The long-term influence of hospital and surgeon volume on local control and survival in the randomized German Rectal Cancer Trial CAO/ARO/AIO-94

BackgroundThe association of treatment volume and oncological outcome of rectal cancer patients undergoing multidisciplinary treatment is subject of an ongoing debate. Prospective data on long-term local control and overall survival (OS) are not available so far. This study investigated the long-term influence of hospital and surgeon volume on local recurrence (LR) and OS in patients with locally advanced rectal cancers.MethodsIn a post-hoc analysis of the randomized phase III CAO/ARO/AIO-94 trial after a follow-up of more than 10 years, 799 patients with stage II/III rectal cancers were evaluated. LR-rates and OS were stratified by hospital recruitment volume (≤20 vs. 21–90 vs. >90 patients) and by surgeon volume (≤10 vs. 11–50 vs. >50 procedures).ResultsPatients treated in high-volume hospitals had a longer OS than those treated in hospitals with medium or low treatment volume (p = 0.03). The surgeon volume was adversely associated with LR (p = 0.01) but had no influence on overall survival. The positive effect of neoadjuvant chemoradiation (CRT) on local control was the strongest in patients being operated by medium-volume surgeons, less in patients being operated by high-volume surgeons and missing in those being operated by low-volume surgeons.ConclusionsPatients with locally advanced rectal cancers might benefit from treatment in specialized high-volume hospitals. In particular, the surgeon volume had significant influence on long-term local tumour control. The effect of neoadjuvant CRT on local tumour control may likewise depend on the surgeon volume.     

AN UNUSUAL BILATERAL VAGAL PARAGANGLIOMAS： ONE CASE STUDY

VAGAL paraganglioma VP)is an uncommonneoplasm originating from neural crest paragan-glion cells located along the vagus nerve,repre-senting less than5%of all paragangliomas of the head andneck.1Despite improvement in microsurgical techniques,management of…     

系统康复治疗对年轻肩关节脱位患者肩关节稳定性的作用

目的对年轻患者肩关节脱位进行系统的康复治疗,以检验系统康复疗法疗效优于单纯固定的假设。方法根据所采用的治疗方法,将43例40岁以下的急性肩关节脱位患者分成实验组23例,对照组20例。实验组患者进行包括关节活动范围锻炼、发展肩胛骨周围肌的肌力训练、发展肩袖肌的肌力、适度的外展、外旋锻炼及耐力训练在内的系统康复治疗。对照组只进行单纯固定后未经系统康复治疗。对两组患者的临床效果进行比较。结果实验组复发率为17%(4/23),对照组复发率为45%(9/20),两组复发率比较差异有显著性意义(χ2=3.866,P<0.05);随访结果显示肩关节ASES评分实验组为90.9±4.87,对照组为75.4±4.94,两组差异有非常显著性意义(t=9.94,P=2.99×10-12<0.01)。结论肩关节脱位年轻患者进行系统的康复锻炼,可以提高患肩的稳定性。     

肿胀法超声抽吸术治疗腋臭83例疗效观察

目的观察肿胀法超声抽吸术治疗液臭的效果,寻找一种治疗腋臭的新方法。方法在腋窝毛发区皮下注入肿胀液80~100ml,经5mm大小切口将超声探头在腋部皮下组织快速移动,直到皮肤发红发热为止,再用负压抽吸被乳化的皮下组织加压包扎。结果83例受术者,术后6~12个月随访,效果良好者76例(91.5%),有效5例(6.25%),无效2例(2.25%)。结论肿胀法超声抽吸术治疗腋臭,操作简单,不留瘢痕,安全有效,是目前治疗腋臭较为理想的方法。     

机械通气治疗小儿急性肺损伤

目的：探讨小儿急性肺损伤(ALI)的临床治疗。方法：对本院综合ICU1998年4月至2002年4月发生的22例小儿ALI的临床治疗情况进行回顾性分析。结果：本组22例小儿ALI采用呼吸末正压机械通气(PEEP)联合大剂量甲基强的松龙冲击治疗，有效率为86．36％；3例死亡，死亡率为13．64％，死于多器官功能不全综合征(MODS)。结论：机械通气治疗小儿ALI应选择最佳PEEP，动态监测动脉血气指标和X线胸片，在综合治疗基础上加用大剂量甲基强的松龙冲击治疗能收到较好的疗效。     

1例射频消融术后并发肺栓塞的抢救配合及护理

总结1例射频消融术后并发肺栓塞的抢救配合及护理体会，认为肺栓塞患者一旦发生晕厥，应立即行心肺复苏，以确保有效的循环和呼吸，尽早溶栓，改善临床症状。积极的抢救、熟练的配合、良好的护理是此患者康复的关键，同时术后早期生命体征的监测、并发症的预防、合理饮食、适当活动及休息对预防肺栓塞的发生也是很重要的。     

