Prospective randomized trial of surgery combined with preoperative and postoperative radiotherapy for rectal carcinoma

Objective To assess the effect of surgery combined with preoperative and postoperative radiotherapy ("sandwich" treatment) in rectal carcinoma. Methods From October 1990 to January 2002, 260 patients with stage Ⅱ (117 patients) and stage Ⅲ (143 patients) rectal carcinoma were randomly divided into three groups: "sandwich" group (92 patients, group A), postoperative radiotherapy group (98 patients, Group B) and operation group (70 patients, Group C). The preoperative accelerated hyperfractionation (15 Gy/6f/3d) was given for "sandwich" group which was followed by conventional postoperative fractionation (DT 35 - 40 Gy/3.5 - 4 weeks). Patients in Group B were given postoperative radiotherapy (Dr 50 Gy/5 weeks). Patients treated with surgery alone served as control. Results The local recurrence rates of Group A, B and C were 5.4% (5/92), 16.3% (16/98) and 64.3% (45/70), respectively (X2 =5.726, P=0.017); and the distant metastasis rates were 6.5% (6/92), 28. 6%(28/98) and 31.4%(22/70), respectively (X2 =15. 703, P= 0. 001). The 3-ycar survival rate was 86. 9%(80/92), 62.2%(61/98) and 51.4%(36/70), respectively (X2 =15. 141, P=0. 001). The 5-year survival rate was 68. 5%(63/92), 54.1%(54/98)and 41.4%(29/70), respectively (X2 =4. 218, P=0.04). The Ⅰ and Ⅱ grades of radiation entero-colitis in Group A and Group B were 7.6% (7/92) and 6.1% (6/98), respectively (X2 = 0. 164, P= 0. 685). Conclusion Surgery combined with preoperative and postoperative radiotherapy can improve the survival rate and reduce the local recurrence rate in rectal carcinoma patients with stage Duke's B (Ⅱ) and C (Ⅲ).     

选择性应用陶瓷人工骨在椎体后凸成形中预防骨水泥渗漏的作用

目的在椎体后凸成形术中选择性使用陶瓷人工骨粒,观察其预防骨水泥渗漏的作用。方法选择西安交通大学医学院第一附属医院骨科自2009年6月～2011年5月116例椎体新鲜骨折患者,CT显示椎体前侧壁有不同程度的破裂,按随机原则分为两组:常规组采用传统的经皮球囊扩张椎体后凸成形术(PKP)方法,人工骨组在其基础上使用陶瓷人工骨粒,并记录人工骨粒填塞量、骨水泥注入量和渗漏发生率及后果;评估手术前后的疼痛程度(VAS法),测量椎体前缘高度压缩率(Lee法),测量椎体后凸角度(Cobb法),术后复查CT观察骨水泥渗漏情况。结果所有患者均顺利完成手术。人工骨组治疗58例,置入人工骨粒(2.83±1.67)g,骨水泥注射量为(3.74±0.66)mL,术中发现骨水泥渗漏2例,发生率为3.4%;手术前后VAS评分改善6.14±0.95,椎体前缘高度压缩率改善(21.74±1.99)%,椎体后凸角度改善23.72°±2.33°;术后CT可见椎体前侧方人工骨粒填充良好。常规组治疗58例,骨水泥注射量为(4.01±0.61)mL,术中发现骨水泥渗漏8例,发生率为13.8%;手术前后VAS评分改善6.00±0.94,椎体前缘高度压缩率改善(21.29±2.01)%,椎体后凸角度改善22.74°±2.00°。两组发生渗漏患者均无明显临床不适。SPSS17.0统计软件分析两组骨水泥注射量及骨水泥渗漏率差异有统计学意义(P<0.05),而VAS评分改善、椎体前缘高度压缩率改善及Cobb角改善情况两组间差异无统计学意义(P>0.05)。结论将陶瓷人工骨粒选择性应用于椎体后凸成形术中,在保证疗效的同时,能有效减少骨水泥的注入量,降低骨水泥渗漏的发生。     

