复发性脑出血的临床研究

目的探讨复发性脑出血的发生率、危险因素及预后。方法180例首次脑出血病人,随访5年,对其临床及实验室资料进行分析。结果8例(4．4％)病人随访中脑出血复发,其中7例有高血压,且血压控制不良,1例无高血压但高龄。8例脑出血复发病人中,4例死亡,2例留有重度后遗症,2例留有轻度后遗症。结论复发性脑出血临床并不少见;血压控制不良及脑淀粉样血管病是其发生的危险因素;复发性脑出血预后不良。     

鼻咽癌放疗后局部复发和纤维化的增强CT鉴别诊断价值

目的探讨鼻咽癌放疗后出现块影时,ＣＴ检查对鉴别肿瘤局部复发和放射性纤维化的价值。方法收集１５９例经ＣＴ检查的鼻咽癌,其中放疗后局部复发（ＲＴ）３７例,放射性纤维化（ＲＦ）５４例,以６８例未经放疗的鼻咽癌（ＰＴ）作对比。使用ＥＬＳｃｉｎｔｓｐｒｉｎｔ２０００型ＣＴ机,测量放疗后出现的块影平扫和强化的ＣＴ值,用统计学的方差分析法处理增强前后的ＣＴ值差异。结果ＲＴ组平扫ＣＴ值为５０．４０±８．１０Ｈｕ,增强为７３．７４±７．３７Ｈｕ;ＲＦ组平扫为４８．６２±１０．１５Ｈｕ,增强为５６．７４±８．６９Ｈｕ;对照组（ＰＴ）病变区平扫为４８．３２±９．２０Ｈｕ,增强为７２．３８±７．７５Ｈｕ。测量表明ＲＴ组有明显强化,ＲＴ组与ＲＦ组强化后ＣＴ值差异有非常显著性（Ｐ＜０．０１）。结论鼻咽癌放疗后出现块影时,ＣＴ增强扫描可作为鉴别诊断的重要方法。     

Aspects of the aetiology of congenital heart disease

A concise overview of current knowledge on the aetiology ofcongenital heart disease is provided. At present, only 10 to20% of the cases occurring in neonates can be attributed toknown risk factors. Recurrence within relatives, chromosomalanomalies, genetic disorders, maternal diseases and teratogenexposure are addressed briefly; contemporary research modelsand methods, e.g. embryology and genetics and molecular biology,are referred to. A major innovation has been the introductionof the concept of common pathogenetic pathways. Thus, differentteratogenic factors or risk-factors may affect normal developmentat an identical stage and cause similar malformations. Also,the importance of timing of an event is stressed. If the timeframe of exposure does not coincide with embryogenesis any teratogeniceffect may be missed. Large-scale epidemiological studies on fetuses and neonateswith congenital heart disease are introduced as a third modeof research on the aetiology, although this approach is notused efficiently at present; cases of intra-uterine death canbe considered a valuable source of information that needs furtherattention. Combined, the above three lines of research may proveproductive, but the design of a comprehensive research projectwould need to be handled carefully. Possibilities for preventionof the occurrence of cardiovascular malformations are reported.Through lack of knowledge of causality, at present, only secondaryprevention may be possible and hence deserves attention. However,there appears to be no provision for thorough pre-natal screeningtests for congenital heart disease in an unselected population.     

Improved survival in young women with breast cancer

Background: Young age has been hypothesized to be an adverse prognostic factor for women with breast cancer. This association, based on historical data, may not reflect recent advances in breast cancer management. Methods: A retrospective study was conducted of all women age 30 or younger who underwent definitive operation at our institution for primary operable breast carcinoma during one of two consecutive 20-year periods (1950–1969 or 1970–1989). All cancers were restaged according to current staging criteria. Actuarial survival and recurrence-free survival rates from the two patient eras were compared with each other and with published statistics for older breast cancer patients. Results: Eligibility criteria were met by 81 women from the 1950–1969 era and 146 women from the 1970–1989 era. Histologic diagnoses, tumor sizes, incidence of axillary nodal metastases, number of positive nodes, and American Joint Committee on Cancer stage at presentation were similarly distributed in the two eras. Despite these similarities, improved survival (p=0.009) was observed in the later era. Local recurrences were also more common (p<0.05) in the later era in association with less extensive resections. These local recurrences had an adverse impact on recurrence-free survival in the later era, but no concomitant decrease in overall survival was observed. Node-positive patients who received chemotherapy demonstrated a trend toward improved survival (p=0.06) compared with node-positive patients who did not. Survival for patients in the later era was similar to that for older women as reported in other published series. Conclusions: The stage of presentation of breast cancer in women 30 years or younger appears unchanged from prior decades, but survival has improved in association with the use of less extensive surgical resections and the introduction of cytotoxic chemotherapy. With current treatment, primary operable breast cancer in young women appears to have a similar prognosis to breast cancer in older women.Results of this study were presented at the 47th Annual Cancer Symposium of The Society of Surgical Oncology, Houston, Texas, March 17–20, 1994, and was judged Best Clinical Paper in the Resident/Fellow Essay Contest.     

Late recurrence of infantile hypertrophic pyloric stenosis

A case of infantile hypertrophic pyloric stenosis that recurred 2 months after Ramstedt's operation is presented. A second pyloromyotomy was carried out with resolution of symptoms. A computer-based review of the literature suggests that this is the first such report.     

