改良外侧"L"型切口治疗SandersⅣ型跟骨骨折的效果观察

目的观察改良外侧"L"型切口对于SandersⅣ型跟骨骨折的临床疗效。方法 2014年6月—2017年6月淮安市第一人民医院一分院骨科行手术治疗的SandersⅣ型跟骨骨折患者68例,采用改良外侧"L"型切口(改良组)和传统"L"型切口进行手术治疗(传统组),每组34例。术后随访1年,记录并比较两组患者手术前后踝-后足评分(AOFAS)、手术时间、术中出血量、切口长度,术后1d和1年的B?hler角、Gissane角、跟骨高度及宽度,以及切口坏死、感染等并发症情况。结果改良组手术时间(73.2±10.4)min、切口长度(9.1±1.2)cm、术中出血量(91.3±8.5)mL均少于传统组,差异有统计学意义(P0.05);改良组术后1d及1年B?hler角(32.5±4.8)°、(32.8±4.9)°,Gissane角(131.5±8.6)°、(131.6±7.8)°,跟骨高度(43.2±2.1)、(43.6±2.6)mm较传统组改善更显著,差异有统计学意义(P0.05),跟骨宽度差异无统计学意义(P0.05)。术后3个月,改良组出现切口感染渗出1例,总发生率为2.9%;传统组出现切口感染4例,切口坏死2例,总发生率为17.6%,差异有统计学意义(P0.05)。术后1年随访,改良组优良率为94.1%,高于传统组的76.5%,差异有统计学意义(P0.05)。结论改良外侧"L"型切口对SandersⅣ型跟骨骨折疗效显著,且并发症发生率低,值得临床推广应用。     

跟骨外侧骨皮瓣入路与传统L形入路治疗Sanders Ⅲ～Ⅳ型跟骨骨折的比较

目的比较跟骨外侧骨皮瓣入路与传统L形入路切开复位内固定治疗SandersⅢ~Ⅳ型跟骨骨折,术后切口并发症、临床功能及影像学结果。方法 2013年2月—2015年2月46例患者纳入本研究,根据手术入路不同将患者分为骨外侧皮瓣入路组(23例)和传统L形入路组(23例),比较两组患者切口并发症、骨折愈合时间、临床功能、跟骨宽度、Gissane角及B9ohler角。结果 46例均获得随访,骨皮瓣入路组随访时间12~36个月,平均24.7个月,传统入路组随访时间12~36个月,平均22.3个月,两组患者随访时间差异无统计学意义(P0.05)。骨外侧皮瓣入路组1例(4.4%)出现切口浅表感染1例;传统入路组8例(34.8%),其中出现皮缘坏死4例、切口部分裂开2例、浅表感染2例,两组患者切口并发症发生率比较,差异有统计学意义(P0.05)。两组患者在住院天数、骨折愈合时间、临床功能、跟骨宽度、Gissane角及B9ohler角等方面的差异无统计学意义(P0.05)。结论对于SandersⅢ~Ⅳ型跟骨骨折,采用跟骨外侧骨皮瓣入路与传统L形入路行切开复位内固定术治疗,均可获得满意的临床疗效与影像学结果,但前者术后切口并发症发生率较低。     

同种异体骨移植结合跟骨接骨板内固定治疗跟骨关节内骨折临床疗效分析

目的探讨通过影像学和功能恢复评估切开复位同种异体骨移植结合跟骨接骨板内固定治疗跟骨关节内骨折的临床疗效。方法笔者收集2005~2013年收治的229例跟骨骨折合并关节内压缩型患者病例,其中121例(A组)行切开复位同种异体骨移植结合跟骨接骨板手术治疗,108例(B组)行切开复位跟骨接骨板治疗。行临床和影像学随访至少2年,根据患者术前术后跟骨侧位片和轴位片测量Bohler's角和Gissane's角,同时测量跟骨高度。依据美国足踝骨科协会标准(AOFAS)评分评估功能恢复情况。结果术后A组平均负重时间(平均3.5个月)较B组(平均5.3个月)显著缩短(P0.05),Bohler's角A组较B组显著增加(P0.05)。Gissane's角恢复及跟骨高度A组较B组高,但无统计学差异。两组AOFAS评分无统计学差异。术后伤口延迟愈合发生率A组较B组显著增高(P0.05),创伤性关节炎发生率B组较A组高(P0.05)。结论术中骨移植不仅有利于患者跟骨Bohler's角度恢复,防止后期跟骨的塌陷和跟骨高度的解剖重建,而且有利于早期负重,但并发症发生率高,两组术后临床功能评估无显著差异。     

