慢性阻塞性肺炎患者在内科治疗方法中临床疗效对比观察

在治疗慢性阻塞性肺炎临床中采用不同的方法进行治疗,将治疗的数据进行分析。方法:80例慢性阻塞性肺炎进行临床研究实验,实验组在治疗时可以采用氨茶碱药品将其运用到临床中,好转后用福莫特罗(FORMOTEROL)进行辅助治疗;临床组在治疗中氨茶碱和多索茶碱进行混合治疗,好转后可以用西咪替丁和福莫特罗(FORMOTEROL)进行辅助治疗;将治疗的数据对比分析。然后把数据进行总结,整理成可用的临床数据。结果:经过数据对比可知临床组的实效率在95%;实验组的实效率在77.5%,治疗之前的效果是没有任何差异,治疗之后临床组中出现轻度反应的1人,出现严重反应的1人;实验组出现轻度反应的3人,出现严重反应的6人;将前后实效率、安全性进行对比发现治疗之后的治疗差异逐渐显露。结论:将氨茶碱和多索茶碱结合治疗可以有效地治疗慢性阳阻塞肺炎,改善患者的呼吸道与肺部血管、中枢神经系统、改善呼吸道功能。

Colonoscopic perforation:A report from World Gastroenterology Organization endoscopy training center in Thailand

AIM： To determine the incidence of colonoscopic perforation （CP）, and evaluate clinical findings, management and outcomes of patients with CP from the World Gastroenterology Organization （WGO） Endoscopy Training Center in Thailand. METHODS： All colonoscopies and sigmoidoscopies performed between 1999 and 2007 in the Endoscopic unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok were reviewed. Incidence of CP, patients＇ characteristics, endoscopic information, intraoperative findings, management and outcomes were analyzed. RESULTS： A total of 17357 endoscopic procedures of the colon （13 699 colonoscopies and 3658 flexible sigmoidoscopies） were performed in Siriraj hospital over a 9-year period. Fifteen patients （0.09%） had CP： 14 from colonoscopy and 1 from sigmoidoscopy. The most common site of perforation was in the sigmoid colon （80%）, followed by the transverse colon （13%）. Perforations were caused by direct trauma from either the shaft or the tip of the endoscope （n = 12,80%） and endoscopic polypectomy （n = 3, 20%）. All patients with CP underwent surgical management： primary repair （27%） and bowel resection （73%）. The mortality rate was 13% and postoperative complication rate was 53%. CONCLUSION： CP is a rare but serious complication following colonoscopy and sigmoidoscopy, with high rates of morbidity and mortality. Incidence of CP was 0.09%. Surgery is still the mainstay of CP management.

A clinical trial of cytokine induced killer cells treating patients with malignant tumor after radiochemotherapy

Objective: Our study investigated the immunity changes and life quality changes after the treatment of cytokine induced killer (CIK) cells for patients with malignant tumor after radiochemotherapy, and explored the therapeutic effects of CIK cells on these patients. Methods: Thirty-one patients with malignant tumor after radiochemotherapy were treated with CIK cells. Before and after CIK cells being transfused back, the immunity indexes of the peripheral blood of these cases were detected and the changes of life quality of these cases were compared. Results: After radiochemotherapy, the percentage of CD3+, CD4+ cells declined, the percentage of CD8+ cells rose; the ratio of CD4+/CD8+ declined, and the percentage of CD16+, CD56+ cells declined. As all the above indexes compared with that of normal people, the difference was significant (P < 0.05). After CIK cells therapy, the above indexes improved (P < 0.05). Life quality improved significantly after CIK cells therapy (P < 0.05). Conclusion: Radiochemotherapy can inhibit the immunity in patients with malignant tumor. CIK cells therapy is safe and effective. It may improve the recent immunity and life quality of the patients, which suggesting that it may be an alternative maintenance treatment for patients with malignant tumor after radiochemotherapy.

