肾转移瘤的CT诊断特征

目的：探讨肾转移瘤的CT诊断特征．方法：回顾性分析12例肾转移瘤及12例原发性肾癌的CT表现．结果：12例肾转移瘤共检出42个病灶,4例单发,8例为双侧、多灶性;9个病灶位于肾髓质内呈楔形,33个病灶累及肾皮髓质、呈类圆形;41个病灶平扫呈等密度,所有病灶增强后均呈轻度强化,均未见包膜;8个病灶引起肾轮廓改变;7例肾转移瘤同时伴有其它部位及脏器的转移．12例肾原发癌均为单发,同时累及肾皮髓质,呈类圆形或不规则形;10例病灶平扫呈等、低密度;1例增强后轻度强化,11例增强后呈中、重度不均匀强化,3例可见假包膜;10例引起肾轮廓改变;2例伴有肾静脉癌栓,1例伴有肾周淋巴结转移．结论：肾转移瘤具有典型的影像学特点,了解这一特点有助于肾转移瘤的诊断．     

早期空肠营养在全胃切除术的应用

1982年以来,我们对35例伴明显营养不良的中晚期胃癌病人施行了全胃切除术。8例未采用特殊的营养支持疗法,术后发生食道空肠吻合口痿3例(37％),均死亡;27例经空肠插管早期供给高营养饮食,结果亦发生吻合口瘘3例(11％),均治愈。本文采用较粗的空肠营养管,灌注自制高营养饮食,未见重大不良反应。术后病人体重、Hb及ALB比未用高营养饮食病人恢复为好,能在手术后早期接受化疗。作者对空肠营养的方法、护理、作用及副作用进行了讨论,认为早期空肠营养具有效果明显、经济、安全、简便的优点,适用于营养不良的全胃切除术病人使用。     

胆道肿瘤患者的营养治疗共识

胆道系统恶性肿瘤在世界范围内虽然不算常见,但其发病率逐年上升,且恶性程度较高.我国胆道系统恶性肿瘤的发病率也有逐年上升的趋势.胆管癌患者的预后均很差,因此,胆道系统恶性肿瘤的姑息和支持治疗尤为重要,其主要目的 是尽可能地提高生活质量、延长生存时间.肝门部胆管癌患者术后早期进食能够有效减少感染、腹胀和尿潴留等并发症的发生...     

经后路保留肛门括约肌功能早期直肠癌切除的探讨（附5例报告）

早期直肠癌是指仅限于粘膜或粘膜下层的直肠恶性肿瘤，由于其无淋巴结转移，外科局部切除就可达到治疗目的。１９９３～１９９４年期间作者针对距肛门５～１０ｃｍ的５例早期直肠肿瘤患者，施行了非开腹后方径路外科局部切除术，经临床观察效果满意，本文就其手术适应证进行了探讨。笔者认为：（１）此法可在直视下行肿瘤切除，费时少，风险小；（２）同时能进行直肠旁淋巴结清扫；（３）保留肛门功能的三大特点。     

Reduced quality of life in living kidney donors: association with fatigue, societal participation and pre-donation variables

Health related quality of life (HRQoL) of living kidney donors on average is good, but some donors experience a low HRQoL after donation. This study assessed the prevalence of reduced HRQoL and explored associations with pre‐ and post‐donation variables. 316 donors (response rate 74%) who donated a kidney between 1997 and 2009 filled in a questionnaire. HRQoL was measured using the Short‐Form 36; fatigue using the Multidimensional Fatigue Inventory; societal participation using the Utrecht Scale for Evaluation of Rehabilitation‐Participation. Donors on average had better HRQoL than the general population. However, 12% had a reduced physical (PCS) and 18% a reduced mental (MCS) HRQoL. Donors with reduced HRQoL reported greater fatigue (P < 0.01), lower societal participation (P < 0.01) and showed a trend towards statistical significance in experiencing more donor–recipient relationship changes (P = 0.07). Prior to donation, donors with reduced PCS had a higher BMI (P < 0.05) and more often smoked (P < 0.05). Donors with reduced MCS had higher expectations (P < 0.05). Reduced HRQoL is associated with higher BMI, smoking and higher expectations prior to donation. These results may be used to develop a screening instrument to select donors at high risk for reduced HRQoL.     

