液基细胞薄层涂片阴道镜对早期子宫颈癌筛查临床与流调应用研究

目的 :探讨液基细胞薄层涂片 ( TCT)、阴道镜合用对早期子宫颈癌及癌前病变筛查的可行性。方法 :以广东省东莞市长安医院妇科就诊的患者作为筛查人群 ,选择从未进行 TCT、阴道镜及 HPV等检查 ,且均有性生活和非孕期妇女 (年龄不限 )共计 2 5 14例 ,其中本地户籍 12 9例 ( 5 .1% ) ,外地户籍 2 385例 ( 94 .9% )。以病理组织学为金标准 ,结合 HPV- DNA分子生物学诊断技术 ,评价 TCT、阴道镜检查的诊断价值。结果 :该人群现患率 :HSIL (高度鳞状上皮内瘤变 )为 1.4 % ( 34/2 5 14 ) ;SCC(鳞状细胞癌 )为 0 .3% ( 7/ 2 5 14 ) ;平均年龄分别为 33.6和 38.1;人群平均初次性交年龄、性伴数、孕次、产次分别为 2 1.5、 3.2、 4 .8、 2 .3;从事宾馆娱乐美容业占 6 7.3%、家庭妇女占 12 .0 % ,3种方法的敏感度、特异度、阳性预测值、阴性预测值分别为 HPV (阳性≥ 1.0 pg/ ml) ( 0 .96 7,0 .84 4 ,0 .2 2 0 ,0 .998) ;TCT (≥ L SIL 为阳性 ) ( 0 .86 1,0 .95 9,0 .5 77,0 .993) ;阴道镜检查 (≥ CIN 为阳性 ) ( 0 .898,0 .6 89,0 .134,0 .993)。结论 :1该患病人群符合子宫颈癌及癌前病变的流行病学特点 ,因此 ,在开放地区开展早期子宫颈癌及癌前病变筛查有着重要的现实意义。 2 TCT制片效果优良 ,敏感度和特异?     

Histopathologic parameters of prognosis in cervical cancer – a review

Apart from clinical stage and lymph node status, acknowledged to be among the most powerful predictors of outcome in cervical cancer, the determination of prognosis and thereby the need for adjuvant therapy in surgically treated patients currently relies on a variety of histopathologic factors. The role of many of these is controversial. This may be because histopathology is genuinely lacking in sensitivity for predicting tumor behavior in vivo. There is, however, wide variation in histopathologic definitions and criteria. This is probably the major reason for both the lack of reproducibility in the reporting of certain factors and in their diminished value in predicting behavior. Tumor type, grade, vascular invasion, pattern of invasion, and depth are all extremely important prognostic indicators when used individually or as a part of a scoring system.     

早期肾盂癌的诊断和诊断方法的比较

目的探讨早期肾盂癌的诊断和最有效的诊断方法。方法在诊断肾盂癌时采用B超、静注尿路造影(IVU)、逆行性肾盂造影、CT、泌尿系磁共振水成像(MRU)、输尿管肾盂镜检查等多种方法,比较各种方法对早期肾盂癌诊断的准确率。结果IVU和逆行性肾盂造影、CT、输尿管肾盂镜、MRU、B超对早期肾盂癌的诊断阳性率分别是89%、94%、80%、50%、40%和22%。结论IVU和逆行性肾盂造影是诊断早期肾盂癌最基本和最必要的有效检查方法,是其他方法不能代替的。因输尿管肾盂镜检查为有创性检查,故可作为疑难病例最后的确诊性检查方法,不宜做首选的检查方法。B超可作为普查之用。     

Oral misoprostol in the third stage of labor.

OBJECTIVE: To compare the efficacy of intravenous ergometrine, intramuscular oxytocin, and oral misoprostol in the control of postpartum hemorrhage. METHODS: Mean blood loss, rates of blood loss between 500 and 1000 ml, hematocrit fall greater than 10%, and need for additional oxytocic agents and nature and rates of adverse effects were assessed in this prospective, randomized, controlled study. RESULTS: All outcomes were similar in the 3 groups. The main adverse effects in the misoprostol group were temperatures higher than 99 degrees F, which normalized within 2 h and shivering, which was mild and self-limiting. CONCLUSIONS: Oral misoprostol is as effective as conventional oxytocic agents in preventing postpartum hemorrhage and can be recommended for use in low-resource settings.     

What is the difference between squamous cell carcinoma and adenocarcinoma of the cervix? A matched case–control study

The objective of this study was to investigate the efficacy of treatment strategies in patients with adenocarcinoma (AC) of the cervix and compare it with those with squamous cell carcinoma (SCC) of the cervix. Women with FIGO (1994) stage IB1 AC, especially pathologic tumor size of 2-4 cm, treated with class III hysterectomy, were compared with those with SCC treated with comparable strategy in a case-controlled study. Eighty patients (20 cases, 60 controls) were analyzed. Lymphvascular space invasion (P = 0.01) and lymph node metastasis (P = 0.07) were more frequent in patients with SCC than in those with AC. However, there was no significant difference in depth of stromal invasion (P = 0.51) and invasion of the parametrium (P = 0.44) between two groups. And there was also no statistically significant difference in disease-free survival (P = 0.86) and overall survival (P = 0.89) between two groups. Primary radical surgery followed by adjuvant therapy, same as for SCC, would be acceptable for AC with pathologic tumor size of 2-4 cm. Although it was difficult to determine whether AC recurred more systemically, more effective treatment strategies than those currently available for AC should be considered to reduce the systemic recurrence.     

