Adrenal cortical carcinoma (ACC) is a rare neuroendocrine tumor with concealed onset and rapid progression. Adults often seek treatment with abdominal mass pain. ACC has the characteristics of endocrine tumor, but its obvious masculinization in women is relatively rare. This article reports a case of a woman who presented with signs of androgenesis and a large abdominal mass. After multidisciplinary discussions, a retroperitoneal mass resection was performed, and a pathological diagnosis of adrenal cortical cancer was made. After the surgery, etoposide and carboplatin were used as adjuvant chemotherapy for 6 cycles. No metastasis or recurrence was found after a follow-up of 6 months.

目的 探讨乙型肝炎病毒(HBV)相关性肝细胞癌(HCC)患者在接受根治性切除术前后血清乙肝病毒抗原(HBsAg)水平变化对预后的预测作用.方法 回顾性分析165例接受根治性切除治疗的HBV相关性HCC患者的临床资料并进行随访.根据术前或术后血清HBsAg水平将患者分为HBsAg高水平组(>200 ng/ml)及HBsAg低水平组(≤200 ng/ml).采用Kaplan-Meier及Log-rank检验比较患者总生存率(OS)和无复发生存率(RFS)差异.采用Cox多因素风险模型对影响患者预后的危险因素进行分析.结果 术前HBsAg低水平组与高水平组的1年OS分别为90.5％、85.3％,3年OS分别为78.0％、70.6％,差异有统计学意义(P<0.05);1年RFS分别为72.3％、67.2％,3年RFS分别为60.8％、50.6％,差异有统计学意义(P<0.05).术后血清HBsAg低水平组与高水平组的1年OS分别为92.6％、88.6％,3年OS分别为80.9％比、72.8％,差异有统计学意义(P<0.05);但两组患者的1年RFS分别为68.3％、72.1％,3年RFS分别为50.6％、45.0％,差异无统计学意义(P>0.05).术后HBsAg上升组与下降组的1年RFS分别为74.1％、73.6％,3年RFS分别为51.1％、57.5％,差异无统计学意义(P>0.05);术后1年OS分别为86.3％、94.9％,3年OS分别为72.8％、84.8％,差异有统计学意义(P<0.05).风险因素分析显示,是否接受抗病毒治疗、HBsAg水平、谷草转氨酶(AST)、甲胎蛋白(AFP)及肿瘤直径是影响患者OS的独立性因素(P<0.05).是否接受抗病毒治疗、HBsAg、AST、谷丙转氨酶(ALT)、AFP及肿瘤直径是影响患者RFS的独立性因素(P<0.05).结论 血清HBsAg水平可作为预测接受根治性肝切除术后肝癌患者预后的潜在指标,手术前后的HBsAg水平越低,患者预后越好.

目的 对比绝经后激素受体阳性晚期乳腺癌一线内分泌治疗失败后使用氟维司群与依西美坦进行二线治疗的疗效和安全性.方法 回顾性分析2016年1月至2018年12月该院肿瘤科收治的72例一线内分泌治疗后进展的绝经后晚期乳腺癌患者的临床资料,分为氟维司群组和依西美坦组,每组36例.氟维司群组给予剂量为500 m g(每28天肌内注射1次)、依西美坦组给予剂量为25 mg(每天口服1次)进行二线内分泌治疗.主要观察指标为无进展生存时间和临床获益率,次要观察指标为不良事件.结果 氟维司群组患者中位无进展生存时间明显长于依西美坦组,临床获益率明显高于依西美坦组,差异均有统计学意义(P<0.05).氟维司群组患者注射部位反应较为常见.2组患者均出现乏力、潮热、头痛、恶心、关节疼痛等Ⅰ ～ Ⅱ级不良反应.结论 绝经后激素受体阳性晚期乳腺癌二线内分泌治疗采用氟维司群的疗效优于依西美坦,不良反应均可耐受.

Objective To investigate the cancer pain status and cancer pain control satisfactory in Longquanyi District of Chengdu city,in order to provide the basis for the improvement of local cancer pain management. Methods The self-designed pain questionnaire survey was conducted on 450 cancer patients who were diagnosed and treated in oncology department of three hospi-tals from January 2015 to December 2015 in the area. Results The incidence rate of cancer pain was 49. 8% in 450 cancer pa-tients,and the satisfaction rate of cancer pain control was 70. 1%. For the main factors affecting cancer pain control satisfactory,the survey showed that for physician they were poor patient compliance,not smooth drug supply,and insufficient dosage; for patients they were fear of adverse drug reaction,refusing to use or refusing to increase the amount because of fear of addiction,and poor an-algesic effect of oral drugs. Conclusion Cancer pain management in Longquanyi District of Chengdu city is insufficient, which needs further training and education about the treatment knowledge of cancer pain, and needs to promote the implementation of standardized treatment of cancer pain in primary hospitals.

