在恶性肿瘤病患者中实施预存式自体输血的临床观察

目的观察恶性肿瘤病手术患者预存式自体输血的临床效果,并了解自体输血后肿瘤病患者术后并发症、术后感染及肿瘤病复发情况。方法术前制定预存式自体输血方案,将恶性肿瘤病患者分为两组,第一组择期手术,接受预存式自体输血,作为观察组;第二组患者除术前未行预存自体血外,其它条件如年龄、手术方式、手术时间等与观察组相似,在手术中输异体血,作为对照组。对比分析两组术后并发症、术后感染及肿瘤病复发情况。结果(1)第一组63例,有2例因术中出血量大,除采取预存式自体输血外,同时加输异体血各2单位浓缩红细胞,其余患者均采取预存式自体输血;第二组60例,患者手术中全部输异体血;(2)两组输血前后各项指标除白细胞(P值<0.05)外,其它血液指标差异无显著性(P值>0.05),两组术后及术后第1天、第3天、第7天的白细胞无显著性差异(P值>0.05),观察组的术后并发症及伤口感染率要明显低于对照组(P值<0.05)。(3)术后1年左右随访,两组生存率均为100%,观察组有1例复发,对照组有2例复发,两组肿瘤病复发率差异无显著性(P值>0.05)。结论对恶性肿瘤病择期手术患者实施预存式自体输血是安全有效的。

血浆维生素D水平与恶性血液病替代供体异基因造血干细胞移植预后的相关性

目的分析血液病恶性肿瘤患者25羟基维生素D[25(OH)D]水平对替代供体的异基因造血干细胞移植预后的影响以及并发症急性移植物抗宿主病(aGVHD)的影响。方法回顾性分析2019年1月至2022年5月期间在河北燕达陆道培医院进行血浆25(OH)D浓度检测的212例患者,查阅HSCT的病例资料及其临床特点,通过Kaplan~Meier法绘制生存曲线;采用cox回归分析进行单因素、多因素分析。结果33例(15.57%)患者的25(OH)D浓度<12 ng/mL,62例(29.25%)患者的25(OH)D浓度12~20 ng/mL,72例(33.96%)患者的25(OH)D浓度20~30 ng/mL,45例(21.23%)患者的25(OH)D浓度≥30 ng/mL。多因素Cox回归分析显示25(OH)D2+D3<12 ng/mL(P<0.001)和Ⅳ度aGVHD(P=0.026;0.023)均是无白血病生存LFS和总生存OS的独立风险因素,二次移植是LFS的独立风险因素(P=0.017)。25(OH)D2+D3<12 ng/mL是aGVHD(P=0.0082)和Ⅱ~Ⅳ度aGVHD(P<0.001)的独立风险因素,年龄≥36岁是aGVHD的独立风险因素(P=0.026)。结论维生素D缺乏是影响HSCT结果的一个独立危险因素:不利于患者预后,容易发生并发症aGVHD,故应及时进行治疗干预。

基于TDM的血液病/恶性肿瘤患者使用伏立康唑的疗效与安全性分析

目的 探索在血液病/恶性肿瘤患者中使用伏立康唑血药谷浓度与抗侵袭性真菌感染的临床疗效和不良反应的关系,为制定个体化给药方案提供参考依据。方法 本研究通过对临床药师在2017年1月~2017年12月参与使用伏立康唑治疗的7例血液病/恶性肿瘤患者的治疗药物监测(TDM)数据进行回顾性分析,评价伏立康唑血药谷浓度与临床治疗效果和药物不良反应(ADR)之间的关系。结果 仅2人的初测谷浓度在1~5.5μg·mL^-1的目标浓度范围内,2人偏低,3人偏高,通过剂量调整后复测,均在治疗窗范围内。经过治疗,6人有效,1人无效。治疗过程中4人发生药物不良反应,其中2人谷丙转氨酶升高,1人发生注射部位疼痛、面色潮红,1人发生视觉障碍。结论 在血液病/恶性肿瘤患者中,伏立康唑谷浓度的个体差异较大,预测性差,应常规进行TDM,临床药师可以根据TDM结果积极参与临床治疗,为患者制定个体化给药方案,促进临床合理用药。

卫生健康委 民政部 医保局 中医药局 药监局关于开展儿童血液病、恶性肿瘤医疗救治及保障管理工作的通知

各省、自治区、直辖市及新疆生产建设兵团卫生健康委、民政厅(局)、医保局、中医药管理局、药监局:儿童的健康受到全社会关注,家庭对于患病儿童救治期望值很高。儿童血液病、恶性肿瘤病种多、治疗难度大,部分病种诊疗过程涉及多个学科或医疗机构,造成治疗周期长、医疗费用高、报销比例低、家庭负担重的情况。

