腹腔镜胃癌根治术中腹腔冲洗液癌胚抗原检测探讨腹膜微转移的价值

目的 研究腹腔镜胃癌根治术术前、术后、温热灌注化疗后腹腔冲洗液中癌胚抗原(CEA)的变化,探讨腹腔镜胃癌手术对脱落癌细胞的影响、腹腔温热灌注化疗的疗效及流式细胞学方法检测腹腔冲洗液CEA对检测腹腔游离癌细胞和预测腹膜转移的价值.方法 收集40例胃癌患者腹腔冲洗液,采用流式细胞学方法检测腹腔冲洗液中CEA;采用HE染色进行腹腔冲洗液细胞学(PLC)检查.结果 腹腔镜胃癌根治术患者,手术开始胃癌未切除时腹腔冲洗液CEA阳性率35.0%(14/40);操作结束时,阳性率40.0%(16/40),术后较手术前高,但两者差异无统计学意义(P>0.05).腹腔温热灌注化疗后CEA阳性率7.5%(3/40),与术后比较,差异有统计学意义(P<0.05).手术开始前腹腔冲洗液PLC阳性4例,流式细胞术检测CEA阳性14例,二者间差异有统计学意义(P<0.05).PLC阳性者CEA均为阳性,PLC阴性者中有10例CEA阳性,CEA阴性者中无PLC阳性.结论 腹腔镜胃癌根治术不增加腹腔胃癌细胞脱落,术中温热灌注化疗简便可行有明显疗效,流式细胞学方法检测腹腔冲洗液CEA是检测腹腔游离癌细胞和预测腹膜转移的有效方法.     

晚期胃癌合并幽门梗阻12例临床分析

目的探讨晚期胃癌合并幽门梗阻的诊断和治疗。方法回顾性分析12例晚期胃癌合并幽门梗阻患者的诊断特点、手术原则和化疗方法。结果围手术期死亡2例．其中胃肠吻合术1例,胃造瘘术1例。其余胃肠吻合术者5例术后生存3．9个月;姑息性肿瘤切除术者4例,术后平均生存1．5年;胃癌根治术（联合脏器切除）者1例,生存3.5年。腹腔灌注化疗比全身静脉化疗副反应轻,效果好。结论晚期胃癌合并幽门梗阻诊断治疗复杂。局部肿瘤减量手术辅以腹腔灌注化疗可以延长患者生存期,提高生活质量。     

进展期胃癌术后腹腔灌注化疗的临床疗效观察

胃癌术后化疗在近10余年来一直受到学者的关注，目前认为其对杀灭脱落癌细胞、亚临床病灶等有临床意义，对提高术后无病生存率及总生存率有益。有报道认为，腹腔内温热化疗能预防胃癌患者术后腹膜转移的发生。因此，浙江省人民医院外科自2001年6月至2002年6月，对65例Ⅱ～Ⅳ期胃癌患者实行胃癌根治手术，术后随机分为两组，分别予腹腔灌注化疗联合静脉化疗和常规静脉化疗患者进行对比研究，报道如下。     

伊立替康联合顺铂节拍法治疗晚期胃肝样腺癌7例临床护理

目的:探讨伊立替康联合顺铂节拍法治疗甲胎蛋白(AFP)阳性的晚期胃癌患者的疗效、不良反应及护理方法。方法:对7例AFP阳性的晚期胃癌患者予盐酸伊立替康每周100 mg,第1、8天给药;顺铂每周10 mg,第1、8天给药,每28 d重复1次。针对化疗出现的不良反应进行针对性护理。结果:本组治疗后完全缓解(CR)2例、部分缓解(PR)3例,稳定(SD)、进展(FD)各1例;有效5例,疾病控制6例。不良反应为Ⅰ~Ⅱ度白细胞下降及消化道反应,Ⅲ度不良反应少见,无Ⅳ度不良反应。结论:伊立替康联合顺铂节拍法治疗AFP阳性晚期胃癌,具有效果好、副作用小、患者依从性好等优点。     

奥沙利铂联合5-Fu及亚叶酸钙治疗进展期胃癌30例毒性反应临床护理

由于早期胃癌缺乏特异性临床表现,42.2%的患者确诊时已属晚期,失去了手术根治的机会[1].化疗是晚期胃癌的主要治疗手段,但由于化疗药物的不良反应较大,许多患者往往不能坚持.减轻化疗不良反应带来的痛苦,是广大患者及医护人员共同的期望.2007年9月～2010年6月,我们使用奥沙利铂(OXA)联合5-氟尿嘧啶(5-Fu)、亚叶酸钙(CF)治疗进展期胃癌患者30例,经精心护理,效果满意.现报告如下.     

