贲门癌切除、肝动脉植入化疗泵治疗贲门癌合并肝转移

我院自 1992年 2月— 1998年 12月 ,共收治贲门癌同期合并肝转移 (即原发灶与转移灶同时发现 )患者 37例 ,其中3例肿瘤广泛转移 ,为探查性手术 ,2例在切原发灶同时 ,同期施行了肝转移灶切除 ,此 5例不列为本文讨论内容。其余32例在切除原发病灶同时 ,采用皮下埋植式化疗泵植入肝动脉 ,术后定期化疗 ,取得了较为满意效果。材料和方法一　研究对象　收治 32例 ,男 2 3例 ,女 9例 ;年龄 41—6 8岁 ,平均 5 3岁。术前证实肝转移者 2 5例 ,术中发现 7例。转移至肝右叶 15例 ,肝左叶 7例 ,肝左右叶均有转移 10例。转移灶 2个结节 11例 ,3个以上结…     

大肠癌肝转移的手术治疗进展

传统的观点,恶性肿瘤转移到肝,意味着全身扩散,失去治愈机会,不宜手术。Foster1970年复习世界文献的83例转移性肝癌手术治疗取得良好的效果后,肯定了外科手术对转移性肝癌的治疗地位。1976年Wilson报告了大肠癌孤立性肝转移灶手术切除,5年及10年生存率分别为42％和28％。近十年来国外有较多的报告,认为结、直肠癌(以下称大肠癌)肝转移后,仍然可以手术切除,完全改变了传统的观点。截至1985年,在美国已达700余例,效果令人鼓舞。     

结肠直肠癌肝转移的外科治疗(文献综述)

手术探查结肠直肠癌时,约有20％病例可见肝转移,其存活时间(中位值)为6～10个月,预后不佳;若能在切除原发病灶同时切除肝转移灶,则可提高生存率,甚至获得痊愈。Foster复习世界文献报告的83例转移肝癌手术切除的效果,47％生存2年,21％生存5年,从而肯定了外科手术对转移性肝癌的效果和地位。     

40例胃癌肝转移的手术治疗及预后

目的 分析胃癌肝转移患者的手术治疗效果及影响预后的因素,以探讨其手术指征。 方法 回顾性分析2010年1月1日至2012年1月1日于我院胃肠外科行原发灶+肝转移灶切除的40例胃癌合并肝转移患者的临床资料,分析其手术效果并用Log-rank检验及Cox风险比例模型分别对胃癌肝转移患者的主要临床病理因素与预后的关系进行单因素和多因素分析。 结果 40例患者均顺利完成手术,其中行R0切除30例,R1切除10例,无R2切除者。术后并发症发生率为15.0% （6/40）,无术后大出血及死亡病例。1年、2年及3年总生存率分别为37.5% （15/40）、10.0% （4/40）、0,中位生存期为10.5个月。单因素分析显示原发灶病理类型、原发胃癌侵犯浆膜、胃周淋巴结转移、血管癌栓、神经侵犯、转移灶分布、转移灶直径、肝转移类型、肝切除方式和手术根治程度与预后相关。多因素分析显示原发胃癌侵犯浆膜、血管癌栓、神经侵犯、转移灶直径和手术根治程度为预后的独立影响因素。 结论 原发胃癌未侵犯浆膜、无血管癌栓、无神经侵犯、肝转移灶直径＜5 cm和R0切除者可能是胃癌肝转移行原发灶+肝转移灶切除术的受益人群,亦可能是较佳的手术适应证。     

肝动脉介入热化疗治疗转移性肝肿瘤的临床应用

肝脏由于血液循环丰富,是恶性肿瘤发生转移的好发器官.肿瘤转移是严重影响患者生存期及生活质量的主要原因之一.目前针对肝转移患者最主要的治疗方法是手术切除转移灶,但在临床上许多患者就诊时已失去了手术切除的机会,此外即使肝内转移灶能完全切除,术后复发率仍有47%～70%.     

