选择性经皮气管造口术用于心脏重症监护病房中长时间人工呼吸的病人

长时间的控制呼吸,需行气管插管,但经喉、口、鼻的导管都有并发症。经气管的导管不仅减少死腔和呼吸阻力,而且舒适性好,可减少卧床时间。经皮扩张性气管造口术是一种公认备用的传统手术方法。在此,我们报道将这种方法应用于心脏重症病房的经验。病人和方法 78例病人(女13例,男65例),平均年龄64±14岁,所患疾病为心功能不全(40％)、复苏后的脑疾患(35％)、肺部感染(15％)及其他疾病(10％)。由于他们都需行长时间控制呼吸,是气管造口术的适应证。     

辐射对脑损害的晚期效应及中药的保护作用

目的　了解小鼠脑组织放射后的晚期损害 (智力、生存率、生存质量 )及寻找保护药物。方法　将 6 0只BALB/C小鼠分为对照和不同处理共 5组 ,各组全脑单次照射 2 2Gy ,观测各组小鼠体重及生存情况 ,小鼠学习和记忆功能的改变 ,组织病理学改变 ,比较组间差别。结果　各用药组小鼠生存率无统计学差异 ;丹参组能明显改善小鼠的学习和记忆功能 ,组间有统计学差异 ;丹参组对放射诱导的小鼠脑组织老年斑和神经原纤维缠结有明显的抑制作用。结论　所选药物复方丹参明显改善小鼠学习和记忆功能 ,对放射诱导脑组织损害的保护有病理学上的证据 ,但未能提高小鼠生存率。     

脑胶质瘤病人的生存分析

目的 探讨脑胶质瘤病人的存活、预后因素和疗效。方法 复习病历、影像学和病理资料，选择17项影响后因素进行生存分析。结果 分组年龄、肿瘤切除范围、显微手术、病理分级、核分裂、钙化、放疗和化疗等8项因素明显延长或缩短病人的生存时间。结论 运用现代新的诊疗手段，结合所筛选出的预后影响因素，注意病人治疗中的各环节，合理安排治疗模式，将有助于不断改善胶质瘤病人的预后。     

脑转移癌全脑放疗相关认知功能损害的临床研究

目的:探讨脑转移癌全脑放疗相关认知功能损害情况,以期提高临床诊治水平。方法:选取2010年5月-2013年5月65例脑转移癌患者为研究对象,以简易精神状态量表作为认知评估工具,对其放疗1-6个月进行总体认知评估,根据有无神经系统症状对患者放疗前后进行总体认知功能改变分析。结果:有无症状在性别、年龄、影响认知基础疾病、颅内转移数目、肿瘤最大直径、其他部位转移、既往化疗史中比较差异无统计学意义（P＞0.05）;而在放疗前认知评分、既往靶向治疗、原发灶癌上比较差异有统计学意义（P＜0.05）。疗效上,部分缓解发生率为27.69%,稳定发生率为41.54%,疾病进展发生率为30.77%,总有效率为69.23%;两者在基线、1、2个月MMSE评分比较差异有统计学意义（P＜0.05）,而在3、4、5、6个月的MMSE评分比较差异无统计学意义（P＞0.05）。结论:脑转移癌全脑放疗对认知功能有损害,放疗后认知功能损害最明显,其后有所恢复。     

卵巢切除对早期乳腺癌病人长期存活的作用

早期乳腺癌治疗试验合作组(EBCTCG)1995年对1980年以前开始的12项随机对照研究进行了总结分析,首次报告卵巢切除能改善早期乳腺癌病人长期存活的决定性结果。 大多数病例至少随访15年。卵巢切除分为手术切除和放射线照射两种。2102例病人年龄50岁以下(绝大多数确诊时未绝经),50岁或以上(绝大多数为围绝     

经肛管切除术对早期低位直肠癌的根治方法

经肛管切除是治疗直肠癌的一种方法。为明确该方法对早期低位直肠癌（距齿状线１０ｃｍ内）的疗效 ,研究人员分析了１９８８年～１９９８年低位直肠癌的病例资料。患者癌肿的平均直径为（２ ６５±１ １）ｃｍ ,距齿状线的平均距离为（４ ５５±１ ６）ｃｍ。结果除１例患者出现直肠穿孔 ,需结肠造口外 ,在术后的６０个月内 ,无复发病例 ,无因癌肿导致的死亡病例。提示经肛管切除术是早期低位直肠癌的根治方法。经肛管切除术对早期低位直肠癌的根治方法@苏森     

早期乳癌施行保留乳头乳癌根治术的远期效果评价

保留乳头乳癌根治术是一种在保留胸大、小肌的基础上进一步保留乳头及乳晕的改良乳癌根治手术方式。作者单位1978年至1993年9月末共施行保留乳头乳癌根治术370例,其中T_1N_0M_0者156例作为评价对象。1982年至1993年9月末间施行传统乳癌根治术(标准及改良乳癌根治术)的T_1N_2M_0病人共46例为对照组。保留乳头组平均年龄低于对照组,肿瘤距乳晕的平均距离大于对     

