胸段食管癌术后放射治疗的临床观察

目的：评价胸段食管癌术后放射治疗的价值。方法：对132例胸段食管癌患者（单纯手术59例，手术加放射治疗73例），分组比较。结果：术后放疗组1、3、5a局部控制率分别为91．8％、54．8％、39．7％；单纯手术组1、3、5a局部控制率分别为78％、20．3％、8．5％。经统计学处理有显著性差异。术后放疗组1、3、5a生存率分别为76．7％、45．2％、37％。单纯手术组1、3、5a生存率分别为50．8％、25．4％、18．6％。统计学处理有显著性差异。结论：手术加放疗能提高生存率和局部控制率。     

晚期喉癌患者不同治疗方法的生存率与生存质量比较

目的探讨晚期喉癌患者不同治疗方法生存率和生存质量比较。方法分析104例喉癌经单纯手术、手术加放射治疗及化学治疗加手术加放射治疗等不同方法治疗的疗效。结果综合治疗组复发率及远处转移率均低于单纯手术组(P<0.05);喉癌Ⅲ期患者5年生存率稍高于Ⅳ期(61.5% vs 56.4%);手术加放疗组和化疗加手术加放疗组5年生存率均高于单纯手术组(P<0.05);综合治疗组术后生存质量高于单纯手术组(P< 0.05)。结论对喉癌采用综合治疗的方法比单纯手术疗效好。     

Ⅰ及Ⅱ期食管癌根治术与术后放疗103例分析

目的评价Ⅰ及Ⅱ期食管癌根治术后放射治疗的价值．方法收治103例术后病理确诊为Ⅰ～Ⅱ期的食管癌，单纯手术72例，加术后放疗31例，放射剂量50～60Gy．结果随访5年以上，47例复发，复发与TNM分期有关，区域淋巴结和食管瘤床失败与食管原发部位有显著关系。手术切除组：1、3、5年生存率分别为87．5％、69．4％、41．7％，术后放疗组1、3、5年生存率为90．3％、83．9％、74．2％。结论术后放疗复发率低，5年生存率术后放疗组明显高于单纯手术组。Ⅰ及Ⅱ期食管癌术后常规放疗可提高远期生存率。     

27例儿童髓母细胞瘤临床研究

目的：分析总结儿童髓母细胞瘤临床特点及其治疗效果。方法：27例经手术切除及病理确诊的儿童患者,单纯手术治疗组12倒,手术＋全脑全脊髓放疗组15例。结果：单纯手术组1年生存率33．3％,3年生存率8．3％,手术加全脑全脊髓放疗组1年生存率93．3％,3年生存率53．3％。术后全脑全脊髓放疗组生存率显著高于单纯手术组。结论：显微镜下全切除肿瘤组织,术后予以全脑加全脊髓段放射治疗,可有效的降低复发转移率,显著延长生存期。     

声门上型喉癌N0～2颈部淋巴结的治疗方法

目的：对声门上型喉癌N0～2颈部淋巴结的治疗方法进行讨论。方法：对64例声门上型喉癌颈部淋巴结N0～2行改良颈清术与改良颈清术加放疗两种治疗方法，并进行分析。结果：64例声门上型喉癌中，改良颈清术32例38侧，改是颈清术加术后放疗32例34侧，N0～N1 32例34侧，N2 32例38侧。3年总生存率64．06％，5年总生存率57．81％。N3行根治性颈清术，在此不作讨论。结论：对N01N病例，改良颈清术与改良颈清术加放疗一样有效（P〉0．05）。对于N2病例，改良颈清术加放疗明显优于单纯改良性颈清术（P〈0．05）     

