CT导向下椎体成形术治疗椎体转移瘤

目的 评估CT导向下椎体成形术治疗椎体转移瘤的疗效.方法 对24例椎体转移瘤共34个椎体在CT导向下施行椎体成形术治疗,术中采用小剂量、较稠浓度骨水泥低压注入病变椎体,术后定期随访评价疗效.结果 24例椎体成形术全部顺利完成,其中18例术后疼痛即刻减轻,2例3d后疼痛减轻,3例1周后疼痛缓解,1例症状改善不明显;末发生严重并发症.结论 CT导向下椎体成形术治疗椎体转移瘤是一种比较安全的微创治疗技术,近期疗效肯定.     

经皮椎体成形术治疗脊柱骨转移癌

目的探讨经皮骨水泥注入椎体成形术治疗椎体转移癌的疗效。方法总结26例32椎体转移癌的治疗,采用单侧或双侧椎弓根入路,在数字减影血管造影DSA监视下注入骨水泥,量约4～10ml。结果26例采用经皮骨水泥注入椎体成形术均获成功。16例患者术后当日疼痛完全缓解,6例于术后2～3d疼痛消失,4例疼痛部分缓解,随访2～9个月,平均3.8个月无病椎疼痛加重,无病理骨折。结论经皮骨水泥注入椎体成形术是治疗椎体转移癌安全有效的姑息性方法。     

经皮椎体成形术治疗活动期椎体血管瘤临床疗效分析

目的 探讨经皮椎体成形术（PVP）治疗活动期椎体血管瘤的临床疗效,总结临床经验.方法 回顾分析2006年8月至今共计23例活动性椎体血管瘤患者,平均年龄47岁,行经PVP治疗,所有患者均经临床、影像学及术后病理确诊,并排除手术禁忌证.结果 23例患者病变椎体均成功完成手术,术后平均随访22个月,术后腰背部疼痛17例显著改善,6例改善,末次随访疼痛均显著改善,无复发,负重活动状况明显好转.术后X线片、CT显示骨水泥填充病灶良好,分布均匀,4例见椎旁静脉渗漏,均未出现神经损伤症状,未出现骨水泥过敏反应及栓塞等并发症.结论 PVP能显著缓解活动期椎体血管瘤引起的顽固性腰背部疼痛,是一种安全、有效的微创治疗方法,具有广泛的应用前景.     

经皮椎体成形术治疗椎体转移肿瘤的疗效观察分析

目的 探讨经皮椎体成形术治疗椎体转移肿瘤的临床疗效.方法 对60例椎体转移肿瘤患者的85个椎体进行椎体成形术,对每个患者术前、术后1周及术后半年分别进行VRS定性评估及VAS、SF-36的定量评估.结果 VRS评分显示术后1周疼痛缓解率为100%,VAS评分显示术后1周和术后半年的VAS评分明显低于术前（P〈0.01）,SF-36评分显示术后1周和术后半年的健康状况评分明显高于术前（P〈0.01）.结论 PVP手术治疗椎体转移肿瘤是安全、有效的,可以明显缓解患者的疼痛,提高患者的生活质量,在脊柱转移肿瘤患者的康复治疗中有一定应用价值.     

HU值对于椎体成形术后非暴力新发椎体骨折的预测价值

目的 探讨HU值对于椎体成形术后非暴力新发椎体骨折的预测价值,为降低经皮椎体成形术(percutaneous vertebroplasty,PVP)后新发椎体骨折及再入院提供参考。方法 回顾性分析2016年1月至2021年9月,在本院行PVP治疗的98例椎体压缩性骨折患者的临床及影像学资料,以术后是否出现新发椎体骨折分组：新发骨折组(PVP术后因非暴力因素新发椎体压缩骨折患者,n=24)和未骨折组(PVP术后2年随访期间未发生椎体压缩性骨折患者,n=74)。对比两组初次手术时年龄、性别、外伤史、骨折椎体位置、PVP椎弓根穿刺部位、初次手术骨水泥填充量。测量并比较两组患者椎体HU值,并采用ROC曲线分析PVP术后再骨折椎体的临界HU值。结果 两组患者年龄、性别、外伤史、骨折椎体位置、PVP椎弓根穿刺部位差异无统计学意义(P> 0.05)。在骨水泥填充量方面,新发骨折组患者首次骨水泥填充量差异有统计学意义(P=0.014),填充4 ml骨水泥患者较多。新发骨折组患者椎体HU平均值为52.47±25.78,未骨折组患者椎体HU平均值为75.38±31.99,差异有统计学意义(t=-3....     

基于术前椎体影像学参数预测椎体成形术骨水泥渗漏风险的研究进展

经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)这两种经皮微创手术方式通过向椎体内推注适量骨水泥起到迅速缓解疼痛,强化骨折椎体,防止椎体进行性压缩、塌陷,实现快速功能恢复的作用[1].据不完全统计,超过半数以...     