外源性p27Kip1对兔眼滤过术后结膜瘢痕的抑制作用

目的观察外源性p27Kip1作用于兔眼滤过术后的效果,研究其对术后结膜瘢痕形成的抑制作用。方法根据GenBank人p27基因序列设计引物,制备腺病毒介导Ad-p27并验证其正确性。兔眼滤过术中结膜下注射Ad-p27、丝裂霉素C(MMC)和PBS,术后28d内测定眼压、观察眼前节的动态变化及并发症,依照Krofeld评分法进行滤过泡评分。结果 Ad-p27作用后28d内维持低眼压的状态,术后3d眼压下降达峰值7.68mmHg。Ad-p27降眼压程度与MMC相似,与PBS比较术后7d(P<0.05)、14d(P<0.01)、21d(P<0.01)和28d(P<0.05)眼压存在显著性差异。Ad-p27作用后14d内滤过泡弥漫性隆起,28d有囊性泡形成。Ad-p27组与PBS组比较,滤过泡评分在7d(P<0.01)、14d(P<0.01)和21d(P<0.05)有显著性差异。Ad-p27组术后21d前房恢复正常,而PBS组术后14d恢复正常。Ad-p27作用偶有前房渗出、前房出血等并发症。结论 Ad-p27通过抑制手术区瘢痕形成保持滤过道通畅,降低眼压。     

乳腺癌癌旁组织中PCNA、c-erbB-2、p53、ER、PR基因的表达

目的 通过检测乳腺癌癌旁组织中增殖细胞核抗原(proliferating cell nuclear antigen, PCNA)、C-erbB-2、p53、雌激素受体(estrogen receptor, ER)﹑孕激素受体(progesterone receptor, PR)蛋白的表达,探讨适合中国女性保乳手术的安全切除范围.方法 收集40例乳腺癌根治术患者的切除标本,将每一标本分为癌肿区和癌旁区,癌旁区再划分为癌旁1cm、2cm、3cm及>3cm组.采用免疫组化SP法检测以上5组乳腺组织中非典型增生的发生率以及PCNA、c-erbB-2、p53、ER、PR蛋白表达的差异.结果 距离原发癌肿越远,癌旁组织发生非典型增生以及c-erbB-2、p53蛋白阳性的比例越低(P<0.05);癌旁1cm、2cm组高危因素(非典型增生以及c-erbB-2、p53)的比例明显高于3cm组(P<0.05),而癌旁1cm与2cm组间比较未见统计学差异(P>0.05);PCNA、ER、PR在癌旁组织中的表达与组织分化、淋巴结转移无明显关系(P>0.05).结论 在乳腺癌保乳手术中,推荐以癌旁2cm作为安全切除范围.     

32例慢性前列腺炎患者的尿流动力学分析

目的　总结慢性前列腺炎患者可能存在的下尿路症状 ,并结合尿流动力学分析各类症状出现的深层次原因。方法　对 32例慢性前列腺炎患者的尿流率、膀胱压力容积、压力 流率、前列腺压和肌电图进行综合性回顾分析 ,并就慢性细菌性和非细菌性前列腺炎组的尿流动力学变化作了比较。结果　 40 6 %的患者存在不稳定性膀胱 ,34 4%的患者有逼尿肌反射亢进 ,46 9%的患者有膀胱出口处梗阻 ,另有 6 8 7%的患者存在逼尿肌 外括约肌协同失调 ;而慢性细菌性和非细菌性前列腺炎组的尿流动力学差异并无显著性。结论　慢性前列腺炎患者出现不同程度的下尿路症状可能与前列腺或盆腔内局部因素诱发的不稳定性膀胱、逼尿肌反射亢进、膀胱出口处梗阻和逼尿肌 外括约肌协同失调有关。认识并解除这些相关因素有助于提高慢性前列腺炎的综合疗效。     

EFFECTS OF LEVOTHYROXINE ON BONE METABOLISM IN PATIENTS WITH DIFFERENTIATED THYROID CANCER AFTER OPERATION AND 131I ABLATION

Objective To investigate the effects of substitutive and suppressive doses of levothyroxine on bone metabolism in patients with differentiated thyroid carcinoma after surgery and 131I ablation. Methods The patients, who had received levothyroxine(L-T4) for at least 3 years for treating their differentiated thyroid carcinoma after surgery and 131I therapy, were classified into substitutive group and suppressive group according to the levels of serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH). We compared the levels of FT3, FT4, TSH, serum parathyroid hormone (PTH), serum calcium (Ca), serum phosphate (P), serum alkaline phosphates (ALP) and Bone mineral density (BMD) to those of healthy volunteers well matched for sex, age, menopausal status, and body mass index (BMI). Results No significant differences were found in the bone density and biochemical parameters of bone metabolism of the subjects treated with substitutive or suppressive doses of L-T4 compared with the control subgroup. No significant differences were observed among the subgroups according to accumulative doses of 131I. No bone fracture was found in all the patients. Conclusion The substitutive and suppressive doses of L-T4 are safe and necessary for patients with differentiated thyroid carcinoma after surgery and 131I therapy. Such treatment for 3 years is not associated with increased risk of osteoporosis. Much longer term of follow up is still needed in patients receiving substitutive and suppressive doses of L-T4.     

