化疗对卵巢功能的影响及预防措施

化疗是恶性肿瘤的主要治疗方法之一。随着生命科学的发展,肿瘤综合治疗技术的提高,更多的年轻女性癌症患者得以存活。化疗药物在杀伤肿瘤细胞的同时,对人体正常的组织细胞也具有毒性作用。化疗可导致年轻女性癌症患者卵巢早衰和不孕。现主要概述化疗对卵巢功能的影响,包括化疗导致卵巢早衰、临床监测指标、化疗后的生育能力、机制及预防措施。     

肺癌化疗后病人恶心与呕吐相关因素Logistic对照研究

目的探讨肺癌化疗后患者恶心与呕吐相关因素Logistic对照分析.方法选取2009年5月~2011年11月收治的肺癌化疗患者400例,对引起恶心、呕吐相关因素进行回顾性分析.结果400例患者中发生恶心、呕吐159例,发生率为39.8%.被纳入方程的包括女性、年龄、饮酒、使用顺铂/卡铂、铂制剂的用量、化疗次数.统计学模型分析恶心、呕吐总体正确率为80%.结论对肺癌化疗后引起患者恶心、呕吐的相关因素进行分析,依据结果调整化疗药物剂量、给予药物辅助应用或应用止吐药,将恶心、呕吐降至最低程度,有助于促使化疗顺利完成.     

大剂量MTX联合化疗及放射治疗原发性中枢神经系统淋巴瘤

目的探讨大剂量MTX联合多药化疗方案治疗原发性下丘脑恶性淋巴瘤的疗效.方法1例经临床及实验室检查、CT、MRI以及活检确诊为鞍区"B"淋巴瘤的患者,选择大剂量MTX、甲基苄肼、VCR、DX联合化疗,每2周1次,共3次,同步行鞘内注射化疗.化疗结束后行头颅放射治疗.以后每3月行原化疗方案巩固1次.结果化疗1疗程后,患者头痛症状完全消失,病灶明显缩小;3疗程后,患者记忆力完全恢复,尿量明显减少,血象及脑脊液检查正常,MRI示病灶完全消失.随访至今未见新、老病灶出现.结论多种能渗透血脑屏障化疗药物的联合应用,尤其加大MTX剂量以及联合放疗,能显著提高原发性中枢神经系统淋巴瘤的治疗效果.     

PICC在淋巴瘤患者应用时的行为指导

淋巴瘤是一种起源于淋巴造血组织的实体瘤.由于对化疗药物敏感,静脉化疗是其主要治疗手段[1].由于化疗药物的毒副作用,患者常常承受静脉炎及渗漏性损伤的痛苦.     

肿瘤化疗引起恶心呕吐的护理体会

肿瘤化疗后出现的恶心、呕吐是化疗最常见的副作用。呕吐不仅增加患者痛苦 ,使生活质量下降 ,而且严重呕吐可导致脱水和电解质紊乱 ,并限制了化疗药物的使用和剂量提高 ,最终影响肿瘤的治疗效果。作者自 1995年 7月至1999年 7月通过加强对 144 6例次肿瘤化疗病人的观察护理 ,预防或减少副作用的发生 ,从而减轻患者痛苦 ,提高生活质量和治疗效果。现总结如下 :临床资料1.一般资料　共收治化疗患者 144 6例次 ,其中男性842例次 ,女性 6 0 4例次。年龄 2 2～ 70岁 ,平均 5 5 4岁。包括肺癌 146例次 ,淋巴瘤 12 0例次 ,乳腺癌 180例次 ,结肠癌 …     

乳腺癌化疗不良反应的护理

2002年1月～2004年4月,我科对128例乳腺癌化疗患者进行相应的护理,有效地减轻不良反应,提高了患者的生存质量。临床资料本组128例,全部女性,年龄26～58岁,平均46岁。化疗常用药物有环磷酰胺、5-氟脲嘧啶、阿霉素、顺铂、紫衫醇,化疗方案为2或3种药物联合应用。结果其主要不良反应有食欲不振、恶心呕吐;白细胞减少;肾功损害;血管损伤;脱发等。其反应程度与用药剂量呈正相关。护理(1)食欲不振:主要由于恶性肿瘤生长过程中,毒素作用机体引起,同时化疗药物会造成暂时性味觉改变产生厌食现象。首先保持病房环境清洁,为患者创造良好的饮食空间,指…     

