芫花醇羊膜腔内注射死因探讨(附3例病理资料)

本文报告3例芫花乙醇液中期引产死亡尸检病理结果,并对死亡原因进行了分析。证实芫花乙醇浸剂可直接引起子宫肌、蜕膜、胎盘组织坏死、出血,伴有无菌性炎症,而且大量凝血活素及坏死物质进入血循环启动外源性凝血系统而导致DIC。强调指出,子宫体炎或内膜结核;恶性葡萄胎或绒毛膜上皮癌治愈后;多胎妊娠或近期哺乳者均列为芫花引产禁忌症。在操作时应注意防止药液带入子宫肌层。     

Oncology: Review of clinical investigation of recurrence of gastric cancer following curative resection

The incidence and mortality of gastric cancer (GC) have dramatically declined for the last several decades, and the therapeutic outcomes of patients with GC continue to improve. Nonetheless, GC remains a major public health issue as the fourth most common cancer and a relevant problem as the second most common cause of cancer death worldwide.[1, 2] The highest incidence rates are in Eastern Asia, Eastern Europe, and South America.[3] Presently, the only potentially curative treatment for GC is radical gastrectomy. Despite curative resection (R0), recurrences are still common, occurring in approximately 60% of patients. The main reason for this is that GC is often advanced at the time of diagnosis.[4-6] Death from GC after curative resection is mostly due to recurrence as well. The GC recurrence rates after curative resection are not uniform as reported,[7] and the recurrence rates at different time points after surgery are quite different from one another. More than 90% of patients relapse within 5 years after surgery, and 70% relapse within 2 years. In a study by Wu et al.,[8] cumulative recurrence rates were 53.5%, 80%, 89.0%, 94.7%, 96.3%, 98%, and 99.5% at 1, 2, 3, 4, 5, 6, and 7 years, respectively. The long-term recurrence rate at 7 years was 15.8% for locoregional relapse and 34.5% for distant recurrence in a recent study.[4] These high rates of recurrence have been attributed to the abundant lymphatic channels within the gastric wall, providing channels for mucosal skip lesions and numerous potential pathways of lymphatic drainage away from the stomach.[9] Both the recurrence rate and recurrence pattern following laparoscopic gastrectomy were similar to those of conventional laparotomy according to a multicenter study.[10] This article reviews the current clinical status and progress of recurrence from GC following radical gastrectomy by concentrating on the patterns of recurrence, clinicopathologic factors affecting recurrence, detection of recurrence, prognosis, and treatment methods.