坚持到底还是半途而废?--决策2:化疗

写给读者的话:我们听到了一些朋友对我们登在第一期的文章的反馈.谢谢大家的关注.我想特别强调一点,我写这一组文章的意图,是想表达作为患者和家属,我们要理智地面对疾病,了解它,研究它,积极地参与和配合医生的诊断治疗决策和实施.眼下,社会上对于医院和医生的妖魔化倾向严重,医患关系成为一个非常敏感的问题,我们看到许多对于医生的指控是以偏概全不符合事实的.     

由内而外的改变

在以往的生活中我一直是个成功的人,女人该有的我都拥有:一份很棒的职业--在达尔马提亚出版社下属的一家儿童读物出版公司任副总经理;我信奉上帝;拥有爱我的懂得体贴的丈夫、朋友和家人;我曾经周游世界,有无数的记忆和旅游纪念品为证.我一直比较善解人意并且能够出色地处理各种问题.可以说我就是一个成功女士的典型.     

癌症病人的爱国情怀

2006年9月9日,天高云淡,秋风送爽.上午9时,一声发令枪响,"北京第二十届卢沟桥醒狮越野跑比赛"的队伍从抗日战争雕塑园出发了.这是为纪念中国人民抗日战争和世界反法西斯战争胜利61周年组织的一次活动.     

GAS7在人骨肉瘤中的表达及其意义

Objective： To detect the expression of GAS7 in osteosarcoma and discuss its significance. Methods： Immunohistochemistry SABC method was applied to detect GAS7 expression in specimens of 54 osteosarcoma and 15 osteochondroma cases. Results： The positive expression rate of GAS7 was 74.7% （40/54） in the group of osteosarcoma and 0% （0/15） in the group of osteochondroma. There was a significant difference in the comparison of GAS expression in these two groups （P 〈 0.05）. GAS7 was higher expressed in the samples which complicated with relapse or pulmonary metastasis than the control group （P 〈 0.05）. There was no significant association between GAS7 expression and the size of tumor, the gender or the age of the patients （P 〉 0.05）. Conclusion： The hyper-expression ot GAST may play an important role in the initiation and development of human osteosarcoma.     

冬令补膏四款

琼玉膏人参120克,鲜地黄800克,白茯苓(去黑皮)245克,白蜂蜜500克.将人参、茯苓研细末,白蜜用洁净纱布滤去杂质,鲜地黄捣取汁(捣时盛器要用陶器,不要用铜、铁器),然后将参、苓、蜜、地黄汁拌匀放入瓷瓶内,用净纸二三十层封口,放锅内隔水蒸三天三夜,而后用蜡纸数层包紧瓷瓶,放入井口约4小时去火毒,而后取出瓷瓶,再放入锅内蒸24小时即成.每次10～30毫升,每日2次,温开水送服.可补气血,填精髓,适用于中老年人平时保健之用.     

触碰医学的温度 ——北京大学肿瘤医院淋巴肿瘤内科朱军主任门诊纪实

“医学倘若缺乏必要的人文关怀,就会失去应有的人性温度。” 把病人当作一个真实的人,体恤其受疾病袭击时的痛苦,面临生命危险时的悲伤以及对于爱抚和同情的渴望——是医学人文的应有之意。 数月前,笔者有过一次旁听朱军主任出诊的经历,至今,那个充满人情味的场面还刻在脑海里。他解读病情时的睿智幽默,让患者轻松起来;介绍方案时的通俗明晰,让医学不再陌生;关注病患内心冷暖,让淋巴瘤不再可怕……谈话间不时发出的笑声,弥漫在空气里,让诊室气氛温暖而愉悦。     

狗可当医生的助手

今年是农历的狗年,有很多说狗的文章见诸报端,比如说狗忠勇、勤劳,助狩猎,帮放牧……狗能帮助追凶擒敌,能搜寻毒品,大家都早已司空见惯,习以为常了,狗的很多非凡的表现都源于它有一个灵敏的鼻子.令我们最感兴趣的是,在<现代癌症综合治疗问题>中,麦克洛科报告,利用狗的嗅觉可早期诊断肺癌和乳腺癌,这一题目的确新颖而有趣,很快在网上和报纸上纷纷转载.我们杂志的对象是癌症康复者更值得高度关注.     