紫杉醇联合顺铂腹腔灌注并口服卡培他滨治疗晚期胃癌临床观察

目的:观察紫杉醇联合顺铂腹腔灌注并口服卡培他滨治疗晚期胃癌的疗效及毒副反应。方法:经组织病理学或细胞学证实的30例晚期胃癌,采用紫杉醇(PTX)150mg/m2,静脉滴注d1;顺铂(DDP)70mg/m2,腹腔灌注d1～d7;卡培他滨(CAP)2 000 mg/m2口服;每21天为1个周期。分别化疗2～4个周期后按RECIST标准评价疗效,按NCFCTC标准评价毒副反应。结果:30例均可评价疗效,完全缓解(CR)1侧,部分缓解(PR)13例,病情稳定(SD)10例,疾病进展(PD)6例,总有效率(RR)46.7%。毒副反应主要为骨髓抑制、恶心呕吐、腹泻、手足综合征、末梢神经毒性。结论:紫杉醇联合顺铂腹腔灌注并口服卡培他滨治疗晚期胃癌有较好疗效,可明显改善生活质量,延长生存时间,毒副反应轻,易于耐受。     

晚期胃癌三种化疗方案应用比较

<正>胃癌是临床上常见消化道恶性肿瘤之一,病情隐匿,通常情况下在对患者确诊之后大部分已经是晚期[1]。晚期胃癌患者因为局部浸润、血道播散以及淋巴结转移等情况而导致患者失去彻底根治的机会,临床手术治疗具有较高风险[2]。因此对于晚期胃癌患者,化疗成为临床主要治疗方案,有效化疗不但有助于对患者临床症状显著缓解,同时提高患者生存质量[3]。但目前关于晚期胃癌患者临床化疗还没有标准方案[4],本研究在     

参芪扶正注射液与SOX方案对晚期胃癌患者的影响

目的:分析晚期胃癌应用参芪扶正注射液与SOX化疗方案联合应用对患者疾病控制率及生存质量的影响。方法:选取2015年2月～2018年1月我院收治的66例晚期胃癌患者,按随机数字表法分为对照组与观察组,每组33例。对照组予SOX化疗方案治疗,观察组在对照组的基础上予参芪扶正注射液联合治疗。两组均治疗4个周期,比较两组缓解情况、治疗前后T细胞亚群CD3+、CD4+、CD4+/CD8+水平及生存质量。结果:观察组缓解率与对照组比较,无显著性差异(P>0.05);观察组疾病控制率明显高于对照组,P<0.05;治疗4个周期后,观察组T细胞亚群CD3+、CD4+、CD4+/CD8+水平均明显高于对照组,P<0.05;观察组EORTC QLQ-C30评分明显高于对照组,P<0.05。结论:晚期胃癌应用参芪扶正注射液联合SOX化疗方案治疗,能改善患者免疫功能,提高疾病控制率、缓解率,改善患者生存质量,应用价值较高。     

腹腔镜技术联合手术及化疗治疗晚期卵巢恶性肿瘤的研究

目的探讨电视腹腔镜技术在晚期卵巢癌诊治中的应用价值。方法回顾性分析近几年来采用电视腹腔镜技术诊治35例晚期卵巢癌的临床资料。结果35例中的29例(三期C)施行抽吸腹水、转移灶电灼、直视插管腹腔灌注化疗并配合静脉化疗,而后择期成功的完成了卵巢癌手术,达到了临床治愈;1例因发现为胃癌盆腔转移,而中转开腹行胃癌根治加次广泛性子宫切除;5例(二期A~三期B)直接施行了理想的肿瘤细胞减灭术。结论电视腹腔镜技术结合热、化疗应用于晚期无手术条件的卵巢癌患者中,诊断准确、治疗合理、损伤小,而且及时赢得了手术时机,大大减轻了病人的痛苦和精神压力,延长了存活时间,有较高的临床推广应用价值。     

阿帕替尼联合化疗治疗晚期胃癌:1例报告并文献复习

胃癌是常见的消化道肿瘤之一，目前早期胃癌可以通过外科手术根治。但由于胃癌早期诊断率低，大部分患者就诊时已是局部晚期或发生转移，主要治疗方式仍然是化疗。然而单纯化疗的疗效仍十分有限且已达到瓶颈。随着肿瘤分子生物学及免疫学的发展，分子靶向治疗及免疫治疗成为晚期胃癌患者带来新的希望。本文报道阿帕替尼联合化疗治疗晚期胃癌1例，为晚期胃癌的靶向联合化疗提供参考。      

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.