The clinical effects of DC-CIK cells combined with chemotherapy in the treatment of advanced NSCLC

Objective: The aim of the study was to evaluate the safety and therapeutic effects of autologous dendritic cells co-cultured with cytokine-induced killer cells (DC-CIK) combined with chemotherapy in advanced non-small cell lung cancer (NSCLC) patients. Methods: Fifty patients with advanced NSCLC (stages III to IV), who had received therapies in our Center (Department of Biotherapy, Affiliated to Cancer Hospital of Shanxi Medical University, Taiyuan, China) from August 2008 to January 2010, were treated by DC-CIK + chemotherapy as the combined treatment group; fifty advanced NSCLC patients treated with chemotherapy at the same time served as controls. The immunologic function, short-term therapeutic effects, the 1-year survival rate, the life quality, the chemotherapy side effects were compared between the two groups, the safety and therapeutic effects of DC-CIK cells therapy were observed too. Results: There was no obvious change of subsets of T cells in peripheral blood before and after therapy in DC-CIK + chemotherapy group, and IFN-γ was improved after therapy in this group (P < 0.05); in chemotherapy alone group, the ratios of CD3+CD4+, CD3+CD8+, CD3-CD56+ cells and the secretion of IL-2, TNF-α decreased significantly after therapy (P < 0.05); the ratios of CD3+CD8+, CD3+CD56+ were improved after cell culture (P < 0.05). The disease control rate (DCR) of DC-CIK + chemotherapy group was higher than that in the chemotherapy alone group (78.0% vs 56.0%, P < 0.05); the 1-year survival rates of DC-CIK + chemotherapy group and chemotherapy alone group were 50% and 44% respectively, had no significant difference. Compared with chemotherapy alone group, the occurrence of chemotherapy side effects (including bone marrow suppression, nausea and vomiting, peripheral nerve toxicity) was less in the DC-CIK + chemotherapy group (P < 0.05). The physical and appetite were better in DC-CIK + chemotherapy group after therapy. Conclusion: To compare with simple chemotherapy, DC-CIK + chemotherapy for advanced NSCLC is safe and effective, and it can improve patients' life quality and remission rate, and prolong their survival time.

The clinical effects of concurrent radiochemotherapy in cases suffered from stages III to IVa nasopharyngeal carcinoma

Objective： The aim of the study was to investigate the clinical effects of concurrent radiochemotherapy in treating locally advanced （Stages III-IVa） nasopharyngeal carcinomas （NPCs）. Methods： A total of 95 patients who suffered from nasopharyngeal carcinoma （Stages III-IVa） was divided into two groups： Group concurrent radiochemotherapy （Group CCRT, n = 49） and Group radiotherapy （Group RT, n = 46）. The two groups were both delivered conventional fractionated radiotherapy, while Group CCRT was delivered three cycles chemotherapy of PF （DDP ＋ 5-Fu） regimen or PLF （DDP ＋ 5-Fu ＋ CF） regimen. Results： The complete remission rate and total remission rate of Group CCRT were higher than those of Group RT, and the differences were of statistical importance （X2 = 4.72-7.19, P 〈 0.05）. The one-year overall survival （OS） rate was calculated by life table method, in Group CCRT, it was higher than that of Group RT and the difference was of statistical importance （X2 = 4.24, P 〈 0.05）. The 3-year overall survival （OS） rate, nasopharyngeal control rate and cervical lymph nodes＇ control rate of Group CCRT were all higher than those of Group RT and the differences were of statistical importance （X2 = 4.28-4.40, P 〈 0.05）. The 5-year overall survival （OS） rate and metastasis-free rate of Group CCRT were higher than those of Group RT and the differences were of statistical importance （X2 = 3.96-8.26, P 〈 0.05）. The incidence rates of acute toxicities in Group CCRT were obviously higher than those in Group RT, and the difference of gastrointestinal reaction was of statistical importance （X2 = 11.70, P 〈 0.05）. Conclusion： This study has demonstrated that concurrent radiochemotherapy can improve the remission rate, overall survival rate and locally control rate. The toxicities of concurrent radiochemotherapy can be tolerated by the patients.

