多层螺旋CT仿真内镜技术在胃间质瘤与胃癌鉴别诊断中的临床应用

目的探讨多层螺旋CT(MSCT)仿真内镜技术(CTVE)在胃间质瘤与胃癌鉴别诊断中的临床应用价值。资料和方法临床疑似胃占位性病变71例,行MSCT扫描并进行CTVE重建。CTVE诊断结果与胃镜或手术后病理结果进行对照。结果经病理证实胃间质瘤18例,胃癌26例,CTVE敏感度为93.2%,特异度为96.3%。CTVE显示腔内型间质瘤呈类球形腔内肿块伴顶端溃疡形成;腔外型间质瘤表现为丘状隆起、桥形皱襞;BorrmannⅠ、Ⅱ型胃癌呈息肉样向胃腔内突出,或伴不规则溃疡;BorrmannⅢ、Ⅳ型胃腔不同程度变窄,伴不规则溃疡形成、胃壁皱襞消失。结论 CTVE在胃间质瘤与胃癌鉴别诊断方面有一定的临床应用价值,但需要注意结合轴位图像及临床资料做出诊断。     

Advances in local and ablative treatment of oligometastasis in prostate cancer

Oligometastasis is a state of limited metastatic disease that may be amenable to aggressive local therapy to achieve long‐term survival. This review aims to explore the role of ablative radiotherapy and surgical management of prostate cancer (CaP) patients with oligometastasis. We performed a systematic review of the literature from November 2003 to November 2013 in the PubMed and EMBASE databases using structured search terms. From our literature search, we identified 13 cases of oligometastatic CaP managed by surgery. The longest disease‐free survival documented was 12 years following pulmonary metastasectomy. We also found 12 studies using radiotherapy to treat oligometastatic CaP with median follow‐up ranging from 6 to 43 months. Local control rates and overall survival at 3 years range from 66 to 90% and from 54 to 92%, respectively. Most patients did not report any significant toxicity. The limited current literature suggests oligometastatic CaP may be amenable to more aggressive local ablative therapy to achieve prolonged local control and delay to androgen deprivation therapy (ADT). There is a larger body of evidence supporting the use of radiotherapy than surgery in this disease state. However, no direct comparison with ADT is available to suggest an improvement in overall survival. Further studies are required to determine the role of aggressive‐targeted local therapy in oligometastatic CaP.     

阿片类联合激素及抗惊厥药治疗晚期癌痛的临床观察

目的　探讨晚期癌痛应用阿片类药物的合理用药方案。方法　选择伴有中、重度疼痛的晚期肿瘤患者,分３组,第一组３６例,采用盐酸羟考酮控释片（奥施康定）单药治疗;第二组１９例,用奥施康定和甲强龙联合治疗;第三组２５例,用奥施康定联合加巴喷丁。观察３组患者治疗后的疼痛缓解情况和生活质量。结果　单用奥施康定组完全缓解率为６３.９％,奥施康定联合甲强龙组为６８.４％,奥施康定和加巴喷丁联用组为４８.０％。主要毒副反应为便秘,其次为恶心、呕吐。第二组毒副反应最轻,第三组部分患者出现头晕和嗜睡。结论　阿片类药物奥施康定治疗晚期癌痛具有较好的疗效,其中奥施康定联合甲强龙尤其适合肺癌伴脑转移或骨转移患者,且安全性高,值得临床推广。     

济南市艾滋病流行特征与趋势分析

[目的]全面了解济南市艾滋病流行特征,探讨切实有效的防治模式.[方法]对济南市近年来有关艾滋病疫情资料进行分析.[结果]1998年以来,累计发现抗-HIV阳性者95例,其中HIV感染者65例,艾滋病病人30例.HIV感染者和艾滋病病人逐年增加.95例中,流动人口80例;男性71例,女性24例;20～39岁青壮年71例;经性接触感染者29例,静脉注射吸毒感染者28例.[结论]济南市HIV感染者和艾滋病病人逐年上升,以性接触、静脉吸毒途径感染为主,外来流动人员占多数.     

胰岛素泵治疗1型糖尿病的临床研究

目的评价胰岛素泵治疗1型糖尿病的治疗效果和安全性。方法将76例患者随机分成胰岛素泵治疗组和常规胰岛素治疗组,并进行相应的治疗,持续1周,观察治疗前后,血糖控制效果及低血糖发生率。结果 2组治疗后3餐前血糖及3餐后2h血糖均较治疗前明显降低,且胰岛素泵治疗组较常规胰岛素治疗组降低更显著(P0.05)。胰岛素泵治疗组低血糖发生率较常规胰岛素治疗组低。结论胰岛素泵治疗能更快、更有效地控制高血糖,降低低血糖的发生率。     

Decreased tear secretion after laser in situ keratomileusis for high myopia

PURPOSE: To investigate the changes in tear secretion and tear film stability after excimer laser in situ keratomileusis (LASIK) for high myopia. METHODS: One eye of 28 patients underwent unilateral LASIK for the correction of myopia with spherical equivalent refractions ranging from -6.37 to -18.25 D (mean, -11.98 +/- 3.45 D). Schirmer tear test values without anesthesia at 5 minutes and tear break-up time values were measured 4 weeks after LASIK. Unoperated contralateral eyes were used as a control for each patient. The Schirmer tear test and tear break-up time values were analyzed statistically using the independent t-test. RESULTS: The mean Schirmer tear test value was 16.17 +/- 2.50 mm in the operated eyes and 21.07 +/- 7.03 mm in the unoperated (control) eyes of the same patients (P = .001). The mean tear break-up time value was 21.0 +/- 3.55 seconds in the operated eyes and 21.27 +/- 6.79 seconds in the control eyes (P = .85). CONCLUSION: Tear secretion decreased following LASIK probably due to decrease in corneal sensitivity, but tear film stability appeared unaltered.     

Intravitreal bevacizumab injection in patients with choroidal neovascularization due to choroid rupture after blunt-head trauma

Purpose To describe and report the effect of intravitreal bevacizumab (Avastin) as primary treatment for secondary choroidal neovascularization (CNV) after choroidal rupture due to blunt-head trauma. Design Interventional case report. Methods The study was of the left eye of a patient who presented with choroidal neovascularization secondary to choroidal rupture due to blunt-head trauma. The patient received single intravitreal injection of 1.25 mg (0.05 ml) bevacizumab as treatment for CNV after informed consent was signed. The patient underwent fundus fluorescein angiography (FA) and optic coherence tomography (OCT) before the bevacizumab injection and then again three months after. Visual acuity was also measured before and after treatment. The patient was re-examined on the first day, and monthly thereafter. After intravitreal injection of bevacizumab the visual and anatomic responses were observed. Results The patient showed regression of the neovascularization three months after injection of bevacizumab. There was no loss of vision in the immediate postoperative period and at the 3rd month vision improved from 20/60 to 20/20. Central retinal thickness decreased. No cataract progression, endophthalmitis, or injection-related complications were observed. Conclusions Our study shows that intravitreal 1.25 mg bevacizumab can be an effective alternative treatment for choroidal neovascularization (CNV) due to choroidal rupture. The authors have no proprietary interest in the material used in this study.