尼日利亚翼状胬肉治疗状况的回顾性分析

目的:总结尼日利亚翼状胬肉的治疗现状。方法:选择1999-01/2002-12的4a期间的翼状胬肉手术患者,所有病例都来自于尼日利亚Enugu市的尼日利亚大学教学医院和Ebrans临床中心。收集这些患者的生理数据、临床表现、手术方法和术后并发症等资料,应用6.1版EPI-INFO方法进行数据处理。共选择3种不同的手术方法:60眼单纯施行巩膜暴露术,42眼施行联合5-氟尿嘧啶(5-FU)的巩膜暴露术,22眼施行联合丝裂霉素C的巩膜暴露术。结果:72例(124眼)施行翼状胬肉切除术的患者,术后至少随访1a,包括男41例(56.9%),女31例(43.1%),男女比例为1∶0.8。术后复发率最高的在病变第III期(55.6%),最低在病变第I期(22.2%)。3种手术方法比较,复发率分别为65.0%、52%和13.6%。结论:在像尼日利亚这样的发展中国家,联合丝裂霉素的早期手术切除术,是一种安全性强、治疗费用低、方法简单且创伤小的治疗翼状胬肉的有效手段,值得推广。     

Cross-linked hyaluronic acid viscoelastic scleral implant in trabeculectomy

Purpose:Patients with glaucoma undergoing trabeculectomy develop bleb cicatrix causing poor postoperative intraocular pressure (IOP) control and low success rates. Several approaches have been explored over the years for better outcomes. This study assesses the safety, efficacy, and outcome of trabeculectomy with HealaFlow^® (Anteis S. A, Geneva, Switzerland), a high-molecular-weight cross-linked hyaluronic acid viscoelastic gel, and comparing it with the antimetabolite Mitomycin-C (MMC).Methods:A prospective, interventional, case-controlled study conducted at a tertiary care hospital in Southern India on 60 eyes of patients requiring trabeculectomy divided in two groups – HealaFlow scleral implant and adjuvant low-dose MMC (0.1 mg/mL). Postoperative IOP reduction along with bleb morphology was assessed over follow-up at 1 week, 1 month, 3 months, 6 months, and 12 months.Results:Preoperatively IOP in the two groups was statistically similar. Postoperative IOP on day 1 had statistically significant reduction in both groups with greater reduction in MMC group. However, by 12 months, the IOP reduction was statistically similar in both groups, i.e., 46.24% (to 11.04 ± 2.55 mmHg) and 54.47% (to 11.99 ± 3.37 mmHg) in HealaFlow^® group and MMC group, respectively (P > 0.05). The bleb morphologies were similar and complications were seen equally, which resolved by 4 weeks. A complete success rate of 89.29% and a qualified success rate of 10.71% were observed equally in both groups.Conclusion:Absorbable biosynthetic cross-linked hyaluronic acid and low-dose MMC are equally safe and efficacious in trabeculectomy with significant IOP reduction and good bleb morphology. Therefore, it is a novel substitute for MMC.     

A novel MMC-loaded pHEMA drainage device for the treatment of glaucoma: in vitro and in vivo studies

Administration of subconjunctival 5-fluorouracil (5-FU) and topical mitomycin-C (MMC) has been shown to improve the success rate of glaucoma-filtering surgery. However, corneal toxicity and administrative problems remain. To overcome this limitation, drainage devices for the sustained release of 5-FU and MMC were designed and tested in vitro and in vivo. This paper presents only the results of our studies which were carried out on MMC-loaded devices. Here, the drainage devices were prepared from MMC-loaded poly(hydroxyethyl methacrylate) (pHEMA) matrices in different cross-linking ratios and in different drug loading capacities, i.e. 0.2, 0.5, and 2.0 mg MMC per device. These devices released MMC at approximately 6.0-90.0 μg day^-1 for over 2 months depending on cross-linking density and initial drug loading. The diffusional release of MMC from glassy and swollen copolymers showed that diffusion mechanism is Fickian in both cases. The usability of the pHEMA implants were investigated by in vivo experiments which were done on eight dog's eye. In the treatment eyes, intraocular pressures remained significantly lower than the control eyes throughout the experimental period (4 months). Subconjunctival implantations revealed no clinical and histological evidence for toxicity. The results of in vitro and in vivo studies indicate that an implantable release system delivering MMC for over 2 months can improve the prognosis for filtering surgery by preventing postoperative fibrosis.     

