坚持到底还是半途而废?--决策2:化疗

写给读者的话:我们听到了一些朋友对我们登在第一期的文章的反馈.谢谢大家的关注.我想特别强调一点,我写这一组文章的意图,是想表达作为患者和家属,我们要理智地面对疾病,了解它,研究它,积极地参与和配合医生的诊断治疗决策和实施.眼下,社会上对于医院和医生的妖魔化倾向严重,医患关系成为一个非常敏感的问题,我们看到许多对于医生的指控是以偏概全不符合事实的.     

由内而外的改变

在以往的生活中我一直是个成功的人,女人该有的我都拥有:一份很棒的职业--在达尔马提亚出版社下属的一家儿童读物出版公司任副总经理;我信奉上帝;拥有爱我的懂得体贴的丈夫、朋友和家人;我曾经周游世界,有无数的记忆和旅游纪念品为证.我一直比较善解人意并且能够出色地处理各种问题.可以说我就是一个成功女士的典型.     

癌症病人的爱国情怀

2006年9月9日,天高云淡,秋风送爽.上午9时,一声发令枪响,"北京第二十届卢沟桥醒狮越野跑比赛"的队伍从抗日战争雕塑园出发了.这是为纪念中国人民抗日战争和世界反法西斯战争胜利61周年组织的一次活动.     

GAS7在人骨肉瘤中的表达及其意义

Objective： To detect the expression of GAS7 in osteosarcoma and discuss its significance. Methods： Immunohistochemistry SABC method was applied to detect GAS7 expression in specimens of 54 osteosarcoma and 15 osteochondroma cases. Results： The positive expression rate of GAS7 was 74.7% （40/54） in the group of osteosarcoma and 0% （0/15） in the group of osteochondroma. There was a significant difference in the comparison of GAS expression in these two groups （P 〈 0.05）. GAS7 was higher expressed in the samples which complicated with relapse or pulmonary metastasis than the control group （P 〈 0.05）. There was no significant association between GAS7 expression and the size of tumor, the gender or the age of the patients （P 〉 0.05）. Conclusion： The hyper-expression ot GAST may play an important role in the initiation and development of human osteosarcoma.     

面向2008面向健康生活让我们齐步走!--记北京癌症患者及社会各界万人健康长走活动

8月29日为29届奥委会接旗日,象征和平、团结、友谊的五环旗帜将从雅典传到北京,来到神州大地,这预示着2008年北京奥运会周期的开始.为了铭记这一历史时刻,在中华人民共和国卫生部、首都精神文明建设委员会办公室、国家中医药管理局、白求恩医科大学北京校友会支持下;由中华慈善总会、中国抗癌协会癌症康复会主办的<九九方元迎奥运癌症患者及社会各界万人健康长走--手拉手迈向2008工程启动仪式>在京隆重举行.     

诈骗艾滋知多少

艾滋病病毒的致病机制很特殊,它一旦进入人体,寄生在T4淋巴细胞内最核心的部位,与细胞核的遗传物质DNA整合为一体,病毒随免疫细胞DNA复制而复制.因此,它成了在全球不可根治的一种"超级瘟疫".在世界各国,对防治艾滋病投入了巨大的人力、财力,众多医学专家们绞尽了脑汁,直至今天尚无有效疫苗可防,更无药物可根治,临床医生束手无策,只能做到一些对症治疗,减轻病人的痛苦,延缓病情,但无法挽救病人的生命,这是科学家公认的结论.     

触碰医学的温度 ——北京大学肿瘤医院淋巴肿瘤内科朱军主任门诊纪实

“医学倘若缺乏必要的人文关怀,就会失去应有的人性温度。” 把病人当作一个真实的人,体恤其受疾病袭击时的痛苦,面临生命危险时的悲伤以及对于爱抚和同情的渴望——是医学人文的应有之意。 数月前,笔者有过一次旁听朱军主任出诊的经历,至今,那个充满人情味的场面还刻在脑海里。他解读病情时的睿智幽默,让患者轻松起来;介绍方案时的通俗明晰,让医学不再陌生;关注病患内心冷暖,让淋巴瘤不再可怕……谈话间不时发出的笑声,弥漫在空气里,让诊室气氛温暖而愉悦。     

冬令补膏四款

琼玉膏人参120克,鲜地黄800克,白茯苓(去黑皮)245克,白蜂蜜500克.将人参、茯苓研细末,白蜜用洁净纱布滤去杂质,鲜地黄捣取汁(捣时盛器要用陶器,不要用铜、铁器),然后将参、苓、蜜、地黄汁拌匀放入瓷瓶内,用净纸二三十层封口,放锅内隔水蒸三天三夜,而后用蜡纸数层包紧瓷瓶,放入井口约4小时去火毒,而后取出瓷瓶,再放入锅内蒸24小时即成.每次10～30毫升,每日2次,温开水送服.可补气血,填精髓,适用于中老年人平时保健之用.     

