Three of cancer pain ladder

Three ladder cancer pain, which is under a different degree of pain in patients with the use of different grades and different drugs for the treatment of pain principles of the analgesic method. As one of the most commonly used and highly effective analgesic methods, the World Health Organization (WHO) strongly recommend, has been widely used in treating various chronic pain.

Three of the use of analgesic ladder on the premise that we must learn how to assess pain levels. Cancer patients should divided into light, medium and heavy 3, the most commonly used method is the use of 0 to 10 pain rating scale. Doctors ask him to answer questions with: “If 0 is a painless, 10 for the most you can imagine the pain, then you are in pain several stages? Pain most at several stages? Lightest at several stages?”

1 ~ 4 for mild pain, the patient has pain but tolerable, and to a normal life; 5 ~ 6 to moderate pain, obviously in pain, unable to stand the impact of sleep; 7 ~ 10 severe pain, severe pain , could not sleep may be associated with passive posture or autonomic dysfunction performance.

Understand the patient’s pain levels, and then in accordance with the WHO’s cancer treatment five main principles of administration:

First, oral administration. Simple, non-invasive and easy with long-term medication, the majority of patients with pain are applicable.

Second, on time delivery. NOTE: “on time” delivery, and not only pain treatment.

Third, the principle of administration according to three ladder. By pain in patients with mild, moderate and severe different levels and different ladder to the drug. Below we list the ladder respectively, in the commonly used drugs.

The first step mild pain to non-opioid (non-steroidal anti-inflammatory drugs) Modified Auxiliary pain medicine. Note: non-steroidal analgesics existence maximum effective dose (ceiling effect Note) problem.

Commonly used drugs, including acetaminophen, aspirin, diclofenac alginate, plus a 100-ling, ibuprofen, to revise their labels (ibuprofen sustained-release capsules), indomethacin, indomethacin, Italy Oxfam Ding (indomethacin GITS), and so on.

The second step weak to moderate pain opioid Modified non-steroidal anti-inflammatory drugs and supporting pain medicine. Weak opioids also exist ceiling effect.

Common drug codeine, for strong pain, tramadol, Aimanding (tramadol sustained-release tablets), the result of double-g (codeine GITS), and so on.

The third step to severe pain opioid Modified non-steroidal anti-inflammatory drugs and supporting pain medicine. Strong opioids no ceiling effect, but can produce tolerance, the need to appropriately increase tolerance dose in order to overcome the phenomenon. Past that will be used painkiller morphine addiction, so reluctant to use morphine for patients, now that this view is wrong - the use of the cancer patients morphine addiction of a few.

This ladder commonly used drugs morphine tablets, the United States Feikang (sustained-release morphine tablets), the United States and MS Contin (morphine controlled-release tablets, rectal administration), and so on. However, this past meperidine common pain medicine, because of its toxic metabolites, and other factors, have not been recommended for control of chronic pain.

In addition, some supporting the increased use of the drug’s analgesic efficacy and reduce the pain medicine dosage and played a good analgesic effect. These drugs include corticosteroid dexamethasone and prednisolone, can be reduced edema and peripheral nerve pain caused by oppression; antidepressant amitriptyline, Doxepin, the United States Shuyu, Prozac, used to analgesia, sedation, improve mood; anticonvulsant drug carbamazepine, phenytoin, burning and tearing treatable like pain and pain after radiotherapy and chemotherapy; hydroxyl triazine antihistamines for analgesia, sedation, the town of vomit.

4, individualized treatment. Dosage according to the circumstances of individual patients, for the purpose of a painless, and should not be too restrictive dose resulting lack of medication.

Fifth, close observation of the changes in patients after treatment, the timely processing of all types of drug side effects, drug efficacy assessment observation, timely adjustment of the dosage.

In addition, we must pay attention to the interaction between the drug and painkiller drug combination with other methods of treatment, and other issues.

Recently, the State Drug Administration cancelled cancer patients use of the very limited volume of morphine, which reflects the government departments to promote the treatment of cancer pain ladder to three, but also of our government on pain control and palliative care support for the work of . Speaking of the medical staff, change the old concepts, learn the necessary knowledge of the pain medication it is a pressing task.

Children must be removed joint swelling osteosarcoma

If young people in swelling, pain, skin temperature is high, and joint activities with limited, we must not take it lightly, and should seek medical treatment as soon as possible.

According to the experts statistics, malignant bone tumors serious threat to young lives, which Osteosarcoma is the most common primary malignant bone tumor, was particularly prevalent in the 10 to 25-year-old youth. Its rapid onset, short-term move quickly. Because of this period of rapid bone growth of young people, the pain from bone cancer so very easily be misdiagnosed as growing pain, or that a general arthritis, sprains, missed the best time for treatment. If young people in swelling, pain, skin temperature is high, and joint activities with limited, we must not take it lightly, and should seek medical treatment as soon as possible. Wang Jin, the incidence of osteosarcoma is about 1.5 to 2 per 100,000, but quite dangerous, cancer within six months to one year will be a lung metastasis, resulting in deaths.

Wang Jin, osteosarcoma occurred in the limbs, rapid development, short duration, and the elderly are more likely suffering from muscle tissue tumors, a common smooth muscle tumors, lymph sarcoma, such as synovial sarcoma. In the early stage of hematogenous metastasis. It is understood that the current sarcoma have already occupied the incidence of tumors of children 15% to 20%, 1% of adult tumors.

He explained that because of the lack of awareness of sarcoma, early clinical symptoms and less obvious, resulting in 60% of patients have been attending in the late 50% of the patients could not receive timely diagnosis and treatment and delay treatment standards.

30% ~ 40% of patients with sarcoma encountered misdiagnosis

“30% to 40% of the patients with sarcoma Cengzaoouguo misdiagnosis, I used to think of the fat or fibrous tumor, even though incision tumor proliferation.” Said Wang Jin, diagnosis and treatment errors could not suppress tumor development, and may even promote proliferation. In the diagnosis of unexplained circumstances a “minor” or open biopsy, it is likely to lose patients with limb-salvage surgery and long-term survival opportunities.