面向2008面向健康生活让我们齐步走!--记北京癌症患者及社会各界万人健康长走活动

8月29日为29届奥委会接旗日,象征和平、团结、友谊的五环旗帜将从雅典传到北京,来到神州大地,这预示着2008年北京奥运会周期的开始.为了铭记这一历史时刻,在中华人民共和国卫生部、首都精神文明建设委员会办公室、国家中医药管理局、白求恩医科大学北京校友会支持下;由中华慈善总会、中国抗癌协会癌症康复会主办的<九九方元迎奥运癌症患者及社会各界万人健康长走--手拉手迈向2008工程启动仪式>在京隆重举行.     

诈骗艾滋知多少

艾滋病病毒的致病机制很特殊,它一旦进入人体,寄生在T4淋巴细胞内最核心的部位,与细胞核的遗传物质DNA整合为一体,病毒随免疫细胞DNA复制而复制.因此,它成了在全球不可根治的一种"超级瘟疫".在世界各国,对防治艾滋病投入了巨大的人力、财力,众多医学专家们绞尽了脑汁,直至今天尚无有效疫苗可防,更无药物可根治,临床医生束手无策,只能做到一些对症治疗,减轻病人的痛苦,延缓病情,但无法挽救病人的生命,这是科学家公认的结论.     

妇科肿瘤专题特邀组稿专家李力教授简介

李力,女,医学博士,教授、主任医师、博士生导师.1980年毕业于第三军医大学医疗系:1992年第三军医大学研究生大队学员,授医学硕士;1997年重庆医科大学研究生院学员,授医学博士.现任第三军医大学第三附属医院(大坪医院)妇产科主任、全军计划生育优生优育技术中心主任、重庆市宫颈癌防治研究所所长.     

新疆地区四肢长骨骨巨细胞瘤的外科治疗

  目的  回顾性分析长骨骨巨细胞瘤不同手术方法的临床疗效。  方法  回顾2007年1月至2012年6月收治四肢长骨骨巨细胞瘤37例,男性20例,女性17例;平均年龄为31.6（20~56）岁。分析假体置换手术和非假体置换手术对术后的复发、肢体功能,综合评定其影响;不同民族之间发病率,复发率的分析;上下肢的发病率,复发率的分析。  结果  本研究病例好发年龄为20~50岁,维吾尔族发病率较高,民族之间复发率差异无统计学意义（P>0.05）。  结论  骨巨细胞瘤好发年龄为20~50岁,维吾尔族发病率较汉族及其他民族高。下肢发病率及复发率均要高于上肢。切除后植骨或骨水泥填充、植骨内固定、瘤段切除人工关节置换均是骨巨细胞瘤的可靠治疗方法。      

恶性神经鞘瘤25例临床分析

目的:对恶性神经鞘瘤的临床特征进行分析,以期提高对该病的认识。方法:对我院1993年1月~2006年2月收治的25例患者的临床表现、治疗模式及转移复发情况进行回顾性分析。结果:全组男性14例(56%),女性11例(44%),平均发病年龄53.7岁。表现为体表肿物16例(64%),腹腔及盆腔肿物7例(28%),腰背痛、下肢乏力1例(4%),体检发现肺转移结节1例(4%)。病理类型均为梭形细胞恶性肿瘤,S-100阳性者24例(96%),S-100阴性1例(4%)。23例给予手术完整或部分切除,1例未行手术,1例行剖腹探查发现广泛转移而无法切除。6例予术后放疗,2例行术前导管化疗。25例随访时间为7个月~5年,随访期内,4例(16%)发生肺转移,2例(8%)淋巴结转移,7例(28%)局部复发,2例失访,余10例(40%)未见复发及转移。结论:恶性神经鞘瘤可发生于全身各部位,体表肿块为常见症状,确诊依赖病理组织学检查。肿瘤易复发及转移,手术切除是最有效的治疗方法。     