300例结直肠癌肝转移患者的临床预后分析

目的 探讨结直肠癌肝转移患者的临床特征及预后因素.方法 对300例结直肠癌首发肝转移患者的临床特征及肝转移后的生存情况进行回顾性分析.结果 300例患者中,原发病灶位于结肠者152例,位于直肠者148例.原发肿瘤为管状腺癌272例,黏液腺癌18例,类癌5例,印戒细胞癌4例,鳞癌1例.原发肿瘤为高分化19例,中分化217例,低分化27例.无区域淋巴结转移104例,有区域淋巴结转移162例.原发肿瘤分期为Ⅰ、Ⅱ期62例,Ⅲ、Ⅳ期为237例.同时性肝转移206例,异时性肝转移94例.肝转移灶为单发48例,多发252例.肝转移灶最大直经≤5 cm249例,>5 cm 51例.300例患者转移后中位生存期为19.0个月,肝转移后1、2和5年生存率分别为79.0%、29.0%和3.0%.单因素分析结果显示,患者KPS评分、组织学分级、原发肿瘤T分期、有无区域淋巴结转移、原发肿瘤分期、有无脉管瘤栓、肝转移灶部位、肝转移灶最大直径、肝转移灶数目、同时合并其他转移均与预后有关.多因素分析结果显示,KPS评分、脉管瘤栓、肝转移灶数目、肝转移灶最大直径是结直肠癌肝转移患者预后的独立影响因素.结论 KPS评分、脉管瘤栓、肝转移灶数目和最大直径是结直肠癌肝转移患者预后的影响因素,KPS评分越高、无脉管瘤栓、肝转移灶数目越少、转移灶最大直径越小的患者预后越好.     

220例结直肠癌同时肝转移患者临床预后分析

背景与目的:结直肠癌是国内常见的肿瘤之一,结直肠癌同时肝转移的发生率可高达10%～25%。本文探讨影响结直肠癌同时肝转移患者预后的因素和治疗的选择。方法:回顾性分析1995年12月至2002年12月中山大学肿瘤防治中心收治的初治结直肠癌同时肝转移患者220例,对其临床资料进行统计分析。用Kaplan-Meier法对结直肠癌同时肝转移患者的预后进行单因素分析,用Cox模型进行多因素分析。结果:本组病例5年生存率为5.52%,中位生存时间为12.93个月。用Kaplan-Meier及log-rank法对临床特征进行单因素生存分析,有统计学意义的变量因素包括:肝转移灶数目、肝转移灶最大径、肝转移灶分布、肝外是否存在侵犯或转移、确诊时CEA水平、局部区域淋巴结有无转移、病理类型。对临床治疗方式进行单因素生存分析,有统计学意义的变量因素包括:治疗方式、原发灶是否完全切除和化疗方案的选择。用Cox模型进行多因素分析后发现:肝转移灶分布肝叶数、肝转移灶最大径、肝外是否存在侵犯或转移、确诊时CEA水平、治疗模式、原发病灶是否切除、化疗方案为独立的预后危险因素。结论:对于结直肠癌同时肝转移的患者,肝转移灶最大直径超过5cm、肝转移灶分布超过一叶、存在肝外侵犯或转移灶和CEA水平超过200μg/L提示患者预后不良。对于仅有肝转移的结直肠癌患者应尽可能手术根治原发灶以及转移灶,对于手术不能切除的肝转移灶可考虑行全身化疗和/或介入治疗,全身化疗最好选用含草酸铂的方案。     

