Pulmonary resection for metastatic breast cancer

The management of pulmonary metastasis from breast carcinoma is challenging and often consists of palliation of symptoms. Surgical resection of pulmonary metastasis is considered inappropriate in view of the disseminated nature of the disease and limited life expectancy. It can however be a worthwhile option if imaging, including bone scans rule out metastatic disease in other part of the body. We report a patient with pulmonary metastasis from breast carcinoma who was successfully treated with pulmonary wedge resection of the metastatic lesion.     

Primary squamous cell carcinoma of the breast: a case report

Primary squamous cell carcinoma of the breast is a rare entity. We treated a 55-year old woman who came to us with bleeding from the left breast tumor. The tumor was 7 x 8 x 10 cm in size with ulceration and surgical biopsy results showed it to be squamous cell carcinoma of the breast, while metastatic work-up findings ruled out other sources of primary tumor. She also complained of nausea and vomiting, and brain CT disclosed cerebellar metastasis. The metastatic brain tumor was surgically removed, however, the symptoms became gradually exacerbated. The patient died 67 days after admission.     

Legionnaires' disease following cardiac transplantation

One case of Legionnaires' disease in cardiac transplant recipient is reported. She was diagnosed by immunofluorescence study of bronchoscopic lavage specimen and was treated by oral erythromycin successfully. The main presentations are fever and single pulmonary nodule with rapid progression and cavitation. In the literatures report, two complicated Legionnaires' disease was reported in cardiac transplant recipient. This case is less complicated than reported and is the first case in this country.     

肺栓塞与心脑血管疾病相关因素分析

目的 提高对心、脑血管疾病并发肺栓塞的认识。方法 对43例心、脑血管疾病并发肺栓塞的病例进行回顾性分析。结果 本文35%的肺栓塞患者有心、脑血管疾病,病情较重。其主要原因可能是心、脑、肺血管疾患影响轿流动力学,使血流缓慢;血液处于高凝状态、高脂血症以及血管内皮损伤。结论 心、脑血管疾病与肺栓塞的发病有关,应提高对心、脑血管疾病合并肺栓塞的警惕性,一旦确诊应立即治疗。     

抗HER2靶向药物治疗HER2阳性乳腺癌脑转移的研究进展

乳腺癌已成为全球发病率最高的恶性肿瘤,同时也是引起女性肿瘤相关死亡的重要原因之一。尽管早期乳腺癌可通过手术及辅助治疗得到治愈,然而仍有部分患者出现转移。一旦发生远处转移,患者5年生存率显著下降。相较于其他转移部位,乳腺癌脑转移(breast cancer brain metastasis,BCBM)患者生存时间最短,仅有3~6个月。由于血脑屏障(blood brain barrier,BBB)的存在,增加了BCBM的治疗难度,是缩短患者生存时间的重要原因之一。人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性患者脑转移发生率较高,近年来各种抗HER2靶向治疗药物为HER2阳性脑转移患者带来了新的挑战和希望。如何延长HER2阳性脑转移患者的生存时间、提高患者生活质量已成为转移性乳腺癌(metastatic breast cancer,MBC)领域临床研究的热点问题。本文根据国内外的最新研究成果,对抗HER2靶向药物在HER2阳性脑转移患者中的应用进行综述,以促进对BCBM的认识,为HER2阳性BCBM患者的治疗及相关临床研究提供参考。     

联合介入治疗肺癌并肝转移的疗效分析

目的 :探讨联合介入治疗肺癌并肝转移的疗效 ,并与静脉全身化疗效果进行比较。方法 :中晚期肺癌并肝转移的患者共 30例 ,其中研究组 15例联合行支气管动脉和肝动脉化疗栓塞术 ,对照组 15例行静脉全身化疗 ,比较两组原发灶和转移灶的治疗疗效。结果 :复查胸片、B超或CT评估近期有效率 ,肺原发灶研究组和对照组的有效率分别为 6 0 %和 2 0 % ,经Fishers确切概率法检验 ,两组疗效差异显著 (P <0 .0 5 ) ,肝转移灶研究组和对照组的有效率分别为 5 3.3%和 13.3% (P <0 .0 5 )。结论 :经支气管动脉和肝动脉联合介入治疗肺癌并肝转移优于静脉全身化疗     

Alveolar soft part sarcoma: Clinical presentation,treatment, and outcome in a series of 13 patients

Background

Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor that typically affects young patients. Similar to other soft tissue sarcomas, it has high pulmonary metastasis ability, whereas compared with other soft tissue sarcomas, it has high brain metastasis ability. Because of the rarity of the disease, most studies on ASPS have been case reports and small series studies.