跟骨骨折术后疗效影响因素的相关分析

目的探讨影响跟骨骨折手术疗效的因素。方法回顾性分析2009年2月~2012年2月我科收治78例86足跟骨骨折行手术治疗的患者,按Maryland足部评分标准综合评定,并选取可能影响手术疗效的因素,如年龄、性别、骨折类型、开放与闭合、手术时机、切口类型、手术方式、关节内复位效果、是否植骨、术后Bhler角、部分负重时间等11项指标进行分组、赋值及单因素筛选和多因素Logistic回归分析。结果78例86足随访18~26个月,评价结果:优47足,良18足,可13足,差8足,优良率75.6%。其中,在骨折类型上将SandersⅡ型和Ⅲ型归为一组与Ⅳ型优良率分别为89.2%和33.3%;闭合骨折组68足(优良率80.9%),开放骨折组18足(优良率55.6%);骨折后2周内手术和2周后手术的优良率分别为87.0%、29.4%;关节内复位3mm组和≥3mm组优良率分别为87.7%、38.1%;术后Bhler角基本恢复者59足(优良率84.8%),27足复位欠满意(优良率55.6%);术后8周后部分负重与8周内部分负重优良率分别为87.1%、45.8%,以上组间均有差异,有统计学意义(P0.05)。通过单因素分析逐步剔除无关因素后进行多因素Logistic回归分析,显示跟骨骨折手术疗效的因素为骨折类型、手术时机、关节内复位效果、术后Bhler角。结论骨折类型、手术时机、关节内复位效果、术后Bhler角为影响跟骨骨折术后疗效的危险因素,临床上尽量避免影响疗效的不利因素,有助于改善手术疗效。     

切开复位A0钢板内固定加植骨治疗跟骨关节内移位骨折

采用切开复位内固定加植骨治疗跟骨关节内移位骨折20例25足.骨折全部愈合,功能改善,跟距关节及跟骨恢复了正常的对合关系.     

跟骨骨折的手术治疗

目的 探讨跟骨骨折的特点、骨折分型，分析手术方法及创伤并发症的防治。方法 自1998年7月至2003年11月，共收治跟骨骨折58例，按Essex—Lopresti系统分型，其中关节外骨折16例；关节内骨折42例，包括关节压缩性骨折24例和舌形骨折18例。关节外骨折为稳定性骨折，采取闭合复位，非负重石膏管型固定；涉及后关节面明显移位骨折采取手术治疗，跟骨后关节面解剖复位，跟骨解剖接骨板内固定；后关节面严重粉碎骨折，同时行距下关节Ⅰ期融合。结果 本组手术治疗的患者随访2～7年，平均3．6年。根据患者的主诉、后跟的外形及距骨下关节的功能及X线征象，尤其是Bohler角的恢复来评价临床疗效。其中优16例（38％），良17例（40％），可6例（14％），差3例（7％），优良率为79％。本组患者术后无感染；后跟变宽，足底扁平6例；7例距骨下关节炎，其中3例因跟骨后关节面塌陷出现严重疼痛性关节炎，行距骨下关节融合手术。1例切口皮瓣顶端坏死、缺损。结论有移位的跟骨关节内骨折非手术治疗并发症多而且后果严重，手术切开复位尤其是后关节面的解剖复位对患者功能的恢复及并发症的防治极其重要。     

