良性肿瘤与恶性肿瘤患者血液流变学及血凝变化的比较研究

目的比较良恶性肿瘤患者的血液流变学及血凝的变化。方法观察50例健康人,100例肿瘤患者(其中50例为良性,50例为恶性),对其血液流变学指标及血小板计数、血小板聚集率指标进行比较。结果良性肿瘤患者全血黏度、血浆黏度、纤维蛋白原、血沉、红细胞压积、红细胞聚集指数、血小板计数、血小板聚集率等与健康人相比无显著性差异(P>0.05),恶性肿瘤患者上述指标均显著高于良性患者及健康人(P<0.01或P<0.05)。结论恶性肿瘤患者存在血液高黏、高凝、血细胞高聚状态。血液流变学及血凝的异常可能会促进肿瘤发生和发展。     

100例消化道恶性肿瘤患者血液流变学指标分析

比较100例消化道恶性肿瘤患者及100例非恶性肿瘤消化内科疾病患者（对照组）全血黏度、血浆黏度、血细胞比容、血沉、红细胞聚集指数、血小板计数、血小板聚集率。消化道恶性肿瘤患者全血黏度、血浆黏度、血沉、血小板计数、血小板聚集率等均显著高于对照组患者,差异有统计学意义（P〈0．01）;红细胞聚集指数以非恶性肿瘤患者高,差异有统计学意义（P〈0．05）：提示消化道恶性肿瘤患者血液流变学指标存在明显异常,具有血液高黏、高凝、高聚状态,通过血液流变学各指标的动态观察．对消化道恶性肿瘤患者诊断、治疗及预后判断有一定的临床价值．     

胃癌化疗前后血液流变学变化及意义

目的 探讨胃癌患者血液流变学情况与临床分期的关系及其对化疗的影响。方法 检测31例健康志愿者和46例胃癌患者化疗前后的血液流变学有关指标。结果 胃癌患者血液流变学全血黏度、血浆黏度、红细胞压积、血沉、血沉方程K值、红细胞聚集指数等有关八项指标均高于对照组（P＜0．05、P＜0．01）;不同期别患者之间比例Ⅲ期患者全血黏度、血浆黏度、红细胞聚集指数等指标高于Ⅱ,Ⅳ期患者（P＜0．05）;化疗后观察组上述指标除全血低切黏度、红细胞压积外均有明显降低,与化疗前比较统计学差异有显著性（P＜0．05）。结论 胃癌患者血液处于高凝状态;不同临床分期的患者血液流变学指标存在差异（P＜0．05）;化疗可能有改善肿瘤患者血液流变学指标,并可改善血液的高凝状态。     

MPV和PCT测定在恶性肿瘤患者反复血小板输注中的应用

目的 探讨血小板（PLT）减少时,肿瘤患者血小板参数MPV和PCT测定的变化规律。方法 采用SE9000全自动血液分析仪对56例反复输入血小板的恶性肿瘤患者进行血小板计数（PC）、血小板平均体积（MPV）和血小板压积（PCT）的分析比较,并同时对52例正常体检者进行血小板参数的测定。结果 反复输入血小板有效的恶性肿瘤患者,其MPV和PCT与反复输入血小板无效的恶性肿瘤患者比较,差异有统计学意义（P〈0．01,P〈0．05）,与正常对照组比较差异无统计学意义（P〉0．05）,反复输入血小板无效的恶性肿瘤患者与正常对照组比较,差异有统计学意义（P〈0．01）。结论 对于多次输注血小板的恶性肿瘤患者,除考虑患者体内易产生PLTAb导致PLT输注无效外,输注PLT前还应对患者的血小板参数进行密切观察,保证PLT输注的有效性。     

碘油栓塞化疗对肝癌合并肝硬化患者肝功能及血液流变指标的影响

[目的]评价经导管肝动脉碘油栓塞化疗对肝癌合并肝硬化患者的肝功能及血液流变指标的影响。[方法]50例原发性肝癌合并不同程度肝硬化患者，经肝动脉碘油栓塞化疗后，观察肝功能指标变化及通过Child Pugh评分评价基础肝功能状态：用血液分析系统及微循环显微镜检测血液流变学指标。[结果]治疗术前患者的Child Pugh评分为5．27±0．17．治疗后7天升高为6．74±1．30（P〈O．01），治疗后4周降低为5．83±0．55（P〈O．05）。治疗后全血低切黏度（15．29±3．68）较术前（6．33±0．62）增加（P〈0．05）；血浆黏度（2．97±0．86）较术前（2．18±0．63）增加（P〈0．05）；治疗后田牛氏加权积分（9．74±0．61）较术前（7．29±0．54）增加（P〈0．01）。6、12、24个月生存率分别为84％、64％、38％。[结论]碘油栓塞化疗可加重肝癌合并肝硬化患者微循环障碍，对肝功能有损害，但为可恢复性的。     

