Selecting a specific pre- or postoperative adjuvant therapy for individual patients with operable gastric cancer

Although the very high locoregional recurrence rates reported with limited D0/D1 surgery can be reduced with extended D2 gastrectomy for operable gastric cancer, overall relapse and survival rates remain poor and can only be improved with adequate perioperative adjuvant treatment. However, despite intensive research, no regimen has been established as standard. Meta-analyses have demonstrated a marginal survival benefit with adjuvant chemotherapy. Two recent large randomized trials for operable gastric cancer, the MAGIC trial and the INT-0116 trial, provide evidence that some patients may benefit from perioperative chemotherapy and chemoradiation, respectively. However, while both trials suggest an overall survival benefit with adjuvant treatment, they don’t provide the harm–benefit ratio for specific subsets of patients wih different extent of surgery (D1 or D2) and tumor stage (early [T1,2]/advanced [T3,4]). This lack of evidence complicates current therapeutic adjuvant decisions. Estimating the risk of local and distant recurrence (high, moderate or low) after D1 or D2 surgery in various tumor stages and the expected harm–benefit ratio, the authors provide useful information for decisions on adjuvant chemotherapy with or withour radiotherapy in individual patients. Research on newer cytotoxic and targeted agents may improve treatment efficacy. Simultaneously, advances with microarray-based gene-expression profiling signatures may improve individualized treatment decisions. However, the validation and translation of these genomic classifiers as biomarkers into a completed ‘bench-to-bedside’ cycle for tailoring treatment to individuals is a major challenge and limits inflated expectations.     

局部晚期直肠癌术前与术后同步放化疗的疗效比较

[目的]比较术前同步放化疗与术后同步放化疗对局部晚期中低位直肠癌的临床疗效和不良反应。[方法]收集100例局部晚期中低位直肠癌患者,50例行术前同步放化疗,同期50例先行根治术再行术后同步放化疗,比较两组的保肛率、局部复发率和生存率以及不良反应。[结果]术前同步放化疗的保肛率明显高于术后同步放化疗组,而局部复发率明显低于术后同步放化疗组（P〈0.05）,3、5年生存率两组间没有差别（P〉0.05）。[结论]局部晚期中低位直肠癌术前同步放化疗可以提高保肛率,降低局部复发率,值得临床推广。     

Phase 2 study of preoperative image‐guided intensity‐modulated radiation therapy to reduce wound and combined modality morbidities in lower extremity soft tissue sarcoma

BACKGROUND:

This study sought to determine if preoperative image‐guided intensity‐modulated radiotherapy (IG‐IMRT) can reduce morbidity, including wound complications, by minimizing dose to uninvolved tissues in adults with lower extremity soft tissue sarcoma.

METHODS:

The primary endpoint was the development of an acute wound complication (WC). IG‐IMRT was used to conform volumes to avoid normal tissues (skin flaps for wound closure, bone, or other uninvolved soft tissues). From July 2005 to June 2009, 70 adults were enrolled; 59 were evaluable for the primary endpoint. Median tumor size was 9.5 cm; 55 tumors (93%) were high‐grade and 58 (98%) were deep to fascia.

RESULTS:

Eighteen (30.5%) patients developed WCs. This was not statistically significantly different from the result of the National Cancer Institute of Canada SR2 trial (P = .2); however, primary closure technique was possible more often (55 of 59 patients [93.2%] versus 50 of 70 patients [71.4%]; P = .002), and secondary operations for WCs were somewhat reduced (6 of 18 patients [33%] versus 13 of 30 patients [43%]; P = .55). Moderate edema, skin, subcutaneous, and joint toxicity was present in 6 (11.1%), 1 (1.9%), 5 (9.3%), and 3 (5.6%) patients, respectively, but there were no bone fractures. Four local recurrences (6.8%, none near the flaps) occurred with median follow‐up of 49 months.

CONCLUSIONS:

The 30.5% incidence of WCs was numerically lower than the 43% risk derived from the National Cancer Institute of Canada SR2 trial, but did not reach statistical significance. Preoperative IG‐IMRT significantly diminished the need for tissue transfer. RT chronic morbidities and the need for subsequent secondary operations for WCs were lowered, although not significantly, whereas good limb function was maintained. Cancer 2013. © 2013 American Cancer Society.     

体外循环下心内直视手术患者的护理

目的探讨心脏直视手术患者的护理方法。方法对96例心脏直视手术患者的围术期护理加以分析、归类和总结并进行随访。结果本组96例心脏直视手术患者均存活,且随访均获得良好生活质量。结论心内直视手术风险大,加强心理护理、术后各项监护的仔细观察及预防术后并发症是手术成功的关键。     

