中西医结合治疗放射性脑脊髓病的临床观察

目的探讨中西医结合治疗放射性脑脊髓病的治疗价值。方法将诊断为放射性脑脊髓病36例随机分成西医组和中西医结合组进行疗效比较。结果中西医结合组起效快，疗效持久，避免了激素反弹及其不良反应；西医组起效快，疗效短，激素用药时间长，激素减量期间病情易反弹，不良反应大。结论中西医结合组对放射性脑脊髓病的疗效显著，对提高患者生存质量起到了积极作用。     

中西医结合治疗放射性脑脊髓病的临床观察

目的探讨中西医结合治疗放射性脑脊髓病的治疗价值。方法将诊断为放射性脑脊髓病36例随机分成西医组和中西医结合组进行疗效比较。结果中西医结合组起效快,疗效持久,避免了激素反弹及其不良反应;西医组起效快,疗效短,激素用药时间长,激素减量期间病情易反弹,不良反应大。结论中西医结合组对放射性脑脊髓病的疗效显著,对提高患者生存质量起到了积极作用。     

鼻咽癌放射治疗后脑脊髓损伤的临床和影像学诊断

目的　探讨鼻咽癌患者放射治疗后脑脊髓放射性损伤的临床和影像学诊断。方法　对 32例鼻咽癌放射治疗脑脊髓放射性损伤患者的临床表现、CT及MRI表现进行回顾性分析。结果　 32例中共发现 4 5个损伤病灶 ,颞叶 30个 (占脑损伤病灶的 70 % ) ,脑干 13个 ,颈段脊髓 2个。其中 6例放射性颞叶损伤无临床症状。CT对颞叶放射性损伤的检出率为 87% ,对脑干损伤的检出率仅 2 9%。放射性颞叶损伤在CT图象上主要表现为指状低密度。MRI检查T1WI图象上放射性脑脊髓损伤均表现为低或等信号 ,T2 WI图象上为高信号或混合信号 ,颞叶损伤可伴有周围指状分布水肿信号 ,86 %病灶有增强效应 ,中间有不增强区。结论　放射性脑脊髓损伤的临床表现无特征性 ,亦可无症状 ,CT及MRI表现具有一定的特征性 ,结合病史可做出诊断。MRI在诊断脑干、脊膜损伤上优于CT。     

鼻咽癌放射性脑病10例分析

 脑脊髓的放射性迟发性损伤是头颈部癌放疗后发生的一种较为严重的并发症。近年来虽然对深部组织包括中枢神经系统的放射性损伤较为注意,但关于放射性脑病的资料并不多。     

谈谈鼻咽癌外照射的护理

放射治疗是鼻咽癌的主要治疗方法,常引起身体各种放射反应。全身反应有疲乏、食欲下降、恶心、呕吐和白血球减少等;局部皮肤可发生红斑,干、湿性皮炎,皮下组织萎缩纤维化;口腔合并症如口干、放射性龋齿、颌骨骨髓炎、张口困难等,还可能发生脑脊髓的放射后遗症——放射性脑病,脊髓软化等;同时还可并发鼻咽出血。但是,只要我们积极做好有     

放射性肠炎的中医治法研究进展

本文通过研究中医治疗放射性肠炎现状,以期为临床中医治疗放射性肠炎提供简单有效治法。对近5年发表在核心期刊及硕博论文中医治疗放射性肠炎的相关文献进行从病因病机、治则、具体治法、名中医经验四方面分析总结归纳。现代中医家及国家级名中医多认为放射性肠炎应根据临床症状及发生时期分为急性期与慢性期,急性期以湿热瘀阻下焦为病机,慢性期以脾肾亏虚为病机,总病机为本虚标实,治疗应以“整体观念辨证辨病论治”“急则祛邪、缓则扶正”为治疗原则,总体急性期以清热利湿、解毒化瘀止泻法,慢性期以健脾益气、渗湿止泻法,温阳补肾、固肠止泻法为具体治法取得良好的效果。因此,放射性肠炎中医治疗具有良好的优势,选择合适的治法具有事半功倍的效果,临床疗效确切。     

