- Nghidn ciJu cho kdt qud 87,5% u nhd du'd'i 4cm du^ng klnh, didu ndy cQng phd hp'p vdi nhdn xdt cQa nhidu tdc gtd trong vd ngodi nu'd'c.
2. Chdn dodn c^n ldm sdng
Kdt qud nghidn cCi-u cho thdy cdc phuang phdp c|n Idm sdng hi$n nay cho chdn dodn chinh xdc khd cao vd bdn chdt Idnh tinh hay dc tinh cQa u (FNA), adng thdi vd htnh thd u, kich thu'd'c vd vj trl cOa u trong mdi lidn quan tgi tuydn vd td chO'C xung quanh tuydn. Cdc phu'Ong phdp chgp CT Scan vd cdng hifdng tO vdi nhQng thd h$ mdy hi$n dgi Id nhQng Phu'O'ng tl$n chdn dodn rdt chlnh xdc, tuy do gid thdnh ndn chdng tdi cht dp dgng theo nhO'ng tm-dng iipp khd, du'pc cht djnh sau sidu dm, Nhidu tdc gid trong vd ngodi nu'd'c cOng cho nhQ'ng kdt qud tu-ong ffirong vd gid trt cQa nhQng phu-ong phdp trdn.
3. vd kdt qud p h l u t h u d t
Qua nghidn cOm chCing tdi thdy phdu thudt u hdn tipp tuydn mang tal dd cd nhidu tidn bd, cht cd 3 trudng hpp phdu thudt cd kdt qud tmng blnh (chidm 6,3%) cdn Igi 93,7% Id kdt qud tdt. Cht cd 1 bdnh nhdn u tdi phdt sau hon 36 thdng hidn vdn duyc theo dOi vdi khoi u tdi phdt d u ^ i 1cm dirdng klnh trdn sidu dm Cd 2 b§nh nhdn ii$t thdn kinh mdt tgm thdi do pliCi nd sau md u I6n cd 2 thCiy, ddu phyc hdi ngay trong thdi glan hdu phSu cht^ng td s y tidn bd thyc sy cua k^ thudt md cOng nhu' d d u trj chdng vidm, chdng nd vd chdm sdc hdu phdu.
K £ T LUi^N
U hSn hyp tuydn mang tai Id bdnh \'j/ khd phd bidn hay gdp d dp tudi > 40 tudi (78.2%), t j 1$ gdp d 2 gidi gkn ngang nhau. Thd'i gian mdc b$nh tmng blnh khodng 20 thdng, da phdn u g$p b thuy ndng cua hiydn (83,2%), phdn I6n u nhd du'd'i 4CTn du'dng klnh (87,5%). Vi$c chdn dodn thud'ng chlnh xdc nhd* ldm sdng vd cdc phuvng phdp cdn Idm sdng.
Phdu thudt u hdn hyp tuydn mang tai hi$n nay dd cd nhidu tidn bd, phdu Uiudt thux^ng d u v c tidn hdnh thudn Ipi, rdt It bidn chdng. Kdt qud tdt 93,7%, tmng binh 6,3%, khdng cd kdt qud xdu.
K\tU NGHj
U hdn hp'p tuydn mang tai Id u Idnh, gdp phd bidn trong cdc b$nh 1^ tuydn mang tai. Vide chdn dodn chlnh xdc u hfin hyp tuydn mang tai cdn phdi cd sy kdt hyp cdc d$c tinh Idm sdng, cdn Idm sdng: sidu dm, chgp CT Scan, chgp cdng hu'dng tir, gdn ddy Id xg hlnh vd'i TC - 99m vd td bdo hpc (FNA) dd cd duvc dp tin edy cao. NhQ-ng tru'd'ng hyp nghi ngd' cdn du-yc cdt Ignh trong md nhdm hgn ehd chdn dodn Idm, gidm cdc bidn chiing vd nguy co tdi phdt.
Vide didu trj bdng phdu thudt vdi md cdt gpn u hodc cdt rpng u bdo tdn ddy thdn kinh mdt, chdng hdi Chiang Frey vd tgo hlnh khuydt Id'n sau khi Idy khdi u to dem igi hi$u qud cao, rdt It bidn chiing. Tuy vdy, phlu thudt vSn can phdl thyc hidn d co sd cd chuydn khoa sdu, p h l u thu$t vidn phdl Id nhQ-ng chuydn gia cd k^ thudt tdt, cd kinh nghidm p h l u thudt tuydn mang tai.