Efficacy of denosumab in joint preservation for patients with giant cell tumour of the bone

BackgroundGiant cell tumour of the bone (GCTB) is an aggressive osteolytic primary tumour. GCTB is rich in osteoclast-like giant cells and contains mononuclear cells that express RANK ligand (RANKL), a key mediator of osteoclast activation. The potential therapeutic effect of denosumab was investigated with special reference to its role in joint preservation.MethodsIn this prospective non-randomised study patients with GCTB received denosumab for 6–11 months preoperatively. Serial radiographs and biopsy and resection tumour specimens were used to monitor response to denosumab.ResultsAll 20 patients experienced pain relief in the first month of treatment. All patients demonstrated a positive radiographic response with improved subchondral and cortical bone which allowed intralesional tumour resection and preservation of the joint and articular surface in 18 cases. Histological examination following denosumab revealed rarely detectable osteoclast-like giant cells. There was an obvious increase in osteoid matrix and woven bone which showed rare RANK staining amongst the mononuclear cells and only focal RANKL positivity. At median 30 months follow-up after resection, local tumour recurrence occurred in three patients.ConclusionDenosumab provides favourable and consistent clinical, radiographic and pathologic responses which facilitates less aggressive surgical treatment, especially joint preservation. However, the local recurrence rate for GCTB following resection does not seem to be affected by denosumab and remains a concern.     

CD117弱表达及阴性表达的胃肠道间质瘤13例分析

  目的 分析 CD117弱表达及阴性表达的胃肠道间质瘤的特点。方法 回顾性分析 13 例经手术病理证实的 CD117弱表达及阴性表达胃肠道间质瘤的特点。结果　肿瘤位于胃部 6 例，小肠 4 例，结直肠 2 例，大网膜 1 例。腹部疼痛不适 6 例，呕血或黑便 3 例。病理学检查肿瘤为良性者 5 例，恶性者8 例。CT 检查表现为软组织密度，5例病变含有囊变及出血，所有病变均未见钙化。良性肿瘤大小（最长径×最短径）平均为3.4 cm×2.8 cm；恶性肿瘤大小平均为7.5 cm×6.2 cm。13 例患者均经手术治疗，手术切除率100 ％。10 例术后获随访6个月~ 4 年，有1 例死于肿瘤复发转移，其余至今仍生存。结论　CD117弱表达及阴性表达的胃肠道间质瘤的好发部位为胃体。CT 扫描有助于 CD117弱表达及阴性表达胃肠道间质瘤的定位和良恶性的判断。手术是其治疗的主要方法。     

Analysis of 6 Cases of Stromal Sarcoma of the Breast

OBJECTIVE To investigate the clinical and pathological characteristics,diagnosis and treatment of stromal sarcoma of the breast(SSB).Methods:The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.METHODS The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.RESULtS Atl patients were female and one was menopausal.The median age of the patients was 39 years old(range,20-55).All cases had a history of a palpable mass.The tumor rapidly augmented in a short time period in 3 patients.One patient had discontinuous pain and 3 patients had masses located in the upper outer quadrant of the breast.The median tumor radius was 6.0 cm(range,3-15 cm).According to the AJCC breast cancer staging standard(6th edition),1 case was of stage ⅡA,2 cases were of stage ⅡB,2 cases were of stage ⅢB and one case couldn't be staged.Four patients were initially treated by excising the tumor and then undergoing mastectomy or modified radical mastectomy after recurrence.Radical mastectomy was suitable for those with pectoralis major muscle involvement.Two patients received simple mastectomy, 2 patients underwent radical mastectomy and another 2 patients received modified radical mastectomy,After surgery,all patients were identified as SSB through pathology,with focal ossification in one case and mucinous degeneration in another one case.Four patients who underwent axillary Iymph node dissection did not have lymph node metastases.Three patients received chemotherapy after surgery. After a median follow-up time of 36.5 months(8-204 months),4 patients had recurrence after local excision and 3 patients had recurrence more than 2 times with a median time to recurrence of 2.5 months(1to 4 months) after surgery.One patient had lung metastases at 7months after the initial surgery and the other 5 patients were alive without disease at the end of the follow-up period.CONCLUSION SSB is difficult to diagnose preoperatively and is characterized by its tendency to recur locally.To obtain negative margins,wide local excision or mastectomy must be performed.Axillary lymph node dissection is not mandatory.The roles of adjuvant chemotherapy and radiotherapy have still been controversial.     

