进展期胃癌新辅助化疗效果的临床观察

目的评估新辅助化疗对进展期胃癌的治疗效果。方法选取48例进展期胃癌(IIIb和IV期)患者,术前行氟尿嘧啶 甲酰四氢叶酸钙 乐沙定化疗,采用双周疗法;经2～3个疗程后,行CT,超声内镜复查,分期。对可切除者行手术治疗。结果新辅助化疗总有效率为58.4%;其中IIIb期为64.1%,IV期为22.2%。39例III期患者中,手术根治率达71.8%。9例IV期患者中,2例行姑息手术切除,1例行探腹术。结论新辅助化疗可有效提高IIIb期胃癌患者的手术根治率,而对IV期患者疗效不显著。     

视频眼震图监视下的良性阵发性位置性眩晕手法复位临床分析

目的探讨良性阵发性位置性眩晕(benignparoxysmal positional vertigo,BPPV)手法复位的临床疗效及视频眼震图在复位中的作用。方法回顾性分析来我科就诊疑似BPPV患者200例,所有患者均分别在裸眼下和视频眼震图下通过变位试验共确诊159例并行手法复位治疗,统计裸眼下与视频眼震图下典型特征眼震的检出率及手法复位的临床治愈率及复发率。结果裸眼下特征眼震的检出率为68.50%,视频眼震图下典型眼震检出率为79.50%。手法复位第一次治愈率为77.99%,总有效率为98.11%,复发率为5.66%,复发患者经再次手法复位后均好转。结论视频眼震图在BPPV诊断及手法复位中起着重要作用,手法复位为治疗BPPV可靠而有效的方法。     

An investigation into current protocols and radiographer opinions on contrast extravasation in Irish CT departments

BackgroundIodinated contrast extravasation is a serious complication associated with intravenous administration in radiology. Departmental protocols and the radiographer's approach on both prevention techniques and treatment will affect the prevalence of extravasation, and the eventual outcome for the patient when it does occur.AimsTo examine contrast extravasation protocols in place in Irish CT departments for alignment with European Society of Urogenital Radiology (ESUR) Guidelines (2014); to establish radiographer's opinions on contrast extravasation; and to examine radiographer adherence to protocols.MethodsContrast extravasation protocols from a purposively selected sample of CT departments across Ireland (n = 6) were compared to ESUR guidelines, followed by an online survey of CT radiographers practicing in the participating centres.ResultsAll participating CT departments (n = 5) had written protocols in place. High risk patients, such as elderly or unconscious, were identified in most protocols, however, children were mentioned in just one protocol and obese patients were not specified in any. The response rate of CT radiographers was 23% (n = 24). 58% (n = 14) of respondents indicated that contrast extravasation was more likely during CTA examinations. While high levels of confidence in managing extravasation were reported, suggested treatment approaches, and confidence in same, was more variable. Clinical workload in CT departments was also identified as a factor impacting on patient care and management.ConclusionWhile contrast extravasation protocols were generally in line with ESUR Guidelines, high risk patients may not be getting sufficient attention. More radiographer awareness of patient monitoring needs, particularly in busy departments with a heavy workload may also reduce extravasation risk, and improve management of same.     

突发性聋疗效及预后相关因素分析

目的研究影响突发性聋治疗效果及预后的相关因素。方法回顾性分析我科住院治疗资料完整的突发性聋病例113例(114耳),将资料应用Stata 12.0计算机系统软件进行处理,疗效为二分类变量和有序多分类变量分别进行分析,以性别、年龄、听力图形、是否有影响微循环障碍的合并症、开始治疗时间、是否伴有耳鸣和(或)眩晕、听阈、是否使用激素治疗、患病耳作为自变量,与预后的关系采用全因素模型和逐步Logistic回归进行分析。结果激素组治疗有效率75.9%,非激素组有效率57.6%。经多因素Logistic回归分析发现,仅听阈是影响治疗效果的唯一因素。结论突发性聋患者听阈越小,治疗效果越好。     

外伤后良性阵发性位置性眩晕的临床特点和治疗

目的 探讨外伤后良性阵发性位置性眩晕(posttraumatic benign paroxysmal positional vertigo,t-BPPV)的临床特点和治疗.方法 回顾性分析2006年7月～2010年6月所诊治的17例t-BPPV患者的临床特点和治疗结果,并与同时间段治疗的43例特发性良性阵作性位置性眩晕...     

交界可切除和局部进展期胰腺癌行新辅助化疗的疗效分析

背景与目的：胰腺癌是一种高致死率的消化道恶性肿瘤,仅有大约20%患者可接受根治性手术切除,5年存活率不到6%。目前,胰腺癌的治疗策略已从传统以手术切除为主逐步过渡到以手术切除为基础的综合多维治疗模式。术前新辅助化疗已成为交界可切除胰腺癌(BRPC)和局部进展期胰腺癌(LAPC)的首选和标准治疗方案。术前新辅助化疗是胰腺癌患者综合多维治疗体系中重要的组成部分,本研究旨在探讨胰腺癌新辅助化疗的临床应用价值。方法：回顾性分析2020年4月—2021年8月期间重庆市人民医院肝胆胰腺外科收治的54例胰腺癌患者的临床资料。所有病例均通过临床影像学评估和相关生化指标判定为BRPC或LAPC;行CT或超声内镜引导下穿刺活检,病理组织学确诊均为胰腺导管腺癌,经多学科诊疗模式决策给予3个周期的AG (吉西他滨+白蛋白结合型紫杉醇)新辅助化疗方案。化疗期间动态监测影像学、CA19-9、临床症状体征等变化情况,行改良实体瘤疗效评价标准(m RECIST)系统性疗效评估手术可切除性。结果：54例患者新辅助化疗后的中位生存期为12.3个月;43例(79.63%)新辅助化疗后CA19-9下降,其中35例(64.81...     

脑蛋白水解物贴膜治疗外伤性鼓膜穿孔

治疗外伤性鼓膜穿孔,传统方法是禁止耳内进入任何物质待其自愈,若时间较长且穿孔仍未愈合则采取颞筋膜內植法手术修复。本文报道我院2008年1月～2009年1月外伤性鼓膜穿孔36例（37耳）,均采用脑蛋白水解物贴膜治疗效果。     

中耳胆脂瘤和慢性化脓性中耳炎手术临床分析

目的　探讨中耳胆脂瘤和慢性化脓性中耳炎术式选择及临床效果。方法　对110例中耳乳突病变,包括中耳胆脂瘤和慢性化脓性中耳炎,根据范围显微镜下实施完壁式或开放式乳突根治,部分同时鼓室成形术,随访术后干耳状况、并发症、复发情况以及术后听力改善程度等。结果　110例患者中66例中耳胆脂瘤、44例慢性化脓性中耳炎,出现颅内外并发症者7例。手术方式：51例（46.36%）行完壁式乳突根治术,46例（41.81%）同时行鼓室成形术,59例（53.64%）行开放式乳突根治术。完壁式乳突根治术后听 力提高＞25 dB 37例（33.64%）,＞15 dB 14例（12.72%）;开放式乳突根治术后听力提高＞15 dB 5例（4.55%）,听力减退4例（3.64%）,比较手术前后言语频率区平均听阈,差异有统计学意义（P＜0.05）。术后随访1年发现开放式和完壁式两组胆脂瘤复发共4例。结论　中耳胆脂瘤与慢性化脓性中耳炎通过选择恰当手术方式可获得较好的临床疗效。