老年前列腺癌的早期诊断及分析

我院 1999年 10月～ 2 0 0 2年 6月对5 2例疑前列腺癌老年患者行B超引导经直肠前列腺穿刺活检术 ,确诊前列腺癌2 8例 ,现将有关资料分析如下。1　资料和方法1.1　对象　本组 5 2例患者年龄 60～ 85岁 ,平均 (73± 5 9)岁。主要临床症状 ,前列腺肥大引起的膀胱刺激症状 2 7例 ,     

Gleason评分对穿刺活检前列腺癌检出率的价值

目的 研究前列腺癌(CRPC)患者的危险因素及前列腺穿刺活检(PSA)患者术后检出率.方法 CRPC穿刺活检和根治术治疗的CRPC患者124例,按照PSA值、Gleason评分和临床分期将患者分为低危29例、中危36例、高危59例,研究CRPC患者的危险因素及穿刺活检患者临床根治术后CRPC检出率.结果 CRPC患者危...     

骨髓瘤相关肾损伤与老年肾活检病理

老年人肾活检的安全性毋庸置疑,其并发症并不比中青年肾活检高.最近Moutzouris等还对极高龄(≥80岁)肾病患者肾活检的安全性进行评价,结果仍是安全的,且67％肾活检对治疗有帮助.我国也有不少高龄患者接受肾活检.由于我国肾活检技术发展不平衡,是否对老年患者行肾活检还应根据各单位自身的条件、对肾活检技术的掌握程度以及患者的病情综合决定.在老年肾病患者的病因诊断方面,肾活检并非唯一手段,应该综合包括肾活检在内的各种检测手段以明确.     

经腹腔镜下前列腺癌根治术后老年患者并发尿路感染的危险因素分析

目的 探讨经腹腔镜下前列腺癌根治术的老年患者术后并发尿路感染的高危因素及院内预防策略。方法 选取2019年1月—2021年10月于南京医科大学第—附属医院行腹腔镜下前列腺癌根治术的老年男性患者288例,根据患者术后有无并发尿路感染分为感染组和非感染组。采用Logistic回归分析并发术后尿路感染的高危因素。结果 在纳入分析的288例患者中,有26例并发术后尿路感染,感染率为9.03%。感染病原菌以大肠埃希菌、变形杆菌和肺炎克雷伯菌等为主。感染组患者中,年龄>70岁、糖尿病史、术前未预防使用抗菌药物、术后留置导尿管时间>5 d、住院天数>7 d的比例显著高于非感染组,差异均有统计学意义(P <0.05)。多因素Logistic回归分析显示,糖尿病史、术前未使用抗菌药物和术后留置导尿管时间长是经腹腔镜下前列腺癌根治术后老年患者并发尿路感染的独立危险因素。结论 老年经前列腺癌根治术后患者并发尿路感染通常以革兰阴性菌为主,且受多种高危因素影响,这可为老年前列腺癌患者的术前准备及并发感染早期预防提供依据。     

老年单纯前列腺特异性抗原升高患者前列腺穿刺活检前抗生素治疗对预后的影响

前列腺特异性抗原(PSA)是检测前列腺癌的重要方法,患者PSA水平异常升高是进行前列腺活检穿刺的有效指标.通常除前列腺癌也有其他原因导致PSA的升高,如前列腺按摩、导尿等操作或前列腺炎症,会影响PSA作为肿瘤标记物的特异性.单纯PSA的升高,直肠检查和经B超检查未发现结节及可疑病灶者穿刺阳性率仅有20％ ～ 30％,说明其余的80％患者接受了不必要的穿刺检查.炎症会导致PSA的升高[1],临床会在进行活检前给予患者抗生素治疗以此来降低炎症所致的PSA升高.本研究分析抗生素治疗前后PSA参数变化同前列腺活检关系,探讨活检前接受抗生素治疗的意义.     

