The effect of cystectomy, and perioperative methotrexate, vinblastine, doxorubicin and cisplatin chemotherapy on the risk and pattern of relapse in patients with muscle invasive bladder cancer

PURPOSE: Trials have demonstrated decreased relapse with perioperative methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy in patients with muscle invasive bladder cancer. We evaluated whether the benefit of chemotherapy correlates with its effects on distant or pelvic relapse. MATERIALS AND METHODS: We retrospectively evaluated the records of all 107 patients who underwent cystectomy for muscle invasive bladder cancer at our institution between 1988 and 1994. Factors predicting relapse were identified and used to group patients at high or low risk. The outcome in each group with and without M-VAC chemotherapy was then analyzed in terms of overall, metastatic and pelvic relapse. Univariate analysis was performed using the Kaplan-Meier method and log rank statistic, and multivariate analysis was done using the Cox proportional hazards model. Median survival was 29 months for patients free of disease. RESULTS: Pathological stage T3 or greater according to the American Joint Committee on Cancer, tumor greater than 3 cm. and creatinine greater than 1.5-fold normal were independent poor prognostic factors in patients treated with cystectomy only. Patients with any of these factors or metastatic involvement of the pelvic lymph nodes were considered at high risk. All 35 low risk patients were treated with cystectomy only and had an excellent outcome with a 3-year relapse-free survival plus or minus standard error of 93% +/- 5%. The 3-year rates in 52 and 20 high risk patients treated without and with chemotherapy, respectively, were 42% +/- 8% versus 57% +/- 13% for relapse-free survival (p = 0.17), 38% +/- 9% versus 8% +/- 8% for pelvic failure (p = 0.02) and 39% +/- 9% versus 38% +/- 13% for distant metastases (not significant). Multivariate analysis of patients who underwent pelvic lymphadenectomy revealed that perioperative chemotherapy improved relapse-free survival and pelvic control but not metastatic control (p = 0.03, 0.02 and 0.31, respectively). CONCLUSIONS: Low risk patients have excellent disease control when treated with cystectomy only. Those with high risk features are at substantial risk for pelvic failure (38% at 3 years) after cystectomy only. Perioperative M-VAC chemotherapy has a profound impact on pelvic but not on metastatic failure.     

38例女性戒毒人员院内心理综合干预的半年操守情况分析

目的:探索较为有效的综合性的院内心理干预方法,以降低女性戒毒人员的复吸率和延长其操守时间。方法:采取授课、心理训练和疏导等方式,运用认知疗法、脱敏疗法、放松训练、心理疏导等方法进行心理干预。结果:干预出院后38例中13例半年内未复吸、12例已复吸、13例失访,半年复吸率在31 .6 % - 6 5 . 8%之间,且本次干预后的操守时间比干预前一次显著延长(P <0. 0 1)。结论:运用心理综合干预措施对院内女性戒毒者进行干预可降低其半年复吸率和延长操守时间。     

408名社区吸毒人员操守保持的相关因素分析

目的:正确推断社区吸毒解教人员操守保持的相关因素,为制定有效的戒毒政策提供科学依据。方法:以408名长沙市芙蓉区登记在册的操守保持者为研究对象,96名复吸者为对照,比较两组吸毒解教人员的人口学、吸毒和社区帮教相关情况的差异,并进行Logistic逐步回归分析。结果:操守保持者与复吸组比较,平均年龄、首次吸毒年龄相对较大,吸毒时间相对较短,曾经使用过毒品的种类和方式相对较少,戒毒次数相对较少;而操守保持者的社会帮教率(95·6%)明显高于复吸者(53·1%),平均每年尿液毒品检测次数相对较多,低保申请率和就业安置率相对较高。多因素分析结果表明劳教戒毒次数、就业安置和年尿液检测次数是影响操守成败的主要因素。结论:社区帮教措施能够促进社区吸毒解教人员保持操守,是戒毒所戒毒工作的延续和宏观戒毒管理的一个重要方面。     

复方甘草酸苷与甘草酸二铵治疗拉米夫定停药后反跳的疗效观察

目的 :观察复方甘草酸苷与甘草酸二铵治疗拉米夫定停药后慢性乙型肝炎 (CHB)患者病情反跳的疗效 ,并比较其差异。方法 :将76例停用拉米夫定后CHB病情反跳的患者分为复方甘草酸苷组和甘草酸二铵组。观察和记录患者症状、体征的变化及药物不良反应 ,定期检测肝功能、HBV血清免疫学标志物、HBV -DNA定量等项目 ,随访12个月。结果 :复方甘草酸苷组与甘草酸二铵组总有效率分别为79 49 %和75 68 % ,两组间无显著性差异 (P>0 05) ;两组在AST复常方面有显著性差异 (P<0 01) ;复方甘草酸苷组显效率为69 23 % ,甘草酸二铵组显效率为48 65 % ,两组亦有显著性差异 (P<0 05)。结论 :复方甘草酸苷与甘草酸二铵治疗拉米夫定停药后CHB患者病情反跳均有明显的疗效 ,前者停药后病情反跳率低 ,疗效稳定、持久。     

Catastrophic relapse of Evans syndrome five years after allogeneic BMT notwithstanding full donor chimerism. Terminal hemolytic-uremic syndrome

A patient with severe Evans syndrome received an allo-BMT from his HLA-identical sister on November, 2000. Full marrow and blood donor chimerism were achieved only after 5 donor lymphocyte infusions (DLI), and coincided with complete clinical remission and disappearence of auto-antibodies. Five years later, hemolytic anemia recurred with rapid increase of serum bilirubin to over 50 mg%: he responded to combined therapy, but died on day +17 from admission of an acute hemolytic uremic syndrome (HUS). All circulating blood cells, including erythrocytes, were 100% donor. Ex vivo cultured and expanded T and B cells from the peripheral blood were also 100% donor. The supernatants from B cell cultures, containing either IgM or IgG, did not react with a panel of erythrocytes. Thus in this typical autoimmune disease with a predominant B cell pathogenesis the donor immune system resulted “innocent of autoimmunity”. The persistence of long-lived recipient autoreactive plasma-cell lines in survival niches, still producing autoantibodies, may be hypothesized for this and similar cases. The postulated graft-versus-autoimmunity (GVA) effect was apparently not sufficient to eradicate autoimmunity in this patient.