光动力疗法治愈上消化道癌5例的临床分析

目的分析光动力疗法治愈5例上消化道癌的临床特点和治疗参数的选择。方法分期较早的上消化道癌患者5例,光敏剂应用血卟啉衍生物治疗患者2例,卟吩姆钠治疗患者3例,给药剂量分别为5 mg/kg和2 mg/kg。给药后24～72 h分别应用金蒸气激光和半导体激光照射,功率密度100～150 mW/cm2,能量密度100～150 J/cm2。结果 3例患者行1个疗程光动力治疗后获得治愈;1例胃窦癌患者1个疗程光动力治疗后获得治愈,4年后,胃体再发癌变,再行1个疗程光动力治疗后治愈;1例患者病灶侵犯固有肌浅层,行1个疗程光动力治疗后病灶少许残留,再次光动力治疗后,病灶完全消失。所有患者随访2～8年未见复发或转移,总体不良反应轻微,1例患者治愈后出现食管瘢痕性狭窄。结论应用光动力疗法治疗分期较早的上消化道癌,可取得根治效果,不良反应轻、耐受性好,值得进一步探讨研究。     

Cisplatin-containing chemotherapy in advanced head and neck cancer

Sixty-two patients with previously untreated advanced head and neck cancer were admitted to a study of pre-radiotherapy combination chemotherapy containing cisplatin. After two courses only 3% were in complete response but 47% had achieved a partial response. Ninety per cent of patients completed radical radiotherapy and at least one course of chemotherapy; 54% of these achieved a complete response at 1 month post-therapy. The overall actuarial survival rate at 2 years was 40.3%, with a median survival of 12 months. The median survival of those with complete response 1 month after therapy has not yet been reached. The toxicity of the chemotherapy was low and no increase in morbidity from the subsequent radiotherapy was noted. Comparison with historical data from this hospital does not suggest any improvement in overall survival for the use of cisplatin-containing chemotherapy prior to radiotherapy.     

光热治疗外阴白色病变的疗效分析

目的探讨光热治疗外阴白色病变的疗效。方法采用KS5A治疗仪,每日1次,每次10～20min,每10次为1个疗程。治疗最长6个疗程,最短1个疗程,平均1.6个疗程。结果56例外阴白色病变患者经治疗后显效47例(83.93%),好转7例(12.50%),无效2例。治疗有效共54例,总有效率96.43%。随访3～5年,2例复发,复发率为3.70%(2/54),癌变率为0。结论光热治疗为外阴白色病变的治疗提供了一种安全、有效、无损伤的治疗方法。     

Photodynamic laser therapy to alleviate complete bronchial obstruction: comparison of CT and bronchoscopy to predict outcome

Photodynamic laser therapy is used in the palliation of advanced lung cancer. To minimize the complications of this form of therapy, physicians must evaluate correctly the extent of extraluminal disease. We undertook a study to compare CT and bronchoscopy in the evaluation of extent of disease before laser therapy in 20 patients with complete bronchial obstruction. The relative contribution of intraluminal and extraluminal tumor to the obstruction and its influence on response to therapy was assessed by using both techniques. Adequate response was defined as greater than or equal to 50% relief of the obstruction on bronchoscopy performed within 1 week of therapy and by any improvement of the postobstructive atelectasis and consolidation on follow-up chest radiographs. Nine patients had predominately intraluminal tumor on both CT and bronchoscopy before laser therapy. Eight of these had a bronchoscopic response and radiographic improvement after therapy. Ten patients had predominately extrinsic compression by tumor on CT. Of these, only two had a bronchoscopic response and none had radiographic improvement after treatment. The differences in bronchoscopic and radiographic response between the two groups were significant (p less than .01). In the 10 patients with predominately extraluminal tumor on CT, bronchoscopy agreed with CT in suggesting mainly extrinsic compression in five, but it incorrectly suggested mainly intraluminal tumor in the remaining five. In one patient with a left upper-lobe tumor, the relative intra- and extraluminal components could not be assessed on CT. We conclude that in complete bronchial obstruction, CT is superior to bronchoscopy in evaluating the extent of extrinsic compression by tumor. The presence of predominately extraluminal tumor compression on CT correlates with a poor response to laser therapy.     

