放射治疗骨转移癌42例临床分析

Objective To analyze the effect of pain control with radiotherapy in bone metastases from malig-nancies. Methods A total of 72 lesions in forty-two cases with bone mestastases were received 6my X ray. The con-ventional radiotherapy was performed in 28 lesions in the way of 200cGy/fraction,5 fracties/week,total dose of 3000 ～5000cGy. The hypofractionation radiotherapy was.performed in 44 lesions in the way of 400cGy/fracfion,3 frac-tions/week,total dose of 2400～3600cGy. Results Overal pain relief rate was 90.28%, there were no significant differences between the two groups(P 0.05). The pain relief of hypofractionation radiotherapy was faster than anoth-er. Conclusion Radiotherapy is a very effective way to relieve pain in bone metastases from malignacies.     

恙虫病并发中毒性肝炎40例临床分析

目的探讨恙虫病并发中毒性肝炎的临床特点。方法按诊断标准选择病例进行临床分析。结果本组除了具有恙虫病特征性的临床表现外，同时出现黄疸占25％(总胆红素平均164μmol/L)，出血点和瘀斑占15％，肝大占76％，脾大占63％。ALT和AST升高，平均分别为295U/L和240U/L。使用特效抗茵药物和护肝退黄治疗有良效。结论恙虫病并发中毒性肝炎较常见，少数可出现严重的肝功能损害。     

Solitary intracranial metastases from primary endometrioid ovarian cancer

A rare case of involvement of the Central Nervous System characterized by brain and subsequent cerebellar metastases without abdomino-pelvic spread is reported. The patient was treated by craniotomy plus external radiation to the brain. Subsequently, Carboplatin-based chemotherapy was started when paraaortic lymph-nodes involvement has been detected. Follow-up is uneventful after clinical complete remission. Received: 17 February 1997 / Accepted: 2 June 1997     

Unknown primary tumours

Unknown primary tumours (UPTs) are defined by the absence of a primary tumour in biopsy proved metastatic cancer. These tumours have a specific biology with clinical characteristics of rapid progression and random atypical metastases. Cytogenetic abnormalities have been demonstrated, particularly deletion of chromosome 1p. Diagnostic evaluation that includes pathology review, physical examination, chest radiography, computed tomography of the abdomen, and mammography is directed at the identification of treatable subsets. Based on clinicopathological criteria, therapy responsive subsets of patients with UPTs can be defined. These subsets have a better prognosis than the average median survival time of four months in patients with UPTs.     

原发性肝恶性淋巴瘤1例报告：附文献复习

目的探讨原发性肝恶性淋巴瘤（ＰＬＬ）影响预后因素及治疗方法。方法收治１例ＰＬＬ治疗情况并复习国内外有关ＰＬＬ治疗病例３８例，合计３９例。分析ＰＬＬ预后因素及治疗结果。结果１．孤立性病灶治疗方式有手术局部切除（１０例），放射治疗（２例）和联合化疗（３例）。局部复发２例（手术１例，放射１例，剂量８Ｇｙ），死亡３例。多发病灶治疗方式有：联合化疗（１７例），放射治疗（３例）和未治疗（４例）。治疗病例中，局部复发７例（化疗６例，放射１例，剂量２１Ｇｙ。死亡１０例。２．有Ｂ症状者（１２例）死亡９例（７５％），无Ｂ症状者（２７例）死亡（３例）（１１．１％）（Ｐ＜０．０１）。结论有Ｂ症状者、肝内病灶多发者预后差；孤立性病灶者，无论手术、放射或／和化疗都有较好的局部控制。肝内多发病灶者，单纯全身化疗局部复发率高，放射治疗对控制局部有一定帮助     

雄激素受体与肝细胞肝癌预后的关系

目的探讨雄激素受体（ＡＲ）与肝细胞肝癌（ＨＣＣ）预后的关系。方法用葡聚糖包裹活性炭饱和吸附法检测４７例ＨＣＣ癌组织和癌旁肝组织中ＡＲ的含量。对４３例病人进行术后随访９～６０个月。结果３３例ＡＲ阳性（３．０～１００ｆｍｏｌ／ｍｇ蛋白），１４例ＡＲ阴性。ＡＲ阳性病人与ＡＲ阴性病人的一、五年存活率没有统计学差别，三年存活率ＡＲ阳性者（３５．５％）显著低于ＡＲ阴性者（６６．７％）。复发时间ＡＲ阳性者（２１．４±１５．２月）与ＡＲ阴性者（３３．９±１３．９月）有显著差异（Ｐ＜０．０５）。结论雄激素能促进ＨＣＣ的增长及周围组织的侵袭，部分ＨＣＣ具有雄激素依赖性，ＡＲ可作为ＨＣＣ的预后指标     

Primary metastatic (stage IV) Ewing tumor: Survival analysis of 171 patients from the EICESS studies

