h********g
发帖数: 19 | 1 谢谢againstwind网友指出我的2cm 不够严谨，我已在原帖加了说明
“尤其是1cm左右（感谢againstwind 网友指正）”。 如果你不喜欢列您的大名，我也
可以改为“某网友指正”。
您提到了医生的动机问题。我相信againstwind是好人。可是你给我的回帖也说“那个
医生是hormone doctor，呵呵，什么背景不言而喻”。所以我也要呵呵了。其实医生也
是人。为了降低自己被诉讼的风险而defensive medicine，这样的研究已经连篇累牍，
不在此赘述。我自己认识的朋友（北美某著名医院的CMIO）就说90%的ＣＴ scan 是不
必要的。
还有就是surgeon们只懂得切除。你把病人refer到他们那里，基本没有别的治疗方案，
就一个字---割。一看结果是疑似恶性，立刻拿出schedule book, 说可以给你安排下周
手术。而且这些surgeon把这个手术说的简单，安全，速效，无痛。在这种情况下，很
多病人都把手术作为唯一的方案，而不再思考。
您提到“甲状腺素片，没有副作用”。可这不等于割了甲状腺没有副作用。甲状腺素片
不完全等效于甲状腺分泌的激素。术后很... 阅读全帖 |
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C*****D
发帖数: 1299 | 2 most adenocarcinomas are not smoke related, only squamous cell and small
cell carcinoma are related. |
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R*******t
发帖数: 367 | 3 眼巴巴等着开门做生意呢，被病人脸上的cold sore给搅黄了。lol。
如果不明原因的bell's palsy，不少病人还得做MR看看究竟什么root cause。见过有
tonsilar carcinoma病史的，发现是残留的肿瘤细胞沿着facial nerve转移到颅内。
如果大家体检和推断都象你那么强，一下子叫出答案来，没有影像什么事，我就得上街
要饭去了。 |
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R*******t
发帖数: 367 | 4 It is all for the benefits of the patients. 作为放射科医生，question
clinician的order并不少见。我们有过泌尿科不停的给一个病人order 腹部CT做肾结石
复查，病人在好几个医院来回做，五年期间做了三十多次CT，他才四十出头，后来得了
renal cell carcinoma，把泌尿科放射科都告了。
只能说，对于别科医生的质问，我从来都觉得是件好事，因为多个人思考，就少点出错
的机会，表面上是在＂冷冷的＂lol质问你，其实换个角度讲也是在保护你。最怕你order什么就照做的同行。行医不是智力
比赛，大家都是board certified，都是合格的，各在岗位各司其责，都是同事，被challenge一下，不用滋味不好受么，
lol， 切磋的乐趣就在于互相讨论。 |
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s******a
发帖数: 184 | 5 甲状腺发现结节，穿刺后的报告如下，大概知道是甲状腺癌，但不明白是不是高度恶性
，请行家指点。谢谢。
Microscopic: seen in a background of lymphocytes and lymphoid tangles are
sheets and clusters of atypical follicular cells, characterized by enlarged,
pleomorphic nuclei and abundant, glassy cytoplasm. Occasional intranulear
inclusions are seen.
A BRAF mutation was detected in a molecular assay. This mutation has been
reported in papillary carcinomas with a more aggressive clinical course. |
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I****a
发帖数: 407 | 6 The fact that the pathology report reads poorly differentiated NSCLC makes
me think the quality of the biopsy was probably not adequate.
For this case, it is not relevant because patient will most likely go for
surgery which will provide the ultimate whole block of the tumor.
