慢性腰腿痛是骨科临床常见病,到目前为止,尚没有一个统一的方法治疗各种原因引起的腰腿痛。本文基于慢性腰腿痛主要以硬脊膜外腔的病理变化(粘连、神经根受压、牵连、移、组织变性等),“同一性”的改变,而临床上主要表现为慢性腰腿痛,根性坐骨神经痛等症状。采用本疗法以期达到“异病同法”的目的。本组病人均拍 X 线片排除肿瘤、结核、炎症(椎体及附件骨髓炎)。注射药物以二、三组为好,注射次数一般为1～2次,3次者极少。治疗结果优良率占77%,总有效率达98%。本法操作简便易行,如能遵守无菌技术,则无并发症,不需住院,为目前慢性腰腿痛的一种理想的非手术疗法。
Background: Tumor ulceration (TU) is considered the second most important prognostic factor after Breslow thickness for localized cutaneous malignant melanoma (CMM). However, many studies have not included mitotic rat...
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Background: Tumor ulceration (TU) is considered the second most important prognostic factor after Breslow thickness for localized cutaneous malignant melanoma (CMM). However, many studies have not included mitotic rate (MR) with TU in these analyses. When both TU and MR are included in the same analysis, MR appears to be the more important than TU and TU loses its significance as an independent prognostic factor. Methods: The relative importance of TU and MR as prognostic factors in localized CMM were compared in a population- based series of 650 consecutive invasive CMM cases ascertained from the Connecticut tumor registry and reviewed by a single dermatopathologist (RLB), during the period between January 15, 1987 and May 15, 1989. Seventeen clinical and histopathological variables including tumor thickness measured in mm, TU recorded as present or absent, and MR recorded as number per mm2 were included in an unconditional logistic regression model and selected for inclusion using a backward stepwise algorithm with death as an endpoint or at least five- years follow- up. Results: Inthemultivariateregression,theindependent prognostic factors included: 1. tumor thickness in millimeters (OR=1.5, 95% CI=1.3- 1.9) 2. moderate mitotic index (between 1 and 6): (OR=8.3, 95% CI 2.4- 28.7), 3. mitotic index (>6): (OR=11.6, 95% CI=3.0- 44.6), 4. solar elastosis: (inversely associated with mortality) (OR=0.4, 95% CI=0.28). After adjustment for MR, TU lost its significance. When MR was left out of the analysis, ulceration then became an independent prognostic factor. The model with ulceration only (excluding MR) showed a relative risk (RR) of 2.4 (95% CI: 1.1- 5.1). In the model with MR only, MR had a RR of 14.5 (95% CIS.9- 53.7). Finally, regression analysis including both TU and MR yielded an RR of 11.6 for MR and 1.7 for TU. Conclusions: Our results suggest that MR as a proxy for tumor proliferation is a more important prognostic factor than TU.
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