Questionnaire analysis of the swallowing‐related outcomes following total laryngectomy

Objective: To determine the effects of a total laryngectomy on the swallow and subsequent quality of life in head and neck cancer patients. Design: Cross‐sectional single centre cohort study. Setting: Head and Neck Oncology Unit, Tertiary Referral Unit. Patients: Sixty‐two patients who underwent total laryngectomy at our centre participated in the study. Methods: Subjects were stratified by age, sex, tumour stage, other procedures such as myotomy and nerve re‐implantation. Pharyngectomy, glossectomy, flap reconstruction, neck dissection and previous radio‐ and chemotherapy were also assessed to see if they affected swallow and subsequent quality of life. Main outcome was measured using the MD Anderson Dysphagia Inventory questionnaire. Results: Responses were received from 46 males and 16 females (response rate of 80.5%) with a mean age of 64.7 years (SD 9.4). Median follow‐up in patients was 90 months (range 1–276). The mean MD Anderson Dysphagia Inventory total score in our series of patients was 77.7 (SD 16.6). MD Anderson Dysphagia Inventory global score was 79.4 (SD 22.6), Emotional score was 77.7 (SD 17.8), Functional score 81.3 (SD 15.9) and Physical score was 74.1(SD 18). Statistically significant differences were seen between the emotional scores of glossectomised and non‐glossectomised patients (Mann Whitney, P = 0.04). No significant correlation was seen between the subscale scores and the remaining treatment variables such as age, gender, site, tumour stage, myotomy, nerve implantation, radiotherapy, reconstruction and major complications. Conclusion: This questionnaire study is the largest of its type to assess the swallow of patients who have undergone laryngectomy at a single centre. The overall result confirmed that most patients had a subjectively good swallow. Only glossectomy and the method of PE segment closure were shown to significantly affect swallowing outcomes following surgery. We recommend further work especially prospective studies pre and post surgery using this or similarly validated instruments to fully assess swallow in the laryngectomy population.     

美托洛尔控释片治疗中青年高血压病的临床观察

高血压病治疗的药物选择是临床医生需要综合考虑的问题，现将我院应用美托洛尔控释片对中青年高血压病进行治疗的观察结果和体会总结如下。     

可切除原发性十二指肠恶性肿瘤X线征象分析

目的 :对可切除的原发性十二指肠恶性肿瘤X线征象进行分析。方法 :对 2 6例原发性十二指肠恶性肿瘤胃肠道造影及CT征象进行了回顾性对比分析总结。结果 :全部病例均经手术病理证实 ,其中腺癌 2 2例 ,平滑肌肉瘤 3例 ,非何杰金氏淋巴瘤 1例。描述包括肿瘤的部位 ,造影X线表现 (黏膜破坏 ,充盈缺损及龛影 ,管腔不规则狭窄 ,肠腔外改变等 )及CT表现 (肠壁增厚肠腔狭窄 ,局部肿块 ,梗阻性改变及转移 )。不能手术切除的影像学征象为 :肿瘤直径大于 6cm ;腹腔、系膜淋巴结成团肿大 ;腔静脉、肠系膜动静脉等重要血管管径被包绕大于 2 / 3时。结论 :CT与X线造影对肿瘤的位置、大小、形态 ,肿瘤的继发征象的术前评价 ,能够提供能否手术切除的重要依据。     

结肠灌洗法对直肠癌患者术后排便功能的影响

Background:Defecation of patients with rectal carcinoma after operation cannot be controlled freely,which brings patients many mental burdens.Cocolyster operation can improve obviously the symptom.     

高等医学院校医学化学教材改革的几点思考

医学的发展已进入分子水平，医学生必须具有扎实的化学基础才能适应专业学习及临床、科研工作的需要。现行医学化学教材大多沿用几十年前的模式，部分内容陈旧滞后，实用性不强。面对现实，改革势在必行。我们认为，突出重点、注重实用、体现医学特色应作为改革的方向。