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F Citroen and leucovorin in colorectal cancer in the efficacy of adjuvant chemotherapy


CurtProblCancer. 1993,17:226-268CohenAM, MinsI 【yBD, NelsonH, eta1. Aaju ~ ther-apyforcolorectalCancer. CartProblCancer. 1998,22:1177 delayed diagnosis and treatment of rupture of spleen - report of 19 cases of Dawa County, Liaoning Province People's Hospital General Surgery (124 200) Wang Wei Zhang Kai Zhang Kai Zhang Haijiang, aged 46, deputy director / physician. Abstract Objective To investigate the pathogenesis of delayed rupture of spleen and treatment measures. Methods A retrospective analysis of 1986 hospital lO lO March 1996 April l9 admitted cases of delayed rupture of the clinical data of patients. Results l9 patients, acute post-traumatic bleeding from the shortest 55h, up to 16d, an average of 6. ld. In which l8 routine splenectomy, only 1 case of acute hemorrhagic shock in the service of the hospital after death. No case of postoperative complications. Conclusions may be delayed splenic rupture in patients 3 weeks after the injury should be closely observed. Diagnostic abdominal paracentesis with B-mode ultrasound examination will be satisfied with diagnosis, and splenectomy is a safe and reliable treatment. Key words Delayed diagnosis and treatment of delayed splenic rupture of spleen (delayed2 discussion ruptureofspleen, Dns) is the clinical features of 2.1 traumatic delayed rupture of spleen in the abdomen after 48h post-traumatic rupture of ignorance is a special type. After an incubation period of significant symptoms, sudden appearance of symptoms of intra-abdominal bleeding spleen and broken l0 hospital from January 1986, a split in 1996. It is a special type of rupture, and more under the splenic capsule rupture by the formation of lO traumatic rupture were treated on 186 patients diagnosed with delayed rupture of which are l9 cases, accounting for l0.2%, is now on its Diagnosis and Treatment of the report is as follows. 1 General Information 1.1 clinical cases in this group l9, l4 male, female 5; age of l4-56 years old, an average of 35 years. The causes of injury: Accident l3 cases, combat injuries in 3 cases, fall injury, 1 case of non-motor vehicle crash injuries, 2 cases were caused by blunt abdominal trauma injuries, including renal injury in 2 cases. 1.2 The nine cases of clinical symptoms fever, abdominal pain l5 cases, the Ministry of referred pain with left shoulder in 6 cases, shifting dullness l7 cases, the limitations of peritonitis in 2 cases, diffuse peritonitis l7 cases, percussion pain left hypochondrium l9 cases, blood loss l7 cases of shock. Acute post-traumatic bleeding from the time :2-5d in 12 cases,[link widoczny dla zalogowanych], accounting for 63.1%; 612d of 5 cases, accounting for 26.3%; 13-16d of the 2 cases l0.5%; shortest 55h, most long-16d, an average of 6.1d. 1.3 3 patients during treatment; outpatients l6 cases, including 7 cases of first visit, return visit in 9 cases. l9 cases underwent abdominal paracentesis are not frozen out of the blood, combined with B-ultrasound diagnosis. Except for 1 patient with hemorrhagic shock, not in the service of the hospital of surgery, and death, the remaining cases were l8 laparotomy, splenectomy, surgery with no deaths and no complications were cured. Splenic hematoma and a few other true rupture after omentum wrapped around the tissue hematoma formation, due to the continued increase in the amount of bleeding, break through the splenic capsule and blood clots caused. Delayed splenic rupture can occur in different periods after injury, mostly in 1-2 weeks after injury, the individual also has until months or years later ... l. Delayed splenic rupture as a longer period of asymptomatic or mild symptoms of the hidden period. Can easily be overlooked by patients and doctors, in the event of intra-abdominal hemorrhage easily misdiagnosed when the symptoms,[link widoczny dla zalogowanych], resulting in treatment delay or treatment timing mistakes. Thus, to improve the diagnosis and treatment of delayed splenic rupture is a serious surgical clinical problems, and improve the treatment of delayed rupture of the key are: (1) latent period of delayed splenic rupture in early diagnosis and monitoring; (2) appears abdominal symptoms of acute bleeding in the timely diagnosis and treatment. 2.2 The diagnosis of delayed rupture of spleen in accordance with the clinical characteristics of occult summarized into two types: (1) persistent abdominal pain: a total of l3 cases, accounting for 68.4%. Strong force injuries, the left hypochondrium pain was continuous,[link widoczny dla zalogowanych], the range gradually expanding. Kehr's sign (left shoulder radiating pain) and Ballanu's sign (continuous left abdominal pain) mostly positive, local symptoms and signs gradually worsened. (2) abdominal pain suspension type: 6 cases,[link widoczny dla zalogowanych], accounting for 31.6%. Injury to the smaller, abdominal pain confined to the left hypochondrium, signs and symptoms are mild,[link widoczny dla zalogowanych], simple out-patient after appropriate rest and after disposal of its signs and symptoms have eased or reduced, or continuing to engage in daily movement, sudden