高剂量表阿霉素治疗进展期和晚期乳腺癌

目的评价高剂量表阿霉素（ＨＤ－ＥＰＩ）合并环磷酰胺（ＣＴＸ）、氟脲嘧啶（５－Ｆｕ）治疗进展期和晚期乳腺癌的安全性和有效性。方法对３２例可评价的Ⅲ、Ⅳ期乳腺癌患者静脉给予ＣＴＸ６００ｍｇ／ｍ２、ＥＰＩ９０ｍｇ／ｍ２～１１０ｍｇ／ｍ２、５－Ｆｕ９００ｍｇ／ｍ２,每２１天重复。并与３０例非同期低剂量组比较（ＥＰＩ为５０ｍｇ／ｍ２）。结果高剂量组的总有效率为７１．９％,完全缓解率为１２．５％,明显高于低剂量组（５６．７％和６．７％）;初治的有效率（８０．０％）略高于复治者（６８．２％）。全组中位缓解期７．４个月,中位生存期１２．５个月。白细胞减少为主要的毒副反应,发生率为８９．５％（６８／７６）,Ⅲ、Ⅳ度分别为２７．６％和１８．４％;胃肠道毒性为轻、中度,未见明显的心肝肾毒性。结论ＨＤ－ＥＰＩ＋ＣＴＸ＋５－Ｆｕ方案治疗晚期乳腺癌安全有效,可在临床进一步试用     

皮层体感Ⅱ区对丘脑腹后外侧核针刺效应的下行调制

<正> 近十余年,越来越多的证据表明丘脑腹侧基底核(VB)内确实含有感受伤害性信息的神经元。研究又证实大脑皮层不仅可感受痛信息,还参与痛调制,大脑皮层的下行调制作用参与针刺镇痛过程。在丘     

Cochlear degeneration in guinea pigs after repeated hyperbaric exposures.

The effects of repeated hyperbaric exposures on inner ear function and morphology in guinea pigs were investigated with auditory electrophysiological testing, histopathological and electron microscopic techniques associated with enzyme histochemical method. The results showed that repeated hyperbaric exposures, though considered "safe," did cause damage to the cochlear system. Possible causes of the pathology include direct effects of repeated compression and decompression on the ear, and the possibility of inner ear decompression sickness and barotrauma cannot be excluded.     

Utilization of acute inpatient psychiatric services: “Heavy users” in New York State

The severely and persistently mentally ill (SPMI) population are often forced to rely on emergency/acute inpatient services. The authors analyze Medicaid expenditures and state hospital utilization data to identify and describe the characteristics of heavy users of these services. Also described is New York State's intensive case management (ICM) initiative targeted at this heavy user group. It is postulated that ICM will alter the utilization patterns of participants from over-reliance on the most costly services and more effectively and efficiently serve the SPMI population, specifically the heavy user subpopulation.     

Reconstruction of the thumb and digit by toe to hand transplantation

Since the rapid development of microsurgery it is feasible to replant most severed thumbs and digits. In certain patients, however, the trauma is so severe that replantation cannot be performed, such as crush or burst injuries where the amputated part is badly smashed or broken into pieces. There are many methods used to reconstruct amputated thumbs or digits. In our hospital reconstruction of the thumb is accomplished by second toe transplantation, nail flap of the great toe transplantation and bone graft, and nail flap of the great toe and skeleton from the second toe transplantation. Reconstruction of fingers is undertaken through second toe transplantation and second and third toe transplantation. After total loss of the hand, double second toe transplant is used for reconstruction.

---

Resumen Gracias al rápido desarrollo de la microcirugía, actualmente es factible reimplantar la mayor parte de los pulgares y los dedos de la mano que hay an sido amputados. Sin embargo, en ciertos pacientes el trauma es tan severo que la reimplantación no puede ser realizada, tal como ocurre con las lesiones por aplastamiento o por explosión, donde la parte amputada resulta severamente aplastada o fragmentada en pedazos. Existen muchos métodos de reconstrucción; los siguientes son los utilizados en nuestro hospital.

