肺癌脑转移患者安全管理中的预见性护理

目的探讨预防和减少肺癌脑转移患者在住院期间发生安全意外的护理措施。方法采用便利抽样法选取2006年1月至2007年12月某院36例住院肺癌脑转移患者为对照组,实施传统护理方法;同法选择2008年1月至2009年12月某院53例住院肺癌脑转移患者为观察组,实施预见性护理措施。比较两组患者安全意外事件发生情况。结果观察组患者安全意外发生率明显降低,与对照组比较,差异有统计学意义（P〈0.05）。结论预见性护理措施能有效地减少和预防肺癌脑转移患者安全意外的发生,改善患者的生活质量。     

Clusterlike Headache in a Patient With a Pituitary Adenoma. With a Review of Literature

A man had left-sided atypical clusterlike headache for II years before he developed symptoms and signs consistent with acromegaly. Preoperative evaluation revealed raised levels of somatomedin C and growth hormone. An MR indicated a left-sided intrasellar mass measuring 8 x 7.5 x 10 mm. He underwent surgery and microscopy confirmed the diagnosis of a benign hypophyseal adenoma. Postoperatively, the acromegalic features regressed, and for the last 4 years the patient has been completely free from headache attacks. On pharmacological testing of the pupillary response to 19 and 5% phenylephrine and 2% tyramine solutions, there was no convincing evidence of persistent sympathetic dysfunction on the earlier symptomatic side.     

非小细胞肺癌骨转移发生骨相关事件的风险因素分析

目的：探讨非小细胞肺癌骨转移患者发生骨相关事件（SREs）的风险因素。方法：回顾分析2009年1月—2010年12月复旦大学附属中山医院314例非小细胞肺癌骨转移患者的临床资料。结果：129例（41.1%）患者发生SRE,其中15例发生1次以上SREs。有软组织肿块（P≤0.001）和无双磷酸盐治疗（P=0.009）是发生SREs的风险因素。无靶向治疗（P=0.042）、有软组织肿块（P=0.004）和血白蛋白低（P=0.006）的患者发生首次SREs的中位时间较短。结论：有软组织肿块和无双磷酸盐治疗是发生SREs的风险因素,因此应密切观察和积极治疗有软组织肿块的骨转移患者,而所有骨转移患者应尽早用双磷酸盐治疗。     

全脑放疗同步VM26+DDP化疗治疗肺癌脑转移

目的:评价全脑放疗同步VM26 DDP化疗治疗肺癌脑转移的近期疗效和毒性。方法:全脑照射剂量30Gy,每次3 Gy,5次/周,或40 Gy,每次2 Gy,5次/周。化疗DDP20 mg/m2,静脉滴注,连续4 d;VM26 60 mg/m2,静脉滴注,连续3 d,3~4周为1周期。全脑放疗5次后开始同步化疗。放疗结束并完成2周期化疗后复查头部CT或MRI评价疗效。结果:全组38例肺癌脑转移患者均完成全脑放疗及2周期化疗。脑转移灶有效率68.4%,CR11例(28.9%),PR15例(39.5%)。结论:全脑放疗同步VM26 DDP化疗治疗肺癌脑转移疗效较好,毒副反应不大,患者可耐受。     

肺癌合并孤立性脑转移的外科治疗效果的分析

目的比较肺癌合并孤立性脑转移患者原发病灶切除及不同方法处理脑部转移灶的临床疗效。方法回顾性分析2004年1月至2008年6月在中山大学附属第一医院收治的37例非小细胞肺癌合并孤立性脑转移的患者的临床资料,其中21例患者接受开颅摘除脑转移瘤＋肺部原发灶的根治性切除治疗（开颅组）;16例患者接受γ-刀照射脑转移瘤＋肺部原发灶根治性切除治疗（γ-刀组）。观察两组患者治疗后的中位生存时间和1年生存率情况。结果中位随访时间20个月（18～26个月）。开颅组和γ-刀组的中位生存时间分别为11．8个月和12．6个月,1年生存率分别为57．14％（12／21）和56．25％（9／16）,但两组的生存曲线无统计学意义（P〉0．05）。结论对于肺癌合并孤立性脑转移灶的患者应积极外科处理;至于脑部转移灶的处理,γ-刀的使用具有创伤小,疗程短的优越性。     

肺癌肝转移瘤二维超声表现与组织病理类型的相关性研究

目的:探讨肺癌肝转移瘤的二维超声表现与组织病理类型的相关性。方法:回顾分析102例肺癌肝转移患者的临床资料,并分析肺癌肝转移瘤的不同病理分型与二维超声图像特性之间的相关性。结果:102例肺癌肝转移瘤中,小细胞癌24例,鳞癌16例,腺癌55例,腺鳞癌5例,大细胞癌1例,腺样囊性癌1例。小细胞癌、鳞癌、腺癌、腺鳞癌肝转移瘤的回声强度不同,组间比较差异有统计学意义(P=0.0169)。小细胞癌以低回声多见,占52.6%;高回声占26.3%。鳞癌以高回声多见,占84.6%;低回声占7.7%。腺癌低回声占31.9%,高回声占38.3%。腺鳞癌以高回声多见,占75.0%;低回声占25.0%。结论:肺癌肝转移瘤的二维超声表现与其病理组织类型有一定的相关性。     

