Objective To study the effects and adverse reaction of imatinib mesylate used to prevent the recurrence of gastrointestinal stromal tumor (GIST) after resection. Methods 22 patients with primary gastrointestinal stromal tumor were included in the First Affiliated Hospital of Chongqing Medical University from January, 2007 to November, 2009 who received resection and were imageologically diagnosed as no residual tumor by enhanced CT or enhanced MRI after resection. They were all given imatinib mesylate 400 mg for oral use daily after resection (median-risk GIST: more than 1 year; high-risk GIST: more than 2 years). Patients’ 1-year and 2-year relapse-free survival (RFS) and adverse reaction were recorded during follow-up. Results Among 22 patients, there were 13 males and 9 females, with median age of 57.4 years, and 9 high-risk cases were included. The median follow-up lasted 34 months (24 to 48 months). Patients’ 1-year and 2-year RFS was 100% and 94.5%, respectively. Adverse reaction mainly included edema, nausea, abdominal pain, muscle or bone pain, thrombocytopenia, weakness, skin rashes, etc., most of which were mild or moderate and could be alleviated after treating symptoms. Conclusion Imatinib mesylate therapy given after resection is a safe and reliable method which could prolong RFS and prevent or delay the recurrence of GIST. However, further high-quality randomized controlled trial was required to verify its curative effects, since no control group has been set in our study.
Objective To analyze the effects and recurrence rate of single miconazole and the miconazole plus living preparation of lactobacillus for the treatment of the uncomplicated vulvovaginal candidiasis. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2008) MEDLINE (1966 to January 2009); PubMed (1966 to January 2009); EMbase (1966 to January 2009); CNKI (1966 to January 2009), and the Chinese Biomedicine Database (CBM) (1966 to January 2009) to identify randomized controlled trials of single miconazole versus the miconazole plus living preparation of lactobacillus.The quality of the included trials was assessed. RevMan 5 software was used to conduct meta–analysis. Results Eight trials involving 5 156 patients were included in the effect analysis. Meta-analysis showed miconazole plus with living preparation of lactobacillus was better compared with just miconazole (RR=0.96, 95%CI 0.92 to 1.00, Z=2.12, P=0.03; RR=0.92, 95%CI 0.85 to 0.99, Z=2.17, P=0.03).Seven trials involving 4 852 patients were included in recurrence rate analysis. Meta-analysis showed miconazole plus living preparation of lactobacillus had lower recurrence rate compared with single miconazole (RR=3.72, 95%CI 1.94 to 7.13, Z=3.97, Plt;0.000 1; RR=12.85, 95%CI 8.27 to 19.96, Z=11.37, Plt;0.000 01). Conclusion Currently available evidence shows that the effect in the combined group is better, and the recurrence rate is lower.
现有预防非妊娠期妇女膀胱炎复发的临床证据如下:①连续预防性使用抗生素:一系列随机对照试验研究表明,连续预防性使用抗生素(甲氧苄氨嘧啶、复方磺胺甲噁唑、呋喃妥英、头孢克洛或一种喹啉)6～12个月可以减少复发性膀胱炎的发生率,但各种不同用药方案间未发现感染率有差异.一个比较持续性每日使用抗生素与性交后使用抗生素的随机对照试验表明,1年后尿培养阳性率差异无统计学意义.②性交后预防性使用抗生素(复方磺胺甲噁唑、呋喃妥英或一种喹啉):4个随机对照试验研究表明,性交后2 h内使用复方磺胺甲噁唑、呋喃妥英或喹啉较安慰剂能显著降低膀胱炎发生率.一个关于性交后预防性使用抗生素和每日连续使用抗生素的随机对照试验发现,1年后二者的膀胱炎发生率的差异无统计学意义.③一次性使用复方磺胺甲噁唑:一个小样本随机对照试验发现,连续每日预防性使用复方磺胺甲噁唑与在膀胱炎症状出现后一次性使用复方磺胺甲噁唑相比,前者能显著降低膀胱炎发生率.但由于证据太有限,不能得出肯定结论.④酸果蔓汁(cranberry juice)和酸果蔓制品:一个系统评价发现,酸果蔓汁及其制品能预防复发性膀胱炎的证据不足.⑤用马尿酸乌洛托品预防:缺乏研究马尿酸乌洛托品的可靠的随机对照试验.