多疗程高压氧治疗对患者凝血功能的影响

目的观察多疗程高压氧（HBO）治疗对患者凝血功能的影响。方法回顾性分析长期住院进行HBO治疗的27例患者，对血小板（PLT）计数、凝血酶原时间（PT）、凝血酶原时间活动度、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）等凝血指标进行比较。所有患者均在治疗前进行了凝血功能指标的化验检查。其中16例患者在3个疗程结束时，14例患者在5个疗程结束时，9例患者在7个疗程结束时，13例患者在8个疗程结束时，16例患者在10个疗程结束时进行了凝血功能指标的化验检查。结果HBO治疗3个疗程时，PLT计数与治疗前比较差异有统计学意义（P〈0．01），8个疗程结束时差异也有统计学意义（P〈0．05）；PT与治疗前比较，只有5个疗程结束时的指标差异有统计学意义（P〈0．05）；各个时间点的FIB与治疗前比较均有下降趋势，但只有3个疗程结束时（P〈0．01）和10个疗程结束时（P〈0．05）的指标差异有统计学意义；HBO治疗结束，各个时间点的凝血酶原时间活动度和APTT两项指标与治疗前比较，差异无统计学意义（P〉0．05）。结论多疗程HBO治疗对患者凝血功能并没有造成明显的不良影响。     

臭氧大自血疗法治疗脑卒中后遗症的疗效观察

目的观察臭氧大自血疗法治疗脑卒中后遗症的临床疗效。方法将符合纳入标准的71例脑卒中后遗症患者按志愿原则分为治疗组（47例）与对照组（24例）,2组都给予常规的基础治疗如针刺、静脉输液,治疗组另加用臭氧大自血疗法治疗;10 d为1个疗程,2组均治疗3个疗程。观察治疗前后2组患者神经功能改善情况（Fugl-Meyer运动功能评分）。结果治疗组和对照组总有效率分别为95.7％和75.0％、Fugl-Meyer运动功能评分差异均有统计学意义(P<0.01),2组均无严重并发症发生。结论臭氧大自血疗法可以有效改善脑卒中后遗症患者缺损的神经功能和提高患者的生活质量,且安全有效。     

双波长立体点阵激光联合翠绿宝石激光照射对面部皮肤年轻化的疗效观察

目的评估双波长立体点阵激光联合翠绿宝石激光对面部皮肤年轻化的效果和安全性。方法颜面部色素性病变及皱纹明显的患者156例,年龄35～56岁,采用双波长（1 320 nm＋1 440 nm）立体点阵激光联合翠绿宝石激光（波长755 nm）照射后治疗2个疗程。末次治疗后1个月,按照色素病损消失面积、面部皱纹消失程度评定疗效。同时观察有无色素沉着、色素减退等并发症。结果 156例患者中轻度改善35例（22.4%）,中度改善102例（65.4%）,显著改善19例（12.2%）,有效率为100%,满意率为77.6%,无1例出现水疱、色素沉着、色素减退等并发症。结论双波长立体点阵激光联合翠绿宝石激光照射对面部皮肤年轻化是一种安全、有效的方法。     

Early effects of intra-arterial chemotherapy in patients with brain tumours studied with PET: preliminary results

In ten patients with malignant gliomas the regional cerebral metabolic rate for glucose (rCMRGlc) was studied with positron emission tomography (PET) using 2-18F-deoxyglucose (18FDG) before and within 1 to 7 days after intra-arterial chemotherapy with the nitrosourea derivative ACNU (iaACNU). Three patients were studied before and after two iaACNU courses and one patients before and after three iaACNU courses. The early effects of iaACNU on tumour rCMRGlc were highly variable and appeared to be more pronounced after the first course of iaACNU than in later iaACNU courses, i.e. more pronounced in untreated patients. Although there was no clear correlation between the change of rCMRGlc following the first course of iaACNU and the clinical outcome in this small group of patients, the patient with the most pronounced decrease of tumour metabolism (-16.5%) after the first course of iaACNU exhibited full tumour remission for 12 months, while the patient with the most pronounced increase of tumour metabolism (+65%) after the first course of iaACNU developed rapid tumour progression. The first results indicate that early effects of intra-arterial chemotherapy may be observed with 18FDG PET, especially following the first course of iACNU. Further studies are needed to evaluate the predictive value of such studies for therapy response.     