山茱萸炮制的历史沿革及探讨

山茱萸为山茱萸科植物山茱萸(Cornus officinalis Sieb.et Zuce)的干燥成熟果肉。中医临床常用以补肝益肾,涩精固脱,并多要求炮制后入药。其炮制历史久远,本文拟就其炮制历史沿革、传统炮制理论及现代研究结果作一概述。1山茱萸炮制历史沿革山茱萸炮制历史悠久。汉代《金匮玉函     

Survival for rectal cancer patients and international comparisons.

BACKGROUND: Population-based cancer registry data are important because they reflect routine care, present long-term follow-up, can show differences in treatment, outcomes and health care over time, and can be used for comparisons between regions and countries. PATIENTS AND METHODS: Details of all cancer patients in the Munich region are recorded by the Munich Cancer Registry. Rectal cancer patients with an invasive primary tumor diagnosed between 1996 and 1998 were included in this analysis (n=936). Observed and relative survival are presented. Observed survival was also investigated with a Cox proportional hazards regression model. RESULTS: Median follow-up time of survivors was 5.7 years. Five-year relative survival for the whole sample was 62.2%. International Union Against Cancer (UICC) stage was the most important prognostic factor in the multivariate analysis. Compared with the 1992-1999 Surveillance Epidemiology and End Results (SEER) data (62.4%), relative survival for each disease stage and the whole sample were very similar. In comparison with other European registries, Munich patients had slightly higher survival rates per stage (for example, 5-year relative survival in UICC III was 58.3% in Munich, 54.6% in South East Netherlands, 33.3% in Modena and 47.4% in Cote d'Or); however, more patients in Munich were in higher disease stages with worse prognoses, indicating poorer early detection. CONCLUSIONS: These results indicate that treatment of rectal cancer in Munich is good, but early detection could be improved. Cancer registries should publish their population-based stage data to ensure quality of care and provide regular feedback to health-care workers and decision makers. Comparisons between countries without stage data should be conducted cautiously.     

卡培他宾治疗晚期肝癌临床观察

目的 探讨卡培他宾在晚期肝癌临床治疗中的疗效。方法 将我科收住的34例肝癌病人随机分为两组：①治疗组：希罗达2000mg／m^2，分2次／d 口服、连用14d，休息7d，为一周期，至少用药二周期以上；②对照组：单纯支持治疗，至少6wk。治疗前后查肝肾功能，血常规，AFP，ECG，CT或MRI、B超等。疗效和不良反应按WHO疗效及不良反应评价标准评价，统计分析方法采用x^2检验，P〈0．05为有统计学意义。结果 治疗组：CR无病例，PR2例，SD10例，PD6例；总有效例数2例，总有效率为11．8％，稳定率58．8％。12例AFP增高中5例下降，下降率为41．7％。生存期最短的为3mo，最长的7mo，中位生存期为5．3mo。希罗达最少为2周期，最多6周期，共40周期。对照组：CR无病例，PR无病例，SD2例，PD15例；总有效率为零，稳定率11．8％。11例AFP增高病人中无AFP下降。生存期最短的为1．5mo，最长的4mo，中位生存期为2．3mo。采用x^2检验，P〈0．05，两组有显著的统计学差异。不良反应，治疗组3例恶心、呕吐，3例中性粒细胞减少，3例出现腹泻，皮肤红肿、脱屑等手足综合征，这些副反应均在1乏级。发生最多的是手足综合症，发生率为：29．4％。结论 本组病例说明希罗达2000mg／d，分二次口服，连用14d，休息7d为一周期，在晚期肝癌中的临床应用是可行、安全而有效的。主要不良反应表现为手足综合症，可以对晚期肝癌进一步推广应用。     

新辅助化疗应用于局部晚期乳腺癌的疗效分析

目的探讨术前新辅助化疗对乳腺癌的疗效及提高患者术后生存率的作用.方法采用CMF和CAF两种化疗方案对50例Ⅲ期乳腺癌术前患者(A组)进行化疗,评价其疗效;与术后化疗(B组)进行总疗效对照比较.结果术前新辅助化疗组经化疗肿瘤全消和部分消退合计总有效率为58.0%;术后随访5 a生存率、无瘤存活率明显高于对照B组,两组无瘤存活率比较χ2＝9.07,P＜0.01.结论术前全身治疗(化疗)作为乳腺癌第一步治疗可能是首先使已存在的临床小转移灶得以控制,进而获得更多治疗成功的机会.     

VEC方案联合激光治疗RB眼内期患儿的效果与安全性

目的：评价VEC方案联合激光治疗不同年龄视网膜母细胞瘤(RB)眼内期患儿的效果与安全性。

方法：选择我院2016-01/2018-03 RB眼内期患儿63例作为研究对象,根据年龄分为≤1岁组23例36眼,>1岁组40例66眼,均给予VEC方案联合激光治疗,参照国际抗癌联盟制定的疗效标准评价疗效。治疗前、6个疗程结束后采用间接检眼镜与超声下测量肿瘤及肿瘤基底厚度与直径,记录治疗期间毒副反应。

结果：≤1岁组缓解率为75.0%,>1岁组缓解率为92.4%(P<0.05)。≤1岁组进展5眼,>1岁组进展1眼均行眼球摘除,其余患眼治疗后肿瘤厚度与基底直径明显小于治疗前(P<0.05)。>1岁组治疗后肿瘤厚度与基底直径均比≤1岁组小(P<0.05)。两组患儿均有轻度恶心呕吐等消化道症状及脱发,≤1岁组各有1例轻度骨髓抑制和肝功能损害,>1岁组有2例轻度骨髓抑制,1例轻度肝功能损害。

结论：VEC方案联合激光治疗RB眼内期患儿安全可行,>1岁患儿疗效优于≤1岁患儿。