无法治愈的晚期结直肠癌肝转移患者的临床病理特征与姑息性治疗预后的生存分析

目的：通过分析无法治愈的晚期结直肠癌肝转移患者临床病理特征与姑息性治疗预后的相互关系,探讨姑息性治疗对患者预后生存的影响。方法：回顾性分析第二军医大学东方肝胆外科医院自2009年1月至2009年12月收治的82例无法治愈的晚期结直肠癌肝转移患者临床资料。采用 Kaplan －Meier 法计算生存率及生存曲线,并进行单因素分析,采用 Log －rank 进行统计学检验。经单因素分析对预后有统计学意义的危险因素带入 COX 多因素回归模型,计算独立预后因素。结果：总体中位生存期为19．09个月,1、2、3年累计生存率分别为82％、28％、13％;对经过严格筛选,评估原发病灶与肝内转移灶可以完整切除而肝外不可切除的转移灶未予以手术处理但生长局限,术中发现肿瘤侵犯周围组织、器官仍可局部切除,且具备强烈手术意愿的晚期结直肠癌肝转移患者实施姑息性手术切除,术后中位生存期、1年、2年累计生存率均显著优于非手术治疗者：27．00个月 vs 16．36个月,85％ vs 79％,57％ vs 0（P ＜0．001）。对于总体生存期而言,单因素分析显示：不同的治疗方式、肝转移瘤生长位置、肝内转移灶数目为影响患者预后的因素（P ＜0．05）;COX 多因素分析结果显示：非手术治疗方式、肝内转移灶多发是对无法治愈的晚期结直肠癌肝转移患者姑息性治疗预后产生影响的独立危险因素。结论：对于经过严格筛选,评估原发病灶与肝内转移灶可以完整切除而肝外不可切除的转移灶未予以手术处理但生长局限,术中发现肿瘤侵犯周围组织、器官仍可局部切除且具备强烈手术意愿的结直肠癌肝转移患者,接受姑息性手术治疗,其生存优于非手术治疗患者。     

手术治疗胃癌肝转移的预后分析

目的：探讨手术治疗胃癌肝转移的预后因素．方法：对25例患者临床病理特征及生存应用多元分析其与预后的关系。结果：20例行同时性肝切除，5例行异时性肝切除，1、3、5年生存率分别为84．0％，28．0％，21．0％。肝转移灶数目（孤立和多灶），转移灶分布（单叶和多叶），肝切除方式，原发灶组织学类型，淋巴结转移及脉管瘤栓与预后相关，多元分析显示多灶肝转移，原发灶淋巴结转移、脉管瘤栓是其预后独立危险因素。结论：对出现孤立转移灶、原发灶无淋巴结转移且无脉管瘤栓的胃癌肝转移患者应手术切除以获得更好的预后。     

羟基喜树碱联合高聚金葡素治疗晚期肝癌近期疗效观察

原发性肝癌晚期及转移性肝癌依然是肿瘤临床治疗上的一个十分棘手的难题。近几年来虽然随着介入治疗,B超引导下肝癌瘤体注射治疗等新技术的推广运用,在治疗手段上有了更多可供选择的方法,但疗效仍不尽人意。近年,作者探索运用羟基喜树碱联合高聚金葡素治疗晚期原发性和转移性肝癌,取得了较好的近期疗效,报告如下: 1 材料与方法 1.1 一般资料 本组28例(原发性肝癌16例,转移性肝癌12例),均符合我国1977年全国肝癌协作组制定的临床诊断标准。其中男性23例,女性5例;年龄为34岁～72岁,平均54.4岁。B超或CT检查肝内单个瘤灶10例,2个瘤灶4例,2个以上瘤灶14例。肝内肿块>10cm者3例(10.7％),6～10cm 18例(64.3％),3～5cm 7例(25％)。AFP>400ng/L者12例(42.9％)。转移性肝癌12例,其中来源于乳腺癌有4例、肺癌4例、结肠癌2例、胃癌2例。治疗前全组患者生活状态按Karnofskv评     

Efficacy of conservative treatment modalities used in epistaxis

Objective

To assess the efficacy of conservative modalities in the management of epistaxis.

Study design

Prospective case studies.

Setting

Rural medical college hospital.