骶前冲洗对直肠前切除术后局部复发影响的Meta分析

目的探讨骶前冲洗对直肠前切除术后局部复发的影响。方法采用Meta分析软件对1980年1月～2011年1月间发表的骶前冲洗对直肠癌前切除术局部复发影响的文献进行分析。结果共筛选出6篇文献(其中1篇文献有77名患者未确定分组,10名局部复发,67名无复发);直肠癌术后局部复发率为7.7%(367/4776),冲洗组局部复发率为6.4%(240/3732),低于未冲洗组的12.2%(127/1044),合并OR值为0.51(95%CI:0.41～0.69),差异有统计学意义(P<0.01);未确定人数并入冲洗组或未冲洗组,总局部复发率为7.8%(377/4852),冲洗组局部复发率6.6%(250/3 808)或6.4%(240/3 732),低于未冲洗组的12.2%(127/1 044)或12.3%(137/1 111),合并OR值为0.51(95%CI:0.40～0.65)或0.49(95%CI:0.39～0.62),差异有统计学意义(P<0.01)。结论骶前冲洗可降低直肠癌的局部复发率。     

宫颈癌Ⅱ_b患者术中大剂量放疗前后T细胞亚群水平的变化

目的　探讨术中放疗对宫颈癌Ⅱb 患者细胞免疫功能的影响。方法　在放疗前后,用流式细胞技术检测61 例宫颈癌Ⅱb 患者T淋巴细胞亚群水平(包括CD4、CD8、CD4/CD8)的变化。其中28 例行术中放疗(IROT),33 例行单纯放疗(SR),并与20例正常人作对照。结果　单纯放疗组和术中放疗组在放疗前CD4,CD4/CD8 均明显低于正常组(P<0.001),而前两组间CD4、CD8、CD4/CD8 无显著性差异;放疗后两组CD4、CD4/CD8 较放疗前均下降,CD8 上升,单纯放疗组CD4、CD4/CD8 明显低于术中放疗组(P<0.05)。结论　与单纯放疗相比,宫颈癌术中大剂量放疗对患者免疫系统的影响较轻,有利于机体的恢复。     

桃叶膏治疗滴虫病效果及其抗滴虫有效成份研究

1.用10％桃叶膏稀释液外用治疗滴虫病,单疗程近期疗效80.9％(89/110)。对单纯性滴虫性阴道炎、合并妊娠、伴有尿道炎者的疗效,分别为79.4％、82.6％、84.2％,无差别。本文对39例伴有尿道炎者进行了比较研究,发现单用桃叶膏组及加服灭滴灵的疗效分别为84.2％及100％,无统计学差别。所有单独外用桃叶膏的病例无任何局部及全身副作用。故认为此种药物值得推广试用。 2.本文实验资料表明,桃叶膏抗滴虫有效成份为扁桃酸酰胺(左旋体),2.5‰即有绝对杀虫力,这对探寻合成新的抗滴虫药物,有参考价值。     

EFFECT OF PREOPERATIVE CHEMOTHERAPY ON METASTASIZED LYMPH NODES IN PATIENTS WITH ADVANCED ESOPHAGEAL CARCINOMA

Recent advances in surgical teChniques and pe-rioperative management have significantly im-proved the resect rate, long-term survival and op-erative mortality of patients with esophageal can-cer. However, treatment of surgery only does notimprove the extremely poor prognosis of the pa-tients with local advanced squamous cell carcino-ma[lj. Multimodal therapy is needed to improve theprognosis for patients with locally advancedesophageal cancer. Most investigators have foundthat adjuvant treatme…     

