Objective To compare the therapeutic effects,toxic side effects of late-course three dimensional conformal radiotherapy plus chrono-chemotherapy(DDP+5-FU/CF) and conventional radiotherapy plus chemotherapy for nasopharyngeal carcinoma (NPC). Methods Eighty-six NPC patients admitted from Feb. 2001 to Jan. 2002 were divided randomly into two groups:1.Chrono-chemotherapy + late course three dimensional conformal radiotherapy(CCR) group—44 patients were treated by late course three dimensional conformal radiotherapy plus chrono-chemotherapy, and 2.Routine-chemotherapy-radiotherapy (RCR) group—42 patients were treated by routine chemotherapy plus radiotherapy. The patients in CCR and RCR group were comparable in age, KPS, stage and pathology. All patients were treated by combined chemotherapy and radiotherapy, with chemotherapy stared 2 weeks ahead of radiotherapy. Chemotherapy: Braun pump was used in all drug infusions;1.CCR group—DDP 80?mg/m2 starting from 10:00 until 22:00,5-Fu 750?mg/d/m2 starting from 22:00 until 10:00 next day, CF 200?mg/d/m2 starting from 10:00 every day, infused at normal speed. These drugs were given for 3 days, 14 days as one cycle, totally 2 cycle, and 2.RCR group—with the same drugs at the same total dose, only with the difference being DDP and CF given QD, starting from 10:00 but at the normal speed. 5-Fu was given throughout the day and continuously for 3 days, totally for 2 cycles. Radiotherapy: linear accelerator irradiation was given to either group. Composite facio-cervical field + anterior cervical tangential field to D_T 40?Gy/4w, followed by the coned down per-auricular field plus anterior tangential field or ?beam irradiation. In CCR group, after D_T 40gy/4w, late course 3-dimensional conformal radiotherapy(3DCRT) was used to add D_T 30?Gy/3w. In RCR group, routine radiotherapy of 40?Gy/w was supplemented with 30?Gy/3w. The total dose in either group was 70?Gy/7w at the nasopharynx, D_T60-70?Gy/6-7w at the neck, as cure while 50?Gy/5w for prophylaxis. Results The CR and PR of the CCR group was 45.5% and 95.5%, while the CR and PR of RCR group was 23.8% and 71.4% respectively. There was significant difference between the two groups in CR and PR (P

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.
Abdomen ; surgery ; China ; Drainage ; methods ; Evidence-Based Medicine ; Humans ; Practice Guidelines as Topic ; Societies, Medical ; organization & administration ; Surgical Wound Infection ; prevention & control ; Traumatology ; organization & administration ; Vacuum