狗可当医生的助手

今年是农历的狗年,有很多说狗的文章见诸报端,比如说狗忠勇、勤劳,助狩猎,帮放牧……狗能帮助追凶擒敌,能搜寻毒品,大家都早已司空见惯,习以为常了,狗的很多非凡的表现都源于它有一个灵敏的鼻子.令我们最感兴趣的是,在<现代癌症综合治疗问题>中,麦克洛科报告,利用狗的嗅觉可早期诊断肺癌和乳腺癌,这一题目的确新颖而有趣,很快在网上和报纸上纷纷转载.我们杂志的对象是癌症康复者更值得高度关注.     

妇科肿瘤专题特邀组稿专家李力教授简介

李力,女,医学博士,教授、主任医师、博士生导师.1980年毕业于第三军医大学医疗系:1992年第三军医大学研究生大队学员,授医学硕士;1997年重庆医科大学研究生院学员,授医学博士.现任第三军医大学第三附属医院(大坪医院)妇产科主任、全军计划生育优生优育技术中心主任、重庆市宫颈癌防治研究所所长.     

Treatment of patients with myelodysplastic syndrome with amifostine

The efficacy and toxicity of amifostine (300 mg/m(2) three times a week for three consecutive weeks for a maximum of six courses) was evaluated in 12 patients with primary myelodysplastic syndromes. Dose escalation up to 400 mg/m(2) was allowed to patients who failed to respond. Hemoglobin concentration was increased > or = 1.5 g/dl in two (18%) of the 11 anemic patients. These two patients obtained transfusion independence for 20 weeks. Reticulocyte counts and ANC increased > or = 50% of baseline in four (44%) of the nine patients with reticulocytopenia and in three (25%) of the 12 neutropenic patients. Platelet count increased in three (50%) of the six patients with thrombocytopenia. Progenitor growth of CFU-GMs and BFU-Es improved in 8/12 patients. No major side effects were observed. In conclusion amifostine is well tolerated and can promote the growth of primitive hematopoietic progenitors and ameliorate the cytopenias in MDS patients.     

吉西他滨联合奥沙利铂与多西他赛联合奥沙利铂治疗晚期食管鳞癌的临床观察

目的：观察吉西他滨联合奥沙利铂及多西他赛联合奥沙利铂治疗晚期食管癌的疗效和毒副反应.方法：68例晚期食管癌患者均接受化疗,随机分为两组,每组34例患者：吉西他滨1000mg/m2,d1,8,静脉滴注30min;多西他赛75mg/m2,d1,奥沙利铂85mg/m2,d1.每3周为1个周期,2个周期后评价疗效及毒副反应.结果：两组没有观察到完全缓解病例.吉西他滨组：PR 19例,SD 9例,PD 6例,总有效率为55.9%,临床获益率 82.4%,中位疾病进展时间6.1个月;多西他赛组：PR 16例,SD 11例,PD 7例,总有效率为 47.1%,临床获益率 79.4%,中位疾病进展时间 5.1个月.两组有效率（55.9%vs 47.1%,P=0.47）、临床获益率（82.4%vs 79.4%,P=0.38）及中位无进展生存时间（6.1月 vs 5.1月,P=0.524 ）均无明显差异.主要毒副反应为血液学毒性和消化道反应,两组Ⅲ-Ⅳ度恶心呕吐发生率分别为14.7%和38.2%（P=0.028）,Ⅲ-Ⅳ度白细胞减少分别为11.8%和47.1%（P=0.001）,Ⅲ-Ⅳ度血小板减少分别为32.4%和8.8%（P=0.016）,肌肉酸痛发生率分别为8.8%和32.4%（P=0.016）,末梢神经麻木分别为11.8%和 35.3%（P=0.022）.结论：吉西他滨联合奥沙利铂及多西他赛联合奥沙利铂治疗晚期食管癌近期疗效相近,毒副反应均可耐受.     