检测血清IL—2R水平与ALP、LDH、γ—CT活性在消化道恶性肿瘤中的意义

检测血清ＩＬ—２Ｒ水平与ＡＬＰ、ＬＤＨ、γ—ＣＴ活性在消化道恶性肿瘤中的意义栗群英，李素华，陈威魏（成都军区总医院检验科６１００８３）白细胞介素─２（ＩＬ─２）及白细胞介素─２受体（ＩＬ─２Ｒ）在人类免疫应答中起着重要作用。ＳＩＬ─２Ｒ是ＩＬ─２Ｒ链...

恶性肿瘤心理护理探讨

恶性肿瘤是严重威胁人民身体健康的疾病,是整个社会所面临的严峻问题.除疾病本身的恶性程度外,患者的心理状态是影响患者生存率的重要因素之一,目前该病尚缺乏特效治疗手段的时候.心理护理就更具有十分重要的作用.人的心理受到生理和环境(包括自然环境和社会环境)这两方面的影响.所以,心理护理就不应局限在医院内部,而应从社会、家庭和医院这三方面进行.

胃食管恶性肿瘤内镜细针穿刺抽吸活检

食管和胃的恶性肿瘤术前组织学诊断对制定特定的治疗方法是必须的。多数情况下,内镜活检和上皮脱落细胞学检查可达此目的。我们对可疑食管和胃的恶性肿瘤病变采用了已广泛用于支气管肿瘤的经内镜细针穿刺抽吸活检法,并与内镜活检和细胞灌洗进行了比较。资料表明,该法很有价值。方法:经X线检查疑有胃或食管恶性病变的50名患者用Olympus GIF—Q型内镜从可疑病灶处取活检和脱落细胞,同时每例都进行了内镜细针抽吸活检。

血清胃蛋白酶原在胃癌早期诊断中的应用意义及价值评析

胃癌为临床常见恶性肿瘤病变,很多患者是有慢性胃炎过渡至萎缩性胃炎,最终进展为胃癌的,因而明确这一过渡过程中患者标志性血清指标特征是促进临床诊断工作改善和确保积极有效治疗的关键[1]。当前临床对胃癌的早期诊断主要通过纤维胃镜或上消化造影两大途径进行,胃镜检查结果一致作为胃癌临床诊断金标准广为推崇,但并不适用于筛查工作。近年来,随着临床医学研究的深入,

吉非替尼治疗晚期非小细胞肺癌的不良反应观察和护理分析

肺癌是现阶段发病率、病死率均居于首位的恶性肿瘤病种,而非小细胞肺癌则是其最主要的病理类型,目前对晚期非小细胞肺癌主要采取的是姑息治疗方案。吉非替尼是我国非小细胞肺癌晚期病例的二线标准治疗药物选择,多项研究证实,吉非替尼用于放化疗治疗失败的非小细胞肺癌晚期病例安全性较高,在延长该类病例的生存时间和提高生存质量方面均存在着显著的治疗优势。

Squamous cell cancer of the rectum

Squamous cell carcinoma of the rectum is a rare malignancy.It appears to be associated with chronic inflammatory conditions and infections.The clear association seen between Human Papilloma Virus and various squamous cancers has not been firmly established for the squamous cell cancer of the rectum. The presentation is nonspecific and patients tend to present with advanced stage disease.Diagnosis relies on endoscopic examination with biopsy of the lesion.Distinction from squamous cell cancer of the anus can be difficult,but can be facilitated by immunohistochemical staining for cytokeratins.Staging of the cancer with endoscopic ultrasound and computed tomography provides essential information on prognosis and can guide therapy.At present,surgery remains the main therapeutic option;however recent advances have made chemoradiation a valuable therapeutic addition. Squamous cell carcinoma of the rectum is a distinct entity and it is of crucial importance for the practicing Gastroenterologist to be thoroughly familiar with this disease.Compared to adenocarcinoma of the rectum and squamous cell cancer of the anal canal,squamous cell carcinoma of the rectum has different epidemiology, etiology,pathogenesis,and prognosis but,most importantly,requires a different therapeutic approach. This review will examine and summarize the available information regarding this disease from the perspective of the practicing gastroenterologist.