Clusterlike headache as first manifestation of a prolactinoma

We report a case of cluster headache in a patient with a macroprolactinoma. Symptomatic cluster headache was suspected because of an unsatisfactory response to medications that are usually effective in idiopathic cluster headache. The neurological examination was normal. However, magnetic resonance imaging demonstrated a large pituitary tumor. One year after starting treatment with cabergoline, the patient remains asymptomatic. Symptomatic cluster headache should be suspected when the clinical features of the headache are atypical. By inducing vascular mechanisms, the parasellar lesion may have played a role in initiating the cluster headache.     

Facial Pain as a Symptom of Nonmetastatic Lung Cancer

Patients with nonmetastatic lung cancer may rarely experience facial pain as a presenting symptom, during the course of the disease or upon recurrence of the disease. This study reviews a 10-year experience at Mayo Clinic. The aim of this study was to (1) further characterize the clinical features of facial pain as a symptom of nonmetastatic lung cancer, and (2) assist clinicians in recognizing this association. Ten cases were identified. All patients complained of severe, aching, facial pain typically aural-temporal in location, ipsilateral to the lung cancer. Six of the 10 cases involved the left side. Recent weight loss was present in 7 of 10 patients, with an elevated sedimentation rate in 6. Digital clubbing was documented in three. Neurologic examinations and neuroimaging were normal in all patients. Lumbar puncture, when performed, was normal. Facial pain preceded the diagnosis of lung cancer by 1 to 24 months. In three patients, facial pain was the initial symptom of tumor recurrence. Four of the 10 tumors were adenocarcinoma; radiation with or without chemotherapyappears to be the treatment of choice for the facial pain. The presumed mechanism is local invasion of the vagus nerve. In suspected cases, a chest x-ray and chest CT are indicated.     

Laser Ablation of Lung Metastases: Technique and Results after 21 Treatments

A thin-caliber applicator system was developed for laser ablation of lung metastases. Feasibility of lung metastases ablation as well as the complication rate and clinical results were evaluated. We calibrated the miniaturized applicator system in non-perfused bovine liver for maximum energy supply and necessary flow of the cooling saline solution in reference to a commercially available system (Power laser applicator kit, Somatex, Teltow, Germany). The size of heat coagulation in bovine liver was 24 ± 2 ml with the miniaturized system in comparison to a size of 29 ± 7 ml for the existing applicator. 15 W were applied for 20 min and a saline flow of 40 ml/h with the miniaturized applicator and 30 W, 20 min, 60 ml/min with the standard applicator. 21 patients with 32 lung metastases were then treated and the results as well as minor and major complications were evaluated. Ablation was technically successful in all but 2 patients. 14 patients were considered to be effectively treated. Their metastases showed a marked reduction of volume. Volume reduction took several months to develop. Successful treatment had either a ground-glass appearance of the treated site or a cystic defect as a morphological correlate. We conclude that successful ablation of lung metastases is possible with a miniaturized applicator.     

肺癌脑转移156例的MRI特征分析

目的:探讨不同组织学类型肺癌脑转移的MRI表现。方法:回顾性分析156例行MRI检查、经手术病理证实为肺癌脑转移且已明确肺癌组织学类型的病例。结果:156例中,单发转移47例,多发转移109例;腺癌73例,鳞癌59例,小细胞癌19例,大细胞癌5例;156例479个转移灶中,腺癌279个,鳞癌132个,小细胞癌49个,大细胞癌17个;各种病理类型的肺癌脑转移病灶中,鳞癌重度水肿比例最高(56.06%),囊性变最多(44.10%),腺癌转移瘤卒中出现率最高(30.47%)。结论:不同组织类型的肺癌脑转移有不同的MRI表现特点。     

CD44v6在非小细胞肺癌(NSCLC)中的表达

目的：研究非小细胞肺癌（NSCLC）中CD44v6的表达及与其分型和颅内转移的关系。方法：应用免疫组化法检测27例NSCLC组织标本中CD44v6的表达，以小细胞肺癌（SCLC）为对照，并分析其临床意义。结果：CD44v6高表达与NSCLC的淋巴结转移及颅内转移有关（P〈O．05），是NSCLC颅内转移的独立风险因子。结论：检测CD44v6蛋白的表达，有可能为判断NSCLC淋巴结转移、颅内转移及评估预后提供依据。     

