右肩关节疼痛活动受限

患者右肩关节隐痛5个月.活动受限2个半月入院,术前影像学检查见右肩胂颈部膨胀性骨质破坏,实验室检查：Hb：88g/L,球蛋白59.9g/L,尿蛋白（＋）;β2-微球蛋白和尿素均高于正常值.术中冰冻病理报告：恶性肿瘤,考虑为转移性低分化腺癌.术后行PET-CT检查,未找到明确原发灶.术后石蜡病理报告：桨细胞瘤,骨髓瘤临床表现多样,易发生误诊,应增加对比病的认识,提高警惕性,培养对临床资料的综合分析能力,拓宽诊断思路,达到对疾病的早期诊治,及时缓解临床症状,延长恶性肿瘤患者的生存期.

Omarthralgia on Right Shoulder with Limitation of Motion

Objectives:To compare the administration of gemcitabine(GEM) alone with GEM-cisplatin(DDP) combination chemotherapy in patients with advanced stage pancreatic cancer(APCa).Methods:MEDLINE,EMBASE and ASCO searches were supplemented with information from data retrievals and registers.A quantitative meta-analysis was carried out using updated information and the inclusion criterion from all available randomized controlled trials.The primary meta-analysis was conducted based on the overall survival rate(OS).The second analysis used objective remission rate(ORR) and toxicity.Results:The meta-analysis included 6 randomized controlled trials.There was no significant improvement in the GEM-DDP combination group for the 6-month survival rate(P=0.24) and the clinical benefit rate(P=0.58).There was a significant improvement in the GEM-DDP combination group in terms of ORR(RD=6%,P=0.05).Moreover,there was a significant improvement in the combination group for 6-month TTP/TTF(RD=9%,P=0.02).However,WHO grade 3-4 toxicity was more frequent for the GEM-DDP combination group along with neutropenia(RD=6%,P=0.08),thrombocytopenia(RD=8%,P=0.17) and vomiting/nausea(RD=11%,P=0.07),but none of these parameters showed a significant difference when compared to the group treated with GEM alone.Conclusion:The regimen of GEM plus DDP had no significant survival benefit compared to GEM alone.GEM-DDP combination should not be recommended as a therapeutic protocol for APCa.Administration of GEM alone is still an optimal treatment for patients with APCa.