TAI LI$U THAM K H A O
1. Nguydn HO'u Philic vd cdng sy (2008): Vai trd cOa cdt thOy ndng trong didu trj bu'du hfin hyp tuydn mang tai. Y hpc TP. HCM. tdp 12, sd 4, trang 44 - 49.
2. Trdn Vdn Thidp vd cpng sy (2008): Bdo tdn thdn kinh tai Id'n trong p h l u thudt cdt tuydn mang tai.
Y hpc TP, HCM, tdp 12, s6 4, trang 36 - 43.
3. Trdn Vdn Thidp vd cOng sy (2007): Vai trd tdi tgo khuydt hdng sau cdt tuydn mang tal. Y hpc TP.
HCM, t$p 2, phg bdn sd 4, trang 92 - 94.
4. Bradley P.J., (2001): Recun'ent salivary gland pleomophic adenoma: etiology, management and results. Current opinoin in ontolarygology-head and neck surgery, 9:100 -108.
5. Granick M.S., Hanna D.C., (1992),
"Complications of surgery. Surgical management of salivary gland disease". Management of Salivary gland lesions. Williams and Wilkins, Baltimore, Maryland, USA, pp 04 - 06.
6. Witt R.L., (2002): T h e significance of the margin in parotid surgery for pleomophic: Adenoma", laryngoscope, 112:2141 -2154.
DANH GIA DOC TINH CAP VA HIEU LOC DIET HP CUA DAI THUOC D-08 TRONG DIEU TRI VIEM LOET DA DAY TA TRANG
T 6 M T A T :
Bii thu6c D-08 bao gdm: Nha dim tO; Cam thio, B9C/1 thu^, 0 t$e c6t, Mim x6i, Seo gi. Dinh ling diy vi Sa nhin, li nhO-ng vj thudc kinh oSn tmng y fipc c6 tmydn ed tie dyng didu trf cic ch&ng bdnh Clio hi tiiu hoi ndi chung vi vlim loit dg diy ti Wng ndi riing. €}6 ting hidu qui didt Hp, chQng tdi (^ gia giim cie vj thuoc vi tgo thinh bii thudc D-08.
T~i4n hinh thO- nghidm ddc tinh cdp dd dinh gii tinh
Lt QUANG DUNG, Vi^n Yhgc c6 truyin quin d^i TRjNH TRQNG D^T, Khoa khim b^nh - Vidn 103;
PHiBiM NGQC HUNG, Hgc vidn Qu&ny.
an toin. kdt qui cho thdy: Xic dinh dOc tinh edp (LDK^ trin 60 chudt nhit trdng ddng Swiss cOa bii thudc D-08 Kdt qui cho thdy: vdi lidu cao nhdt li lOOg/kg trrfng luqng, khing xic djnh duvc lidu LDgo.
Lidu lOOg^g tr^ng lif(;mg c6 ddu hidu tdn thuvmg trdn ca quan ndi t$ng ddng v$t. Cf ndng dd 02g/ml (ndng dd pha loSng gap tXii d^ng sSe y figc cd truydn) kdt qui didt Hp 100% d mdu Iff vi khudn/ml.
TO' khoi: Ddc tinh cdp. Bii thudc D-08.
^ l l Q C THVC HANH (856) - SO 1/2013
EVALUATION OF THE ACUTE TOCIXITY AND KILL HP EFECT OF D-08 DRUG IN THE TREATMENT OF GASTRIC AND DUODENAL ULCER.
SUMMARY
D-08" Included Fmctus mceae. Semen Bmceae, Radix Glycynfiiza. Radix Paconniale Albae, Sepia esculenta Hoyle, Rubus alceaefolius Polr, Pteris multifida Poir, Radix Poiysclas fnjticosa and Amomum xanlhioides. Which is dmg used tmatment for gastminlestinal disease genemi and gastric and duodenal ulcer in pariieular. For increase effectiveness kill Hp. we have to modifying component and cmat a D-08 dmg. The acute toxicity test was carried out on mice, with the maximum dose of 100 g/kg body weight. The msults showed that:
them was not acute toxicity and the LD50 was not determined. At a concentmtion of 02g/ml (double dilute concentmtion as excellent tmditional medicine), 100% Hp was killed in 1(f bacteria/mi sample.
Keywords: The acute toxicity. D-08 dmg.
OAT VAN
D £Tgi Vl$t Nam cd 5-7% ddn sd mdc bdnh vidm lodt dg ddy td trdng (VLDDTT) chidm 2% trong cdc bdnh npi khoa, airr\g hdng ddu vd cdc bdnh tidu hda [1].