But I would request a repeat biopsy if this patient presents with metastatic
disease and you get this poorly differentiated histology . The emergence of
new targeted therapies and clinical trials demonstrating differing eff... 阅读全帖 |
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I****a
发帖数: 407 | 7 It actually causes pulmonary hemorrhage on both squamous and adenocarcinoma
but the incidence in squamous histology is quite high on phase 2 study, it
happened in 4 of 13 patient which is kind of make sense because squamous
carcinoma is more centrally located in contrast to adenocarcinoma, therefore
the bleeding side effect will be more pronounced and more fatal. |
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R*******t
发帖数: 367 | 8 I am a strong advocate for annual screening from the age 40, or earlier if
there is strong family history of family cancer. Screening MRI should also
be considered when calculated Gail score of lifetime breast cancer risk more
than 25%.
A Sweden study with 30 years trial has proven screening mammogram does save
lives, and they only used one-view screening mammogram rather than The two-
views that we use here as standard protocol.
Now there are lots of debates if we should start from 50 or do it ... 阅读全帖 |
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R*******t
发帖数: 367 | 9 There is case report of laryngeal adenocystic carcinoma metastasized to the
spleen. I guess it is rare but not impossible, and mets in this case can't
be excluded either. |
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f*********1
发帖数: 189 | 10 Your symptoms sound like neuroendocrine tumor.
Differentials based on limited CT images are broad: GIST; prior granuloma
disease such as TB or sarcoidosis; pheo especially your symtoms fit well
with it and sounds
like you also have some family history which makes it fit even better,
however pheo usually enhance well with contrast while yours do not enhance
much with contrast, although necrotized pheo may not enhance; adrenal
cortical adenoma especially hyper functioning adenoma, with adrenal cor... 阅读全帖 |
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f*********1
发帖数: 189 | 11 A combination of your lab (biochemical) tests, CT, and PET-CT should come to
a definite diagnosis.
Sometimes image readers put more differentials on the list to protect/cover
themselves.
Pathologists are also clever to cover/protect themselves, and I saw that
pathologists put comments in their core biopsy reports such as ..., with...
carcinoma
less likely but can not be completely excluded. They know exactly the
diagnosis, but they still add something in their report to have themselves
covered.... 阅读全帖 |
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g******z
发帖数: 77 | 12 最近的update，谢谢大家的回复
几周前看了外科医生，医生说在做biopsy之前，需要验尿验血，尿是24小时的。
今天受到了结果，应该不是pheochromocytoma因为metanephrine没有超
在检验的项目中，glucose和cortisol超标，尤其是cortisol，超标了3倍。。。
外科医生很忙，我想听他的建议可是他一直没有空。朋友说这个事情应该ask for 2nd
and 3rd opinion，所以今天又约了另外一个医生。
自己也在网上做了一些阅读，感觉根据验血验尿的结果，应该要么是adrenal cortical
adenoma（肾上腺皮质腺瘤）要么是adrenal cortical carcinoma （肾上腺皮质癌）
。到底是啥也不知道了。看到网上说检验尿17酮能区分良性恶性，真的可以吗？网上还
说皮质腺瘤比较均匀，而皮质癌不均匀，我这个不均匀。。。皮质腺瘤少钙化，我这个
明显有钙化。。。感觉越来越像皮质癌了。因为之前做了PET scan这个东西没有亮，所
以一直以来觉得没啥事，可是现在又开始紧张了。。。
下一步我想再看两个医生，也可以做biopsy进一... 阅读全帖 |
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u***e
发帖数: 611 | 13 Adrenal carcinoma is extremely rare, it's unlikely. |
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g******z
发帖数: 77 | 14 那倒是没有。。。不过网上说cushing syndrome好像adenoma和carcinoma都可能引起，
因为两种情况cortisol都可能升高。。。自己只能搜到只言片语，所以很想找医生问问
。。。谢谢！ |
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z**********4
发帖数: 467 | 15 Adrenal cortical carcinoma is very rare. But so much cals in adrenal mass
does not support adrenal adenoma.
I look at your CTs again and found that there is pre-contrast, portal venous
, it is best to have 15 mins delay phase.
