乳腺癌患者化疗致败血症并发症的临床治疗观察

目的研究乳腺癌患者化疗致败血症并发症的临床治疗观察。方法针对本次对乳腺癌化疗致败血症并发症的临床治疗观察的研究,将我院内2012年6月~2016年6月收治的1200例乳腺癌化疗患者中22例化疗致败血症患者作为临床研究对象,采用回顾性分析的方式对其治疗方式和效果进行分析。结果本次研究中入选的22例患者中20例患者因化疗后出现严重骨髓抑制的患者,以高热为首诊症状就诊,血常规检查提示四度粒细胞缺乏,经血培养检查证实败血症,血液中培养出革兰氏阴性菌。2例患者因行Port化疗管道感染,导致败血症,血液中培养出革兰氏阳性菌,及时发现后拔除输液港管道,积极抗感染治疗后痊愈。22例化疗乳腺癌致败血症患者总治愈率为100.00%。结论乳腺癌患者化疗致败血症并发症形成的因素主要包含抵抗力下降、局部护理不当、血栓形成等因素,但及时发现、经积极治疗后对患者的生命安全无影响,通过给予有效的抗生素抗感染治疗、提高免疫力治疗、及时拔除感染管道等措施处理后败血症症状能短期内缓解,治疗效果显著。     

临床药师参与1例卵巢癌药物治疗的实践与分析

目的:通过临床药师参与卵巢癌的治疗实践,保障肿瘤患者化疗的安全有效.方法:临床药师在临床工作中与医师协作,根据患者的具体情况,从药物的选择、给药剂量的计算等方面为卵巢癌患者制定个体化给药方案,并跟踪实施.结果:通过临床药师参与的卵巢癌药物治疗实践,避免了潜在的治疗风险,提高了患者用药的疗效.结论:临床药师参与临床药物治疗实践,有利于提高临床药物治疗水平.     

Prolonged clinical benefit with metronomic chemotherapy in patients with metastatic breast cancer

The clinical efficacy and antiangiogenic effect of low-dose, metronomic administration of cyclophosphamide (CTX) and methotrexate (MTX) (CM) have been demonstrated. The authors report results and long-term follow-up for patients with metastatic breast carcinoma who obtained prolonged clinical benefit with CM. Prospectively collected data from two successive clinical trials were evaluated. From July 1997 to October 2003, patients with metastatic breast carcinoma were treated with low-dose oral chemotherapy (MTX 2.5 mg, twice daily on day 1 and day 2 or 4, and CTX 50 mg daily). Patients who achieved prolonged clinical benefit for a duration of 12 months or more (complete remission, partial remission or stabilization of disease) were considered for the analysis. Median follow-up was 23 months. A total of 153 patients were enrolled and are evaluable: Eastern Cooperative Oncology Group performance status 0-1 in 90 patients, two or more sites of metastatic disease in 97 patients, zero regimen for metastatic breast carcinoma in 48 patients. Among 153 patients, five demonstrated complete remission and 25 partial remission. The proportion of patients who achieved prolonged clinical benefit was 15.7% (95% confidence interval 9.9-21.4%). Median time to progression for patients with prolonged clinical benefit was 21 months (range 12-37+ months). One patient maintained complete remission 42 months after therapy discontinuation. At the multivariate analysis endocrine responsiveness and the achievement of an objective response significantly correlated with the achievement of prolonged clinical benefit. Metronomic chemotherapy can induce prolonged clinical benefit in metastatic breast cancer, supporting its role as an additional therapeutic tool in the treatment of patients with metastatic breast carcinoma.     

华蟾素胶囊联合化疗治疗晚期肺癌患者的临床研究

目的分析华蟾素胶囊联合化疗治疗晚期肺癌患者的临床价值。方法在2013年11月至2014年11月,收集陕西中医药大学附属医院晚期肺癌患者的临床资料100例。并且随机数字表法分配为试验组与对照组各50例,试验组华蟾素胶囊联合化疗,对照组给予单纯化疗。2组患者在年龄、体质量、病程等方面差异无统计学意义(P>0.05)。结果华蟾素胶囊联合化疗治疗晚期肺癌患者的总体有效率达到了36%,单纯接受化疗治疗的总体有效率为30%。结论华蟾素胶囊联合化疗治疗晚期肺癌患者的临床价值比较好,能够有效改善临床的些许症状。     