何杰金氏病胸腔大射野照射后的 X 线表现、时间与剂量关系的研究

胸腔何杰金氏病应用大射野放射治疗,作者回顾检查了患者的胸腔放射反应。皆用钴~(60)治疗。严格选择病人,即以前用过放射治疗、化疗、肺实质有疾患者、或随诊 X 片检查不充分者皆行排除。20例中19例有改变;即13例显示放射性肺炎、6例胸膜肥厚。19例出现放射性纤维化或呼吸量减小。放射性肺炎一般在放射治疗结束后8～12周出现。放射性     

放射性延脑颈髓病1例

放射性延脑颈髓病１例蔡白振，唐启信海南省人民医院放疗科（海口市５７００１１）鼻咽癌放疗后放射性延脑颈髓病罕见，本文报告１例。患者男性，３２岁，１９９２年１２月因鼻咽癌Ｔ２Ｎ２Ｍ０Ⅲ期、低分化鳞状细胞癌于外院放疗。颈左上肿大淋巴结２个，大者４ｃｍ×３ｃ...     

对放射性肠炎的认识及其可能的机制探讨

放射性肠炎严重影响盆腔肿瘤放疗患者的生活质量,作为一种放疗相关的肠道炎症,相关的基础研究显示放射性肠炎本质上是一种黏膜的炎症,由于程序性坏死可能介导了炎症性肠病的发生,因此,同样作为肠道炎症性疾病的一种,程序性坏死可能也介导了放射性肠炎的发生发展。本文拟对放射性肠炎的本质以及可能的发生机制进行综述,期待能够指导放射性肠炎的治疗,进而有望提高患者的生活质量。     

头颈部肿瘤根治性放疗后的远期不良反应

放射治疗是头颈部肿瘤常用的治疗手段.虽然包括三维适型技术在内的精确放疗可有效提高肿瘤的局部控制率及治愈率,但肿瘤周围的腮腺、脑脊髓、颅神经等正常组织会受到一定剂量的放射.因此,部分患者治疗后可能出现放射性损伤从而使生存质量降低,远期不良反应对放疗后长期生存者的影响尤为显著.减少放射损伤的关键在于控制正常组织的受放射体积和剂量.本文对头颈部肿瘤放射治疗相关正常组织损伤的发生机制及剂量体积效应关系作一综述.     

Encephalomyelopathy following intrathecal methotrexate treatment in a child with acute leukemia

A previously undescribed type of encephalomyelopathy after prophylactic intrathecal methotrexate (MTX) treatment for acute leukemia is reported. The patient was treated systemically with vincristine, MTX, stereoids and mercaptopurine. Radiation therapy was not given. The neurologic symptoms started 24 hours after the completion of the fifth intrathecal MTX instillation and death ensued 18 days later. The lesions consisted of superficial and sharply circumscribed areas of incomplete necrosis with astrocytosis on the base of the brain and along the insula regions, around the foramina of Luschka, and over the superior and inferior colliculi. Similar superficial lesions were found over the surface of the cerebellum and along most of the surface of the spinal cord. Most of the affected areas in the brain were located under the large subarachnoid cisterns. In the cord the lesions were most pronounced along the entrance zones of the roots. There was also a severe loss of anterior horn cells. There were no signs of meningeal leukemia, no pathological changes were caused by the intrathecal MTX treatment.     

Intensive 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), NSC #4366650 and cryopreserved autologous marrow transplantation for refractory cancer. A phase I-II study