Incidence of port-site metastasis after undergoing robotic surgery for biliary malignancies

AIM： To investigate the incidence of clinically detected port-site metastasis （PSM） in patients who underwent robotic surgery for biliary malignancies. METHODS： Using a prospective database, the patients undergoing fully robotic surgery for biliary malignan- cies between January 2009 and January 2011 were in- cluded. Records of patients with confirmed malignancy were reviewed for clinicopathological data and informa- tion about PSM. RESULTS： Sixty-four patients with biliary tract cancers underwent robotic surgery, and sixty patients met the inclusion criteria. The median age was 67 year （range： 40-85 year）. During a median 15-mo follow-up period, two female patients were detected solitary PSM after robotic surgery. The incidence of PSM was 3.3%. Pa- tient 1 underwent robotic anatomatic left hemihepa- tectomy and extraction of biliary tumor thrombi for an Klatskin tumor. She had a subcutaneous mass located at the right lateral abdominal wall near a trocar scar. Patient 2 underwent robotic pancreaticoduodenectomy for distal biliary cancer. She had two metachronous subcutaneous mass situated at the right lateral abdomi- nal wall under a same trocar scar at 7 and 26 mo. The pathology of the excised PSM masses confirmed meta- static biliary adenocarcinoma. CONCLUSION： The incidence of PSIVls after robotic surgery for biliary malignancies is relatively low, and biliary cancer can be an indication of robotic surgery.

A CLINICOPATHOLOGICAL ANALYSIS OF 22 CASES OF MULTIPLE MALIGNANT TUMORS

To get a better understanding of the location,pathophysiology,etiology and prognosis of multiple malignant tumors (MPMT),we evaluated the medical records of 22 patients with MPMT.Our results suggested that radiotherapy and chemotherapy might play an important role in the pathogenesis of MPMT and follow up is important in detecting a secondary primary malignant tumor (PMT) at an early stage.Surgical removal of tumors is the first choice therapy for MPMT.

Tumor angiogenesis and its clinical significance in pediatric malignant liver tumor

AIM: To investigate the expression of vascular endothelial growth factor (VEGF) and microvascular density (MVD) count in pediatric malignant liver tumor and their clinical significances. METHODS: Fourteen children with malignant liver tumors including seven hepatocellular carcinomas (HCCs), five hepatoblastomas, one malignant mesenchymoma and one rhabdomyosarcoma were studied. Twelve adult HCC samples served as control group. All samples were examined with streptavidin-biotin peroxidase (SP) immunohistochemical staining for VEGF expression and MVD count. RESULTS: VEGF positive expression in all pediatric malignant liver tumors was significantly higher than that in adult HCC (0.4971±0.14 vs0.4027±0.03, P<0.05). VEGF expression in pediatric HCC group was also markedly higher than that in adult HCC group (0.5665±0.10 vs0.4027±0.03, P<0.01) and pediatric non-HCC group (0.5665±0.10 vs 0.4276±0.15, P<0.05). The mean value of MVD in pediatric malignant liver tumors was significantly higher than that in adult HCC (33.66±12.24 vs 26.52±4.38, P<0.05). Furthermore, MVD in pediatric HCC group was significantly higher compared to that in adult HCC group (36.94±9.28 vs 26.52±4.38, P<0.05), but there was no significant difference compared to the pediatric non-HCC group (36.94±9.28 vs 30.37±14.61, P>0.05). All 7 children in HCC group died within 2 years, whereas the prognosis in pediatric non-HCC group was better, in which two patients survived more than 5 years. CONCLUSION: Children with malignant liver tumors, especially with HCC, may have extensive angiogenesis that induces a rapid tumor growth and leads to a poor prognosis.

Biloma: An unusual complication in a patient with pancreatic cancer

The term biloma describes an encapsulated collection of bile within the abdomen, usually secondary to bile duct disruption. The commonest causes reported in the literature are iatrogenic （secondary to hepatobUiary surgery）, trauma or complications due to choledocho- lithiasis. A few cases have been reported as complica- tions of cholangiocarcinoma or acute cholecystitis. We report the case of a 64-year-old man initially diagnosed with a non-obstructive malignancy of the pancreas, who developed a spontaneous intrahepatic biloma 8 mo later. This was identified following a 1-wk history of fever, rigors and icterus. The biloma was identified on computed tomography and subsequently drained under ultrasound guidance. Forty-eight hours later, a stent was inserted endoscopically into his common bile duct and he made an uneventful in-hospital recovery. We believe this is the first documented case of spontaneous intrahepatic biloma to occur secondary to pancreatic malignancy.