Neurotoxic effects associated with antibiotic use: management considerations

The clinical manifestations of antibiotic-induced neurotoxic effects, the underlying mechanisms and management strategies have been reviewed. PubMed and OVID searches (January 1960-June 2010) were conducted using search terms such as antibiotics, side effects, neurotoxicity and encephalopathy which yielded approximately 300 articles. All relevant case reports, case series, letters and retrospective reviews describing neurotoxic effects and those discussing mechanisms of neurotoxicity were included. Antibiotic-induced neurotoxic side effects can have a myriad of neurologic presentations. Patients with prior central nervous system (CNS) disease, renal insufficiency and advanced age may be particularly vulnerable. Treatment consists of discontinuation of the offending agent, use of antiepileptic drugs in the case of seizures or status epilepticus and haemodialysis in certain cases. The risk of CNS toxicity may be reduced via dosage adjustments in high risk populations. Awareness of the potential neurotoxic clinical manifestations of various antibiotics and high degree of vigilance in critically ill patients is essential in identifying a potentially serious, though reversible complications of antibiotic therapy particularly with the advent of newer antimicrobial agents.     

Phase I clinical trial of doxorubicin and iproplatin combination chemotherapy in patients with breast cancer

Summary Forty-eight patients with advanced breast cancer were treated in a disease-specific phase I trial of doxorubicin and iproplatin combination chemotherapy. The doses of doxorubicin ranged between 30 and 50 mg/m₂, and the doses of iproplatin ranged between 150 and 250 mg/m₂. Myelosuppression was observed at all levels, but was dose-limiting at the highest level. In addition, nausea, diarrhea and malaise were prominent toxicities. Neither cardiac nor renal toxicity was encountered. Nine of 26 (35%) of previously untreated patients, and 5 of 22 (23%) previously treated patients demonstrated partial or complete responses. Although this combination possesses therapeutic activity, given its toxicities, further evaluation of doxorubicin in combination with iproplatin is not recommended.     

Bax和CD34在宫颈癌新辅助化疗中的临床研究

目的探讨Bax和CD34在宫颈癌新辅助化疗中的意义。方法选择60例宫颈癌患者（动脉化疗组32例,静脉化疗组28例）进行研究,采用免疫组化（IH—CA）和链霉抗生物素蛋白-过氧化酶SP法检测化疗前和化疗后15d宫颈癌组织CD34微血管密度和凋亡基因Bax表达,并进行病理效果的评价和临床随访。结果动脉化疗组的病理缓解率为81％,与静脉化疗组的53％比较,差异有显著性;动脉化疗后Bax基因表达增加,Bax高表达者其病理缓解疗效明显优于Bax低表达者;且治疗前组织中CD34微血管密度增高者,其病理缓解疗效明显优于微血管密度低者。结论宫颈癌动脉化疗的疗效优于静脉化疗,Bax基因表达和CD34微血管密度的检测可预测动脉化疗的敏感性。2种治疗方法的5年生存率比较无差异。     

术前口服肠内免疫营养在食管癌新辅助化疗 患者中的临床应用

摘要：目的 观察术前肠内免疫营养对食管癌新辅助化疗患者营养状态、免疫状况及临床结局的影响。方法 选取行食管癌切除手术的患者65例,按随机表分为肠内免疫营养组（EIN组,34例）和常规饮食组（对照组,31例）。 所有入组患者术前均行新辅助化疗2周期,并于新辅助化疗结束后3～4周行食管癌根治术。EIN组于新辅助化疗第 2疗程结束后1周开始在常规饮食基础上口服肠内免疫营养,直至术前1 d。对照组于新辅助化疗第2疗程结束后只 给予常规饮食。观察2组患者新辅助化疗第2疗程结束后1周及术前1 d的体质量指数、肱三头肌皮皱厚度和上臂 围。观察2组患者新辅助化疗第2疗程结束后1周、术前1 d、术后1 d、术后1周的营养及免疫指标。观察2组患者术 后1 d下床活动时间完成例数、术后首次肛门排气时间、术后肠内营养相关不良反应发生例数、术后肺炎发生例数和 住院时间。结果 2组患者在性别、年龄、吸烟史、饮酒史、临床分期、肿瘤位置等方面比较差异无统计学意义（P＞ 0.05）。术前1 d EIN组的体质量指数、肱三头肌皮皱厚度和上臂围与对照组相比差异有统计学意义（均P＜0.05）。 术前1 d EIN组营养指标和免疫指标显著上升（P＜0.05）;术后1 d 2组各营养指标和免疫指标均明显下降,与术前1 d 相比差异有统计学意义（P＜0.05）;术后1周2组患者各指标较术后1 d显著上升（P＜0.05）。术后1周2组指标和免 疫指标相比差异有统计学意义（P＜0.05）。术后下床活动完成例数EIN组较对照组明显增多,术后肠内营养相关不 良反应（腹胀、腹泻）及肺炎并发症例数EIN组较对照组少,术后首次排气时间和住院时间EIN组比对照组均较短,差 异有统计学意义（P＜0.05）。结论 对于食管癌新辅助化疗患者,术前口服肠内免疫营养,能改善患者的营养状态和 免疫状况,增加患者对手术的耐受力,降低并发症的发生,促进患者的快速康复。     