跗骨窦联合外侧纵形切口与传统外侧L型切口治疗Sanders Ⅱ型跟骨骨折的比较研究

目的比较跗骨窦联合外侧纵形切口与传统外侧L型切口行切开复位内固定治疗SandersⅡ型跟骨骨折的疗效,探讨更为合理有效的手术入路方式。方法纳入2014年1月—2015年1月湖州市第一人民医院骨科收治的40例SandersⅡ型单侧闭合性跟骨骨折患者,根据切口方式不同分为观察组及对照组,每组20例;观察组采用跗骨窦联合外侧纵形切口,对照组采用传统外侧L型切口。比较两组患者的年龄、坠落高度、伤后至手术时间,以及跟骨术前、术后及末次随访的B9hler角和Gissane角,并采用Maryland足功能评分、健康调查简表(SF-36)比较两组的临床疗效。结果两组在年龄、坠落高度、伤后至手术时间等方面差异无统计学意义(P0.05)。观察组术后平均随访时间为(13.4±2.0)个月,均未出现相关切口并发症;对照组术后平均随访时间为(14.3±2.4)个月,早期出现皮缘坏死及切口红肿渗出各1例;两组末次随访时均获得临床骨性愈合。两组术后B9hler角和Gissane角同术前相比均显著改善,差异有统计学意义(P0.05)。末次随访时观察组Maryland评分、SF-36评分为(82.6±11.8)、(82.6±7.2)分,对照组为(81.1±12.9)、(79.7±8.8)分,两组比较差异无统计学意义(P0.05)。结论跗骨窦联合外侧纵形切口可以取得同外侧L型切口相似的临床疗效,但其对切口软组织保护较好,且发生距下关节僵硬的概率较低。     

改良小切口复位植骨联合经皮克氏针内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床研究

目的探讨改良小切口复位植骨联合经皮克氏针内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效及并发症。方法 2015年1月—2017年5月沧州中西医结合医院骨科收治Sanders Ⅱ、Ⅲ型跟骨骨折患者91例,按照随机数字表法,将患者分为切开复位钢板内固定治疗组45例(切开复位组)和改良小切口复位植骨联合经皮克氏针内固定治疗组46例(改良组)。切开复位组中男性25例,女性20例;年龄23～67岁,平均46. 0岁;骨折原因:高处坠落伤28例,道路交通伤17例。改良组中男性24例,女性22例;年龄23～68岁,平均46. 1岁;骨折原因:高处坠落伤29例,道路交通17例。分析统计治疗后的临床优良率,患者的住院情况,同时观察患者手术前后Bohler角、Gissane角、踝-后足评分(American orthopedic foot and ankle society,AOFAS),跟骨长度、宽度及高度,观察术后并发症发生情况。结果改良组患者临床优良率为93. 48%(43/46)明显高于切开复位组的62. 22%(28/45),两组比较差异有统计学意义(P 0. 05)。改良组患者出血量、伤口愈合时间及住院时间均明显低于切开复位组,分别为[(25. 17±7. 62) mL vs.(69. 25±10. 54) mL、(5. 42±1. 03) d vs.(10. 57±2. 69) d、(6. 04±1. 21) d vs.(12. 19±3. 68) d],而手术时间和费用均显著高于切开复位组,分别为[(95. 24±20. 58) min vs.(60. 12±15. 23) min、(1. 09±0. 03)万元vs.(0. 68±0. 04)万元],两组比较差异均有统计学意义(P 0. 05);与治疗前相比,两组患者治疗后Bohler角、Gissane角、AOFAS、跟骨长度及高度明显升高,而跟骨宽度显著下降,同时改良组患者治疗后临床指标的改善情况明显优于切开复位组,且差异均有统计学意义(P 0. 05);改良组患者术后并发症发生率为4. 35%,明显低于切开复位组的17. 78%(P 0. 05)。结论改良小切口复位植骨联合经皮克氏针内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效显著,能够改善患者的住院情况及临床相关指标,并且安全性高,值得在临床上推广应用。     

