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Objective To observe the incidence of adverse reactions and short-term efficacy of S-1 and concurrent intensity-modulated radiotherapy ( IMRT) for locally advanced gastric cancer in a phase Ⅱclinical trial based on the phase I clinical trial.Methods Patients pathologically diagnosed with stage TN (+) gastric adenocarcinoma with local or distal metastasis after R0 resection were enrolled as subjects.IMRT was delivered 5 times per week with a total dose of 45 Gy in 25 fractions.S-1 was orally administered on the day of radiotherapy at a dose of 80 mg/m2 .Results A total of 40 patients, consisting of 6 patients from the phase I trial and 34 patients from the phaseⅡtrial, were enrolled in this study.In those patients, the age ranged between 27 and 73 years ( median age 50 years) and the male-to-female ratio was 3:1.Thirty-nine ( 98%) out of the forty patients completed radiotherapy and thirty-five ( 88%) completed concurrent chemotherapy.The most common grade 3-4 adverse reactions were nausea/anorexia ( 13%) , leukopenia ( 10%) , vomiting ( 8%) , radiation esophagitis ( 5%) , and neutropenia ( 5%) .There was no perioperative death.The 2-year overall survival and disease-free survival rates were 74% and 77%, respectively. Conclusions Postoperative S-1 and concurrent IMRT achieve satisfactory outcomes and tolerable toxicity in patients with locally advanced gastric cancer.
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Objective Primitive neuroectodermal tumor ( PNET) is a small round cell tumor occurring mostly in children or young adults and categorized into the Ewing sarcoma family of tumors, the purpose of the study was to investigate the clinical features, treatment and prognosis of Children PNET. Methods A retrospective study was performed on clinical data of 13 children with PNET hospitalized in our hospital from March 2010 to Octorber 2014.In order to analyze the clinical effects and prognostic results, statistical analysis was made on their clinical manifestations, CT and ultrasonic results, therapeutic schemes, postoperative pathology and immu-nohistochemical staining results, along with telephone and outpaitient follow-up of average 19 months. Results Of the 13 patients, 4 cases were central nervous system PNET(CNS-PNET) and 9 cases were peripheral PNET(pPNET).The clinical manifestations of the former were headache, vomiting, convolsion, movement disorder or decreased muscle strength, while the latter mainly showed mas-ses and abdominal distention.3 cases with metastasis to lung, lymph nodes and bones respectively showed masses on surface or in cavi-ty in imaging.Homer-Wright pseudorosette textures were found in 12 patients.Immunohistochemical results showed 11 cases with CD99(+), 9 cases with VIM(+) and 8 cases Syn( +).Among 11 patients underwent chemotherapy, 2 cases were lost to follow-up, 7 cases were in stable condition without occurrence and the other 2 cases recurred 4-6 months after chemotherapy.3 of 4 cases with CNS-PNET survived with the sequelae of decreased muscle strength, convolsion and movement disorder.1 case with CNS-PNET and 1 case with pPNET died 7 months and 16 months after diagnosis respectively. Conclusion PNET in children is a very highly malignant tumor with low long-term survival rate.Immunohistochemi-cal examination including CD99 and VIM is of important diagnostic value and CNS-PNET is prone to sequelae.
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Objective To assess the efficacy and safety of CyberKnife radiotherapy in the treatment of locally advanced pancreatic carcinoma. Methods The data of 59 patients with locally advanced pancreatic carcinoma who were treated with CyberKnife radiotherapy from 2006 to 2014 were retrospectively analyzed. The tumor volume ranged from 13?? 0 cm3 to 125?? 1 cm3 with a median value of 27?? 1 cm3 . A dose of 35?50 Gy (median value= 45 Gy) in 3?8 fractions (median value = 5 fractions) was prescribed. The tumor progression was evaluated based on computed tomography. The overall survival (OS) and local progression?free survival ( LPFS) rates were calculated using the Kaplan?Meier method. Results The 1?and 2?year sample sizes were 26 and 17, respectively. The 1?and 2?year OS rates were 54% and 35%, respectively, while the 1?and 2?year LPFS rates were 91% and 70%, respectively. The median OS and LPFS times were 12?? 5 and 10?? 9 months, respectively. The overall incidence of grade 1?2 acute and late gastrointestinal toxicity was 61%. One patient with grade 3 late gastrointestinal toxicity had incomplete intestinal obstruction. Conclusions CyberKnife radiotherapy can achieve excellent treatment outcomes and mild complications in the treatment of locally advanced pancreatic carcinoma.