半胱氨酸蛋白酶抑制剂C对肿瘤患者早期肾功能损害的评估价值

目的:探讨检测血清半胱氨酸蛋白酶抑制剂C(Cys C)水平对肿瘤患者早期肾功能损害的诊断价值.方法:对811例住院肿瘤患者进行血清肌酐(Scr)、尿素(Urea)和Cys C测定,按照简化的MDRD方程计算估算的肾小球滤过率(eGFR)并将其分为5组.结果:各组Cys C、Scr和Urea随eGFR的降低逐渐升高,Cys C在各组间差异均有统计学意义(P＜0.05),而Scr和Urea在前三组中差异无统计学意义(P＞0.05).在eGFR＜60时,Cys C和Scr异常率间差异无统计学意义(P＞0.05),eGFR≥60时,两者异常率差异有统计学意义(P＜0.05).结论:Cys C能反映早期肾功能损害,敏感性高于Scr,是反映肾小球滤过功能的理想指标.     

在农村基层医院经腹腔施行12例全胃切除术的体会

胃癌是常见的恶性肿瘤之一,在农村基层医院就诊时80%以上的病例已属中、晚期,需行全胃切除者并非少数,故选择简单、安全、行之有效并适应基层医院采用的全胃     

伴有脑转移病人的原发肿瘤部位

肿瘤的脑转移虽然在肿瘤病人中并不多见,但神经病学家认为中枢神经系统的转移多到33～36%。必须确定原发肿瘤的位置,从而恰当地采取有效的治疗.中枢神经系统转移最多的是来自肺、乳腺和黑色素瘤,可是,有脑转移的病人,而相当多的没有觉察到肿瘤的原发过程.至于肿瘤定位能否提供预后的意义也有争议.本文作者研究了脑转移的120个病人,并且把对病人有关的处理和评价作了回顾性分析。作者复习了从1959～1979年以大脑损害为第一体征的120     

Nasal mucociliary clearance in patients with tracheostomy

Nasal mucociliary clearance (NMC) time was estimated in 30 tracheostomized patients (24 males & 6 females) in the age group of 13–55 years which was 7.04±0.38 minutes: The patients suffering from nose and paranasal sinus disorders; taking drugs like bromhexine; undergoing radiotherapy and smokers were excluded from the study. The nasal mucociliary clearance in 30 age & sex matched healthy controls was 9.16±0.62 minutes. The NMC was found to he significantly lowered in patients with tracheostomy (p<0.01). This decrease in NMC tune was significant in tracheostimized patients of more than 3 weeks duration (p<0.01), whereas, it was not found significantly lowered in patients with tracheostomy of less than 3 weeks duration (p>0.1).     

早期营养制剂与自制匀浆在重型颅脑损伤患者中的应用

目的 探讨早期营养制剂补充和自制匀浆膳食在重型颅脑损伤(sTBI)患者营养治疗中的应用效果.方法 于2018年1月至2019年6月选择宜宾市第二人民医院住院治疗的sTBI患者84例,随机分为营养制剂组和匀浆组,分别给予营养制剂和自制匀浆制剂,4周后观察患者营养相关指标、不良反应/并发症发生情况、格拉斯哥昏迷评分(GCS...     

Early perfusion changes in patients with recurrent high-grade brain tumor treated with Bevacizumab: preliminary results by a quantitative evaluation

Background

To determine whether early monitoring of the effects of bevacizumab in patients with recurrent high-grade gliomas, by a Perfusion Computed Tomography (PCT), may be a predictor of the response to treatment assessed through conventional MRI follow-up.

Methods

Sixteen patients were enrolled in the present study. For each patient, two PCT examinations, before and after the first dose of bevacizumab, were acquired. Areas of abnormal Cerebral Blood Volume (CBV) were manually defined on the CBV maps, using co-registered T1- weighted images, acquired before treatment, as a guide to the tumor location. Different perfusion metrics were derived from the histogram analysis of the normalized CBV (nCBV) maps; both hyper and hypo-perfused sub-volumes were quantified in the lesion, including tumor necrosis. A two-tailed Wilcoxon test was used to establish the significance of changes in the different perfusion metrics, observed at baseline and during treatment. The relationships between changes in perfusion and morphological MRI modifications at first follow-up were investigated.

Results

Significant reductions in mean and median nCBV were detected throughout the entire patient population, after only a single dose of bevacizumab. The nCBV histogram modifications indicated the normalization effect of bevacizumab on the tumor abnormal vasculature. An improvement in hypoxia after a single dose of bevacizumab was predictive of a greater reduction in T1-weighted contrast-enhanced volumes at first follow-up.

Conclusions

These preliminary results show that a quantification of changes in necrotic intra-tumoral regions could be proposed as a potential imaging biomarker of tumor response to anti-VEGF therapies.     

