小剂量顺铂联合变异LV5FU2治疗进展期胃癌的临床观察

目的：观察小剂量顺铂联合变异LV5FU2（Lc—LV5FU2）治疗进展期胃癌的疗效。方法：60例进展期胃癌随机分为观察组（Lc-LV5FU2）和对照组（FOLFOX4），就其有效率、临床受益反应率、毒性和QOL评分改善率进行比较。结果：观察组和对照组的腿（42％vs46．6％），CBR（84％vs85．6％），QOL评分改善率（25％vs22％）的差异无统计学意义。P值均〉0．05。两组的毒性反应为恶心呕吐、白细胞减少和外周神经毒性，但多轻微。结论：小剂量顺铂联合变异LV5FU2方案治疗进展期胃癌有效、安全，毒副作用可耐受，且价格较低，是一个有价值的方案。     

原发性高血压及相关危险因素与颈动脉内-中膜厚度的相关性研究

目的探讨原发性高血压(高血压)及相关危险因素与颈动脉内-中膜厚度(intima-media thickness,IMT)的相关性。方法本文收集了2007年6月至2007年12月在贵阳医学院诊治且病历资料较完整的186例高血压患者,按血压水平由低至高分成3组:高血压1级组50例;高血压2级组56例;高血压3级组80例。另外,选择门诊健康体检者50名作为对照组。收集研究对象的一般情况、血生化指标及双侧颈总动脉IMT及斑块的超声测量结果。结果高血压各组的颈动脉IMT,颈动脉斑块发生率明显高于对照组,并随血压等级增加而增加,方差分析及q检验显示差异有统计学意义(P0.05)。Logistic回归分析显示,年龄、男性、吸烟、总胆固醇及低密度脂蛋白胆固醇是颈动脉IMT增加的独立危险因素(P0.05),而脂蛋白(a)、尿酸、肌酐与颈动脉IMT无明显相关性(P0.05)。结论高血压可使颈动脉IMT增加,其程度和颈动脉斑块发生率均随血压分级增高而增加;年龄、男性、吸烟、总胆固醇及低密度脂蛋白胆固醇是颈动脉IMT增加的独立危险因素;脂蛋白(a)、肌酐、尿酸与颈动脉IMT无明显相关性。     

FOLFOX-6与肝动脉灌注化疗对结直肠癌肝转移治疗效果的比较

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.     

蕈样霉菌病1例

患者,男,23岁,2个多月前不明原因出现大小不等斑丘疹,略高起皮肤表面,灰白及浅红色,主要在面部,起初自行消退,但又有新的出现。近期发现颈部、前胸也有类似皮疹,并且数量增加。患者在当地医院行局部皮肤活检,病理未给予明确诊断。患者3个月前因感冒吃过祛寒药（剂量及用法不详）,将皮肤活检切片送我院会诊。     

中等卫校实验教学改革探讨

实验教学是学校教学工作的重要组成部分,是使理论联系实际、培养学生动手能力的重要环节。实验就是科学实践,它不仅可以使学生验证和深入理解理论知识,还可以加强学生基本操作、基本技术的训练,从而提高学生思考、分析、解决问题的能力。医学是一门实验科学,随着医学模式的转变和新技术革命对医学的冲击,中等卫校的实验教学在中等医学教育中显得尤为重要。     

高枕并非无忧

正常人的脊柱有四个生理弯曲：颈部往前凸，胸部往后凸，腰部往前凸，骶尾部往后凸。只有适应脊柱的这种正常曲线，才能使身体健美。枕头过高，无论是仰卧还是侧卧，都会使脊柱的生理状态改变。在早期可引起“落枕”（颈肌酸痛、头转动受限），长期如此，可使颈椎强直、错位，导致头颈胀痛、失眠、记忆力减退等症状，还影响血液循环。一般患高血压、高颅压、心脏病、肺气肿、哮喘的病人，需要高枕；患有低血压、休克、低颅压、颈椎病、贫血的病人，则需要低枕。新生儿的头比较大，可以不用枕头平卧床上，随着身体的生长发育，头与躯干的比例…     

经腋路腋动脉后臂丛神经阻滞麻醉40例

经腋路腋动脉后臂丛神经阻滞麻醉４０例内江市第一人民医院（６４１０００）周声鳞，孙永红，江福斌，华薇经腋胳臂丛阻滞麻醉的血管旁注射法（简称血管旁法），安全；成功率高，但阻滞不全机会多，尤其是桡神经。我院自１９９２年采用腋动脉后注射法（简称血管后法），收...     

改良子宫次全切除术10例临床疗效观察

以往的子宫次全切对卵巢的血供有很大影响,因而影响了卵巢的功能.子宫内膜也有许多分泌功能[1],切除后其内分泌功能会受影响.我院从2001年1月始实行改良式子宫次全切除术共10例.术后彩超复查卵巢血供与术前基本相同,均获成功.现报道如下.     

听觉脑干诱发电位对椎基底动脉系统短暂性缺血的研究

30例椎基底动脉短暂性缺血缓解期作听觉脑干诱发电位(BAEP)检查,有听力减退和/或脑干功能异常者23例(76.6％),对14例BAEP异常者动态观察,在其临床症状痊愈后仍有5例BAEP异常,提示可能有影响听觉通路的微小梗塞灶或亚临床的血循环障碍,表明BAEP对诊断本病有一定的临床意义.     

MEBO在宫颈糜烂CO_2激光术后的应用探讨

宫颈糜烂二氧化碳（CO。）激光水后涂MEBO治疗100例，旨在探索提高其疗效的方法，结果3周后治愈率88％，总显效率98％，平均治意时fol25k。对照组100例，单纯采用CO。激光治疗，治愈率60％，总显效率80％，平均治愈时间29天。CO。激光联合MEBO疗效明显优于对照组（PwtO．001），且疗程明显缩短（P＜0．001）。MEBO在宫颈糜烂CO_2激光术后的应用探讨@孙永红$山东省莱芜市第2人民医院!271100@黄庆山$山东省莱芜市第2人民医院!271100@朱雪芹$山东省莱芜市第2人民医院!271100…