乳腺癌伴随疾病全方位管理之乳腺癌患者的生育保护

外科手术、化疗、放疗、内分泌治疗等乳腺癌综合治疗显著提高了乳腺癌患者的长期生存率,越来越多的年轻患者希望在乳腺癌治疗之后仍能够妊娠和分娩,但年轻乳腺癌患者也面临着治疗后产生的闭经和生育能力保留的问题。对于部分年轻乳腺癌患者,在全身治疗前须考虑保留生育能力的措施。该文将探讨乳腺癌患者治疗期间的生育保护问题。     

长链非编码RNA与乳腺癌的相关性

<正>乳腺癌全球发病率及死亡率分别超过20%和10%~([1])。目前乳腺癌治疗包括手术、化疗、放疗、内分泌治疗和靶向治疗,但治疗效果有时亦不太理想。长期持续放化疗会导致一定毒副反应且降低患者抵抗力而杀伤癌细胞治疗效果也较差~([2,3])。徐兵河~([4])在中国肿瘤临床中对乳腺癌的靶向治疗进行了总结,主要体现在激素受体阳性乳腺癌的内分泌靶向治疗和表皮生长因子受体(HER)-2阳性乳腺癌的靶向治疗上。然而临床上使用曲妥珠单抗治疗     

抗肿瘤血管生成药物治疗乳腺癌的研究进展

乳腺癌是女性常见的恶性肿瘤之一。目前乳腺癌的发病率逐年上升。全球每年新诊断的乳腺癌病例≥120万,死亡约50万。乳腺癌的综合治疗(手术、放疗、化疗、内分泌治疗)及抗Her-2靶向治疗(Herceptin)在临床中的广泛应用,在很大程度上提高了乳腺癌患者的生活质量,并延长了乳腺癌患者的生存期。现阶段乳腺癌的治疗水平已达到     

乳腺癌的内分泌治疗

内分泌治疗是乳腺癌重要的全身治疗手段之一．与化疗相比,其有以下特点：ER阳性者,疗效可靠;毒副反应较少、较轻,适用于长期辅助治疗和巩固治疗;治疗中患者的生活质量明显提高。主要治疗机制为：阻断雌激素合成,降低雌激素水平(如芳香化酶抑制剂);阻断雌激素受体活性(如三苯氧胺);内分泌轴负反馈机制(如大剂量孕激素、雌激素、雄激素)。     

乳腺癌保乳手术再塑形临床观察

对67例有乳腺癌保乳手术指征患者行肿瘤局部完整切除、乳房再塑形加腋窝淋巴清扫治疗,术后行辅助放疗、化疗和内分泌治疗。随访3～55个月,总生存率98.5%,保留的乳房外形优良率为88%。认为对符合保乳手术指征的乳腺癌患者行保乳手术再塑形治疗,术后近期乳房外形、疗效满意。     

乳腺癌内分泌药物治疗的应用及进展

乳腺癌的内分泌治疗是目前肿瘤内分泌治疗中研究最成熟、最有效的独立治疗手段。因其对雌激素受体(ER)阳性的绝经后乳腺癌的疗效与化疗相当，且毒副反应轻、少，有利于长期治疗，故无论在术后辅助治疗，还是在复发转移后解救治疗中都有十分重要的地位，现将其应用进展情况综述如下。     

老年女性乳腺癌72例临床分析

目的探讨老年乳腺癌患者临床特点、手术方式及术后综合治疗选择,探讨老年乳腺癌外科治疗的最佳方案。方法对华东医院自2004年1月至2008年12月收治的72例≥65岁乳腺癌患者的临床资料进行回顾性分析。所有患者均行手术治疗,行乳腺癌改良根治术61例,乳房单纯切除术8例,乳房象限切除术3例。术后行化疗45例,放疗12例,行内分泌治疗患者58例。结果所有患者均顺利度过围手术期。出现皮下积液15例,切口感染2例。无一例出现严重并发症或原有并发症加剧。结论老年乳腺癌患者的治疗应以外科手术为主,辅以化疗和内分泌治疗。年龄并非是手术禁忌证,但应重视并处理好并存疾病。     

国产与进口多西他赛治疗中老年转移性乳腺癌的疗效

以多西他赛为主的联合化疗方案治疗转移性乳腺癌疗效较佳[1],是目前治疗转移性乳腺癌的主要推荐方法.但多西他赛在国内外有不同的生产厂家,国产与进口的多西他赛在价格上相差也较大,其疗效及毒副反应是否有差别有待研究.笔者分别采用国产和进口多西他赛为主的联合化疗治疗了转移性乳腺癌患者,并互相做了一个疗效及毒副反应比较.     