大肠癌病人围手术期腹腔热化疗与静脉化疗的临床对比研究

目的　系统比较结直肠癌病人围手术期腹腔温热化疗 (IPC)与全身化疗 (IVC)的优劣。方法　比较两组术前化疗后腹腔游离癌细胞的阴转率 ;术后 2周、6周时T细胞亚群及NK细胞的变化 ,骨髓抑制和消化道反应、体力状况等临床症状。结果　①术前腹腔游离癌细胞阳性者IPC组 3例 ,IVC组 2例 ,经术前IPC后开腹即时IPC组均阴性 ,而IVC组 2例仍为阳性 ;②术后 2周时外周血WBC、CD3 、CD4、CD4/CD8和NK细胞下降IVC组更明显 ,两组差异有显著意义 (P <0 0 5 ) ;③两组消化道反应和体力状况下降IPC组优于IVC组。结论　IPC能直接杀灭腹腔游离癌细胞 ,作用于腹腔及内脏微小转移灶 ,对防治大肠癌术后局部复发、腹腔及肝脏转移 ,提高手术疗效具有科学理论依据及确切的临床疗效。     

白血病儿童化疗中严重心脏损害的临床分析

目的探讨急性白血病患儿化疗中发生严重心脏损害的临床特征及预后。方法应用含蒽环类化疗药物的治疗中出现严重心脏损害的患儿8例。排除其他引起心脏损害的原因，化疗中出现以下1项异常改变：心力衰竭、心肌炎、心包炎、心源性休克。分析发生严重心脏损害发生时机、临床表现、实验室检查、治疗后转归。结果8例患儿严重心脏毒性均为亚急性，均发生心力衰竭，其中合并心包积液3例，合并心源性休克2例，合并细菌感染7例。发生时间为应用最近1次蒽环类化疗药物后5—10d。蒽环类药物累积剂量（以阿霉素计）（104．3±30．6）mg／m^2。心电图均明显异常，超声心动图指标变化差异无统计学意义（P〉0．05）。抢救成功4例，其中3例可耐受后续化疗。结论儿童白血病化疗中合并感染的严重心脏损害易导致急骤发生的心力衰竭，死亡率高，但抢救成功病例恢复好。蒽环类抗肿瘤药物用于儿童患者时应密切监测心电图。     

Guanidino-containing drugs in cancer chemotherapy: biochemical and clinical pharmacology

The pharmacology and clinical application of three guanidino-containing compounds are reviewed in this commentary with special focus on a new member of this group of drugs, CHS 828 [N-(6-(4-chlorophenoxy)hexyl)-N'-cyano-N"-4-pyridylguanidine]. m-Iodobenzylguanidine (MIBG) and methylglyoxal bis(guanylhydrazone) (MGBG) have been extensively studied, preclinically as well as clinically, and have established use as anticancer agents. MIBG has structural similarities to the neurotransmitter, norepinephrine, and MGBG is a structural analog of the natural polyamine spermidine. CHS 828 is a pyridyl cyanoguanidine newly recognized as having cytotoxic effects when screening antihypertensive compounds. Apart from having the guanidino groups in common, there are many differences between these drugs in both structure and their mechanisms of action. However, they all inhibit mitochondrial function, a seemingly unique feature among chemotherapeutic drugs. In vitro in various cell lines and primary cultures of patient tumor cells and in vivo in various tumor models, CHS 828 has cytotoxic properties unlike any of the standard cytotoxic drugs with which it has been compared. Among these are non-cross-resistance to standard drugs and pronounced activity in tumor models acknowledged to be highly drug-resistant. Similar to MIBG, CHS 828 induces an early increase in extracellular acidification, due to stimulation of the glycolytic flux. Furthermore, ATP levels decrease, and the syntheses of DNA and protein are shut off after approximately 30 hr of exposure, indicating active cell death. CHS 828 is now in early clinical trials, the results of which are eagerly awaited.     