微波治疗窦道的临床研究

目的:窦道是通达组织深部的盲管性创道,时发时愈,迁延日久.是临床工作者常见的问题,治疗十分困难;为探索窦道的新的治疗途径,开展了微波治疗窦道的临床研究.方法:微波组:采用微波热机局部照射 外科常规换药治疗;根据病变部位分别选择直径为10cm或16cm的辐射器,辐射器距窦道口距离为3cm～5cm,隔1d或隔2d治疗1次,每次30 min,10次为1个疗程,微波治疗功率为70W,治疗结束观察治疗效果.对照组:按外科常规换药治疗.结果:微波组痊愈率98%,好转率2%,总有效率100%;对照组痊愈率37.5%,有效率37.5%,无效率25%,总有效率75%;结论:微波治疗窦道不愈患者具有简单、安全、方便、疗效独特等优点.     

Dermatofibrosarcoma protuberans: a population-based cancer registry descriptive study of 66 consecutive cases diagnosed between 1982 and 2002

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare malignant tumour of the skin, with an estimated incidence of 0.8 to five cases per 1 million people per year. OBJECTIVE: To study epidemiological, immunohistochemical and clinical features, delay in diagnosis, type of treatment and outcome of DFSP from 1982 to 2002. METHODS: Using data from the population-based cancer registry, 66 patients with pathologically proved DFSP were included (fibrosarcomatous DFSP were excluded). Each patient lived in one of the four departments of Franche-Comté (overall population of 1 million people) at the time of diagnosis. The main data sources came from public and private pathology laboratories and medical records. The rules of the International Agency for Research on Cancer were applied. RESULTS: The estimated incidence of DFSP in Franche-Comté was about three new cases per 1 million people per year. Male patients were affected 1.2 times as often as female patients were. The trunk (45%) followed by the proximal extremities (38%) were the most frequent locations. DFSP occurred mainly in young adults between 20 and 39 years of age. Mean age at diagnosis was 43 years, and the mean delay in diagnosis was 10.08 years. Our 66 patients initially underwent a radical local excision. Among them, 27% experienced one or more local recurrences during 9.6 years of follow-up. There was one regional lymph node recurrence without visceral metastases. These recurrences were significantly related to the initial peripheral resection margins. We observed a local recurrence rate of 47% for margins less than 3 cm, vs. only 7% for margins ranging from 3 to 5 cm [P=0.004; OR=0.229 (95%, CI=0.103-0.510)]. The mean time to a first local recurrence was 2.65 years. Nevertheless, there was no death due to the DFSP course at the end of the follow-up, and the final outcome was favourable. CONCLUSION: Our study emphasizes the importance of wide local excision with margins of at least 3 cm in order to prevent local recurrence. However, the recent development of inhibitors of signal transduction by the PDGFB pathway should soon modify the surgical strategy, which is often too mutilating.     

从天价医药费事件折射出当前我国医疗机构存在的问题

目前，我国许多医院的医疗卫生工作人员在为患者进行医疗卫生服务的过程中，为了医院和个人的经济利益，存在着过度医疗消费现象。最典型的是哈尔滨医科大学第二附属医院发生的天价医药费事件。导致这种现象出现的原因是由于法律的不健全、制度的不完善等而导致的监督力度不够，加之有些医务工作者在经济利益的驱使下使自己的职业道德滑坡，从而导致了老百姓看病贵现象的出现。     

The value of a pantaloon cast test in surgical decision making for chronic low back pain patients: a systematic review of the literature supplemented with a prospective cohort study

The results of lumbar fusion in chronic low back pain (LBP) patients vary considerably, and there is a need for proper patient selection. Lumbosacral orthoses have been widely used to predict outcome, however, with little scientific support. The aim of the present study was to determine the value of a pantaloon cast test in selecting chronic LBP patients for lumbar fusion or conservative management. First, a systematic review of the literature was carried out in which two independent reviewers identified studies in Medline, Cochrane and Current Contents databases. Three papers met the selection criteria. In the only study with a control group, a significantly better outcome after fusion compared to conservative treatment was found in patients who reported significant pain relief while in a cast (i.e. a positive cast test). The results of lumbar fusion, however, were not significantly different for patients with a positive and those with a negative cast test. In addition to the review, a clinical cohort study of 257 LBP patients, who had been allocated to either lumbar fusion or conservative management by a temporary external transpedicular fixation trial, was performed. Prior to allocation, all had undergone a pantaloon cast test. Patients with no history of prior spine surgery and with a positive pantaloon cast test had a better outcome after lumbar fusion than those treated conservatively (P = 0.002, χ ² test). In patients with previous spine operations the outcomes were poor and the test was of no value. From the literature and the present patient cohort, it was concluded that only in chronic LBP patients without prior spine surgery, a pantaloon cast test with substantial pain relief suggests a favorable outcome of lumbar fusion compared to conservative management. The test has no value in patients who have had previous spine surgery.