Breast cancer surveillance — a cost-effective strategy

Summary The effectiveness of a surveillance program for breast cancer recurrence in extending survival is predicated on two assumptions: 1) most recurrences are detected at an early stage at surveillance visits; and 2) the early treatment of recurrence offers a better chance of cure or longer survival. However, the data suggest that neither of these two assumptions is correct, and that postoperative follow-up of patients with breast cancer is expensive and does not significantly extend survival.This minisymposium was presented December 8, 1992, at the annual San Antonio Breast Cancer Symposium, and was sponsored by educational grants from Amgen and from Bristol-Myers Oncology Division.     

某部队急性腹泻病监测报告 Ⅰ.流行病学部分

１９９１年６月～１９９２年５月在驻粤某部队进行了急性腹泻病的主动监测。年发病率为０．６４～１．０次／人／年。发病率与相对湿度（Ｘ２）、气温（Ｘ３），特别是雨量（Ｘ１）的关系经多元回归分析表明呈正相关。ｙ＝１．９８＋０．０２ｘ１＋０．０２ｘ２＋０．０７ｘ３，ｒ＝０．８７２７，Ｐ＜０．０１。病例－对照研究结果提示，饭前、便后不洗手等生活习惯用腹泻发病有密切关系。２６．３％的患者有淋雨、腹部受凉或感冒等     

内蒙古赤峰地区鼠疫现状和流行趋势预测及控制措施的研究

赤峰地区于１９４８￣１９９６年发现了１６６３２．２ｋｍ＾２鼠疫自然疫源地，分布于１１个旗（县、区）。目前达到控制鼠疫面积１３９１７．８ｋｍ＾２，占疫源地总面积的８３．６８％。选取与疫源地相关的１２种量经因子进行聚类分析，结果可分为：１．疫源性长存区；２．动物鼠疫间断流行区；３．鼠疫动物病控制区；４．疫源性基本消除区。同时对措施进行了探讨。     

自然疫源性疾病流行因素分析及对策

目的总结和分析我国1991-2006年重点自然疫源性疾病的流行现状和分布情况,探讨新时期疫情的影响因素,提出加强自然疫源性疾病监测建议。方法收集1991-2006年全国鼠疫、肾综合征出血热(HFRS)、狂犬病、流行性乙型脑炎(乙脑)、钩端螺旋体病(钩体病)、布鲁氏菌病(布病)、登革热、疟疾等重点自然疫源性疾病的疫情监测资料并进行统计分析。结果1991-2006年全国鼠疫、HFRS、狂犬病、乙脑、钩体病、布病、登革热、疟疾等报告病例1 859 295例,死亡39 028例,发病比例由20世纪90年代初期的7%左右降至2%,下降近70%,死亡比例则由50%降至目前的40%左右,所占比重依然较大;疫情主要集中在我国南方温带和亚热带地区,呈现出南多北少的特点。全球气候变暖、媒介和宿主动物入侵与耐药性、生态环境变化以及畜牧养殖业和其相关产品加工产业的高速发展等因素是目前自然疫源性疾病疫情的影响因素。结论在监测工作中重点加强预警监测、免疫接种和防制策略的效果评价以及媒介生物和宿主动物综合治理等的研究。     

某幼儿园1991～2005年儿童传染病发病趋势分析

[目的]了解幼儿园儿童传染病发病情况和流行趋势,为制定传染病防治策略提供依据.[方法]统计幼儿园内每年发病儿童人数与当年9月份在园儿童人数相比得出当年各种传染病发病率,对传染病进行特征性分析,用统计软件SPSS11.0作u检验.[结果]幼儿园是儿童传染病易感者集中的场所,1年12个月均有传染病发生.9种常见传染病中,腮腺炎、水痘、手足口病的发病率居顺构前3位.与计划免疫相关的“病”未见发病.乙肝自1994年以来未有检出.手足口病自2000年首次发病,发病率居近4年来各种传染病发病率之首.[结论]有必要将流腮疫苗和水痘疫苗纳入计划管理.重视对手足口病的监测,将手足口病纳入幼儿园常见传染病的管理之中.     

0～5岁儿童睡眠时间流行病学调查

目的:了解成都市0～5岁儿童不同年龄阶段的睡眠时间及其影响因素。方法:采用随机抽样的方法抽取成都市2个城区1276例儿童,对其家长或看护人进行睡眠状况的问卷调查。结果:成都市0～5岁儿童白天睡眠时间和总的睡眠时间随年龄增加逐渐减少,不同性别间睡眠时间无显著差别;影响睡眠时间的主要因素有儿童年龄、喂养方式、入睡方式以及母亲年龄和睡眠总时间等。结论:目前成都市小年龄阶段儿童睡眠时间较少,需引起重视;对儿童睡眠时间影响较大的主要是社会环境因素,从小培养良好的睡眠习惯和良好的睡眠环境是保证儿童充足睡眠的重要前提。     