肺癌骨转移放射止痛治疗的临床分析

目的分析36例肺癌骨转移放射治疗止痛效果。方法采用6MV或15MV-X线照射肺癌骨转移患者36例共计50处病灶,常规分割照射32处病灶,照射剂量：21．6-60Gy／12-30次,共3-6周,非常规分割照射18处,照射剂量：29．7-45Gy／3-15次,共1-3周。结果全组50处病灶放疗止痛总有效率92．00％,且与照射总剂量、时间-剂量分割方式、照射部位、原发灶是否行局部治疗、转移灶是单发或多发无关系。起效时间与剂量分割方式有关,非常规分割照射起效快（P-0．0125）。全组有7例患者,计10处病灶在放射期间有疼痛加重．但其发生率与照射方式无关。结论放射治疗肺癌骨转移止痛效果确切,可提高患者生存质量,已成为肺癌骨转移止痛治疗的主要方法。     

通心络与尼莫地平联合治疗脑动脉硬化性头痛

目的:探讨通心络与尼莫地平联合治疗脑动脉硬化性头痛的临床疗效。方法:通心络与尼莫地平联合治疗脑动脉硬化性头痛患者36例(治疗组),并与32例脑动脉硬化性头痛患者选用肠溶阿西林和尼莫地平联用作治疗对照(对照组)。观察治疗前后患者头痛程度和颅脑平均血流速度(VM)最大的血管检测值指示变化。结果:治疗组疗效明显优于对照组,P<0.05。结论:通心络与尼莫地平联合应用能显著改善脑动脉硬化患者的脑血管功能,增加流量,缓解头痛等症状,是治疗脑动脉硬化性头痛的有效药物。     

CT灌注成像方法在评估脑转移瘤放射治疗疗效中的应用

目的研究CT灌注成像方法在脑转移瘤放射治疗疗效评价中的应用价值。方法对20例脑转移瘤病人全脑放射治疗前后分别行常规CT及CT灌注检查,得到TDC曲线,并合成脑血容量（CBV）图、脑血流量（CBF）图以及达峰时间（TTP）图。从灌注图像上测得感兴趣区的CBV、CBF以及TTP值并计算出相对CBV（rCBV）、相对CBF（rCBF）、相对TTP（（rTTP）。观察比较20例脑转移瘤患者瘤体实质以及正常脑实质放疗前及放疗后各项CT灌注参数的变化,并比较不同灌注参数的脑转移瘤的放疗疗效。结果放疗前的脑转移瘤瘤体实质区绝大部分均表现为rCBV、rCBF明显升高,rTTP略有降低。20例脑转移瘤放疗后2例体积无明显变化,其余18例均有不同程度的体积缩小。瘤体实质区的CBF、rCBF、rCBV均有明显降低,差异有统计学意义。rCBF低于3．0和rCBF高于3．0的脑转移瘤放疗后的治疗有效率及rCBF下降比率、rCBV下降比率差异有统计学意义。后者的放疗疗效明显高于前者。结论脑转移瘤的CT灌注图像具有一定的特征性表现;CT灌注成像方法能有效评价脑转移瘤的放疗疗效,并可在一定程度上对不同灌注参数的脑转移瘤进行放疗疗效的预测,rCBF高于3．0的脑转移瘤放疗后疗效比rCBF低于3．0的脑转移瘤放疗后疗效好。     

中央型左上肺癌压迫左喉返神经的声像图间接征象

为探讨左喉返神经受左上肺癌转移性淋巴结肿块压迫的声像图间接征象，对１２例中央型左上肺癌伴声音嘶哑患者进行了检测，取心底短轴主肺动脉窗切面探测左肺动脉与主动脉弓下之间导管韧带外缘即左喉返神经经过处。结果：以左肺动脉受肿块压迫的表现，间接提示左喉返神经压迫征，分别来自主动脉弓下肿大淋巴结３例；左主支气管上肿大淋巴结５例；原发癌与左上肺尖后段支气管淋巴结融合形成肺门肿块４例，全部病例经纤维支气管镜活检病理及Ｘ线、ＣＴ、ＭＲＩ对照证实。     

The International Headache Society (IHS) Headache Classification as applied to a headache clinic population

Four hundred patients attending a headache clinic were classified using the IHS criteria. The majority required more than two, often three or four, diagnoses. Even though migraine was the most common diagnosis, only 1/4 of those with a migraine diagnosis had it as the only diagnosis. Seventy-five percent of migraine patients had coexistent chronic tension-type headache (CTTH), drug-induced headache or both. Ninety-six percent of patients diagnosed as having migraine with aura also suffered from migraine without aura. More than 1/3 of patients (37.7%) attending the clinic suffered from chronic daily headache (CDH) (chronic cluster headache excluded), which is not included as a separate entity in the IHS classification. Pure CTTH formed only a small minority of CDH, whereas 86.6% of CDH had migraine as one of the diagnoses. Drug-induced headache was a prominent second or third diagnosis. The advantages and disadvantages of multiple verses single diagnosis in CDH and the need to recognize the natural history of headache disorders in the classification are discussed.