巨块型宫颈癌术前高剂量率腔内放疗近期疗效分析

目的探讨巨块型宫颈癌根治术前高剂量率腔内近距离放疗(ICBT)的治疗效果。方法对200001-200412中山大学附属肿瘤医院和附属第二医院收治的51例ⅠB2～ⅡB期巨块型宫颈癌根治术前采用ICBT,对患者的局部肿瘤缓解情况、毒副反应、手术情况及高危病理因素进行回顾性分析;与同期直接接受根治术的同期别56例巨块型宫颈癌比较。结果施行ICBT后,宫颈肿瘤临床完全缓解5.9%(3/51),部分缓解51.0%(26/51),无变化43.1%(22/51),恶化0。并发症发生率较低,主要是骨髓抑制、腹泻、放射性直肠炎和膀胱炎。全部患者均按宫颈癌根治术规范完成。ICBT组较直接手术组手术时间缩短(3.58±1.08)h对(4.46±0.93)h,术中出血量减少(395.1±219.8)mL对(999.1±637.4)mL,术后拔尿管时间缩短(11.47±6.48)d对(15.18±8.41)d,尿潴留的发生率减少(37.25%对48.2%)。除尿潴留外,两组比较差异均有显著性(P<0.05)。高危病理差异无显著性(P>0.05)。结论宫颈癌根治术前适当剂量腔内放疗是较早期巨块型宫颈癌较理想的治疗方案。     

Combination external beam radiotherapy and high-dose-rate intracavitary brachytherapy for uterine cervical cancer: analysis of dose and fractionation schedule

PURPOSE: To determine an appropriate dose and fractionation schedule for a combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) for uterine cervical cancer. METHODS: Eighty-eight patients with uterine cervical squamous cell carcinoma treated with EBRT and HDR-ICBT were analyzed. Twenty-five patients were classified as early disease (nonbulky Stage I/II, less than 4-cm diameter) and 63 patients as advanced disease (greater than 4 cm diameter or Stage IIIB) according to the American Brachytherapy Society definition. Tumor diameter was measured by MRI. Pelvic EBRT was delivered before applications of ICBT. HDR-ICBT was performed once a week, with a fraction point A dose of 6 Gy. Source loadings corresponded to the Manchester System for uterine cervical cancer. No planned optimization was done. A Henschke-type applicator was mostly used (86%). Median cumulative biologic effective dose (BED) at point A (EBRT + ICBT) was 64.8 Gy(10) (range: 48-76.8 Gy(10)) for early disease, and 76.8 Gy(10) (range: 38.4-86.4 Gy(10)) for advanced disease. Median cumulative BED at ICRU 38 reference points (EBRT + ICBT) was 97.7 Gy(3) (range: 59.1-134.4 Gy(3)) at the rectum, 97.8 Gy(3) (range: 54.6-130.4 Gy(3)) at the bladder, and 324 Gy(3) (range: 185.5-618 Gy(3)) at the vagina. Actuarial pelvic control rate and late complication rate were analyzed according to cumulative dose and calculated BED. RESULTS: The 3-year actuarial pelvic control rate was 82% for all 88 patients: 96% for those with early disease, and 76% for advanced disease. For pelvic control, no significant dose-response relationship was observed by treatment schedules and cumulative BED at point A for both early and advanced disease. The 3-year actuarial late complication rates (Grade > or =1) were 12% for proctitis, 11% for cystitis, and 14% for enterocolitis. There were significant differences on the incidence of proctitis (p < 0.0001) and enterocolitis (p < 0.0001), but not for cystitis by the treatment schedules and cumulative point A BED. All 4 patients treated with 86.4 Gy(10) at point A suffered both proctitis and enterocolitis. Patients with cumulative BED at rectal point of > or =100 Gy(3) had significantly higher incidence of proctitis (31% vs. 4%, p = 0.013). CONCLUSIONS: In view of the therapeutic ratio, cumulative BED 70-80 Gy(10) at point A is appropriate for uterine cervical cancer patients treated with a combination of EBRT and HDR-ICBT. Present results and data from other literatures suggested that cumulative BED at the rectal point should be kept below 100-120 Gy(3) to prevent late rectal complication.     