---

Résumé En raison du développement rapide de la microchirurgie, il est possible de réimplanter la plupart des doigts amputés. Chez certains patients, cependant, le traumatisme est tellement important qu'aucune réimplantation ne peut être tentée: dans les accidents par écrasement ou les lésions par souffle dans lesquelles la partie amputée est abîmée ou fracasée. Il existe de nombreuses méthodes pour reconstruire un pouce ou un doigt. Les procédés que nous employons dans notre Hôpital sont: (1) pour le pouce, le transfert du deuxième orteil, le lambeau unguéal du gros orteil avec greffon osseux, le lambeau unguéal et le transfert osseux du deuxième orteil; (2) pour les autres doigts, le transfert du deuxième orteil, seul ou combiné avec celui du troisième; (3) pour la main, le transfert bi ou unilatéral du deuxième orteil; et (4) des prothèses de main à visée esthétique.

     

14例大疱性表皮坏死松解型药疹治疗体会

报告14例大疱性表皮坏死松解型药疹的治疗。以磺胺类药和解热镇痛药引起者居多,各4例。皮损面积按九分法计算,皮损面积80％以上者9例,80％以上者5例,治愈9例,死亡5例,我们认为早期使用足够剂量皮质激素类药物是有效措施。病程中注意防治感染,给予足够的液体以防止水电解质失平衡,局部治疗使用本院中药“五黄油”。     

辨证施治冠心病48例临床疗效分析

本文对1974年11月～1976年12月,经中西医结合治疗的48例冠心病,作一回顾性分析,着重探索辨证施治在冠心病的中西医结合治疗中的优越性及如何提高临床疗效等问题。材料与方法一、一般资料:48例中,男42例,女6例:年龄38～85岁,除1例外均在40岁以上。二、病例选择及分型:全部病例均按1974年冠心病、高血压普查预防座谈会修订标准进行诊断;47例属确诊冠心病,1例属可疑冠心病。其中:(1)以心     

HIV-1 infected mononuclear phagocyte secretory products affect neuronal physiology leading to cellular demise: relevance for HIV-1-associated dementia

Viral and cellular products from HIV-1-infected and/or immune competent mononuclear phagocytes (MP) (brain macrophages and microglia) affect neuronal function during HIV-1-associated dementia (HAD). Neurotoxic MP factors include, but are not limited to, pro-inflammatory cytokines, chemokines, platelet activating factor, arachidonic acid and its metabolites, nitric oxide, progeny virions and viral structural and regulatory proteins. The mechanisms for immune-mediated neural injury in HAD, only now, are being unraveled. In this regard, we reviewed the current knowledge of how postmitotic neurons, which can neither divide nor be replaced, are damaged by MP secretory activities. Linking neuronal function with brain MP activation was made possible by placing viral and/or immune products onto neurons and measuring cell signaling events or through ex vivo electrophysiological tests on MP-treated brain slices. Such linkages are shown, in this report, by select demonstrations of MP factors which cause neuronal dysfunction in HAD.     

铝碳酸镁对十二指肠液反流所致大鼠食管病变的防治作用

目的　通过动物实验 ,研究十二指肠液反流对食管上皮的损伤及评价铝碳酸镁对食管粘黏损伤的预防和治疗作用。方法　 16 0只SD大鼠 ,♂ ,2 0只为正常空白对照 (C组 ) ,14 0只行全胃切除 +食管空肠吻合术 ,术后 2周存活的大鼠随机分为A、B两组 ,A组予以铝碳酸镁管喂 ,B组管喂等量的生理盐水 ,术后 10周处死所有的大鼠 ,对食管上皮进行大体形态、病理学及电镜观察。结果　A、B两组的食管有程度不同的反流性食管炎 ,组织学表现为炎症、糜烂、溃疡、鳞状上皮增生、Barrett上皮化生及不典型增生。B组的炎症程度重于A组 (P <0 .0 1) ,Barrett上皮化生及不典型增生的发生率明显高于A组 (P <0 .0 5 )。B组有 1例食管微灶腺癌形成。扫描及透射电镜发现B组有Barrett化生的食管上皮典型分泌型肠上皮的特征。结论　铝碳酸镁能有效保护十二指肠液反流的食管粘黏 ,预防及治疗因其所致的多种病理学损害