精神分裂症患者的性别、年龄与药物有效剂量的相关性

目的探讨分裂症患者的性别、年龄与药物有效剂量之间关系. 方法对164例精神分裂症患者按性别、年龄进行分组,根据病情服用抗精神病药物进行研究.结果男性剂量高于女性剂量,男病人25岁以下年龄组有效剂量最大,女性则是46～55岁组剂量最高,而55岁以上男女病人有效剂量明显低于其他年龄组.结论药物有效剂量可能与激素及躯体机能状况有关.     

化疗及内分泌治疗对乳腺癌患者肝脏脂肪变性影响的研究进展

乳腺癌是女性中最常见的恶性肿瘤之一.对于乳腺癌的治疗除手术切除外,化疗和内分泌治疗是极其重要的治疗手段,而服用抗雌激素药物他莫昔芬的乳腺癌患者易诱发脂肪肝,并且近年其发病率明显增高.脂肪肝是应用他莫昔芬治疗的乳腺癌患者化疗期间和化疗后常见的并发症,是化疗药物对肝脏损伤的一种综合表现.乳腺癌化疗及内分泌治疗对肝脏脂肪变性影响的研究有利于加强医务工作者对脂肪肝的认识,从而能引起临床医生对此病的重视,并及早给予治疗.本文从脂肪肝的概述、乳腺癌化疗性脂肪肝、乳腺癌内分泌治疗方面对肝脏脂肪变性的影响进行了综述.     

48例非霍奇金淋巴瘤患者自体外周造血干细胞动员采集的影响因素分析

目的 回顾性分析非霍奇金淋巴瘤患者自体外周造血干细胞动员采集过程中的影响因素.方法 2014 年1月至2016年8月,共有48例非霍奇金淋巴瘤患者在该院血液科行自体外周造血干细胞动员采集,对患者的年 龄、性别、疾病分期、诊断时是否骨髓侵犯、化疗次数及病程中是否复发等因素进行回顾性分析.结果 37例患 者(77.10%)干细胞动员采集成功,其成功率受疾病诊断到干细胞动员采集的间隔时间、化疗次数、前期化疗 (包含氟达拉滨)、复发,以及采集干细胞前的白细胞及血小板水平的影响.结论 拟行自体外周造血干细胞的 非霍奇金淋巴瘤患者,前期化疗次数不宜多,动员采集要尽早,尽量避免使用可能损伤干细胞的药物,需同时关 注患者外周血白细胞和血小板水平,来确定动员采集时机.     

非霍奇金淋巴瘤患者化疗的护理

作者通过对非霍奇金淋巴瘤患者化疗期间实施一系列护理,达到预防和(或)减轻化疗期间相应的毒副作用的发生,减轻患者的痛苦,提高生活质量. 对36例非霍奇金淋巴瘤患者在做好基础护理和肿瘤专科护理的同时,根据患者年龄、文化程度等采取相应的健康宣教,给予正确的心理疏导,精心的心理护理、使患者能以平和的、轻松的心态积极地配合化疗,有效的帮助了非霍奇金淋巴瘤患者在化疗期间减轻了因化疗导致的痛苦,提高了生活质量,从而保证了治疗的顺利进行,提高了患者治疗疗效,又减轻患者经济负担.     

Factors determining the outcome of management of patients with Burkitt's lymphoma at the University College Hospital Ibadan,Nigeria--an eleven year review