Or your can have MR(chemical shift imaging) or PET to assist diagnosis. |
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z******1
发帖数: 666 | 16 上面星星的发言十分专业，很有参考价值。
10cm至少是T3了。手术机会极微。 但如果是neuroendocrine carcinoma，那是完全不
一样了。 可以针穿活检一下。
如果是adenocarcinoma，若想争取手术机会，一定首先要放疗五周，附以一种化疗药。
再用PET CT 看效果。
感觉美国治疗胰腺癌会比国内好。但对晚期效果也不是很理想。考虑花费可能还是应在
国内治疗。 但若很有钱的话也可以到美国一试，星星推荐的两所医院是最好的了。 |
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l*****9
发帖数: 9501 | 17 今天确诊了一个腺样囊性癌，上级让他去做放疗，但是这个癌放疗不敏感，而且我认为
他还有手术的机会，上级就是不想做，怕风险，要是在湘雅就好了，肯定是一台非常令
人兴奋的手术。
>adenoid cystic carcinoma of maxillary sinus |
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e***y
发帖数: 4307 | 18 【 以下文字转载自 Medicine 讨论区 】
发信人: eeguy (ILYF), 信区: Medicine
标 题: 求助，老婆的甲状腺癌可能复发了
发信站: BBS 未名空间站 (Mon Sep 24 00:52:36 2012, 美东)
年初曾经发帖咨询过，当时的帖子在这里：http://www.mitbbs.com/article_t0/Medicine/31238469.html
老婆今年28岁，二月在UCSF确诊是papillary thyroid carcinoma，四月做了total
thyroidectomy，冷冻切片符合papillary，但是是diffuse sclerosing variant比较
aggressive，而且是moderately differentiated，所以当时已经知道复发的可能性很
大。七月份做了RAI，剂量是100 millicuries。RAI后的全身PET scan没有发现I-131
uptake，TSH在0.1左右，但是因为thyroglobulin antibody (TgAb)非常高（>3000），
所以thyrogl... 阅读全帖 |
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a*********d
发帖数: 2763 | 19 1. RAI后做的是whole body scan吧，你确定是PET?
2. 有的aggressive的肿瘤对I131不敏感，所以没有uptake
3. TgAb如果baseline就高，不说明问题，跟TG高是两回事情。
4. 淋巴结原来做手术前有吗？术前应该有详细的颈部超声，影响外科手术清扫淋巴的
范围。现在需要穿刺确诊。
5. 甲状腺癌的治疗手段很limited,如果I131不敏感，有复发，可以考虑参加clinical
trial, 现在有几个药可以试试看的。
6.甲状腺癌带瘤生存的情况很多，有时候就是没有办法根治的。
年初曾经发帖咨询过，当时的帖子在这里：http://www.mitbbs.com/article_t0/Medicine/31238469.html
老婆今年28岁，二月在UCSF确诊是papillary thyroid carcinoma，四月做了total
thyroidectomy，冷冻切片符合papillary，但是是diffuse sclerosing variant比较
aggressive，而且是moderately differentiated，所... 阅读全帖 |
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s*********l
发帖数: 11 | 20 怀孕时甲状腺右侧长了个肿块，生完宝宝后做的穿刺活性检查，医生说初步诊断结果是
滤泡性肿瘤（follicular neoplasm）,但是不能确诊是良性（follicular adenoma）还
是恶性(follicular carcinoma)--医生说30%的可能是恶性，得做手术切除做全面病理
检查才能确诊。但是手术后得长期吃甲状腺素的药，而且有复发的可能。现在想能不能
先不做手术，用其他保守的手段诊断是良性还是恶性，或者有没有其他方法治疗？如果
必须手术的话，这个手术会有什么complication么，手术后长期服药有没有副作用？请
懂行的人指点一下。我的宝宝现在才一个月大，想到自己年纪轻轻得这种病觉得很绝望
，请求大家帮帮忙。多谢了！ |
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a**********2
发帖数: 3726 | 21 Yes, follicular adenoma vs. carcinoma can only be diagnosed by tissue biopsy
. Fine needle biopsy in most cases can not give the final diagnosis.