Pre-emptive effect of epidural sufentanil in abdominal hysterectomy

Background. Experimental studies suggest pre-emptive administrationof analgesics is effective but clinical evidence is less convincing. Methods. Forty-one patients undergoing abdominal hysterectomywere allocated randomly in a double-blind fashion to receivesufentanil 50 µg via a lumbar epidural catheter beforeor at the end of surgery. Results. Sufentanil consumption from a patient-controlled epiduralanalgesia (PCEA) system and numerical pain scores at rest andduring movement over the initial 72 h were similar in thetwo groups. When the study period was divided into five timeintervals, sufentanil consumption in the pre-emptive group wassignificantly less than in the control group between 8 and 16 hafter surgery (P=0.04). Furthermore, the number of failed bolusattempts from the PCEA device was significantly lower and patientsatisfaction was significantly better in the pre-emptive groupduring the 72 h of PCEA treatment (P<0.05). In addition,the median decrease in ACTH and cortisol on the first postoperativemorning relative to baseline values was greater in the pre-emptivegroup than in the control group (P<0.05). In subjects whohad a Pfannenstiel incision, touch and pain sensitivity in thewound area were less in the pre-emptive group over the first4 postoperative days (P<0.05). Conclusions. We conclude that pre-emptive analgesia with epiduralsufentanil was associated with a short-term sufentanil-sparingeffect, and could have reduced stress hormone responses andwound sensitization after abdominal hysterectomy. Br J Anaesth 2002; 88: 803–8     

Effects of oral glucose administration on plasma growth hormone levels in women with polycystic ovary syndrome

Objective: To evaluate the sensitivity of GH secretion to the suppressive effect of oral glucose administration in women with polycystic ovary syndrome (PCOS).

Design: Comparison of the GH response to an oral glucose load in women with PCOS and in weight-matched normally menstruating women (controls).

Setting: Reproductive endocrinology unit.

Patient(s): Eighteen obese and 11 nonobese patients and 10 obese and 10 nonobese controls.

Intervention(s): After an overnight fast, each woman underwent a 75-g, 3-hour oral glucose tolerance test (OGTT).

Mean Outcome Measure(s): Growth hormone, glucose, and insulin responses to OGTT.

Result(s): No significant differences in the glycemic and insulinemic responses were found between the patients and the weight-matched controls. No decrease in plasma GH was observed in both obese and nonobese patients and in obese controls during the OGTT, whereas a significant GH decrease occurred in nonobese controls 60 and 120 minutes after glucose intake.

Conclusion(s): Oral glucose administration was unable to suppress GH levels in nonobese as well as in obese women with PCOS and in obese control women. These data suggest that both PCOS and obesity are associated with a reduced sensitivity of GH secretion to glucose suppression.     

Knowledge and willingness to use emergency contraception among low-income post-partum women

We performed a multivariate analysis to determine factors associated with knowledge and willingness to use emergency contraception in a consecutive sample of 371 post-partum women from an inner-city public hospital. Women were queried about previous contraceptive use, pregnancy history including abortions and unplanned pregnancies, and demographic characteristics. Outcomes included knowledge of emergency contraception and willingness to use it. Questionnaires were conducted in person, in English or Spanish.

Of 371 women, 3% had used emergency contraception, 36% had heard of it, and 7% knew the correct timing for use. Two-thirds of the population indicated a willingness to use emergency contraception in the future. Factors positively associated with knowledge included being a teenager or more than 30 years old, prior use of condoms, and history of an elective abortion. Being multiparous, monolingual Spanish-speaking, or Asian were negatively associated with knowledge. Willingness to use emergency contraception was positively associated with being multiparous and negatively associated with a higher income, moral or religious objections to the use of emergency contraception, a belief that it is unsafe or a perception that it is an abortificient.

Knowledge about emergency contraception, especially correct timing, remains low. Multiparous women should receive increased education given their lack of knowledge but willingness to use emergency contraception. In order to increase the acceptability of emergency contraception, educational efforts must include accurate information about its mechanism of use and safety.     