跗骨窦入路联合锁定钢板治疗移位跟骨关节内骨折

目的分析移位跟骨关节内骨折经跗骨窦入路联合锁定钢板内固定治疗的疗效。方法回顾性分析采用跗骨窦入路切开复位联合跟骨锁定钢板内固定治疗的移位跟骨关节内骨折11例(12足),其中男性8例,女性3例;年龄16~61岁,平均42.3岁。骨折根据Sanders分型:Ⅱ型7足,Ⅲ型4足,IV型1足。比较手术前后跟骨B9hler角、Gissane角,并按照Maryland足部评分系统进行疗效评价。结果伤后3~6d手术,平均4.5d,均获得随访,时间5~16个月,平均11.4个月。术后无内固定失败、感染坏死等软组织并发症;骨折愈合时间8~16周,平均12.6周。B9hler角由术前平均7.2°提高至术后平均32.3°;Gissane角由术前平均104.3°提高至术后平均131.6°。按照Maryland足部评分系统:优11足,可1足。结论跗骨窦入路联合锁定钢板内固定是治疗SandersⅡ、Ⅲ型跟骨关节内骨折的理想方法,微创,并发症少,疗效满意。     

距下关节镜辅助在SandersⅡ、Ⅲ型跟骨骨折微创治疗中的应用价值分析

目的 探讨距下关节镜辅助在SandersⅡ、Ⅲ型跟骨骨折微创治疗中的应用价值.方法 前瞻性分析2018年1月—2019年6月平顶山市第一人民医院骨科收治的80例跟骨骨折患者,男性49例,女性31例;年龄18～65岁,平均39.3岁.随机数字表法分为关节镜组(40例,距下关节镜辅助踝关节外侧有限切口接骨板内固定治疗)、普通组(40例,关节外侧有限切口接骨板内固定治疗).术后门诊随访6个月.比较两组患者手术时间、手术切口长度、术中出血量、骨折愈合时间,解剖学指标(Bohler角、Gissane角),踝关节功能(AOFAS)及术后并发症(创面感染、距关节僵硬、创伤性关节炎)发生情况.结果 关节镜组手术时间(60.9±8.1)min长于普通组(54.3±7.1)min,P<0.05;手术切口长度、术中出血量与普通组对比差异均无统计学意义(P>0.05),关节镜组骨折愈合时间(11.5±1.6)周少于普通组(12.7±1.8)周,P<0.05.两组患者术前Bohler角、Gissane角水平相近(P>0.05);术后6个月Bohler角分别为(25.4±4.8)°、(24.1±4.2)°,Gissane角分别为(129.8±20.2)°、(123.8±19.3)°,相较于术前均提高(P<0.05),且两组术后Bohler角、Gissane角水平相近(P>0.05);两组患者术前AOFAS评分相近(P>0.05),术后6个月AOFAS评分分别为(87.2±15.9)分、(83.9±13.8)分,相较于术前两组AOFAS评分均提高(P<0.05),且两组AO-FAS评分相近(P>0.05);关节镜组总并发症发生率(3％)低于普通组(15％),P<0.05.结论 在SandersⅡ、Ⅲ型跟骨骨折微创治疗中应用距下关节镜可达到良好的复位固定,减少并发症发生率,加快患者康复.     

龙葵碱对骨肉瘤细胞放射敏感性的影响

目的 研究龙葵碱对骨肉瘤细胞放射敏感性的影响。方法 用龙葵碱处理骨肉瘤细胞,同时给予6 MV X射线照射,噻唑蓝（MTT）方法测定细胞增殖变化,流式细胞术测定细胞凋亡,Western blot检测细胞中Ki-67、PCNA、Bax、Cleaved Caspase-3蛋白水平,JC-1法检测线粒体膜电位,DCFH-DA法检测细胞中ROS水平,平板克隆实验测定放射敏感性。结果 与未经龙葵碱和照射后的细胞比较,龙葵碱或照射处理后骨肉瘤细胞增殖能力和Ki-67、PCNA蛋白水平均降低（F=55.165、50.667、23.389,P<0.05）,细胞凋亡率和Bax、Cleaved Caspase-3蛋白水平均升高（F=54.588、42.924、51.541,P<0.05）,线粒体膜电位下降（F=40.762,P<0.05）,细胞中ROS水平升高（F=79.055,P<0.05）。与龙葵碱或单纯照射的细胞比较,龙葵碱联合照射处理后的骨肉瘤细胞增殖能力和Ki-67、PCNA蛋白水平降低（F=55.165、50.667、23.389,P<0.05）,细胞凋亡率和Bax、Cleaved Caspase-3水平升高（F=54.588、42.924、51.541,P<0.05）,线粒体膜电位降低（F=40.762,P<0.05）,ROS水平升高（F=79.055,P<0.05）。龙葵碱对骨肉瘤细胞的放射增敏比为1.786。结论 龙葵碱抑制骨肉瘤细胞增殖并诱导凋亡,提高骨肉瘤细胞放射敏感性。     