幼年类风湿关节炎免疫指标检测及临床意义

目的 探讨幼年类风湿关节炎(JRA)息儿T细胞亚群、免疫球蛋白(Ig)和红细胞沉降率(ESR)、C反应蛋白(CRP)联合检测的临床价值.方法 对40例确诊JRA患儿采用流式细胞术测定外周血T淋巴细胞亚群(CD3+、CD4+、CD16+、CD16+CD56+),采用速率散射比浊法检测Ig、CRP,ESR采用魏氏法,设正常对照组40例.结果 T细胞亚群CD3+、CD8+、CD16+CD56+与对照组比较明显降低,CD4+与对照组比较明显升高(均P<0.05),IgG、IgA、IgM、ESR和CRP均高于正常对照组(均P<0.05).结论 JRA患儿存在炎性反应,疾病活动时伴有细胞免疫、体液免疫两种免疫功能紊乱.     

老年胃癌患者的临床特点及术后并发症

目的 分析老年胃癌患者的临床特点并探讨术后并发症的防治对策.方法 选择2009年2月-2013年5月手术治疗的老年胃癌患者26例,分析26例胃癌患者的临床特点并探讨术后并发症的防治对策.结果 26例患者术后切口感染3例（11.5%）,胸腔积液4例（15.4%）,切口开裂1例（3.8%）,肺部感染2例（7.7%）,心功能不全2例（7.7%）,吻合口瘘2例（7.7%）,胃排空障碍1例（3.8%）.经采取及时合理的对症治疗措施后,均得到有效控制,未出现因并发症而死亡的患者.结论 根据老年胃癌患者的临床特点,在做好术前准备、合理选择手术方式及有效预防,可有效减少老年胃癌患者的术后并发症,促进患者恢复.     

Drug targeting in cancer chemotherapy: a clinical perspective

Drug targeting is a phenomenon which maneuvers the distribution of drug in the body in such a manner that the major fraction of the drug interacts exclusively with the target tissue at a cellular or subcellular level. Numerous strategies have been developed to accomplish this goal; some of them have been tried clinically for improving cancer chemotherapy. This review updates the current status of research in the area of targeted drug delivery, with particular emphasis on its application in the clinical management of carcinomas.     

Neurotoxic effects in patients poisoned with organophosphorus pesticides

In this paper we review neurotoxic disorders appearing in patients poisoned with organophosphorus pesticides. These compounds cause four important neurotoxic effects in humans: the cholinergic syndrome, the intermediate syndrome, organophosphate-induced delayed polyneuropathy (OPIDP) and chronic organophosphate-induced neuropsychiatric disorder (COPIND). Compared to the cholinergic syndrome, that causes millions of cases of poisoning each year, other disorders involve much smaller numbers of patients. The review is focused on the neurotoxic effects appearing after acute and chronic exposure to organophosphates with emphasis on clinical presentation, pathogenesis, molecular mechanisms, and possibilities for prevention/therapy.     

胰腺癌与反复发作性胰腺炎的临床及CT征象分析

目的探讨胰腺癌与反复发作性胰腺炎的临床及CT征象,旨在提高对胰腺癌的认识,减少胰腺癌的误诊。方法将2010年1月～2011年1月病理证实的15例胰腺癌(观察组)与15例反复发作性胰腺炎(对照组)的临床及CT资料进行回顾性分析。结果观察组与对照组入院时及24h后查血清淀粉酶差异均无统计学意义(P>0.05);观察组CT表现多为胰腺局限性增大并肿块状或结节状持续弱强化,对照组多表现为非肿块不均匀性弱强化;观察组5例与对照组7例胰管扩张,观察组4例扩张胰管于病变区突然中断,观察组1例与对照组7例扩张胰管贯通病变区(P<0.05);观察组7例与对照组1例胰周淋巴结增大(P<0.05),观察组5例出现胰周血管改变,对照组无胰周血管改变。结论胰腺癌与反复发作性胰腺炎酶学改变相似,不具鉴别价值;胰腺癌与反复发作性胰腺炎CT征象各有特点,CT检查能为两者鉴别提供重要依据。