A Randomized Clinical Study on Combination of Concurrent Chemo-Radiotherapy and Thalidomide for Middle-Late Esophageal Cancer

OBJECTIVE To evaluate the response rate and tolerance of patients with middle-late esophageal carcinoma, who were treated with concurrent chemoradiotherapy （CCRT） plus thalidomide.METHODS Sixty-five eligible patients with local middle-late esophageal carcinoma were randomly assigned to the treatment group （TG） and the control group （CG）. The 33 patients from the TG were treated with CCRT plus thalidomide （a 60-70 Gy of radiation dose, and 5-FU plus cisplatin; oral administration of thalidomide at a dose of 100 mg/d on the first week and 200 mg/d on the second. Both were taken with water, at bedtime until completion of the radiotherapy. In the CG, 32 patients received CCRT only. The clinical effects and tolerance to the CCRT between the 2 groups were compared.RESULTS The response rates of the therapeutic combination in the TG and CG were 87.9% and 68.7%, respectively. There were no statistical differences in comparing the response rates between the 2 groups （P 〉 0.05）; the local control rates in the TG and CG were 93% and 91%, respectively, and there were no statistical differences between the 2 groups （P 〉 0.05）; the 1-year survival rates of the patients in the TG and CG were 74.0% and 63.0%, respectively, without statistical differences between the 2 groups （P 〉 0.05）. The improvement rates of KPS scoring in the TG and CG were 57.6% and 31.3%, respectively. There were significant differences in comparing the improvement rates between the 2 groups （P 〈 0.05）. The incidence rates of nausea and vomiting were lower in the TG compared to the CG, with a statistical significance between the 2 groups （P 〈 0.05）. However, the incidence rates of constipation, lethargy and fatigue were higher in the TG than in CG, showing a statistically significant difference between the 2 groups （P 〈 0.05）. CONCLUSION CCRT combined with thalidomide in treating esophageal carcinoma may improve the quality of life of the patients, the treatment may also raise patients＇ compliance to chemoradiotherapy, and possibly increase their long-term survival rate. Further studies related to this topic are needed.

Clinical outcomes of elderly South-East Asian patients in primary percutaneous coronary intervention for ST- elevation myocardial infarction

Objective To evaluate the clinical characteristics and in-hospital outcomes of elderly South-East Asian patients undergoing primary pereutaneous coronary intervention （PPCI）. Methods From January 2009 to December 2012, 1268 patients （86.4% male, mean age of 58,4 ± 12.2 years） presented to our hospital for ST-elevation myocardial infarction （STEMI） and underwent PPCI. They were divided into two groups： elderly group defined as age _〉 70 years and non-elderly group defined as age 〈 70 years. Data were collected retrospectively on baseline clinical characteristics, door-to-balloon （D2B） time, angiographic findings, therapeutic modality and hospital course. Results The elderly group constituted 19% of the study population with mean age 76.6 ± 5.0 years. There was a higher proportion of female gender and ethnic Chinese patients in the elderly group when compared with the non-elderly group. The former was less likely to be smokers and have a significantly higher prevalence of hypertension. The mean D2B time was significantly longer in the elderly group. They also had a significantly higher incidence of triple vessel disease and obstructive left main disease. The use of radial artery access, glyeoprotein 2b/3a inhibitors and drug-eluting stents during PPCI were also significantly lower. In-hospital mortality was significantly higher in the elderly group. The rate of cardiogenic shock and inhospital complications were also significantly higher. Conclusions Our registry showed that in-hospital mortality rate in elderly South-East Asian patients undergoing PPCI for STEMI was high. Further studies into the optimal STEMI management strat- egy for these elderly patients are warranted.

Clinical study of Shenqi Fuzheng injection decreasing side-effects of chemotherapy for patients with ovarian epithelial cancer