One hundred forty-three patients with refractory cancer were treated with intensive BCNU (600-2850 mg/m2) and autologous marrow transplantation to determine the maximum tolerated dose and antitumor effects of this regimen. Recovery from severe pancytopenia in less than 4 weeks after transplantation occurred in 92.8% of evaluable patients, suggesting the efficacy of the autologous marrow in limiting the prolonged myelosuppression anticipated with intensive BCNU. Serious extramedullary toxicity was encountered at BCNU 1200 mg/m2, where a 9.5% incidence of fatal interstitial pneumonitis and a 3.0% incidence of fatal hepatic necrosis was observed. Higher BCNU doses, 1500 to 2850 mg/m2, were associated with a 35.3% incidence of fatal hepatotoxicity. Fatal encephalomyelopathy was encountered in two patients given BCNU 2250 and 2850 mg/m2. One patient who received the highest cumulative dose of BCNU (3450 mg/m2 in 2 courses) died of cardiac necrosis. Other serious extramedullary toxicities were not encountered, even in the 14 patients who survived from 1 to nearly 5 years after BCNU therapy. Antitumor responses occurred in 40.0% of evaluable patients; a dose effect could not be evaluated due to patient heterogeneity. The BCNU doses associated with acceptable toxicity, 600 to 1200 mg/m2, produced a 37.5% total and an 11.3% complete response (CR) rate, including five patients with prolonged CRs of 1 to nearly 5 years. Notable among the CRs was the 25.0% CR rate in previously untreated metastatic melanoma, and the production of CRs in malignant disease in the central nervous system (CNS) including melanoma, lung cancer, adenocarcinoma of unknown primary, acute leukemia and glioblastoma multiforme. It is concluded that augmented doses of BCNU can be given when autologous marrow transplantation is used to limit myelosuppression. Lung and liver toxicity prevent the use of BCNU doses greater than 1200 mg/m2; neurotoxicity, and perhaps cardiotoxicity, are manifestations of the highest doses used in this study. The antitumor activity of BCNU 600 to 1200 mg/m2 remains to be determined for most neoplasms; these results suggest improved results in melanoma and CNS malignancy compared to conventional-dose BCNU therapy.     

Fruit and vegetables and cancer risk

The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established. For cancers of the upper gastrointestinal tract, epidemiological studies have generally observed that people with a relatively high intake of fruit and vegetables have a moderately reduced risk, but these observations must be interpreted cautiously because of potential confounding by smoking and alcohol. For lung cancer, recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and reduced risk. For other common cancers, including colorectal, breast and prostate cancer, epidemiological studies suggest little or no association between total fruit and vegetable consumption and risk. It is still possible that there are benefits to be identified: there could be benefits in populations with low average intakes of fruit and vegetables, such that those eating moderate amounts have a lower cancer risk than those eating very low amounts, and there could also be effects of particular nutrients in certain fruits and vegetables, as fruit and vegetables have very varied composition. Nutritional principles indicate that healthy diets should include at least moderate amounts of fruit and vegetables, but the available data suggest that general increases in fruit and vegetable intake would not have much effect on cancer rates, at least in well-nourished populations. Current advice in relation to diet and cancer should include the recommendation to consume adequate amounts of fruit and vegetables, but should put most emphasis on the well-established adverse effects of obesity and high alcohol intakes.     

Religiosity and Physical and Emotional Functioning Among African American and White Colorectal and Lung Cancer Patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Cell and tissue interactions in carcinogenesis and metastasis and their clinical significance

This review describes a new vision for future directions in the study of metastatic cancer biology and pathology. It is based upon clinical and experimental observations on the constituent cell lineages within a neoplasm and on tumour-host interactions. The vision incorporates information from studies in population biology, developmental biology and experimental pathology as well as investigations upon human malignant disease. The assembled information reveals that invasion and metastasis are supra-cellular manifestations of "emergent behavior" among combinations of normal and malignant cell lineages in vivo. Emergent behavior is a combinatorial interactive process in which a population displays new traits which cannot be achieved by individuals acting separately and which subside when the specific population mix disaggregates. Disruption of such pathological interactions in the field of a developing primary or secondary tumour is, therefore, required to disable the malignant population and arrest progression without tissue destruction. These conclusions originate, in part, from principles which govern the sociobiology and group behavior of bees, ants, fish, birds and human societies. In all these social organisms, external factors can disrupt signaling mechanisms and induce expanding self-perpetuating rogue behavior, leading to social disintegration. These principles also apply to cellular societies composing higher animals, which likewise need intrinsic rules to maintain social order and avoid anarchy, and recognition of this is essential for advancing future research on the mechanisms involved in carcinogenesis and metastasis. Summarised evidence is presented here to support the conclusion that miscommunications between cells and tissues in the region of the developing tumour and its metastases are the main direct perpetrators of malignant disease. Genetic lesions (mutations, deletions, translocations, reduplications, etc.), commonly seen in cancers, can significantly disrupt important molecular pathways in the networks of communications needed to sustain orderly tissue/organ structure and function. However, genetic lesions can also, themselves, be induced by abnormal cell interactions initiated by extrinsic carcinogenic agents such as chemicals, viruses, hormones and radiation. The evidence shows that, irrespective of the initiating cause, it is this miscommunication in the region of a developing tumour and its metastases that is ultimately responsible for the emergence and progression of the disease. The article describes how this information collectively, provides a framework for designing specific novel therapeutic approaches targeting the cell and tissue interactions driving tumour metastasis and its manifold effects on the whole body.     

