射频热凝与伽玛刀治疗原发性三叉神经痛的疗效比较

 目的 比较立体定向射频热凝术与立体定向放射技术(伽玛刀)治疗原发性三叉神经痛的疗效。方法 回顾性分析2014-01至2016-01收治的46例原发性三叉神经痛患者临床资料,其中立体定向射频热凝术21例(射频组),伽玛刀治疗25例(伽玛刀组)。对比两组治疗后疼痛控制率、并发症和复发情况,评定疗效。结果 46例随访时间12～36个月,平均25.6个月。根据巴罗(BNI)疼痛量表评定,射频组术后Ⅰ级17例(81.0%),Ⅱ级2例(9.5%),Ⅲ级1例(4.8%),Ⅳ～Ⅴ级1例(4.8%),有效Ⅰ～Ⅲ级20例(95.2%);伽玛刀组术后Ⅰ级12例(48.0%),Ⅱ级4例(16.0%),Ⅲ级6例(24.0%),Ⅳ～Ⅴ级3例(12.0%),有效Ⅰ～Ⅲ级22例(88.0%)。术后两组比较,射频组Ⅰ级优于伽玛刀治疗组,差异有统计学意义(P＜0.05),Ⅱ、Ⅲ级及有效率差异无统计学意义。术后射频组面部麻木发生率(81.0%)明显高于伽玛刀组(9.5%),咀嚼肌力下降、口角流涎、角膜炎发生率等两组对比,差异无统计学意义。射频组、伽玛刀组复发各1例。结论 射频热凝和伽玛刀治疗三叉神经痛疗效肯定,射频治疗起效快,恢复优良率高,但有一定的侵袭性和并发症;伽玛刀治疗无创,并发症少且轻,相对更安全,缺点是起效较慢。     

Lack of definitive presurgical pathological diagnosis is associated with inadequate surgical margins in breast-conserving surgery

PurposeTo determine the impact of definitive presurgical diagnosis on surgical margins in breast-conserving surgery (BCS) for primary carcinomas; clinicopathological features were also analyzed.MethodsThis retrospective study included women who underwent BCS for primary carcinomas in 2016 and 2017. Definitive presurgical diagnosis was defined as having a presurgical core needle biopsy (CNB) and not being upstaged between biopsy and surgery. Biopsy data and imaging findings including breast density were retrieved. Inadequate surgical margins (IM) were defined per latest ASCO and ASTRO guidelines. Univariable and multivariable analyses were performed.Results360 women (median age, 66) met inclusion criteria with 1 having 2 cancers. 82.5% (298/361) were invasive cancers while 17.5% (63/361) were ductal carcinoma in situ (DCIS). Most biopsies were US-guided (284/346, 82.0%), followed by mammographic (60/346, 17.3%), and MRI-guided (2/346, 0.6%). US and mammographic CNB yielded median samples of 2 and 4, respectively, with a 14G needle. 15 patients (4.2%) lacked presurgical CNB. The IM rate was 30.0%. In multivariable analysis, large invasive cancers (>20 mm), dense breasts, and DCIS were associated with IM (p = 0.029, p = 0.010, and p = 0.013, respectively). Most importantly, lack of definitive presurgical diagnosis was a risk factor for IM (OR, 2.35; 95% CI: 1.23–4.51, p = 0.010). In contrast, neither patient age (<50) nor aggressive features (e.g., LVI) were associated with IM.ConclusionLack of a definitive presurgical diagnosis was associated with a two-fold increase of IM in BCS; other risk factors were dense breasts, large invasive cancers, and DCIS.     

Local and Regional Staging of Invasive Breast Cancer With Sonography: 25 Years of Practice at MD Anderson Cancer Center

At The University of Texas MD Anderson Cancer Center, we have used sonography (US) extensively for more than 2 decades to refine the local and regional staging of invasive breast cancer. Although magnetic resonance imaging is superior to all other imaging modalities in the measurement of the primary tumor and detection of additional foci of malignancy, in our experience US has shown sufficient accuracy in clinical practice to stage most invasive breast cancers. The exceptions are ill‐defined tumors such as invasive lobular cancers and tumors in breasts containing extensive diffuse benign disease. An advantage of US is that multifocality or multicentricity can be confirmed via US‐guided fine‐needle aspiration within 15 minutes and the information shared immediately with the patient and the breast surgeon or medical oncologist. US has also proved indispensable in the evaluation of lymphatic spread because it can evaluate more nodal basins (e.g., the supraclavicular fossa and low neck) than magnetic resonance imaging can and because it can guide needle biopsy to confirm the status of any indeterminate node (including internal mammary nodes) within minutes.     

补阳还五汤联合长针阴阳透刺治疗脑卒中后遗症随机平行对照研究

[目的]观察补阳还五汤联合长针阴阳透刺治疗脑卒中后遗症疗效。[方法]使用随机平行对照方法,将82例住院患者按就诊顺序编号法分为两组。对照组41例长针阴阳透刺,患者取侧卧或仰卧位,使用捻转补虚泻实法,得气之后留针30min,1次/d,透刺10d后隔1d再透刺10d;取穴:曲池透少海,外关透内关,合谷透劳宫,绝骨透三阴交,阳陵泉透阳陵泉,梁丘透血海。治疗组41例补阳还五汤(白芍、牛膝、桑寄生、丹参各15g,桃仁10g,红花15g,大黄制6g,地龙10g,三七6g,鸡血藤10g,赤芍15g,黄芪60g,当归15g;气虚加太子参或党参),1剂/d,水煎200mL,早晚口服;长针阴阳透刺治疗同对照组。连续治疗14d为1疗程。观测临床症状、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效21例,有效16例,无效4例,总有效率90.24%。对照组显效14例,有效16例,无效11例,总有效率73.17%。治疗组疗效优于对照组(P0.05)。[结论]补阳还五汤联合长针阴阳透刺治疗脑卒中后遗症效果显著,值得推广。     

Y型留置针单手置管法在桡动脉穿刺中的应用

目的探讨Y型留置针单手置管法应用于桡动脉穿刺中的优势。方法选择150例需行有创动脉监测的危重疑难患者,分为三组各50例。试验组(T组)采用Y型留置针单手置管法,对照组(M组)采用Y型留置针传统操作法,对照组(N组)采用动脉留置针传统操作法。观察每组操作一次性成功率以及操作过程中是否有血液溢出造成血液污染。结果一次穿刺成功率T组明显高于M、N组,差异有统计学意义(P<0.05);血液污染例数T、M组明显少于N组(P<0.05)。结论 Y型留置针单手置管法用于桡动脉穿刺可以提高一次性穿刺成功率,并且可以减少由血液溢出管道造成的血液污染。