Marked improvement of delayed methotrexate-induced leukoencephalopathy treated with high-dose folinic acid

We report the case of a patient with delayed methotrexate (MTX)-induced leukoencephalopathy who showed a marked improvement both in clinical and neuroimaging findings after a high-dose of the active form of folinic acid (leucovorin) treatment. The patient developed progressive affective impairment accompanied by headache, nausea and vomiting after treatment with MTX during the chemotherapy for acute lymphoblastic leukemia, and diagnosed as delayed type MTX-induced leukoencephalopathy. After an intravenous injection of high-dose folinic acid (total 1920 mg), neurological deficits and white matter changes dramatically improved in a few weeks. Although delayed MTX-induced leukoencephalopathy may cause irreversible brain damage, an early treatment with high dose leucovorin may thus facilitate the marked improvement of clinical findings and white matter abnormalities.     

内支架结合放疗治疗晚期食管癌18例临床分析

目的　通过被覆支架治疗晚期食管癌恶性狭窄 ,并行术后放射治疗 ,以提高生活质量 ,延长生存期。方法　晚期食管癌恶性食管狭窄 18例 ,狭窄直径均在 2 .5mm以下 ,其中 3例呈梗阻状 ,4例合并有食管瘘 ,1例出现肝部转移。经口置入镍钛合金被覆支架 2 0枚 ,于 2周后行外照射 ,肿瘤试剂照射剂量 (DT) :6 0～ 70Gy。结果　所有患者均一次顺利完成支架置入 ,患者进普食顺利 ,疗效满意。 2周后均顺利接受放射治疗 ,未出现并发症。经随访复查 ,支架未发生移位及出现再狭窄改变 ,食管通畅 ,患者进食顺利 ,生存期延长 ,平均 11个月。结论　被覆支架治疗晚期食管癌恶性食管狭窄及术后结合放疗 ,能有效地抑制肿瘤生长 ,提高生活质量 ,延长生存期 ,是治疗晚期食管癌患者的一种安全有效的治疗方法。     

Intraoperative radiotherapy of upper abdominal tumours

Thirty patients with malignant tumours in the upper abdomen underwent surgery and intraoperalive radiation (IORT), using electron beam, to: the surgical bed, residual or unresected tumour. The technical aspects and results of this treatment are described. Renal, adrenal, bile duct and gastrointestinal tumours were treated. along with several other lesions. The surgical procedure consisted in 10 cases simply of exposure of the tumour for IORT and in 20 the tumour was resected. The TORT dose ranged from 10 to: 20 Gv. In 13 patients, external beam radiation was also given to: residual tumour or to: areas of high risk for recurrence. Chemotherapy was given to: 10 patients. Tolerance to: the combined treatment was acceptable; with few complications related to: IORT.The median follow-up and survival time 23 months (range 4-more than 70 months). Local tumour control rate (or tumour stabilisation) is 90%. Distant metastases developed in 19 patients (63%). The actuarial survival rate for the group projected at 70 months (maximum follow-up) is 37%. IORT in useful in the management of tumours arising in the upper abdominal organs, for palliation surgery or when resectability of the tumour is in doubt. Indications for IORT include patients with uncommon tumours of the upper abdomen who are not be candidates for standardised cancer treatment.Presented at the European Congress of Radiology, Vienna, September 15–20,1991     

各具特色的国外妇幼保健工作

本文通过对国际上几个主要国家的妇幼保健工作的介绍,使人们对不同特色的妇幼保健事业有所了解,他山之石,可以攻玉,希望能够对我国妇幼保健工作的发展提供借鉴。     

分次照射对兔外周血T淋巴细胞DNA合成影响动态观察

本文对长耳白兔受一次与分次~(60)Cor线不同剂量照射后一个月内其外周血T淋巴细胞DNA合成率进行了连续观察。结果表明一次性照射各剂量组均在照后第1天DNA合成受抑最严重;照后第3天各组开始恢复;第7天各组均恢复到照前水平。在分次照射停照后1.0Gy组不但未下降反而有升高趋势。当剂量率、累积剂量均相同,仅分割次数不同时发现0.05Gy/d组受抑程度比0.10Gy/d组明显。     