MRI features of tuberculosis of the knee

Objective  The objective of this study was to describe the magnetic resonance imaging (MRI) features of tuberculosis (TB) of the knee joint. Materials and methods  The MRI features in 15 patients with TB of the knee, as confirmed by histology of the biopsied joint synovium, were reviewed retrospectively. The images were assessed for intra-articular and peri-articular abnormalities. Results  All patients had florid synovial proliferation. The proliferating synovium showed intermediate to low T2 signal intensity. In the patients who were administered intravenous contrast, the hypertrophic synovium was intensely enhancing. Marrow edema (n = 9), osteomyelitis (n = 4), cortical erosions (n = 5), myositis (n = 6), cellulitis (n = 2), abscesses (n = 3), and skin ulceration/sinus formation (n = 2) were seen in the adjacent bone and soft tissue. Conclusion  Synovial proliferation associated with tuberculous arthritis is typically hypointense on T2-weighted images. This appearance, in conjunction with other peri-articular MRI features described, can help in distinguishing TB arthritis from other proliferating synovial arthropathies.     

Diagnostic value of CT features of the gallbladder in the prediction of gallstone pancreatitis

Purpose

The aim of this retrospective study was to evaluate the diagnostic value of CT features of the gallbladder in the prediction of gallstone pancreatitis.

Materials and methods

Eighty-six patients who underwent a diagnostic computed tomography (CT) scan for acute pancreatitis were included. The readers assessed the presence of pericholecystic increased attenuation of the liver parenchyma, enhancement of gallbladder (GB) and common bile duct (CBD) wall, pericholecystic fat strands, GB wall thickening, stone in the GB or CBD, and focal or diffuse manifestations of pancreatitis on abdominal CT scans. In addition, the maximal transverse luminal diameters of the GB and CBD were measured.

Results

The presence of pericholecystic increased attenuation of the liver parenchyma, GB wall enhancement and thickening, pericholecystic fat strands, stone in the GB or CBD, and diffuse manifestations of pancreatitis achieved statistical significance for differentiation of gallstone induced pancreatitis from non-biliary pancreatitis (p < 0.05). The mean values of maximal transverse luminal diameter of GB and CBD were significantly higher in gallstone induced pancreatitis group (39.67 ± 7.26 mm, 10.20 ± 4.13 mm) than non-biliary pancreatitis group (27.01 ± 6.14 mm, 3.85 ± 2.51 mm, p < 0.0001).

Conclusion

Gallbladder features of CT in patients with pancreatitis could be the valuable clues for the diagnosis of gallstone induced pancreatitis.     

Results of postoperative interstitial brachytherapy of resectable floor of mouth tumors

PurposeThe purpose of this study was to describe the results of postoperative sole interstitial brachytherapy (BT) in patients with resectable floor of mouth tumors.Methods and MaterialsBetween January 1998 and December 2017, 44 patients with squamous cell histology, stage T1-3N0-1M0 floor of mouth tumor were treated by excision of the primary lesion with or without neck dissection followed by sole high-dose-rate tumor bed BT with an average dose of 22.7 Gy (10–45 Gy) using rigid metal needles (n = 14; 32%) or flexible plastic catheters (n = 30; 68%).ResultsDuring a median followup time of 122 months for surviving patients, the probability of 5- and 10-year local and regional tumor control, overall survival (OS), and disease-specific survival (DSS) was 89% and 89%, 73% and 67%, 52% and 32%, 66% and 54%, respectively. In univariate analysis, lymphovascular invasion was a negative predictor of regional tumor control (p = 0.0062), DSS (p = 0.0056), and OS (p = 0.0325), whereas cervical recurrence was associated with worse DSS (p < 0.0001) and OS (p < 0.0001). The incidence of local Grade 1, 2, and 3 mucositis was 25%, 64%, and 11%, respectively. Grade 4 side effect, that is soft tissue necrosis occurred in four cases (9%).ConclusionsResults of postoperative sole high-dose-rate BT of floor of mouth tumors are comparable with those reported with low-dose-rate BT, and this method could improve local tumor control and DSS compared with exclusive surgical treatment.     