甲钻胺对64例突发性耳聋患者耳鸣症状的疗效观察

目的观察甲钴胺对改善突发性耳聋患者耳鸣症状的疗效。方法运用前瞻分组对照研究的方法,取发病7d内就诊且伴有耳鸣的突发性耳聋患者64例,按就诊先后顺序分为治疗组及对照组,两组均应用东菱克栓酶（DF-521）、丹参、地塞米松、辅酶A等常规药物治疗,治疗组加用甲钴胺注射液500μg肌注1次／d;对照组加用生理盐水注射液10ml肌注1次／d。10d为1个疗程,治疗2个疗程。疗程结束1个月后观察患耳耳鸣恢复情况。结果治疗组耳呜恢复有效率为52．9％;对照组有效率为26．7％,差异有统计学意义（P＜0．05）。结论甲钴胺对改善突发性耳聋患者的耳鸣症状有明显效果。     

钬激光在治疗输尿管结石中的应用

目的总结分析钬激光治疗输尿管结石的经验和教训,提高结石的治疗水平。方法本组患者189例,右侧输尿管结石108例,左输尿管结石72例,双侧输尿管结石9例,共进行手术196例次。193例采用连续硬膜外麻醉,3例采用全麻。患者取截石位,先经膀胱镜在同侧置入输尿管导管,在导管的引导下置入输尿管镜。找到结石,经输尿管镜置入钬激光光纤,对结石进行粉碎,如遇有黏膜包裹结石或有息肉形成时,可直接用钬激光清除黏膜或息肉后再进行碎石。治疗结束后置双J管,排石治疗,2~4周后复查,必要时再行体外碎石治疗。结果本组患者196例次,6例改开放,9例结石退入肾盂失败,2周后复查结石清除率为72%(130/181),1个月后复查结石消除率为89%(161/181),3个月后复查,结石清除率为98%(177/181)。4例未排净结石者行ESWL治愈。术后并发症:发热29例次(16%);血尿161例(89%),无严重的肉眼血尿。5例术中出现穿孔,留置双J管后痊愈,本组患者最长随访2年,未出现远期并发症。结论经钬激光治疗输尿管结石效果好、并发症少,可反复应用。     

Positron emission tomography with fluorine-18 fluorodeoxyglucose to evaluate response of early breast carcinoma treated with stereotaxic interstitial laser therapy

Stereotaxic interstitial laser therapy is a promising new alternative to surgery to treat early-stage breast cancer. With this, laser energy coagulates the tumor with controlled heat, leading to fibrosis. Fluorodeoxyglucose positron emission tomography (FDG PET) scanning was performed in four patients treated by this technique to determine the degree of necrosis after interstitial laser therapy. The results showed that FDG PET scanning was in close agreement with histopathologic findings, confirming complete necrosis in one patient and variable response in the other three patients. Uptake of FDG appears to be a reliable means to monitor treatment response after interstitial laser therapy and may be useful in the management of breast cancer when used with this new procedure.     

Botulinum toxin efficacy in the treatment of patients with spasmodic dysphonia

BACKGROUND/AIM: Spasmodic dysphonia (DS) is a disabling speech disturbance appearing as the consequence of dystonic vocal folds contraction. Its intermittent appearance in the laryngeal muscles causes vocal function discontinuation. The quality of life of these patients is significantly disturbed. Surgical and a medical therapy appear to be inadequate and unsuccessful ones of no steady improvement. It is the botulinum toxin therapy that proved to be highly efficacious one, with the established improvement in 80-100% of patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in patients with SD and to show our preliminary results. METHODS: The study included 10 patients with adductor spasmodic dysphonia. After diagnostic procedures, botulinum toxin was applied either in one or both vocal folds, in doses of 12-16 units each. In our study we applied indirect technique originally developed by Hocevar and Pirtosek. Perceptive voice and speech analysis was performed prior to and after the instillation of botuline toxin as per structured Scale of pathological characteristics of voice and speech appearing in the spasmodic dysphonia. RESULTS: The majority of our patients experienced both subjective improvement and the improvement in the terms of the quality of life, Voice Henolicap Index--(VHI) that was rated as rather significant one (t = 3.562; p = 0.006). CONCLUSION: Regardless unquestionable improvement of definite phonation, further function restitution requires individual vocal therapy and psychotherapy. Vocal therapy includes structural vocal techniques which reduce degree of vocal tension and rapid changes in the power and the height of voice. Further investigations are necessary for the scope of the definition of a standardized therapeutically procedure for spasmodic dysphonia treatment which comprises multidisciplinary approach in diagnosis, therapy and treatment efficacy evaluation.     

