胃肠道类癌的诊治及预后分析

目的:探讨胃肠道类癌的诊治方法及影响预后的相关因素.方法:对30例胃肠道类癌病人的临床、病理及随访资料进行回顾性分析.结果:33%的胃肠道类癌病人有腹胀,27%出现腹痛或便秘,未发现类癌综合征病例.术前53%的病人经胃镜或结肠镜检查确诊.直肠类癌占33%,胃类癌及十二指肠类癌各占20%.所有病人均经手术完整切除.肿瘤直径0.5～6.0 cm,20%的肿瘤侵及浆膜层,伴淋巴结转移者占20%.中位随访时间70个月,5年生存率占60%.平均生存期为(73±26)个月,其中肿瘤直径不超过2.8 cm者为(82±5)个月,超过2.8 cm者为(52±6)个月,P=0.0142;肿瘤浸润深度不超过肌层者为(78±5)个月,肿瘤侵及浆膜者为(47±10)个月,P=0.007;伴有淋巴结转移者为(49±10)个月,不伴淋巴结转移者为(77±5)个月,P=0.0081.生存分析提示肿瘤直径、浸润深度及淋巴结转移影响患者预后.结论:胃镜与结肠镜检查有利于胃肠道类癌的诊断,完整切除病变为治疗的有效手段,肿瘤大小、浸润深度及淋巴结转移与预后有关.     

高龄患者胃上部癌临床及病理特征分析

目的：探讨高龄患者胃上部癌的临床、病理特征，选择合理的外科治疗方法。方法：分析我院1991年1月－2002年6月收治93例70岁以上胃上部癌患者的临床、病理特征及对外治疗情况。结果：男女发病比例为4．1：1，平均病程4．6个月；早期诊断率2．5％；进展期主要临床表现为进食梗阻感65．65（61／93）、贫血52．6％（52／93）；术前并存疾病的发生率为54．8％，以慢支呼吸系和心血管疾病为主。癌细胞分化程度高64．5％（60／93），Borrman Ⅱ-Ⅲ型77．4％（72／93）。手术切除率92．5％，淋巴结转移率49．5％。肿瘤大小、大体分型、组织学类型和浸润深度均与淋巴结转移相关。结论：高龄胃上部癌病程长、恶性程度相对低，手术切除率高。肿瘤直径＞5cm、Borrman Ⅱ-Ⅳ型、肿瘤侵及浆膜及浆膜外和分化低腺癌易发生淋巴结转移，并存疾病的发生率高。加强术前并存疾病的处理和术后监护，积极并选择适当的外科手术治疗，可以取得较好的治疗效果。     

胃肠道类癌的诊治和预后分析

目的探讨胃肠道类癌的诊断治疗和预后影响因素。方法对1998年12月至2007年12月间收治的40例胃肠道类癌患者的临床资料进行回顾性分析。结果40例患者男女比例1.86∶1,平均年龄59.3岁。主要临床表现为腹部疼痛、消化道出血和腹泻。病灶中位大小4 cm,肿瘤直径≤2 cm者5年生存率88%,直径>2 cm者5年生存率为32%(P=0.0038)。T1-2、T3和T4期患者的5年生存率具有明显差异(P<0.01),分别为82%、44%和17%。不伴有淋巴结转移者和伴有淋巴结转移者的5年生存率分别为80%和31%(P=0.0017),总5年生存率52%。结论手术是胃肠道类癌的主要治疗手段,预后和肿瘤大小、浸润深度以及淋巴结转移相关。     

