前列腺癌热点问题评述

前列腺癌的治疗方法很多,局限前列腺癌以根治性手术和放射治疗为主,而晚期前列腺癌则以内分泌治疗为主.然而,多年来对于不同临床分期,尤其是T3期和局部晚期前列腺癌治疗方法的选择问题一直存在争议,百家争鸣,各持己见.下面就几个热点问题做一评述.     

晚期前列腺癌的综合治疗

目的：了解晚期前列腺癌综合治疗的方法及效果。方法：回顾性分析1990年1月-2001年12月收治的62例晚期前列腺癌病人，采用以内分泌治疗为主的综合治疗措施。结果：随访6-60个月，平均24.5月。接受内分泌治疗后病人下尿路梗阻症状均有不同程度缓解，前列腺缩小，PSA下降。TURP、输尿管皮肤造瘘、局部放疗或同位素放射治疗等可有效解除尿路梗阻，保护肾功能，减轻转移性骨痛。结论：对晚期前列腺癌病人应采取积极的综合治疗措施。睾丸切除或口服已烯雌酚 抗凝剂是经济有效的内分泌治疗。     

内镜注射硬化剂治疗晚期前列腺癌和膀胱癌大出血的探讨

目的：探讨内镜注射硬化剂治疗晚期前列腺癌和膀胱癌引起的膀胱内顽固性出血的疗效.方法：对15例患者经膀胱镜检查明确出血部位,在出血灶内和出血灶周围联合注射聚桂醇治疗晚期前列腺癌和膀胱癌引起的膀胱内顽固性出血.结果：15例患者治疗后1周左右血尿停止,膀胱镜复查肿瘤体积均有不同程度缩小.结论：内镜注射硬化剂治疗晚期前列腺癌和膀胱癌能明显止血,延长生存时间,改善生活质量,无并发症,是一种简单、高效、微创的治疗新方法.     

新辅助内分泌治疗联合腹腔镜前列腺癌根治术治疗高危及局部晚期前列腺癌的临床研究

目的:探讨新辅助内分泌治疗联合腹腔镜前列腺癌根治术治疗高危及局部晚期前列腺癌的可行性及临床效果。方法:回顾性分析2015年1月～2017年1月临沂市中心医院确诊的36例高危及局部晚期前列腺癌患者临床资料,先行3个月辅助内分泌治疗,再行腹腔镜前列腺癌根治术,术后即刻给予辅助内分泌治疗。结果:手术均获得成功,无中转开放手术。平均手术时间为(201±21) min,平均出血量为(240±122) ml,平均住院时间为(20.6±2.3) d,平均术后留置尿管和引流管时间分别为(14.8±3.8) d和(5.6±2.8) d,切缘阳性5例(13.9%),淋巴结阳性11例(30.6%),术后尿失禁2例,尿瘘1例,勃起功能障碍22例。术后随访12～36个月,平均24个月,术后1年尿控满意率为91.6%(33/36),术后1、2年生化复发率分别为25.0%(9/36)和38.9%(14/36)。结论:新辅助内分泌治疗联合腹腔镜下前列腺癌根治术治疗高危及局部晚期前列腺癌安全、可行,但有较高的淋巴结阳性率和生化复发率,术后需要进一步治疗及随访观察。     

前列腺癌的流行病学特征及晚期一线内分泌治疗分析

目的 分析北京、上海、广州的三个中心前列腺癌的流行病学特征,初步反映中国发达地区的前列腺癌现状.对晚期前列腺癌患者内分泌治疗相关资料进行分析,寻找内分泌治疗效果以及生存预后的预测因子.方法 收集三个中心525例前列腺癌患者的临资料,进行流行病学分析.并对其中272例资料完整的晚期前列腺癌患者的内分泌治疗效果以及生存预后进行分析.结果 68.0%的患者确诊时已属于晚期,80.2%的患者以内分泌治疗为主要治疗手段.Gleason分值、有无骨转移和血清前列腺特异性抗原最低点是晚期前列腺癌疾病进展的独立预后因子.结论 绝大多数患者在确诊时已经为疾病晚期,内分泌治疗是主要治疗方法.Gleason分值、有无骨转移和PSA最低点是晚期前列腺癌疾病进展的独立预后因子.     

