进展期胃癌术后辅助性化疗的10年随访结果

报告１０２例进展期胃癌术后患者，随机进行３组不同化疗方案并经平均随访１０．７年的结果。所有病例均为１９８３年５月到１９８５年５月间手术者。术后随机给予单一５－ＦＵ、５－ＦＵ＋ＣＣＮＵ和ＭＴＸ＋ＭＭＣ＋５－ＦＵ三组不同化疗。随访至１９９４年１２月止，死亡７７例，存活２５例。结果３、５和１０年总生存率分别为４２．１％；２９．４％和２４．５％。三组间比较，总自下而上率并无显著差异（Ｐ〉０．０５），但中位     

Optimising Hormone Therapy in Advanced Disease

Although most prostate cancer (PCa) patients nowadays are diagnosed at an early stage of disease, unfortunately still a significant number of patients will develop advanced PCa or will be diagnosed at an advanced (or metastatic) stage of disease. The group of patients showing the highest increase in incidence are those with rising prostate specific antigen (PSA) after radical therapy.In the last quarter of 2004, a Medline search has been performed targeting publications on patients diagnosed with advanced PCa, as well as with PSA relapse after previous radical therapy. This review aims at providing guidance to optimise hormone therapy in those selected groups of patients by addressing three pivotal questions; (i) who should receive hormonal treatment, (ii) what type of hormonal therapy should the patient be offered and (iii) what is the best timing of starting hormonal treatment.In patients relapsing after radical therapy, the PSA doubling time (PSA DT) has become a critical instrument to distinguish patients to have innocuous PSA evolution from patients at high risk for disease progression. A PSA DT of 3 months seems to be the cut-off point for identifying patients at risk. Therefore patients with a PSA DT of less than 3 months should be advised to initiate hormonal therapy. Antiandrogen monotherapy may be considered in this setting as it has been shown to delay progression; however, significant survival data are not yet available. Whether luteinising hormone releasing hormone (LHRH) agonists should be given continuously or intermittently (IHT) remains subject of debate.Surgical castration has been the standard of care in patients diagnosed with advanced PCa. Currently, LHRH agonists have become the preferred way of suppressing testosterone.Combination of an antiandrogen and a LHRH agonist (CAB) shows a modest benefit over LHRH agonist monotherapy. As CAB leads to increased side effects and costs, LHRH agonist monotherapy is preferred in the majority of patients.Conflicting data have been published concerning the optimal timing of LHRH agonist therapy. So it is not clear whether LHRH agonist therapy should be started immediately or deferred until appearance of symptoms. When initiating continuous hormone therapy, patients should be carefully monitored for the risk of long term androgen deprivation (anaemia, osteopenia and osteoporosis).     

肺及胸膜全切除治疗伴恶性胸积液的晚期肺癌

我们于93年6月至94年6月期间,共收治并行手术治疗的伴胸膜转移及恶性胸积液的肺癌病人共15例,手术包括全肺或肺叶切除,同时均行全胸膜切除术,本方法可明显减轻症状,改善晚期肺癌的生活质量,提高生存率。另本文对手术方法作探讨。     

进展期胃癌患者手术前后外周血T细胞及其亚群变化的研究

目的:研究进展期胃癌患者外周血T细胞免疫功能状态,手术对T细胞免疫功能的影响,以及对术后免疫治疗的指导。方法:采用间接免疫荧光染色流式细胞仪检测法,对43例进展期胃癌患者作手术前后外周血T细胞及亚群的测定,17例健康人作术前正常对照组。结果:与对照组相比,术前患者CD_3~+、CD_4~+细胞及CD_4~+/CD_8~+比值显著减少(P<0.01),而CD_8~+细胞无差异(P>0.05)。9例行非根治术者,手术前后T细胞及亚群无明显变化;而34例行根治术者,术后除CD_8~+细胞无变化外,CD_3~+、CD_4~+细胞及CD_4~+/CD_8~+比值均较术前有显著提高(P<0.01或P<0.05)。结论:术前进展期胃癌患者外周血T细胞免疫功能低下,行根治性切除术后得以改善。术后辅助免疫治疗或免疫化疗,以期提高生存率。     

阿帕替尼对Her2阴性晚期胃癌患者的治疗效果及毒副作用分析

目的:探究Her2阴性晚期胃癌患者采用阿帕替尼进行治疗的疗效及毒副作用。方法:按照不同治疗方法将本院就诊的Her2阴性晚期胃癌患者分为阿帕替尼组(AP组)和替吉奥组(TI组),各46例,分析比较两组患者的临床疗效、生活质量、毒副作用及远期疗效。结果:治疗后,AP组11例、TI组6例患者出现部分缓解,AP组患者RR、DCR数值明显比TI组高(P<0.05);AP组患者生活质量明显优于TI组(P<0.05)。AP组和TI组患者均出现血小板减少、蛋白尿、肝功能异常等不良反应,但未出现Ⅳ级毒副作用,其中AP组患者高血压、血小板减少的发病率分别为63.52%、76.73%,TI组患者发病率分别为62.45%、78.11%, AP组出现毒副作用的患者人数与TI组比较无明显差异(P>0.05)。随访3年结果显示,AP组患者3年生存率为10.86%,TI组患者为0,AP组患者总生存率明显高于TI组(P<0.05)。结论:阿帕替尼对Her2阴性晚期胃癌患者的临床疗效及远期治疗效果较佳,虽然治疗后也会出现一定的毒副作用,但与替吉奥治疗后出现的毒副作用相近,且患者身体承受程度较佳。阿...     