Anisotropy of NMR properties of tissues

Orientational anisotropy of T₂ and T₁ relaxation times, diffusion, and magnetization transfer has been investigated for six different tissues: tendon, cartilage, kidney, muscle, white matter, and optic nerve. Relaxation anisotropy was observed for tendon and cartilage, and diffusional anisotropy was measured in kidney, muscle, white matter, and optic nerve. All other NMR measurements of these tissues showed no orientational dependence. This pattern of NMR anisotropies can be interpreted from the underlying geometrical structures of the tissues.     

低剂量电离辐射对医务放射工作人员甲状腺影响Meta分析

目的 评估低剂量电离辐射对医务放射工作人员甲状腺的影响。方法 检索1996—2022年发表的相关文献,按照纳入和排除标准筛选文献,最终纳入27篇文献,涉及22 937人。采用Stata 16.0开展Meta分析,分析血清中三碘甲状原氨酸（T₃）、游离三碘甲状腺原氨酸（FT₃）、甲状腺激素（T₄）、游离四碘甲状腺原氨酸（FT₄）、促甲状腺激素（TSH）水平和甲状腺结节检出率,并开展不同职业分类放射工作人员甲状腺功能的亚组分析。结果 采用随机效应模型分析,放射工作人员T₃、T₄水平的标准化均数差（SMD）分别为-0.19（-0.37,-0.01）和-0.34（-0.38,-0.30）,与对照组比有降低的危险性（Z=2.07、-16.06,P<0.05）;放射工作人员FT₄水平的SMD为0.22（0.06,0.39）,与对照组比有升高的危险性（Z=2.61,P<0.05）;放射工作人员甲状腺结节发生相对危险度为1.47（1.19,1.82）,与对照组比有升高的危险性（Z=3.58,P<0.05）。亚组分析结果表明介入放射学工作人员T₃、T₄、TSH水平的SMD分比为-0.29（-0.51,-0.07）、-0.31（-0.47,-0.15）、-0.43（-0.73,-0.13）（Z=-2.55、-3.86、-2.82,P<0.05）,核医学工作人员T₄水平SMD为-0.26（-0.45,-0.07）,与对照组比有降低的危险性（Z=-2.70,P<0.05）。结论 长期低剂量电离辐射可能影响放射工作人员甲状腺素水平和甲状腺结节,尤其是介入放射学工作人员,应重点关注其放射防护。     

Estimation of time of death by quantification of melatonin in corpses

A method for the estimation of time of death (TOD), was evaluated by measuring the melatonin (MT) content of pineal bodies (PBs), sera and urine samples from 85 cadavers. A total of 44 cadavers were investigated in Sapporo (geographical coordinates N 43° 4, E 141° 21) and 41 in Tokyo (N 35° 39, E 139° 44). MT contents were measured by radioimmunoassay (RIA) in 75 PBs, 27 sera and 14 urine samples. Exponential differences of pineal MT content were recognized between peaks in nighttime and nadirs in daytime, ranging from 0.099 to 63.2 ng/PB. Circadian rhythms were also observed for the concentrations of MT in serum (11–205 pg/ml), and in urine (7.5–137.5 pg/ml). Consequently, criteria for the TOD estimation are proposed as follows. 1) Pineal MT contents — (1) 0–0.2 ng/PB: TOD 1100–1700 hours, (2) 0.2–0.3 ng/PB: TOD 0700–2000 hours, (3) 0.3–1 ng/PB: inconclusive, (4) 1–4 ng/PB: TOD 1600–1000 hours, (5) 4–8 ng/PB: TOD 2000–0800 hours, (6) over 8 ng/PB: TOD 2000–0500 hours, 2) Serum MT concentration — (1) 0–100 pg/ml: inconclusive, (2) over 100 pg/ml: TOD 2200–0100 hours, and 3) Urinary MT concentration — (1) 0–35 pg/ml: inconclusive, (2) over 35 pg/ml: TOD 1800–0600 hours. The range of the estimation can be limited by a combination of these 3 criteria. The present method can be combined with other methods for estimating the TOD to decrease the range.     

