中晚期卵巢癌综合治疗疗效及影响因素的分析

目的：探讨细胞减灭术及化疗对卵巢上皮性癌的治疗效果及影响因素。方法：回顾性分析1988年1月－1998年1月在我院治疗且经细胞减灭术后肿瘤残留灶≤2cm的卵巢上皮性癌38例的临床资料,其中Ⅱ期13例,Ⅲ期25例;术后无残留灶者26例,残留灶直径≤2cm者12例。术后均采用CAP方案（环磷酰胺、阿霉素、顺氯铵铂）、AP方案（阿霉素、顺铂）,CE方案（卡铂、表阿霉素）进行化疗。结果：总的5年生存率为33．6％。其中Ⅱ期为34．9％,Ⅲ期为29．5％（P＞0．01）。有残留灶与无残留灶者的5年生存率分别为16．5％及37．6％（P＜0．05）。化疗疗程数＜8个及≥8个者的5年生存率分别为20．0％及60．1％（P＜0．001）。结论：经细胞减灭术后,有无肿瘤残留灶和术后化疗的疗程数均与预后有关,其中化疗疗程数对生存期影响更大。     

10年间卵巢上皮性癌的治疗及预后因素分析

目的：探讨本院90年代卵巢上皮性癌的治疗与预后影响因素。方法：对1990年1月至1999年12月在我院治疗的294例卵巢上皮性癌进行回顾性分析。全部手术切除标本经病理诊断并按FIGO分期标准分期。294例全部经手术治疗。其中58例经2－4次手术。结果：3年，5年及10年的生存率分别为I期92．1％，86．8％及82．1：II期79．9％，65．4％及52．3％，III期54．8％，37．2％，及20．8％（P＜0．005），3例未化疗者均在术后2年内死亡。COX回归模型单，多因素分析发现，上皮性癌的预后与年龄，病理类型的关系不大（P＞0．05），而与临床分期，细胞分级，术后残留癌灶大小有关（P＜0．005），化疗疗程≥6次与不足6次相比，相对风险率为0．7456，死亡风险概率降低0．25，残留癌灶小于等于2厘米与＞2厘米者相比，相对风险度为0．3261，死亡风险概率降低0．67，结论：临床分期、细胞分级、术后残留癌灶大小及化疗疗程是否≥6疗程是影响卵巢癌预后的主要因素。晚期卵巢上皮性癌的预后近10年有所改善，初次手术时要尽量切净，使残留癌灶＜2厘米，术后尽早正规，足量，足疗程化疗，可提高生存率，对复化转移者，只要能切除者尽量切除，术后再次化疗或加放疗等综合治疗仍可提高生存率。     

中晚期卵巢癌综合治疗疗效及影响因素分析

目的：探讨细胞减灭术及化疗对卵巢上皮性癌的治疗效果及影响。方法：回顾性分析1998年1月—2008年1月治疗且经细胞减灭术后肿瘤残留灶≤2 cm的卵巢上皮性癌38例的临床资料,其中期13例,期25例;术后无残留灶者26例,残留灶直径≤2 cm者12例。术后均采用CAP方案（环磷酰胺、阿霉素、顺铂）,AP方案（阿霉素、顺铂）,CE方案（卡铂、表阿霉素）进行化疗。结果：总的5年生存率为33.6%。其中期为34.9%,期为29.5%（P〉0.1）。有残留灶与无残留灶者5年生存率分别为16.5%及37.6%（P〈0.05）。化疗疗程数〈8个及≥8个者5年生存率分别为20.0%及60,1%（P〈0.001）。结论：经细胞减灭术后,有无肿瘤残留灶和术后化疗的疗程数均与预后有关,其中化疗疗程数对生存期影响更大。     

晚期上皮性卵巢癌腹膜后淋巴结清扫的临床价值

目的评价腹膜后淋巴结清扫对晚期上皮性卵巢癌预后的影响。方法将67例晚期上皮性卵巢癌患者随机分为研究组32例及对照组35例。研究组行卵巢肿瘤细胞减灭术+术后规范化疗,对照组行卵巢肿瘤细胞减灭术+腹膜后淋巴结清扫术+术后规范化疗,对比2组手术时间、术中出血量、术后病率及术后1、3、5年生存率的差异。结果研究组术中出血量、手术时间、术后病率均显著小于对照组。2组1、3、5年生存率均无显著差异;而2组术后残留癌灶<1.0 cm的患者3、5年生存率均显著高于同组残留癌灶≥1.0 cm的患者。结论理想的肿瘤减灭术是影响晚期上皮性卵巢癌患者预后的重要因素,而腹膜后淋巴结清扫不能提高晚期上皮性卵巢癌的生存率,反而使围手术期的并发症显著提高。     

卵巢上皮性癌术后静脉化疗期的血管保护

卵巢上皮性癌对化疗较敏感,即使广泛转移,也可取得一定疗效[1]。卵巢癌早期无明显的症状和体征,一旦发现多属中、晚期。早期卵巢癌术后需静脉化疗3个～6个疗程,晚期要行静脉腹腔联合化疗或静脉化疗6个～8个疗程来杀灭残留的癌灶,以控制复发、缓解症状。由于化疗药物对血管刺激大、化疗     