X线透视机引导下经皮椎体成形术治疗胸腰椎椎体转移瘤疗效分析

目的 探讨X线透视机引导下经皮椎体成形术(PVP)治疗胸、腰椎椎体转移瘤的疗效.方法 在X线透视机引导下,81例胸、腰椎椎体转移瘤患者的101个椎体实施PVP,比观察实施PVP前、后患者生活质量、骨痛评分、脊柱稳定性的改变以及并发症.结果 PVP治疗前、后生活质量及骨痛评分差异均有统计学意义(P<0.05).PVP治疗后脊柱稳定.术后6例9椎发生骨水泥渗漏,未出现临床症状.无骨水泥毒副反应、肺栓塞、感染和神经损伤等并发症的发生.结论 X线透视机引导下PVP是一种治疗胸、腰椎椎体转移瘤较为有效的方法.     

经皮椎体成形术联合放疗治疗脊椎骨转移瘤的临床观察

目的:探讨经皮成形术(PVP)联合放疗治疗脊椎骨转移瘤的方法及疗效.方法:对26例经病理学证实的42个病变椎体行PVP.骨水泥按粉、液、对比剂3:2:1比例配制.胸腰骶椎区均采用经椎弓根或椎体后外侧穿刺,在确定穿刺到位并无椎管内渗漏后,将骨水泥快速灌注至椎体内.灌注量为胸椎平均4.6ml,腰椎平均5.4ml,骶椎平均5.5ml.术后观察患者疼痛缓解程度,并于当日、1个月CT检查注射椎体.放疗在PVP后第3～4天开始,采用60C0照射,2～3Gy/次,总量35～45Gy/3～4周.结果:穿刺成功率100%本组26例单侧穿刺32个椎体,双侧穿刺10个椎体.CT检查骨水泥周围组织渗漏2例,但均未出现临床症状.26例放疗过程顺利.PVP后止痛有效率为80.8%(21/26),联合放疗后,止痛有效率上升至96.2%(25/26).随访4～10个月,止痛有效率在10个月内为88.5%(23/26).结论:PVP有靶区硬度压强和快速缓解疼痛的作用,放疗能强化对肿瘤的抑制,从而达到提高疗效的目的.     

经皮椎体成形术治疗脊柱转移肿瘤的价值

目的探讨经皮椎体成形术（percutaneous vertebroplasty,PVP）在脊柱转移肿瘤中的治疗价值。方法2003年8月～2007年8月采用经皮椎体成形术治疗脊柱转移癌23例39个椎体（胸椎22个,腰椎17个）。男13例,女10例,年龄45～76岁,平均64.5岁。实施PVP同时均进行了活检,31个椎体采用单侧穿刺注射骨水泥,8个椎体采用双侧穿刺注射骨水泥;单个椎体注射骨水泥3～11ml,平均6.5ml;术后进行CT、MRI等影像学检查和临床疗效评价。结果本组无严重心、肺、脑血管不良反应和围手术期内死亡,术后17例疼痛完全缓解,3例部分缓解,2例无明显缓解,1例加重,VAS评分由术前平均75分降至26分,有效率为87%;术后CT显示11例18个椎体存在不同程度的骨水泥渗漏。住院时间12～42d,平均20.5d,随访2～18个月,平均10.5个月,随访期间7例死亡,其余带瘤生存。结论PVP治疗脊柱转移肿瘤,具有创伤小、迅速缓解疼痛、防止椎体病理骨折或塌陷压迫脊髓造成截瘫的良好效果,并可与放疗、化疗等联合应用提高患者生存质量。     

经皮椎体成形术及经皮椎体后凸成形术治疗椎体转移瘤的临床应用

目的：探讨经皮椎体成形术（PercutaneousvertebroplastyPVP）及经皮椎体后凸成形术（KyphoplastypereutaneousPKP）治疗椎体转移性肿瘤的临床疗效。方法：对38例共44个椎体行PVP,7例9个椎体行PKP,术前VAS标准（visualanalogscale,VAS）评分。结果：45例53个椎体手术无死亡病例。术前轻度疼痛4例,中度11例,剧痛31例。术前VAS评分平均为9．2±2．2分。术后3天疼痛完全缓解38例（84．4％）;部分缓解5例（11．1％）;轻微缓解1例（2．2％）;NR1例（2．2％）;有效为95．5％,VAS评分2．0±1．4,与术前比较差异有统计学意义（P〈0．05）;53个椎体术中骨水泥渗漏至椎间盘3例,硬膜外囊2例,椎旁静脉丛1例,椎旁软组织3例;骨水泥外漏发生率16．98％,其中PKP仅发生椎旁软组织外渗1例,术中及术后均无其它并发症发生。PVP式Cobb’s角术前19．3±8．7,术后为18．4±7．8;PKP术前为22．1±8．7,术后为12．2±5．8,术后Cobb’s角与术前比较,PKP术式差异有统计学意义（P〈0．01）,PVP术式差异无统计学意义（P〉0．05）;轻度疼痛及中度疼痛完全缓解及部分缓解为100％;重度疼痛完全缓解及部分缓解为93．6％,轻微缓解及无效为6．4％,轻、中、重度各级术后较术前疼痛缓解明显,差异有统计学意义（P〈0．05）。结论：PVP及PKP对缓解或消除由椎体转移性肿瘤引起的疼痛有明显的治疗效果,无严重并发症。PKP术对塌陷椎体高度有一定程度恢复。     