血清唾液酸在恶性肿瘤中的临床应用价值

目的探讨血清唾液酸（SA）在恶性肿瘤中的临床应用价值。方法采用酶法对50名健康人、90例良性疾病及160例恶性肿瘤患者血清SA的水平进行检测,分析血清SA水平在肿瘤不同病理类型及相关治疗前后的表达变化。结果恶性肿瘤各组血清SA水平均显著高于良性疾病组及健康对照组（P〈0．01）,恶性肿瘤各组阳性率亦显著高于良性疾病组（P〈0．01）;各组织学类型恶性肿瘤组血清SA水平显著高于良性疾病组及健康对照组（P〈0．01）,但各组织学类型恶性肿瘤组之间血清SA水平差异无统计学意义（P〉0．05）;恶性肿瘤患者经相关治疗后,病情好转组血清SA水平明显下降,与治疗前相比差异有统计学意义（P〈0．01）;病情恶化组血清SA水平有上升趋势,但与治疗前相比差异无统计学意义（P〉0．05）。结论血清SA对恶性肿瘤的诊断、治疗、疗效判断、病情监测及预后判断具有一定临床应用价值。     

恶性肿瘤,高血压病患者及健康人血液流变学观察

目的　探讨恶性肿瘤与血液流变学的关系。方法　对恶性肿瘤患者４４ 例与高血压病患者４２ 例及健康人４２例的血液流变学进行观察分析。结果　恶性肿瘤患者的红细胞沉降率、血浆粘度、血栓长度、血小板粘附率均高于高血压组及正常组（Ｐ＜ ０．０５ 和Ｐ＜ ０．０１）;红细胞压积低于高血压组及正常对照组（Ｐ＜ ０．０１）;血栓湿重明显高于正常组（Ｐ＜ ０．０１）;全血高切粘度平均值低于高血压组（Ｐ＜ ０．０５）,有显著性差异,晚期转移组的红细胞沉降率,血浆粘度高于非转移组（Ｐ＜ ０．０５）;血球压积低于非转移组（Ｐ＜ ０．０１）。结论　恶性肿瘤患者存在着明显的血液流变学异常,晚期患者尤其明显,提示恶性肿瘤患者处于高粘高凝状态,检测血液流变学对判断病情预测预后有一定意义,改善血液粘滞状态可以延缓病情,防止转移,预防血栓并发症发生。     

化疗对晚期非小细胞肺癌患者凝血功能的影响

目的：探讨晚期非小细胞肺癌（NSCLC）患者化疗前后凝血指标的变化及临床意义。方法：对60例肺癌患者及20例健康人的血浆凝血酶原时间（PT）、纤维蛋白原（FIB）、部分活化凝血活酶时间（APTT）和D-二聚体（D—D））水平进行测定,同时计数血小板（PLT）。结果：化疗前肺癌患者凝血指标凝血酶原时间、纤维蛋白原、部分活化凝血活酶时间、D-二聚体、血小板与正常对照组比较有显著差异（P〈0．05）;肺癌患者化疗后与化疗前各项指标相比有显著性差异（P〈0．05）。结论：晚期NSCLC患者普遍存在凝血功能异常,化疗可改善患者的凝血功能。     

消化系统恶性肿瘤患者血液流变学指标检测的临床价值

目的 探讨消化系统恶性肿瘤患者血液流变学相关指标的检测价值.方法 收取消化系统恶性肿瘤患者119例作为观察组,对其临床资料进行回顾性分析,同时收取同期健康体检的人群82例作为对照组,对2组的血液流变学指标检测结果进行观察与比较.结果 恶性肿瘤患者全血粘度以及纤维蛋白原含量与健康体检人群无统计学差异(P＞0.05),但血浆黏度、红细胞沉降率及血小板粘附率均远高于健康体检人群,血细胞比容远低于健康体检人群,差异均具有统计学意义(P＜0.05).转移组患者血浆粘度及红细胞沉降率均明显高于非转移组患者,差异有统计学意义(P＜0.05),而在其他血液流变学指标方面,2组差异无统计学意义(P＞0.05).治疗后,恶性肿瘤患者的血浆黏度明显降低,血细胞比容明显升高,与治疗前相比差异均具有统计学意义(P＜0.05);而在其他血液流变学指标比较方面,治疗前后尚无统计学差异(P＞0.05).结论 消化系统恶性肿瘤患者血液存在明显高凝状态,因此血液流变学指标对于评价肿瘤发生发展具有十分重要的意义.     