In recent times, our experience in the chemotherapy of Burkitt's lymphoma patients in Ibadan, Nigeria has been that of poor outcome, hence this study was undertaken to determine the factors leading to the poor results of chemotherapy of Burkitt s lymphoma in Ibadan. A retrospective analysis of Burkitt s Lymphoma patients seen over eleven year period, between January 1987 to December 1997 at the Paediatrics and Haematology Departments of the University College Hospital, Ibadan was carried out. There were 67 patients, mean age 11+5 years (range 4 to 30 years), 42 males, 25 female giving M:F ratio of 1.7:1. Majority of the patients (76.2%) were stage D, only 4.5% were stages A and of the 67 patients, only 57 (83.6%) had chemotherapy, 40 of whom had COAP, 8 had COMP and 9 patients had either cyclophosphamide or cytosar as monotherapy. Only 22.8% of patients that received chemotherapy went into complete remission. In this study, we observed a declining overall complete remission rate of 22.8% (compared to 47% in 1979) in Burkitt s Lymphoma patients. The presence of large amount of fake drugs in the Nigerian market may imply that some of the cytotoxic drugs used in these patients could have been fake drugs. We suggest that the government should subsidize the therapy of these patients as well as eradicate the presence of fake drugs in the market, thereby increasing the chances of a cure.     

Cytokines : as useful Prognostic Markers in Lymphoma Cases

Cytokines are believed to be involved in the pathogenesis and enhanced expression in patients with Hodgkin''s and Non-Hodgkins lymphoma. Based on this phenomenon, a multicentric study was carried out in various lymphoma cases. The diagnosis of lymphoma was made on tissue biopsies and fine needle aspiration cytology (FNAC). Out of a total of 72 cases studied, 45 were of Hodgkin''s lymphoma (62.5%) and 27 cases were of Non-Hodgkin''s lymphoma (37.5%). Maximum cases of Hodgkin''s disease occurred in the age group of 30-40 years and males outnumbered females. Hodgkin''s lymphoma cases were predominantly of mixed cellularity histologic type (46.66%) whereas majority cases of Non-Hodgkin''s lymphoma were of high grade histologic type (48.14%) with predominance in the age group 51-60 years. In both these type of lymphomas, the IL-2R and IL-6 levels were found to be increased more than four fold (as compared to healthy controls) (p<0.05). The cytokine levels decreased after chemotherapy in patients showing response to therapy. However, there were few conflicting and unreliable trends in the IL-6 levels after chemotherapy where elevated IL-6 levels persisted in patients in clinical remission. Overall, it was seen that both IL-2R and IL-6 can be used as an indicator for assessing prognosis and drug therapy in lymphoma cases. IL-2R was found to be a better prognostic marker than IL-6 in assessing the response of lymphoma patient to chemotherapy, more so in Hodgkin''s disease.Key Words: Cytokines, IL-2R, IL-6, Lymphoma     

乙肝病毒感染的恶性淋巴瘤患者化疗后肝功能变化

目的:研究乙肝病毒(hepatitis B virus,HBV)感染的恶性淋巴瘤患者化疗后肝功能变化。方法:收集本院确诊HBV感染恶性淋巴瘤接受化疗患者278例,检测并比较HBV感染合并霍奇金淋巴瘤(hodgkin’s lymphoma,HL)及非霍奇金淋巴瘤(non hodgkin lymphoma,NHL)患者化疗后肝功能变化特点。结果:HBV感染的恶性淋巴瘤患者化疗后肝功能损害发生率47.8%(133/278)。HL组肝功能损害发生率37.0%,低于NHL组的54.7%(χ~2=8.263,P=0.003),HL组重度肝功能损害(Ⅲ度+Ⅳ度)率3.7%(4/108),低于NHL组的13.5%(23/170)(χ~2=7.271,P=0.005)。治疗前HBV-DNA>104copy/m L患者肝功能损害发生率42.3%(58/137),<104 copy/m L患者肝功能损害发生率53.2%(75/141),差异无统计学意义(χ~2=3.282,P=0.045);但是治疗前HBV-DNA>104 copy/m L患者重度肝功能损害发生率14.6%(20/137)高于<104 copy/m L患者重度肝功能损害发生率5.0%(7/141)(χ~2=7.355,P=0.006)。结论:恶性淋巴瘤合并乙肝病毒感染化疗后肝功能损害明显,NHL患者更易感染,临床诊疗时需注意监测并及时处理。     