Background: In the multicenter European Intergroup Cooperative Ewing's Sarcoma Studies, localized Ewing tumors of bone were treated by combination chemotherapy with surgery and/or radiotherapy. Patients with primary metastases (pm-pts) were treated in high risk protocols.Patients and methods: One hundred seventy-seven pm-pts were registered from January 1990 to December 1995, 171 were evaluable for survival analyses. Thirty-six pm-pts received myeloablative megatherapy with stem cell rescue following conventional treatment. Bilateral whole lung irradiation (WLI) was administered in 57 pm-pts with pulmonary involvement. Event-free survival (EFS) rates were estimated by Kaplan–Meier analysis. Prognostic factors were identified by log-rank statistics, Cox procedures and logistic regression.Results: Eighty-nine deaths were recorded by 1 February 1997, EFS four years after diagnosis for all 171 pm-pts was 0.27. EFS for isolated lung metastases was 0.34, for bone/bone marrow (BM) metastases, 0.28, and for combined lung plus bone/BM metastases, 0.14 (P < 0.005). WLI improved outcome in case of isolated pulmonary involvement (0.40 vs. 0.19, P < 0.05). In pm-pts with combined pulmonary/skeletal metastases, intensification by megatherapy and/or WLI improved EFS from 0.00 to 0.27 (P = 0.0001).Conclusions: EFS four years after diagnosis in patients with disseminated Ewing tumors is 0.27. Whole lung irradiation and megatherapy improve outcome in subgroups of patients with disseminated Ewing disease.     

骨转移瘤的放射治疗

目的探讨关于骨转移瘤常规分割放疗组与低分割放疗组的止痛效果。方法４８例病人，２８例采用常规分割，ＤＴ２００ＣＧＹ／次，每周５次，ＤＴ３０００～５０００ＣＧＹ；２０例采用低分割照射，ＤＴ４００～５００ＣＧＹ／次，每周２～３次，ＤＴ２５００～３０００ＣＧＹ。结果放疗起到了明显的止痛作用，常规分割放疗组与低分割放疗组止痛效果大致相同，无统计学意义（Ｐ＞０．０５）。结论放疗原则应根据病情及预计生存期长短来决定。对一般情况好，预计生存期长的病人应采取积极的治疗，给予大剂量长疗程的常规分割，而对于那些病情相对较重，行动又不方便，无望长期生存的病人，应采取低分割照射，且见效快，同样起到止痛作用     

“抑肝纤”对大鼠实验免疫损伤性肝纤维化阻断作用的研究

目的本研究利用人血白蛋白免疫损伤Ｗｉｓｔｅｒ大鼠造成肝纤维化模型，以观察“抑肝纤”对大鼠肝纤维化的阻断作用。方法将不同浓度中药“抑肝纤”用于治疗组并与模型组和对照组进行对比，综合分析血清肝纤维化指标、肝组织病理改变、肝组织胶原纤维和网状纤维病理图像定量分析等结果。结果治疗组血清肝纤维化指标（ＰＣⅢ、ＨＡ、ＬＮ）均低于模型组，接近正常组，差异有显著性（Ｐ＜０．００１或Ｐ＜０．０５）。光镜下肝组织病理变化，肝组织中胶原纤维和网状纤维病理图像定量分析结果治疗组优与模型组，尤以低浓度组更为明显（Ｐ＜０．００５或Ｐ＜０．０５）。结论研究结果表明，中药“抑肝纤”如能早期应用，可有效地阻断或延缓实验鼠肝纤维化的发生     

Factors associated with liver biopsy performance in HCV-HIV coinfected injecting drug users with HCV viremia: Results from a five-year longitudinal assessment

The last international consensus conference about hepatitis C virus (HCV) treatment emphasized the importance of treatment for persons coinfected with HCV and human immunodeficiency virus (HIV). As liver biopsy precedes treatment, we aimed to identify factors associated with the performance of liver biopsy among HIV-HCV coinfected drug users during a 5-year follow-up to study their access to HCV treatment. Of the 296 patients followed in the HIV hospital departments of Nice and Marseilles and with retrievable records about HCV diagnosis and care, 166 were eligible for analysis having had detectable HCV RNA at least once during the study period. Overall, 45.2% of patients underwent liver biopsy during follow-up. Using proportional hazard models, predictors of having had a liver biopsy were high social support, complete abstinence from drug injection, and lack of immunosuppression as well as male gender, no history of multiple incarcerations, more recent onset of drug use, and an increase of liver enzyme levels. These results suggest that specific efforts should be devoted to HIV-HCV coinfected drug users to assist with stabilizing these patients to optimize their access to HCV care whenever possible. The MANIF 2000 study group includes C. Boirot, A. D. Bouhnik, M. P. Carrieri, J. P. Cassuto, M. Chesney, P. Dellamonica, P. Dujardin, S. Duran, J. G. Fuzibet, H. Gallais, J. A. Gastaut, G. Lepeu, D. A. Loundou, C. Marimoutou, D. Mechali, J. P. Moatti, J. Moreau, M. Nègre, Y. Obadia, I. Poizot-Martin, C. Pradier, D. Rey, C. Rouzioux, A. Sobel, B. Spire, F. Trémolières, and D. Vlahov.