Patients

Indoor and outdoor patients with epistaxis.

lntervention

Conservative(non surgical) management techniques in epistaxis.

Results

Chemical cauterization was successful in 72.07% cases, anterior nasal packing in 84.5% and posterior nasal packing in 95.6% cases.

Conclusion

Out of 300 cases of epistaxis included in the study (except for one case that required internal maxillary artery ligation). all cases were treated successfully with conservative treatment alongwith treating the underlying pathology causing epistaxis.     

The role of neuropathology in the management of progressive glioblastoma

Question

1. What are the most important diagnostic considerations in reporting progressive glioblastoma?

Target population

These recommendations apply to adults with progressive glioblastoma

Recommendations

Level III

For patients who undergo biopsy or neurosurgical resection at the time of radiologic or clinical progression, it is recommended that the pathologist report the presence and extent of progressive neoplasm as well as the presence and extent of necrosis within the pathologic material examined. Furthermore, to ensure the proper interpretation of progressive glioblastoma, it is recommended that the pathologist take into account the patient’s previous diagnosis and treatment, as well as the current clinical and neuroimaging features that have led to a second biopsy or resection.

Question

2. What techniques and ancillary studies are most useful in separating malignant progression from treatment effect?

Target population

These recommendations apply to adults with progressive glioblastoma

Recommendations

Level III

In the setting of prior radiation and chemotherapy, it is recommended to adhere to strict histologic criteria for microvascular proliferation and necrosis in order to establish a diagnosis of a glioblastoma. Immunohistochemistry and genetic studies are selectively recommended for distinguishing neoplastic cells from atypical reactive cells in progressive glioblastoma.     

Diagnostic significance of nasal eosinophilia in allergic rhinitis

Background

Nasal eosinophilia is one of the potential tests for substantiating the diagnosis of allergic rhinitis.

Objective

The aim was to establish the validity of nasal eosinophilia in allergic rhinitis, to study it's various clinical correlates and interpret it in context of skin sensitivity pattern.

Study Design

Prospective cased study.

Setting

Hospital based.

Patients

The patients were selected on the basis of history and clinical examination and were from the Himalayan region.

Intervention

Diagnostic.

Methods

The patients and the equal number of controls, were subjected to nasal smear for eosinophilia and intra-dermal skin tests to various allergeus.

Results

Overall, eighty percent of nasal smears were positive in various degrees among the cases. Around eighty-eight percent of cases showed both smear and skin test positivity, thereby signifying a high degree of harmony among them and further validating and confirming the diagnosis of allergic rhinitis.

Conclusion

Nasal eosinophilia was found to be a useful diagnostic test in allergic rhinitis, with a moderately high sensitivity and a high specificity.     

Successful treatment of parotid fistula with tympanic neurectomy

Background

Parotid fistula is a cause of great distress and embarrassment to the patient. A host of treatment modalities have been described in past but no unanimity exists regarding the most satisfactory of all. Tympanic neurectomy is an effective procedure for persistent parotid fistula with no significant side effects.

Objective

To describe our experience with tympanic neurectomy for the treatment of persistent parotid fistula and discuss the other treatment modalities described.

Setting

Tertiary care referral centre.

Methods

Two cases with post traumatic parotid fistula recalcitrant to conservative therapy were treated with tympanic neurectomy between 2004–2005. The cases were followed up regularly for any recurrence of fistula.

Results

Successful and immediate cessation of flow from parotid fistula with no recurrence in subsequent followup.

Conclusion

Tympanic neurectomy is a safe and effective procedure for the successful treatment of persistent parotid fistula.     

Enhancing life after cancer in diverse communities

BACKGROUND:

Although large numbers of cancer survivors exist in every community, including minority communities, there is a significant gap in knowledge about best practices for these patients.

METHODS:

The Community Networks Program, funded by the National Cancer Institute Center to Reduce Cancer Health Disparities, has developed and tested unique services for these communities. These programs have used community‐based participatory research techniques under a framework of diffusion of innovation and communications theory.