Modifying subsceral fluid pressure in an experimental model of mitomycin-C diffusion

BACKGROUND: Episcleral application of mitomycin-C (MMC) during glaucoma filtration surgery hinders the post-operative wound healing. Diffusion through the sclera might result in a toxic effect on the ciliary body resulting in reduced aqueous humor production leading to post-operative hypotony. We developed an experimental model to investigate the influence of intraocular pressure on the diffusion of MMC through the sclera and in subscleral compartments. METHODS: Scleral quadrants of 10 human donor eyes were mounted on PMMA tubes filled with saline imitating the intraocular volume. By height variation of a coupled infusion line different intraocular pressures were simulated (0, 8, 23 and 80 mmHg). Additionally the model included a subscleral sponge to mimic the compartment of the ciliary body. The episcleral sides of the scleral quadrants were exposed for 1 min to sponges soaked with 200 microg ml(-1) MMC. An 8-mm-diameter scleral disk was punched out with a trephine and horizontally dissected with a kryotome. The MMC concentrations of scleral layers, epi-and subscleral sponges and the fluid within the tubes were analysed by means of high-performance liquid chromatography. RESULTS: The MMC concentration gradually declined from the episcleral sponge (165 microg ml(-1)) to the superficial (3.3 microg ml(-1)) and deep scleral layers (1.2 microg ml(-1)), and to the subscleral sponge (0.2 microg ml(-1)). We were able to detect very small concentrations of MMC in the fluid within the PMMA tubes (0.01 microg ml(-1)). CONCLUSION: We developed a new experimental in vitro model for investigating transscleral MMC diffusion. The different simulated intraocular pressures had no effect on the concentration gradient through the investigated compartments of our model.     

PRK+MMC与LASEK治疗高度近视效果比较

目的比较PRK术中预防性使用丝裂霉素C（MMC）治疗高度近视和LASEK治疗高度近视的疗效.方法将高度近视（-6.0～-10.0D）随机分为PRK＋MMC组40例（80眼）和LASEK组38例（76眼）.另以早年PRK手术屈光状态与之相似的40例（80眼）作为对照.PRK＋MMC组在PRK术中使用0.02%MMC,LASEK组采用常规LASEK,评价术后角膜上皮下雾状浑浊（haze）,屈光回退、视力及角膜内皮细胞改变等情况.结果PRK＋MMC组未出现2级或2级以上haze,无术后矫正视力下降者,术后欠矫小于-0.5D者70眼;LASEK组有6眼出现2级及2级以上haze,有6眼出现术后矫正视力下降,术后欠矫小于-0.5D者56眼.两组的差异有显著性.使用MMC未见明显毒副作用.结论PRK术中预防性使用MMC,在术后减少haze、防止屈光回退、改善视力方面较LASEK为优.     

Mitomycin and fluorouracil in combination with concomitant radiotherapy: a potentially curable approach for locally advanced head and neck squamous cell carcinoma

OBJECTIVE: The purpose of this study was to evaluate the efficacy of radiotherapy and concurrent mitomycin-C (MC) plus 5-fluorouracil (5FU) infusion in locally advanced squamous cell carcinoma of the head and neck (SCCHN). METHODS: Sixty-nine patients with SCCHN (6 Stage III and 63 Stage IV patients) were treated with external beam radiotherapy (70 Gy) and simultaneous intravenous chemotherapy with 5FU (600 mg/m(2)/day, Days 1-5) and MC (10 mg/m(2), Days 5 and 36). RESULTS: After a mean follow-up of 28.5 months, 59.4% of patients were alive without disease. Complete response was seen in 76.8% of patients. The 3 years overall survival, locoregional relapse-free survival and disease-free survival was 62.3, 63.1[corrected] and 49.5%, respectively. Treatment was well tolerated (Grade III mucositis in 43.5% and Grade II leukopenia in 5.8%). CONCLUSIONS: This concurrent chemoradiotherapy regimen offers a curative option for our patients where primary and nodal disease is fairly large resulting in hypoxic radioresistant tumors.     