Pulmonary tuberous sclerosis responds to progesterone treatment

A 35 year old woman, known to have tuberous sclerosis, presented with shortness of breath. She was found to have pulmonary infiltration on her chest X-ray, due to tuberous sclerosis and a massive chylous pleural effusion. Despite repeated drainage the effusion continued to reaccumulate. In view of the encouraging response reported in patients with pulmonary lymphangioleimyomatosis we treated our patient with medroxyprogesterone acetate. This led to a resolution of the effusion. She has remained on monthly injections of medroxyprogesterone and remained free of symptoms and pleural effusions over the following twelve months. Thus, it appears that medroxyprogesterone may be of value in pulmonary tuberous sclerosis, an entity that has hitherto been resistant to treatment.     

膝关节机械加载改善小鼠乳腺癌肺转移的实验研究

目的: 探讨脉冲式机械加载对小鼠乳腺癌肺转移的抑制作用。 方法:30只4～6周龄BALB/c雌性小鼠随机分为模型组 与治疗组 ,通过每只尾静脉注射鼠源性乳腺癌细胞（4T1）,建立小鼠乳腺癌肺转移模型。治疗组小鼠每天接受膝关节机械加载治疗,治疗18 d后处死。取肺脏,解剖显微镜下计数肺部转移瘤数目,TUNEL法分析肿瘤细胞凋亡情况,墨汁灌注肺脏切片观察转移灶周围血管生成情况,免疫组化分析细胞增殖和血管生成情况。结果:与模型组相比,治疗组肺部转移瘤数目明显减少（P<0.05）,TUNEL阳性细胞明显增多（P<0.01）,转移灶周围血管面积明显降低（P<0.05）。结论:机械加载能够有效地抑制小鼠乳腺癌肺转移,该抑制作用可能与机械加载能够促进肿瘤细胞凋亡和抑制肿瘤血管生成有关。?     

多西他赛联合洛铂治疗鼻咽癌肺转移的疗效初探

目的评价多西他赛联合洛铂治疗鼻咽癌肺转移的近期疗效及其毒性反应。方法 2009年9月至2012年7月我院共收治鼻咽癌肺转移患者24例,其中首程鼻咽癌肺转移5例,经放化疗后发生肺转移19例。多西他赛75 mg/m^2,静脉滴注,第1天;洛铂30 mg/m^2,静脉滴注,第1天,每3-4周重复化疗。连用两个周期后行胸部CT检查评价疗效,化疗期间常规复查血常规及肝肾功能,并观察其他毒副反应。结果多西他赛联合洛铂方案的总有效率为70.8%,疾病控制率为87.5%,毒副作用较轻,主要表现为骨髓抑制如粒细胞减少、贫血及血小板减少。结论多西他赛联合洛铂治疗鼻咽癌肺转移的近期疗效满意,且具有应用简便、毒副反应较轻的优点。     

异源性促肾上腺皮质激素综合征——副乳腺类癌肺转移一例报告

<正> 异源性促肾上腺皮质激素综合征(异源性ACTH综合征,下同)为异源性内分泌综合征的一种。其中以副乳腺类癌而致者,至今尚未见有报告。现将我们的一例报告如下,并就有关问题作初步讨论。     

肺癌脑转移瘤不同放射治疗方法的疗效分析

目的分析不同的放射治疗方法治疗肺癌脑转移瘤的疗效。方法回顾性分析2010年6月至2013年6月期间在本院采用全脑放疗及伽玛刀治疗的126例有病理学证实的肺癌脑转移瘤患者的临床资料,其中男性66例,女性60例。根据肿瘤的大小、个数、位置及肿瘤周边正常织的耐受情况,对于转移病灶数≤5个的小病灶（直径〈3.0 cm）直接选择伽玛刀一次性治疗;而对于较大肿瘤病灶（直径≥3 cm但≤4 cm）选择伽玛刀二次剂量分割治疗。对于转移病灶数〉5个的肿瘤病灶,选择全脑放疗与伽玛刀相结合的治疗方法治疗。结果随访126例患者,随访期6~45个月,肿瘤控制率95%,中位生存期16.8个月,1年生存率63%,2年生存率25%。KPS评分在1个月内达到90分以上者占93%。结论伽玛刀治疗肺癌脑转移瘤安全有效,根据肿瘤大小、个数及神经功能受损情况选择不同的放射治疗方法综合治疗,能及时改善临床症状,减少放射损伤,显著提高患者生存质量,延长生存期。其疗效与肿瘤大小、位置、个数、治疗剂量及不同的放疗方法的选择有关。     

38例非小细胞癌脑转移的综合治疗分析

目的探讨非小细胞肺癌脑转移的有效治疗方案.方法对38例非小细胞肺癌脑转移患者进行头部、胸部放疗并结合全身化疗的综合治疗.结果近期疗效的有效率为76.3%(29/38).神经精神症状缓解率73.7%(28/38),肺部症状缓解率60.5%(23/38).1年生存率31.5%(12/38),2 a生存率10.5%(4/38).结论合理采用综合治疗可有效提高非小细胞肺癌脑转移患者的生存率.     

