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Objective To distinguish choriocarcinoma from gestational or non-gestational choriocarcinoma and also identify the causative pregnancy of gestational choriocarcinoma by the genetic origin through molecular genetic analysis. Methods Twelve patients with choriocarcinoma, who had experienced surgery prior to chemotherapy were enrolled in this study. All 12 cases were diagnosed pathologically as choriocarcinoma. Peripheral venous blood samples and formalin-fixed paraffin-embedded blocks of choriocarcinoma tissue microdissected from haematoxylin and eosin-stained sections of tissue by microdissection method were available from the patient and (or) her husband. DNA was then prepared from the couples' blood samples and choriocarcinoma tissue by using standard techniques. PCR amplification and fluorescent microsatellite genotyping were performed by using DNA from the couples and captured choriocarcinoma tissues. The genetic contributions to the choriocarcinoma tissue were determined by comparing the fragments of genes from the choriocarcinoma tissue to those from blood samples of the couples. Results The primary lesion was ovary in 7 cases, but only 4 of them had the maternal contribution, indicating a non-gestational origin; the other three were gestational choriocarcinoma. The primary lesion was uterus in 5 cases, which were all gestational choriocarcinoma confirmed by genetic analyses. The causative pregnancies of the 8 cases with gestational choriocarcinoma were identified as androgenetic complete hydatidiform mole (AnCHM) in six cases and normal pregnancies in two cases, respectively. Conclusion Microsatellite polymorphism analysis is a molecular approach for distinguishing the non-gestational choriocarcinoma from the gestational one, and also be used to identify the causative pregnancy of gestational choriocarcinoma.
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Objective To know the indication for patients with spinal cord injury during the course of intermittent urethral catheterization.Methods Divided 33 patients with spinal cord injury into the experimental group(18 cases)and control group(15 cases)randomly.The indication of beginning in the experiment group was less than 500 ml transfusion per day,without press ulcer,more than 150 ml bladder capacity.The indication in the control group was＞28 cm H2O pressure of bladder.Compared the effects between the two groups.Results The incidence rate of infection in the experiment group was lower than control group,all the indexes of uretharal catheterization were better in the experiment group than those of in the control group.Conclusions The indication of less than 500ml transfusion per day,without press ulcer,more than 150 ml bladder capacity are proper.
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Objective To evaluate the efficacy of surgical management combined with chemotherapy in the treatment of drug-resistant gestational trophoblastic neoplasm(GTN)patients,and investigate factors influencing the outcome of the surgery combined with chemotherapy.Methods Medical records of 42 patents with drug-resistant GTN who were treated by chemotherapy combined with surgical management at Peking Union Medical College Hospital from Jan 1996 to Jan 2006 were reviewed.Results Among 42 patients,32 achieved serologically complete rendssion(SCR)with an SCR rate of 76%,and 10 patients had a treatment failure.Treatment failure was more frequently geen in patients who also had metastasis of other sites except for lungs and vagina and patients with antecedent non-molar pregnancy (P=0.023 and 0.017,respectively).Preoperative human chorionie gonadotropin-beta subunit(β-hCG)titer>10 U/L (P=0.020),failure to reach normal serum titers of β-hCG during treatment(P=0.003),age ≥35 years (OR:12.6,95%CI:2.4-66.0,P=0.002)and preoperative chemotherapy regimens≥4(OR:4.5,95% CI:1.0-20.1.P=0.059)were also correlated with treatment failure.All the 10 patients with treatment failure had at least 3 of 6 above mentioned predictors of treatment failure.Conclusions Surgical management combined with chemotherapy is effective in the treatment of drug-resistant GTN.Age≥35 years,antecedent non-molar pregnancy,metastasis of other sites except for lungs and vagina,preoperative β-hCG titer>10 U/L,failure to reach normal serum titers of β-hCG during treatment,and preoperative chemotherapy regimens≥4 are significant predictors of treatment failure.Patients with 3 or more predictors of treatment failure usually have poor prognosis.Therefore,surgical management should not be performed for these patients.
