食道贲门双原发癌：附6例报告

本文报告食管癌并存贲门癌６例，全部病例均经手术病理证实，没有手术死亡和术后并发症发生。作者认为：由于术前漏诊率高，应提高对该病的警惕，Ｘ线钡检对确有重要价值。术中应常规检查管和贲门部，，并尽可能对所有肿瘤一次性切除。     

颅后窝髓母细胞瘤的治疗（附89例临床分析）

目的对近几年收治的儿童髓母细胞瘤患者的临床资料进行回顾性分析，旨在提高对该疾病的认识和治疗效果。方法89例全部采用手术切除加术后放疗。结果手术全切除72例、次全切除17例；术后2例死于脑干功能衰竭，2例术后2月出现脑积水，3例出现缄默症，2例上消化道出血，所有患者均有不同程度的发热；随访52例，术后3年无瘤生存49例，桥小脑角1例术后7年原部位复发。结论手术应尽量全切并注意保护脑干及蛛网膜下腔，若肿瘤较大者应首先分块切除中心部位，减少体积后再沿边界切除，以减少术后并发症；术后放疗应作为常规治疗手段，放疗范围及剂量应视患者年龄而定。     

复发性肝癌再手术问题探讨

作者对１７例复发性肝癌再手术进行分析，认为对首次术后患者，定期Ｂ超结合ＡＦＰ检查可早期诊断复发性肝癌，一经发现应尽早手术，术式以肝段、亚肝段切除为佳，使用术中Ｂ超有利于引导手术及发现微小病灶。     

分化型甲状腺癌再手术42例分析

１９８５年１月至１９９５年１０月，４２例分化型甲状腺癌施行了再手术治疗。其中男性７例，女性３５例。再手术原因；原发癌灶残留；术后复发；对侧甲状腺及对侧颈淋巴结出现癌灶，再手术方式：原发癌灶局切者应再次切除残叶及峡部；对肿瘤侵出包膜者，作者认为应放宽预防性淋巴结清扫术的指征，有淋巴结转移者施行生或功能性颈淋巴结清扫术；对侧腺叶出现癌灶或对侧出现颈淋巴结转移者，应做对侧甲状腺癌根治手术。     

分化型甲状腺癌再手术42例分析

１９８５年１月至１９９５年１０月，４２例分化型甲状腺癌施行了再手术治疗。其中男性７例，女性３５例。再手术原因：原发癌灶残留；术后复发；颈淋巴结转移灶残留；对侧甲状腺及对侧颈淋巴结出现癌灶。再手术方式：原发癌灶局切者应再次切除残叶及峡部；对肿瘤侵出包膜者，作者认为应放宽预防性淋巴结清扫术的指征，有淋巴结转移者施行传统性或功能性颈淋巴结清扫术；对侧腺叶出现癌灶或对侧出现颈淋巴结转移者，应做对侧甲状腺癌的根治手术。     

连台手术术前禁食时间对原发性肝癌患者术后血糖水平的影响

目的探讨连台手术术前禁食时间对原发性肝癌（primarylivercancer，PLC，简称“肝癌”）患者术后血糖水平的影响，为临床上减少术后应激性高血糖的发生提供依据。方法将96例行肝癌切除术的患者根据手术开始时间分为连台组和首台组，其中连台组40例，首台组56例，比较两组术前禁食时间及术前、术后第1日、第3日、第5日、第7日的空腹血糖值。结果连台组术前禁食时间长于首台组（P〈0．01），连台组术后第3日、第5日、第7日的空腹血糖值高于首台组（P〈0．01）。结论连台手术术前禁食时间延长可能是导致肝癌患者术后血糖水平升高的原因之一，临床上应重视对连台手术患者进行个体化的术前饮食指导，以减少术后应激性高血糖的发生。     

自体结肠平滑肌游离移植原位重建肛门术（附11例报告）

从１９９４年５月至１９９５年７月，作者对１１例低位直肠癌采取Ｍｉｌｅｓ术后结肠平滑游离移植进行原位重建肛门，手术效果满意。文中重点介绍了手术方法，并对手术适应证，移植肌片的生存、肛门功能和术中应注意的问题进行了讨论。     

食管贲门癌患者围手术期血液流变学的改变及临床意义

我们对２１例食管贲门癌（研究组）开胸手术的男性患者手术前后血液流变学的变化进行了研究，并取２５例健康人与研究组术前比较。结果表明：研究组血粘度高于对照组（Ｐ＜０．００１），术前显著低于术后即刻和术后１天（Ｐ＜０．０１），血粘度升高可能是食管贲门癌治疗效果差的原因之一，术后血粘度升高与心肌梗塞的发生可能有一定关系。为此，老年患者应重视围手术期处理，血粘度升高者，手术前后应采取降低血粘度的措施，尤其是术后２天内尽量少用增加血粘度的胶体液，防止血粘度过高引起的心脏并发症。     