目的：观察紫杉醇联合顺铂化疗在晚期非小细胞肺癌中的临床疗效和安全性。方法将50例初治的晚期非小细胞肺癌患者随机分为治疗组和对照组，每组25例。治疗组用TP方案，对照组应用GP方案，分别接受至少2个周期以上化疗，观察肿瘤客观疗效、生存质量和不良反应。结果①治疗组、对照组肿瘤客观总有效率分别为44%、40%，其差异无统计学意义(P>0.05)；②治疗组、对照组生存质量有效率分别为80%、64%；其差异有统计学意义(P<0.05)；③两组白细胞、血小板降低情况差异有统计学意义(P<0.05)。结论 TP方案比GP方案更有助于提高患者生存质量，对骨髓造血功能的影响不同，是临床上治疗晚期肺癌的有效方法。

Objective To study the first-line chemotherapy effect,toxicity,average hospitalization duration and cost for non-small-cell lung cancer( NSCLC) by TP and GP respectively. Methods 68 advanced NSCLC patients were randomly designat-ed into TP group and GP group for treatment no less than 2 cycles. Primary treatment effect,median survival time,scale III-IV ad-verse reaction,one-year survival rate, and average hospitalization duration and cost were compared. Results Primary effective rate,median survival time and one-year survival rate in two groups had not differ significantly(P>0. 05);significant differences of white blood cell,blood platelet decrease,hair loss,hospitalization duration and cost were revealed(P<0. 05). Conclusion The TP group and GP group showed similar treatment effect for advanced NSCLC. Moreover,advanced NSCLC patients with TP treat-ment were demonstrated to have less hospitalization duration and cost compared to GP treatment.

Objective To investigate the clinical features of renal impairment in patients with multiple myeloma(MM) and analyze the relevant factors. Methods Retrospective analysis of clinical data of 65 patients with MM . Renal function was evaluated by Cockcroft-Gault equations. According to the Ccr,Patients were divided into two groups:group A: Ccr<60mL/ min/( 1.73m2); group B:Ccr≥60mL/ min/(1.73m2). Then comparison of the clinical data between them.Results Compared with group B, group A beta-2 microglobulin, uric acid, blood calcium, urinary protein light chain, the incidence of anemia all higher (P<0.05). beta-2 microglob-ulin, uric acid, blood calcium, urinary protein light chain, hemoglobin levels all adverse renalfunction obviously. Conclusion Renal damage in MM has certain clinical features. IT have close relationship to beta 2 microglobulin, uric acid, blood calcium, urinary protein light chain, anemia.

目的探讨过敏性肺炎住院患者的临床特征,以提高诊断的准确性。方法收集2005～2009年我院收治的30例过敏性肺炎患者的病例资料,回顾性分析过敏性肺炎的病因学、临床表现、胸部CT、肺功能等检查项目结果及治疗效果和预后情况。结果接触油漆引起过敏性肺炎有增多趋势。影像学以"磨玻璃"样影与边缘模糊的小叶中心性小结节影为主要表现,"马赛克"样低灌注区也较多见。肺功能主要表现为限制性通气功能障碍伴有弥散功能的降低。临床经积极脱离过敏原,糖皮质激素治疗后症状及影像学均有明显改善,预后良好。结论早期认识过敏性肺炎,积极消除引起过敏性肺炎发生的病因和诱因,对症处理,疗效满意。

Objective To investigate the current status of secondary prevention of cerebral infarction in Longquanyi District of Chengdu. Methods Prospective Investigation on the secondary prevention was conducted in 94 pa-tients with cerebral infarction at 3, 12 and 24 months following stroke. Results The percentages of patients receiving anti-platelet therapy, antihypertensive treatment, antidiabetic drug treatment and statin therapy were 96.8%, 92.1%, 91.7%and 63.8%at hospital discharge, 79.8%, 88.9%, 91.7%and 55.3%at 3 months, 76.1%, 75.0%and 41.4%, 63.8%at 12 months and 33.0%, 71.4%;58.3%and 22.3%at 24 months, respectively. None of stroke patients with atrial fibrillation re-ceived anticoagulation therapy. Conclusion There is a large gap between the current practice of secondary prevention and guideline in patients with cerebral infarction in Longquanyi District of Chengdu.

Objective:To study the risk factors in patients with the acute cerebral infarction combined with pulmonary infection,so that effective prevention and treatment.Methods:253 cases of patients with cerebral infarction of the clinical data of statistics,analysis the risk factors combined with pulmonary infection.Results:Age,disorder of consciousness,swallowing disorder,massive cerebral infarction and combined with chronic pulmonary diseases is the risk factors in patients with the acute cerebral infarction combined with pulmonary infection.Concurrent pulmonary infection rate of the patients increased significantly.Conclusion:The patients with the acute cerebral infarction combined with pulmonary infection illness and death is the important factors,positive control pulmonary infection helped to lighten the disability and reduce mortality.

目的:观察纤溶酶的溶栓效果和安全性.方法:对符合入选条件的急性脑梗死患者按随机表进行分组,分别采用纤溶酶(治疗组)与尿激酶(对照组)进行一次性溶栓治疗,观察患者症状、体征的变化、不良反应以及电生理、CT、凝血功能、生化指标等变化,用<卒中患者临床神经功能缺失程度评分标准>评价临床疗效,并对各项观察指标进行统计学处理.结果:治疗组与对照组在治疗前后临床疗效评分、脑电图、心电图、血小板、凝血时间和D-二聚体、血糖、尿素氮和转氨酶等方面的变化,均无显著性差异,P＞0.05(除于治疗后1d在纤维蛋白原方面P＜0.05);而于溶栓治疗后1～7dCT显示,脑出血发生率治疗组为4.8%,与对照组26.3%比较有显著性差异,P＜0.05.结论:纤溶酶治疗脑梗死临床疗效满意,并发脑出血机率低,值得推广应用.