鼻咽癌放疗患者院外康复训练依从性及其影响因素的调查

目的了解鼻咽癌放疗患者院外康复训练的依从性状况,分析其影响因素。方法采用康复锻炼依从性问卷对110例完成放疗的鼻咽癌患者进行调查,并进行有序多分类Logistic回归分析。结果110例患者中72例院外康复锻炼依从性差;Logistic回归分析显示,康复锻炼依从性差与家庭月人均收入低有关(P0.05)。结论鼻咽癌放疗患者院外康复训练的依从性较差,家庭月人均收入是重要的影响因素。医护人员应采取有效的措施,提高鼻咽癌放疗患者院外康复训练的依从性,以预防晚期并发症的发生。     

Chemotherapy with or without radiotherapy in patients with locoregionally recurrent nasopharyngeal carcinoma

BACKGROUND: Treatment of locoregionally recurrent nasopharyngeal carcinoma (NPC) is challenging because of prior radiotherapy, morbidities from disease recurrence, and limited therapeutic options available. METHODS: A retrospective study of patients with locoregionally recurrent NPC. RESULT: Between March 1994 and December 1999, there were 42 patients; most were Chinese (98%) men (81%) with undifferentiated NPC (86%). A repeat course of radiotherapy was feasible in 20 patients and given concurrently with cisplatin followed by adjuvant cisplatin/5-fluorouracil (PF) (group 1). The remaining 22 (group 2) received palliative chemotherapy (PF) with a response rate of 50%. Significant morbidities resulted from cranial nerve palsies. The 2-year progression-free survival of patients in group 1 was expectedly better (58% vs 38%). Six (14%) developed systemic metastases at 12 months (median) from first recurrence. CONCLUSION: Concurrent chemoradiotherapy for locoregional recurrent NPC seems promising. The morbidity experienced resulted from locoregional disease with few progressing to develop systemic involvement.     

鼻咽癌放疗患者社交回避因素的描述性质性研究

目的 探讨鼻咽癌放疗患者社交回避的引发因素,为制订针对性护理策略提供依据。 方法 采用描述性质性研究方法,以目的抽样法选取12例鼻咽癌放疗患者为研究对象,对患者进行半结构式访谈,根据内容分析法对资料进行分析并提炼主题。 结果 提炼出3个主题7个亚主题,即理想自我形象构建无能（包括面对面交流困难、潜在的负面评价）,自我价值感削弱（现实的无效应对、社交活动参与度降低、加重家庭负担的愧疚感）,社会支持缺乏（亲友认同支持不足、专业支持不足）。 结论 医护人员需重视鼻咽癌患者社交回避的影响因素,加强医院、社区、家庭的协同合作,增强患者的自我价值感,减轻鼻咽癌放疗患者社交心理负担,使其重返社交环境。     

Clinically underdetected asymptomatic and symptomatic carotid stenosis as a late complication of radiotherapy in Chinese nasopharyngeal carcinoma patients

BACKGROUND: Carotid artery stenosis is a late complication of radiotherapy to the neck region. This complication has, however, a significant impact with increased risk of stroke causing mortality and morbidity. Clinicians' awareness of this complication and early detection is therefore important. METHODS: Eighty patients with nasopharyngeal carcinoma (NPC) who had received radiotherapy were recruited for color Doppler ultrasonography of the carotid arteries. fifty-eight patients with newly diagnosed NPC who had never received any radiotherapy were recruited as controls. All patients with significant carotid stenosis were referred to the neurology clinic for further assessment. RESULTS: Twenty-four patients were found to have more than 50% diameter reduction in the extracranial carotid artery. Clinical assessment by a neurologist showed 9 of 24 patients had a history of transient ischemic attack, amaurosis fugax, or stroke. Seven of these patients had clinically detectable neck bruit. CONCLUSIONS: Clinicians attending to patients after radiotherapy for head and neck cancers should be aware of this long-term complication of radiotherapy. A detailed clinical history and incorporation of auscultation of carotid arteries in routine follow-up of postradiotherapy patients are recommended.     

Delayed and localized pemphigus vulgaris after breast cancer radiotherapy

Breast cancer treatment involving ionizing radiation causes characteristic radiation dermatitis in the majority of patients. The DNA damaging effects of radiation can rarely predispose to primary inflammatory dermatoses, such as pemphigus vulgaris. In such cases, the disease presents with all the hallmarks of the primary dermatosis, but the eruption is limited to the field of irradiation and is often amenable to treatment. In contrast, occurrence of generalized pemphigus vulgaris in this setting may mean cancer recurrence. The mechanism by which radiotherapy induces localized disease remains unknown, but there is likely a loss of self‐tolerance which maybe coupled to antigen exposure.     

PDCA循环健康教育对鼻咽癌放疗患者张口锻炼依从性的影响

目的探讨PDCA循环健康教育对鼻咽癌放疗患者张口锻炼依从性的影响。方法将287例鼻咽癌放疗患者根据其入院顺序分为对照组和干预组。对照组采用常规的张口功能锻炼健康教育方法,干预组采用PDCA循环健康教育方法,在放疗开始时实施干预。观察放疗后和出院3个月两组患者的张口功能锻炼依从性和张口困难发生率。结果放疗后和出院后3个月干预组患者的张口功能锻炼依从性显著高于对照组,张口困难程度显著低于对照组(P0.05,P0.01)。结论采用PDCA循环的健康教育能有效提高鼻咽癌放疗患者的张口锻炼依从性,降低张口困难的程度,促进患者康复。     

Cullen's sign - Case report with a review of the literature

IntroductionCullen's sign is described as superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. It is also known as peri-umbilical ecchymosis.Presentation of caseWe report a case of a fifty-three year old gentleman who presented with non-specific abdominal pain. Significant bruising was present within the subcutaneous fatty tissue on the anterior abdominal wall in keeping with ‘Cullen's sign.’ Of note he denied any alcohol intake and his amylase was normal. A diagnosis of pancreatitis was made following a CT scan of his abdomen.DiscussionA search of the entire English literature using PubMed with the phrase ‘Cullen's sign’ has been performed. Papers were reviewed in relation to recognition of this clinical sign, differential diagnosis, and management.ConclusionOur case and review of the literature highlights the rarity of this clinical sign which a clinician may encounter. In addition we draw to attention the importance of having knowledge of the underlying possible conditions which may lead to this sign, and can be vital in successful acute management.