Successful pregnancy in advanced renal failure without dialysis

We describe a successful pregnancy in a 22-year-old patient with advanced renal failure, who gave birth to a living boy in the 35th week of pregnancy. At the time of spontaneous delivery the mother had a serum creatinine of 851 mol/l. No dialysis treatment had been instituted during this successful pregnancy.     

Setting out the frame conditions for feasible use of FFPE derived RNA

Introduction

The usage of formalin-fixed paraffin embedded (FFPE) tissue is characterized by its long shelf-life and simple handling. Therefore it is the most commonly available tissue specimen in routine diagnostics and histological studies. Formaldehyde fixation may result in RNA degradation and cross linking with proteins, while storage conditions also affect RNA integrity. The present study was designed to investigate the influence of these factors on RNA analysis.

长程体外反搏对高胆固醇血症猪高级氧化蛋白产物和高敏C反应蛋白的影响

目的探讨长程体外反搏对高胆固醇血症猪血清中高级氧化蛋白产物(AOPP)和高敏C反应蛋白(hs-CRP)的影响.方法 18头雄性乳猪随机分为正常饲养组(n=6)、高脂饲养组(n=6)及高脂饲养+体外反搏组(n=6).后2组通过高脂饲养复制高胆固醇血症猪模型并对高脂饲养+体外反搏组进行36 d共36 h的长程增强型体外反搏.分别于分组饲养前、反搏前、反搏中期和反搏结束时留取3组动物静脉血,采用分光光度法检测血清AOPP浓度,采用乳胶凝集反应法检测血清hs-CRP浓度.结果高脂饲养组和高脂饲养+体外反搏组经高脂饲养后血清总胆固醇和低密度脂蛋白明显升高(P<0.05).血清AOPP和hs-CRP浓度在分组饲养前组差异无统计学意义(P>0.05).反搏前、反搏中期和反搏结束时,高脂饲养组与高脂饲养+体外反搏组血清AOPP和hs-CRP浓度较正常饲养组同时期均有显著增高(P<0.05);而反搏中期和反搏结束时高脂饲养+体外反搏组血清AOPP浓度较高脂饲养组显著降低[(95.38±12.66)μmol/L比(128.46±12.55)μmol/L;(85.78±10.33)μmol/L比(158.22±16.32)μmoL/L,P<0.05];且反搏中期和反搏结束时高脂饲养+体外反搏组血清hs-CRP浓度较高脂饲养组也有显著降低[(0.47±0.14)mg/L比(0.62±0.32)mg/L;(0.47±0.16)mg/L比(0.59±0.43)mg/L,P<0.05].结论 AOPP和hs-CRP参与了高胆固醇血症猪的发病过程.长程体外反搏可能通过减轻机体体内氧化应激和微炎性反应过程,从而阻止高胆固醇血症的病理生理进程.     

局部晚期肺癌外科手术治疗(附18例报告)

目的为提高晚期肺癌患者的外科手术切除率及提高手术疗效，总结18例晚期肺癌患者手术治疗中切开心包处理肺静脉或切除部分左心房的经验。方法对18例晚期肺癌患者施行肺叶或全肺切除时，在心包内处理肺静脉或切除部分左心房。左肺下叶切除5例、左全肺切除3例、右肺中下叶切除4例、右肺下叶切除4例、右全肺切除2例；术中发现13例患者的肺静脉根部有癌侵犯或有癌栓，在心包外元法常规处理肺静脉，在切开心包后可较满意地处理肺静脉，切开心包后发现其中有9例明显有左心房侵犯，行肺切除的同时切除部分左房；5例虽可在心包外处理，但癌肿离肺静脉根部太近处理肺静脉困难，而切开心包后处理肺静脉很轻松。结果18例均无手术死亡，术后有2例发生心律失常，2例并发肺炎，1年生存率61．2％（11／18）、3年生存率38．8％（7／18）、2例生存〉5年。结论晚期肺癌累及肺静脉根部或左心房时应切开心包处理肺静脉或同时切除部分左心房以达到肿瘤学上的根治性切除，从而延长病人的寿命。     

姑息关怀服务模式对癌症晚期患者生命质量的影响研究

目的 评估姑息关怀服务对癌症晚期患者生命质量的影响并提出管理建议。方法 采用问卷调查的方式对H医院接受姑息关怀治疗和常规抗癌治疗的248名癌症晚期住院患者的生命质量进行调查。选取中国癌症患者生命质量量表对癌症晚期患者的生命质量进行评估,然后通过统计分析探讨不同治疗方式下患者生命质量的差异。结果 癌症晚期患者生命质量普遍较差(36.38±4.82),其中躯体症状得分最低,依次是精神心理和社会关系。接受姑息关怀后患者生命质量及各指标得分均有显著提高。治疗前生命质量更差、疼痛程度更高的姑息关怀组患者,其治疗后的生命质量评分与常规抗癌组患者相比无显著差异,疼痛程度更是低于常规抗癌组。两组治疗方式下患者生命质量治疗前后的差值对比(6.82±2.71 vs 2.53±2.95),姑息关怀组的改善效果更明显(t=11.908,P<0.05)。结论 姑息关怀治疗相对于常规抗癌治疗,对癌症晚期患者生命质量的改善效果更为显著,应加强对以价值为核心的姑息关怀服务模式的宣传和推广。