Targeted therapy in gastric cancer:Personalizing cancer treatment based on patient genome

Gastric cancer is the second leading cause of cancerrelated deaths worldwide.Conventional cytotoxic chemotherapy has limited efficacy for metastatic gastric cancer,with an overall survival of approximately ten months.Recent advances in high-throughput technologies have enabled the implementation of personalized cancer therapy for high-risk patients.The use of such high-throughput technologies,including microarray and next generation sequencing,have promoted the discovery of novel targets that offer new treatment strategies for patients lacking other therapeutic options.Many molecular pathways are currently under investigation as therapeutic targets in gastric cancer,including those related to the epidermal growth factor receptor family,the mesenchymal-epithelial transition factor axis,and the phosphatidylinositol 3-kinase-AKTmammalian target of rapamycin factors.Advances in molecular diagnostic tools further support the discovery of new molecular targets.Limitations exist,however;not all patients can be tested for biomarkers,and numerous challenges hamper implementation of targeted therapy in clinical settings.Indeed,the scale of tumor genomic profiling is rapidly outpacing our ability to appropriately synthesize all the information in order to optimally refine patient care.Therefore,clinicians must continue to educate themselves regarding new tools and frameworks,and to utilize multidisciplinary team science,comprised of oncologists,geneticists,pathologists,biologists and bioinformaticians,to successfully implement this genomic approach therapeutically.     

Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler‐guided transanal haemorrhoid dearterialization for third‐degree haemorrhoids

Aim Doppler‐guided transanal haemorrhoid dearterialization (THD) and stapler haemorrhoidopexy (SH) have been demonstrated to be less painful than the Milligan–Morgan procedure. The aim of this study was to compare the effectiveness of THD vs SH in the treatment of third‐degree haemorrhoids in an equivalent trial. Method One hundred and sixty‐nine patients with third‐degree haemorrhoids were randomized online to receive THD (n = 85) or SH (n = 84) in 10 Colorectal Units in which the staff were well trained in both techniques. The mean follow‐up period was 17 (range 15–20) months. Results Early minor postoperative complications occurred in 30.6% of patients in the THD group and in 32.1% of patients in the SH group. Milder spontaneous pain and pain on defecation were reported in the THD group in the first postoperative week, but this was not statistically significant. Late complications were significantly higher (P = 0.028) in the SH group. Residual haemorrhoids persisted in 12 patients in the THD group and in six patients in the SH group (P = 0.14). Six patients in the SH group and 10 in the THD group underwent further treatment of haemorrhoids (P = 0.34). No differences were found in postoperative incontinence. The obstructed defecation score (ODS) was significantly higher in the SH group (P < 0.02). Improvement in quality of life was similar in both groups. Postoperative in‐hospital stay was 1.14 days in the THD group and 1.31 days in the SH group (P = 0.03). Conclusion Both THD and SH techniques are effective for the treatment of third‐degree haemorrhoids in the medium term. THD has a better cost‐effective ratio and lower (not significant) pain compared with SH. Postoperative pain and recurrence did not differ significantly between the two groups.     

Long-term adherence of patients with relapsing-remitting multiple sclerosis to subcutaneous self-injections of interferon β-1a using an electronic device: the RIVER study

ABSTRACT

Objectives: The BRIDGE study has previously shown a high short-term (12 weeks) adherence rate (>85%) of patients with relapsing-remitting multiple sclerosis (RRMS) to subcutaneous self-injections of interferon β-1a using an electronic auto-injection device (RebiSmart®). The primary goal of the RIVER study was to investigate in a real-life setting the long-term adherence to the use of RebiSmart among patients enrolled in the parent BRIDGE study.

Methods: The RIVER study was designed as a real-life extension study of the BRIDGE trial. RRMS patients who completed BRIDGE and still had an indication for treatment were included. Data were collected prospectively through the RebiSmart device, and analyzed retrospectively. Long term adherence (administration of ≥ 80% of injections) to and safety of RebiSmart were assessed. The expected follow-up period ranged from 19 to 26 months.

Results: A total of 57 RRMS patients participated in the follow-up study. The mean observation period was 20.5 ± 5.7 months. The overall adherence to the use of RebiSmart in the entire study cohort was 79.8% (median = 85.2%, range = 16–100%). There were 36 patients (63.2%) who completed at least 80% of the scheduled injections. No statistically significant differences were found between adherent and non-adherent patients in terms of age, sex, duration of the observation period, and occurrence of relapses. No serious treatment-related adverse events occurred.

Conclusions: This study showed a high level of long-term adherence to the use of RebiSmart, with 63.2% of participants meeting the criterion for adherence to treatment.