常量硫酸镁治疗重型颅脑损伤的临床研究

目的探讨常量硫酸镁治疗重型颅脑损伤(sTBI)的临床效果、用药方案及其安全性。方法将入选病例随机分为治疗组和对照组,每组30例。对照组按常规治疗,治疗组加用常量硫酸镁。正常组20例,为成年健康献血员。按预设时间抽取肘静脉血,采用原子分光光度法测定血清Mg2+浓度。患者入院时、入院2周分别记录GCS评分。3月随访记录GOS评级并量化评分。观察记录治疗组和对照组患者伤后5 d的不良反应情况。应用SPSS13.0软件包分析数据。结果 sTBI后对照组患者血清Mg2+浓度立即下降,24 h内最低,7~14 d基本正常。治疗组患者伤后2~3 d血清Mg2+浓度明显高于对照组(P<0.01),7~14 d基本下降至正常。患者治疗2周后的GCS评分比较,治疗组高于对照组(P<0.05)。3月GOS评分治疗组高于对照组,但差异无统计学意义。治疗组和对照组患者sTBI后5 d内出现的不良反应比较,差异无统计学意义。结论常量硫酸镁治疗sTBI的近期疗效良好;伤后24 h内用药、连用5 d的用药方案是科学、有效、安全的。     

长托宁治疗急性有机磷农药中毒的临床观察

目的观察长托宁与阿托品治疗急性有机磷农药中毒(AOPP)的临床效果。方法97例急性有机磷农药中毒的患者随机分为长托宁组(50人)与阿托品组(47人),长托宁组用长托宁配合氯磷定治疗,阿托品组用阿托品配合氯磷定治疗,对疗效进行比较。结果长托宁可使有机磷中毒患者的中毒症状持续的时间缩短(两组间M样症状消失时间分别为1.2 h和5.0 h,有显著性差异,P<0.05),治愈率提高,死亡率减少(长托宁组分别为98%、2%,阿托品组分别为80.75%、19.15%),阿托品中毒人数减少(长托宁组3人、阿托品组14人),因阿托品中毒死亡率减少(长托宁组0、阿托品组17%),患者住院平均日缩短(长托宁组4-5 d、阿托品组7-10 d)。结论长托宁目前是救治急性有机磷农药中毒最理想的抗胆碱药。     

诺和灵强化治疗糖尿病肾病临床疗效分析

用诺和灵短期强化治疗糖尿病肾病慢性肾功能不全氮质血症期３５例。并与诺和灵常规治疗组对照。结果表明∶经强化治疗的患者在疗程结束后血糖控制理想，内生肌酐清除率显著上升，提示强化治疗糖尿病肾病可以延缓肾功能不全的恶化过程。     

围手术期食管癌患者血浆D-dimer的变化规律

目的探讨围手术期食管癌患者血浆D-dimer水平的变化规律,评估发生血栓的风险。方法随机选取行手术治疗的29例食管癌患者为癌症组,同期开胸的12例良性病变患者为对照组,测定两组患者术前、术后3d、术后9d的血浆D-dimer水平,与其病理学特征及手术方式进行统计学分析。结果术后D-dimer在对照组(P<0.001)和癌症组(P<0.001)中均升高,但在癌症组中升高趋势明显(P<0.001)。癌症组中,血浆D-dimer在术后3d较术前升高显著,在术后9d升高趋于平缓。围手术期食管癌患者D-dimer水平改变与病理类型(P=0.64)、病理分级(P=0.84)、TNM分期(P=0.52)、手术方式(P=0.83)均无关。结论食管癌患者术后血浆D-dimer变化明显,术后可能并发血栓的风险也较高。     

紫草活血汤治疗银屑病的疗效及对血液流变学的影响

目的　评价紫草活血汤治疗寻常型银屑病的临床疗效及对血液流变学的影响。方法　采用紫草活血汤治疗92例寻常型银屑病 ,观察治疗前后皮损面积、红斑丘疹、鳞屑、瘙痒、PASI积分及血液流变学的变化。结果　临床治疗有效率 97.5 %。银屑病各主证积分、PASI积分治疗后较治疗前显著下降 (P <0 .0 1)。高切血液黏度、低切血液黏度、血浆黏度、红细胞压积比、血沉、红细胞聚集指数等血液流变学指标在治疗后与治疗前比较有显著性下降(P <0 .0 5 )。结论　紫草活血汤能降低寻常型银屑病患者的血液黏度 ,治疗寻常型银屑病有较好的临床疗效     

