硝苯地平控释剂和缓释剂高血压治疗时肾素、血管紧张素Ⅱ、儿茶酚胺及醛固酮的变化

硝苯地平控释剂和缓释剂高血压治疗时肾素、血管紧张素Ⅱ、儿茶酚胺及醛固酮的变化王旭１张敏２邵一兵１许琳１王晏平１逄金塔１张放１宋文宣１（１．青岛市立医院心内科２６６０１１２．青岛医学院附属医院内分泌科２６６００３）ＥｆｅｃｔｏｆＰｌａｓｍａＲｅｎｉｎＡ...     

Myelodysplastic syndrome in a patient with adult T-cell leukaemia

A 53-year-old female who developed myelodysplastic syndrome (MDS) after chemotherapy for adult T-cell leukaemia (ATL) is described. The latent period of therapy-related MDS (t-MDS) from the time of diagnosis of ATL was approximately 35 months. Cytogenetic analysis of the bone marrow cells at the time of diagnosis of t-MDS revealed a clonal abnormality; 46,XX,add(7)(p13), der(17)t(3;17)(p11;p13). Although monoclonal integration of human T lymphotropic virus type I (HTLV-I) proviral DNA was detected in the peripheral blood lymphocytes at ATL diagnosis, bone marrow cells at t-MDS diagnosis did not show monoclonal integration of HTLV-I. To our knowledge, this is the first report of t-MDS associated with ATL.     

Endoscopic biliary drainage for acute obstructive cholangitis: Effects of bilionasal drainage and stent placement

Acute obstructive suppurative cholangitis is a life-threatening condition which requires prompt biliary decompression. A retrospective review of 92 patients with acute obstructive suppurative or nonsuppurative cholangitis (46 men and 46 women with a mean age of 65.1 years) was conducted. All patients had undergone endoscopic biliary decompression by retrograde cannulation with (79 patients) or without (13 patients) sphincterotomy. Nineteen patients had received sphincterotomy previously. In addition to biliary decompression, 48 of the 92 patients had a bilionasal catheter or a stent placed in the common bile duct (group A), while the other 44 patients did not (group B). The effect of drainage was successful in 83 of the 92 patients (90%), but 1 patient in group A died of liver failure due to advanced cirrhosis of the liver despite successful drainage; thus, the overall mortality rate was 1.1%. Although the mortality and overall morbidity rates (2.1% and 42% in group A, and 0% and 34% in group B, respectively) did not differ between the two groups, the frequency of recurrent cholangitis was significantly higher in group B (60%) than in group A (4.2%) (P<0.001). We conclude that endoscopic biliary decompression is a prompt, safe, and effective method for the treatment of acute obstructive cholangitis. We stress that a stent or a bilionasal drainage catheter should always be placed if recurrent cholangitis is to be prevented until complete clearance of the stones is achieved.     

Single-cycle induction chemotherapy for resectable advanced hypopharyngeal cancer

Background

The role of induction chemotherapy (IC) in the treatment of resectable advanced head and neck squamous cell carcinoma has not been elucidated, and the most effective IC regimen for chemoselection is still unknown. At our institute we have not used the triple combination of docetaxel, cisplatin, fluorouracil (TPF) for chemoselection, but rather the double combination of docetaxel + cisplatin (TP). The aim of this study is to report the outcome of patients with advanced hypopharyngeal cancer treated by single cycle of IC with TP followed by chemoradiation (CRT) or surgery.

Methods

A total of 29 patients with resectable advanced hypopharyngeal cancer who were treated with a single cycle of IC were entered into the study. Responders were treated by CRT while nonresponders underwent surgery. Outcomes were analyzed using the Kaplan–Meier method.

Results

A single cycle of IC with TP achieved response in 21 of the 29 patients. The major side effect was neutropenia which could be managed without delaying the sequential treatment. The 2-year overall survival and disease-specific survival were both 74.0% (stage III 100%, stage IVA 69.1%). The cumulative 2-year laryngeal preservation rate was 100% for stage III and 53.6% for stage IVA.

Conclusion

A single cycle of IC with the combination of docetaxel + cisplatin may be sufficient to select advanced hypopharyngeal cancer patients with radio-sensitivity. IC intended for organ preservation strategies should be low toxic. Our strategy may be a useful for providing the benefits of IC and the opportunity for curative surgery without delay.

     

Expression of laminin 5 basement membrane components in invading and recurring adenoid cystic carcinoma of the head and neck

OBJECTIVE: Adenoid cystic carcinoma (ACC) of the head and neck grows slowly with structural differentiation, however, this tumor nevertheless also shows a highly invasive potential and a high recurrence rate. Extracellular matrices have been suggested to play an important role in the differentiation and growth of ACC. The aim of this study is to understand the roles of laminin 5 basement membrane (BM) components, including collagen IV and laminin gamma2 for the high degree of invasiveness and the recurrence of ACC. METHODS: Collagen IV and laminin gamma2 were immunohistochemically localized in tissue sections from nine patients with ACCs. RESULTS: Cribriform structures with pseudocysts were preserved in small invading tumor nests, and the expression of both of collagen IV and laminin gamma2 was observed in the inner border of the pseudocysts and the surrounding area of the tumor nests. In areas of perineural invasion, the BM components continued to be expressed around the long tumor nests. Recurrent tumors consisted of multiple small nests with a few tumor cell layers, and the expression of the BM components was observed on both the inside of the inner tumor cells and the outside of the outer tumor cells, which was an obviously different appearance from that of the primary tumor. CONCLUSION: ACC appears to possibly grow and invade using the laminin 5 BM matrices while also preserving their differentiated architecture. The laminin 5 BM matrices might play an important role not only in the differentiation and growth, but also in the invasion and recurrence of ACC of the head and neck.     

Single-cell microinjection of cytochrome c can result in gap junction-mediated apoptotic cell death of bystander cells in head and neck cancer

BACKGROUND: Gap junction intercellular channels are required for metabolic cooperation between cells and regulate normal tissue homeostasis by means of the transfer of small molecules between contacting cells. Not surprisingly, the gap junction phenotype is frequently lost during carcinogenesis in human tissues (including those of the upper aerodigestive tract), freeing individual cancer cells from the growth control signals of normal surrounding tissues and less aggressive adjacent cancer cells. We hypothesized that gap junctional intercellular communication (GJIC) could mediate a bystander effect (apoptotic cell death) in squamous cell carcinoma of the head and neck (SCCHN) cells adjacent to individually targeted SCCHN cells. METHODS: Single-cell microinjection of cytochrome c was used to induce apoptosis in target SCCHN cells with endogenous GJIC activity and in an SCCHN cell line with exogenously introduced GJIC activity. Apoptosis was followed in target and surrounding bystander cells through light and time course microscopic characterization. All of the preceding experiments were carried out in the absence and presence of 18-beta-glycerretinic acid, a pharmacologic inhibitor of GJIC. RESULTS: When cytochrome c was introduced into SCCHN cells with endogenous GJIC activity through single-cell microinjection, bystander effects (apoptosis of nontarget cells) were observed. When GJIC activity was blocked with the specific pharmacologic inhibitor of gap junctions, 18-beta-glycerretinic acid, a bystander effect was never seen in GJIC active SCCHN cell lines. CONCLUSIONS: Gap junction intercellular channels can mediate a bystander effect in SCCHN. Inconsistencies in our data will be discussed in the context of recent advances in this field, as well as our future research directions.