流行性出血热流产婴儿与胎盘的病理变化及巨噬细胞内抗原定位

妊娠6~ 个月孕妇感染流行性出血热(EHF),临床有典型的EHF的发病过程。第23病日血清学检测孕妇外周血EHF-IgG(卅)、IgM(-),第24病日流产一女婴,抽取脐带血检测EHF-IgG(卅),流产女婴心血检测EHF-IgG(卅),IgM(-)。病理:肾小球上皮细胞肿胀,上皮细胞足突融合、坏死,毛细血管基底膜皱缩,肾小管上皮细胞线粒体肥大,间质内大单核细胞浸润。肺间质细胞增生、水肿、毛细血管基底膜不规则增厚,肺泡壁Ⅱ型细胞增多。肝细胞肿胀,胞浆内查见包涵体样物质,有多核肝巨细胞,地依红染色阴性。胎盘母体面、脐带、肺、肝间质内大单核细胞、中性粒细胞浸润。EHF-MCAb荧光直接法染色、PAP、ABC等免疫组化染色,在巨噬细胞浆内均为阳性反应,从而证实母体感染EHF可以经胎盘感染给胎儿,其传播方式可能是通过巨噬细胞系统。     

苯妥英钠血清浓度监测（31例报告）

报告31例口服DPH治疗的门诊癫痫病人RIA法血清DPH浓度监测结果。在随访中记录的临床治疗反应。病人平均药物剂量为4．39±1．19mg/kg／d，不同病人服用同一剂量DPH，其血清药物旅度可相差9倍。22例获良好(较好)的治疗反应，其平均有效血清药物浓度为24．1±10．1μg／ml。9例出现中毒反应；血清药物浓度在25μg／ml以上时可出现眼球震颤、视物模糊，共济失调。DPH血清浓度监测有功于实现个体化给药方案，提高疗效并避免中毒。     

Anal and rectal cancer in Crohn's disease

Several epidemiological studies have been published regarding the risk of Crohn's disease‐ associated colorectal cancer. The findings are, however, contradictory and it has been particularly difficult to obtain indisputable information on the incidence of cancer limited to the rectum and the anus. During 1987–2000 rectal or anal cancer was diagnosed in 335 patients in Sweden (153 males, 182 females). In other words, approximately 3 Crohn patients per million inhabitants were diagnosed with rectal or anal cancer every year during that time period which is 1% of the total number of cases. At diagnosis of cancer 36% were aged below 50 years and 58% below 60 years. Corresponding figures for all cases of anal and rectal cancer were 5% and 18%, respectively. Present knowledge from the literature implies that there is an increased risk of rectal and anal cancer only in Crohn's disease patients with severe proctitis or severe chronic perianal disease. However, the rectal remnant must also be considered a risk factor. Multimodal treatment is similar to that in sporadic cancer but proctectomy and total or partial colectomy is added depending on the extent of the Crohn's disease. The outcome is the same as in sporadic cancer at a corresponding stage but the prognosis is often poor due to the advanced stage of cancer at diagnosis. We suggest that six high‐risk groups should be recommended annual surveillance after a duration of Crohn's disease of 15 years including extensive colitis, chronic severe anorectal disese, rectal remnant, strictures, bypassed segments and sclerosing cholangitis.     

MANAGEMENT OF SEMINOMA OF THE TESTIS: RECOMMENDATIONS BASED ON TREATMENT RESULTS

Background : The results of management of seminoma of the testis at the Department of Radiation Oncology St Vincent's Hospital, Sydney were evaluated retrospectively to: (i) establish that outcomes were in keeping with published results from centres in Australia and overseas; (ii) assess the impact of chemotherapy on management; and (iii) to determine ‘best practice’ management protocols based on our results and a review of the relevant literature. Methods : (i) Assessment of treatment results for stage I and II seminoma of the testis treated by post-orchidectomy radiotherapy and/or chemotherapy at St Vincent's Hospital between 1979 and 1993; (ii) literature review of published data from Australian and overseas centres on the management of seminoma of the testis, and in particular the use of surveillance or chemotherapy either alone, at time of relapse or combined with radiotherapy; and (iii) development of recommendations for use as management protocols in our department. Results : Our data and a review of the literature suggest that post-orchidectomy radiotherapy with chemotherapy for relapse in stage I and IIA disease results in long-term cure rates approaching 100%. Treatment with chemotherapy either routinely or selectively or using a surveillance policy is unlikely to show any improvement in outcome and may be less cost-effective and/or produce increased morbidity and the risk of secondary leukaemia. For stage IIB disease (5–10 cm) the use of initial combination chemotherapy with or without subsequent radiotherapy did not appear to give better outcomes than initial radical radiotherapy alone, reserving chemotherapy or further radiotherapy for relapse. For bulkier stage IIB disease (> 10cm). the use of initial chemotherapy plus consolidation radiotherapy appeared to be an appropriate treatment. Conclusions : Management protocols for seminoma of the testis at St Vincent's Hospital, Sydney Department of Radiation Oncology currently are (i) stage I, IA and IIB (5–10 cm): post-orchidectomy radiotherapy alone with chemotherapy or further radiotherapy for relapse; and (ii) stage IIB (> 10 cm) disease: initial chemotherapy post-orchidectomy followed by radiotherapy to sites of initial disease involvement.