目的 分析腰椎间盘突出症手术后复发的原因，探索有效的手术治疗方法。 方法 对2004年8月－2011年7月收治的32例腰椎间盘突出症术后复发再手术的患者，根据其病因采用3种不同手术方法治疗，其中椎间盘摘除术14例，椎间盘摘除联合腰椎后外侧融合内固定术7例，椎间盘摘除联合腰椎后路椎体间融合内固定术11例，术后应用改良Macnab疗效评定标准、Oswestry功能障碍指数（ODI）和影像学检查对手术治疗的临床疗效进行评价。 结果 3种手术治疗方法均取得了满意的优良率；术后3个月及末次随访ODI评分术后较术前明显降低，差异有统计学意义（P＜0.05）。 结论 腰椎间盘突出症术后复发与多种原因有关；根据复发患者的情况合理选择手术治疗方法均能取得较好的临床疗效。
【摘要】 目的 探讨对自体造血干细胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）后复发的非霍奇金淋巴瘤患者再进行异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）治疗的临床疗效。 方法 收集2000年1月-2010年12月难治性恶性淋巴瘤采用auto-HSCT后复发患者11例，病程27个月~6.5年。所有患者在auto-HSCT前均为复发难治性病例，auto-HSCT后，完全缓解8例，部分缓解3例，自体移植后中位复发时间15个月，患者复发后采用异基因亲缘造血干细胞移植，人类白细胞抗原（human leukocyte antigen，HLA）全相合（6/6）6例，5/6相合3例，4/6相合2例；性别相同6例，性别不同5例。预处理方案为FBC方案，即氟达拉滨30 mg/m2 1~5 d，白消安12~14 mg/kg分4 d口服，环磷酰胺120 mg/kg分2 d使用。移植物均为外周血造血干细胞加骨髓。移植物抗宿主病（graft-versus-host disease，GVHD）的预防：HLA全相合采用环孢素+短程甲氨蝶呤+吗替麦考酚酯，不全相合采用抗胸腺细胞球蛋白+环孢素+短程甲氨蝶呤+吗替麦考酚酯。 结果 11例患者全部获得造血重建，急性GVHD发生6例（54.55%），其中Ⅰ度、Ⅱ度4例，Ⅲ度、Ⅳ度各1例；1例Ⅳ度GVHD因合并感染死亡，5例均得到有效控制；发生慢性GVHD 7例（63.64%），其中有2例急性GVHD转为慢性，4例局限型，3例广泛型。随访8个月~9年，有4例分别于移植后8、15、21、34个月疾病复发，另外6例仍生存。 结论 allo-HSCT对于auto-HSCT后复发的非霍奇金淋巴瘤患者仍是一种有效的挽救性治疗手段。【Abstract】 Objective To explore the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on relapsing non-Hodgkin′s lymphoma after autologous stem cell transplantation (auto-HSCT). Methods The clinical data of 11 patients with recurrent non-Hodgkin′s lymphoma after auto-HSCT from January 2000 to December 2010 were collected, including nine males and 2 females with the median age of 39 years (13-48 years old), and the median duration of the disease was 3 years (27 months-6.5 years). All patients were relapsed or refractory cases. After auto-HSCT, complete remission was found in 8 and partial remission was in 3. The recurrence median time after auto-HSCT was 15 months. The patients underwent allo-HSCT after the recurrence of the disease. In the 11 patients, human leukocyte antigen (HLA) full matched (6/6) in 6, 5/6 matched in 3, and 4/6 matched in 2; the same gender in 6 and different gender in 5. FBC conditioning regimen: fludarabine 30 mg/m2 for 1-5 days, BU 12-14 mg/kg in 4 days of oral, CY 120 mg/kg in 2 days. Grafts are peripheral blood stem cells plus bone marrow. Prevention of graft-versus-host disease (GVHD): HLA full-matched by CsA+short-term MTX+MMF and mismatched by ATG+CsA+short-term MTX+MMF. Results All of the 11 patients received hematopoietic reconstruction, acute GVHD occurred in 6 cases (54.55%), including degree Ⅰ plus Ⅱ in 4, degree Ⅲ in 1 and degree Ⅳ in 1. One patient died of infection due to degree Ⅳ GVHD, and the rest had been effectively controlled. Chronic GVHD occurred in 7 patients (63.64%); limited type was in 4 in and extensive type was in 3. During the follow-up period of 8 months-9 years, 4 patients relapsed 8, 15, 21, and 34 months after transplantation, and the other 6 patients was still alive. Conclusion Allo-HSCT is effective on relapsing non-Hodgkin′s lymphoma after auto-HSCT.
目的：探讨在CT引导下经小关节内侧缘穿刺，应用造影剂观察药物分布，准确行靶位注射胶原酶［1］治疗术后复发的腰椎间盘突出症的疗效。方法:10例经临床确诊为腰椎间盘突出症术后复发的患者,在CT引导下经小关节内侧缘入路将穿刺针直接刺入突出物内,注射欧乃派0.5 ml，观察药物分布情况后，注入胶原酶600 u。临床观察患者术后6～12个月的治疗效果，用改良的Macnab方法评价疗效。结果:10例患者穿刺针均顺利准确刺入突出物，造影剂均匀分布在突出物及盘内。治疗优、良率为100%，无严重并发症。结论: CT引导下穿刺造影，观察造影剂的扩散后，再行靶位注射胶原酶对于术后复发的腰椎间盘突出症，可以进一步提高治疗效果，减少并发症的发生。
Objective To explore the surgical techniques and the clinical effect of laparoscopic transabdominal preperitoneal （TAPP） hernia repair for recurrent inguinal hernia. Methods Clinical data of 130 cases of recurrent inguinal hernia who underwent TAPP hernia repair from Mar. 2009 to Dec. 2012 in Beijing Chao-Yang Hospital of Capital Medical University were retrospectively analyzed. Results Operations were completed successfully in 129 cases and 1 case was converted to open surgery. The operation time was （54.5±16.1） min （30-100min） and the hospital stay was （4.5±2.1） d （2-11d）. The rates of postoperative pain， hydrocele， and urinary retention were 3.8% （5/130），11.5% （15/130）， and1.5% （2/130） respectively. There were no complications such as foreign body sensation，wound infection，and intestinal obstruction after operation. All cases were followed-up for 7-50 months 〔（24.3±11.3） months）〕 with no recurrence was observed. Conclusions Laparoscopic TAPP hernia repair for recurrent inguinal hernia has advantages of minimal invasion and few complications，who is safe and effective.
目的 介绍1例因外伤后耻骨缺损造成反复复发腹股沟疝的治疗经验。方法 回顾性分析该患者的诊治经过，总结治疗经验。结果 该患者在外院接受左侧腹股沟疝修补术（Lichtenstein法），术后1年左侧腹股沟疝复发，再于笔者所在医院先后接受两次手术治疗。第1次行开放的双侧腹膜前间隙无张力疝修补术，术后1年再次复发，复发原因可能是补片下界固定不可靠。第2次的术式与第1次相同，术后患者恢复良好，随访16个月无复发。结论 外伤后耻骨缺损是疝修补术后复发的主要原因，坚固有效的补片支撑点是防止再次复发的关键。