小肠间质瘤临床诊断和治疗

目的探讨小肠间质瘤(GIST)的诊断和治疗。方法对我院1999年1月~2004年4月收治的16例小肠GIST患者的临床表现、手术处理及病理结果进行回顾性分析。结果全组平均发病年龄53岁。发病至就诊时间为半个月至5年不等。首诊主要表现为黑便、腹部不适、腹部肿块,发生部位为空肠5例,回肠8例,空、回肠均有3例。术前5例行DSA检查,诊断小肠肿瘤4例;11例行CT检查,均发现腹腔占位,诊断小肠肿瘤7例;全消化道造影检查8例,发现小肠受压2例。均行手术治疗,其中4例在腹腔镜下完成。手术标本均经病理及免疫组化证实。12例随访时间6个月至5年,平均随访27.3个月,4例失访。其中根治性切除9例,复发2例,均再次手术,仍健在;腹腔镜下小肠肠段切除术4例均无复发。结论小肠GIST缺乏特征性临床表现,DSA检查和CT检查对诊断有一定帮助,但术前确诊率较低,其确诊依赖病理结果。目前小肠GIST的治疗仍以手术切除为主,对复发或远处转移者应积极再次手术,可延长生存期。     

CD133和Ki-67在骨巨细胞瘤中的表达及其临床意义

目的 探讨CD133和Ki-67在骨巨细胞瘤（GCTB）中的表达及其与预后的关系,为临床判断其生物学行为及评估预后提供有力的证据。方法 采用用免疫组织化学染色检测CD133和Ki-67蛋白在80例GCTB组织中的表达,并分析2种蛋白的表达与GCTB临床病理特征及预后的关系。结果 GCTB组织中CD133阳性表达率为43.8％ （35／80）,Ki-67阳性表达率为57.5％（46／80）。CD133表达与肿瘤直径、肿瘤复发、Jaffe分级、Campanacci分期及手术方式有关（P＜0.05）;Ki-67表达与肿瘤直径、Jaffe分级和Campanacci分期有关（P＜0.05）。全组GCTB患者1、3、5年无复发生存率分别为93.0％、88.0％和80.0％。CD133阳性和阴性表达者的1、3、5年无复发生存率分别为89.0％、83.0％、75.0％和99.0％、91.0％、91.0％,差异有统计学意义（P＜0.05）。Ki-67阳性和阴性表达者的1、3、5年无复发生存率分别为89.0％、75.0％、68.0％和 97.0％、93.0％、90.0％,差异亦有统计学意义（P＜0.05）。结论 CD133和Ki-67表达与GCTB患者的预后密切相关,是评估其恶性程度以及预后的重要指标。     