Ndm 1983, Bany Marshall vd Robin Wairen phdt hidn vai trd cua vi khudn Helicobacter pylori (Hp) trong bdnh ly dg ddy td trdng [2], [3], [4]. Vide sO dgng cdc khdng sinh didt Hp Id tidn bd quan trpng trong didu trj bdnh. \^ khudn Hp cd khd ndng Khdng thudc khdng sinh rdt nhanh, tj Id tir 5,0% ddn 41,6% tOy tCcng thudc. Y hpc c6 tmydn (YHCT) md td VLDDTT trong phgm trO "vj thdng; vj qudn thdng; bT mdn...". That tinh Idm thu-o-ng can, hodnh nghjch phgm vj, Idm vj mdt hda gidng gdy ra. Trdn co sd' ca ehd bdnh sinh cua VLDDTT theo Y hpc hidn dgi kdt hyp vdi nhOng thdnh tyu nghidn cCru cdp nhdt vd thudc thdo mdc theo y ly Y hpc cd tmydn, ddng thfrl tdn dgng ngudn du'p'c lidu sin cd tgi i^a phuvng, chCing tdi xdy dyng bdi thudc D-08, hy vpng gdp phdn Idm phong phO them cdc thudc didu trj VLDDTT, khdc phgc tinh trgng quen thudc, khdng thudc cOa vi khudn Hp.
Dd cd thd nghidn cQ-u, sCr dgng ehd phdm 'D-08' trdn Idm sdng, chOng tdi tidn hdnh nghidn ei>u tinh an todn cua bdi thudc trdn ddng vdt thyc nghidm, trdn Invitro vd'i mgc tidu: Xic dfnh ddc Unh cap vi hidu liK t^it tr\K khuin Hp cOa tfiu6c D-08 trdn /nvftro.
D61 TUVNG, PHiraNG PHAP NGHlgN CChJ 1. Odi tuvng nghldn cfru.
1.1. Thudc nghiin cOv: Thudc sdc D-08 duvc bdo ehd tCf 8 vj thudc ehd theo edng thi>e
STT 1 2 3 4 5 6 7 8
Tdn vl thudc Nha ddm ti> Fmctus ruceae,
Semen Bmceae Cam Thdo Radix Glycvnhiza Bgch Thuyc Radix Paconniale Albaa
0 tdc cot Sepia esculent Hoyle Mdm xdi Rubus alceaefolius Poir Seo sd - Pteris multifkia Poir
£)lnh idng Radix Pc^ysdas &utkx)sa Sa nhdn Amomum xanthir^des Wall
Hdm luting 1 gam 10 gam 20 gam 12 gam 20 gam 20 gam 20 gam 10 gam
1.2. Bfng v$t nghiin cCrut Chuit nhit tring ^ musculus trpng lu'ong 19 ± 1 gam, ktici ' " i " ' ! . SW phin biit giing, bio dim cic cht tliu sinh tfli thu'ftng do viin V i sinh djch t i thing uwng cung cl
1.3. TrtfC khuin Hallcobacter Pylori (HP)i khuin HP ehCing CCUG17e74 do b i min VI sinh HVQY eung cip.
2. PhuKyng phip nghiin cOu. i 4 2.1 ThOdfc tinh cip (LD50) dfng ttuicsilS ^ Thyc hiin tal khoa Nghiin cCru thvc nghiint vl Y hoe c i tmyin Quin dii. Du'O'c liiu dang sic truyin D-06: Thuic du'O'c c i die tfti liiu die nhit' tf l i 4:1 (4g/ml). Pha loing thinh cie ning d i 100 80%, 60%, 40%, 20%. Chuit nhit tring ding Swi chia thinh 6 l i , mil IS 10 con, 5 l i thi nghlim, 1 chO'ng.
Phu'Ong phip tlin hinh: cho ehuit ft cic l i nghiim uing thuic bing kim cong diu t i , dira thi thuic vio d? diy, luvng thuic 0,5ml/lliu duy nh Thim d i cic liiu giy die trin ding vit thi nghli Nhim dii chl>ng eho uing nuftc c i t
Theo dil Ilin tuc diin biin cua chuit trong 2 diu, tiip tue theo dii eic biiu hiin sinh 1^ trong 4 tiip theo. Mi chuit chit ft cic l i d i tim hliu nguy nhin giy chit v i nhin xit dai thi. Sau 72h mi ehi ein sing ft cic l i , nhin xit dai thi.
2.2. Phuang phip thii nghifm hifu life c
thuic dfng sic c6 truyin vOi vi khu Hellcobactor Pyiort trin Invltro.
