Benign intracranial hypertension and recombinant growth hormone therapy in Australia and New Zealand

Benign intracranial hypertension (BIH) is reported in three children from Australia and one from New Zealand, who were being treated with recombinant human growth hormone (rhGH). Three males and one female, aged between 10.5 and 14.2 y, developed intracranial hypertension within 2 weeks to 3 months of starting treatment. A national database, OZGROW, has been prospectively collecting data on all 3332 children treated with rhGH in Australia and New Zealand from January 1986 to 1996. The incidence of BIH in children treated with growth hormone (GH) is small, 1.2 per 1000 cases overall, but appears to be greater with biochemical GHD (<10IUml ^-1), i.e. 6.5/1000 (3 in 465 cases), relative risk 18.4, 95% confidence interval 1.9-176.1, than in all other children on the database. The incidence in patients with Turner's syndrome was 2.3/1000 (1 in 428 cases). No cases in patients with partial GHD (10–20 IUml ^-1) or chronic renal failure were identified. Possible causative mechanisms are discussed. The authors'practice is now to start GH replacement at less than the usual recommended dose of 14IUm-² week^-1 in those children considered to be at high risk of developing BIH. Ophthalmological evaluation is recommended for children before and during the first few months following commencement of rhGH therapy and is mandatory in the event of peripheral or facial oedema, persistent headaches, vomiting or visual symptoms. The absence of papilledema does not exclude the diagnosis.     

Benefits and risks of antifibrinolytic therapy in the management of ruptured intracranial aneurysms

Summary One hundred patients with a verified subarachnoid haemorrhage were studied in a double blind, placebo-controlled trial at a single centre to determine the value and relative risks of tranexamic acid (TXA) in the management of ruptured intracranial aneurysms. The incidence of recurrent haemorrhage between active and placebo groups was identical (12%) and the mortality from recurrent haemorrhage was 7% and 5%, respectively. The overall incidence of cerebral infarction before surgery, at discharge and at 6 months follow-up was greater in the TXA group (27%) than in the control group (11%). Post-operative cerebral ischaemia was significantly more frequent in the active, 18 of 29 as compared to 6 of 32 patients, in the placebo group. In a fifth of the patients in whom cerebral blood flow was estimated there was a significant reduction of cerebral blood flow (CBF) on the side of the ruptured aneurysm in the TXA treated group. It is suggested that this may be the cause of the increased incidence of cerebral ischaemia in this group. There was no significant difference in the incidence of cerebral vasospasm, hydrocephalus, visual disturbances and gastrointestinal disturbances.More fatalities were encountered from ischaemia and recurrent haemorrhage in the TXA group but these differences did not reach statistical significance at the 5% level. Given that disability was due to either vasospasm or recurrent haemorrhage then a patient under TXA treatment was significantly more likely to have disability due to vasospasm (p<0.04); the reverse was true for the placebo patient (p<0.05).     

Granular cell tumors of the breast: A report of two cases

Granular cell tumors (GCT) are rare neoplasms, and only 173 cases of benign GCT of the breast have been documented. We report herein the cases of two patients with this tumor and discuss the methods of diagnosis and treatment. The first patient was a 60-year-old woman who presented with a firm ill-defined mass in her left breast. Mammography showed a dense shadow with spicula and skin thickness, and ultrasonography revealed a hypoechoic mass with an irregular border. Radical mastectomy was performed under the wrong preoperative diagnosis of breast cancer. The second patient was a 31-year-old woman who presented with an elastic-hard mass in her left breast. Mammography showed a well-demarcated dense mass, and ultrasonography revealed a well-defined hypoechoic mass with a large depth-width ratio. Fine-needle aspiration cytology (FNAC) showed a large number of histiocytic cells with abundant granular cytoplasm. An excisional biopsy was performed, and histological examination confirmed a diagnosis of GCT. GCT is benign, but often misdiagnosed as breast cancer both clinically and radiologically. Therefore, histological examination is essential for making a correct diagnosis, while FNAC is also useful. Local resection is still the treatment of choice, and surgeons should do their utmost to avoid performing needless radical mastectomy.     