早期NSCLC患者全胸腔镜肺叶切除术的临床应用研究进展

肺癌是世界上患病率和死亡率增长最快的恶性肿瘤，对人类的健康和生命有巨大威胁，其中非小细胞肺癌（NSCLC）的占比约为80%~85%，需引起高度重视。对早期NSCLC患者应积极实施根治术治疗以延缓病情发展，延长生存期。随着微创技术的发展和医疗设备的更新，全胸腔镜肺叶切除术作为一种微创术式已经在早期NSCLC患者临床治疗中得到了广泛的应用，且其相较于传统开放手术的优势也已得到该领域工作者的一致认可。本文首先探讨全胸腔镜肺叶切除术的解剖学基础，总结其适应证和禁忌证和手术流程，然后重点探讨其在早期NSCLC患者中的优劣，以期为临床治疗方案的选择提供系统化的参考。未来，应拓宽该术式的适应证，改进和优化手术切口的选择、更新术前和术中定位方法，进一步探讨该术式对远期生存率的影响，还应关注如何降低手术难度和费用。     

原发性胃肠道恶性淋巴瘤诊治探讨

目的：探讨原发胃肠道恶性淋巴瘤的临床特征、术前提高诊断率的有效措施、最佳手术方式及术中注意事项与术后综合治疗方案。方法：对34例PGIML进行回顾性分析并结合有关文献对PGIML诊话进行探讨。结果：PGIML术前漏误诊率迭85.8％92.3％，全组均行手术治疗，大部分术后行化(放)疗，单纯手术组3年、5年生存率分别为30.0％和10.0％，明显差于手术加化(放)疗组的72.7％和63.7％。结论：PGIML术前应采用内镜、X线、CT、分子生物学等各种手段明确诊断。治疗不应单纯手术，术后应辅以化疗和(或)放疗以提高长期存活率。     

低级别胶质瘤复发、恶变中VEGF、EGFR表达的变化及意义

目的 低级别胶质瘤预后的决定因素很多,但即使是相同情况下预后也可以明显不同。部分低级别胶质瘤术后很快复发,且伴有病理级别的升高,这部分病人的预后较差。本研究旨在探讨在低级别胶质瘤复发恶变中VEGF和EGFR表达的变化,并分析这些变化的意义。方法 采用免疫组化SP二步法对24对初发低级别及复发、恶变后高级别胶质瘤标本分别进行VEGF和EGFR的表达检测,分析它们在低级别胶质瘤初发和复发、恶变过程中的表达差异。结果 与初发的低级别胶质瘤标本相比,VEGF、EGFR在复发、恶变后的表达率明显升高,其表达差异有统计学意义(P＜0.05)。结论 本研究表明VEGF和EGFR在低级别胶质瘤复发、恶变中起到非常重要的作用。VEGF和EGFR的表达可以作为低级别胶质瘤预后的指标之一,并为今后胶质瘤的靶向治疗提供理论依据。     

Iatrogenic and idiopathic acute myelogenous leukemia: a comparison of clinical features and treatment complications

We have compared the clinical and laboratory features as well as treatment complications observed in 6 patients with iatrogenic acute myelogenous leukemia (I-AML) with those of 26 patients with idiopathic acute myelogenous leukemia (AML). I-AML patients were significantly younger and their disease appeared less virulent on admission than in the AML patients. Following identical chemotherapy, hemorrhagic complications and the need for platelet support were found to be similar for both groups. Major infections, including systemic candidiasis and Gram-negative septicemias, occurred 3 times more frequently among I-AML than AML patients. More marked suppression and delayed regeneration of the bone marrow also occurred in I-AML patients. These observations and other factors, such as post-splenectomy state and inherent immune deficiency among surgically staged lymphoma patients as well as radiation induced immunologic impairment, may have contributed to the increased propensity to develop infection observed in this group of patients. Five of the 6 I-AML and 17 of the 26 AML patients achieved remission. We attribute the satisfactory outcome in our I-AML patients to treatment in a protective environment and availability of facilities for hematologic supportive care.     

