子宫内膜癌合并多原发性肿瘤

【目的】探讨子宫内膜癌合并多原发癌的发生率、病因、诊断及预后。【方法】对45例子宫内膜癌合并多原发癌的临床及病理资料进行回顾性分析。【结果】本组子宫内膜癌合并多原发癌的发生率为3.2%(45/1389);异期癌两癌发生间隔时间最短8个月,最长19年;间隔5年以上者62%(16/26);子宫内膜癌合并生殖器官恶性肿瘤53%(24/45),其中大部分为同期癌(19/24);合并乳腺癌16%(7/45);合并大肠癌11%(5/45)。先期癌的临床分期中、早期者87%,治疗均采用相应的根治性治疗,其中31%(8/26)有放疗史,23%(6/26)有化疗史。本组多原发癌的治疗,全部为根治性治疗,5年生存率为63%。【结论】①必须警惕子宫内膜癌合并生殖器官、乳腺、大肠等器官多原发癌的发生;②子宫内膜癌合并多原发癌的病因可能与共同的胚胎来源、共同的雌激素受体、放射线、抗癌药物的使用等因素有关。     

Concordance of second opinion diagnosis in salivary gland cytopathology: experience from a single academic institution

Interpretation of fine needle aspiration (FNA) material from salivary gland lesions has high interobserver variability due to the heterogenous and overlapping cytological features of various lesions. For this reason, second opinion consultation may play an important role in guiding appropriate clinical management for challenging cases. We aimed to report our experience with salivary gland cytology consultation cases at our academic center. Consecutive salivary gland FNA cases received from outside institutions for second opinion consultation between 2013 and 2022 were reviewed. Cases were divided into true consults (diagnostic assistance sought) or confirming consults (reviewed by in-house cytopathologists for patients being transferred to our institution for treatment). All diagnoses were re-classified using the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Discordance between reclassified consult diagnostic categories and preliminary diagnostic categories was recorded. Consultation resulted in a change in the diagnostic category in 15% of confirming and 18% of true consult cases. The overall distribution of diagnostic categories provided by outside pathologists was similar to consult diagnoses. Only 4 (5.4%) confirming and 3 (5.5%) true consult cases had major diagnostic discrepancies, which may impact the clinical treatment. Moderate interobserver variability is often expected with salivary gland FNA. However, in our consultation practice, we found a relatively high degree of concordance between submitting and consult diagnoses utilizing the MSRSGC.     

第一趾蹼皮瓣修复虎口挛缩

目的：探讨吻合血管的第一趾蹼皮瓣修复虎口挛缩的方法和疗效。方法：供区为第一趾蹼皮瓣,将皮瓣所携带的第一跖背动脉、大隐静及犀利腓深神经分别与受区桡动脉腕背支,头静脉及桡神经浅支吻合。结果：本组32例皮瓣全部成活,经1.0-3.5年随访,第一趾蹼游离皮瓣能满足保留虎口深度、展开度、良好感觉和美观外形的要求,临床效果较好。结论：第一趾蹼皮瓣与虎口皮肤组织结构伯厚薄及功用方面相似,是再造虎口的理想组织皮瓣。     

瞬间反应式二次谐波显像评价正常犬肝脏超声学造影的实验研究

目的：评价瞬间反应二次谐波显像（Ｔｒａｎｓｉｅｎｔ ｒｅｓｐｏｎｓｅ ｓｅｃｏｎｄ ｈａｒｍｏｎｅｃ ｉｍａｇｉｎｇ,ＴＲＳＨＩ）对正常肝脏声学造影的增强效果及动态变化规律,并与常规连续二次谐波显像进行对比分析。方法：６只健康杂种犬 经外周静脉注射氟碳声学造影剂,分别用常规二次谐波显像和瞬间反应式二次谐波显像扫描肝脏。造影效果评价使用视觉评分和视频密度分析。结果：常规二次谐波显像有４次Ｉ级增强、４     

氧化铝颗粒大小对PEO—NaSCN络合物电导率的影响

研究分散第二相Ａｌ２Ｏ３的含量及颗粒大小对ＰＥＯ－ＮａＳＣＮ络合物电导的影响,结果表明：当颗粒度为０．７μｍ时,电导率比纯ＰＥＯ－ＮａＳＣＮ提高了一个半数量级。颗粒度较大时,电导率均比纯ＰＥＯ－ＮａＳＣＮ低,并在ｗＡｌ２Ｏ３＝０．２５时,存在电导率最大的峰值。     

晶氧和碳酸氢钠改善第二产程母血酸碱平衡

对９９ 例经阴道分娩的产妇于第二产程开始时给予鼻导管吸氧,静脉滴注碳酸氢钠、过氧化氢碳酸酰胺（ 晶氧） ,于第二产程始末两次采母桡动脉血行血气分析。结果显示：晶氧碳酸氢钠联用组（ Ⅰ组）于第二产程结束时其ｐＨ,ＢＥ,ＰＯ２ 及Ｏ２ｓａｔ均显著高于对照组（ Ⅲ组）（ Ｐ ＜ ０ ．０５ 和＜ ０ ．０１） ,而ＰＯ２ 及Ｏ２ｓａｔ则无统计学差异;Ⅰ组与Ⅱ组ｐＨ,ＰＯ２ 及Ｏ２ｓａｔ 值于第二产程末较开始时显著升高（ Ｐ ＜ ０ ．０５ 和＜ ０ ．０１） ,ＢＥ 在该产程始末无统计学差异;Ⅲ组上述４ 指标明显下降（ Ｐ ＜ ０ ．０５ 和＜ ０ ．０１） 。各组间及组内比较ＰＣＯ２ 均无明显变化。提示第二产程中常规给予纠酸,吸氧内给氧能有效地改善产妇过度消耗所致的酸中毒和缺氧倾向。     

Gliomatosis peritonei: the value of a "second look" operation.