肾细胞癌与良性肾肿瘤组织微血管密度和血管内皮细胞生长因子表达的对比研究

目的：通过检测肾细胞癌、肾脏良性肿瘤标本中的微血管密度（MVD）及血管内皮细胞生长因子（VEGF）表达情况,研究不同性质肾脏肿瘤血管生成的差异。方法：肾细胞癌标本39例,良性肾脏肿瘤标本12例。采用“热点（hotpoint）”法计数MVD,VEGF的定量标准为VEGF染色强度与阳性细胞百分比分值的乘积。结果：MVD、VEGF在肾细胞癌和良性肾脏肿瘤均有表达。肾细胞癌组织MVD（18．3±6．9）计数／视野,VEGF乘积值3．63±2．5（×400）,转移者MVD和VEGF乘积值分别为（26．2±7．8）计数／视野、5．83±2．4,未转移者MVD和VEGF乘积值分别为（14．4±4．6）计数／视野、2．06±2．7;12例良性肾脏肿瘤MVD为（2．5±1．3）计数／视野,VEGF乘积值为0．32±0．2。肾细胞癌组织MVD和VEGF表达显著高于良性肾肿瘤（P〈0．01）,转移组肾细胞癌MVD和VEGF表达显著高于未转移组（P〈0．01）;肾细胞癌组织MVD与VEGF统计学上呈正相关（r=0．684,P〈0．001）。结论：肾细胞癌MVD及VEGF表达均显著高于良性肾脏肿瘤,提示不同性质的肾脏肿瘤其血管生成情况不同．转移肾细胞癌血管生成水平亦高于未转移肾细胞癌,提示血管生成与肾细胞癌转移相关,肾细胞癌组织MVD和VEGF表达水平呈正相关     

胃癌腹主动脉旁淋巴结转移规律的临床分析

目的：探讨胃癌腹主动脉旁淋巴结转移的规律和清扫术的适应症。方法：对D3加腹主动脉旁淋巴结廓清术53例患者的临床资料进行回顾性分析。结果：本组16a2,16b1组淋巴结转移率17％，均为进展期胃癌，均有N1－N2淋巴结转移，胃癌浸润深度达T3，T4者淋巴结转移率21．5％，低分化型瘤的淋巴结转移率为22．2％，癌灶直径≥5cm的淋巴结转移率25.8％，弥漫型胃癌患者淋巴结转移率更高达42．8％，结论：胃癌浸润深度，癌肿组织学类型和分化程度，肿瘤部位，肿瘤大体类型，肿瘤大小等病理因素是预测腹主动脉旁淋巴结转移的主要根据，对高度怀疑或证实有N1－N2淋巴结转移，浸润浓度T3，T4，进展期低分化型癌，癌灶直径≥5cm,以及弥漫型胃癌，但无肝脏，腹膜等远处转移的胃癌患者尽可能行D3加腹主动脉旁淋巴结廓清术。     

上皮样卵巢癌淋巴结转移的临床特征分析

【目的】研究上皮样卵巢癌肿瘤分期、组织学类型、细胞分级与淋巴结转移的关系。【方法】对本院收治的89例上皮样卵巢癌患者的临床资料进行分析。【结果】从肿瘤分期看，89例患者中25．8％（23／89）出现淋巴结转移，其中Ⅰ期患者中出现淋巴结转移者3例（5．8％），Ⅱ期转移为3例（27．3％），Ⅲ期转移为12例（60％）。Ⅳ期转移为5例（83．3％），临床分期与淋巴结转移率间存在相关，差异有显著性（P〈0．01）。仅累及主动脉旁淋巴结者占13．4％（12／89）例，仅累及骨盆淋巴结者3．3％（3／89），两种淋巴结均累及者占8．98％（8／89）。浆液性肿瘤26例，其中38．7％（10／89）出现淋巴结转移；非浆液性肿瘤63例，15．8％（10／63）出现淋巴结转移，浆液性肿瘤累积淋巴结转移数高于非浆液性肿瘤，两者比较差异有显著性（P〈0．05）。浆液性肿瘤中仅累积腹主动脉旁淋巴结者23．3％（6／26），明显高于非浆液性肿瘤3．1％（2／63），差异有显著性（P〈0．01）。从细胞分级看，淋巴转移随细胞分化之不良而增加。89例患者中出现淋巴结转移者，细胞分化1，2级占10％，细胞分化3级占26％。两者比较差异有显著性（P〈0．01）。【结论】肿瘤分期、组织学分型及细胞分级影响淋巴结转移率，且对于浆液性肿瘤，主动脉旁淋巴结为其主要转移点。而对于非浆液性肿瘤主动脉旁和骨盆淋巴结均可累及。     