硬膜外持续镇痛对食管癌手术患者血液流变学的影响

目的：观察硬膜外术后镇痛患者的血液流变学变化，为减少术后并发症提供参考。方法：将28例患者随机分为观察组和对照组，2组患者均于麻醉前、手术结束时、术后24h和48h分别抽取外围静脉血进行血液流变学测定和比较。结果：观察组术后24h全血及血浆黏度、纤维蛋白原、红细胞压积和红细胞叠连指数始升高，48h近术前值。对照组24h上述指标始升高，其中全血黏度、纤维蛋白原升高显著，且48h时仍明显高于麻醉前(P＜0．05)。观察组红细胞可塑性变形指数增加，至48h仍高于术前（P＜0．05)，对照组渐下降至术前水平。结论：持续硬膜外术后镇痛，能够减少术后并发症，有利于术后患者的康复。     

Synchronous bilateral primary germ cell tumors of the testis: a case report and review of the literature

Synchronous bilateral primary germ cell tumors of the testis are exceedingly rare. The most common synchronous testicular tumors are seminomas, followed by embryonal carcinomas, teratocarcinomas, and choriocarcinomas. In a series of 385 patients we found nine with bilateral primary germ cell tumors of the testis (2.3%), including one with synchronous involvement of both testes. The treatment of synchronous bilateral primary germ cell tumors of the testis is in principle the same as that of solitary testicular primary germ cell tumors, and is based on tumor histology and tumor metastasis.     

Skin manifestations of endocrine and neuroendocrine tumors

The skin signs of benign and malignant endocrine and neuroendocrine tumors are manifold and early identification of these dermatologic features is crucial in initiating timely diagnosis and management. This article reviews the salient cutaneous features of these tumors that arise in the classic endocrine glands, lung and gastrointestinal tract either as individual neoplasms or as part of a syndrome.     

Pediatric brain stem tumors: patterns of treatment failure and their implications for radiotherapy

There have been conflicting opinions regarding the correct volume to be used in radiotherapy fields for brain stem tumors of childhood. Whereas many clinicians recommend limited fields designed to cover the tumor volume with a margin, some have advocated whole brain radiotherapy. Using our clinical experience at Duke University Medical Center, we have made an attempt to determine the proper irradiation volume in this group of tumors. We have evaluated 38 patients with brain stem tumors in children less than 18 years of age. The most common presenting symptoms were headache, ataxia, and hemiparesis. Thirteen patients had a histologic diagnosis made prior to treatment or post-mortem. All had either an anaplastic astrocytoma or a glioblastoma multiforme. Tumors were located in the thalamus, hypothalamus, or midbrain in 9 patients and in the pons or medulla oblongata in the remaining 29 patients. All patients received a course of radiotherapy. The mean minimum tumor dose was 52.6 +/- 5 Gy given at 1.7 to 2.0 Gy/fraction. Twenty-three patients received radiation to a limited field and 14 received whole brain irradiation. In one patient, the field size could not be ascertained. The five year survival of the total group was 39%. The survival of patients with thalamic, hypothalamic, or midbrain tumors was 73% compared with 28% for those with tumors of the pons or medulla oblongata (p = 0.0159). Eighty-eight percent of the tumor recurrences in evaluable patients (22/25) occurred within the radiotherapy fields. Patients were stratified for tumor location and no difference was observed in survival or relapse-free survival among those individuals treated with limited irradiation fields or whole brain irradiation fields. When our results are examined in conjunction with previously published data, the bulk of existing evidence supports the use of limited fields for irradiation of brain stem tumors of childhood.     

Testicular seminomas in Saudi Arabia: clinical characteristics, prognostic indicators, and recommendations for management

Thirty Saudi patients with pure testicular seminoma were treated at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia, between January 1977 and June 1983. Disease characteristics in Saudi Arabia including clinical findings, response to therapy, and prognosis are described and compared to those in other populations reported in the literature. Symptom durations were 3 to 42 months. Many of the patients presented with an extensive tumor burden and a poor performance status. There was a higher incidence of anaplastic seminoma and of cryptorchidism than in other series and a relatively high incidence of elevated betahuman chorionic gonadotropin (B-HCG). Patients initially underwent funiculo-orchiectomy. Twenty-two patients received radiation therapy and four received chemotherapy. Patients with limited disease responded well to orchiectomy and radiation therapy. However, those with extensive tumor burden had an unsatisfactory response to radiation therapy. Preradiation chemotherapy is recommended for patients with massive retroperitoneal metastases, nodal disease above the diaphragm, or extranodal disease and patients with minimal or moderate sized retroperitoneal nodal disease associated with an elevated B-HCG.     