Thue hiin tal khoa VI sinh vit - Hpc viin Quin j DU'O'C Niu: dang sic e i truyin tft thuie D-l Phirong phip tiin hinh nghiin ciru gim cic bu sau:
Buftc 1, TTiuic dang nirftc sic cao ling tf l i 1 Hin djch ban diu niy duvc pha tiip thinh eic loing: 1/2, 1/4, 1/8, 1/16, 1/32, 1/64, 1/128, 1/21 1/512.
Birfte 2, VI khuin Helicobacter pylori chC CCUG 17874 duoc pha trting nuftc muii sinh thinh hin d|ch 10° vi khuin/ml, sau d i lai pha loi tiip thinh cie ning d i 10', 10', 10=, 10'- lO'-10' khuin/ml.
Budc 3, Trin hSn d|ch vi khuin lO"*" vfti i ning d i thuic d i pha loing ft buftc 1 theo tf li 1 0 ft 37^* C trong 2 gift, sau d i dOng loop djnh lug ciy trin thach Pyiort agar.
Cic dung dich eft ning d i vl khuin 10', 10°, 1 10'- 10'' 1(r vl khuin/ml ft buftc 2 cOng duvc i trin thach Pylori agar d i tao thinh cic dia thi ning d^ vi khuin dii chliu vfti cic dTa thach ci thi tie dung vfti vl khuin. Tit c i cic dia th?ch trin du dit tiong blnh Jar e i til tao vi hiiu khi Helicobai fiaat do hing /Vnaerocuit C Metck (German^ a cip (85%Ni, 10% CO2, 5%02) ft nhiit d i 37°C, gift doc kit qui.
KET QUA NGHIEN CI>U
1. Kit qui nghiin cCru tinh an toin cia thuic D-08
Y H p c THV'C H A N H (856) - SO ^
Bdng 1: OOc tinh cdp cua ch6 phdm D-08 tr6n chuWnhSttrSng.
Nh6m Q&Ml^
1 2 3 4 S
S 5 chu&t thf nghifem (con)
10 10 10 10 10 10
LiSu dung (g/kg chudt)
100 80 60 40 20
Sfi chuat chfit 24h
0 2 0 0 0 0
48h 0 1 0 0 0 U
72h 0 0 U 0 0 0 - Nhin xit: Vd'i Ii6u 100 glkg th6 trpng (s6 iu'p'ng t^i da chuOt cd th4 uAng iStfi^c) chuOt ir cdc \b d^u tu^t dOng, dn u6ng blnh thuang, Ithfing c6 chuQt ndo ch^t trong thCri gian 72 gid* Uieo dOi. VI chuQt khOng Gh^t cho ndn khOng xdc dinh du-iyc LDM.
2. K4t qud nghldn cCru hi$u l^rc trdn Invltro cOa thuic D-08 vM vl khuin Helicobacter Pylori.
Bdng 2: Hl$u IM'C cOa thuAc vdi vi khudn HP.
KPnq OH thu6c
•Mfluinauvdn (4g/1ml) Uinphn indna 1/2
••biHiilnllnnlfd
•bl>KiaMlnn1/R
• l R h B k d r n l / 1 6 Ndngd
i>n
w -
+10'
- -
+
vi khudn mgc tirang 1] n6ng d^ chuin
10"
+ +
IO"
+ + +
10*
+ + +
10^
+ + +
10'
+ + + Ghi chi;i: N6ng d$ thu6c ban ddu cho cdc miiu thu6c l i 10* vl l(huin/mi.
Nhin xit:
+ Miu thu6c ban tfiu (4g/1mi) vi tnSu pha iodng 1/2 khOng mpc vi ithudn (thudc c6 hi$u lu'a i>c ch£ vi Ithuin hodn todn).
+ MSu thuic pha loSng 1/4: c6 vi i<hulin mpc ling v*i ning iJO 10* vi i<huin/nii so v*i ning 01) chuin (giim 1000 lin so vai ndng d9 vi Ithuin ban (^u).
+ Miu pha lodng 1/8: cA vi ithuin moc tuong i>ng vdi nAng dO vi khudn 10^ vl khuin/ml so vdi n6ng tfO ctiuin (giim 100 lin so vdi ndng tfO vi khuin ban dSu).
+ M5U pha lodng 1/16 flin 1/256: ning dO vi khuin mpc tuong i>ng vdi 10* vi khuin/ml (khing c i khi nSng i>c chi vi khuin)
BAN LUAN.