257例非霍奇金淋巴瘤患者乙型肝炎病毒感染分析

目的探讨恶性淋巴瘤患者中乙型肝炎病毒(HBV)的感染率及其与化疗后肝功能损害发生和严重程度的关系。方法对257例初诊恶性淋巴瘤患者不同性别、年龄、分型中HBV感染进行评价;随机抽取恶性肿瘤257例(肝癌除外)和健康志愿者100例,比较HBV感染与非感染患者在治疗过程中及治疗后肝功能损害的情况。结果非霍奇金淋巴瘤(NHL)患者的HBV感染率远高于其他肿瘤患者及正常健康人群;而其他肿瘤患者与健康人群之间无明显差异(P<0.05)。B细胞NHL的HBV感染率均明显高于健康人群;T细胞NHL与健康人群无明显差异,B细胞性NHL患者的HBV感染率明显高于T细胞性NHL,HBsAg阳性者和HBcAb阳性者化疗后肝功能损伤发生率明显高于HBsAg阴性组(P<0.05)。结论化疗后肝功能损伤比较,HBsAg及HB-cAb阳性者化疗后肝功能损伤发生率明显高于阴性者,HBsAg阳性者应提前给予抗HBV病毒治疗,可减轻化疗后肝功能损害;HBcAb与NHL最为密切。     

湖南某三甲综合医院85例PICU儿童意外伤害临床分析

目的探讨儿童意外伤害的防范措施,为永州地区儿童意外伤害的有效干预提供一定的理论依据。方法回顾性研究2017年1月至2019年12月在本院PICU救治的85例儿童意外伤害病例,统计分析儿童意外伤害的不同影响因素及分布特点。结果儿童意外伤害病例中男童多于女童,农村多于城市;年龄分组中以幼儿期组最多见;种类分布以中毒(43.53%),尤其是以药物中毒最常见(28.24%);不同年龄组意外伤害种类分布不同。因意外伤害死亡的病例占同期死亡病例的41.38%。结论重症监护室意外伤害儿童死亡率高,具有性别、年龄及分布特点,对不同区域、不同年龄段儿童,尤其是男童,要有侧重地采取防范措施、加强监护、提高安全意识,可有效预防儿童意外伤害事件的发生。     

儿童胸腔巨大肿瘤临床特点及预后因素分析

目的 探讨儿童胸腔巨大肿瘤临床特点及影响预后的相关因素。方法 回顾性分析上海交通大学附属儿童医院心胸外科2009年1月~2015年6月收治的76例经手术治疗的原发性胸腔巨大肿瘤患者的临床病理资料,采用Kaplan-Meier法行单因素生存分析。结果 本组良性肿瘤35例,以神经节细胞瘤多见（12例）,其次为脉管瘤（9例）,畸胎瘤（8例）;恶性肿瘤41例,以神经母细胞瘤多见（13例）,其次为神经节母细胞瘤（7例）和淋巴瘤（7例）。参与随访的70例胸腔巨大肿瘤患者5年生存率>75%;39例胸腔巨大恶性肿瘤患者5年生存率>50%。Kaplan-Meier法单因素分析显示,患者性别、肿瘤胸腔内原发部位等与神经源性肿瘤预后无相关性（P>0.05）,而患者年龄、肿瘤临床分期、肿瘤病理类型、术后是否化疗则与神经源性肿瘤预后有相关性（P<0.05）。结论 手术切除是胸腔巨大良性肿瘤预后相关因素;胸腔巨大恶性肿瘤复发率、转移率高,预后差,术后结合化疗/放疗可延长患者生存时间;儿童胸腔巨大肿瘤以神经源性肿瘤多见,患者性别、肿瘤胸腔内原发部位等与神经源性肿瘤预后无相关性,而患者年龄、肿瘤临床分期、肿瘤病理类型、是否辅助化疗是神经源性肿瘤预后相关因素。     

Treatment outcome in children with central nervous system-positive Burkitt lymphoma using only intrathecal and systemic chemotherapy combined with rituximab