Levothyroxine replacement will be required after surgery, it's a synthetic
thyroid hormone. Most people take it without obvious adverse reactions. |
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e***y
发帖数: 4307 | 22 我不是医生，但是我老婆现在正经历甲状腺癌，说说我们的经验吧，虽然你的肿瘤可能
不是恶性的。请医生指正。
这个病手术治疗是最最重要的，一定要找一个可靠，有经验的endocrine or ENT
surgeon. 这样能最大限度的减少并发症，和尽可能把颈部的肿瘤清除干净。手术的风
险主要是有可能伤害到颈部控制呼吸，说话，还有肩部等部位的神经。还有促甲状腺旁
腺(parathyroid gland)也有可能受影响，造成缺钙。一个好的医生能把这些可能性降
到几个百分点以下。然后要作的就是radioactive iodine therapy (RAI)，和定期复查
。甲状腺替代药品levothyroxine只要把剂量调整好了基本没有副作用，生活不会有影
响。不要怕手术，对于甲状腺癌这是保命或者根治的唯一途径。复发的几率因人而异，
有说达到30％的。如果是在颈部复发一般会再做手术。
甲状腺发生结节的一个保守疗法是吃甲状腺素，这样可以降低TSH(thyroid
stimulating hormone)从而减少对甲状腺细胞的刺激，达到缩小结节的效果。但是现在
有医生认为这个疗法的效果有限。但作为术后... 阅读全帖 |
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g*****d
发帖数: 991 | 24 1. Tumor markers are not specific, which means that the test may be falsely
normal (false negative) in many cases, or abnormally elevated in people who
have no cancer at all.
2. CEA is mainly used as a tumor marker to monitor colorectal carcinoma
treatment.
3. CA19-9 is mainly used for screen of pancreatic cancer.
Suggestion:
Please keep following up the CEA and CA19-9 periodically. |
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A*******s
发帖数: 9638 | 25 下面这个case是一个医生俱乐部贴出来的，我给了他们一个建议，结果今天看到LZ回帖
证实了我的诊断，并且根据诊断治疗有效，病人出院了！
网上咨询看来确实有它的实际效果。
大家讨论一下，第一个答对的请版主发奖。
??? ANY IDEAS REGARDING HYPOTHERMIA????
68 year old family with no past medical history except basal cell carcinoma
of face who has no primary care physician and is on no chronic medications
presents with altered mentation. She has difficulty speaking, hearing,
ambulating and seems "catatonic" per family who admits she has been severely
withdrawn and depressed since the death of her 98 year ... 阅读全帖 |
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k****i
发帖数: 8 | 26 【 以下文字转载自 Medicine 讨论区 】
发信人: kkruxi (空空如洗), 信区: Medicine
标 题: 急求教：老婆刚被诊断为乳腺癌
发信站: BBS 未名空间站 (Sat Mar 15 22:07:30 2014, 美东)
LP和我两地，但LP的医疗主要是在我那边。四五个月前LP发现左侧乳房有肿块，因为以
前也出现过两次类似的肿块，但都是cyst，加上但是正在怀孕（后不成功），所以也没
有特别担心。半个月前LP去我那边，顺便看了家庭医生，家庭医生refer到一家医院，
做了mammo和biopsy，这周三收到电话，说是mucinous carcinoma cancer of the
breast(乳房粘液性癌症)。
约了十天后在同一家医院的first appointment。也在LP所在城市的onocology clinic
约了下周一的appointment，主要是想有个second opinion。LP心态倒是非常的好，我
正在做research,但是还有很多事情不明白，比如说第一次见医生问哪些问题，日常生
活上要注意什么。另外，LP所在的城市很小很小，医... 阅读全帖 |
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l******u
发帖数: 715 | 27 国内一个朋友被确诊得了这种肾癌。说国内目前没办法治。他们想打听一下美国这边治
疗的情况。麻烦这里的朋友帮忙提供一下相关信息，比如美国这边的治疗方法，还有哪
家医院治这类病比较擅长权威。多谢了！ |
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l******u
发帖数: 715 | 28 国内一个朋友被确诊得了这种肾癌。说国内目前没办法治。他们想打听一下美国这边治
疗的情况。麻烦这里的朋友帮忙提供一下相关信息，比如美国这边的治疗方法，还有哪
家医院治这类病比较擅长权威。多谢了！ |
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l******u
发帖数: 715 | 30 非常感谢你热心提供的信息。我在网上也刚看到土土妈妈写的博客。我会试着在