Radiotherapy and chemotherapy in stages I and II non-Hodgkin's lymphomas of Waldeyer's ring

Sixty-four patients with stages I and II non-Hodgkin's lymphomas (NHL) involving Waldeyer's ring treated between 1970 and 1987 were reviewed. Patients with stage II NHL were subdivided into stage II 1 (limited type) and stage II2 (advanced type) from the state of neck nodes. Stage II1 was defined as involvement of unilateral cervical nodes less than 4 cm in diameter as well as Waldeyer's ring involvement. Other stage II cases were classified as stage II2. All 17 patients with stage I NHL were treated with radiation therapy alone. Their diseases were well controlled, and none of them died of causes related to the lymphoma. Among 14 patients with stage II1 NHL, the 5-year survival rate for the 9 patients treated with radiation therapy alone was 87.5%. Until 1982, 19 of 21 patients with stage II2 NHL treated with radiation therapy alone or radiation therapy and adjuvant chemotherapy (VEMP or COPP) died within 5 years mainly of disseminated diseases. Since 1983, CHOP has been used as the main treatment as well as radiotherapy for the 12 stage II2 NHL patients. So far, only 3 of them relapsed and 2 of them died of causes related to the lymphoma. Only 1 of these 12 patients was T-cell lymphoma compared to 7 of 9 stage II2 patients before 1982. This suggests that patients with stage I and those with limited stage II can be safely treated with radiotherapy. Also aggressive chemotherapy as well as radiotherapy should be used for patients with advanced stage II NHL involving Waldeyer's ring.     

Fatigue, anxiety and depression and their management

Sickness behaviors such as fatigue, anxiety and depression play an important role in the body's defense mechanism. However, once these symptoms become chronic, they are harmful to patients with cancer by decreasing the immune reaction or exacerbating pain and other symptoms. It should be recalled that both medical and surgical interventions profoundly influence fatigue, anxiety and depression of cancer patients. Since latent fatigue, anxiety and depression may be overlooked behind somatic symptoms, communication skills are necessary to understand the suffering of patients. Routine assessment of these symptoms are essential for early intervention in the care of cancer patients. Communication skills such as careful listening and counselling are also useful methods in caring for patients with these symptoms. Although non-medical intervention is usually effective for these symptoms of fatigue, anxiety and depression, approximately 10 to 15% of patients require specific treatment by a psychiatrist. Above all, fatigue, anxiety and depression should be treated as part of the total pain experienced by cancer patients.     

Vaccination with hybrids of tumor and dendritic cells induces tumor-specific T-cell and clinical responses in melanoma stage III and IV patients

Hybrid cell vaccination was developed as therapeutic approach that aims at stimulating tumor-specific cytotoxic T-cell responses in cancer patients using hybrids of autologous tumor and allogeneic dendritic cells. We tested this concept and the efficacy of the vaccines in inducing clinical and immunologic responses in a clinical trial with melanoma stage III and IV patients. Of the 17 patients evaluated, 1 experienced a complete response, 1 a partial response and 6 stable disease with remarkably long survival times. In 11 of 14 patients analyzed, high-frequency T-cell responses to various tumor-associated T-cell epitope were induced and detectable in the peripheral blood. These immune responses were detected in clinical response patients as well as nonresponders. Failures of clinical responses in all the cases investigated correlated with loss of antigen expression and presentation. Hybrid cell vaccination thus proves effective in inducing tumor-specific T-cell responses in cancer patients.     

NK-cell and T-cell functions in patients with breast cancer: effects of surgery and adjuvant chemo- and radiotherapy

Breast cancer is globally the most common malignancy in women. Her2-targeted monoclonal antibodies are established treatment modalities, and vaccines are in late-stage clinical testing in patients with breast cancer and known to promote tumour-killing through mechanisms like antibody-dependent cellular cytotoxicity. It is therefore increasingly important to study immunological consequences of conventional treatment strategies. In this study, functional tests and four-colour flow cytometry were used to detect natural killer (NK)-cell functions and receptors as well as T-cell signal transduction molecules and intracellular cytokines in preoperative breast cancer patients, and patients who had received adjuvant radiotherapy or adjuvant combined chemo-radiotherapy as well as in age-matched healthy controls. The absolute number of NK cells, the density of NK receptors as well as in vitro quantitation of functional NK cytotoxicity were significantly higher in preoperative patients than the post-treatments group and controls. A similar pattern was seen with regard to T-cell signalling molecules, and preoperative patients produced significantly higher amounts of cytokines in NK and T cells compared to other groups. The results indicate that functions of NK and T cells are well preserved before surgery but decrease following adjuvant therapy, which may speak in favour of early rather than late use of immunotherapeutic agents such as trastuzumab that may depend on intact immune effector functions.     

