- 期刊
膀胱小細胞癌：二病例報告
Small Cell Carcinoma of Urinary Bladder: Report of Two Cases
摘要
膀胱小細胞癌是罕見且具高度襲性的腫瘤。我們於此報告兩例經尿刮除術及全身性化學治療的膀胱小細胞癌，提醒基層醫師於病患因血尿而求診時，需注意罹患此病的可能性。 第一位是五十九歲男性，因持續一個月的無痛血尿及尿灼感而求診。靜脈腎盂攝影檢查發現有膀胱腫瘤。於經尿道切除腫瘤後，病理診斷為膀胱小細胞癌。因病患拒絕進一步手術而接受全身化療及緩和性放射治療。於診斷後13個月，病患死於多處轉移及敗血症。 第二位是七十二歲男性，主訴為10天的無痛血尿及尿中血塊。像檢查顯示一巨大的骨盆腔腫塊附著於膀胱壁上，同時已有腹膜及肺的轉移。病患接受緩和性的經尿道刮除術，隨後因病理報告顯示為小細胞而接受全身性化學治療。病患於診斷後10個月死於多處轉移。 膀胱小細胞癌的臨床表現和其他膀胱的惡性腫瘤差異不大，最常見的臨床表徵是無痛血尿，接著有排尿困難和頻尿的現象，然而因其早期轉移的病程特性，大部分的病人在診斷出罹患此病時，已有局部的深度浸澗或轉移。雖然全身性化療合併手術或放射治療似乎是處理這類病患的準則，但因迄今發現之病例數有限，治療預後亦不佳，膀胱小細胞的最適當治療依然是一項艱難的課題。
關鍵字
無資料並列摘要
Hearing loss in the workplace, due to noise exposure, is an important issue in occupational health. The purpose of this study is to analyze the characteristics and factors related to noise-induced hearing loss of factory workers who worked in a noisy environment. A total of 2216 male noisv environment workers obtained form six different factories from an enterprise at southern Taiwan were selected for analysis. Samples were divided into the high frequency hearing impaired group (n=1,400) or the non-impaired group (n=816). Variables including pure-tone audiometry data, age, working department, working year, smoking and drinking habits were collected for analysis. High frequency hearing impairment rate showed showed significant difference in working factories. Furthermore, one of the factories had a higher impairment rate in two of its working departments (p＜0.05). After age-adjusted hearing acuity by the normal standard, we found that there is an obvious high frequency (4 kHz and 6 kHz) hearing impairment tendency in the younger workers. In addition, a total of 174 suspected early noise-induced hearing loss cases (8%) were diagnosed and the 95% C.I. of mean hearing threshold at 4 KHz increased from 6 to10dB in a 2-year period. Future field studies should be conducted to confirm and evaluate factors that affect noise-induced hearing loss in a studied enterprise. Hearing program for workers should be promoted to prevent employees from severe noise-induced hearing loss.
延伸閱讀
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