In the South China Sea with a local hospital, was diagnosed as soft tissue Nongfu local, tumor tissue incision found to be immediately transmitted to Guangzhou, “but we found that it has already emerged tumor cells to the body bone metastasis, are advanced sarcoma, although done for tumor The wide excision, but two years after the patients died of cancer or lung metastasis. “Wang Jin introduced.

“Many young people in the knee after the mass movement that is the injury, and topical treatment of traditional Chinese medicine, found that more and more mass, and the pain intensified.” Wang Jin said that after the operation the appropriate application of Chinese medicine for adjuvant therapy, can achieve justifications for blood gas, and enhance immune function and role, but if that rely solely on local internal medicine and traditional Chinese medicine and topical as a “guaranteed” means treatment can delay time, and ultimately died of lung metastasis occurred.

“Many of the families want to be conservative treatment, surgery is not only the best medication, but in fact many of the existing drug sarcoma is not sensitive or resistant to long-term use will be.” Wang Jin said that the drug only as a supplement means, it is difficult to completely wipe tumor, and clinical findings, many of eight of 10 patients with drug resistance after the start.

Early treatment with 80% of patients such as the right to cure

Wang Jin, including clinical diagnosis and treatment of sarcoma, images, the three subjects joint pathology diagnosis. Sarcoma classification and diagnosis are complex, relying solely on clinical examination and imaging is very difficult to make a correct diagnosis, biopsy diagnosis sarcoma is most of the necessary channels.

“Early patients with proper treatment 80% of the patients can cure patients with advanced almost 100% mortality.” Wang Jin pointed out that the higher the cure rate of sarcoma found sooner, standardized treatment is the key to cure sarcoma.

The first consultation directly related to the first rule could retain patients with limb function, the best treatment for the first time surgery, the introduction of surgery, radiotherapy and chemotherapy combination of the individual treatment programmes. Because chemotherapy drugs can be very good through the destruction of tumor cells in the treatment of malignant bone tumor therapy one of the important means can greatly improve the prognosis.

Early detection characteristics of the four sarcoma

Wang Jin said that the fact that the early signs of sarcoma can be traced to the remarks if the following four characteristics, it should be promptly to the hospital for treatment of bone tumor specialist.

1. Limbs in patients with early onset of pain often irregular discomfort or pain around joints increase;

2. Nothing to do with the movement, “Night pain” Obviously, the pain is because at tumor growth performance;

3. Emerging swelling mass, and with skin temperature increased, such as intravenous Nuzhang performance. Growing mass, increasing symptoms;

4. Course developed very rapidly, and even the next day, have increased.

Amenorrhea

Amenorrhea is common gynecologic symptoms of the disease. Refers to the cessation of friends at least six months. According to the causes, divided into two categories: The first category is that the physiological amenorrhea due to a physiological causes of women in a certain period of time and not menstrual cramps, for example, before the onset of pregnancy, and post-lactation period, such as postmenopausal. The other is the pathological amenorrhea is that, for some pathological reasons not women menstrual cramps. According to the age of onset can be divided into two categories of primary and secondary. The former refers to all women aged 18 years or mature Second Sex levy no more than 2 years of menstrual cramps, which refers to women who have had rules menstrual cramps, but because after a certain period of rational reasons to stop 6 months or more. This chapter describes only pathological amenorrhea.

[Etiology and Category:

Menstruation is endometrial cyclical changes in the cyclical bleeding. Normal menstrual cycle is hypothalamus - pituitary - ovarian axis all aspects of the endocrine function of the adjustment, if any one link will take place obstacles in menstrual disorders, and sometimes lead to amenorrhea. Both primary and secondary amenorrhea, and the causes of both its common also different. Control of the normal menstrual cycle has four main components, the failure of a link will appear amenorrhea:

A uterine amenorrhea amenorrhea due to the uterus, normal menstrual regulation, functional ovarian, endometrial not have normal ovarian response, it said uterus amenorrhea. Of the uterus caused amenorrhea common diseases are:

(1) endometrial injury or adhesion syndrome often occur in abortion, postpartum hemorrhage, or bleeding after curettage abortion, the number is due to excessive curettage, damage the uterus, causing Asherman, there amenorrhea.

(B) Endometritis the most common result of endometritis amenorrhea TB uterine mucositis, post-abortion or other serious postpartum endometritis may also occur amenorrhea.

(C) absent or hypoplastic uterus because of the renal hypoplasia or not the result of the development of uterine hypoplasia or not, often manifested as primary amenorrhea.

(D) after hysterectomy or uterine cavity after radiation therapy for uterine reproductive tract disease after resection or uterine cancer as a result of certain brachytherapy treatment of endometrial damage arising after amenorrhea.

Second, ovarian amenorrhea amenorrhea due to the ovary, ovarian sex hormone level is low, endometrial cyclical changes do not result in amenorrhea, common diseases are:

(1) Ovarian congenital hypoplasia or so, lack of ovarian development, or just a cord-like non-functional, multi-primary amenorrhea, common diseases are:

1, and the most common chromosomal abnormality ① with Turner syndrome mosaicism such as nuclear ② 45, XO/46, XY, 45, XO/46, XX, 45, XO/46, XXX, 45, XO/47 , such as XXX.

2, as simple chromosome normal ovarian hypoplasia.

(B) ovarian function premature senility early postmenopausal women in the 40-year-old postmenopausal women who had previously called ovarian function premature senility (premature ovarian failure). Patients demonstrated secondary amenorrhea, and the menopausal syndrome with symptoms such as facial flushing, RUF fever, sweating, mood fluctuations, internal and external genital mutilation and the Second Sex levy gradually shrinking and degradation.

(C) ovariectomized or organization due to the destruction of more than surgical resection of bilateral ovarian or bilateral ovarian by radiation therapy after ovarian tissue destruction resulting loss of function, performance for the primary or secondary amenorrhea. Severe inflammation can also destroy ovarian ovarian tissue caused amenorrhea.

(4) ovarian tumors have androgen ovarian tumors because of the excessive androgen suppression of the hypothalamus - pituitary - ovarian axis function caused amenorrhea. Estrogen secretion of granulosa cell tumor can sometimes cause temporary amenorrhea is the result of sustained secretion of tumor estrogen, and restraining ovulation, there endometrial hyperplasia caused amenorrhea.