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Objective To improve the understanding of bacteria bolt in upper urinary tract,and to investigate its diagnosis and treatment.Methods The clinical data of 11 cases with bacteria bolt in upper urinary tract were reviewed retrospectively.The clinical manifestation and treatment were summarized.Results Infection and obstruction were the clinical manifestation.Two-stage treatment was provided.Ureteral stent was indwelled in two cases,and percutaneous nephrostomy was provided at the first stage in the other 9 cases.Then the bacteria bolt was taken by ureteroscopy (1 case) or by percutaneous nephrostomy (10 cases) when the condition improved.The second stage operation took 37 min on average (ranged from 20 to 55).Estimated blood loss 60 ml on average (ranged from 10 to 200 ml).Hemoglobin decreased 5.1 g/L (3-11 g/L) 48 hours after operation in the 10 cases underwent percutaneous nephrostomy.Bolt-free rate was 100％.There was no infectious shock occurred.No relapse was observed during the 16 months of follow-up.Conclusions Bacteria bolt in upper urinary tract is not common.Infection and obstruction are its manifestation.Two-stage treatment is safe and effective.
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Early stage Hodgkin' s lymphoma (HL) is highly curable with abbreviated chemotherapy plus involved-filed radiotherapy or chemotherapy alone,but the role of radiation remains the subject of debate and disagreement.The management of recurrent or refractory HL remains challenging with limited effective treatments except high dose therapy with autologous stem cell transplantation.Emerging new safe and effective drugs such as brentuximab vedotin might promisingly improve the outcome of these patients in the future.The interim positron emission tomography (PET-i) scan has important prognostic value in patients with early and advanced stage HL,especially PET scan after 2 cycles.However,the PET-i guided treatment decisions are not currently recommended outside clinical trials.
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La púrpura trombocitopénica idiopática es una enfermedad hemorrágica autoinmune relativamente frecuente. Se realizó un estudio retrospectivo en 141 pacientes atendidos entre los años 1983 y 2003, con el objetivo de evaluar los resultados terapéuticos obtenidos en esta enfermedad. Del total evaluado, el 98,6 % necesitó tratamiento con diferentes esquemas terapéuticos y el 1,4 % restante mostró remisiones espontáneas. La modalidad de primera línea (tratamiento esteroideo) fue aplicada al 97,1 % de los pacientes al momento del diagnóstico inicial; la mayoría respondió favorablemente (65,7 %). La esplenectomía fue la segunda modalidad terapéutica, realizada al 54,6 % de los enfermos, que resultó en largos períodos de remisión (62 %, 59,7 % y 54,5 % de respuesta completa sostenida a los 3, 6 y 12 meses posesplenectomía). El tratamiento de tercera línea fue empleado en el 29,1 % de los casos refractarios a las terapias escogidas, con un índice de respuesta del 61,0 %. La prednisona sola o combinada fue el agente terapéutico más utilizado después del fracaso con los esteroides y/o esplenectomía. Los inmunosupresores y los alcaloides de la vinca fueron los más efectivos en estos casos, con 60 % y 71,4 % de respondedores. Se encontró significación estadística al evaluar la respuesta obtenida por línea de tratamiento al mes y a los 6 meses, y al comparar la respuesta inicial según la edad.