不同起搏模式对病人生存质量影响的调查研究

[目的]探讨不同起搏模式对病人生存质量（QOL）的影响。[方法]以健康调查问卷（SF一36量表）对112例不同起搏模式病人进行问卷调查，比较3种起搏模式下病人的QOL水平。[结果]除机体疼痛、角色情绪2个维度外其余6个维度（生理功能、角色限制、活力、社会功能、精神健康、总体健康）3种起搏模式间比较差异有统计学意义（P〈0．05）。[结论]应用AAI型、DDD型起搏器的病人生存质量优于VVI型起搏。     

外语多媒体软件界面设计的认知策略模式

外语学习软件界面的设计除了应注意实现软件功能的技术因素、表现媒体的物理性状以及信息内容的学科把握 ,还应对软件界面的内容组织方略、交互通达方式、语用认知功能等方面提出要求。界面设计的出发点 ,应该是学生、学习任务及其相应的学习活动。应该根据需求分析、学习者分析、任务和内容分析来确定目标和步骤。外语教学应以语言能力、交际能力、学习策略能力为目标 ,界面设计应以此为据选择表现媒体、结构层次、交互方式和技术手段。     

Breast Conservation Therapy in Patients with Early-Stage Breast Cancer Who Have Undergone a Second Re-Excision of the Primary Tumor Bed: A Report of Four Cases

Abstract: For the women with early-stage breast cancer who are candidates for breast conservation therapy, re-excision of the primary tumor bed has commonly been used in patients for several indications. These indications include positive margin or uncertain margin status of the primary excision or residual microcalcifications on postbiopsy mammogram. If the pathology from the re-excision does not confirm negative margin status, mastectomy is generally recommended. This article examines patients who have undergone a second re-excision (i.e., a lumpectomy followed by two re-excisions) who have been treated with breast conservation therapy rather than a mastectomy.
From September 1977 to November 1995, 1,562 patients underwent breast conserving therapy at this institution. Seven hundred forty of these patients underwent a re-excisional biopsy because of positive or uncertain margin status or residual microcalcifications after the first excision. Four patients (0.5%) underwent a second re-excision because of positive or uncertain margin status or residual microcalcifications on mammogram after the first re-excision. The final margin status after the second re-excision of all four patients was negative. The radiation dose was 4,600–5,000 cGy to the whole breast followed by a conedown to bring the total dose to 6,400–6,800 cGy to the primary tumor bed.
Follow-up in the four patients was 13 years, 4 years, 14 months, and 8 months respectively. All four patients are clinically without disease and have not had a locoregional recurrence. Cosmesis was excellent in all four patients. One patient had an adriamycin-induced recall reaction causing a cellulitis, which resolved with antibiotics. There were no other complications.
Highly selected patients may undergo breast-conserving therapy after a second re-excision. Good outcome and cosmesis can be achieved for this small subset of patients with avoidance of a mastectomy.     

Long-term follow-up results of 175 patients with malignant glioma: Importance of radical tumour resection and postoperative adjuvant therapy with interferon,ACNU and radiation

Summary We analysed long-term follow-up results of 175 patients with malignant glioma (110 glioblastoma and 65 anaplastic astrocytoma) treated under five different regimes during the past two decades. The factors of age (less than 40), histology (anaplastic astrocytoma) and type of adjuvant therapy (radiation and chemotherapy) contributed to long survival. The other important factor was the response to adjuvant therapy.Cases of gross total removal or complete response (CR) of a residual tumour to an adjuvant therapy showed a better prognosis. The three and five year survival rate was 42% and 24%, respectively. The highest CR ratio (23%) was seen in patients treated by intravenous injection of interferon and ACNU in addition to radiotherapy (IAR therapy).