facebook上联系她的。 |
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h****n
发帖数: 333 | 31 好的，她应该常看facebook的
你说的朋友是小孩子吗？还是成人？adult patient和pediatric patient这个病上好像
不太一样。我刚才自动认为是儿童了，现在突然想起来也可能是成人的 |
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h****n
发帖数: 333 | 33 bless你的朋友。你在咨询土土妈或者任何医生的时候记得一定要提及病人的年龄。土
土是小孩子，情况可能不太一样。 |
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h****n
发帖数: 333 | 35 真心祝福你的朋友能找到好的医生有好的治疗方案。说实话这个病不好治，成人似乎尤
其复杂，希望发现的stage不算太晚
如果有什么进展和发现，如果方便的话也在这里更新一下，我也很好奇对于这个病，尤
其是对于成人，有没有什么新的进展 |
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l******u
发帖数: 715 | 36 好的，具体什么stage我还不清楚。托我打听的人也不清楚。 |
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yf
发帖数: 272 | 37 Your mother has stage IIIA(T3N0M0) ER positive/PR positive/HER2 positive
Invasive ductal carcinoma. There is discrepancy regarding the PR status and
Ki 67 percentage. Ki 67 is usually not so reliable. PR status is considered
positive in the second hospital pathology but negative in the first hospital
pathology. Anyway the cancer is high risk, your mother needs chemotherapy,
radiation therapy, 1 year of trastuzumab(Herceptin), and at least 5 years of
aromatase inhibitor. Every part of the treatme... 阅读全帖 |
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i*****r
发帖数: 265 | 38 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: integer (integer), 信区: MedicalCareer
标 题: 关于乳腺癌，大牛看看
发信站: BBS 未名空间站 (Wed Feb 4 02:49:02 2015, 美东)
帮个朋友问的，57岁，下面是病理报告：
Examination Findings
Specimen of right breast mass 4X2X3CM was sent for inspection. A grey nodule
with size of 2.5X2CM was found in the section. Endoscope finding: The tumor
cells were in nest shape and glandular tube. The cells arranged solidly and
grew invasively. Nuclear fission was easy to see, and nuclear atypia was
obvious. No cancer met... 阅读全帖 |
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i*********5
发帖数: 19210 | 39 Leanda Cave: World Ironman triathlon champion has skin cancer
http://www.bbc.co.uk/sport/0/wales/21533041
The 34-year-old Welsh athlete made the announcement on her Twitter account
on Thursday, saying: "I was just diagnosed with a skin cancer this morning.
She told her followers on social media: "The skin cancer I have is not
serious or life threatening at all.
"It's called a Basal Cell Carcinoma (BCC) and is 100% curable.
"It is a direct result of too much sun exposure. I just want to make peo... 阅读全帖 |
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U***3
发帖数: 2082 | 40 A Holstein presents with large patches of erythema and edema. There are also
vesicles, scabbing and ulceration.
Which one of the following choices is the most likely diagnosis?
[image]
Image courtesy, Dr L Mahin.
A - Contagious ecthyma
B - Tick bite hypersensitivity
C - Photosensitization
D - Dermatophytosis
E - Squamous cell carcinoma
C is the right answer!