Third, pituitary amenorrhea is the major pituitary lesion. Or organic diseases of the anterior pituitary dysfunction can affect gonadotropin secretion, thus affecting ovarian there amenorrhea, the major diseases:

(1) the anterior pituitary dysfunction

1, pituitary induced amenorrhea due to pituitary ischemia, inflammation, radiation and surgery, such as the destruction of the anterior pituitary function, the performance of some or all of loss of function caused amenorrhea. Sheehan syndrome is due to postpartum hemorrhage and shock caused by the organization before the pituitary avascular necrosis, pituitary dysfunction in amenorrhea, emaciated and looking pale, Boling, no milk, hair loss and other symptoms. Second Sex and the internal and external genital levy gradually shrinking. Patients may also be associated with low blood sugar, low blood pressure, low basic metabolism, such as loss of libido.

2, gonadal function of the pituitary promoting a low rare genetic disease can be manifested as a single primary pituitary gonadotropin, or the lack of a single growth hormone deficiency, demonstrated for the primary amenorrhea.

(2) of pituitary tumor anterior pituitary tumor is the most common brain tumor, many different types. By electron microscopy and by the clinical data and the secretion of hormones, can be divided into adenoma growth hormone, prolactin adenomas, adenomas thyroid stimulating hormone, gonadotropin adenoma mixed tumors, non-functional pituitary adenomas, etc.. According to the different nature of the tumor in different symptoms, but there are amenorrhea performance. The age of onset different, there are also different types of amenorrhea, before the onset of adolescence, primary amenorrhea frequently manifests itself in adolescence showed the incidence of secondary amenorrhea. Craniopharyngioma slow growth, and more on the sella turcica, any age could occur.

4. Hypothalamic amenorrhea under the most common types of amenorrhea, the hypothalamus pituitary dysfunction affected, thereby affecting ovarian caused amenorrhea. The etiology is complex, because of the central nervous organic diseases, mental factors, systemic disease, drugs and other secretory function disorder caused:

(1) mental, neurological factors

1, the environment changes, such as over-stretched mental trauma, fear, anxiety, as well as various external stimuli such as cold, and other central nervous system and can lead to the hypothalamus between dysfunction, and through hypothalamus - pituitary - ovarian axis, ovulation barriers affecting mature follicles caused amenorrhea.

2, the spirit of Anorexia Nervosa caused dysfunction of the hypothalamus of the disease. Patients with anorexia, seriously emaciated, amenorrhea, and other thyroid, adrenal, gonadal, pancreas, and other functions are lower.

(B) nutrient malnutrition due to consumption of certain disorders or diseases, such as gastrointestinal dysfunction, and severe tuberculosis, severe anemia, schistosomiasis, malaria, caused systemic malnutrition, which affects the hypothalamus of gonadotropin-releasing hormone and growth Synthesis and secretion of hormones to suppress gonadotropin, gonadal dysfunction caused by primary or secondary amenorrhea.

(C) drugs inhibit some women's syndrome needle injection of long-acting contraceptive lead after oral contraceptives or secondary amenorrhea, the original common in women after abortion menstrual disorders or premature use of contraceptives, is due to inhibition of the drug hypothalamus and pituitary the function is often reversible, general withdrawal 3 to 6 months can be natural recovery.

(D) In addition to patients with amenorrhea Yiru also sustained amenorrhea, milk secretion, in the genital atrophy. Hypothalamus Shengru-inhibitory factor or reduce dopamine can lead to abnormal lactation, and gonadotropin-releasing hormone secretion caused by lack of amenorrhea. Yiru result of many causes, such as oral contraceptives, long service reserpine, chlorpromazine, Mian Seoul etc. can cause amenorrhea Yiru syndrome.

(5) patients with polycystic ovary syndrome mainly amenorrhea, infertility, hirsutism, obesity, bilateral ovarian increasing LH / FSH ratio High, ovarian secretion of testosterone and Androstenedione volume increased, a corresponding reduction in estrogen that without ovulation, there amenorrhea.

(6) Other endocrine dysfunction adrenal gland, thyroid gland, pancreas dysfunction can be caused amenorrhea, a common disease hyperthyroidism and shortcomings, hyperthyroidism adrenal cortex, such as adrenal tumor.

[Diagnosis]

First of all to find the causes amenorrhea, or hypothalamus - pituitary - ovarian axis adjustment disorders in which a link, and then determine which is caused by a disease.

First, asked in detail about how patients with a history of menstrual history, age at menarche, menstrual cycle, menstrual, the level. Understanding of their growth and development history, family history, childhood health conditions, whether congenital defects or other diseases, taking off drugs, required married women to their reproductive history, post-natal complications. In addition to the situation prior to the onset asked, have any incentive to lead to amenorrhea spirit of factors such as environmental change, all kinds of diseases.

Second, physical examination should pay attention to body, whether it is normal for development, whether deformities, attention should be paid to their height, weight, limbs, trunk ratio, intelligence, nutrition and health. Gynaecological examinations should pay attention to the development of internal and external genitalia, whether defects, deformities, as well as distribution of The Second Sex levy such as hair, breast development, such as whether lactation.

Third, aided diagnosis methods

(1) uterine function of the inspection, is used mainly to understand the uterine endometrium and function, a common method:

1, the diagnosis of endometrial tissue curettage and too many inspections apply to married women, to understand whether the uterine smooth, and the depth and width of uterine, endometrial Guaqu sent to understand pathological examination of ovarian hormones endometrial reaction cyclical changes, except tuberculosis uterine mucositis possible, and the scraps of a Mycobacterium tuberculosis culture.

2, uterus, fallopian tube lipiodol angiography understanding of the uterine cavity shape, the size, whether deformities and tubal situation.

3, endoscopy laparoscopy direct peep uterus, fallopian tubes and ovaries, and a biopsy. Sometimes needed for the observation of Hysteroscopy and endometrial uterine cavity, sent from endometrial tissue pathological examination, observation of uterine cavity whether malformations.

4, drug testing

(1) Progesterone test two methods: ① progesterone intramuscular injection 20 mg daily for 3 to 5 days; ② Medroxyprogesterone 10 mg daily oral even served five days. After stopping 3-7 days to withdraw properties for the bloodshed positive results, suggesting that functional endometrial, has been a certain level of estrogen, progesterone response from stripping.

