恶性血液病患者的心理状况及治疗

目的 :了解恶性血液病患者的心理状况及治疗方法。方法 :在常规化疗前后 (相隔 6周 )用焦虑自评量表 (SDS)、抑郁自评量表 (SAS)各对患者测定 1次 ,期间进行一般性心理疏导 ,少数患者给盐酸氟西汀和氯硝西泮口服。另设对照组和正常人群组予以对照。结果 :研究组和对照组的SDS标准分均值为 4 6 .12± 11.6 1和4 5 .4 1± 13.5 2 ,均高于正常人群组 39.0 2± 9.89(均P <0 .0 1)。SAS的标准分均值为 4 7.78± 12 .17、4 7.0 9±13.89,均高于正常人群组 38.16± 9.92 (均 P <0 .0 1)。治疗后研究组和对照组的SDS分别为 31.2 3± 9.98和4 3.5 6± 10 .2 6 ,SAS分别为 37.18± 10 .81和 4 4 .94± 11.0 4 ,两组差异有统计学意义 (P <0 .0 1)。与治疗前相比 ,研究组有显著改善 (P<0 .0 1) ,而对照组改善不明显 (P >0 .0 5 )。盐酸氟西汀和氯硝西泮配合治疗SDS标准分大于 5 0分的患者 9例 ,标准分均值由 6 0 .5 6± 12 .31下降到 4 0 .12± 10 .76 (P <0 .0 1) ,6例患者分值降至 5 0分以下 ,下降 6 6 .7%。SAS大于 5 0分的有 10例 ,治疗后均值由 6 3.36± 11.4 2下降到 4 1.89± 10 .2 4 (P <0 .0 1) ,7例患者分值降至 5 0分以下 ,下降 70 .0 %。结论 :恶性血液病患者大部分存在焦虑、抑郁情绪 ,常规化疗下心理     

Sepsis in patients with hematological diseases

Sepsis is one of the important complications on the treatment of severe hematological diseases. In this report, we analyzed sepsis in 309 patients with hematological diseases who were admitted to the First Department of Internal Medicine of Yokohama City University Hospital from 1979 to 1986. Positive blood culture were found in 17.8% (55/309 cases) and total positive cases were 73 including recurrent patients. Positive rate by underlying diseases was 30.3% in acute leukemia, 20.8% in chronic myelocytic leukemia, 17.2% in aplastic anemia, 8.0% in multiple myeloma, 6.0% in malignant lymphoma and 6.5% in others. The organisms causing sepsis were as follows; gram negative bacilli 56.4%, gram positive organisms 34.6%, fungus 6.4% and anaerobic bacteria 2.6%. Pseudomonas aeruginosa was found in 19.2%. The mortality rate of patients with sepsis was 34.2% (25/73 cases). The significant prognostic factors in patients with sepsis were the degree of neutropenia, duration of neutropenia (500 less than microliters), the species of organisms, simultaneous complication with shock and the site of other infections.     

Two cases of Burkholderia cenocepacia in septicemic patients

We herein report repeated isolation of Burkholderia cenocepacia from two cases of septicemia admitted to cardiothoracic and bone marrow transplant (BMT) units. The two blood cultures taken from each patient grew B. cenocepacia. Both patients turned afebrile after appropriate antimicrobial therapy, and the subsequent blood cultures were sterile. However, both patients had recurrence of fever after about a week, and the patient in the BMT unit died due to respiratory failure. Environmental surveillance was conducted in both units. Non-fermenting Gram-negative bacilli including Pseudomonas aeruginosa were isolated from environmental samples in the cardiothoracic ward.     

自体造血干细胞移植治疗恶性血液病的临床研究

应用自体造血干细胞移植(ASCT)治疗恶性血液病11例,并随机选择病种、年龄及性别相似的13例应用常规化疗的恶性血液病作为对照.结果显示所有患者均造血重建,白细胞降至0的中位时间为6(3～10)天,持续5(1～14)天,中性粒细胞恢复至＞0.5×109/L的时间为18(13～24)天.在不输血小板情况下,维持血小板计数＞20×109/L中位时间为23(17～42)天.中位持续完全缓解时间(CCR)667.7(83～1885)天.3年无病生存率46%,而对照组3年无病生存率仅为18%,P＝0.035.提示自体造血干细胞移植可提高生存质量,明显提高无病生存率.     