老年前列腺癌患者雄激素去势治疗后的长期心力衰竭风险的回顾性研究

目的 回顾性分析美国国立癌症数据库(SEER)老年前列腺癌患者雄激素去势治疗(ADT)后的长期心力衰竭(HF)风险,并分析ADT和HF风险的相关性. 方法 回顾性观察性研究.纳入1996-2003年在SEER数据库中老年(≥65岁)前列腺癌患者,根据是否给予ADT治疗分为ADT组(82 514例)和对照组(121 85...     

老老年冠心病患者血小板参数的相关变化及临床意义

目的 探讨长期规律服用抗血小板药物的老老年冠心病患者血小板参数的相关变化及临床意义.方法 选择2013年7月至2014年1月入住中国中医科学院广安门医院的217例老老年冠心病患者,将其分为稳定型心绞痛组74例和不稳定型心绞痛组143例,选取无冠心病的老老年患者64例作为对照组.入院后即分别测定血小板计数（PLT）、血小板分布宽度（PDW）、平均血小板体积（MPV）、大型血小板比率（P-LCR）、血小板比积（Pct）等血小板参数并进行比较,冠心病患者不需停服抗血小板药物.结果 不稳定型心绞痛组PDW值和P-LCR值高于对照组及稳定型心绞痛组,差异有统计学意义（P＜0.05或P＜0.01）.PLT、MPV、Pct三组比较未见统计学差异（P均＞0.05）.结论 入院时测定的血小板参数有助于对长期规律服用抗血小板药物的老老年冠心病患者的稳定型心绞痛及不稳定型心绞痛的鉴别,可作为判断冠心病病情进展的辅助指标之一.     

3.0T磁共振多参数成像对老年前列腺癌的诊断价值

目的探讨3.0T磁共振(MRI)多参数成像在老年前列腺癌诊断中的价值。方法回顾性分析经手术病理和穿刺活检证实的30例早期前列腺癌患者的常规序列、DWI及动态增强扫描表现。结果 30例早期前列腺癌患者中,病变均位于包膜内。T2WI抑脂像15例表现为T2WI外周带内异常低信号区,8例表现为中央带稍高信号,DWI序列10例呈高信号,7例呈等信号。多期动态增强扫描21例病灶于动脉期明显强化,平衡期为低信号,6例呈持续渐进性强化,3例动脉期强化不明显。结论 3.0T MRI的常规T2WI序列、DWI及动态增强扫描老年前列腺癌诊断中具有特征性表现,联合应用具有明确的诊断价值。     

Prostate Cancer Testing following a Negative Prostate Biopsy: Over Testing the Elderly

Background Screening elderly men for prostate cancer is not recommended because definitive treatments are unlikely to extend life expectancy. Objective Describe clinical outcomes after a negative prostate biopsy in a population-based cohort of men ages 65 and older. Design Retrospective cohort study. Participants 9,410 Medicare-eligible men who underwent a prostate biopsy in Los Angeles or New Mexico in 1992. Measurements We used Medicare and SEER databases to identify a cohort with an initial negative biopsy (n = 7,119) and to ascertain survival, subsequent PSA testing, prostate biopsies, and prostate cancer detection and treatment through 1997. Results The overall 5-year survival was 79.4% (95% CI 78.4–80.3), but only 74.6% (72.4–76.7) for men ages 75–79 at the time of the initial negative biopsy and 55.0% (51.9–57.9) for men ages 80+. During a median 4.5 years follow-up, a cumulative 75.0% (73.9–76.1) of the cohort underwent PSA testing. Among men ages 75–79 and 80+, the cumulative proportions that underwent PSA testing were 75.4% (73.0–77.8) and 74.3% (71.1-77.5), respectively. Additionally, 29.1% (26.7–31.6) of men ages 75–79 and 20.1% (17.6–23.1) of men ages 80+ underwent repeat prostate biopsy, and 10.9% (9.4–12.7) and 8.3% (6.6–10.4), respectively, were diagnosed with cancer. Among men ages 75+ with localized cancers, approximately 34% received definitive treatment. Conclusions High proportions of men ages 75+ underwent PSA testing and repeat prostate biopsies after an initial negative prostate biopsy. Given the known harms and uncertain benefits for finding and treating localized cancer in elderly men, most continued PSA testing after a negative biopsy is potentially inappropriate. This work was presented in part at the Annual National Meeting of the Society for General Internal Medicine. Los Angeles, California, May 2006.     