Genotoxic effects of polychlorinated biphenyls (PCB 153, 138, 101, 118) in a fish cell line (RTG-2)

Polychlorinated biphenyls (PCBs) are persistent pollutants in aquatic environments, often causing the decline or disappearance of wild populations. The primary aim of this study was to investigate the genotoxic effects of some PCBs (PCB153 (2,2′,4,4′,5,5′-hexachlorobiphenyl) and 138 (2,2′,3,4,4′,5′-hexachloro-biphenyl), both non-dioxin-like compounds, and the pentachlorobiphenyls PCB118 (2,3′,4,4′,5-) and 101 (2,2′,4′,5,5′-), the former an ortho-substituted, low-affinity dioxin-like compound and the latter a non-coplanar congener classified as non-dioxin-like) in fish cells (RTG-2). These congeners are mostly present in surface waters and in edible aquatic organisms and the loss of DNA integrity in vitro serves as a sensitive biomarker of cytogenetic alterations and is considered as an initial step for the identification of genotoxic effects.The alkaline comet assay and the micronucleus test show clear genotoxic damage after short and longer exposure (2 and 24 h) to maximum soluble, non-cytotoxic doses, evident sooner with PCBs 101 and 118. Oxidative stress situations involving ROS release, reduction in total GSH, lipid peroxidation and alteration to superoxide dismutase, seen after exposure with all the congeners, though with different kinetics, seem the most likely explanation for the genotoxic damage. This appears to be confirmed by the modified comet assay (pH 10) for detection of oxidized bases using endonuclease III. The increased generation of intracellular ROS might explain the apoptosis seen after treatment with the single PCBs and evaluated on the basis of the rise in 3-7 caspase activity. Therefore both the non-coplanar, non-dioxin-like PCBs (153, 138, 101) and the low-affinity dioxin-like compound PCB118 cause evident genotoxic damage, probably as a consequence of oxidative stress.     

Nitrilotriacetic acid does not induce sister-chromatid exchanges in hamster or human cells

The effect of nitrilotriacetic acid on sister-chromatid exchanges (SCEs) in human peripheral blood lymphocytes and Chinese hamster ovary cells was studied. The chemical did not increase the frequency of SCEs in either cell type. The negative response of these cells supports other evidence that nitrilotriacetic acid is not genotoxic and that its carcinogenicity to the urinary tract may involve an epigenetic mechanism.     

Genotoxicity of monosodium glutamate

Monosodium glutamate (MSG) is one of the most widely used flavor enhancers throughout the world. The aim of this study is to investigate the genotoxic potential of MSG by using chromosome aberrations (CAs), sister-chromatid exchanges (SCEs), cytokinesis-blocked micronucleus (CBMN), and random amplified polymorphic DNA-polimerase chain reaction (RAPD-PCR) in cultured human lymphocytes and alkaline comet assays in isolated human lymphocytes, which were incubated with six concentrations (250, 500, 1000, 2000, 4000 and 8000 μg/mL) of MSG. The result of this study indicated that MSG significantly and dose dependently increased the frequencies of CAs, SCE and MN in all treatments and times, compared with control. However, the replication (RI) and nuclear division indices (NDI) were not affected. In this paper, in vitro genotoxic effects of the MSG was also investigated on human peripheral lymphocytes by analysing the RAPD-PCR with arbitrary 10-mer primers. The changes occurring in RAPD profiles after MSG treatment include increase or decrease in band intensity and gain or loss of bands. In the comet assay, this additive caused DNA damage at all concentrations in isolated human lymphocytes after 1-h in vitro exposure. Our results demonstrate that MSG is genotoxic to the human peripheral blood lymphocytes in vitro.     

膀胱灌注黏膜黏附化疗药物HPC-MMC预防肿瘤复发的疗效观察(附46例报告)

目的探讨黏膜黏附化疗药物HPC—MMC预防肿瘤复发的效果。方法对46例表浅膀胱癌患者于TURBt术后随机分两组行膀胱灌注化疗,黏膜黏附化疗药物组20例,以20mg／20ml％HPC—MMC膀胱灌注;MMC组26例,以20mg／20ml MMC膀胱灌注。疗程1年。HPCMMC组总灌注次数少于MMC组4次。随访6～36个月。结果HPC-MMC组未发现出血性膀胱炎,无明显尿路刺激症状。平均随访27．4个月,7例复发,1年复发率为16．7％,3年总复发率38．9％。MMC组平均随访26．8个月,9例复发,1年复发率为22,7％．3年总复发率40．9％。结论黏膜黏附化疗药物HPC-MMC膀胱灌注防止肿瘤复发优于单用MMC,同时可降低副作用,减轻患者痛苦及经济负担。