Background:With current chemotherapy treatment, >90% of survival has been obtained for Burkitt lymphoma (BL). In this study, the demographic characteristics and treatment outcomes are presented for 78 children in China with central nervous system-positive (CNS+) BL.Methods:This retrospective study consecutively enrolled 78 CNS+ BL patients in Beijing Children''s Hospital (BCH) from 2007 to 2019 who received the BCH B-cell non-Hodgkin''s lymphoma regimen (modified by French-American-British mature lymphoma B-cell 96 [FAB/LMB96] C1 arm ± rituximab). Clinical characteristics, methods of disease detection in the CNS, and outcomes were evaluated. Univariate and multivariate analyses were used to assess prognostic factors.Results:The median age of 65 boys and 13 girls at the time of diagnosis was 5.7 years (ranging from 1 to 14 years). Patients were followed up for a median time of 34 months (ranging from 1 to 72 months). Bone marrow invasion was found in 38 (48.7%) patients. There were 48 (61.5%), 44 (56.4%), and 25 (32%) patients with cranial nerve palsy, intracerebral mass (ICM), and para-meningeal extension, respectively. Abnormal cerebrospinal fluid (CSF) morphology and CSF immunophenotype appeared in 15 (19.2%) and 15 (19.2%) patients, respectively. There were 69 (88.5%) patients treated with chemotherapy combined with rituximab, and nine patients were treated solely with chemotherapy. Finally, five patients died of treatment-related infection, recurrence occurred for 13, and one developed a second tumor. The 3-year overall survival and event-free survival rates were 78.9% ± 4.7% and 71.4% ± 6.0%, respectively. Treatment with chemotherapy only, ICM positivity, and >4 organs involved at diagnosis were independent risk factors.Conclusions:Rituximab combined with a modified LMB96 regimen has greatly increased the efficacy of treatment for Chinese children with CNS+ BL, and with the continuous collection of outcome data, treatment-related complications are decreasing. For further verification, a large sample multicentre randomized controlled study should be performed to explore a treatment scheme for Chinese children with even greater efficacy.     

Parkinson's disease.

Parkinson''s disease is a common disabling disease of old age. The diagnosis of idiopathic Parkinson''s disease is based on clinical signs and has poor sensitivity, with about 25% of patients confidently diagnosed as having the disease actually having other conditions such as multi-system atrophy and other parkinsonism-plus syndromes. Benign essential tremor and arteriosclerotic pseudo-parkinsonism can easily be confused with Parkinson''s disease. The cause of Parkinson''s disease remains unknown. Speculative research highlights the role of oxidative stress and free radical mediated damage to dopaminergic cells. Parkinson''s disease is the one neurodegenerative disorder in which drugs have been demonstrated to be of value. There is now a wide variety of drugs and formulations available, including anticholinergics, amantidine, L-dopa, dopamine agonists including apomorphine, selegiline and soon to be available catechol-O-methyltransferase inhibitors. Disabling side-effects of treatment, fluctuations, dyskinesias and psychiatric problems require strategic use of the drugs available. There is an increasing potential for neurosurgical intervention.     

胃黏膜相关淋巴组织淋巴瘤的病理特征与疗效相关性分析

目的:探讨胃黏膜相关淋巴组成淋巴瘤(Mucosa-Associated Lymphoid Tissue,MALT)病理学特征与治疗方法之间的关系,以提高其疗效。方法:选择23例胃MALT淋巴瘤患者,统计其临床症状、内镜形态、病理特点,以及不同治疗方法所产生的疗效。结果:幽门螺杆菌(H.pylori)感染21例,感染率为91.3%;胃窦、胃体多灶性13例(56.5%),胃窦部9例(39.1%);病变局限于胃黏膜及黏膜下层20例(87.0%),侵犯肌层2例(8.7%),侵达浆膜1例(4.3%);21例H.pylori感染者均经质子泵抑制剂(PPI)加克拉霉素加阿莫西林规范治疗,根除H.pylori后2个月复查胃镜,17例(73.9%)病灶完全消失,随访2年内未复发;4例行COP方案化疗,其中3例病灶消退,随访至今未复发;1例出现恶化,1年后死亡。2例H.pylori阴性的巨大溃疡患者直接手术切除,术后均行CHOP方案化疗,随访5年未发现病灶复发。结论:胃MALT淋巴瘤与发病年龄、性别、肿瘤累及部位和体积大小等对生存率没有明显影响,而肿瘤侵犯深度和是否有远处转移与生率存在显著相关性,在不同发展阶段采取正确的治疗方法是提高治愈率的关键。