Radiotherapy in the management of giant cell tumor of bone

PURPOSE: To evaluate the outcomes of patients with giant cell tumor of bone (GCTB) treated with radiotherapy (RT) with or without surgical resection. METHODS AND MATERIALS: We performed a retrospective review of the records from 25 consecutive patients with pathologically confirmed GCTB who had undergone RT between 1956 and 2000. RESULTS: Patients ranged in age from 11 to 69 years (median 32); 16 were female and 9 were male. The anatomic distribution of lesions was as follows: cervical spine, 3; temporal bone, 1; thoracic or lumbar spine, 9; sacrum, 8; ilium, 1, and humerus, radius, and thumb metacarpal, 1 each. Tumors ranged in size from 2 to 20 cm (median 9.5) at their maximal dimension. Thirteen patients had been referred for RT for primary GCTB and 12 had been referred with locally recurrent disease after having undergone one or more other treatments. Fourteen patients had undergone RT for gross disease, and the remaining 11 had been treated with RT after gross total resection. In 10 of these 11 patients, the treatment margins were positive or uncertain. Radiation doses ranged from 25 to 65 Gy (median 46). At a median follow-up of 8.8 years (range 0.67-34), 7 patients had developed isolated local recurrence, 2 had developed isolated distant recurrence, and 3 had developed both. The actuarial 5-year overall and disease-free survival rate was 91% and 58%, respectively, and the actuarial 5-year local control and distant metastasis-free survival rate was 62% and 81%, respectively. Univariate analysis suggested that treatment for recurrent disease correlated with a lower disease-free survival rate (83% vs. 33%, p = 0.06), distant metastasis-free survival rate (100% vs. 64%, p = 0.08), and local control rate (83% vs. 42%, p = 0.08) at 5 years. Of the 12 cases of recurrence, 7 were ultimately successfully treated with additional salvage therapy. In 4 of these patients, salvage therapy included interferon-alpha 2b. CONCLUSION: RT should be considered an adjuvant to surgery or as alternative therapy in cases of GCTB that are unresectable or in which excision would result in substantial functional deficits. When RT is used as primary therapy, the rate of local control seems to be satisfactory. In heavily pretreated patients, however, RT delivered as it was in this series can result in poor local control, and alternative therapies should be considered.     

Analysis of 6 cases of stromal sarcoma of the breast

OBJECTIVE To investigate the clinical and pathological characteristics, diagnosis and treatment of stromal sarcoma of the breast （SSB）. Methods： The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.
METHODS The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.
RESULTS All patients were female and one was menopausal. The median age of the patients was 39 years old （range, 20-55）. All cases had a history of a palpable mass. The tumor rapidly augmented in a short time period in 3 patients. One patient had discontinuous pain and 3 patients had masses located in the upper outer quadrant of the breast. The median tumor radius was 6.0 cm （range, 3-15 cm）. According to the AJCC breast cancer staging standard （6th edition）, 1 case was of stage ⅡA, 2 cases were of stage ⅡB, 2 cases were of stage ⅢB and one case couldn＇t be staged. Four patients were initially treated by excising the tumor and then undergoing mastectomy or modified radical mastectomy after recurrence. Radical mastectomy was suitable for those with pectoralis major muscle involvement. Two patients received simple mastectom）~ 2 patients underwent radical mastectomy and another 2 patients received modified radical mastectomy. After surgery, all patients were identified as SSB through pathology, with focal ossification in one case and mucinous degeneration in another one case. Four patients who underwent axillary lymph node dissection did not have lymph node metastases. Three patients received chemotherapy after surgery. After a median follow-up time of 36.5 months （8-204 months）, 4 patients had recurrence after local excision and 3 patients had recurrence more than 2 times with a median time to recurrence of 2.5 months （1 to 4 months） after surgery. One patient had lung metastases at 7 months after the initial surgery and the other 5 patients were alive without disease at the end of the follow-up period.
CONCLUSION SSB is difficult to diagnose preoperatively and is characterized by its tendency to .recur locally. To obtain negative margins, wide local excision or mastectomy must be performed. Axillary lymph node dissection is not mandatory. The roles of adjuvant chemotherapy and radiotherapy have still been controversial.     

The comparative biochemical and morphological characteristics of chondrosarcoma and giant-cell tumor of the bone

Spectrometry has been employed to assess the levels of collagenase, catepsin D, trypsin-like proteinases and their inhibitors as well as bone acid and alkaline phosphatase both in the center and along the periphery of giant cell tumor of bone (GCTB) and chondrosarcoma. The levels of collagenase, trypsin-like proteinases and their inhibitors in the center of chondrosarcoma were much higher while those of alkaline phosphatase--lower than along tumor periphery. The catepsin D and acid phosphatase concentrations of the center and periphery of chondrosarcoma were similar. It was suggested that an extremely low concentration of trypsin-like inhibitors may contribute to degradation of the matrix in tissues adjacent to chondrosarcoma and, consequently, to tumor invasion development.