紫杉醇联合顺铂新辅助化疗方案治疗中晚期食管癌98例

目的:了解紫杉醇联合顺铂新辅助化疗方案治疗中晚期食管癌的疗效。方法:选取中晚期食管癌共98例。所有患者术前接受的新辅助化疗方案为:紫杉醇135mg/m2,第1天;顺铂60mg/m2,第1天。每3周为1个周期,共两个周期。观察原发病灶的缓解情况。结果:临床有效率为45.9%(45/98),其中完全缓解率(CR)23.5%(23/98),部分缓解率(PR)22.5%(22/98),疾病稳定(SD)43.9%(43/98),疾病进展(PD)10.2%(10/98),术后病理水平缓解率6.1%(6/98)。结论:紫杉醇联合顺铂新辅助化疗方案治疗中晚期食管癌疗效显著。     

周剂量紫杉醇、氟尿嘧啶及顺铂治疗晚期食管癌效果观察

目的:研究周剂量紫杉醇、氟尿嘧啶及顺铂联合方案治疗晚期食管癌的近期疗效和毒副反应。方法:30例晚期食管癌使用周剂量紫杉醇(60mg/m2)、氟尿嘧啶(500mg/m2)及顺铂(25mg/m2),第1、8、15天,每4周为一周期组成联合方案行全身化疗,2周期后评定疗效。结果:每例平均化疗3.2周期,总有效率达60%,中位肿瘤进展时间(TTP)为5.9月,中位生存期(MST)为10月。化疗主要毒性反应表现为骨髓抑制、脱发、消化道反应,但可耐受。结论:周剂量紫杉醇、氟尿嘧啶及顺铂治疗晚期食管癌近期疗效显著,毒副反应小。     

三维适形放疗联合同步化疗治疗食管癌31例疗效观察

目的: 评价三维适形放疗(3DCRT)联合同步化疗治疗食管癌的局部控制率、生存期和毒副作用。方法: 31例食管癌患者应用3DCRT 1.8~2 Gy/f,总放射剂量55~65 Gy;同步行化疗,放疗开始第1天应用顺铂30 mg/m2静脉滴注,每周1次至放疗结束。放疗结束后行2周期辅助化疗,顺铂20 mg静脉滴注5天,替加氟1.0 g静脉滴注5天,28天为1个周期。结果: 完全缓解22例,部分缓解7例,无变化2例,总有效率为93.55%;进食梗阻缓解率为96.77%。1、2、3年局部控制率分别为88%、51%、40%;1、2、3年生存率分别为93%、66%、58%;均发生急性放射性食管炎,≥ 3级占15%;白细胞下降发生率为56%,≥ 3级占34%。结论: 3DCRT联合同步顺铂方案治疗食管癌可提高局部控制率并延长生存期,毒副反应可耐受。     

新辅助化疗在中晚期食管癌治疗中的应用分析

目的 探讨新辅助化疗在中晚期食管癌治疗中的疗效.方法 入组患者术前采用DF方案(顺铂40 mg/次,第1～3天,5-FU 0.5 g,第1～5天,静滴)或采用紫杉醇加顺铂方案(紫杉醇135～180 mg/m2,静滴3 h,第1天;顺铂40 mg/次静滴,第1～3天),共两个周期.化疗结束后10～15 d开始进行手术治疗.结果 应用DF方案或紫杉醇联合顺铂方案新辅助化疗后,CR 23.8%(5/21),PR 28.6%(6/21),SD 9例,PD 1例,总有效率为52.4%(11/21).所有患者均进行了根治性手术,术后病理水平缓解率9.5%(2/21).结论 应用新辅助化疗可以提高中晚期食管癌手术切成率和治疗效果.     

周剂量紫杉醇、替加氟及顺铂联合方案治疗转移性食管癌的临床观察

目的:研究周剂量紫杉醇、替加氟及顺铂联合方案治疗转移性食管癌的近期疗效和毒副反应。方法:38例转移性食管癌患者使用周剂量紫杉醇(80mg/m2,第1、8天)、替加氟(600mg/m2,第1￣5天)及顺铂(25mg/m2,第1￣3天)联合方案行全身化疗,每3周为1周期,2周期后评定疗效。结果:38例食管癌患者平均化疗2.9个疗程,总有效率(RR)为57.9%,既往曾行化疗的复治患者有效率仍可达55.2%。中位肿瘤进展时间(TTP)5.8个月,中位生存期(MST)10.8月。化疗中主要毒性反应表现为骨髓抑制、脱发,患者耐受性好。结论:周剂量紫杉醇、替加氟及顺铂联合方案治疗转移性食管癌近期疗效显著,毒副反应小。     