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Objective To investigate the effect of sumical resection in the management of gestafional trophoblastic neoplasia(GTN)patients with pulmonary metastases.Methods A retrospective review of the medical records of 62 GTN patients who underwent pulmonary resection was carried out.The cases were divided into recurrent group(group A,,l=10),drug-resistant group(group B,n=28),and the group with satisfactory response to chemotherapy but residual pulmonary lesion(s)(group C,n=25).One patient underwent lobectomy twice,and she was allocated simultaneously to groups A and B.The patients'median age,antecedent pregnancy,International Federation of Gynecology and Obstetrics(NGO)risk score,number of preoperative chemotherapy courses,preoperative β-human chorionic gonadotrophin (β-hCG)titer,lesion size,number of lobes affected,positive rate of histology,follow-ups and prognosis were compared between the three groups.Results The proportion of hish-risk patients in the three groups wag 90%,82%and 44%,respectively.The complete remission rates of the three groups were 90%,79%and 100%,with relapse mtes of 2/8,15%and zero,respectively.Positive histology of the resected specimen wasmore frequently recognized in recurrent and drug-resistant groups(A 60%,B 36%,C 12%).In the drug-resistant group there were more preoperative chemotherapy 8essiorls(A 3,B 7,C 5)and more patients with abnormal preoperative B-hCG titer(A 50%,B 61%,C 12%).Conclusions Surgical resection is effective in the treatment of pulmonary metastases of GTN.Surgery is indicated when clinical evidence suggests that pulmonary metastatic disease causes relapse or drug—resistance and the lesions are relatively localized.Surgical resection is not recommended for patients with satisfactory response to chemotherapy but residual pulmonary lesions.
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@#Objective To study a rehabilitation nursing menus for neurogenic large intestine dysfunction.Methods Various nursing approaches were used for defecation dysfunction.Results and Conclusion 94.60% patients improved in the second week,which including gained more awareness,control,and spend less time of defecation.
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@#ObjectiveTo investigate the human resources arrangement of rehabilitation wards in general hospital.MethodsAll works of the nurses in a rehabilitation ward within 7 days were recorded with data of average man hour of Taiwan's Hospital as the standards, the daily working hours of the related number of the nurses were calculated correctly on the missing items.Resultsthe ratio of beds to nurses was 1∶0.45, the work consumed the longest time was transfusion, others followed were medical observation, distribution of medicines, prevention of bedsore, change of bed sheets and health education and so on.ConclusionThe number of hours of rehabilitation care is to be increased; it will be more reasonable to arrange rehabilitation care training in the evenings.
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@#ObjectiveTo investigate the human resources arrangement of rehabilitation wards in general hospital.MethodsAll works of the nurses in a rehabilitation ward within 7 days were recorded with data of average man hour of Taiwan's Hospital as the standards, the daily working hours of the related number of the nurses were calculated correctly on the missing items.Resultsthe ratio of beds to nurses was 1∶0.45, the work consumed the longest time was transfusion, others followed were medical observation, distribution of medicines, prevention of bedsore, change of bed sheets and health education and so on.ConclusionThe number of hours of rehabilitation care is to be increased; it will be more reasonable to arrange rehabilitation care training in the evenings.
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@#目的探讨康复患者使用经外周置入中心静脉导管(PICC)的可行性。方法对康复组16例住院患者行PICC,并与非康复组行PICC的12例患者进行对照观察,分别观察留管时间、局部症状、全身症状等。结果康复组与非康复组的留管时间、局部症状、全身症状无显著性差异。结论康复治疗活动对PICC的留管时间等无影响,PICC对康复治疗也无影响,进行康复治疗的患者可行PICC。
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@#目的探讨住院偏瘫患者的“偷行”行为与跌倒的关系,以防止患者跌伤。方法自制“偏瘫患者偷行动机与行动问卷”调查表,发给404例住院偏瘫患者填写或由他人协助填写。结果56.93%的被调查患者有偷行动机,5.44%有偷行行为,占有偷行动机人数的9.48%,发生跌倒的占有偷行行为的86.36%,跌倒患者中出现跌伤者占10.52%。结论偏瘫患者中普遍有偷行动机,相当一部分患者有偷行行为,偷行者跌倒率高,容易跌伤,故偷行行为是引起住院偏瘫患者跌伤的主要原因之一 ,应引起医护人员重视,并列为评估患者跌倒因素的内容之一。
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@# ObjectiveTo research a way to verify whether the stomach duct is misplaced into the trachea.MethodsThe air pressure of the stomach duct placed in the stomach or in the trachea were measured using a water bottle.ResultsThe air pressure of the stomach duct was (1±0.45)cmH2O When it was put in the stomach, and was (7±2.03)cmH2O when it was put in the trachea(P<0.01).ConclusionsWhen it is impossible to draw out acerbic substances from the stomach to verify whether the stomach duct is placed in the stomach or misplaced in the trachea, measure the air pressure stomach duct by a water bottle can be used as substitute, which is reliable and convenient.
