王耀光教授治疗小儿免疫性血小板减少症经验采撷

免疫性血小板减少症（ITP）是小儿常见出血性疾病,王耀光教授认为本病为虚实交杂之证,本虚者脾肾亏虚、阴虚血燥,标实者热毒内蕴、血脉瘀阻,在临床上将其分为急性期、迁延期和慢性期三个阶段,相应地提出祛邪解毒兼止血、补气健脾兼养血、调护脾肾兼活血的治疗法则,尤重视黄芪剂量的应用。并在辨病的基础上强调病证结合,综合辨证施治。     

多剂量复方苦参注射液对吉西他滨在大鼠体内药物代谢动力学参数的影响

目的 探讨多剂量复方苦参注射液与盐酸吉西他滨联合使用后对吉西他滨在大鼠体内药物代谢动力学参数的影响。方法 选取24只健康雄性SD大鼠,随机分为对照组和实验组（复方苦参高、中、低3个剂量组）,实验组大鼠连续10 d尾静脉给予不同剂量的复方苦参注射液,对照组大鼠连续10 d尾静脉给予等量的生理盐水,于最后一天给药5 min后注射吉西他滨,分别于13个时间点眼底静脉丛采血,通过高效液相色谱法测定血样中吉西他滨的浓度,并采用DAS 2.0软件处理,得出吉西他滨药物代谢动力学参数。结果 各组大鼠体内吉西他滨药物代谢动力学过程符合二室模型拟合;与对照组比较,复方苦参高剂量组可以增加吉西他滨的药-时曲线下面积（P<0.05）,并延长平均滞留时间（P<0.05）。结论 多剂量复方苦参注射液对大鼠体内吉西他滨的药物代谢动力学行为有明显影响,在临床上应根据病情需要联合使用复方苦参注射液与吉西他滨。     

中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性AML患儿的疗效及安全性

【摘要】目的 探讨中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性急性髓系白血病（AML）患儿的疗效及安全性。方法 选取2008年12月～2012年12月我院收治的行阿糖胞苷联合米托蒽醌、依托泊甙巩固治疗的难治复发性AML患儿96例作为研究对象,采用回顾性分析法分析所有患儿的临床及随访资料,根据阿糖胞苷使用剂量的不同将其分为低剂量组、中剂量组和高剂量组3组,每组各32例,治疗结束后分析并比较3组患儿近期和远期临床疗效,并记录3组患儿治疗过程中不良反应的发生情况。结果 近期临床总有效率3组相比较差异均无统计学意义（P＞0.05）,且所有部分缓解的患儿中8例患儿进行骨髓移植治疗后治愈,余42例继续采用药物进行治疗;3组患儿5年总生存率（OS）比较差异有统计学意义（P＞0.05）,中剂量组和高剂量组患儿5年OS均高于低剂量组（P＞0.05）,但中剂量和高剂量组5年OS比较差异无统计学意义（P＞0.05）,3组患儿其5年无事件生存年率（EFS）比较差异均无统计学意义（P＞0.05）;3组患儿在骨髓抑制和心脏毒性的不良反应方面比较差异无统计学意义（P＞0.05）,但中剂量组和高剂量组患儿其感染、胃肠道反应以及肝肾功能损伤的不良反应发生率均显著高于低剂量组,且高剂量组患儿胃肠道和肝肾功能损伤的不良反应发生率均高于中剂量组患儿,组间比较差异均有统计学意（P＞0.05）。结论 中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性AML患儿具有较好的临床疗效和较低的毒副反应,存在一定的安全性,可作为临床上治疗AML患儿的首选治疗方案。     