晚期卵巢上皮性癌19例手术治疗体会

卵巢上皮性癌是临床上最常见的一种卵巢恶性肿瘤 ,其恶性程度较高 ,疗效较差。目前的主要治疗方法仍为手术、化疗、放疗等综合治疗 ,其中手术治疗是主要有效手段。作者采用手术治疗晚期卵巢上皮性癌 1 9例 ,现将结果报告如下。1　临床资料本组晚期卵巢上皮性癌 1 9例 ,ＦＩＧＯ分期Ⅲ期 1 8例 ,Ⅳ期 1例。年龄 40～ 77岁。手术范围包括 :腹水或腹腔冲洗液检查 ,全面腹盆腔隔面探查 ;行大网膜切除 ;盆腔肿块切除包括全子宫 双附件、双卵巢动静脉高位结扎 ;盆腔腹主动脉旁淋巴结清扫术 ;阑尾切除术 ;转移瘤切除。按照以上手术范围完成手术为…     

16例卵巢正常大小的原发性卵巢上皮癌综合征的临床分析

目的 :探讨卵巢正常大小的原发性卵巢上皮癌综合征的临床特点及影响预后的因素。方法 :对 16例患者的病例资料采用回顾性分析。结果 :本病的临床特点为 ,发病年龄在 5 0岁以上的占 85 % ;以腹胀为首发症状 ;就诊晚 ,误诊率高 ;卵巢均正常大小 ,盆腹腔有广泛种植 ,生存率低 ,预后差。术后无残留癌灶或残留癌灶直径≤ 2cm者生存时间明显高于术后残留癌灶直径 >2cm者 ,差异显著 (P <0 0 1)。化疗疗程数≥ 6个者生存时间明显高于疗程数 <6个者 (P <0 0 1)。本组患者的 1a、3a、5a的生存率分别为 65 %、3 0 %、2 5 %。中位生存期 2 3个月。结论 :术后残留癌灶大小可能是影响卵巢正常大小的原发性卵巢上皮癌综合征患者的预后的重要因素 ,术后系统化疗疗效显著。     

16例卵巢正常大小的原发性卵巢上皮癌综合征的临床分析

目的：探讨卵巢正常大小的原发性卵巢上皮癌综合征的临床特点及影响预后的因素。方法：对16例患者的病例资料采用回顾性分析。结果：本病的临床特点为：发病年龄在50岁以上的占85％；以腹胀为首发症状；就诊晚，误诊率高；卵巢均正常大小，盆腹腔有广泛种植，生存率低，预后差。术后无残留癌灶或残留癌灶直径≤2cm者生存时间明显高于术后残留癌灶直径＞2cm者，差异显著（P＜0．01）。化疗疗程数≥6个者生存时间明显高于疗程数＜6个者（P＜0．01）。本组患者的1a,3a,5a的生存率分别为65％、30％、25％。中位生存期23个月。结论：术后残留癌灶大小可能是影响卵巢正常大小的原发性卵巢上皮癌综合征患者的预后的重要因素，术后系统化疗疗效显著。     

晚期卵巢上皮性癌的治疗及预后分析

【目的】探讨晚期卵巢上皮性癌的治疗及预后影响因素。【方法】回顾性分析87例晚期卵巢上皮陛癌的临床病理资料。应用COX风险比例模型判断影响预后的因素。【结果】多因素分析显示,临床分期、残余灶大小及术后化疗的疗程数是影响预后的重要因素。【结论】满意的肿瘤细胞减灭术及术后规则化疗可以改善晚期卵巢上皮性癌的预后。     

卵巢上皮性交界性肿瘤72例临床病理特征与预后的关系

目的 探讨卵巢上皮性交界性肿瘤的临床病理特征对预后的影响.方法 回顾性分析我院1995 年1 月至2005 年12 月初治的72 例卵巢上皮性交界性肿瘤的临床病理资料,采用Kap-lan-Meier 进行生存分析,并进行复发相关因素分析.结果 本组患者的5 年无复发生存率为94.4%.4 例患者复发,均为黏液性交界瘤,其复发率为5.6%,平均复发时间24 个月.单因素分析显示:肿瘤晚期(Ⅲ期与Ⅰ期:25.0% vs.3.1%;P ＝0.058)、肿瘤破裂(破裂与无破裂:25.0%vs.3.1%;P ＝0.058)和术后有残存肿瘤(有残存与无残存肿瘤:50.0% vs.1.4%;P ＝0.055)者的复发率明显高于肿瘤早期、无破裂和手术切净者,但经统计学处理P 值处于临界状态.而肿瘤有浸润性腹膜种植(有腹膜种植与无:25.0% vs.4.4%;P ＝0.208)、双侧卵巢病变(双侧与单侧病变:40.0%vs.3.0%;P ＝0.22)和术前血清CA199 异常升高(异常升高与正常:13.6% vs.4.2%;P ＝0.64)者的复发率明显高于无浸润性腹膜种植、单侧病变和CA199 正常者,但均无统计学意义.另外,患者的年龄(P ＝0.614)、肿瘤大小(P ＝1)、有无微浸润(P ＝0.566)、手术方式(P ＝0.64)及术后辅助化疗(P ＝1)等均不影响肿瘤的复发.结论 卵巢上皮性交界性肿瘤的预后好,复发率低,且黏液性患者易复发.肿瘤晚期、破裂和术后肿瘤残存可能与交界性肿瘤术后复发相关,而浸润性腹膜种植、双侧卵巢肿瘤、手术方式、年龄、肿瘤大小、微浸润等对交界性肿瘤的复发均无显著影响,且术后辅助化疗也不降低肿瘤复发.     

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.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.