RESULTS:

This article describes some specifically tailored interventions that may be useful to a wide range of providers working with the underserved.

CONCLUSIONS:

Enhancing life after cancer can be achieved in underserved communities by supplementing local resources. Cancer 2012. © 2012 American Cancer Society.     

Results of intravenous steroid injection on reduction of postoperative edema in rhinoplasty

Objective

To determine the efficacy of intravenous dexamethasone in reducing postrhinoplasty edema.

Design

A prospective, randomized clinical trial with placebo control.

Setting

Department of Otorhinolaryngology, Al-Sabah and Zain Hospital, Kuwait.

Subject

Eighty-four patients (male = 28; female = 56) aged between 20 and 40 years, undergoing open rhinoplasty with hump removal and bilateral lateral osteotomies were enrolled in this study.

Intervention

Patients were randomized to receive two doses of 10 mg of dexamethasone intravenously or placebo, first dose during surgery and second dose 12 hours after surgery.

Main outcome measures

Patients were evaluated postoperatively at 24 hours, days 2, 5, 7 and 10 for periorbital edema.

Results

10 mg of dexamethasone given intravenously during rhinoplasty and a second dose 12 hours after surgery, reduced postoperative periorbital edema significantly.

Conclusion

This study showed a statistically significant benefit of dexamethasone over placebo in reducing periorbital edema after rhinoplasty. No complications were attributed to the administration of dexamethasone.     

Cancers et environnement : explorer les comportements de recherche et les sources d’information des personnes atteintes et non atteintes d’un cancer

Aim

To explore information-seeking behaviors on links between cancers and environment.

Method

Focus groups and individual semi-structured interviews realized, respectively, with individuals without and with personal cancer experience.

Results

The majority of respondents reported informationscanning behaviors. Only half cancer patients searched for information regarding the links between cancers and environment.

Conclusion

Little information is sought on links between cancers and environment.

     

Interventionelle Verfahren in der Tumorschmerztherapie

Background

Analgesics and antineuropathic substances are the mainstays of cancer pain management. Interventional procedures for the relief of cancer pain are only rarely applied.

Aim

In this review the indications for interventional pain management of cancer pain are presented.

Material and methods

In a systematic review PubMed and the Internet were searched for clinical trials and case reports documenting effects, adverse events and complications of specific interventional procedures used in the management of cancer pain.

Results

Based on the criteria of evidence-based medicine, there is no proof that the use of interventional procedures for cancer pain is necessary.

Discussion

The use of interventional procedures for cancer pain should be restricted to patients with individual indications. Interventional procedures have the potential to reduce adverse events but can also have additional severe complications.     

Societal preference values for advanced melanoma health states in the United Kingdom and Australia

Background:

No studies measure preference-based utilities in advanced melanoma that capture both intended clinical response and unintended toxicities associated with treatment.

Methods:

Using standard gamble, utilities were elicited from 140 respondents in the United Kingdom and Australia for 13 health states.

Results:

Preferences decreased with reduced treatment responsiveness and with increasing toxicity.

Conclusions:

These general population utilities can be incorporated into treatment-specific cost-effectiveness evaluations.     

The interaction between prognostic and pharmacodynamic biomarkers

Background:

Interactions between prognostic and pharmacodynamic (PD) biomarkers have received little attention.

Methods:

Prognostic and PD utilities were assessed with linear mixed-effects models using published data on repeated measurements of circulating caspase-cleaved (ctCK18) and total (tCK18) cytokeratin 18, in 57 patients with metastatic colorectal cancer undergoing chemotherapy.

Results:

The model for tCK18 (but not cCK18) separated the prognostic/PD interaction from the pure prognostic effect, illustrating the principle of dual prognostic and PD characteristics for a given biomarker.

Conclusion:

These models provide the framework for the analysis and interpretation of longitudinal data to detect prognostic/PD biomarker interactions.