Occupational and environmental radiation and cancer

Epidemiologic evidence on the relation between occupational and environmental radiation and cancer is reviewed. Studies of pioneering radiation workers, underground miners, and radium dial painters revealed excess cancer deaths and contributed to the setting of radiation protection standards and to theories of carcinogenesis. Occupational exposures today are generally much lower than in the past, thus any associated increases in cancer will be difficult to detect. Pooling investigations of these more recently exposed workers, however, has the potential to validate current estimates of risk used in radiation protection. New information on the effects of chronic radiation exposure also may come from studies in the former Soviet Union of Chernobyl clean-up workers and of workers at the Mayak nuclear facilities. Studies of environmental radiation exposures, other than radon, are largely inconclusive, due mainly to the difficulties in detecting the low risks associated with low dose exposures. Thyroid cancer, however, has been linked to environmental radiation from the Chernobyl accident and from nuclear weapons tests. Low-level radiation released during normal operations at nuclear plants has not been found to increase cancer rates in surrounding populations. Radon, a human carcinogen, is the most ubiquitous exposure to human populations; remediating high residential-radon levels is recommended, recognizing that the exposure can never be removed completely because it occurs naturally.     

VEGF及KDR在大肠腺瘤和腺癌中的表达及意义

目的：探讨VEGF和KDR在大肠腺瘤和大肠腺癌中的表达及临床病理特征的关系。方法：大肠腺瘤和大肠腺癌组织标本各100例,采用免疫组织化学染色法检测VEGF和KDR在标本中的表达情况。结果：VEGF和KDR在大肠腺癌组中的阳性表达明显高于大肠腺瘤组（P〈0.05）;在正常大肠黏膜均未见VEGF和KDR表达的阳性染色;VEGF阳性表达组中KDR的阳性表达率为70%,显著高于VEGF阴性表达组中KDR的阳性表达率16%,两组比较有统计学意义（P〈0.01）。结论：大肠腺癌组织中KDR的表达与肿瘤大小、转移情况、浸润深度密切相关;VEGF和KDR在大肠腺瘤中的表达与患者的年龄、性别及分型均无相关性,而与增生程度相关（P〈0.05）。在大肠腺癌患者中VEGF及KDR表达更高,二者具有协同效应。     

New and emerging radiosensitizers and radioprotectors

The combination of chemotherapy and radiation has led to clinical breakthroughs in several disease sites, and current work continues to define optimum combinations of proven chemotherapy as well as more recently available, noncytotoxic agents. Administration of systemic therapies allows modulation of radiation response to improve tumor control (radiosensitization) or to prevent normal tissue toxicity (radioprotection). Substantial progress has been made in identifying the targets of standard chemotherapeutic radiation sensitizers and protectors as well as in the introduction of a new generation of molecularly targeted therapies in combination with radiation. We have reviewed the most recent, predominantly early phase clinical trials combining systemic agents with radiation. Although the proof of an improved schedule ultimately needs to come from well-run Phase III trials, the search among schedules could be shortened by the use of surrogate endpoints such as presence of active drug metabolites in the tumor. This has been accomplished only in a few cases and needs to become a more standard part of radiation sensitizer and protector trials.