30例经支气管镜针吸活检术在老年患者中的临床应用

目的:研究探讨经支气管镜针吸活检术在老年患者中的临床应用.方法:对30例经胸部CT检查提示有肺部占位性病变存在,并伴有纵隔、肺门及支气管周围淋巴结肿大的患者行经支气管镜针吸活检术,并对经支气管镜针吸活检术的诊断准确率、穿刺成功率、阳性率等进行计算和观察.结果:患者的穿刺位置在1个到3个之间,30例老年患者共穿刺43次,穿刺成功34次,穿刺的成功率为79.1％.28例患者能明确诊断,诊断的准确率为93.3％,共诊断出肺癌13例(包括腺癌9例,鳞癌和小细胞癌各2例),良性病变15例(包括结核、肺炎各5例,结节病4例,纵隔淋巴结增生性炎症1例);其中13例肺癌患者,共穿刺18次,穿刺成功15次,穿刺成功率为83.3％,穿刺阳性13次,穿刺阳性率为72.2％;15例良性病变患者,共穿刺20次,穿刺成功17次,穿刺成功率为85.0％,穿刺阳性16例,穿刺阳性率为80.0％;2例患者诊断不明,穿刺5例,成功2次,穿刺成功率40.0％,穿刺阳性0,阳性率0.结论:经支气管镜针吸活检术在诊断老年患者的纵隔、肺门及支气管周围淋巴结病变等的过程中具有准确率高、安全性好的特点,具有十分重要的临床应用价值;同时,其在诊断的过程中还具有操作简便、创伤小、经济性好、术后的并发症发生率低等优点,值得在肺部疾病的临床诊断过程中推广.     

Evaluation of Plasma Interleukin-8 Concentration in Patients with Prostate Cancer and Benign Prostate Hyperplasia

Background: Prostate specific antigen (PSA) has been used as a screening test for the early detection of prostate cancer (PC) for many years. Although the introduction of PSA test led to a considerable increase in reported prostate cancer cases, there is still some controversy over the sensitivity and specificity of this marker in distinguishing PC patients from those with benign prostate hyperplasia (BPH), the most common benign prostate condition. Objective: An attempt is made to elucidate if the plasma level of Interleukin 8 (IL-8) could be used effectively as a marker for the detection of prostate cancer. Methods: Plasma levels of IL-8 and PSA were measured in two groups of 40 BPH and PC patients using enzyme-linked immunosorbent (ELISA) and radioimmunoassay (RIA) techniques, respectively. In addition IL-8 levels in PC3 and DU145 cell line supernatants were measured by ELISA technique. Results: The concentration of IL-8 in the plasma of PC patients was not significantly higher than the BPH subjects. Although, a correlation between plasma IL-8 concentration and the Gleason score of PC patients was found, no indicated correlation was detected between the concentration of IL-8 or PSA and age of the patients in both groups. DU145 and PC3 cell lines produced and secreted IL-8 in the media. Conclusion: Data of this investigation collectively conclude no correlation between IL-8 concentration in PC and BPH patients.     