Diopathic thrombocytopenic purpura is a relatively common autoimmune hemorrhagic disease. A retrospective study was conducted among 141 patients that received attention from 1983 to 2003 aimed at evaluating the therapeutic results obtained in this disease. Of the total of evaluated patients, 98.6 % needed treatment with different therapeutic schemes and the other 1.4 % showed spontaneoous remissions. The first-line modality (treatment with steroids) was applied to 97.1 % of the patients at the moment of the initial diagnosis. Most of them had a favorable response (65.7 %). Splenectomy was the second therapeutic modality and it was performed in 54.6 % of the sick. It had long periods of remission (62 %, 59.7 % and 54.5 % of sustained complete response at 3, 6 and 12 months postsplenectomy). The third-line treatment was used in 29.1 % of the cases refractory to the therapies selected, with an index of response of 61.0 %. Prednisone alone or combined was the most used therapeutic agent after the failure with steroids and/or splenectomy. The immunosuppressors and alkaloids from Vinca were the most efficient in these cases, with 60 % and 71.4 % of responders. Statistical significance was found on evaluating the response attained by the treatment line at one month and at six months, and on comparing the initial response according to age.
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Objective To observe the changes in serum High Sensitive C-reactive Protein(hs-CRP)in newly dignosed type 2 diabetic patients after treament with short-term intensive insulin aspart and investigate the relationship of inflammatory factors with insulin resistant.Methods30 newly dignosed ty 2 diabetic were treated by 14 d intensive aspart treament,the levels of fasting plasma glucose(FPG),2hours postprandial glucose(2hPG),insulin and C-peptide,hs-CRP,the mean area under the curve(AUC)of insulin and C-peptide,insulin resistance index(HOMA-A),insulin secretion index(HOMA-B)were compared before and after transient intensive nsulin aspart treament.ResultsAfter the treament,FPG,2hPG,hs-CRP and HOMA-A were significantly decreased(P
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OBJECTIVES: The pharmacologic treatment of obsessive-compulsive disorder(OCD) with serotonergic antidepressant agents is well established in clinical psychiatry on the basis of serotonin hypothesis. Studies on predictive factors of treatment response to OCD are relatively scarce. The author compared the demographic factors, age of onset, length of illness, family history of mental illness, previous drug history for OCD, severity and type of symptoms between the drug responders and non-responders to find out the predicitive factors that may be related to treatment response. METHODS: The subjects were 31, both inpatients and outpatients who met the diagnostic criteria for OCD by DSM-IV and scored 20 or higher on the Yale-Brown Obsessive-Compulsive Scale(Y-BOCS) completed 12-week trial of sertraline. Y-BOCS, National Institute of Mental Health Obsessive-Compulsive Scale(NIMHOCS), Clinical Global Impression Scale(CGI) were scored to measure the changes of obsessive-compulsive symptoms, and Hamilton Anxiety Scale(HAM-A) was measured at each visit. RESULTS: 1) The responders, defined as achieving at least a 40% decrease in the Y-BOCS total score and more than a 2 point decrease in CGI score, were 17(54.8%), and non-responders were 14(45.2%). Responders tended to show later onset(p<0.1), and shorter duration of illness(p<0.05), and less previous drug therapy for OCD(p<0.05) than non-responders. There were no significant differences in family history of mental illness between the two groups. 2) The baseline Y-BOCS compulsive score was significantly lower in responders(p<0.05), although there was no significant difference in the baseline severity of other measures. 3) The obsession of contamination and washing behaviors were more frequent, but compulsive counting was not shown, in responders(p<0.05). The pathological doubt tended to be more common in nonresponders(p<0.1). CONCLUSIONS: In summary, the patients with shorter duration of illness, less prior drug therapy for OCD, and less severe compulsive behaviors, and the obsession of contamination and washing behaviors are expected to be better outcome with sertraline, whereas compulsive counting are the predictor of poor response.