This is an example of Photosensitization. Notice that the areas covered by
black fur are not affected. The most common cause in cattle is ... 阅读全帖 |
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U***3
发帖数: 2082 | 41 A Holstein presents with large patches of erythema and edema. There are also
vesicles, scabbing and ulceration.
Which one of the following choices is the most likely diagnosis?
[image]
Image courtesy, Dr L Mahin.
A - Contagious ecthyma
B - Tick bite hypersensitivity
C - Photosensitization
D - Dermatophytosis
E - Squamous cell carcinoma
C is the right answer!
This is an example of Photosensitization. Notice that the areas covered by
black fur are not affected. The most common cause in cattle is ... 阅读全帖 |
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l******u
发帖数: 715 | 44 国内一个朋友被确诊得了这种肾癌。说国内目前没办法治。他们想打听一下美国这边治
疗的情况。麻烦这里的朋友帮忙提供一下相关信息，比如美国这边的治疗方法，还有哪
家医院治这类病比较擅长权威。多谢了！ |
|
l******u
发帖数: 715 | 45 国内一个朋友被确诊得了这种肾癌。说国内目前没办法治。他们想打听一下美国这边治
疗的情况。麻烦这里的朋友帮忙提供一下相关信息，比如美国这边的治疗方法，还有哪
家医院治这类病比较擅长权威。多谢了！ |
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l*******r
发帖数: 39279 | 46 【 以下文字转载自 Biology 讨论区 】
发信人: zxt (Asoka & Akaba), 信区: Biology
标 题: Re: 大家说说Cancer cell metabolism吧，这个越来越火啊！
发信站: BBS 未名空间站 (Sun Nov 4 01:53:57 2012, 美东)
在做相关项目，上来胡说几句，当是抛砖引玉，大家多多指正
otto warburg老早就发现cancer更喜欢glycolysis，还因此得了诺奖，之前的肿瘤代谢
主要在体外造影上有一定的应用，为啥肿瘤代谢要到现在又火了呢。在这个field里真
正让代谢又火起来的个人看来是三个topic: PKM2, IDH1/2, Lkb1/mTor/AMPK。
尤其是Lewis Canteley 2008 Pkm2的nautre，让人们知道了cancer cell是如何建立
Warbug
effect的，这之后各种可能和warburg effect相关的pathway又被人们陆续挖掘了出来
。而通过对PKM2/LDHB等glycolysis相关酶的knockdown, tumor cell的生长... 阅读全帖 |
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s**********9
发帖数: 846 | 48 This another subscriber only info: it is not as excited as RPC
It appears the long-awaited PHASE III trials for Cel-Sci's Multikine are
officially open, although we have not seen any official announcement from
the company.
Perhaps they are waiting until there are more people back in the market (
this week is traditionally slow) before they officially announce something
via an official press release. The company does have a number of days
grnted to them before they announce a material event.
Hav... 阅读全帖 |
|
s**********9
发帖数: 846 | 49 This another subscriber only info: it is not as excited as RPC
It appears the long-awaited PHASE III trials for Cel-Sci's Multikine are
officially open, although we have not seen any official announcement from
the company.
Perhaps they are waiting until there are more people back in the market (
this week is traditionally slow) before they officially announce something
via an official press release. The company does have a number of days
grnted to them before they announce a material event.
Hav... 阅读全帖 |
|
y*****l
发帖数: 5997 | 50 Celsion Reports First Quarter 2011 Financial Results and Provides Business
Update
Now - Marketwire via Comtex
MarketwireCelsion Corporation (NASDAQ: CLSN), a leading oncology drug
development company, today announced financial results for the first quarter
ended March 31, 2011 and addressed the progress of its clinical trials of
ThermoDox(R), Celsion's proprietary heat-activated liposomal encapsulation
of doxorubicin for the treatment of hepatocellular carcinoma (HCC), commonly
referred to as pr... 阅读全帖 |
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