同步辐射X线相衬成像对裸鼠胰腺癌的早期诊断

目的 通过建立裸鼠胰腺癌模型,结合磁共振成像（magnetic resonance imaging,MRI）,探讨同步辐射X线相衬成像技术对胰腺癌的早期诊断。方法 32只nu/nu雌鼠,采用数字表法随机分为A、B两组：A组（n=24）为人胰腺癌细胞PANC-1胰腺原位移植瘤组,即于胰腺被膜下注射10⁸×2 μL单细胞悬浮液;B组（n=8）为空白对照组,即于胰腺被膜下注射2 μL 0.9%（质量浓度）氯化钠注射液。再根据术后1、2、3、4周处理时间的不同,将A、B两组分为4个亚组,即A1、A2、A3、A4（n=6）和B1、B2、B3、B4（n=2）。术后分别行MRI扫描、肿瘤标本相衬成像及病理学检查。结果 ①A组术后平均成瘤率73%（16/22）,术后4周成瘤率最高,达到100%,成瘤率随观察时间的延长而升高,二者之间存在线性趋势关系（χ_线性趋势²=4.718,P=0.030）;病理组织学检查为胰腺低分化腺癌。②同步辐射X线相衬成像可显示直径为0.5 mm的胰腺原位肿瘤,早期（两周）的灵敏度和特异度达到100%,明显高于MRI扫描（P=0.029）。结论 PANC-1细胞原位移植是建立裸鼠胰腺癌模型的可靠方法;与MRI相比,同步辐射X线相衬成像能发现胰腺癌微小病变,有可能为胰腺癌的早期诊断提供了一种全新的技术手段。     

蝎肽抗菌凝胶治疗急性放射性皮炎的临床疗效观察

目的研究蝎肽抗菌凝胶对急性放射性皮炎的治疗作用。方法将接受放射治疗后出现急性放射性皮炎的102例患者,创面清洁后,随机分为研究组(n=53)和对照组(n=49),研究组以蝎肽抗菌凝胶均匀涂于创面,对照组以生理盐水、庆大霉素、地塞米松溶液持续湿敷,两组均每天换药3次,治疗14天;观察两组皮肤愈合情况、愈合时间、放疗中断时间以及不良反应发生情况,治疗前后进行放射性皮肤损伤评估量表(RISRAS)评定。结果与对照组相比,研究组治愈率和总有效率均显著增高(54.7%vs 26.5%,88.7%vs 63.3%),差异有统计学意义(P0.05);平均治愈时间明显缩短[(6.23±2.62)天vs(10.43±2.45)天,P0.05];研究组治疗后RISRAS评分低于对照组[(2.44±1.21)vs(3.23±1.31),P0.05];研究组放疗中断时间为(6.39±2.12)天,明显短于对照组(11.37±3.05)天,差异有统计学意义(P0.05)。结论蝎肽抗菌凝胶能有效治疗急性放射性皮炎,对各级皮损均有显著疗效,可明显缩短治愈时间和放疗中断时间,无不良反应。     

Cavernous malformation after radiation therapy for astrocytoma in adult patients: report of 2 cases

Summary Radiation-induced cavernous malformations are rarely reported, and most cases have been children. We describe two adult patients with cavernous malformation after irradiation for astrocytoma. Magnetic resonance (MR) imaging, at their ages of 53 years, showed a cavernous malformation in the irradiated field 26 and 10 years after resection and irradiation, respectively. Cavernous malformations were confirmed by the histopathological examination in the both cases. Radiation-induced cavernous malformations are rare in adult patients with astrocytoma. One reason why we found two such cases was that these patients had been successfully treated for astrocytoma and had long follow-up periods.     