Objective: The aim of the study was to observe the clinical effects of Shenqi Fuzheng injection decreasing sideeffects of chemotherapy for patients with ovarian epithelial cancer. Methods: The 36 cases of ovarian epithelial cancer in The Third Affiliated Hospital of SUN Yat-sen University(Guangzhou, China) from June 2010 to June 2013, were randomly divided into the study group and the control group. The study group contained 18 cases using Shenqi Fuzheng injection combined with TP(Taxol + Carboplatin/cisplatin) chemotherapy, and the control group contained 18 cases only using TP chemotherapy without Shenqi Fuzheng injection. During and after chemotherapy, the side-effects and therapy effects were observed. Results: The grade II of nausea and vomit were less in the study group than that in the control group, which was significantly different(P < 0.05). But there were no significantly differences in grade I of nausea and vomit between the two groups(P > 0.05). There was less degree of decrease of lymphocyte in the study group than that in the control group, which was significantly different(P < 0.05). But between two groups, there were no significant differences in the drop of white blood cells and red blood cells, the incidence of allergic reaction, liver and renal functions, nerve lesion and phalacrosis(P > 0.05). There was no significant difference in chemotherapy effect between the two groups(P > 0.05). Conclusion: Shenqi Fuzheng injection can in some degree relieve the side effects of TP chemotherapy for the patients with ovarian epithelial cancer, including relieving nausea and vomiting, protecting lymphocytes, and has no conflict effect on chemotherapy efficacy.

Safety and efficacy of oral HD-03/ES given for six months in patients with chronic hepatitis B virus infection

AIM： To investigate the safety and efficacy of the formulation HD-03/ES capsules in the management of patients with chronic hepatitis B infection.METHODS： A total of 25 patients were recruited to the study and were given HD-03/ES, two capsules twice daily for six months. Clinical assessment of symptoms and signs were done using the ＂clinical observation table＂ once a month before and after the treatment. Biochemical investigations of total bilirubin, ALT, AST, serum protein for liver function tests were done every month after initiating treatment. Serum was analyzed for HBV markers for HBsAg, HBeAg and HBV DNA at baseline, 4 and 6 mo alter therapy using ELISA kits from Roche.RESULTS： After 6 mo of therapy with HD-03/ES, a significant reduction of ALT values from 66.5 ± 11.1 to 39.1 ± 5.2 （P 〈 0.01） and a significant HBsAg loss （52%, P 〈 0.001）, HBeAg loss （60%, P 〈 0.05） and HBV DNA loss （60%, P 〈 0.05） was observed. Adverse effects were mild and never warranted withdrawal of the drug.CONCLUSION： The results of this pilot study indicate that HD-03/ES might be a safe and effective treatment for chronic hepatitis B infection and a long-term multicentric comparator trial is warranted and under way.

Clinical observation of continuously subcutaneous-pumped octreotide infusion in palliative treatment of malignant bowel obstruction

Objective： The aim of the study was to observe the effectiveness of continuously subcutaneous-pumped octreotide infusion in palliative treatment of malignant bowel obstruction （MBO）. Methods： Clinical data were retrospectively analyzed in 26 carcinoma patients complicated with MBO, in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, China, from March 2007 to April 2009. All 26 carcinoma patients with MBO were divided into no groups： the controlling group （CG, routine therapy, 15 patients） and the octreotide group （OG, 11 patients）. The octreotide group received routine therapy combined with octreotide （0.3 mg/d） by 24 hours continuously subcutaneous octreotide infusion. The changes of curative effectiveness related to symptoms, the times of recovering exsufflation and defecation, the average drain of gastrointestinal drainage tube, the duration of gastrointestinal drainage tube and the rate of extubation, were observed and compared between the two groups. Results： After treatment, remarkable changing rates of MBO related symptoms were 81.8% （9/11） in OG, and 46.7% （7/15） in CG （P 〈 0.05）. The 78% of SG and 30% of CG recovered the exsufflation and defecation, and the mean times they needed were 3.2 d and 5.8 d, respectively （P 〈 0.05）. The durations of gastrointestinal drainage tube of OG and CG were （5 ± 1.2） d and （10 ±2.3） d, respectively, and the rates of extubation were 54.5% and 20%, respectively. The improvement rate in the octreotide group was better than that in the controlling group and the difference was significant （72.7% and 26.7%, P 〈 0.05）. Conclusion; The administration of octreotide in combination with routine treatment can be very effective in the treatment of MBO. It can relieve the symptoms of MBO effectively and improve the quality of life of the end-stage patients. It has provided one kind of new treating thought and method for treatment of malignant bowel obstruction.