小剂量FP方案联合放疗治疗中晚期食管癌的临床研究

目的 观察小剂量顺铂、氟脲嘧啶方案(小剂量FP方案)同步联合放疗治疗中晚期食管癌的疗效和毒副反应.方法 60例中晚期食管癌患者根据入组标准随机分成小剂量FP方案化疗+常规放疗组(试验组)和常规顺铂、氟脲嘧啶方案(常规FP方案)化疗+常规放疗组(对照组).常规放疗采用60Co或6MV X射线3野等中心照射,2GY/次,1次/天,5天/周,总剂量56-60GY/28-33次.对照组采用放疗同期使用常规FP方案化疗顺铂(DDP)75～100mg/m2静脉滴注,第1天、第29天,氟脲嘧啶(5-FU)450mg/m2静脉滴注,第1～5天、第29～33天.试验组采用放疗同期使用小剂量FP方案化疗5-FU 250mg/m2/d采用微量输液泵静脉输注维持24小时,连续28天,DDP 5～7mg/m2/d静脉滴注1小时,每周用5天,共3～4周.结果 试验组1、3、5年生存率分别为86.7%、50.0%、33.3%.对照组1、3、5年生存率分别为76.7%、33.4%、16.8%.中位生存期分别为25.7个月与19.3个月.两组比较差异有统计学意义(P＜0.05).结论 小剂量FP方案同步联合放疗治疗中晚期食管癌的疗效高、毒副反应轻,值得临床进一步研究.     

紫杉醇与顺铂同期放疗治疗局部晚期食管鳞癌的Ⅱ期临床研究

目的研究紫杉醇联合顺铂同期放疗治疗局部区域性食管癌的不良反应和近期疗效。方法入组标准:初治、Ⅱ～Ⅳ期、年龄≤75岁的食管鳞癌。根治性同期放化疗:放疗剂量60～70 Gy。放疗第1天开始化疗,紫杉醇175 mg/m2,d1;顺铂25 mg/m2,d1～3,每21天为1个周期,共4个周期。结果除1例患者拒绝完成放疗外,其余都顺利完成放疗。化疗完成1、2、3和4个周期者分别为4、5、5和23例。3～4级白细胞下降59.5%(22/37)、中性粒细胞下降67.5%(25/37),血小板下降8.1%(3/37),脱发73%(27/37)。3级放射性食管炎和放射性肺炎均为8.1%(3/37)。中位随访时间16个月(2～24个月),1年存活率70%。结论紫杉醇联合顺铂同期放疗食管癌,患者能很好地耐受,且有较好的疗效。     

TP方案在食管癌术前化疗中的疗效观察

目的评价TP方案(紫杉醇+顺铂)在食管癌术前化疗中的疗效及不良反应。方法 69例患者在食管切除术前采用顺铂75 mg/m2,d1;紫杉醇60 mg/m2d1,8,15,22化疗。在第50天行食管癌切除术。结果在行TP方案治疗过程中,患者耐受性良好,完全缓解38例(55%),部分缓解29例(42%),无效2例(3%)。其中只有13%的患者出现3级或4级嗜中性白血球减少症,17%的患者需要管饲支持。约90%的患者在手术后肿瘤组织得到完全切除,中位生存期为24个月,1,2,3年的生存率分别为75%,50%和34%。结论 TP方案用于局部食管癌患者的术前治疗非常合理。     

5-FU联合CDDP新辅助化疗治疗进展期胃癌的临床研究

探讨5-氟脲嘧啶的联合顺铂新辅助化疗方案治疗局部进展期癌的临床疗效和毒副作用.方法 我院2003年6月～2005年6月收住31例Ⅲ、Ⅳ期进展期胃癌病人,术前接受的新辅助化疗方案为:5-氟脲嘧啶50 mg/m2,第1～14天,顺铂75 mg/m2,第8天;每3周为1周期,共3个周期.观察新辅助化疗后肿瘤原发病灶的缓解情况,并观察新辅助化疗的毒副反应.结果 29例完成术前化疗,新辅助化疗后临床有效率为55.3%,其中完全缓解CR2例(7%),部分缓解PR14例(48.3%),疾病稳定SD6例(20.7%),疾病进展PD72例(24.1%),毒性反应主要为白细胞减少症、腹泻、恶心,呕吐、脱发,均在0～2级,治疗患者均无因毒性反应至死,有轻度肝功能损害.结论 5-氟脲嘧啶的联合顺铂新辅助化疗方案在进展期胃癌的治疗中近期临床疗效明显,耐受性良好.     

替吉奥联合洛铂同步放化疗治疗中晚期食管癌疗效观察

目的:观察替吉奥联合洛铂同期放化疗治疗中晚期食管癌的疗效。方法:将75例中晚期食管癌患者随机分为观察组(n=37例)和对照组(n=38例)。观察组采用放疗联合替吉奥胶囊60 mg/m2口服化疗+洛铂25 mg/m2静脉化疗,对照组采用放疗联合5FU 750 mg/m2+顺铂40 mg/m2静脉化疗。放化疗结束后4周评价近期疗效和毒性反应,并随访患者1年,2年生存率。结果:所有患者均可评价疗效。观察组和对照组近期有效率分别为89.2%和48.4%,差异有统计学意义(P<0.05)。1年生存率分别为86.4%和63.1%,差异有统计学意义(P<0.05),2年生存率分别为64.8%和31.9%,差异有统计学意义(P<0.05)。观察组血小板下降率高于对照组,但恶心呕吐及白细胞下降率明显低于对照组,放射性食管炎发生率两组差异无统计学意义(P>0.05)。结论:替吉奥联合洛铂同步放化疗治疗中晚期食管癌疗效切确,不良反应更低。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.