Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization

AIM: To compare the incidence of early portal or splenic vein thrombosis (PSVT) in patients treated with irregular and regular anticoagulantion after splenectomy with gastroesophageal devascularization.METHODS: We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010. Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation, respectively. Group A (153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin (LMWH) irregularly. Group B (148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery, followed by oral warfarin and aspirin for one month regularly. The target prothrombin time/international normalized ratio (PT/INR) was 1.25-1.50. Platelet and PT/INR were monitored. Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.RESULTS: The patients’ data were collected and analyzed retrospectively. Among the patients, 94 developed early postoperative mural PSVT, including 63 patients in group A (63/153, 41.17%) and 31 patients in group B (31/148, 20.94%). There were 50 (32.67%) patients in group A and 27 (18.24%) in group B with mural PSVT in the main trunk of portal vein. After the administration of thrombolytic, anticoagulant and anti-aggregation therapy, complete or partial thrombus dissolution achieved in 50 (79.37%) in group A and 26 (83.87%) in group B.CONCLUSION: Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization, and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy. Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.     

VD方案和VAD方案治疗多发性骨髓瘤的疗效观察和比较

目的 探讨VD方案和VAD方案治疗多发性骨髓瘤的临床疗效和安全性.方法 回顾性分析了2008年6月到2011年6月我院收治的59例多发性骨髓瘤患者的临床资料,根据治疗方案将患者分为VD组(38例)和VAD组(21例),VD组接受硼替佐米联合地塞米松治疗,3周为一个疗程,治疗2个疗程;VAD组接受长春新碱、阿霉素联合地塞米松治疗,4周为一疗程,治疗2个疗程.分别对两组疗效和不良反应进行分析.结果 VD组和VAD组治疗缓解率分别为83.78％和59.09％,VD方案优于VAD方案,差异具有统计学意义(P＜0.05).VD组主要不良反应为血液毒性和周围神经病变,症状较轻微,在停药和对症处理后症状消失或缓解.VAD组主要不良反应为感染、脱发和血液毒性等,其中感染多以3～4度为主.结论 VD方案治疗多发性骨髓瘤疗效优于VAD方案,不良反应轻微,患者可耐受,值得临床推广使用.     

鸦胆子油乳协同周剂量TX方案治疗晚期胃癌的疗效研究

摘 要 目的：评价鸦胆子油乳注射液协同周剂量TX方案治疗晚期胃癌的临床疗效。方法：42例晚期胃癌患者随机分为观察组（给予鸦胆子油乳注射液联合周剂量用剂量TX方案）19例和对照组（给予单纯周剂量TX方案化疗）23例。入组患者均至少接受2个周期以上的化疗。观察比较两组近期疗效、生活质量和生存期。结果：观察组近期有效率为63.2%,显著高于对照组的8.7%(P<0.05);观察组疾病控制率为94.7%,对照组为87.0%,差异无统计学意义( P>0.05)。观察组中位生存时间为741 d,显著高于对照组的359 d( P<0.05)。 结论：鸦胆子油乳注射液联合周剂量TX方案治疗晚期胃癌可明显提高患者化疗的近期疗效,延长患者的生存期。     

胰腺癌新辅助化疗的应用现状及进展

目的总结近年来胰腺癌新辅助化疗的治疗现状及进展,以期提高对胰腺癌新辅助化疗的认识,并指导临床工作。方法通过阅读并复习国内外有关胰腺癌新辅助化疗方面的文献并进行综述。结果新辅助化疗可缩小肿瘤病灶、提高R0切除率、降低术后并发症发生率且改善患者的预后,但目前尚缺乏高质量的循证医学证据。目前国际上并无统一的胰腺癌新辅助化疗方案,FOLFIRINOX、吉西他滨+白蛋白结合型紫杉醇和吉西他滨+替吉奥3种方案较为常见。同时,新辅助化疗存在化疗方案无统一标准、疗效评估手段不足等问题。结论尽管胰腺癌的新辅助化疗尚存在一些核心问题亟待解决,但其显示出的疗效正逐渐被临床工作者所认可并广泛应用,这有利于改善胰腺癌患者的预后。     

类风湿性关节炎临床治疗方案的研究进展

类风湿性关节炎(RA)是一种临床上常见的全身性自身免疫性疾病,患者临床表现主要为对称性、涉及多个关节、慢性的关节疾病和滑膜关节炎,其发病相关因素主要涉及遗传、滑膜中T细胞、B细胞及细胞因子等免疫细胞等,但具体机制现仍不完全明确。目前,RA的临床治疗效果尚不理想,主要的治疗方法为常规药物、中医中药、外科手术及新技术疗法等。     

阿莫西林克拉维酸钾不同给药方案治疗细菌性呼吸道感染的效果分析

目的：分析阿莫西林克拉维酸钾不同给药方案治疗细菌性呼吸道感染的效果。方法将本院2011年6月~2013年6月收治的细菌性呼吸道感染患者936例随机分为A、B两组,A组患者给予注射用阿莫西林钠克拉维酸钾100 mg/kg,溶于100 ml氯化钠注射液,静脉注射,1次/d。 B组患者采用同批次注射用阿莫西林钠克拉维酸钾,50 mg/kg,溶于50 ml氯化钠注射液,静脉注射,2次/d。根据病情,给药时间为1～2周。比较两组的临床疗效及给药时间。结果轻度和中度感染患者中,A、B两组的给药时间差异无统计学意义（P＞0.05）;重度感染患者中,A组给药时间明显长于B组,差异有统计学意义（P＜0.05）。轻度和中度感染患者中,B组治疗有效率高于A组,但差异无统计学意义（P＞0.05）;重度感染患者中,B组的有效率显著高于A组,差异有统计学意义（P＜0.05）。结论A给药方案在轻度和中度感染治疗效果较好,同时减少给药次数,B方案可对重度感染进行有效治疗。     

Bone marrow transplantation for acquired aplastic anemia: What's new

Bone marrow transplantation is a major therapeutic option for patients with acquired severe aplastic anaemia: improved survival has been achieved in younger patients, thanks to better donor selection, conditioning regimens and graft versus host disease prophylaxis, together with improved supportive care, including diagnosis and treatment of opportunistic infections. This has not been the case for older patients over the age of 40 years.We will discuss transplantation platforms as used for different donor types and we will analyse major breakthroughs of the last years: the combination of Fludarabine and cyclophosphamide as a conditioning regimen, the use of alternative donors including HLA haploidentical related donors and new strategies to prevent acute and chronic graft versus host disease, including post transplantation Cyclophosphamide. These changes extend the option of a bone marrow transplantation for patients who lack an HLA matched donor and appear to improve engraftment and reduce graft versus host disease: whether this will be true for all age groups is currently being investigated.