人工晶状体植入后瞳孔前膜的处理

目的　探讨人工晶状体植入术后瞳孔前膜的形成机制与处理方法。方法　 2 9例患者 ,分别与术前、术后应用抗生素和激素 ,术中仔细操作、减少刺激 ,植入肝素钠处理的人工晶状体 ,术后积极活动瞳孔及早期行YAG激光切膜。结果　除 1例行YAG激光切膜 ,2例行手术去除瞳孔前膜外 ,2 6例均通过药物治疗吸收。结论　人工晶状体植入术后瞳孔前膜的形成是有一定规律的 ,是可以预防和治疗的     

The number of 131I therapy courses needed to achieve complete remission is an indicator of prognosis in patients with differentiated thyroid carcinoma

Purpose

To assess the risk of differentiated thyroid cancer (DTC) recurrence, DTC-related mortality and life expectancy in relation to the number of courses of ¹³¹I therapy (RIT) and cumulative ¹³¹I activities required to achieve complete remission (CR).

Methods

The study was a database review of 1,229 patients with DTC, 333 without and 896 with CR (negative TSH-stimulated thyroglobulin and negative ¹³¹I diagnostic whole-body scintigraphy) after one or more courses of RIT.

Results

The median follow-up was 9.0 years (range 0.1 – 31.8 years) after CR. Recurrence rates at 5 years, 10 years and the end of follow-up were 1.0?±?0.3 %, 4.0?±?0.7 % and 6.2?±?1.1 %, and DTC-related mortality was 0.1?±?0.1 %, 0.5?±?0.3 % and 3.4?±?1.1 %, respectively. Recurrence rates also increased with an increasing number of RIT courses required (p?=?0.001). DTC-related mortality increased from four RIT courses. In patients with CR after one RIT course, there were no differences in recurrence or DTC-related mortality rates between low-risk and high-risk patients. In patients requiring two RIT courses these rates remain elevated in high-risk patients. Recurrence and DTC-related mortality rates were only significantly elevated in those requiring a cumulative activity over 22.2 GBq (600 mCi) from multiple RIT courses for CR. Regardless of the number of RIT courses or activity needed, life expectancy was not significantly lowered.

Conclusion

If more than one RIT course is needed to achieve CR, higher recurrence and DTC-related mortality rates are observed, especially in high-risk patients. Patients requiring >22.2 GBq ¹³¹I for CR should be followed in the same way as patients in whom CR is never reached as long-term mortality rates are similar.     

Recognition of a chronic relapsing form of Hodgkin's disease in a population of patients demonstrating no second tumours

Of 167 patients with Hodgkin's disease seen in a single centre between December 1972 and December 1982, only one has developed a myelodysplastic state. Between 1972 and 1977, therapy consisted of radiotherapy alone for early-stage disease, combined-modality treatment for intermediate-stage disease and chemotherapy alone using mustine, vinblastine, prednisone and procarbazine (MVPP) for advanced disease. Seventy-one per cent of these patients are disease-free at 5-10 years. From 1978, chlorambucil was substituted for mustine in the chemotherapy schedule (CLVPP). Combined-modality therapy has been used more frequently for patients with Stage III disease since 1978. Complete remission rates for patients treated with MVPP and CLVPP alone were 79% and 78%, respectively. Eight patients (5%) have been designated as a clinical subgroup of 'chronic relapsing' Hodgkin's disease. This chronic relapsing subgroup received substantially more chemotherapy than the remainder and one of these patients has developed a myelodysplastic state. Patients within the chronic relapsing group can be recognised and it is possible to obtain and maintain substantial remissions with fewer courses of chemotherapy than is currently the norm.     

半导体激光和 He-Ne 激光穴位照射治疗小儿慢性腹泻的疗效

目的比较镓铝砷（galliumaluminiumarsenide,GaAIAs）半导体激光和He—Ne激光穴位照射治疗小儿慢性腹泻（infantilechron．icdiarrhea,ICD）的疗效。方法ICD患儿100例,随机分为两组：半导体激光照射组50例,其中小肠病变和结肠病变各25例;He-Ne激光穴位照射组50例,其中小肠病变23例和结肠病变27例。半导体激光组,照射波长830nm,取神阙、双侧大肠俞和天枢穴,功率密度318mW／cm2,每穴照射10min,每日1次,10次为1个疗程,均治疗两个疗程。He-Ne激光组,照射波长632．8nm,治疗方法同半导体激光组。治疗结束后,比较两组患儿的临床疗效。结果半导体激光组,治愈38例（76．O％）,好转9例（18．0％）,无效3例（6．0％）;He-Ne激光组治愈27例（54．0％）,好转13例（26．0％）,无效10例（加．0％）,半导体激光组疗效好于He-Ne激光组（P〈0．05）。结果表明,年龄〉5岁、病程3—5个月患儿均以半导体激光组疗效较好（P〈0．05）;两组均以小肠病变疗效好于结肠病变（P〈0．01）;治疗后排便平均次数,半导体激光组少于He-Ne激光组（P〈0．05）。结论镓铝砷半导体激光穴位照射治疗ICD疗效好于He-Ne激光组,可作为激光穴位照射治疗ICD的首选方法。     