乳腺癌跟骨转移1例报道

目的探讨乳腺癌跟骨转移的临床特点、诊断和治疗方法。方法报道1例乳腺癌跟骨转移病例,结合文献进行回顾性分析。结果患者女性,64岁,左侧乳腺浸润性导管癌根治术后10年,发现肺转移癌1年余,出现左足部疼痛,左踝部轻度浮肿,轻度活动受限于2011年5月19日收入我院。踝关节磁共振显示左踝关节距骨及跟骨多发异常信号。结合临床表现及影像学检查诊断跟骨转移,经化疗、跟骨局部放疗及对症支持治疗后足部疼痛症状明显缓解。结论乳腺癌跟骨转移容易被误诊为炎症、外伤或痛风等,临床表现及影像学检查等有助于早期诊断,局部放疗、化疗及内分泌疗法等综合治疗有较为显著的疗效。     

Mitral stenosis in a girl of five years

Mitral stenosis(MS) detected below the age of 20 years is called juvenile mitral stenosis (JMS). JMS constitute 25-40 % of all cases of isolated mitral stenosis, though overall incidence of rheumatic fever and rheumatic heart disease (RHD) within mixed population is 7.5- 7.8 per thousand. The patient was 5 years old girl hailing from Modhupur, Tangail got herself admitted into CCU Mymensingh Medical College Hospital with the complaints of low grade fever, shortness of breath and also associated with failure to thrive. She was ill looking, mildly anaemic. Precordial examination revealed apex beat was in the left 5th intercostals space, tapping in nature, palpable P(2). There was left parasternal heave. 1st heart sound loud, pulmonary component of the 2nd heart sound was accentuated, opening snap with mid diastolic murmur with pre systolic accentuation. Routine blood examination reveals leucocytosis with raised ESR. C-reactive protein (CRP) and ASO titre were significantly raised. X-ray chest P/A view showing the features of mitral stenosis. Echocardiography showing MS (moderate) with pulmonary hypertension. She was treated with antibiotics and other relevant drugs and discharge with an advice for follow up and take preparation for cardiac intervention.     

早期光动力学治疗对前胃癌移植瘤的消长及肺转移的影响

目的 探讨光动力学疗法（ＰＤＴ）的治疗时机或辐照方式对肿瘤消长及转移的影响。方法 采用两种照射方式（瘤区固定照射、瘤周封闭照射）对不同生长时期的小鼠前胃癌移植瘤进行ＰＤＴ治疗，观察治疗后瘤体消长、耳廓移植瘤周围区的微循环变化及肿瘤肺内转移情况。结果 各治疗组ＰＤＴ后瘤体明显缩小；移植后６ｄ治疗组的肿瘤肺转移率低于移植后９ｄ组；加封闭照射组的肿瘤消除数高于瘤区固定照射组，肺转移率有下降趋势。结论 Ｐ     

Simultaneous coronary artery bypass grafting, replacement of the innominate artery and subtotal thyroidectomy in a 61 year-old patient: a case-report

The management of patients with coexisting diseases who undergo cardiac surgery is a subject to controversial discussions as the operative mortality is thought to be increased by simultaneous procedures. Traditionally, the surgical procedures have been staged with the cardiac surgery performed first followed by the visceral operation at a later date. However, especially in cases of malignant disease (e. g. pulmonary or abdominal) the curative treatment is delayed and the additional costs of two settings have to be considered.     

DIAGNOSIS AND TREATMENT OF THE MALIGNANT GESTATIONAL TROPHOBLASTIC TUMOR WITH PULMONARY METASTASIS COMPLICATED WITH PULMONARY TUBERCULOSIS

INTRODUCTION　　Malignantgestationaltrophoblastictumors(MGTT)arewellrecognizedashavingapropensityfordissemination,particularlytothepulmonaryparenchyma.PulmonaryinvolvementisthemostcommonsiteofmetastasiswithMGTT,occurringinabout80%ofpatientswithmetast...     