Clinico-pathological study and treatment results of 1009 operable breast cancer cases:Experience of NCI Cairo University,Egypt

Objective： This retrospective study was designed to evaluate ciinico-pathological data including stage, results of treatment, and prognostic factors which affect the overall survival ＆ disease free survival. Methods： This was a retrospective study carried out at the Radiotherapy Department, National Cancer Institute, Cairo University, Egypt on 1009 patients treated for primary breast cancer between 1999-2003. Results： The median follow-up was 68 months. Loco regional relapse occurred in 23 patients （2.3%） and distant relapse occurred in 203 patients （20.1%）. Both Ioco regional and distant relapse were reported in 32 patients （3.2%）. The disease free survival （DFS） at 3 and 5 years were 87% and 78% respectively, while OAS at 3 and 5 years were 96.4% and 91.4% respectively. Multivariate analysis of different prognostic factors showed that the independent bad prognostic factors in the study for disease relapse were positive lymph nodes （LNs, more than 10）, tumor size T3, T4 with significance of 0.0001 for each, and pathologic grade with significance of 0.003. Conclusion： The most important independent bad prognostic factors for relapse are positive LNs more than 10, tumor size T3, T4 and pathologic grade. The timing of radiotherapy affects the disease free survival significantly also it is recommended to analyze the group of patients with LNs negative using well designed randomized trials.

Comparative Analysis of Intractable Postpartum Hemorrhage Intervention Treatments

Abstract： Objective： To explore the clinical efficacy of different treatment methods of intervention for intractable postpartum hemorrhage. Methods： From the accept and treat patients with intractable postpartum hemorrhage in our hospital from June 2013 to March 2014, 86 cases were chosen to be retrospectively analyzed, randomly divided into observation group and control group with 43 cases in each group. The control group was underwent gauze packing while observation group were packing gauze joint with improved uterine suture Cho, the two groups were observed therapeutic effects and complications. Results： The total efficiency of observation group is 93.02%, and the total efficiency of the control group is 62.79%, there is a significant better treatment effect for observed group than the control group （P 〈0.05）, and complication rate of observation group is significantly lower than the control group （P 〈0.05）. Conclusions： In refractory postpartum hemorrhage intervention therapy, the use of gauze packing combined with modified suture uterus Cho has better clinical treatment effect with high security, so it is worthy of clinical application.

Comparative Analysis of Intractable Postpartum Hemorrhage Intervention Treatments

Objective： To explore the clinical efficacy of different treatment methods of intervention for intractable postpartum hemorrhage. Methods： From the accept and treat patients with intractable postpartum hemorrhage in our hospital from June 2013 to March 2014, 86 cases were chosen to be retrospectively analyzed, randomly divided into observation group and control group with 43 cases in each group. The control group was underwent gauze packing while observation group were packing gauze joint with improved uterine suture Cho, the two groups were observed therapeutic effects and complications. Results： The total efficiency of observation group is 93.02%, and the total efficiency of the control group is 62.79%, there is a significant better treatment effect for observed group than the control group （P 〈0.05）, and complication rate of observation group is significantly lower than the control group （P 〈0.05）. Conclusions： In refractory postpartum hemorrhage intervention therapy, the use of gauze packing combined with modified suture uterus Cho has better clinical treatment effect with high security, so it is worthy of clinical application.

A clinical comparative study of GP and TP 1st-line chemotherapies for advanced non-small cell lung cancer

Objective： The aim of the study was to evaluate the efficacies of initial gemcitabine plus cisplatin （GP） and paclitaxel plus cisplatin （TP） 1st-line chemotherapies for advanced non-small cell lung cancer （NSCLC） and observe their side effects. Methods： Eighty-one cases were randomly divided into two groups： GP group and TP group. In GP group, adminis- tered gemcitabine （GEM） 1000 mg/m2 on days 1 and 8; i.v. cisplatin （DDP） 30 mg/m2 from days 2 to 4 on a 28-day cycle. In TP group, administered paclitaxel （PTX） 175 mg/m2 on day 1, i.v. DDP 30 mg/m2 from days 2 to 4 on a 28-day cycle. Results： GP group had an overall response rate （ORR; CR＋PR） of 45.0% （18/40）. TP had an overall response rate of 43.2% （16/37）. Short-term ORR had no significant difference between two groups （x2 = 0.527, P = 0.957）. GP had median survival time of 11 months and 37.7% of one-year survival rate, while TP showed 11 months of median survival time and 31.7% of one-year survival rate. Survival had no significant difference between two groups （x2 = 0.140, P = 0.708）. However, main side effects varied. Thrombocytopenia of GP group was significantly more than that of TP group, while peripheral neuritis, nausea/vomiting and myalgia of TP group were significantly more than those of GP group. Conclusion： Both GP and TP regimens had no significant difference in short-term treatment effect and survival rate for initial treatment of advanced NSCLC. However, side effects related to GP regimen treatment were slighter. Therefore, it was considered as the preferred initial first-line treatment for NSCLC.