晚期前列腺癌联合雄激素阻断治疗的长期随访

目的:了解晚期前列腺癌联合雄激素阻断治疗的长期生存率。方法:选取1993年1月~2000年1月初采用联合雄激素阻断治疗的59例前列腺腺癌患者,其中28.81%和45.76%为临床局部晚期(T3-4 N0M0期)和转移(TxNxM+期)病例,全部随访5年以上。结果:全组病例3、5、7年的总体生存率分别是79.36%、61.46%、49.15%,其中,临床局部晚期和转移者的5年生存率分别为80.77%和32.65%,而高分化腺癌和低分化腺癌的5年生存率分别为86.21%和30%(P<0.01)。另外,PSA>30μg/L时其长期生存率有明显下降趋势。结论:采用内分泌治疗的晚期前列腺癌,病理低分化、临床分期达T3 c-4NxMx或TxNxM+期及PSA>30μg/L均提示预后较差,晚期前列腺癌病例的治疗应综合多因素,选择个体化方案。     

前列腺癌实验研究现状与展望

前列腺癌是泌尿系统最常见的恶性肿瘤之一, 在全球范围内发病率不断升高, 严重危害老年男性健康, 且国内大部分患者确诊时已属于局部晚期或转移性前列腺癌。尽管手术、放疗、化疗及新型内分泌治疗等多模式治疗提高了患者的生存期, 但每年仍有很多患者死于前列腺癌。随着各种实验技术方法的发展和不断运用, 人们对前列腺癌的发生发展等方面取得了新的研究进展。本文将就前列腺癌实验研究的最新进展进行综述。     

晚期前列腺癌的诊断与治疗(附41例报告)

目的:提高晚期前列腺癌的治疗效果。方法:回顾性分析采用睾丸切除术、内分泌治疗、放射治疗和同位素治疗等综合治疗的41例晚期前列腺癌患者资料。结果:41例经随访3～12个月,尿路梗阻症状均有不同程度改善,前列腺明显缩小,血清前列腺特异性抗原迅速降低,骨痛缓解。结论:积极的综合治疗能明显提高患者的生活质量     

前列腺癌的放射治疗进展

在前列腺癌的治疗中,放射治疗处于重要的地位。早期前列腺癌的放射治疗可以达到根治的目的,疗效与前列腺癌根治性手术相近。而局部晚期的前列腺癌以放射治疗为主,有远处转移者放疗也可减轻症状,改善生存质量等。本文主要对前列腺癌放疗最新应用情况及技术新发展作一综述。     

抗雄激素分子靶向治疗前列腺癌药物的新进展

前列腺癌作为男性泌尿系统常见的恶性肿瘤,已经严重威胁我国男性健康。药物治疗作为转移性或局部晚期前列腺癌主要的治疗手段,对于延缓疾病进展、改善患者预后显得尤为重要。目前针对雄激素轴线进行的分子靶向治疗的新疗法,更加精确地针对雄激素或雄激素受体发挥作用,为延长患者存活率提供了可能。现就目前抗雄激素分子靶向治疗前列腺癌相关研究现状及药物做一综述。     

Usefulness of chosen websites concerning diseases of the spine at different stages of the therapy

In the last years a huge increase in the accessibility to the Internet came. At the this paper we are pointing demonstration out websites, mainly English-speaking, which according to our assessment are very well designed conerning content that is published at them as well as the way of presenation of this content. Thanks to these thematic websites it is easier for the sick to find datum about one's diseases, as well as for doctors to reach patients, both with the information and with the therapeutic offer.     

Clinical significance of computerized tomography of the posterior area of the foot

Computertomographic examinations of the hindfoot in the frontal and horizontal view will show us morphological findings, which we could not see with conventional X-ray-technique. Out of these findings we are able to control our operative reconstruction as well as late changes in bone healing. The horizontal view will show us the osseous structures of the talus and calcaneus as well as of the navicular and cuboid bone, as it is necessary for preoperative evaluation of the hindfoot.     

Hormonal Regulation of the Immune Microenvironment in the Mammary Gland

It is well established that the development and homeostasis of the mammary gland are highly dependent upon the actions of ovarian hormones progesterone and estrogen, as well as the availability of prolactin for the pregnant and lactating gland. More recently it has become apparent that immune system cells and cytokines play essential roles in both mammary gland development as well as breast cancer. Here, we review hormonal effects on mammary gland biology during puberty, menstrual cycling, pregnancy, lactation and involution, and dissect how hormonal control of the immune system may contribute to mammary development at each stage via cytokine secretion and recruitment of macrophages, eosinophils, mast cells and lymphocytes. Collectively, these alterations may create an immunotolerant or inflammatory immune environment at specific developmental stages or phases of the menstrual cycle. Of particular interest for further research is investigation of the combinatorial actions of progesterone and estrogen during the luteal phase of the menstrual cycle and key developmental points where the immune system may play an active role both in mammary development as well as in the creation of an immunotolerant environment, thereby affecting breast cancer risk.     