Oncologic effectiveness of selective neck dissection in the N0 irradiated neck

BACKGROUND: The incidence and patterns of nodal spread in previously irradiated N0 necks are not well defined. Therefore, the safety and efficacy of selective neck dissection (SND) in this patient population is not well established. In a previous report from our institution, SND in irradiated patients with recurrent disease at the primary site but clinically negative necks resulted in excellent tumor control in the neck. The objective of this study is to validate our initial observations in a larger sample of patients with longer follow-up. METHODS: A retrospective chart analysis of patients previously treated with primary radiation therapy or chemoradiotherapy for squamous cell carcinoma (SCC) of the head and neck between January 1997 and June 2003 was performed. Patients with recurrent or persistent disease at the primary site or a second primary head and neck SCC, with no clinical or radiologic disease in the neck, who underwent surgical salvage with resection of the primary site along with a site-specific SND were analyzed. Patients who remained disease free at the primary site were analyzed for regional control after SND. RESULTS: Sixty-nine patients underwent a total of 96 site-specific SNDs. The mean age was 64.1 years (range, 39-91 years). There was histologically positive nodal disease in 17 of 69 patients (25%), and 22 of 96 necks (23%). Fifty-three patients had at least a 12-month follow-up. The mean follow-up was 23.3 months (range, 1-96 months). Of the patients with 1-year of follow-up, six patients died from recurrence at the primary site, and nine died from distant metastasis. There were no cases of neck recurrence with the primary site controlled. All patients who had more than two positive nodes had recurrence either at the primary site or distant metastasis. CONCLUSIONS: Our results confirm that the patterns of lymphatic spread are not affected by radiation. We conclude that SND is oncologically safe in the management of the N0 irradiated neck and that the finding of more than two positive nodes predicts a poor outcome.     

丙泊酚复合艾司氯胺酮用于全麻的镇静效果

目的 探讨丙泊酚复合艾司氯胺酮用于全麻的镇静效果。方法 选择择期手术全身麻醉患者150例,男63例,女87例,年龄18～64岁,BMI 18～30 kg/m²,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为三组：丙泊酚组(P组)、艾司氯胺酮组(E组)和丙泊酚复合艾司氯胺酮组(S组),每组50例。每组再随机分为五个亚组,每个亚组10例。在麻醉诱导前,P1组、P2组、P3组、P4组和P5组分别予丙泊酚0.80、1.00、1.25、1.56和1.95 mg/kg, E1组、E2组、E3组、E4组和E5组分别予艾司氯胺酮0.11、0.18、0.30、0.50和0.84 mg/kg, S1组、S2组、S3组、S4组和S5组按照4∶1剂量比分别予丙泊酚/艾司氯胺酮0.38/0.10、0.48/0.12、0.60/0.15、0.75/0.19和0.94/0.24 mg/kg。记录给药5 min内呼吸抑制、高血压、低血压等不良反应发生情况。采用点斜法测定两药及复合用药的半数有效剂量(ED₅₀)和95%可信区间(CI),并用等辐射分析法分析两药复合使用时镇静效应的...     

Gliomatosis Cerebri: Clinical Features, Treatment, and Prognosis

Summary  To clarify clinical features and to elucidate prognostic factors and prognosis, the authors retrospectively analyzed 16 cases of gliomatosis cerebri treated at Seoul National University Hospital between January 1988 and December 1995. Age at diagnosis ranged from 19 to 62 (median 34) years and male to female ratio was 10:6. Most presented with headache or seizure, and the mean duration of symptoms was 12.8 months. A poorly defined diffuse high signal intensity lesion, extending in T2-weighted images for two lobes or more, was the characteristic magnetic resonance (MR) image finding. On postcontrast T1-weighted MR imaging, focal enhancement of the lesion was detected in five cases. All patients underwent histological confirmation by craniotomy (9 cases) or stereotactic biopsy (7 cases). Histologically, all patients had compatible findings of gliomatosis cerebri which are the widespread infiltration of neoplastic glial cells with minimal destruction of pre-existing structures.  After histological diagnosis, external radiation therapy was begun except in one case, who declined this treatment. Fourteen patients completed the whole procedure and received the planned dose (mean 5780 cGy). Median survival time after diagnosis was 38.4 months. In univariate analysis, the Ki-67 labelling index (>1) showed significant correlation with the length of survival (p=0.006).  It is suggested that 1) gliomatosis cerebri can be diagnosed by a combination of MR imaging findings and histological examination; 2) histological diagnosis and external radiation therapy might be a good treatment modality; 3) the Ki-67 labelling index correlates significantly with survival time.