Clinical analysis of 45 cases of surgical treatment for inner thigh primary soft tissue sarcoma

Objective: We aimed to study the relationship between clinical effect and surgical methods of inner thigh primary soft tissue sarcomas. Methods: Wide or radical resection were performed in 45 cases of soft tissue sarcomas, including 20 cases of postoperative recurrence after radiation therapy, 7 cases of first treatment. Thirty-six cases received 4–6 cycles of postoperative chemotherapy. Results: Thirty-eight of 45 cases were followed up for 1–5 years, with 5 case of recurrence and 6 cases of distant metastasis. Conclusion: The inner thigh primary soft tissue sarcoma can be effectively treated with wide or radical resection.

Regression Model to Analyze Differential Response to Treatment in Randomized Controlled Clinical Trial

The primary aim of clinical trials is to investigate whether a treatment is effective for a particular disease or condition. Randomized controlled clinical trials are considered to be the gold standard for evaluating the effect of a certain intervention. However, in clinical trials, even after randomization, there are situations where the patients differ substantially with respect to the baseline value of the outcome variable. Many a times the response to interventions depends on the baseline values of the outcome variable. When there are baseline-dependent treatment effects, differences among treatments vary as a function of baseline level. Although variation in outcome associated with baseline value is accounted for in ANCOVA, analysis of individual differences in treatment effect is precluded by the homogeneity of regression assumption. This assumption requires that expected differences in outcome among treatments be constant across all baseline levels. To overcome this difficulty, Weigel and Narvaez [7] proposed a regression model for two treatment groups to analyze individual response to treatments in randomized controlled clinical trials. The authors reviewed the model suggested by Weigel and Narvaez and extended further for three or more treatment groups. The utility of the model was demonstrated with real life data from a randomized controlled clinical trial of bronchial asthma.

FDG-PET AS A ROUTINE SURVEILLANCE TOOL IN HEAD AND NECK CARCINOMA SIX MONTHS AFTER TREATMENT

Objective To evaluate prospectively the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography (FDG-PET) in the detection of recurrence, second primary cancers, and distant metastases in head and neck squamous cell carcinoma (HNSCC) 6 months after treatment. Methods A total of 41 patients without any clinical element for recurrence, second primary cancer, or distant metastases received a whole-body FDG-PET as a routine surveillance tool 6 months after initial combined curative therapy for HNSCC. Results There were 35 negative PET results and 6 positive. One patient with abnormal FDG-PET did not have recurrent HNSCC (false positive). Five had true positive results: proven recurrence in 2 patients, second primary cancer in 2, and distant metastasis in 1. The sensitivity and specificity of FDG-PET for the diagnosis of HNSCC recurrence, second tumor, and distant metastases were 100% (5/5) and 97.2% (35/36), respectively. The positive predictive value was 83.3% (5/6). The negative predictive value was 100% (35/35). The overall accuracy was 97.6% (40/41). FDG-PET had a therapeutic impact in 5 of 41 patients (12.2%). There was no impact of FDG-PET on management in other 36 patients. Conclusion FDG-PET is useful as primary method for detecting nodal recurrence and distant metastases in HNSCC as well as second cancer in subclinical patients as it had a high effectiveness. But systematic FDG-PET performed at 6 months in patients without any clinical suspicion of local recurrence was scarcely useful.