(2) test such as estrogen progesterone test was negative (note in patients with low levels of estrogen, progesterone no reaction to it), can be used for estrogen trial. That is, to serve patients Yixicifen 1 mg daily, for 20 days or intramuscularly estradiol benzoate Note 2 mg every other day, a total of 5 times. After the withdrawal from 2 to 7 days dismantling properties bloodshed, suggesting that the hormone has endometriosis and uterine smooth normal reaction.

(B) ovarian function checks

1, vaginal examination Watchlist exfoliated cells, in the bottom of the percentage of cells, cell surface to reflect the higher percentage of the higher levels of estrogen.

2, Crystal checks such as cervical mucus smear on the dentate gyrus crystallization see sheep, goats dentate crystallization of the more obvious, the more rough, suggesting that estrogen significantly. Such as the Pap smear, see rows of oval body, suggesting that the role of estrogen and progesterone on the basis of the impact has been.

3, such as the basal body temperature of the menstrual cycle than two weeks after the first two weeks of basal body temperature increased by 0.4 to 0.6 ℃, for duplex-type, suggesting that ovarian with ovulation and luteal formation total. Description normal ovarian function.

4, in the serum estrogen and progesterone content such as estrogen and progesterone levels low, suggesting that ovarian function is not normal or failure.

(C) pituitary function tests suggested that estrogen positive test in patients with low estrogen levels, but the lack of estrogen may be due to ovarian dysfunction, but also may be due to the lack of a result in gonadotropin secretion of ovarian steroid hormones not, it needs further examination pituitary function.

1, determination of serum LH and FSH to the PRL output in the menstrual cycle in normal serum FSH value of 0.66 to 2.50 μ g / L LH values ranged from 6 to 30 IU / L, ovulation peak value of about three times the value of the foundation. If FSH than 2.5 μ g / L tips ovarian failure, LH less than 6 IU / L said gonadotropin dysfunction. If FSH and LH are low, suggesting that the central pituitary dysfunction or higher.

In the normal menstrual cycle, 24-hour urinary FSH biometric mouse uterus usually less than 52.8 units, if the FSH level higher than the 52.8 units mouse uterus, suggesting that hyperthyroidism pituitary, ovary amenorrhea reasons. If FSH less than 6.6 units mouse uterus, suggesting that pituitary dysfunction, amenorrhea in the pituitary or their reasons for the above positions.

2, Sella radiography suspected pituitary tumor can be used for sella radiography. Greater tumor can affect bone sella turcica and saddle cavity size, X-ray can be identified. Such as smaller tumor still stratified radiography inspection or for more sella to fault radiography.

3, in patients with pituitary stimulation test when the LH and FSH levels are low, should be conducted to distinguish between pituitary stimulation test in the pituitary lesions, in the hypothalamus suppression. Pituitary stimulation test is LHRH100 μ g dissolved in 5 ml saline, intravenous, 30 seconds End Note. Injection before and after injection of 15,60,120 minutes borrow 2 ml blood. Serum LH levels (RIA). If injection of 30 to 60 minutes before the injection of LH increased to more than three times the pituitary function of good tips on LHRH response is good, in the hypothalamus causes amenorrhea or more parts. LH injection after the increased value does not increase or not, suggesting that may cause amenorrhea in the pituitary.

4, other tests such as the suspected endocrine dysfunction or other deformity, and so on, should be for the relevant biochemistry, pathology, pathophysiology check-such as nuclear and chromosomal banding analysis, pelvic inflatable contrast, the site of B-mode ultrasonography checks to support the diagnosis.

[Treatment]

One to correct systemic health of female genital mutilation is part of the overall, systemic health will affect genital mutilation, treatment of amenorrhea, it should be corrected in patients with systemic health.

Second, find causes for the organic diseases caused amenorrhea given appropriate treatment. Such as TB uterine mucositis that is, to anti-tuberculosis treatment. Asherman patients should be placed and expansion of intrauterine contraceptive ring, again to prevent adhesion. Pituitary or in the diagnosis of ovarian tumors are defined, according to the tumor location, size, nature determine treatment programmes, choose surgery, radiotherapy and chemotherapy other comprehensive measures.

Third, hormone replacement therapy on ovarian congenital dysplasia, or damage to or destruction of ovarian function that premature senility are available hormone replacement therapy. General application of artificial cycle hormone therapy. Application of sex hormones, a kind of cyclical menstrual bleeding dismantling properties, on the one hand with the correct physical and psychological state, on the other, to promote genital mutilation and Second Sex levy a certain level of development.

(A) low-dose estrogen treatment cycle of its role is to promote pituitary function, luteinizing hormone secretion, thereby increasing the secretion of ovarian hormones, and to promote ovulation.

(B) estrogen and progesterone sequential therapy whose role is to inhibit hypothalamus - pituitary axis, may resume after stopping menstruation and ovulation.

(C) estrogen and progesterone combined therapy whose role is to inhibit pituitary gonadotropin, after stopping occasionally to jump role due to menstruation and ovulation resumed. Use of oral contraceptives, a night service, since the service from the fifth day of menstruation, and even served 22 days to stop. The first five days of next menstrual started the second course, the sharing of 3 to 6 cycles.

(D) if inducing ovulation failure of ovarian function and fertility requirements of the patients, hormone or its analogues can be induced ovulation:

1, pituitary dysfunction in postmenopausal women using urine from the follicle stimulating hormone (hMG), to promote follicle growth, secretion of estrogen. And the merger of similar pituitary luteinizing hormone human chorionic gonadotropin (hCG), the mature follicles that can promote ovulation and luteal promote the formation and development.

2, in the low sexual function, ovary and pituitary a normal reaction, hypothalamus insufficiency or lack of co-ordination, which uses chlorine Di phenol-amine promote hypothalamus of gonadotropin-releasing hormone secretion, and to rectify its function of inducing ovulation.

3, hypothalamus insufficiency, which LHRH inadequate secretion, and can be pulsed injection of trace LHRH inducing ovulation.