The case history of a 10-year-old black girl with gliomatosis peritonei, Grade 0, is presented. The primary tumour was resected and a "second look" operation carried out 3 months later. The glial implants demonstrated distinct circumferential and intra glial fibrosis (resolution). Because the peritoneal implants had undergone resolution, further therapy became unnecessary. We believe gliomatosis peritonei fully justifies a second laparotomy in order to be able to accurately grade the implants. The grade of the peritoneal implants influences the prognosis and therefore determines the type of therapy to be instituted.     

Multicenter phase II trial evaluating a three-weekly schedule of irinotecan plus raltitrexed in patients with 5-fluorouracil-refractory advanced colorectal cancer.

BACKGROUND: Irinotecan (CPT-11) and raltitrexed are active against advanced colorectal cancer (ACC), act through different mechanisms, and have only partially overlapping toxicity profiles. Phase I studies have shown that single-agent full doses of both drugs can be safely combined. The aim of this multicenter study was to assess the efficacy and toxicity of the combination in patients with 5-fluorouracil (5-FU)-refractory ACC. PATIENTS AND METHODS: Between October 1999 and December 2000, 52 patients (31 males, 21 females) with a median age of 62 years (range 39-75) were included and received CPT-11 (350 mg/m(2) as a 60-min infusion) plus raltitrexed (3 mg/m(2) as a 15-min infusion, 1 h after CPT-11), with courses repeated every 21 days. Objective response was assessed after every three courses, and treatment maintained until tumor progression or unacceptable toxicity. RESULTS: A total of 313 cycles were administered, with a median of six cycles per patient (range 1-14). Seven patients (13.5%) achieved a partial response and one a complete response (1.9%), for an overall intention-to-treat response rate of 15.4% (95% confidence interval 6.1% to 27.2%). The incidence of grade 3/4 toxicity was 23.1% for diarrhea, 21.2% for asthenia, 17.3% for neutropenia, 13.4% for emesis and 7.7% for infection. There were no treatment-related deaths. With a median follow-up of 20 months, median survival was 11.9 months and median time to progression was 4.6 months. CONCLUSIONS: CPT-11 plus raltitrexed is active in patients with 5-FU-refractory ACC, at the expense of moderate toxicity.     

Second primary cancers in breast cancer patients in Slovenia

Data from the Cancer Registry of Slovenia were used in a cohort studyto determine whether the incidence of second primary cancers in patients withfirst primary breast cancer differs from the incidence expected in thegeneral population. Special interest was given to long-term survivors. Theexpected numbers of second primary cancers were calculated by multiplying thenumber of appropriate person-years at risk by the corresponding age-andcalendar-period-specific cancer incidence rates for women in Slovenia. Therisk of a second primary cancer was expressed as the standardized incidenceratio (SIR). Of the 8,917 patients newly diagnosed in the period 1961-85 andfollowed-up to the end of 1994, 547 (6.2 percent) developed second primarycancers, whereas 410 (4.7 percent) were expected (SIR = 1.3, 95 percentconfidence interval [CI] = 1.2-1.4). The risk was higher among youngerpatients. In long-term survivors, the risk was increased significantly forsecond primary cancer of th e breast (SIR = 1.4, CI = 1.1-1.7), lung cancer(SIR = 1.6, CI = 1.1-2.3), melanoma (SIR = 2.7, CI = 1.5-4.4) andnon-melanoma skin cancers (SIR = 2.0, CI = 1.6-2.4), corpus uteri cancer (SIR= 1.6, CI = 1.2-2.1), ovarian cancer (SIR = 2.3, CI = 1.7-3.0), and thyroidcancer (SIR = 2.5, CI = 1.2-4.6). Our results confirm the findings of severalcohort studies carried out in Europe, the United States, and Japan,indicating that breast cancer patients should be monitored carefully for theoccurrence of second primary cancers.     

Second cancers after medulloblastoma: population-based results from the United States and Sweden

Medulloblastoma, one of the most common central nervous system(CNS)tumors in children, requires aggressive multimodality therapy including surgery, radiation therapy, and occasionally chemotherapy. Given its intensive treatment regimen and improved survival during the past 20 years, it is likely that a cohort of survivors will result who may incur consequences of therapy, including a second cancer. We used population-based data from the United States and Sweden to estimate risks of second neo plasms in patients with histologically confirmed medulloblastoma (n = 1,262).Overall, there was a 5.4-fold excess of second neoplasms (95 percent confidence interval = 3.3-8.4) based on 20 observed and 3.7 expected cancers. The second cancers occurred eight to 432 months after initial diagnosis(median, 73 months) with significantly elevated ratios for all intervals examined except for less than one year after initial diagnosis. Significantly elevated risks were seen for cancers of the salivary glands, cervix uteri, brain and CNS, thyroid gland, and acute lymphoblastic leukemia. Of the 15second cancers with treatment data, seven occurred in the radiation field or within areas of scatter while two others may have been radiation-related. Although based on small numbers of second cancers, the results suggest that as survival increases, some patients with medulloblastoma will have an increased risk of a second cancer, particularly a radiation-related cancer. Thus, as survival improves, late-occurring consequences of diagnosis and treatment will need to be carefully assessed. Identification of patients hypersensitive to radiation therapy, such as those with Gorlin Syndrome, should also be attempted in order to reduce the sequelae from intensive radiation exposure. This revised version was published online in July 2006 with corrections to the Cover Date.