关注乳腺癌伴随疾病全方位管理之非酒精性脂肪性肝病的管理

非酒精性脂肪性肝病在乳腺癌患者化疗及内分泌治疗期间有较高的发生率,它是患者肝功能损伤或肝酶异常的常见原因,并影响乳腺癌患者的治疗和预后,但其防治尚未引起足够的重视。该文将系统阐述乳腺癌患者辅助治疗期间非酒精性脂肪性肝病的管理与防治,以提高对其认识,并进一步改善乳腺癌患者的生存质量和预后。     

高龄Luminal A型乳腺癌的临床内分泌治疗

目的探讨高龄Luminal A型乳腺癌内分泌治疗的临床应用。方法该院收治的高龄Luminal A型乳腺癌患者11例,均采用内分泌治疗8~42个月,方案为依西美坦,25 mg/d,评估近期疗效。结果 11例患者中临床完全缓解(c CR)2例,部分缓解(PR)6例,稳定(PR)3例,无疾病进展(PD)病例,内分泌治疗总有效率(OR)为72.7%(8/11);所有患者均未出现严重毒副反应或因无法耐受而停止用药。结论内分泌治疗对于高龄Luminal A型乳腺癌患者安全、有效,尤对年迈、体弱、伴其他重要疾病而不能耐受化疗和手术的患者是很好的治疗选择。     

Practical management of management

Presented in this monograph is a dynamic concept of hypertensive diseases. We all are aware that the appallingly high morbidity and mortality from the consequences of hypertensive diseases can be drastically reduced with antihypertensive therapy, provided that the patients with hypertension are recognized and that they continue to remain on effective therapeutic programs following their evaluation. Inherent in this concept of “preventive cardiology” is the acknowledgment that evaluation of the hypertensive patient provides a baseline for a lifelong program for the management of a chronic disease. Therefore, discussed herein is the rationale for the evaluation of the findings obtained from the patient's history, physical examination, laboratory studies, and the pathophysiological concepts of the vascular disease and the cardiac involvement. These considerations should permit judicious selection of an effective treatment program.     

绩效管理在康复医院管理中的应用探析

随着我国医疗体制改革的逐渐深化,医院的管理体制走进了新的阶段。在现代康复医院管理中绩效管理使用的得当与否,对医院的综合竞争力有着至关重要的作用。本文通过对绩效管理的含义及意义进行分析,探索绩效管理在实际应用中存在的问题,并针对现实问题提出针对性的解决措施和建议。     

Surgical management

Surgical management of renal calculi depends on stone size and location. Spontaneous passage can be expected for calculi less than 5 mm in diameter, however larger stones are unlikely to pass. Proximal ureteral stones less than 10 mm are preferably treated with extracorporeal shock wave lithotripsy (ESWL), whereas larger stones can be treated with percutaneous nephrolithotripsy (PCNL) alone or in addition to ESWL. For distal ureteral stones, patients can choose between ESWL and ureterolithotripsy. Stones located in the renal pelvis unlikely to pass on their own are treated with ESWL if less than 2 cm or PCNL alone or in combination with ESWL. Open stone surgery is rarely performed today and is, reserved for cases where minimally invasive management is contraindicated or has previously failed.     

Conservative management

Treatment of diverticulitis comprises at least two options: conservative or surgical management. There is a recent trend to limit surgical treatment of acute diverticulitis and to favor conservative management. This review addresses general aspects of conservative patient care with special focus on the treatment of patients with a first attack of diverticulitis. The presentation does not include a discussion of specific drugs which is given in other sections of this issue.     

Pain management

Pain is a common problem encountered among elderly people in subacute and long-term care facilities. Pain often is underestimated and undertreated in these settings. Most pain problems can be improved by careful assessment and careful use of analgesic drugs and nondrug strategies. Subacute care and other long-term care facilities often present unique challenges to pain management. Clinicians who care for patients in these settings must help to establish a plan of care that is reasonable for the given resources and skills often available in these settings. Clinicians have an obligation to improve comfort and dignity for these patients, especially those near the end of life.