4, Application for Bromocriptine treatment of patients with amenorrhea Yiru, whose role is to promote inhibition Lactagogue hormone prolactin to reduce, at the beginning, with small dose of 1.25 mg, 2 to 3 times a day, such as no obvious reaction that gradually increases volume, the largest daily dose should not exceed 10 mg.

Senile vaginitis to fill estrogen

Liu took her 56-year-old this year, not just post-menopausal years, usually paid great attention to personal hygiene, often to “Sterilization” the use of liquid cleaning genital. This for some time, Liu Huijun Leucorrhea more and found themselves with purulent, the smell, while incontinence symptoms. To a hospital for a check, no bleeding in the vaginal secretions are not mold, E. coli and Staphylococcus aureus is higher than the normal value of a doctor, the diagnosis is a look, with postmenopausal women is common senile vaginitis.

Postmenopausal three adults suffering from senile vaginitis

Normal women of childbearing age, ovarian secretion of estrogen, the vaginal epithelial hyperplasia hypertrophy, very strong antibiotics. And postmenopausal women, ovarian function recession, estrogen levels decrease, vaginal wall shrinkage, thinning mucosal epithelial cells glycogen content, the pH of the vagina up, and local resistance reduced vulnerability to bacterial infection of the vagina caused elderly Yan. General pathogen infection often, such as Staphylococcus aureus, Streptococcus, or anaerobic bacteria such as E. coli. According to statistics, postmenopausal women about 30% of the people in senile vaginitis.

In addition to older women, ovarian function premature senility, surgical resection of bilateral ovarian and pelvic radiotherapy and chemotherapy, artificial menopause, breast-feeding too long the young women, because of the lack of estrogen in vivo, but also of similar lesions, it was also to the disease called Atrophic Vaginitis. Vaginal trauma, endometritis also easily leads to pelvic inflammatory disease or senile vaginitis. In addition, poor personal hygiene habits, lack of nutrition, particularly the lack of B vitamins, and the incidence may be related. A senile vaginitis is another reason for the low immune function. As the elderly thymus atrophy, resulting immune response slow dysfunction.

Inflammation can lead to vaginal empyema

Senile vaginitis Leucorrhea the main symptoms are increased. Leucorrhea for more water-like, serious infection, can be a purulent Leucorrhea, unpleasant smell. Mucosal surface of superficial ulcers, secretions to bloody, but it also might spotting. Accompanied by genital itching, burning sense Zhuichan pelvic discomfort. Often affected urethral inflammation caused frequency, or incontinence Nitong symptoms.

Senile vaginitis health of older women from the impact of the three symptoms, itching, pain and vaginal intercourse adhesion. Pruritus enable people sitting unrest, severe can affect sleep. Genital itching skin due to repeated efforts by the patient, washing, hot, cause redness, rupture. Vaginal atrophy and inflammation can cause painful intercourse, older women’s decline in the quality of life. Because of the long-term existence of inflammation, and can cause vaginal mucosa part of adhesion, and even vaginal atresia, inflammatory secretions can lead to poor drainage vaginal or uterine empyema. Older women in their lives to pay special attention to self-care, emphasizing health, reduce the chance of infection vagina.

(1) that is not to genital itching genital washing with scalding hot water, or with their hands scratching graffiti topical ointment, although doing so can temporarily alleviate the genital itching, but will genital skin dry, rough.

(2) use of all kinds of liquid soap or genital cleansing. Because the genital skin of older women generally dry, atrophy, often using soap irritation strong cleaning supplies cleaning genital will add dry skin, itching caused. After stool backward to wipe the past so as to avoid genital faecal contamination caused E. coli infection.

(3) there is timely genital not to use drugs. Because of senile vaginitis caused more for E. coli bacteria, such as Staphylococcus aureus bacteria, not as women of childbearing age to fungal vaginitis, Trichomonas vaginitis, the most common and therefore refrain from treating fungal drugs or trichomoniasis, Do not vulvovaginitis as genital eczema and indiscriminate use hormone ointment, it will backfire.

(4) With the older women vaginal mucosa thin, flexible vaginal worse, it may have roommates injury in the vaginal mucosa and submucosa of the blood vessels, so that the opportunity invasive bacteria cause inflammation. In the vagina before sexual life I smear a small amount of tetracycline ointment or erythromycin ointment.

Estrogen-Sibu more secure

Senile vaginitis treatment principle, first, add a small amount of estrogen, the vaginal mucosa thickening and increase endurance. However, the irrational use of estrogen-triggered endometrial and breast cancer, they must be used under the guidance of a doctor. Supplementary estrogen, Sibu fill more than drug safety. Elderly women recommendations premature ovarian failure as well as the signs of middle-aged women, and sooner or later fasting send clothes with cold water 1 to 2 tablespoons of fresh royal jelly, and insisted on a cup of fresh fruit every day, or eat a soybean products, as royal jelly and soybeans contain rich in natural estrogen. British and American scientists after study has revealed the Oriental women face pretty, delicate skin, breast cancer incidence rate lower than the mysteries of Europe and the United States, the original, soybean (soybeans) is known as the “King of estrogen.”

The second is the principle of local anti-inflammatory therapy, inhibit bacteria growth and reproduction. After short-term treatment that is able to return to normal conditions.

Since the occurrence of the disease and the lack of B vitamins and therefore can be properly taking vitamin B complex, honey, Chinese wolfberry, walnut, seaweed and other foods rich in B vitamins, eat properly.

Comprehensive treatment of ovarian tumors

[Treatment]

1, benign ovarian tumors young patients with tumor resection or annex side of the strip. If both bilateral ovarian tumors, should fight to retain part of normal ovarian tissue. Commissioner abdominal post-mortem before, as samples of suspected malignant, and sent frozen biopsy. To patients before and after menopause to hysterectomy and bilateral resection of the Annex to activities.

2, a malignant ovarian tumor treatment, supplemented by chemical treatment, such as radiation therapy.

(1) to general surgery for hysterectomy, bilateral Annex and the omentum resection. Patients with advanced tumors should as far as possible with the transfer, that is, reduction of the tumor cells. As for retroperitoneal lymph node removal of the therapeutic value can not be determined.