Renal Biopsy in the Very Elderly

Background and objectives: Data regarding renal biopsy in the very elderly (≥age 80 yr) are extremely limited. The aim of this study was to examine the causes of renal disease and their clinical presentations in very elderly patients who underwent native renal biopsy.Design, setting, participants, & measurements: All native renal biopsies (n = 235 including 106 men, 129 women) performed in patients aged ≥80 yr over a 3.67-yr period were retrospectively identified. Results were compared with a control group of 264 patients aged 60 to 61 who were biopsied over the same period.Results: The indications for biopsy were acute kidney injury (AKI) in 46.4%, chronic-progressive kidney injury in 23.8%, nephrotic syndrome (NS) in 13.2%, NS with AKI in 9.4%, and isolated proteinuria in 5.5%. Pauci-immune GN was the most frequent diagnosis (19%), followed by focal segmental glomerulosclerosis secondary to hypertension (7.6%), hypertensive nephrosclerosis (7.1%), IgA nephropathy (7.1%) and membranous nephropathy (7.1%). Comparison with the control group showed pauci-immune GN to be more frequent (P < 0.001) and diabetic glomerulosclerosis (P < 0.001) and membranous nephropathy (P < 0.05) less frequent in the very elderly. Diagnostic information had the potential to modify treatment in 67% of biopsies from the very elderly, particularly in those with AKI or NS.Conclusions: Renal biopsy in very elderly patients is a valuable diagnostic tool that should be offered in clinical settings with maximal potential benefit. Advanced age per se should no longer be considered a contraindication to renal biopsy.The elderly population in the United States is growing. In 2003, people aged 65 and older comprised 12% of the total population. This number is projected to increase from 26 million in 2003 to 72 million in 2030, at which point the elderly will comprise 20% of the population (1). In addition, patients aged 85 or more represented 1.6% of the total population in 2003, but they are projected to double from 4.7 million in 2003 to 9.6 million by 2030 and to double again to 20.9 million by 2050. Moreover, between 1980 and 1997 there was an 18% increase in individuals more than 65 yr of age and a 73% increase in those older than 85 yr (2). As life expectancy increases, more elderly patients are surviving longer with acute and chronic diseases. In particular, renal disease is increasingly common in the elderly. A progressive decline in GFR with age or in the course of cardiovascular or other systemic diseases, as well as because of the potential nephrotoxic effects of medical and surgical treatments, may contribute to the increased incidence of renal disease in this population. Advanced age is no longer considered a contraindication for renal biopsy, immunosuppressive therapy, or renal replacement therapy, and consequently the number of diagnostic renal biopsies performed in the very elderly is increasing. Recent studies in limited numbers of very elderly patients suggest that renal biopsy can provide significant diagnostic and prognostic information, leading to change of treatment in as many as 40% of patients (3,4).Several studies have focused on the findings in renal biopsies in elderly patients (4–13). However, most of these studies considered elderly patients in the age groups of over 60 or 65 yr. Only two of these studies included a subset analysis for patients aged over 80 yr, and then in limited numbers (4,14). In addition, some of these studies contained relatively few patients (11,12) and the clinical presentations and indications for biopsy were not always clearly defined. In the last 2 decades, only one study (3) has focused on renal biopsy findings in very elderly patients (>80 yr), reporting on only 100 patients without clear delineation of the indications for biopsy.The aim of this study was to examine the specific causes of renal disease and their respective clinical presentations in a large group of elderly patients aged ≥80 yr who underwent native renal biopsy and to compare the frequency of these diagnoses with a control group of patients aged 60 to 61 yr. In addition, we retrospectively sought to determine the utility of renal biopsy in the very elderly by categorizing biopsy results into those which potentially affect patient management versus those revealing chronic, age-related conditions or conditions managed by nonspecific or supportive therapies.     

小剂量多西他赛治疗老年晚期非小细胞肺癌的疗效研究

目的 观察小剂量多西他赛单药治疗老年晚期非小细胞肺癌（NSCLC）的疗效和不良反应.方法 46例老年NSCLC（Ⅲ～Ⅳ期）患者均经病理学或细胞学检查确诊.应用江苏恒瑞生产多西他赛（艾素）35mg/m2,1次/周,连用6周,休息两周为1周期,两周期后评价疗效.结果 46例患者均可评价疗效,CR 1例,PR 11例,有效率26.0%,中位生存期8.3个月,中位疾病进展时间（TTP）7.2个月,1年生存率45.5%.主要不良反应为白细胞减少和过敏反应,均可耐受.结论 小剂量多西他赛单药治疗老年晚期NSCLC疗效确切,可改善老年患者生存质量,延长生存期,不良反应轻.