颅内前循环动脉瘤的外科治疗

自 1990年 2月至 1998年 8月 ,共收治颅内前循环动脉瘤 32例 ,15例行血管内栓塞术(其中 1例栓塞失败改作手术治疗 ) ;17例显微镜下直视手术 ,术后死亡 1例。随访 2 8例 ,2 2例恢复良好 ,1例植物生存 ,2例偏瘫 ,2例动眼神经麻痹 ,1例癫痫。对前循环动脉瘤的诊断、治疗方法的选择及手术要点作了讨论。     

自血回输加补肾益脑汤治疗缺血性脑血管病的研究

１４５例缺血性脑血管病分为治疗组和对照组。治疗组采用自血回输（ＵＶＢ）加中药补肾益脑汤治疗，对照组采用脑活素加对症治疗。结果：治疗组的临床有效率和临床主要症状好转率均明显高于对照组，其实验室检测项目（ＴＧ、ＰＯ２、ＳＯＤ、ＭＤＡ、ＷＢＶ）两组治疗前后对比，治疗组明显地得到改善（Ｐ＜０．０５）。说明该疗法可降低血脂、血粘度和ＭＤＡ，提高血氧含量和ＳＯＤ含量，较单纯西药为好。     

THE FIRST CHOICE OF TREATMENT FOR URINARY INFECTED RENAL STONES

Objective To investigate the appropriate treatment of infectious renal stones. Methods Between April 1999 and June 2006, 60 patients presented to our department with infectious renal stones. Twentynine patients were treated by extracorporeal shock-wave lithortripsy( ESWL ) only, 31 patients were given a combination therapy. Thirty-four males and 26 females were evaluated by routine urine tests including urine culture and sensitivity before ESWL treatments. The total number of shock waves varied from 1 600 to 2 800 and the energy levels ranged from 1 to 6 unit. Results The fragmentation after ESWL was 61.6%; 18. 3% after 2 ESWL sessions,8.3% after 3 ESWL sessions, 5.0% after 4 ESWL sessions, 3. 3% after 7 ESWL sessions and 1.66% after 9 ESWL sessions. Only one ( 1. 66% ) patient failed and changed to open surgery. Conclusion ESWL is an effective and reliable treatment for patients with infectious renal stones. However, better effects and shorter treatment time is obtained by the combination therapy of ESWL with other therapy options.     

The effect of prostaglandin E1 on recovery of early renal graft functions after transplantation

Objective To investigate the effect of prostaglandin E: (PGE1) on recovery of early renal graft functions after transplantation. Methods One hundred and seven patients after renal transplantation were allocated in the treated group, and treated by conventional treatment with injection of 10 μg prostaglandin E1 additionally twice a day for 14 days. And eighty-eight patients who received conventional treatment alone after renal transplantation at the corresponding period were allocated in the control group. Indexes of the two groups, including incidence of delayed graft function and acute rejection reaction, volume of urine, serum certaintie (SCr), endogenous certainties clearance rate (CCr), the blood flow resistance in graft as well as blood viscosity (BV), and platelet aggregation rate (PAR), were determined. Results The urinary volume and endogenous certainties clearance rate of the treated group were significantly higher, but the level of SCr, incidence of renal function recovery retardation, BV, PAR and blood flow resistance in graft were significantly lower than these of the control group (P<0.05). The difference of incidence of acute rejection reaction between the two groups was insignificant (P>0.05). Conclusion Prostaglandin E1 can improve blood microcirculation and decrease the incidence of renal function recovery retardation. These effects are helpful for recovery of renal function after renal transplantation.     

鞘内给氧与高压氧对颅脑损伤患者神经功能恢复的对比研究

目的　通过鞘内给氧与高压氧对颅脑损伤患者神经功能恢复的情况对比研究 ,探讨鞘内给氧对颅脑损伤患者神经功能障碍的治疗作用及其机制。方法　选择 15 0例颅脑损伤患者 ,随机分为鞘内给氧组、高压氧治疗组和鞘内注入过滤空气组 ,分别施行鞘内注入氧气、高压氧治疗及鞘内注入过滤空气 ,观察患者神经功能的改变 ,并检测脑脊液中超氧化物歧化酶 (SOD)、丙二醛 (MDA)和一氧化氮 (NO)水平的变化。结果　鞘内给氧组患者神经功能得到明显改善 ,且脑脊液中SOD、NO水平增高和MDA水平降低均较高压氧组明显。结论　鞘内给氧可以促进颅脑损伤患者神经功能障碍的改善 ,优于高压氧 ,且简便易行