(2) Chemical treatment for the major adjuvant therapy. Surgical removal of the tumor difficult estimated preoperatively by using 1 or 2 courses of chemotherapy, surgical resection can be improved. Postoperative chemotherapy can prevent recurrence; not complete surgical excision, chemotherapy will be temporarily alleviate or even long-term survival; unresectable surgery, chemotherapy can reduce tumor loose, and create conditions for the re-operation.

On the choice of chemotherapeutic drugs, dosage, usage and treatment are yet to be reunified. From the effects of high-dose intermittent treatment to smaller dose continuous medication better than a single chemotherapy combined with chemotherapy better histologic classification developed by chemotherapy better:

① systemic chemotherapy to intravenous drug based. At present governance hear epithelial ovarian cancer, use of cisplatin (DDP) and Adriamycin (ADM), Rokko Melamine (HMM), and cyclophosphamide (CTX), 5 - fluorouracil (5 - Fu) combined with chemotherapy.

Single-dose cisplatin 30 mg/m2 general, doxorubicin 30 mg / m2, Rokko Melamine 150 mg / m2, (oral), cyclophosphamide 150 mg / m2, 5 - fluorouracil 8 mg / kg.

Ovarian germ cell tumors, commonly used VAC programme, vincristine (VCR) 2mg, intravenous injection once a week, a total of 12 times; release actinomycin D (KSM) 400 μ g, 2 to 6 days infusion; Central phosphorus Amine (CTX) 400mg, 2 to 6 days injection. In recent years, the programme adopted at the same time with DDP20mg VAC / m m2, No. 1 ~ 5 days infusion interval of three to four weeks to repeat. Sex cord stromal tumors use of AFC, that is put actinomycin D0.01/kg daily intravenous 1, a total of five (the maximum amount of 0.5 mg / d); 5 - fluorouracil 8 mg / kg, 1 infusion daily, a total of five times; cyclophosphamide 7 mg / kg daily intravenous 1, a total of five times. Repeat every four weeks.

② intraperitoneal chemotherapy may direct role in the tumor, high local concentration, detection of ascites good effect, less side effects. At present the use of cisplatin plus 60 to 80 mg 1000 ml saline, intravenous hydration, the 24-hour urine volume of more than 2000 ml to reduce kidney toxicity.

③ arterial injection chemotherapy in under local anesthesia, percutaneous femoral artery, retrograde catheterization of iliac artery injection of anti-cancer drugs, anti-cancer drugs can be reduced and plasma protein, the combination of increased free drug concentration; increase cancer cytotoxic drugs, thereby enhancing effect. In addition, the fair reduce systemic side effects.

④ chemotherapy to the artery embolization at the same time infusion of anti-cancer drugs and embolization, the role of anti-cancer drugs by the cancer hypoxia-ischemia, necrosis easier.

(3) put to thank for different types of ovarian cancer, the sensitivity of the different radiotherapy, radiotherapy clonal cell tumor of the most sensitive and moderately sensitive granulosa cell tumor, tumor epithelial there is a certain sensitivity; major postoperative irradiation in vitro against residual basin abdominal tumors. No intra-abdominal adhesions have minimal residual tumour, in the 7 to 14 days after radionuclide perfusion, P10-32 commonly used 15mCi, Chi 300 ~ 500 ml saline, slow intraperitoneal injection.

4, Chinese medicine treatment can be used as anti-cancer treatment one of the measures applied to certain inappropriate surgery and radiotherapy or chemotherapy after surgery in patients with relapse. Hebei Tumor Hospital Fu Shan Chinese high-tech achievements developed using the cellular and molecular regulation of tumor suppressor medicine, “Fu Shan God” series of agents (Shuiwan, capsules, oral solution), and tumor suppressor injections, breaking the “poisonous cancer, killing cancer, anti - Cancer, “” traditional set thinking, “There is no toxic drug itself, not the cancer have a direct positive stimulus, it is cell gene therapy in clinical application. Principle is its g cancer: carcinoid tumor angiogenesis inhibiting the formation of networks, blocking nutrient supply to the cancer cells, cancer cells metabolic cut off channels, causing cancer are not sources of nutrition and gradually withered, the waste can not be discharged gradually degeneration and necrosis, and do not harm normal cells. Enhance the body’s own immune function, and promote the body’s anticancer immune monitoring system regeneration, the activation of various types of cancer cells kill At the same time, regulation of cell cycle and cell engine power to control the cancer cells back to normal rhythm of the cycle, so that cancer cells reversed. The drug with chemotherapy and radiotherapy, can significantly reduce the release of toxic side effects of chemotherapy, raising the number of white blood cell. Even have lost surgery, radiotherapy and chemotherapy in patients with advanced opportunities, but also can control the transfer, less pain, improve syndromes, and improve the quality of life and prolong survival time with cancer.

Self-metal stent is effective in treatment of esophageal gastric cancer complications

Netherlands Siersema and other reports, self-metal stent palliative treatment of esophageal, stomach cancer caused by stenosis, fewer complications, relatively safe and effective. Also metal stent for the treatment of esophageal cancer, stomach complications and (or) tumor recurrence.

Siersema will take membrane metals such as stent placement 57 cases of patients in vivo. Cases. (GastrointestEndosc2001, 54:579)

The results showed that 57 patients, 55 cases (96%) stent placement success. Dysphagia average score from 3.6 points to 1.6 points (P <0.001). There are 13 cases (23%) occurred in patients with more serious complications. All were esophageal fistula closure. Five cases of esophageal - tracheal fistula patients, 28 cases of gastric cancer patients after gastric tube insertion, three cases of stomach after patients, two cases of tumors located in the vicinity of the distal esophageal sphincter on patients with tumor recurrence. The median survival time was 61 days. Past radiotherapy, chemotherapy or radiotherapy and chemotherapy increased esophageal stent-related complication rate [were 38% (6 / 16 patients) and 10% (4 / 41 cases), the ratio ratio 5.5,95% CI 1.3 to 24, P = 0.018].

Researchers believe that when esophagus, stomach cancer patients due to fistula formation, tumor recurrence after tumor located in or near the esophageal sphincter on the cause dysphagia, consideration should be given at the earlier-metal stent.

Clinical manifestations of gastric cancer treatment

[Clinical]

1, on the early and more abdominal pain or discomfort for the secret anguish and late can have severe pain. Pain no laws, and instead increased postprandial, but also some pain in patients with similar flooding, Tang disease, may ease of use acid-fast.