Drug-induced respiratory disease in patients with hematological diseases

Patients with hematological malignancies or recipients of hematopoietic stem cell transplants may develop myriad pulmonary manifestations, as a complication of either the disease or the diverse agents used to treat the disease. Clinical, radiographic, and physiological features of drug-induced and radiation-induced pulmonary injury are often difficult to distinguish from other causes of pulmonary infiltrates (e.g., infections, pulmonary edema, alveolar hemorrhage, etc.). Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) is essential to exclude infectious etiologies. In some cases, surgical lung biopsies are required to establish a specific etiological diagnosis. This review discusses the myriad causes of lung injury/toxicity that may afflict patients with hematological malignancies or transplant recipients, and presents diagnostic and therapeutic approaches.     

无环鸟苷和丙氧鸟苷在恶性血液病中应用研究

无环鸟苷和丙氧鸟苷在恶性血液病中应用研究周锡建干祥生孟沛霖无环鸟苷（ＡＣＶ）是鸟苷的衍生物。而丙氧鸟苷（ＧＣＶ）是ＡＣＶ的类似物。ＡＣＶ的化学名为９－（２－羟乙氧甲基）鸟嘌呤，ＧＣＶ的化学名为９－（１，３－二羟－２－丙氧甲基）鸟苷，ＧＣＶ又可称为ＤＨ...     

Performance evaluation and relevance of the CellaVision DM96 system in routine analysis and in patients with malignant hematological diseases

The CellaVisiontrade mark DM96 is an automated image analysis system dedicated to locating and preclassifying the various types of white blood cells in peripheral blood smears. The system also partially characterizes of the red blood cell morphology and is able to perform platelet counts. We routinely analyzed the blood samples from 440 patients with quantitative and/or qualitative abnormalities detected by the XE-2100 Sysmextrade mark. Only 2.6% of cells are not identified by DM96trade mark. After classification of the unidentified cells very good correlation coefficients are observed between DM96trade mark and manual microscopy for most hematological parameters and accuracy is judged excellent up to 98%. For most common parameters, false positive and false negative ratios are also very good. Whatever the pathology and the number of blasts on smear, all patients were positive for blast detection on DM96trade mark. The system is a useful tool for assisting in the diagnosis and classification of most acute or chronic leukemia. Automatic cell location and preclassification, along with unique cell views on the computer screen, could reduce the time spent performing differentials and make real-time collaboration between colleagues a natural part of the classification process. The workstation also provides an ergonomically correct and relaxed working environment. We suggest its use in routine analysis; the system could be very helpful for the accurate morphological diagnosis of samples from patients with malignant hematological disease.     

恶性血液病医院感染分析

对我院2000年12月～2001年11月血液科住院病人中发生医院感染的81例患者进行回顾性统计分析。结果发现：恶性血液病医院感染率明显高于普通疾病，尤其是髓系细胞恶性血液病；感染好发部位为呼吸道、血液、口腔、消化道等，病原菌以G-杆菌为主，原发病性质及化疗是医院感染率明显增高的主要因素。认为对于恶性血液病患者采取预防措施，提高机体免疫力，早期给予积极的干预，可以减少或减轻医院感染。     

Hepatitis B in patients with hematological diseases: An update

Hepatitis B virus(HBV) reactivation(HBVr) in patients undergoing immunosuppressive therapy is still a hot topic worldwide. Its prevention and management still represents a challenge for specialists dealing with immunosuppressed patients. Aim of this paper is to provide a critical review of the relevant information emerged in the recent literature regarding HBV reactivation following immunosuppressive treatments for oncohematological tumors. A computerized literature search in MEDLINE was performed using appropriate terms arrangement, including English-written literature only or additional relevant articles. Articles published only in abstract form and case reports not giving considerable news were excluded. Clinical manifestation of HBVr can be manifold, ranging from asymptomatic self-limiting anicteric hepatitis to life-threatening fulminant liver failure. In clusters of patients adverse outcomes are potentially predictable. Clinicians should be aware of the inherent risk of HBVr among the different virological categories(active carriers, occult HBV carriers and inactive carriers, the most intriguing category), and classes of immunosuppressive drugs. We recommend that patients undergoing immunosuppressive treatments for hematological malignancies should undergo HBV screening. In case of serological sign(s) of current or past infection with the virus, appropriate therapeutic or preventive strategies are suggested, according to both virological categories, risk of HBVr by immunosuppressive drugsand liver status. Either antiviral drug management and surveillance and pre-emptive approach are examined, commenting the current international recommendations about this debated issue.     