He-Ne激光在带状疱疹治疗中的作用

目的探讨He-Ne激光在带状疱疹治疗中的作用。方法带状疱疹患者200例,随机分为治疗组和对照组,每组100例。治疗组采用波长为632.8 nm、功率密度为3.75 mW/cm2的He-Ne激光直接照射皮损处,每日1次,10次为一个疗程;同时口服阿昔洛韦,每次0.2 g,每日5次;多糖蛋白片,每次1.5g,每日3次;维生素C,每次0.2 g,每日3次。对照组患者仅口服上述药物。结果一个疗程后,治疗组痊愈82例,显效10例,好转8例,有效率92%。对照组痊愈56例,显效28例,好转16例,有效率达84%。结论 He-Ne激光在带状疱疹的治疗中具有增强疗效、缩短疗程、快速解除患者痛苦等作用。     

半导体激光联合超声电导仪辅助治疗输卵管继发性不孕的临床观察

目的观察半导体激光联合超声电导仪辅助治疗输卵管继发性不孕的效果.方法将98例输卵管继发性不孕症患者随机分为两组,对照组50例,口服抗炎药,活血化瘀中药,3个月经周期为一疗程;治疗组48例,除口服药物外,于月经干净第3天,同时给予半导体激光和超声电导仪治疗,每天各1次,连续15次,3个月经周期为一疗程;治疗1个疗程后行输卵管通液对治疗组和对照组进行疗效观察.结果治疗组有效率为83.3%,对照组有效率为58.0%,治疗组有效率明显高于对照组(P＜0.05),差异有统计学意义.结论口服药物外加半导体激光联合超声电导仪辅助治疗输卵管继发性不孕是一种较好的方法.     

Analyse des Iststands an ärztlichem Personal in den Abteilungen und Praxen für Strahlentherapie in Deutschland

BACKGROUND: Physician workload directly influences the ability of an institution to provide high standards in radiotherapy services. MATERIAL AND METHODS: Data of 189 radiotherapy units of the DEGRO survey 2000 complemented and corrected (Table 1) are analyzed with simple and multiple linear regression (models in Table 2). RESULTS: In 21 private radiotherapy facilities actual numbers of physicians split up in 0.19 for every 1,000 megavoltage courses per year, 1.8 per megavoltage unit, 0.68 for every ten beds for inpatients minus 0.67 or plus 1.2 physicians per facility providing radiotherapy only or combined with other services, respectively. Radiotherapy units in hospitals were analyzed in two groups, i. e. radiotherapy only (n = 69) or in combination with other services (n = 59). In the latter, reported numbers of physicians split up in 3.2 for every 1,000 megavoltage courses per year, minus 0.13 per megavoltage unit, 0.87 for every ten beds for inpatients, plus 2.2 per facility. Units providing radiotherapy only had 0.86 physicians for every 1,000 megavoltage courses per year plus 1.0 per megavoltage unit plus 0.97 for every ten beds plus 1.0 per facility. In 36 radiotherapy university clinics actual numbers of physicians split up in 2.4 for every 1,000 megavoltage courses per year, 1.7 per megavoltage unit, 0.86 for every ten beds for inpatients, plus 1.5 per clinic. For confidence limits see Table 3, for results of univariate analysis Figure 1 and 2. CONCLUSION: In German radiotherapy facilities, physician workload varies considerably. It exceeds that reported for the USA by a substantial margin.     

Radiotherapy in endocrine ophthalmopathy--evaluation of 56 cases

The authors present the radiotherapeutic results achieved in 56 patients with endocrine ophthalmopathy, 15 out of them with severe, so-called malignant course. All patients were irradiated conventionally with small doses between 3 and 10 Gy at the surface. For this purpose, a deep therapy unit with 250 kV was used. The X-ray irradiation produced an improvement in 62% of the cases; the separate evaluation of cases with malignant course showed an improvement in nine cases. Thus the results produced by this method are as good as those of high doses, the greater possibilities in case of recurrence, however, are to be considered as an advantage. The irradiation should be applied early, and the simultaneous administration of a cortisone preparation is preferred by our team.