Reduction in radiation exposure to nursing personnel with the use of remote afterloading brachytherapy devices

The radiation exposure to nursing personnel from patients with brachytherapy implants on a large brachytherapy service were reviewed. Exposure to nurses, as determined by TLD monitors, indicates a 7-fold reduction in exposure after the implementation of the use of remote afterloading devices. Quarterly TLD monitor data for six quarters prior to the use of remote afterloading devices demonstrate an average projected annual dose equivalent to the nurses of 152 and 154 mrem (1.5 mSv). After the implementation of the remote afterloading devices, the quarterly TLD monitor data indicate an average dose equivalent per nurse of 23 and 19 mrem (0.2 mSv). This is an 87% reduction in exposure to nurses with the use of these devices (p less than 0.01).     

依济复防治急性放射性皮肤和粘膜反应的初步临床观察

目的　观察依济复在预防及治疗放射性皮炎和粘膜炎中的作用。方法　 1999年 10月～ 2 0 0 0年 9月 ,应用依济复喷剂预防及治疗 5 0例行放射治疗患者 (预防治疗组 ) ,并设同等数量常规处理的患者为对照组。结果　预防治疗组Ⅱ度以上放射性皮炎发生率为 2 0 %,对照组 93.3%,两组有显著性差异 (P <0 .0 0 5 ) ;预防治疗组Ⅱ度以上放射性粘膜炎发生率为 10 %,对照组为 90 %,两组也具有显著性差异 (P <0 .0 0 5 )。结论　依济复对Ⅱ度以上放射性皮炎和粘膜炎的预防有一定作用 ,对放射性皮炎和粘膜炎的治疗效果显著 ,可以将放射性皮炎和粘膜炎基本控制在Ⅱ度以内 ,起到止痛、止痒、促进伤口愈合等作用。     

Considerations appropriate to a clinical trial of definitive radiation therapy in adenocarcinoma of the pancreas

The Author describes criteria for selection of patients who might be eligible for entry into a clinical trial of definitive Radiation Therapy for adenocarcinoma of the pancreas. Most emphasis is placed on careful surgical staging, target volume and location, and the use of bypass procedures when appropriate.     

Comparison of L-thyroxine and a saturated solution of potassium iodide in preventing damage to the thyroid following iodine-131-labeled antibody injection

Following injection of radioiodinated antibodies in diagnostic amounts, there is variable uptake of radioiodine by the thyroid. Unless preventive steps are taken, radiation damage to the gland may occur. We have evaluated the role of L-thyroxine and a saturated solution of potassium iodide (SSKI) in preventing radiation damage to the thyroid glands of Sprague-Dawley adult male rats by measuring DNA strand breakage by the nucleoid sedimentation gradient method. Pretreatment with SSKI reduced DNA damage and also reduced 131I accumulation in the thyroid. Pretreatment with L-thyroxine also reduced DNA damage without significantly reducing 131I accumulation in the thyroid. The possible mechanisms of action of L-thyroxine and SSKI in preventing radiation damage to the thyroid are addressed.     

参附注射液联合长春瑞宾提高老年非小细胞肺癌生活质量的随机对照研究(英文)

Objective: The present study aimed to investigate the efficacy of Shenfu injection plus vinorelbine on the promotion of the quality of life (QOL) in elderly non-small cell lung cancer (NSCLC) patients. Methods: A randomized single blind trial method was used. Forty-six patients with stage IIIB–IV of NSCLC were randomly divided into experimental group and control group. In the experimental group, the patients were treated with 50 mL Shenfu injection from day 1 to 14, plus vinorelbine (NVB) 25 mg/m2 on day 1 ...     