Anionic fixed charges in the fenestrated capillaries of the mouse mesentery

Previous studies showed the existence of submesothelial fenestrated capillaries in the human parietal and rabbit diaphragmatic peritoneum, as well as in the mouse mesentery. The present study demonstrates the presence of electronegative fixed charges at the luminal aspect of endothelial cells, as well as long the subendothelial basement membrane of the fenestrated capillaries of the mouse mesentery. This situation will eventually preclude the transfenestral passage of anionic plasma proteins. On the other hand, fenestrated capillaries are much more permeable to water and small-molecular-size solutes than those of the continuous type. Therefore, the high hydraulic conductivity of fenestrae may well imply that a substantial part of water and small solutes leave the blood compartment through the fenestral channels.     

Surgical management of the deep plantar abscess in the diabetic patient

The authors report the case of a deep plantar abscess in a diabetic patient. The pathophysiology of diabetic foot lesions as well as classification is discussed. The philosophy of local radical debridement involving ray resection, as well as postdebridement management is discussed in detail.     

Dermoid cyst of the floor of mouth

A case report of a 30-year-old male with a huge suprahyoid neck swelling and causing respiratory as well as oral function difficulties is reported. The mass was enucleated through oral route, following which normal oral functions as well as respiratory ease were restored. The gross appearance was consistent with dermoid form of congenital cyst of the mouth floor.     

烧伤及脓毒症中骨骼肌有氧糖酵解及其发生机理的实验研究

目的观察和验证正常大鼠骨骼肌组织是否存在有氧糖酵解的生理过程,烧伤早期和脓毒症状态下骨骼肌组织有氧糖酵解过程是否发生显著的变化。方法借助大鼠烧伤和脓毒症模型,建立伸趾长肌和比目鱼肌的充分供氧离体孵育系统,采用ＮＡＤＨ荧光探针方法,检测骨骼肌组织细胞乳酸的产生量及其变化。结果在可靠的肌肉组织充分供氧离体孵育系统中,两种肌肉组织在烧伤后和脓毒症情况下乳酸产生量均较正常对照组有不同程度的增加;不同类型的肌肉组织有氧糖酵解的水平及其在烧伤后和脓毒症状态下有氧糖酵解过程的改变具有各自不同的特点。结论在烧伤和脓毒症情况下,骨骼肌细胞存在有氧糖酵解增强的病理生理过程,即组织缺氧并非细胞乳酸产生增加的唯一原因。对烧伤及脓毒症中骨骼肌有氧糖酵解及其发生机理的深入分析和研究,有重要的理论和临床意义。     

Exercise Induced Chronic Compartment Syndrome of the First Dorsal Interosseous Compartment of the Hand: A Case Report

Exercise-induced chronic compartment syndrome in the first dorsal compartment is an uncommon entity and relatively rare condition which is not very well understood. It is a usually activity-related condition and is associated with decreased function of muscle with intracompartmental swelling. We present a case with proven exercise-induced raised compartment pressure that responded well to surgical fasciotomy.     

Multidigit camptodactyly of the hands and feet

A clinical case of a 12-year-old boy who presented with multidigit, nonsyndromal, progressive camptodactyly is discussed. While bilateral little finger camptodactyly is well described, there is no documentation of camptodactyly involving all fingers and many toes as well as both proximal (PIP) and distal interphalangeal (DIP) joints. This patient responded well to surgery, which was performed on four toes and seven fingers, despite having established radiographic changes of camptodactyly in the PIP joints as well as two DIP joints. This case illustrates that in the skeletally immature patient, successful surgical outcomes can occur even in patients with radiographic bone changes, which themselves may be reversible following PIP contracture release. This patient’s separate fingers presented with deformity at different stages. A single patient with multiple digit involvement is illustrative of the range of clinical presentations and treatment options for camptodactyly. This article serves to inform hand surgeons about the potential consequences of avoiding surgical treatment, the need for a severity staging system, and the breadth of presentations in camptodactyly.     

Surgical treatment of degenerative osteoarthritis of the fingers

Degenerative osteoarthritis of the long fingers is rare and surgical management is often necessary if there is joint pain, however this indication should not only be based on radiographic imaging. The specific anatomical problems of the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are described. The surgical approach for each joint is described as well as functional management, in particular that of the extensor apparatus. Mobility should always be preserved for the MCP, arthroplasties are recommended for the PIP except for the index, and arthrodesis for the DIP. The different and most frequently used implants are described as well as the indications and expected results. The indications are discussed in relation to the limited results in the literature as well as the preferences of a panel of French hand surgeons.