Adrenal leiomyoma: A case report and review of the literature

We describe a case of a 65-year-old Caucasian woman found to have an enlarging mass of the left adrenal gland. Laboratory examination revealed the mass to be nonfunctional. The patient underwent an uneventful left adrenalectomy. Pathological examination revealed the mass to be a leiomyoma. These tumors are benign and develop from smooth muscle cells. They can occur in any part of the body where smooth muscular layers exist, but occur frequently in the uterus and gastrointestinal tract. This case report presents a review of the recent literature on this rare entity. J. Surg. Oncol. 1998;69:111–112. © 1998 Wiley-Liss, Inc.     

Schwannomas of the head and neck

Schwannomas are benign encapsulated nerve sheath tumors composed of Schwann cells. Malignant change in head and neck schwannomas is rare, with the incidence varying between 8 and 13.9%. In this review, we discuss the presentation and the management of head and neck schwannomas. The issues and difficulties based on our own experience as well as the experience of published reports from the literature are presented.     

Penetration of VP-16 (etoposide) into human intracerebral and extracerebral tumors

VP-16 100 mg/m2 was given intravenously to 10 patients undergoing surgical resection of intracerebral tumors, and the drug was assayed in resected tumor using high pressure liquid chromatography. VP-16 concentrations varied from undetectable (less than .1 microgram/g) to 5.9 micrograms/g (mean, 1.4 microgram/g). VP-16 concentrations in tumors were lower than concurrent plasma concentrations. In addition, intracerebral tumors had a lower concentration of VP-16 than did extracerebral tumors (mean VP-16 concentration, 3.9 micrograms/g) from 7 patients receiving VP-16 50-100 mg/m2 intravenously. Plasma pharmacokinetics of VP-16 were different in our patients with intracerebral tumors than in previously studied patients with extracerebral tumors and it is unclear what role this may played in variability of tumor VP-16 concentrations. VP-16 concentrations were similar in glioblastomas and brain metastases. Specimens from patients with small cell undifferentiated carcinoma of the lung had the highest VP-16 concentrations. A patient who had both viable and necrotic tumor resected during an occipital lobectomy had a higher drug concentration in the necrotic than in the viable area of tumor. In addition, VP-16 concentration decreased as a function of distance into brain from the tumor. Based on our data, VP-16 might be expected to have less activity against intracerebral than against extracerebral human tumors.     

Outcomes of patients treated with capecitabine and temozolamide for advanced pancreatic neuroendocrine tumors (PNETs) and non-PNETs

Background

Retrospective studies have demonstrated high response rates among patients with advanced pancreatic neuroendocrine tumors (PNETs) treated with capecitabine and temozolamide (CapTem), while responses are infrequently seen among non-PNETs. The objective of the study was to describe progression free survival (PFS) among neuroendocrine tumor (NET) patients treated with CapTem, and to identify factors associated with better activity.

Methods

Patients who were referred to one of five provincial cancer treatment centers between 2009 and 2013 for advanced NETs and initiated CapTem were included. Patients received Cap 1,500 mg/m² on days 1-14 and TMZ 200 mg/m² on days 10-14 every 28 days. Their characteristics and outcomes were retrospectively analyzed.

Results

In our cohort, 29 patients (16 males) with a median age of 59 (range 26-76) received palliative CapTem, 15 of them as first-line chemotherapy. Primary tumors included pancreas (48.3%), small bowel (20.7%), lung (10.3%), unknown (10.3%), rectum (6.9%) and appendix (3.4%). Median number of cycles was three. Fifteen patients (51.7%) received CapTem as first-line chemotherapy and 14 (48.3%) as subsequent lines. Median PFS for the entire cohort was 4.7 months. PNETs had a median PFS of 4.9 months compared to 2.8 months for non-PNETs (P=0.178). Patients with PNETs who received CapTem in the first-line setting had a median PFS of 15.9 months as compared to only 3.1 months for the remainder [P=0.047, hazard ratios (HR) 0.342]. Patients with Ki67 above 5% and ≤5% had median PFS of 4.0 and 4.7 months, respectively (P=0.260).

Conclusions

CapTem showed good activity among PNETs, but its broader role in the treatment of carcinoid tumors remains unclear.