鼻咽癌腔内放射治疗的护理

引言目前放射治疗是鼻咽癌治疗最有效的方法[1]。我院自1996年11月~2003年4月采用STS公司BUCHLERFACTS型后装治疗机对160例鼻咽癌患者进行了腔内放射治疗,现将放疗前、后的护理体会介绍如下:1临床资料本组160例中,男93例,女67例,年龄16~67岁。所有病例均经病理诊断为鼻咽鳞状细胞癌。其中外照射足量后,鼻咽肿块未完全消失40例,局部复发病人不能进行外照射而补充腔内照射93例,为减少外照射并发症,增加局部剂量27例。2治疗前准备2.1心理护理腔内放射治疗前应说明放疗的必要性和有效性,耐心回答患者的提问,消除顾虑和紧张情绪,使之及时接受腔内放射治疗。2.2鼻咽及口咽部的准备患者在治疗前应到牙科行口腔疾患的治疗,因射线可破坏龋齿周围的骨质。鼻咽腔部位若有炎症,如鼻炎、鼻窦炎或鼻咽肿瘤坏死感染等等,应首先控制感染,消除炎症。鼻咽部有出血者应先止血,止血无效者应改为外照射。2.3照射前准备腔内放射治疗前不必禁食,治疗当天给病人鼻咽部喷入2%利多卡因和1%麻黄素作局部麻醉并收缩局部血管,减轻不适和防止出血。治疗前30min硫酸阿托品0.5mg肌肉注射以减少腺体分泌。施源器置放前先在施源器表面涂...     

拓扑替康联合环磷酰胺治疗儿童神经母细胞瘤

目的观察评价拓扑替康联合环磷酰胺治疗神经母细胞瘤的疗效和毒性.方法14例神经母细胞瘤患儿,应用拓扑替康联合环磷酰胺联合静脉用药.大剂量应用环磷酰胺[70mg/(kg·d)×2 d]和拓扑替康[2mg/(m2·d)×3 d].其中12例治疗2～13个周期,进行疗效和不良反应评价.结果12例患者中,进展3例,稳定及缓解9例,总有效率为75%.不良反应主要为骨髓抑制和消化道反应,但对症治疗后,无相关性死亡.结论拓扑替康联合环磷酰胺治疗儿童神经母细胞瘤安全有效.     

Treatment of bladder carcinoma with irradiation combined with misonidazole

One hundred patients suffering from cancer of the bladder were treated by external beam irradiation, 400 cGy twice a week to a total dose of 4800 cGy. One half of the patients were randomized to receive the electron affinic sensitizer agent, misonidazole, at a dose of 1 gr/m2 and a total dose of 12 gr/m2. There was no statistically significant difference in tumor responses and in recurrence--free survival time between the patients who received irradiation and misonidazole as compared to those who received irradiation and placebos.     

Association of antidepressant drug use with outcome of patients with glioblastoma

Depressive symptoms are common among patients with glioblastoma, but patients are often not treated with antidepressants. There is only limited evidence on the association of antidepressant drug use with survival in glioblastoma. We performed a pooled analysis of patients treated within the CENTRIC, CORE, AVAglio and ACT-IV trials to explore the relation of antidepressant drug use with progression-free (PFS) and overall survival (OS) at baseline, at the start of maintenance therapy and at the start of maintenance cycle 4. We further assessed the association of antidepressant drugs with seizure, cognition, fatigue and a diagnosis of depression. Among more than 1700 patients, we found no significant association between the use of antidepressants at baseline or at the start of maintenance therapy and PFS or OS. However, we found OS, but not PFS, to be significantly worse in patients using antidepressants at the start of maintenance cycle 4. After adjustment for antiepileptic drug use and despite showing a trend for increased risk, seizures were not significantly associated with antidepressant drug use, nor was there a change in mini mental state examination (MMSE) scores or fatigue by antidepressant drug use at baseline. However, there was a significant positive association between antidepressant use at the start of maintenance treatment and fatigue during maintenance treatment. The association of antidepressant use at the start of maintenance cycle 4 with inferior OS of glioblastoma patients requires independent confirmation and further study. Further prospective trials should evaluate efficacy, side effects and associations with outcome of antidepressants in glioblastoma.