Estimation of Fetal Weight in Utero from Symphysisfundal Height and Abdominal Girth Measurements

The ability to estimate fetal weight accurately from symphysis-fundal height (SFH) and abdominal girth (AG) measurements was evaluated. Multivariate regression analysis was performed on measurements made on 208 primigravidas within 48 hours of delivery. A better correlation with birth-weight was obtained with the SFH than with the AG. The equation BW = -1.515 + 0.092 (SFH) + 0.016 (AG) yielded a coefficient of multiple correlation of 0.7259. Using this equation, the mean percentage prediction errors were 5.7% +/- 4.2(SD) in fetuses between 2,500 and 3,500 g (n = 156), 9.4% +/- 5.25(SD) in those larger than 3,500 g (n = 33), and 19.1% +/- 8.2(SD) in those smaller than 2,500 g (n = 19). All the generated equations similarly underestimated the fetal weight in the larger babies and overestimated in the smaller babies. Inclusion of quadratic and logarithmic functions as well as skin-fold thickness measurements into the equations did not decrease the error or alter the distribution of errors. It was concluded that although fetal weight estimation may be reasonably accurate between 2,500 g and 3,500 g, the error is too great for the method to be clinically useful in the smaller and larger babies. Moreover, a theoretical basis for a high sensitivity in the detection of small for dates fetuses from these parameters would be difficult to establish.     

Amniocentesis in prenatal diagnosis A controlled series of 78 cases

The outcome of 78 pregnancies, monitored by second trimester amniocentesis for prevention of genetic disease, and the outcome of an equal number of matched controls are reported. The controls were selected from the same obstetrical department, among the same population, and were matched for age, number of previous children, abortions and stillbirths. No significant difference was found in Apgar score, birth-weight and length, duration of pregnancy, placenta condition or malformation.     

Visual classification of banded human chromosomes:

Visual classification and karyotyping of 897 integrated density profiles generated from straight and non-overlapping chromosomes from 22 trypsin-bandedmetaphases of average quality was carried out and evaluated. The results were compared with visual classification of photographic prints of the same 897 chromosomes. The experiments were carried out by one observer. About 5% errors were made in classification of isolated profiles; 0.5% errors were made in karyotyping profiles and about 3% errors were made in classification of isolated chromosome prints. The reason for the small error rate obtained by karyotyping profiles as compared to the error rate when classifying isolated profiles was assumed to be the use of a priori knowledge of the composition of (normal) metaphases and the possibility of making appropriate comparisons between the individual profiles within the metaphase. Comparison between classification of isolated prints and of profiles showed different error patterns on the basis of which it was assumed that prints constitute a better basis for visual classification than profiles. The results seemed to indicate two ways of improving computer classification of banded chromosomes: (1) information of value in the chromosomes (band pattern, shape etc.) should be extracted from the digitized chromosome image in a manner superior to the simple integration by which profiles are produced; (2) computer karyotyping should simulate the human method, thus taking advantage of a priori knowledge of the composition of the metaphases and being able to make appropriate comparisons between individual chromosomes.     

Advanced grandmaternal age on the mother's side – a risk of giving rise to trisomy 21

The age distribution of maternal grandmothers of children with Down syndrome was compared with paternal grandparents of the same group and with grandparents of healthy children (controls). The significant advanced maternal grandmaternal age was found in cases of Down syndrome caused by first meiotic error in the maternal oogenesis. The advanced maternal grandmaternal age was found independent of maternal age. No differences were found between the ages of grandfathers of Down syndrome and of controls.     

CERVICAL TERATOMA IN A FETUS AND AN ADULT Two Case Reports and Review of Literature

Two cases of cervical teratoma in a 30-weeks fetus and a 26-year-old female have been presented. In the former case a large mass entirely occupied the anterior neck but showed no invasive or metastatic lesions, and in the other case a mass containing multiple cysts was situated in the right lower pole of the thyroid gland. Histologically, both tumors were composed of the elements derived from three germ layers including various epithelial components, cartilage, muscle, and adipose tissue. In addition to these predominantly mature elements, there were some elements showing primitive immature structure in the former case. Positive immunohistochemical staining for thyroglobulin displayed only in the former case and was observed in the compressed thyroid follicles located in the fibrous capsule and several small foci of primitive glandular structure which was an element of the tumor.