应用CD3AK细胞预防肝癌术后复发的初步观察

目的 观察ＣＤ３ＡＫ细胞治疗对肝癌术后复发的影响。方法 ６２例肝癌切除术按序列单双数的原则分为两组,研究组３２例术后１周开始应用ＣＤ３ＡＫ细胞治疗,每隔２～３个月施行一疗程,共２～６个疗程;对照组３０例术后不用ＣＤ３ＡＫ细胞治疗,仅作一般护治疗。结果 ①研究组术后１年复发率６．３％（２／３２）明显低于对照组２６．７％（８／３０）（Ｐ〈０．０５）;②研究组和对照组术后４周免疫功能有明显差异（Ｐ〈０．     

Clinicopathologic findings of recurrent primary sclerosing cholangitis after orthotopic liver transplantation

Whether primary sclerosing cholangitis (PSC) occurs after orthotopic liver transplantation is controversial, largely because the pre-transplant diagnosis of PSC is based on nonspecific radiological and histological findings. We reviewed clinical, radiological, and histological records of 53 patients who underwent liver transplantation for PSC between 1985 and 1998. Three patients with patent hepatic arteries and no evidence of chronic rejection had radiological and histological findings that may have been due to recurrent PSC. Bile duct stricturing in these patients proved permanent and progressive and affected both the quality of life and graft survival. The first patient, who is 110 months after transplantation, has had repeated episodes of cholangitis for the last year. The second patient underwent excision of a strictured hepatic duct 45 months after transplantation and was ultimately retransplanted 95 months after initial transplantation. The third patient underwent left hemihepatectomy of an atrophied lobe 50 months after transplantation. Although the patient population assessed in this study is limited, putative recurrent PSC in the allografts has led either to graft loss or to clinically significant hepatobiliary complications of the graft. Received for publication on March 8, 1999; accepted on April 30, 1999     

5-氟尿嘧啶对直肠癌术后骶前手术间隙灌注化疗的临床研究

目的 探索预防直肠癌术后盆内局部复发的新途径。方法 对126例直肠癌切除术后患者采用盆内能前手术间隙灌注式化疗新方法，术中盆内能前手术间隙置管，术后连续3天经该管生理盐水冲洗，术后7天灌注5—氟尿嘧啶进行盆内手术间隙化疗。结果 126例无手术死亡。术后随访5年，局部复发ll例(8．7％)，肝转移16例(12．7％)，腹膜后淋巴转移8例(6．3％)，5年生存率为74．7％。治疗副作用及术后并发症包括：白细胞减少1例，恶心呕吐5例，吻合口瘘1例，腹部伤口感染2例、会阴伤口感染3例，拖出肠段坏死1例。无盆内大出血、盆内感染等严重局部并发症。结论 所用方法操作简单，应用方便，具有高选择性区域化疗特点，全身毒副作用小，无严重局部并发症，局部复发率低，5年生存率较高，具有较好的预防局部复发效果，可望成为直肠癌切除术后防治局部复发的辅助化疗新途径。     

Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients.

BACKGROUND: The impact of various medical and demographic factors on the quality of life (QoL) of breast cancer patients has been discussed controversially. We investigated the influence of six different factors on long-term QoL and body image of women with primary breast cancer. PATIENTS AND METHODS: Two-hundred and seventy-four breast cancer patients were administered the QoL questionnaire following a mean interval of 4.2 years after primary diagnosis. All women had been primarily treated for stage I to III breast cancer without evidence of distant metastases. QoL was evaluated by using the QLQ-C30 questionnaire Version 2.0. Supplementary scales included body image, satisfaction with surgical treatment, cosmetic result and fear of recurrence. We analyzed the impact of tumor stage, surgical treatment, adjuvant radiotherapy, adjuvant cytotoxic therapy, age and length of follow-up period on the examined outcome parameters. RESULTS: At the time of the follow-up examination, patients showed minor impairment of QoL (mean 67.8) and body image (mean 24.8), but more fear of recurrence (mean 60.7). None of the studied factors had a significant impact on overall QoL (P >0.05) according to the QLQ-C30 questionnaire. In contrast, with the exception of the factors 'cytotoxic therapy' and 'radiotherapy' all investigated variables influenced at least one of the additional psychological scales (P <0.05). The primary surgical treatment modality had the strongest impact and affected all four scales. Patients treated with breast conservation reported a more favorable body image, compared to those treated with mastectomy (17.2 versus 37.5, P <0.01), more satisfaction with surgical treatment (4.0 versus 10.7, P = 0.01), rated a better cosmetic result (75.5 versus 57.1, P <0.01), but presented more fear of recurrence (63.9 versus 55.3, P = 0.04). CONCLUSION: Current QoL questionnaires do not sufficiently cover all relevant aspects of QoL, but might be complemented by breast cancer specific aspects such as body image and fear.     

食管癌放疗后复发再程治疗的疗效观察

目的　探讨食管癌放疗后复发再程治疗的价值。方法　 5 0例食管癌放疗后复发患者接受再程治疗。随机分成手术切除组和再程放疗组 ,2 5例手术切除组左侧进胸 ,行食管—胃吻合术 ;2 5例再程放疗组 ,采用超分割治疗。 1 2Gy/f,Bid ,6MV X线 ,相隔 6小时 ,剂量 44～ 60Gy。结果　 2 5例手术切除组 1、2、3年生存率分别为 80 %、3 6%、2 8% ;再程放疗组 1、2、3年生存率分别为 44 %、2 0 %、8 7%。结论　食管癌放疗后复发治疗应首选手术治疗 ,放射治疗亦可作为一种有效治疗手段。