2, upper abdominal discomfort.

3, anorexia, anorexia greasy meat, but whose favorite diet, despite eating as usual, there was a late anorexia.

4, cardia cancer can be expressed as swallowing,剑突under obstruction flu.

5, illness, there will be the development of advanced anorexia, weight loss, anemia, pyloric obstruction, continued black soiled, ascites, abdominal mass, evil quality of the symptoms.

6, no early signs.

Advanced:

(1) Multi-abdominal mass in the abdomen, quality hard (sometimes resembles liver leaves, susceptible to liver cancer or cirrhosis error).

(2) transfer performance can be left supraclavicular lymph nodes touch of the hardware; cancer ascites; cancer metastasis to the liver, lung, ovarian, and other emerging corresponding symptoms and signs.

(3) Upper gastrointestinal barium meal examination positive rate of over 90 percent, common are:

① filling defect;

② cavity niche, ulcers usually greater than 2.5 cm in diameter, external and see crescent, not on the edge, near the mucosal folds rough chaos, interrupted or disappear;

③ stenosis and obstruction. X-ray examination in recent years because of improved methods, such as the use of double photographic method can be observed by the mucosal folds gap existing micro-lesions, which can be found that the majority of early gastric cancer.

(4) gastroscopy and gastric mucosa in vivo cytology both fiber endoscopy or electronic endoscopy are an important basis for the diagnosis of gastric cancer, a pathological examination in vivo diagnosis of gastric cancer is the single most direct indicators.

(5) cytology examination of stomach gastric cancer diagnosis also contributed.

(6) laboratory

① fecal occult blood repeatedly about half of patients were positive.

② erythrocyte sedimentation rate of about 2 / 3 of patients with growth.

③ gastric juice of about 20% acid-free, and the remaining acid or low pH was normal.

The above three more checks early, the positive rate, the lower and therefore could not be considered normal results of this disease can be ruled out.

④ variety of other laboratory tests such as immunization inspection carcinoembryonic antigen (CEA), alpha-fetoprotein (aFP), the specificity of the diagnosis of gastric cancer are not high. Gastric cancer monoclonal antibody to detect gastric juice or gastric cancer antigen in the serum of methodological research is still active, so far no breakthrough progress.

[Treatment]

1, surgical treatment

Surgical resection of gastric cancer is the most effective method of treatment, radical surgery early as possible, according to preoperative and intraoperative judgment tumor location, depth of invasion, the extent of lymph node metastasis decision surgery program. With stage III and IV can not be as radical surgery, they may consider palliative surgery, such as palliative or subtotal gastrectomy the gastrointestinal ostomy surgery, such as palliative short-circuit.

2, chemotherapy

(1) of the surgery and chemotherapy

Preoperative 3 days from the (including operation) and can be used after 2 days of chemotherapy (eg, 5 Fu daily 500 ~ 750 mg intravenous) to reduce surgery cancer metastasis. T3 over to gastric cancer after surgery plus intraperitoneal chemotherapy to reduce postoperative peritoneal metastasis rate.

(2) conventional chemotherapy

Advanced gastric cancer after surgery or in patients with advanced gastric cancer, chemotherapy drugs be required to extend survival time and improve three years that 5-year survival rates. Commonly used anti-cancer drugs to 5 Fu, mitomycin C (MMC), Adriamycin (ADR) or epirubicin (epirubicin), carboplatin or cisplatin. General application of combination chemotherapy, combined chemotherapy with a variety of programs to choose from, such as ① MFC programs: MMC4mg, plus saline 20 ml, intravenous 5 Fu250 ~ 500mg, and 25% glucose 20 ml, intravenous; cytarabine (Ara - C) 100 mg, and 10% glucose 500 ml, slow infusion; these three drug application the same day, every four dl times to 10 to 12 times for treatment; ② FAM program: 5 F u, 750mg, slow injection, lasted 10 hours more than a day, a total of 5 days; section on the 1st at the same time using ADR, 60 ~ 80mg, plus saline 20 ml injection, and the MMC, 6 ~ 10mg, plus saline 20 ml, intravenous, 21 ~ 28 days for treatment , going on for several months; ③ can also use a single agent alone: 5 Fu, 500 ~ 750mg / d for 5 d, monthly meeting, timely and micro infusion pump slow drip, better efficacy than the rapid injection; tegafur (Chu Nom fluoride, FT207) 200mg oral four times daily, or fluoride Furtulon 200 mg, orally four times daily.

Gastric cancer cells or progesterone receptors such as estrogen receptor positive, and each should be used megestrol acetate or tamoxifen (tamoxifen), extended remission period.

3, immune enhancement treatment

Lentinan, Coriolus versicolor polysaccharide, solubilization chain are non-specific immune enhancer, interleukin-2 for transmission on behalf of the cytokines may improve treatment of patients with symptoms, improve quality of life and prolong survival time.

4, Anticancer Treatment

Integrated treatment can be used as one of the measures that apply to some not suitable for surgery and radiotherapy and chemotherapy or relapse after surgery patients. Hebei Tumor Hospital Fu Shan Chinese high-tech achievements developed using the cellular and molecular regulation of tumor suppressor medicine, “Fu Shan God” series of agents ( capsules, oral liquid, etc.) and tumor suppressor injections, breaking the “poisonous cancer, killing cancer, anti - cancer, “” traditional set thinking, “There is no toxic drug itself, not the cancer have a direct positive stimulus, it is cell gene therapy in clinical application. Its principle is the grams of cancer: carcinoid tumor angiogenesis inhibiting the formation of networks, blocking nutrient supply to the cancer cells, cancer cells metabolic cut off channels, causing cancer are not sources of nutrients gradually withered, the waste can not be discharged gradually degeneration and necrosis, and do not harm normal cells. In enhancing the body’s own immune function, and promote the body’s anticancer immune monitoring system regeneration, the activation of various types of cancer cells kill At the same time, cell cycle regulation and cell molecular dynamic engine, lost control of the cancer cell cycle back to normal rhythm, so that cancer cells reversed. The drug with chemotherapy and radiotherapy, can significantly reduce the release of the toxic side effects of chemotherapy, raising the number of white blood cell. Even has lost surgery, radiotherapy and chemotherapy in patients with advanced opportunities, but also control the transfer, less cancer pain, improve Syndrome, improve quality of life and prolong survival time with cancer.