DIAGNOSIS AND TREATMENT OF THE MALIGNANT GESTATIONAL TROPHOBLASTIC TUMOR WITH PULMONARY METASTASIS COMPLICATED WITH PULMONARY TUBERCULOSIS

Objective. To evaluate the diagnosis and treatment for malignant gestational trophoblastie tumor (MGTT) with pulmonary metastasis complicated with pulmonary tuberculosis. Methods. To analyze ten cases of MGTT with pulmonary metastasis complicated with pulmonary tu-berculosis in oar hospital from 1980 to 1997 retrospectively, Results. From the x-ray film, there are great resemblances between MGTT with pulmonary metastasis and pulmonary tuberculosis. Of 10 patients, 7 of them were examined out pulmonary tuberculosis during the ehamotherapy of MGTT. Pulmonary tuberculosis appeared six months before chemotherapy in three eases, All of the patients were treated with multiagent chemotherapy. Seven patients achieved a complete remission, 2 patients developed drug resistance and died of cerebral haemorrhage and cerebral herniation, 1woman who had achieved a complete remission from MGTT for 14 months died of miliary tubereulosis. Condu.non. It is very important to make differential diagnosis oi the MGTT with pulraonary metasta-sis complicated with pulmonary tuberculosis, Trying to avoid excessive anti tumor treatment owing to mis-take pulmonary tuberculosis for pulmonary metastasis, and avoiding missing an opportunity of anti-tuber-culosis treatment because of missed diagnosis should be emvhasized.     

骨肉瘤肺转移大鼠模型建立及清肺固金汤的干预研究

[目的]建立“肺虚痰阻证”骨肉瘤肺转移病证结合大鼠模型,探讨清肺固金汤对骨肉瘤肺转移大鼠的干预作用。[方法]将80只SD大鼠随机分为4组,空白对照组、骨肉瘤模型组、骨肉瘤肺转移模型组和清肺固金组,选用骨肉瘤UMR-106细胞株建立SD大鼠骨肉瘤肺转移模型。骨肉瘤肺转移模型建立成功后,采用冷风刺激加烟熏法建立“肺虚痰阻证”模型。骨肉瘤模型组、骨肉瘤肺转移模型组给予0.9%氯化钠溶液灌胃,清肺固金组给予清肺固金汤灌胃,连续给药8周。观察分析清肺固金汤对各组大鼠体质量、原发灶肿瘤生长及肺转移情况的干预作用。采用酶联免疫吸附法(enzymelinked immunosorbent assay,ELISA)检测各组大鼠血清及瘤体内白细胞介素-10(interleukin-10,IL-10)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)含量。以Western blot法检测大鼠右胫骨组织趋化因子基元受体4(CXC motif receptor 4,CXCR4)蛋白表达。[结果]除空白对照组外,其余各组接种大鼠均出现肉眼可见的右膝关节肿块,X线检查提示右胫骨干骺端骨质破坏,呈团片状密度增高影;病理检查右胫骨可见核大深染的骨肉瘤细胞,肺组织可见转移性骨肉瘤结节。与骨肉瘤模型组比较,骨肉瘤肺转移模型组体质量减轻,清肺固金组体质量增加,差异有统计学意义(P<0.05)。与骨肉瘤模型组、骨肉瘤肺转移模型组比较,清肺固金组瘤体质量、体积均明显减少,差异有统计学意义(P<0.05,P<0.01)。骨肉瘤肺转移模型组的肺转移灶数目最多,其中Ⅲ+Ⅳ级结节最多,而清肺固金组肺转移灶数目及Ⅲ+Ⅳ级结节数目均为最低。与空白对照组比较,骨肉瘤模型组、骨肉瘤肺转移模型组的血清IL-10、TGF-β1含量以及右胫骨CXCR4蛋白表达均增加,差异有统计学意义(P<0.05,P<0.01)。与骨肉瘤模型组比较,骨肉瘤肺转移模型组血清及瘤体内IL-10、TGF-β1含量,右胫骨CXCR4蛋白表达均增加,清肺固金组IL-10、TGF-β1含量及CXCR4蛋白表达均明显下降,差异有统计学意义(P<0.05,P<0.01)。[结论]“肺虚痰阻证”骨肉瘤肺转移病证结合大鼠模型临床契合度好,成功率高,稳定性佳。清肺固金汤具有较好的抗骨肉瘤肺转移作用,其机制可能与下调IL-10、TGF-β1及CXCR4表达有关。