形变配准在宫颈癌近距离放疗分次间剂量评估中的可行性研究

目的:比较近距离放疗分次间靶区和正常组织在形变配准(DIR)和简单累加剂量体积直方图(DVH)情况下,累积剂量的剂量学差异,分析在宫颈癌三维近距离放疗计划中,形变配准技术应用于靶区和正常组织剂量评估的可行性。方法:回顾性选取13例宫颈癌近距离放疗病例,每个病例均进行了4次CT定位的近距离放疗。对每个病例的4次CT进行形...     

Declining use of brachytherapy for the treatment of prostate cancer

PurposeTo analyze the recent trends in the utilization of external beam radiation therapy (EBRT) and brachytherapy (BT) for the treatment of prostate cancer.Methods and MaterialsUsing the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all patients diagnosed with localized prostate adenocarcinoma between 2004 and 2009 who were treated with radiation as local therapy. We evaluated the utilization of BT, EBRT, and combination BT + EBRT by the year of diagnosis and performed a multivariable analysis to determine the predictors of BT as treatment choice.ResultsBetween 2004 and 2009, EBRT monotherapy use increased from 55.8% to 62.0%, whereas all BT use correspondingly decreased from 44.2% to 38.0% (BT-only use decreased from 30.4% to 25.6%, whereas BT + EBRT use decreased from 13.8% to 12.3%). The decline of BT utilization differed by patient race, SEER registry, median county income, and National Comprehensive Cancer Network risk categorization (all p < 0.001), but not by patient age (p = 0.763) or marital status (p = 0.193). Multivariable analysis found that age, race, marital status, SEER registry, median county income, and National Comprehensive Cancer Network risk category were independent predictors of BT as treatment choice (all p < 0.001). Moreover, after controlling for all available patient and tumor characteristics, there was decreasing utilization of BT with increasing year of diagnosis (odds ratio for BT = 0.920, 95% confidence interval: 0.911–0.929, p < 0.001).ConclusionsOur analysis reveals decreasing utilization of BT for prostate cancer. This finding has significant implications in terms of national health care expenditure.     

CT-analysis of the course of gastrointestinal graft-versus-host disease—Patterns of involvement

Objective

To describe the main patterns of distribution of gastrointestinal graft-versus-host disease (GVHD) and their chronological course.

Methods

Twenty-five adult patients (17 men, 8 women, mean age 47 years) were enrolled from 11/2003 to 11/2007. All patients underwent abdominopelvic CT shortly after onset of GVHD-related symptoms and also at follow up. The mean number of CT examinations per patient was 3.2 ± 2.7 with a total of 81 in a median time period of 97 days after HCT. The gastrointestinal tract was divided into 7 segments. Gastrointestinal abnormalities were defined as follows: presence of wall thickening (>4 mm), increased mucosal enhancement, bowel dilatation (>3 cm for the small bowel, >8 cm for the colon), fluid-filled loops of the bowel, bowel loop separation and double-halo sign.

Results

40% (10/25) of the patients presented a classical pattern of evolution of involved segments by GI-GVHD. In these cases, especially the small bowel was initially involved showing a retreat with time towards the terminal ileum with longer length of stay in this location. 28% (7/25) of the patients presented with a nonclassical permanently migratory involvement of the GI jumping from one GI segment to another. Other 32% (8/25) of our patients revealed a nonclassical persistent, unchanged involvement pattern of GI involvement by GVHD at time.

Conclusion

Contrary to existing reports, our data collected in 25 patients diagnosed with GI-GVHD after allogeneic hematopoietic stem cell transplantation suggest the presence of three different courses (classical, nonclassical migratory and nonclassical persistent) of this disorder. Awareness of this knowledge enables more accurate risk stratification.