乳腺癌嗜银细胞检测及其临床意义

发生于乳腺的类癌或含有嗜银细胞的乳癌的起源、分类、命名及其生物学意义，国外已有不少报道。作者等用喀银染色和组织化学方法研究乳腺癌组织中的嗜银细胞的分布及其生物学意义。1材料与方法1．1标本来源收集乳腺癌标本“例，－70℃冰箱保存（＜1个月），低温连续冰冻切片，厚8μm。66例乳腺癌，平均年龄46.7±8.5岁；有腋窝淋巴结转移者40例（60．6％），绝经期妇女23例（34．8％），就诊前病程＜6个月30例，6-12个月10例，＞12个月历例。组织病理学类型：单纯癌对例（31．8％），浸润性导管癌25例（37．9％），髓样癌10例（15．2％），…     

胃癌组织中Stat3的活化及P53、C-erb-B2的表达

目的探讨胃癌患者Stat3（信号传导与转录激活因子3）的活化状态与胃癌临床病理学特征的关系及意义。方法采用免疫组织化学SP法检测了74例胃癌组织及其所匹配的癌旁组织中p-Stat3的表达水平,及突变型P53、C-erb-B2癌基因编码蛋白的表达水平。这些免疫组化结果与患者临床病理学特征之间的关系进行了分析。结果活化型p-Stat3的阳性率在不同组织中呈现以下明显特点：（1）胃癌组织中p-Stat3明显高于癌旁组织（P〈0.01）;（2）低分化癌中高于中-高分化癌（P〈0.01）;（3）癌浸润达浆膜层者高于癌浸润未达浆膜层者（P=0.01）;（4）有淋巴结转移者高于无淋巴结转移者（P〈0.01）;（5）临床癌分期为Ⅲ-Ⅳ期者高于Ⅰ-Ⅱ期者（P〈0.05）。P53、C-erb-B2的表达水平也与胃癌的临床病理学特征及生物学行为显著相关。此外,p-Stat3水平还分别与P53表达水平呈正相关。结论 p-Stat3的高活化状态可能与胃癌的发生、浸润及转移等多个环节有关。检测p-Stat3联合P53,对胃癌的辅助诊断、胃癌增殖状态的评估、胃癌恶性程度和癌浸润/转移潜能的预测可能具有更为全面而重要的临床参考意义。     

联合脏器切除术治疗晚期脾区结肠癌

目的分析结肠脾曲癌浸润脾下极、胰尾或脾门淋巴结转移施行联合胰尾、脾脏切除术的疗效。方法1995年5月至2004年1月，我院对41例结肠脾曲癌患者施行联合胰体尾、脾脏根治性切除术（观察组），与同期施行姑息性手术的21例结肠脾区癌患者（对照组）进行疗效对照分析。结果术后并发症发生率观察组和对照组分别为36．6％和19．0％，术后中位生存时间分别为（33±3）个月和（15±3）个月，1年生存率分别为82．9％和76．2％，差异无统计学意义（P〉0．05）。3年存活率分别为41．5％和23．8％，5年存活率分别为34．1％和5．6％，差异均有统计学意义（均P〈0．05）。结论对结肠脾曲癌侵及邻近脏器患者，严格掌握手术适应证及禁忌证，施行联合胰尾、脾脏切除术是安全的，且能够延长患者的生存时间。     

胸段食管癌淋巴结转移156例临床分析

目的探讨胸段食管癌淋巴结转移的相关因素及其规律。方法对156例行胸段食管癌根治术患者的临床资料进行回顾性分析。结果全组淋巴结转移率为59．0％，转移度为13．28％，跳跃性转移率为3．8％。胸中段癌的淋巴结转移率明显高于上段和下段（P〈0．05）；蕈伞型食管癌的淋巴结转移率明显低于其他3个类型（P〈0．05）；肿瘤浸润至浅肌层后，其淋巴结转移率明显升高（P〈0．05）；但淋巴结转移率与肿瘤长径、患者性别无明显相关性。结论胸段食管癌淋巴结转移与肿瘤部位、分型及浸润深度明显相关。胸中段癌转移率较高。蕈伞型转移率较低，浸润达浅肌层后，其淋巴结转移率明显升高。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.