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Humans , Age of Onset , Anxiety , Compulsive Behavior , Demography , Diagnostic and Statistical Manual of Mental Disorders , Drug Therapy , Inpatients , Obsessive Behavior , Obsessive-Compulsive Disorder , Outpatients , Serotonin , SertralineABSTRACT
Inappropriate treatment of the injury of the lateral collateral ligaments of the ankle produce residual instability, which causes serious disability. There is considerable divergence of opinion as to whether fresh rupture of the lateral ligaments of the ankle are best treated by conservative or opreative method. We have conducted a trial to analyze thirty patients, who were treated by immediate open surgical rupair of rupture of the lateral ligaments of the ankle between April 1991 and February 1992. The results were as follows: 1. All patients were active, young men, Injuries to left ankle were three times more than right side. The most common cause of injury is occurred during sports, especially association football. 2. The decision to operate was based on 1)Talar tilt angle of the injured ankle measures 8-10 degrees more than that of the stress uninjured ankle. 2)A positive arthrogram showing contrast leakage into peroneal tendon she-aths & anterolateral aspect of the lateral malleolus. 3. Diagnostic accuracy rate of arthrography is 94.5%, stress radiography 61.1 %. Arthrography is more reliable than stress radiography in the diagnosis of acute injuries to the lateral ligament of the ankle. 4. At operation, isolated rupture of anterior talofibular ligament was in 5 cases, isolated rupture of middle calcaneofibular ligament in 3 cases, concomittant ruptures of anterior talofibular and middle calcaneofibular ligements in 22 cases. 5. Location of tears of anterior talofibular ligament was mostly mid-portion, middle calcaneofibular ligament in mid-portion or distal portion. 6. On radiologic results, average angle of talar tilt was 14.4° preoperatively, 5.2 preoperatively. There was correction of talar tilt angle of average 9.2°. 7. Clinical results of treatment were excellent in 9 patients, good in 6 patients, fair in 4 patients, poor in 2 patients by authors rating system. The satisfactory result was achieved in 15 patients(71.4%). 8. Postoperative complication was reduced mobility in 4 cases, functional instability 1 case, neuroma in operation scar in 2 cases, minor sensory loss in 4 cases. 9. Primary surgical repair gave good results in the aspect of radiologic & fun ctional instability, but clinical results were not satisfactory, due to high incidence of postoperative complication.
Subject(s)
Humans , Male , Ankle , Arthrography , Cicatrix , Collateral Ligaments , Diagnosis , Football , Incidence , Lateral Ligament, Ankle , Ligaments , Methods , Neuroma , Postoperative Complications , Radiography , Rupture , Sports , Tears , TendonsABSTRACT
The incidence of trochanteric fracture of the femur is increasing, which is likely to continue for many years because of an increase in traffic accidents and the population of elderly people. The primary goal in the treatment of an elderly patient with an intertrochanteric hip fracture is to return the patient to his prefracture activity without any complication, as soon as possible. Rapid mobilization with stable internal fixation helps to prevent skin ulceration, pneumonia, urinary stasis, thromboembolic disease and other complications of confinement to bed in the elderly. Stable internal fixation depends mainly upon the fracture type and operative techniques. A clinical study of operative techniques was done in twenty three patients with trochanteric fracture of the femur who had been admitted and treated surgically at the Orthopaedic Department of W.M.B.H. during of two years from Mar. 1982 to Feb. 1984. The following are brief descriptions of the operative techniques. l. An L-shape incision and refiection of the vastus lateralis muscle provided wide exposure and facilitated anatomical reduction under direct vision. 2. The nail insertion site was selected at a slightly eccentric position anterior to rather than exactly midway from the opposite lateral cortex of the lesser trochanter. Therefore the nail could be laid rigidly between the thick anteromedial cortex and the posteromedial calcar portion. 3. The best stable position among the fracture line, the neck shaft angle and the nail plate could be obtained by the yoking procedure. It also allowed for later proximal migration of the shaft fragment and fracture impaction without impingement on the base of the barrel.