Oral rehydration therapy for preoperative fluid and electrolyte management

Aim: Preoperative fluid and electrolyte management is usually performed by intravenous therapy. We investigated the safety and effectiveness of oral rehydration therapy (ORT) for preoperative fluid and electrolyte management of surgical patients.Methods: The study consisted of two studies, designed as a prospective observational study. In a pilot study, 20 surgical patients consumed 1000 mL of an oral rehydration solution (ORS) until 2 h before induction of general anesthesia. Parameters such as serum electrolyte concentrations, fractional excretion of sodium (FENa) as an index of renal blood flow, volume of esophageal-pharyngeal fluid and gastric fluid (EPGF), and patient satisfaction with ORT were assessed. In a follow-up study to assess the safety of ORT, 1078 surgical patients, who consumed ORS until 2 h before induction of general anesthesia, were assessed.Results: In the pilot study, water, electrolytes, and carbohydrate were effectively and safely supplied by ORT. The FENa value was increased at 2 h following ORT. The volume of EPGF collected following the induction of anesthesia was 5.3±5.6 mL. In the follow-up study, a small amount of vomiting occurred in one patient, and no aspiration occurred in the patients.Conclusion: These results suggest that ORT is a safe and effective therapy for the preoperative fluid and electrolyte management of selected surgical patients.     

Comparison of panoramic and conventional cross-sectional tomography for preoperative selection of implant size

Objective: To compare panoramic and conventional cross‐sectional tomography for preoperative selection of implant size for three implant systems (Brånemark, Straumann^®, 3i). Material and methods: Presurgical panoramic (Pan) and cross‐sectional tomograms (Tomo) of 121 implant sites in 121 patients scheduled for single‐tooth implant treatment were recorded; in 70 of the Pans (Pan‐B), a metal ball was placed in the edentulous area. By means of dedicated software, an implant with subjectively determined proper dimensions for the respective site was outlined by manually placing four reference points in each image by three observers. Additionally, four reference points corresponding to the margins of the metal ball were manually placed in Pan‐Bs. The length and width of the implant were calculated after calibration to the reference ball (true magnification) in Pan‐Bs and to a “standard” calibration method in all images (magnification factor 1.25 in Pans and 1.7 in Tomos). Based on the corrected dimensions, the nearest, smaller implant size was selected among those available in each of the three implant systems. Results: When comparing Pans with Tomos, selected implant size differed in on average 89% of the cases. The length differed in 69% and the width in 66%. Implants planned on Tomos were longer than those planned on Pans in 47% and narrower in 30% (<10% in posterior regions). The Straumann^® system, with the smallest range of available implant sizes was significantly less affected by the radiographic method compared with the other two systems. Conclusion: The selected implant size differed considerably when planned on panoramic or cross‐sectional tomographs. To cite this article:
Schropp L, Stavropoulos A, Gotfredsen E, Wenzel A. Comparison of panoramic and conventional cross‐sectional tomography for preoperative selection of implant size.
Clin. Oral Impl. Res. 22 , 2011; 424–429.     

重庆市二级及以上医院手术室护士术前访视行为的调查

目的 调查手术室护士术前访视行为,促进护理质量的提高.方法 对334名手术室护士进行问卷调查,调查手术室护士收集患者信息的方式、术前访视关注点及健康教育行为.结果 84.43%的护士认为有必要实施术前访视.不同级别医院手术室护士收集患者病情的方式、术前信息关注点和术前健康教育行为不同,差异具有统计学意义(P<0.01或...     

剖宫产手术术前健康教育的实施与效果评价

目的 探讨一种应对急诊剖宫产手术的健康教育方法,以有效缓解产妇术中紧张、焦虑情绪,提高手术配合程度.方法 2010年3月于手术当天提交手术单、术前在手术室内接受健康教育的产妇55例为研究组,术前30 min采用多媒体播放、护士讲解和解答疑问相结合的方式实施健康教育;2010年2月急诊需紧急进行剖宫产手术,未接受术前健康...     

腹腔镜手术治疗异位妊娠护理体会

目的:探讨腹腔镜手术治疗异位妊娠的观察和护理。方法:术前准备同一般开腹手术,采用全身麻醉,置镜探查腹腔情况,根据腹腔内积血多少及病灶部位是否破裂,有无生育要求决定手术方式。术后持续性监测和观察血压、腹痛、阴道流血以及血HCG。结果:术后随访,56例患者均无不适主诉,有效率100%。结论:腹腔镜手术治疗异位妊娠提高治愈率并缩短了住院时间,减轻了患者的痛苦,患者易接受。     

中低位直肠癌术前与术后同步放化疗的疗效比较

目的:比较术前同步放化疗与术后同步放化疗对中低位直肠癌的临床疗效和毒性反应。方法:中低位局部晚期直肠癌36例行术前同步放化疗,同期41例先行根治术再行术后同步放化疗,术前和术后放射治疗的剂量为45-50Gy,分次剂量为1.8-2Gy/d,每周5 d。自放疗开始,给予5-Fu 400 mg/m2持续静脉泵入和CF200 mg静脉滴注,d1-4和d15-19。比较两组的临床疗效和毒性反应。结果:术前同步放化疗的保肛率明显高于术后同步放化疗组,而局部复发率和急性放射性消化道反应明显低于术后同步放化疗组(P<0.05)。术后的并发症和生存率在两组之间没有差别(P>0.05)。结论:中低位直肠癌术前同步放化疗可以提高保肛率,降低局部复发率和急性放射性消化道反应,值得临床推广。