喉癌、下咽癌复发的临床分析和治疗转归

目的：探讨喉癌、下咽癌术后复发的原因及挽救性手术的可行性。方法：回顾分析98例复发性喉癌、下咽癌的临床资料。68例行癌复发手术切除及术后常规放疗，其中喉部分切除术后局部复发21例，颈淋巴结转移7例，局部复发并颈淋巴结转移5例；全喉切除术后气管造瘘口复发癌8例；下咽癌切除术后局部复发2例。颈淋巴结转移15例；30例行单纯放疗或姑息性治疗。68例行癌切除术和(或)改良根治性颈清扫术，其中胸大肌皮瓣修补术29例，胃上提代食管下咽15例，游离结肠上徙代下咽食管2例。结果：喉癌手术后1年、3年生存率分别为96.10％和33.33％，下咽癌手术后1年、3年生存率分别为64.71％和5．88％，而单纯放疗或姑息治疗1年及3年的生存率仅为10％和0％。结论：复发性喉癌、下咽癌的预后较差，适当的手术治疗可延长患者生命，提高生存质量。     

喉癌122例临床分析

本文报道了我院近十年来治疗，经病理确诊的122例喉癌患者，其中手术治疗62例，放射治疗60例（手术加放射治疗18例）。50～70岁组最多性别以男性居多，占总数的84．4％，其中鳞状细胞癌199例占总数的97．5％，其它为乳头状瘤癌变及白斑癌变。手术冶疗62例中，全喉切除39例，部分喉切除21例。五年生存率：手术组五年生存率为58％，其中部分喉切除的五年生存率的28％，全喉切除为39％，而放疗组五年生存率只有13％，说明手术治疗优于放射治疗。讨论作者证实吸烟与喉癌的发病关系密切。并讨论了早诊早治与提高治愈率和五年生存率的关系，治疗方…     

肝切除加肝动脉置泵栓塞化疗联合^125I放射治疗肝癌24例

目的观察不规则肝切除加肝动脉置泵栓塞化疗联合^125I粒子植入放射治疗原发性肝癌的24例治疗效果。方法回顾性分析近10年来59例肝癌患者单纯肝切除与不规则肝切除加肝动脉置泵栓塞化疗联合^125I粒子植入放射治疗原发性肝癌的临床资料。结果单纯手术组与不规则肝切除加肝动脉置泵栓塞化疗联合^125I粒子植入放射治疗组1、3、5年术后复发率分别为67．2％＆37．5％、84．4％＆55．0％、94．8％＆72．5％，差异有显著性（P〈0．05）。两组病人1、3、5年生存率分别为58．7％＆90％、41．1％＆72．5％、13．8％＆40％，差异有显著性（P〈0．05）。结论不规则肝切除加肝动脉置泵栓塞化疗联合^125I粒子植入放射治疗原发性肝癌可明显降低术后复发率，提高生存率。     

复发性喉癌42例临床分析

目的：探讨喉癌复发的相关临床因素及挽救性手术的可行性。方法：分析42例复发性喉癌的临床资料。结果：局部复发24例，颈淋巴结转移17例，局部复发并颈淋巴结转移1例。治疗采取部分喉切除、全喉切除及(或)颈廓清术。局部复发组3、5年生存率分别为66．7％(16／24)和54．2％(13／24)。颈淋巴结转移组3、5年生存率分别为35．3％(6／17)和23．5％(4／17)。结论：喉癌复发可能与原发肿瘤的临床分期以及治疗方式的选择有关。对复发性喉癌的治疗仍以手术为主，术后容易出现切口延期愈合及咽瘘，应注意防治。     

64例喉癌治疗结果分析

对６４例被治喉癌治疗结果进行回顾性分析。治疗方法包括单纯放疗１９例、放疗加化疗１０例、手术后放疗２２例、手术后放疗加化疗１３例。随访率为９５．３％，总的５年生存率为４２．１８％。结果表明：手术后放疗加或不加化疗的生存率都高于其他方法的生存率（Ｐ＜０．００１）；单纯放疗剂量以６０～７５Ｇｙ、术后放疗剂量以５０～６０Ｇｙ为佳；Ⅰ期病人采用单纯放疗的三、五年生存率分别为９０．９％、７２．７％；有颈淋巴结转移的病人预后差。说明早期发现、合理选择治疗方法是提高喉癌生存率的关键。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.