大鼠腹腔肥大细胞肿瘤坏死因子合成与释放的研究

应用免疫细胞化学技术及酶联免疫吸附试验（ELISA）对大鼠腹腔肥大细胞合成和释放肿瘤坏死因子（TNF）的状况进行了观测。结果:新鲜分离纯化的大鼠腹腔肥大细胞胞浆呈TNF蛋白阳性。单纯肥大细胞培养早期（2～4 h）,上清液中未能检测到TNF,随着培养时间延长,上清液中TNF含量增多;盐酸吗啡与肥大细胞共同培养2h时,上清液中出现可测TNF。四甲基偶氮唑盐（MTT）比色分析试验表明,肥大细胞培养上清液具体有TNF的抗肿瘤活性中。提示:大鼠腹腔肥大细胞能合成和释放TNF,盐酸吗啡能促进肥大细胞释放TNF。     

神经内镜治疗脑室内病变

目的探讨脑室内病变的神经内镜治疗。方法应用神经内镜对68例脑室内病变进行治疗,其中松果体区肿瘤16例,囊性颅咽管瘤15例,丘脑肿瘤14例,脑室内囊肿16例,侵及室管膜下的胼胝体肿瘤3例,侧脑室脉络丛乳头状瘤2例,侧脑室猪囊尾蚴病1例,侧脑室内分流管脱落1例。结果随访17～69个月,56例有效,12例死于肿瘤扩散。无严重并发症。结论对脑室内病变选择性应用神经内镜治疗安全、有效。     

新生儿颅内出血的临床分析

目的 为探讨各种类型新生儿颅内出血的早期诊断方法，明确其临床特点与CT的关系。方法 对176例经CT证实有颅内出血新生儿的临床资料进行回顾性分析。结果 176例患儿中缺氧所致123例(72．6％)，产伤21例(11．9％)，新生儿出血症22例(12．5％)，早产儿10例。患儿有意识障碍者156例(88．6％)，惊厥98例(55．68％)，肌张力改变113例(64．2％)，原始反射减弱或消失104例(59％)，贫血16例。CT示：SAH121例。占68．75％，为NICH最常见类型；SDH17例，IPH13例，IVH5例，混合性出血20例。结论 根据临床表现考虑NICH者应做头颅CT或头颅B超检查。Cr是确诊的最佳手段，能正确显示出血部位、范围、程度及区分各种类型，头颅B超对早产儿、低出生体重儿的IVH、IPH检出率高。     

纳米技术在肿瘤诊断与治疗中的现状与展望

目的介绍21世纪前沿科技--纳米技术在肿瘤诊断与治疗中的现状与展望.方法通过检索国内外文献,从肿瘤的诊断与治疗两方面分别论述.结果纳米技术在肿瘤诊断与治疗中有其巨大优势.结论尚处初级阶段,广泛应用于临床还需多方努力.     

肝癌病人血浆和癌组织中血栓调节蛋白的检测

目的　检测肝癌病人血浆和肝癌组织中血栓调节蛋白 (TM )的表达 ,探讨TM与肝癌临床病理特征的关系。方法　用酶联免疫吸附夹心法检测 45例肝癌和 6例肝良性占位病人手术前后的血浆TM水平 ;用免疫组织化学法检测肝癌及肝良性占位组织中的TM蛋白表达水平。结果　术前肝癌组血浆TM水平 ( 10 .2± 5 .7)ng/mL明显高于肝良性占位组 ( 6.1± 2 .2 )ng/mL和正常人对照组 ( 5 .7± 1.0 )ng/mL ,P <0 .0 5 ;术前TM血浆水平肝癌伴门静脉癌栓组 ( 6.9± 4.5 )ng/mL和多发肝癌结节组 ( 8.1± 4.6)ng/mL明显低于无门静脉癌栓组( 11.4± 5 .6)ng/mL和单发肝癌结节组 ( 11.5± 5 .9)ng/mL ,P <0 .0 5 ;40例肝癌病人肝癌切除术前TM水平( 10 .8± 5 .3 )ng/mL与肝癌切除术后 ( 7.6± 4.2 )ng/mL相比差异显著 ,P <0 .0 5。肝良性占位组术前与术后相比差异无显著性 ,P >0 .0 5。肝癌组织中TM蛋白表达阳性的病人术前血浆TM水平明显高于TM表达阴性者 ,P <0 .0 5 ;而术后血浆TM水平两者则无显著性差异 ,P >0 .0 5。结论　肝癌病人血浆中TM水平升高 ,TM水平的高低与门静脉癌栓的形成有关     

放疗化疗联合治疗局部晚期非小细胞肺癌43例

目的 探讨以顺铂为主的化疗方案加放疗对局部晚期非小细胞肺癌的疗效。方法 86例局部晚期非小细胞肺癌患随机分为治疗组及对照组各43例，放疗方案以CAP、EP、MVP或MOP，每人至少化疗两个周期，化疗后10～14天放射治疗，放疗采用^60Co外照射。结果 治疗组有效率83．7％，中位生存期14．5个月，对照组有效率67．4％，中位生存期10个月，两组不良反应为骨髓抑制、胃肠道反应。结论 以顺铂为主的化疗方案加放疗治疗局部晚期非小细胞肺癌的疗效较高，可提高肿瘤的局部控制率和延长生存期。