Early intervention with epoetin beta prevents severe anaemia in patients with solid tumours receiving platinum-based chemotherapy: results of the NeoPrevent study

Background Anaemia is common during platinum-based chemotherapy. This study aimed to evaluate the efficacy and safety of epoetin beta in the prevention of severe anaemia in patients with solid tumours receiving concomitant platinum therapy.Patients and methods In this open-label, single-arm study, patients (n = 255) with solid tumours and haemoglobin (Hb) levels ≤ 13 g/dl (men) or ≤ 12 g/dl (women) received epoetin beta 450 IU/kg (∼30,000 IU) weekly until 4 weeks after their last platinum-based chemotherapy cycle.Results An anaemia prevention response [defined as patients with a Hb response (increase in Hb level > 1 g/dl from baseline) plus patients whose Hb levels remained ± 1 g/dl of baseline throughout the study] was observed in 234 patients (92%). Response to epoetin beta was rapid. Of the 159 patients achieving a Hb response, 139 (87%) had Hb levels > 1 g/dl of baseline within 4 weeks of treatment initiation. Mean Hb levels had improved from 10.8 ± 1.0 g/dl at baseline to 12.2 ± 1.8 g/dl by the final visit. Quality of life measured by linear analogue scale assessment significantly (P < 0.01) improved in patients achieving a Hb response (n = 159).Conclusions Epoetin beta effectively prevents anaemia in most patients with solid tumours receiving concurrent platinum-based chemotherapy.     

Lymphocyte subsets in patients with brain tumors

Summary T lymphocyte subsets of peripheral blood were studied in preoperative patients with various types of intracranial neoplasms. The subsets were analysed using monoclonal antibodies against lymphocyte membrane markers, and flow cytometry was used to quantitate percent positive cells with the antibodies. Twenty-seven patients were selected for this study, including twelve patients with malignant primary intrinsic tumors histologically consistent with a diagnosis of malignant astrocytoma or glioblastoma multiforme, and fifteen patients with extrinsic tumors diagnosed as meningioma, pituitary adenoma, craniopharygnioma and neurinoma. Twenty-five age and sex-matched individuals without evidence of either local or systemic disorders served as control subjects.The results revealed that the OKT4/8 cell ratio was 1.4±0.4 in the malignant group, 1.8±0.4 in the benign group and 2.1±0.8 in the control group. The ratio was significantly lower in the malignant group than in the control group (p<0.05). Leu-11⁺ cells were found to be 9.7±4.7 in the malignant group, 9.0±3.4 in the benign and 7.8±2.7 in the control group. These results showed that Leu-11⁺ cells in the patients with malignant tumors were significantly increased in comparison with the control group (p < 0.05). The alteration of the lymphocyte subsets is considered to be an effect of neurohormones in balance through the transmission function of the brain-endocrine axis to lymphocytes in immunomodulation.     

Peri-ictal pseudoprogression in patients with brain tumor

Recent advances in the treatment of malignant gliomas have highlighted the fact that the appearance of new contrast-enhancing lesions on magnetic resonance imaging (MRI) is not always indicative of tumor recurrence. It has been suggested that transient seizure-related MRI changes could mimic disease progression (peri-ictal pseudoprogression [PIPG]). However, the clinical and MRI features associated with this situation have not been well described. Here, we consulted the databases of 6 institutions to identify patients with brain tumor who presented during the follow-up period transient MRI lesions wrongly suggesting tumor progression in a context of epileptic seizures. Ten patients were identified. All patients but 1 were long-term survivors who had initially been treated with radiotherapy. The PIPG episode occurred after a median interval of 11 years after radiotherapy. MRI features were highly similar across patients and consisted of transient focal cortical and/or leptomeningeal enhancing lesions that erroneously suggested tumor progression. All patients improved after adjustment of their antiepileptic drugs and transient oral corticosteroids, and MRI findings were normalized 3 months after the PIPG episode. Two patients demonstrated several seizure relapses with the same clinicoradiological pattern. After a median follow-up period of 3.5 years after the initial PIPG episode, only 1 patient presented with a tumor recurrence. In conclusion, in patients with brain tumor, especially in long-term survivors of radiotherapy, the appearance of new cortical and/or leptomeningeal contrast-enhancing lesions in a context of frequent seizures should raise the suspicion of PIPG. This phenomenon is important to recognize in order to avoid futile therapeutic escalation.     

Palliative care in patients with brain metastases

PURPOSE OF REVIEW: With improvements in systemic therapy, central nervous system metastases have increased in incidence in patients with cancer. Patients with brain metastases from solid tumors often have a dismal prognosis, and supportive measures are often critical in improving patient outcome. They include treatments against vasogenic edema, seizures, symptomatic venous thrombosis, and pain, and the management of iatrogenic side effects. This article reviews all the supportive care measures in patients with brain metastases, with the exception of tumor-specific chemotherapy treatments that are also used in this patient population. RECENT FINDINGS: Recently, improvement has been made in the management of the following complications of brain metastases: epilepsy and antiepileptic drug side effects, thromboembolic complications, fatigue and cognitive disorder of mixed (tumoral and/or iatrogenic) origin, pain, hematological side effects of chemotherapy, and steroids complications. SUMMARY: Patients with brain metastases are particularly prone to develop severe side effects, increased fatigue, and cognitive deteriorations following apparently minor changes in symptomatic treatments. Palliative management of brain metastasis requires a multidisciplinary approach, and it is important to avoid any treatment that is useless or harmful or has a poor toxicity/efficacy ratio.