Relationship between DNA double-strand break rejoining and cell survival after exposure to ionizing radiation in human fibroblast strains with differing ATM/p53 status: implications for evaluation of clinical radiosensitivity

PURPOSE: To better understand the impact of defects in the DNA damage-surveillance network on the various cell-based assays used for the prediction of patient radiosensitivity. METHODS AND MATERIALS: We examined noncancerous human fibroblast strains from individuals with ataxia telangiectasia (ataxia telangiectasia mutated [ATM] deficient) or Li-Fraumeni syndrome (p53 deficient) using the neutral comet, H2AX phosphorylation, and clonogenic survival assays. RESULTS: Using the comet assay, we found that, compared with normal fibroblasts, cells lacking either ATM or p53 function exhibited a reduced rate of double-strand break (DSB) rejoining early (< or =4 h) after exposure to 8 Gy of gamma-radiation and also exhibited high levels of unrejoined DSBs later after irradiation. ATM-deficient and p53-deficient fibroblasts also exhibited abnormally increased levels of phosphorylated H2AX (gamma-H2AX) at later intervals after irradiation. In the clonogenic assay, ATM-deficient cells exhibited marked radiosensitivity and p53-deficient cells had varying degrees of radioresistance compared with normal fibroblasts. CONCLUSION: Regardless of whether ataxia telangiectasia and Li-Fraumeni syndrome fibroblasts are DSB-repair deficient per se, it is apparent that p53 and ATM defects greatly influence the cellular phenotype as evidenced by the neutral comet and gamma-H2AX assays. Our data suggest that the gamma-H2AX levels observed at later intervals after irradiation may represent a reliable measure of the overall DSB rejoining capabilities of human fibroblasts. However, it appears that using this parameter as a predictor of radiosensitivity without knowledge of the cells' p53 status could lead to incorrect conclusions.     

A comparison of field-only electronic portal imaging hard copies with double exposure port films in radiation therapy treatment setup confirmation to determine its clinical application in a radiotherapy center.

PURPOSE: To determine in which treatment sites field-only hard copy electronic portal images (EPI) captured during a treatment exposure could replace traditional double exposed port films in a busy radiation oncology department. METHODS AND MATERIALS: The three linear accelerators in the William Buckland Radiotherapy Centre (WBRC) at the Alfred Hospital in Melbourne are each equipped with an electronic portal imaging device (EPID). These devices can be used daily on all patients where the treatment fields are within the size constraint of the cassette, for example, less than 25 x 25 cm. Port films using radiographic film in hard cassettes were previously considered the standard method of field placement verification. After the radiation therapists were trained in all program aspects of capturing, enhancing, and producing hard copies of EPIs, a study was developed to evaluate the possibility of replacing port films with EPI hard copies within the established departmental procedures. Comparison of EPI hard copy with the simulator film and the port film of the same field was carried out by the radiation oncologist specialists. Seventy-eight comparison sets were generated and grouped into seven anatomical regions for evaluation by the radiation oncologist specialist responsible for each particular region. The outcome decision was the preferred imaging option. Where no preference was stated, EPI became the modality of choice, as it increased the efficiency of work practice. RESULTS: The results indicate that field-only EPI can be considered to be at least as clinically useful for treatment verification in the following sites: breast, chest, hip, spine, and large pelvic fields. Port films using a standard, double exposure technique were considered necessary for partial brain fields, small pelvis fields, extremities, and radical head and neck fields. CONCLUSION: The quality of field-only images captured using an EPID has been favorably assessed to be equivalent to, or an improvement on, the traditional double exposed port films for some treatment areas. Departmental policy has been altered to incorporate this new imaging modality as a practical alternative to port films, resulting in a direct benefit in terms of resource management and patient care. Continuing research is currently evaluating open area exposed EPI hard copies as a potential alternative to port films.     

Design of the BRISC study: a multicentre controlled clinical trial to optimize the communication of breast cancer risks in genetic counselling

Background  

Understanding risks is considered to be crucial for informed decision-making. Inaccurate risk perception is a common finding in women with a family history of breast cancer attending genetic counseling. As yet, it is unclear how risks should best be communicated in clinical practice. This study protocol describes the design and methods of the BRISC (Breast cancer RISk Communication) study evaluating the effect of different formats of risk communication on the counsellee's risk perception, psychological well-being and decision-making regarding preventive options for breast cancer.     

Development of a mantle cell lymphoma in an ATM heterozygous woman after occupational exposure to ionising radiation and somatic mutation of the second allele

Predisposition to lymphomagenesis is a well-known phenomenon of ataxia-telangiectasia, a recessive disorder caused by germline inactivation of ATM. ATM encodes a protein implicated in the repair of radiation induced double-strand breaks. Biallelic ATM inactivation was described also in sporadic lymphoid malignancies, supporting a role of ATM as a tumour suppressor gene. It is, however, still unclear whether ATM heterozygotes are at higher risk of tumours. We describe an ATM heterozygous patient, who developed a mantle cell lymphoma (MCL) after occupational exposure to ionising radiation and somatic mutation of the second ATM allele supporting the contention that heterozygous germline ATM alterations in combination with irradiation exposure predisposes to sporadic MCL.