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@#目的观察水封瓶排除偏瘫患者鼻饲前胃管误入气管的效果。方法将胃管与水封瓶连接,检测胃管前端的压力,通过观察水封瓶内的水柱波动范围来判断胃管的位置,以确定胃管是否误入气管。结果此法经过28例,78次测量,无一次判断失误,及时发现4例患者胃管部分脱出。结论用水封瓶检测判断胃管是否误入气管,是一种客观、可靠、简便的方法。
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@#目的帮助截瘫患者解决便秘的痛苦及促进排便功能的恢复。方法卫生棉条刺激排便和定时排便训练。结果治疗组的有效率为90.49% ,明显高于对照组的33.33%(P<0.01)。结论棉条刺激和定时排便训练能使患者短时间内大量排便并对排便功能的恢复有促进作用。
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Objective To study the diagnosis, management and prognosis of intracranial metastases of gestational trophoblastic tumour (GTT) patients who had emergency surgical decompression due to highly increased intracranial pressure. Methods Ninety-three patients with intracranial metastases of gestational trophoblastic tumour were hospitalized in our department of Peking Union Medical College Hospital from 1985 to 2004. Thirteen of them who underwent emergency craniotomy were retrospectively analyzed, and all of them presented with raised intracranial pressure and intracerebral haemorrhagic mass. Result Of the thirteen patients who underwent surgery in combination with multiagent systemic chemotherapy, seven achieved complete remission(CR), five had partial remission(PR), and one died of disease progression. Conclusions Emergency surgical treatment is the important method of choice for brain metastasis in patients displaying rapidly deteriorating signs. An undetermined intracranial haemorrhage in young female patients of reproductive age group should raise the suspicion of cerebral metastatic choriocarcinoma.
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Objective To investigate the clinical characteristics, management and prognosis of gestational trophoblastic disease in women aged 50 years or more. Methods Thirty-eight cases of gestational trophoblastic disease in women aged 50 years or more, who were treated in Peking Union Medical College Hospital between 1992 and 2002, were reviewed retrospectively. Results The median age was 52 years (range from 50 to 58 years ). The lesions included 5 hydatidiform moles (13%), 19 invasive moles (50%), 12 choriocarcinomas (32%) and 2 placenta site trophoblastic tumors (5%). All of 38 cases presented with abnormal vaginal bleeding. Twenty-three cases of hydatidiform moles were diagnosed at their first visit to the hospital, and 15 of them received prophylactic chemotherapy, of whom 10 progressed to invasive mole, 3 developed lung metastasis. All of the other 8 cases without prophylactic chemotherapy progressed to malignant changes with metastasis of lung. The use of prophylactic chemotherapy reduced the incidence of subsequent metastasis. All of 38 cases received chemotherapy. Thirty-two cases underwent hysterectomy, complete remission was achieved in 91% of patients; complete remission was achieved in 2 of 6 patients without hysterectomy. Conclusions The diagnosis of pregnancy and pregnancy-related disease should be considered in the elderly women presenting with abnormal vaginal bleeding. Once gestational trophoblastic disease in women aged 50 years or more is diagnosed, chemotherapy should be given as soon as possible. Hysterectomy is frequently required to improve the prognosis of gestational trophoblastic disease in the elderly women.
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Objective To establish the drug resistant cell line of choriocarcinoma and to study the transfection of the human interleukin 2 (hIL 2) gene into the established drug resistant cell line and investigate the reversal of the multidrug resistance Methods The resistant cell line was established by pulse exposed choriocarcinoma cell line JEG 3 to etopside (VP 16) for ten months The recombinant plasmid containing pcDNA3 1(+) hIL 2 gene was constructed The drug resistant cell line was transfected with the constructed plasmid by lipofectin, and the tumor cell colonies containing the IL 2 sequence were selected by genetin The expression of hIL 2 and drug resistant related genes was detected by reverse transcript polymerase chain reaction The chemosensitivity of the gene transfected tumor cells and the non transfected cell lines to methetraxate, VP 16, kengshengmycine, paclitaxol and 5 fluorouracil was determined by the methyl thiazolyl tetrazolium cytotoxicity assay Results The transfected cells expressed human hIL 2 gene, and showed the reversal of multidrug resistance by methyl thiazolyl tetrazolium assay The transfected cells expressed no multidrug resistance gene 1 (MDR1) on mRNA level Drug resistance index to VP 16 decreased from 38 7 to 6 0 and 6 1, the index to methetraxate decreased from 14 5 to 2 6 and 2 5, to methetraxate from 13 0 to 2 0 Conclusion The transfection of hIL 2 gene into the drug resistance cell line of choriocarcinoma can modulate the MDR1 expression on the mRNA level, and reverse the drug resistance