Alterations in plasma lipid profile patterns in head and neck cancer and oral precancerous conditions

BACKGROUND: The changes in lipid profile have long been associated with cancer because lipids play a key role in maintenance of cell integrity. AIMS: The present study evaluated alterations in plasma lipid profile in untreated head and neck cancer patients as well as patients with oral precancerous conditions (OPC) and its association with habit of tobacco consumption. MATERIAL AND METHODS: This hospital-based case control study included 184 head and neck cancer patients, 153 patients with OPC and 52 controls. Plasma lipids including: (i) Total cholesterol, (ii) LDL cholesterol (LDLC), (iii) HDL cholesterol (HDLC) (iv) VLDL cholesterol (VLDLC) and (v) triglycerides were analysed by spectrophotometric kits. STATISTICAL ANALYSIS USED: Student's t-test was performed to compare mean values of the parameters. RESULTS: A significant decrease in plasma total cholesterol and HDLC was observed in cancer patients (P=0.008 and P=0.000 respectively) as well as in patients with OPC (P=0.014 and P=0.000, respectively) as compared to the controls. The plasma VLDL and triglycerides levels were significantly lower in cancer patients as compared to the patients with OPC (P=0.04) and controls (P=0.059). The tobacco habituates showed lower plasma lipid levels than the non-habituates. Our data strengthen the evidence of an inverse relationship between plasma lipid levels and head and neck malignancies as well as OPC. CONCLUSION: The lower levels of plasma cholesterol and other lipid constituents in patients might be due to their increased utilization by neoplastic cells for new membrane biogenesis. The findings strongly warrant an in-depth study of alterations in plasma lipid profile in head neck cancer patients.     

Vascular and neural invasion in colorectal carcinoma. Incidence and prognostic significance

The incidence and significance of histologic vascular and/or neural invasion in 77 patients with colorectal carcinoma treated over a 6-year period were analyzed retrospectively. Vascular invasion was found in 37.6% of patients and neural invasion in 14.3%. The following three types of vascular invasion were identified: tumor lining epithelium, tumor thrombi, and destruction of the vessel wall. The incidence of metastases in patients with vascular invasion was 60% as opposed to 17% in those without vascular invasions (P less than 0.0001). Survival in these patients was 29.7% and 62.2%, respectively (P less than 0.003). Metastases were found in 72.7% of patients with neural invasion, as opposed to 27% of those without neural invasion (P less than 0.01). Survival was 29.6% as opposed to 57.7% in those without neural invasion (P less than 0.003). Even among patients in the same Dukes' stage, prognosis, as determined by incidence of recurrence, metastases, and survival, was worse significantly among those patients demonstrating vascular invasion (P less than 0.03). Examination of patients with colorectal carcinoma for the presence of vascular and neural invasion may provide useful information for determining future treatment and prognosis.     

Identifying supportive and unsupportive responses of others: perspectives of African American and Caucasian cancer patients

This study uses focus group methodology to examine supportive and unsupportive responses experienced by African American and Caucasian cancer patients. Supportive responses included practical assistance, as well as people's willingness to listen, maintain a positive attitude, and pray. Unsupportive responses included others' withdrawal behaviors, patients having to support friends/family as they coped, and family/friends limiting patients' independence. Results reflect ways in which mental health providers, social workers, and health care providers can help patients express support needs, as well as how social networks can be better educated about the types of support valued by patients.     

Acute toxicity and preliminary clinical outcomes of concurrent radiation therapy and weekly docetaxel and daily cisplatin for head and neck cancer

OBJECTIVE: To examine the feasibility and efficacy of concurrent weekly docetaxel and radiation therapy as a definitive treatment for head and neck cancer (HNC). METHODS: Thirty-two patients with primary HNC, who were treated with concurrent weekly docetaxel and radiation therapy, were analysed. The distribution of the disease stage was as follows: Stage II, 18 patients; Stage III, 3 patients; Stage IVA, 7 patients; Stage IVB, 3 patients; the patient of cervical lymph node metastasis with unknown primary tumor was not assessable. The average total dose of radiotherapy was 67.5 Gy. Docetaxel (10 mg/m(2), intravenously, once a week) was given to all patients up to four cycles, and cisplatin (6 mg/m(2), intravenously, five times a week) was also administered to all patients for up to 3 weeks from the beginning of the radiation therapy. RESULTS: Only in two patients did the radiotherapy need to be temporarily interrupted due to the development of acute mucositis. Grade 3 toxicity was observed in six patients. Grade 4 acute mucositis was seen in one patient. The response rate was 100%, and complete response (CR) was observed in 30 patients (94%). At the time of the analysis, the 2 year local control and relapse-free rates in the 30 patients showing CR were 90 and 76%, respectively. CONCLUSIONS: Concurrent weekly docetaxel and radiation therapy did not affect the compliance of the patients for the radiation therapy, indicating that the acute toxicities were within acceptable limits.