Thrombotic complications in patients with malignant diseases

The incidence of thromboembolic disease (TED) in malignant diseases is high and is often the cause of death in these patients. The most important thrombogenic factors are changes of the coagulation system, venostasis, changes in the function and structure of the endothelium and the influence of specific anti-tumour therapy. The most frequent clinical manifestation is phlebothrombosis of the lower extremity. Diagnostic procedures in detection of thrombosis do not differ fundamentally from standard procedures (clinical examination, duplex sonography, phlebography, possibly pulmonary scintigraphy). More intensive prophylaxis of TED is necessary under certain conditions (surgical treatment, immobilization, chemotherapy). Therapeutic patterns with heparins, possibly thrombolytics, are common but subsequent anticoagulation treatment must be provided as long as the active stage of the neoplastic disease persists, in particular if the patient is treated with cytostatics. When anticoagulation treatment is contraindicated and there is a general favourable prognosis, implantation of caval filters is an adequate provision. New findings indicate the possible anti-tumourous action of low-molecular heparins, but these are only initial observations.     

Anorectal infections in patients with malignant diseases

Fifty-seven episodes of anorectal infection in 44 patients with malignant diseases primarily leukemia or lymphoma, have been retrospectively reviewed. Seventeen patients died in hospital, but only in seven cases was the anorectal infection a major contributing cause of death. The most important prognostic indicator of outcome was number of days of neutropenia during the infectious episode. Cultures obtained at the time of surgical drainage or by needle aspiration of the wound revealed multiple organisms in 26 of 29 instances, and anaerobic organisms were the commonest isolates. Anorectal infection was controlled in 28 (55%) of 51 treatment courses when antibiotics were the only treatment given. However, if the antibiotic regimen included both an aminoglycoside and an antibiotic with anaerobic coverage, control of infection was observed in 15 (88%) of 17 cases. There were 26 surgical procedures performed, with acceptable morbidity. Infection was controlled in 19 (73%) of 26 cases treated with surgery and antibiotics. The results support managing most of these infections initially with medical treatment, using an antibiotic regimen that includes an aminoglycoside and a specific drug against anaerobes. Surgery is recommended if there is obvious fluctuance, a significant amount of necrotic tissue evident, or progression of the infection locally or continued sepsis after an adequate antibiotic trial.     

应重视血液病侵袭性真菌感染的诊治

传统意义上,真菌感染属于皮肤科大夫的诊治范围,但近年来我们深切体会到深部真菌感染已成为血液科工作者面临的重大问题,而这方面的研究比较薄弱,值得高度重视。随着血液恶性疾病如白血病、恶性淋巴瘤的化疗、放疗和骨髓移植治疗(BMT)的研究开展,使恶性血液病患者的预后和生存期得到明显改善。但是,由于恶性血液病本身的原因以及临床治疗手段的发展,免疫力低下的血液病患者不断增多,成为感染的高危人群。各种有效的抗生素的大量问世使细菌感染得到较好控制;与之相反,以上种种原因导致血液病患者过去十分罕见的侵袭性真菌感染(IFI)发病率…     

Clinical characteristics and analysis of patients with hematological diseases and HCV-Ab positive

正Objective To observe the biological characteristics of patients with hematological diseases and hepatitis C antibodies positive and to investigate features of HCV infection and reactivation.Methods A total of 85 patients with seropositive HCV at the hematology ward in Henan Cancer Hospital between October 2010 and October 2015 were analyzed.The clinical characteristics and laboratory data were retrospectively reviewed.Original disease     

Pseudomonas cepacia septicemia in patients with burns: report of two cases

Pseudomonas cepacia has been ascribed to low pathogenicity in man. Within a 10-day period this organism caused 2 cases of septicemia in the Karolinska Hospital burn unit, one with fatal outcome. Both cases were severely burned patients. A serological response to Ps. cepacia was observed in the surviving patient. The blood isolates from the patients showed a very high degree of similarity in biochemical tests, indicating a common origin although the source was not found. The characteristic antibiogram with resistance to aminoglycosides as well as ampicillin and most cephalosporins causes therapeutic problems, since many septicemias of unknown origin are treated with a combination of ampicillin and an aminoglycoside.