[Prevention]

No precise methods of prevention, it is important to state precancerous gastric cancer and precancerous lesions in high-risk targets should Files legislature cards, periodic review to improve the diagnosis rate of early gastric cancer. Mass of the Census and gastric cancer knowledge and education to sustain the current biggest problem is the lack of an effective screening tool to investigate the electronic answer questions Pattern Recognition Act or gastric occult blood tests were all beads and evaluation of the trial. Fresh vegetables, a variety of vitamins, such as HP both prevention and treatment of gastric cancer incidence rates may be lower. Fresh garlic can be reported against gastric cancer.

Auxiliary radiotherapy and chemotherapy can improve the prognosis of patients with gastric cancer

Published in the New England Journal of Medicine on a study showed that postoperative radiotherapy and chemotherapy combination can improve the prognosis of patients with gastric cancer cases.

New York, Saint Vincent Comprehensive Cancer Center Dr. John S. MacDonald and his colleagues selected 556 cases of gastric or gastroesophageal junction cancer patients were randomly divided into surgery alone group and the surgery with postoperative radiotherapy and chemotherapy group compared to the prognosis. The program includes fluorouracil and radiotherapy, formyl tetrahydrofolate and 45% gray dose of radiotherapy.

The results showed that group and radiotherapy and chemotherapy after surgery alone group average survival time were 36 and 27 months (P = 0.005), postoperative survival without recurrence were 30 and 19 months (P <0.001). Three cases with the death is considered as arising from the toxicity of radiotherapy and chemotherapy in patients receiving radiotherapy and chemotherapy in 3 and 4 toxicity response rates were 41% and 32%.

Dr. MacDonald said, despite the large number of previous studies that on the whole, all kinds of postoperative chemotherapy there was no significant treatment effect. However, the study by radiotherapy and chemotherapy combination, statistical analysis showed that could significantly improve the overall survival rate and disease-free survival rates.

He pointed out that the understanding of the tumor resection of tumor recurrence pattern is very important. For gastric cancer, about 80% to 90% of the recurrent factors involved in a local recurrence, to take measures to control local recurrence has important significance. The latest study by systemic chemotherapy supplemented by radiotherapy control local recurrence, the prognosis of patients with significantly improved.

MacDonald Dr., the current study used chemotherapy drugs in the 1990s, is popular drugs, it is therefore necessary for the 21st century and the new chemotherapy drug developed by an in-depth study to find out whether it has better efficacy. Furthermore, the preoperative adjuvant treatment effect also needs further study.

Complete resection is the treatment of gastrointestinal stromal tumors only way

Massachusetts General Hospital at Harvard Medical School’s Center for Cancer and Tumor statistics, scientific research personnel of 1973-98 in the third treatment center 69 cases of gastrointestinal stromal tumor (GIST) patients were retrospectively analyzed. GIST is a rare tumor invasiveness, it is difficult to cure. Recent research findings published in the “Archives of Surgery” magazine.

The ratio of men to women on patients for 40:29, the median age was 60 years, median follow-up time was 38 months. Results showed that the tumor located in upper gastrointestinal of 61%, in the digestive tract to 23 percent next digestive tract of 16%. The median tumor size was 7.9 cm (1.8-25 cm). In every 10 high power field is a mitotic tumors accounted for 57%. Distant metastasis is the first time the attendance of 49 percent. The complete resection of 59%. Complete resection of the 5-year survival rate was 42 percent, can not be completely resected patients 5-year survival rate was 9%, a significant difference. Radiotherapy and chemotherapy had no effect. Complete resection in the 39 cases of patients in the 2% of patients lymph node recurrence, 25% of patients local recurrence, and 33% distant recurrence (54% in the liver and 20% in the peritoneum).

The researchers found through multivariate analysis, mitosis greater than 1, tumor larger than 5 cm tumor of local recurrence and distant metastasis opportunities increased significantly (P <0.05). In 69 cases the patient’s multivariable analysis showed that incomplete resection, age greater than 50 years of age, tumor mitotic greater than 1, tumors larger than 5 cm in survival rates decreased significantly.

The researchers concluded that complete resection is the treatment of gastrointestinal stromal tumors only way. Mitosis greater than 1 and greater than 5 cm tumor prognosis poor, the low survival rate, local and / or distant relapse rate.

Synchronous advanced gastric cancer radiotherapy and chemotherapy

First gastric cancer mortality in cancer, prolong survival time and improve quality of life after Tianjin People’s Hospital first launched the “concurrent postoperative gastric cancer chemotherapy” so that the survival rate of patients with advanced gastric cancer increased nearly 50 percent.

At present, the treatment of gastric cancer with surgery. Tianjin People’s Hospital, said Dr. Wang Feng Wei, such as in advanced gastric cancer after chemotherapy alone, the 5-year survival rate has not markedly improved, is the main reason for cancer metastasis. Even if the operation is successful, it is impossible for the original lesion around the remnants of organizations, the surrounding lymph nodes, the cancer cells within all peritoneal resection. In addition, the stomach and liver, pancreas and other abdominal organs by the portal blood supply, blood returning to the liver, blood transfer in a great possibility. Therefore, the transfer of control of cancer cells extended survival period is the fundamental.

If postoperative gastric cancer in parallel radiotherapy and chemotherapy, radiotherapy can quickly kill local residual cancer cells, tumor cells increased local control rate. Chemotherapy can control the cancer distant metastasis, the potential role of anti-metastasis. More CAST Tongzhi gastric cancer better>>

Zhang, deputy director of the hospital Dr. Kim Tae cautioned that the development of early gastric cancer to advanced gastric cancer, only two years time, the majority of early gastric cancer with atrophic gastritis or ulcer disease, and so on. Therefore, if there unexplained loss of appetite, abdominal discomfort, suffering from weight loss; unexplained hematemesis, and will be long suffering from chronic gastropathy symptoms increase in the near future; has been diagnosed with gastric ulcer, gastric polyps in patients with atrophic gastritis should be vigilant gastric cancer, early inspection.