Metastasis to the gallbladder:A single-center experience of 20 cases in South Korea

AIM： To evaluate the clinicopathologic characteristics of patients with metastases to the gallbladder （MGBs）. METHODS： We performed a single-center retrospective study of 20 patients with MGBs diagnosed pathologically from 1999 to 2007. RESULTS： Among 417 gallbladder （GB） malignancies, 20 （4.8%） were MGBs. The primary malignancies originated from the stomach （n = 8）, colorectum （n = 3）, liver （n = 2）, kidney （n = 2）, skin （n = 2）, extrahepatic bile duct （n = 1）, uterine cervix （n = 1）, and appendix （n = 1）. Twelve patients were diagnosed metachronously, presenting with cholecystitis （n = 4）, abdominal pain （n = 2）, jaundice （n = 1）, weight loss （n = 1）, and serum CA 19-9 elevation （n = 1）; five patients were asymptomatic. The median survival after the diagnosis of MGB was 8.7 mo. On Cox regression analysis, R0 resection was the only factor associated with a prolonged survival [hazard ratio （HR）： 0.01, P = 0.002]; presentation with cholecystitis was associated with poor survival （HR： 463.27, P = 0.006）. CONCLUSION： MGBs accounted for 4.8% of all pathologically diagnosed GB malignancies. The most common origin was the stomach. The median survival of MGI3 was 8.7 mo.

Malignant gastrointestinal melanomas of unknown origin: Should it be considered primary?

We read with interest the article entitled： ‘Jejuno-jejunal invagination due to intestinal melanoma’ by Resta , et al. They reported a rare clinical case of a young woman with a bleeding jejunal melanoma, whose early clinical presentation was an intestinal invagination. The article is also referred to the rarity of gastrointestinal melanomas as well as their possible primary nature.

Early Age of Onset, Multiple Primary Malignancies and Poor Prognosis Are Indicative of an Inherited Predisposition to Esophageal Squamous Cell Carcinoma in Familial Rather Than Sporadic Disease- An Update Based on 14- to 23-year Follow-up

OBJECTIVE To demonstrate the effects of an inherited predisposition to familial esophageal squamous cell carcinoma （ESCC） through the comparison and analysis of the clinicopathologic differences between familial and sporadic ESCC cases. METHODS Differences in age of onset, prevalence rates of double primary ESCC, and survival rates between familial ESCC （n = 476） and sporadic ESCC cases （n = 1226） were analyzed. RESULTS Overall, familial ESCC cases showed a significantly younger age of onset （51.9±8.2 vs. 53.4 ±8.0, Pt.test = 0.00）, a significantly higher prevalence rate for double ESCC （2.73 % vs. 1.22%, adjusted with TNM：χMH2 = 4.029, P = 0.045）, and a lower survival rate than in sporadic cases （Pwald = 0.04）. The familial cases showed both a younger age of onset and poorer survival in most subgroups, and the differences were more marked in early-stage rather than in the .late-stage disease groups. CONCLUSION Theses findings confirm the existence of familial as opposed to sporadic ESCC. By the theory of the ＂two-hit＂ origin of cancer, these findings also suggest that the ＂first hit＂, a genetic predisposition, can affect the age of onset, number of primary carcinomas, and the prognosis for familial ESCC patients.

Female breast cancer in Vietnam: a comparison across Asian specific regions

Breast cancer is one of the most commonly diagnosed malignancies and the leading cause of cancer death of women over the world. A large number of females with breast cancer in Vietnam and other Southeast Asian(SEA) countries present at an early age with more aggressive tumors compared with women in Australia. Despite experiencing a low incidence rate, the increasing incidence rate among SEA countries exceeds that of the Westernized world. Changes in reproductive factors, environmental exposures, and lifestyle are the possible causes of this trend. However, limited evidence shows that these factors are associated with breast cancer in the Vietnamese population. Breast cancer incidence rates within Vietnam are not uniform and appear to be dependent on geographic location. Findings from this review have important implications for breast cancer control and treatment in Vietnam. A good understanding of the morphology of the breast and the type and nature of breast cancers presenting in Vietnam is required to facilitate the introduction of an effective national breast screening program.

Successful isolation of Helicobacter pylori after prolonged incubation from a patient with failed eradication therapy

Helicobacter pylori(H pylori),a gastric pathogen,is a major cause of chronic gastritis and peptic ulcer disease,and is an important risk factor for the development of gastric malignancies.Culture of the bacterium from gastric biopsy is essential for the determination of drug resistance of H pylori.However,the isolation rates of H pylori from infected individuals vary from 23.5%to 97% due to a number of factors such as biopsy preparation,cultural environment,medium and the method adopted.In the present case,we found that a prolonged incubation period of up to 19 d allowed successful isolation of H pylori from a patient who received triple therapy that failed to eradicate the bacterium.