Microsurgical Resection of Pituitary Adenoma via Single-Nostril Transsphenoidal Approach

OBJECTIVE To explore the methods and experience of thesingle-nostril transsphenoidal approach for treating pituitaryadenomas.METHODS We retrospectively analyzed 46 patients whohad pituitary tumors and received surgery via the singlenostriltranssphenoidal approach and observed the effects andcomplications of surgery. The specific surgical methods are: a nasalspeculum is inserted slowly through the right nostril towards theanterior wall of the sphenoid sinus. A 1.5 cm incision is made intothe nasal mucosa in the right nasal cavity at the level of the middlenasal turbinate. By fracturing the bony septum, a space is formedbetween the bilateral nasal mucosa and the bony septum of thesphenoid sinus. Then, the inside of the sphenoid sinus is exposed.The remaining part of the bony septum, the anterior sphenoidsinus wall, and the sphenoid mucosa are gradually removed. Theanterior sphenoidotomy is less than 1.5 cm wide. After confirmingthe tumor by dural puncture, a cross incision of the dura is made,and the tumor is slowly removed by curette. The sella is usuallycollapsed and visible after the total tumor removal. When thetumor is resected satisfactorily, gelatin sponges are placed into theoperative cavity to stop bleeding.RESULTS Postoperative MRI scans revealed that among the 46cases, total resection of the tumor was achieved in 34 cases andsubtotal in 12. No deaths or disability occurred, and the hormonelevels of almost all patients improved. Signs of diabetes insipidusoccurred in 17, electrolyte disturbances in 5, and there were noreports of postoperative cerebrospinal fluid rhinorrhea.CONCLUSION The direct single nostril transsphenoidalapproach of continuous improvement has the advantages ofa convenient approach, simplified operation, safety and highefficiency.

Clinical observation of Fufangchangtai decoction combined with FOLFOX4 regimen for postoperative colorectal cancers

Objective:The aim of the study was to observe the therapeutic effect of FOLFOX4 regimen plus Fufangchangtai decoction on postoperative colorectal cancers.Methods:Thirty postoperative colorectal cancer patients were allocated into control and experiment groups respectively.Patients in experiment group were given Fufangchangtai decoction combined with FOLFOX4 regimen.Patients in control group were given FOLFOX4 regimen alone.Efficacy was evaluated after 2 periods of treatment.Results:The improvement rate of symptoms were 86.6% in experiment group compared to 53.3% in control group.KPS was stable in experiment group,and decreased in control group.QOL was increased in experiment group,and stable in control group after the treatment.For impact of immunity parameters,there were enhancements of CD3+ and CD4+ in experiment group,while they did not change in control group.In experiment group,WBC reduction was slighter than that of control group.The differences were not remarkable in PLT reduction,alimentary response,and toxicity of liver and kidney and nervous system.Conclusion:The clinical observation showed that Fufangchangtai decoction plus FOLFOX4 regimen could effectively enhance KPS,improve the symptoms,the quality of life and the immunity state,and down-regulate the side effects.In conclusion,Fufangchangtai decoction can decrease the toxicity so as to increase the treatment effect.

Clinical application of intraperitoneal chemotherapy before surgery for ovarian cancer and its evaluation

Objective： To investigate the clinical efficacy of intraperitoneal chemotherapy before surgery for ovarian cancer. Methods： 60 patients with stages Ⅱ-Ⅳ of ovarian cancer were treated with intraperitoneal chemotherapy of CAP or TP regimen followed by a surgery treatment and another chemotherapy for 6 cycles. And then the efficiency of the therapy was evaluated by analyzing the changes of ascites, the serum CA-125 and CA-19-9 levels and the findings in the operation, and investigating the recurrence of cancer and the survival. Results： After 1-3 cycles of intraperitoneal chemotherapy, serum levels of CA-125 and CA-19-9 and carcinous ascites significantly reduced in all patients, ascites reduce was over 50% in 98.3% cases; all cases were successfully treated with cytoreduction and it was found during the operation that bulky tumor was reduced and looser so as to be easily isolated and removed; PFS of the patients was prolonged, while the toxicity and side-effects were not so serious as beyond the patient toleration. Conclusion： Intraperitoneal chemotherapy before surgery for ovarian cancer has an active efficacy in clinic, being able to improve conditions of surgery and increase the opportunity of maximal cytoreduction, and prolong survival of the patients, and should be a good selection for the treatment of advanced ovarian cancer.