1. Bin lu$n v l die tinh cip
Mit chit d u ^ coildkhingdicniunhuLDsoCua lin hom 15g/kg thi trpng. d ddy, vdi liiu 100 g/kg BJtvin Chu'a chit, vl thi chi phim D-08 c i thi coi lir khing dSc cip dii vdi chuit nhit tring qua
"ing tiiu hOa. So sinh vdl mit s i thd nghiim die tinh cOa cdc chi phim DQNM-OS, DQCM-08 ig diiu tii dit quy nio tnrdc diy thiy cdc thuic YHCT niu sd dgng cic liiu thing thudng diu dim bSo tinh an todn trong diiu trj. Khi thi} nghiim si>
' Ing liiu cap lOOg/ kg trpng lu'O'ng, c i diu hiiu tin ig d9i thi cdc tsng: tim. Gan, thin.Tuy nhiin
trin thvc t i lim sing khing dgng liiu ndy (05kg thuic / BN 50 kg). Dv sao khi sO dung mit s i vj thuic nam cin chy y theo dCfi ti'nh trgng ChO'C ndng gan thin trong qui trinh diiu trj.
2. Bdn lu$n v i hliu \\fc diit Hp cia thuic D-08 trin thtfc nghiim
Qua kit qud bdng thing kd 1.2 thiy r i ning d i thuic ban diu 4g hda tan trong 1ml nu'd'c cit c i tdc dyng i>c chi hodn toin vi khuin Hp vii ndng dd 10*
vl khuin/ml. Kit qui NC cOng khdng dinh hiiu Ig'c diit Hp i ndng dd lodng 1/2 cda bdl thuic l i rit tit.
Cdc vi Nha ddm tCr, mim xii. seo gi du'pc YHCT Trung Hoa, y hpc truyin thing Viit Nam sij dgng trdn thg'C nghlim cQng nhu' lim sing dig c i tic dgng khdng tn,i'c khuin ly, ky sinh tn/ng amib, tring roi im dso rit tit. Cam thdo, Bsch thupc, Blnh ldng, cdc vj thuic ndy trin thgc nghiim cOng nhu' trin lim sdng diu di dirpc khing dinh vai tri ldm ting khd ndng khd ndng kich thlch cic co quan miin djch: Idch, tOy xirong, hgch, ting khd ning thg'C bdo cda dgi thvc bdo; ting interleukin 2; ting cdc t i bip giit tg nhiin (Native killer cells). 0 ^ c cit, mim xii, sa nhin, cam thio tdc ding sig sic din d i pH djch vi dg ddy, ting ChO'C ndng bio vd nlim mgc dg ddy.
Trin lim sdng chdng tii sir dyng thgic sic, ban dig chp 600ml nuic sdi, tirpng dng 3 bit: sic cin 200mt, liig niy pha loing gip ddi vin c i tdc dgng didt Hp tirong duong nhu kit qud cOa bang 1.2 d i ChO'ng minh.
KET LUAN
Bdi thuic D-08 t i chu'c dya theo nghiim phuong, dypc bdo chi dgng sic theo phuvng phdp kinh diin cda Y hoc Ci truyin. Thg'C hiin nghiin ci>u thyc nghidm tiin ddng vit, qua thir nghiim LDa,, chua phdt hiin thiy liiu die cip cua thuic O ning dd 02g/ ml (ning d i pha lodng gip dil dgng sic y hpc c i truyin) kit qui diit Hp 100% * miu 10* vi khuin/ml.
TAI LIEU THAM KHAO
1. Nguyen Th| Hia Blnh (2001), Nghiin cilu chin doin b$nh nhin viim da diy man bing nii sd, mO bfnh hoc vi If ti nhiim Hp. Luin vin tiin sf y hoc.
Sai hoc Y Hi Nil
2. /Vxon ATR (2007), Relationship between Heiicobacter pyiod gasttitis. gastnc cancer and gasttic acid secretion. Advances in medical Sciences 2007. Vol 52.55-59
3. H L Scott, Tymcthy L Cover(2006), Heiicobacter pylori Persistence: an Ovetview of interactions between H. pylon and host immune defences. Clinical micrebiology reviews 2006.
American Society for Microbiology 597-613 Vol.19, No.4.
4. Johannes G. Kusters, Amoud H. M. van Vliet, and Emst J. Kuipers (2006), Pethogenesis of Heiicobacter pylori Infection. Clinical microbiology reviews 2006. American Society fer Micrpbiology 449-490 Vol. 19, No. 3.
S T H V C H A N H (856) - SO 1/2013