Concordance Between Mothers' and Children's Reports of Somatic and Emotional Symptoms in Patients with Recurrent Abdominal Pain or Emotional Disorders

Mother–child concordance regarding children's somatic and emotional symptoms was assessed in children with recurrent abdominal pain (n = 88), emotional disorders (n = 51), and well children (n = 56). Children between 6 and 18 years of age and their mothers completed questionnaires assessing the children's somatic symptoms, functional disability, and depression. Mothers of children with recurrent abdominal pain reported more child somatic and depressive symptoms than did their children, and mothers of children with emotional disorders reported more child depressive symptoms than did their children. Higher levels of maternal distress were associated with greater mother-child discordance in the direction of mothers reporting more child symptoms than did their children. No significant child age or sex differences were found in concordance patterns.     

腹主动脉瘤的外科治疗决策

腹主动脉瘤破裂是最常见、最凶险的疾病之一。提高对其治疗的临床决策水平至关重要。比较传统开腹修复治疗和血管腔内修复治疗的优缺点,以最佳证据为指导,选出最佳方案应用于临床实践。以人为本,做出科学决策,从而降低医疗费用及提高疗效及患者生活质量。     

急腹症疼痛管理新观念——早期止痛

从早期止痛的意义,早期止痛的依据以及传统止痛观念的成因等三个方面论述急腹症早期止痛的必要性和合理性,并探讨早期止痛的策略。提醒医务人员要更新观念,对急腹症患者应尽早实施止痛干预。     

不同干预方法对应激时身心状态的影响

选取72名被试,随机分配到对照组、腹式呼吸组和忽视调节组中。采用重复一个因素的三因素混合实验设计,测量被试基线期、干预期、应激期、恢复期的指温、收缩压和应激前后的主观感受,探讨不同干预方法对应激的干预效果。结果表明,腹式呼吸能够降低男生的心血管反应,忽视调节能够降低女生的主观体验,同时也表明,个体生理反应升高并不必然伴随主观体验的升高。     

慢性腹痛

慢性腹痛病史较长,性质不定。引起慢性腹痛的原因很多,除器质性疾病外,一些功能性疾病也引起,如最终找不出具体原因,则可称之为功能性腹痛综合征。诊断比较困难,也容易误诊,甚至误治,外科医生应特别慎重。误诊的思维原因包括对引起慢性腹痛的原因认识不全面,思维惰性,辩证思维不周密和思维简化等。     

Internet-Delivered Exposure-Based Cognitive-Behavioral Therapy for Adolescents With Functional Abdominal Pain or Functional Dyspepsia: A Feasibility Study

Functional abdominal pain (FAP) and functional dyspepsia (FD) are common in adolescents and associated with low quality of life. Exposure-based cognitive-behavioral therapy (CBT) is efficient for adult and adolescent irritable bowel syndrome (IBS), but has never been evaluated for adolescent FAP/FD. The aim of this study was to evaluate the feasibility and potential efficacy of a novel disorder-specific Internet-delivered CBT (Internet-CBT) for adolescents with FAP or FD, using an uncontrolled open pilot including 31 adolescents. The Internet-CBT consisted of 10 weekly online modules, which focused mainly on exposure to abdominal symptoms. Parents received modules to help them reduce unhelpful parental behaviors. Participants reported the treatment to be credible, and an overall satisfaction with the treatment. Data attrition rate was low (7%) and adherence to treatment was acceptable. We saw a significant and large effect on the primary outcome, pain intensity, at posttreatment (d = 1.20, p < .001) that was further improved after 6 months (d = 1.69, p < .001). Participants also made significant and large improvements on gastrointestinal symptoms (d = 0.84, p < .001) and quality of life (d = 0.84, p < .001) that were sustained or further improved at follow-up 6 months after treatment. This study demonstrated that exposure-based Internet-CBT, tailored for adolescents with FAP or FD, is a feasible treatment that potentially improves pain intensity, gastrointestinal symptoms, and quality of life.     

超声药物透入靶向性治疗胸腰椎骨折后腹胀的疗效研究

观察胸腰椎骨折后,应用超声药物透入治疗腹胀的临床效果.60例胸腰椎骨折后腹胀的患者,随机分为治疗组和对照组,每组30例.治疗组:应用胃肠宁凝胶贴片超声药物透入;对照组:应用复方大承气汤口服治疗.记录两组患者肛门排气、排便及腹胀缓解时间,按照相应标准进行疗效评价.结果两组患者肛门初次排气、排便时间及总有效率比较,差异具有统计学意义(P＜0.05).超声药物透入治疗可促进脊柱骨折患者排气、排便,加快胃肠功能恢复,显著改善腹胀症状.     

Variations in Psychological Profile Among Children with Recurrent Abdominal Pain

This study was designed to determine whether distinct subgroups of children with recurrent abdominal pain (RAP) could be identified based on patterns of psychological functioning. Two hundred and eighty-three children (ages 8–17 years), and a primary caretaker, completed the Behavior Assessment System for Children (BASC) during the initial evaluation of RAP at a pediatric gastroenterology clinic. Cluster analysis of BASC scores supported a 3-cluster solution, with fair agreement observed between parents and children on cluster assignment. Approximately half of the sample identified no significant psychological problems. A small percentage (13%) evidenced intense and broad-based psychological problems, while the remainder (35–45%) indicated relative elevations in anxiety only. Cluster membership did not vary systematically by age, gender, race, or functional gastrointestinal disorder diagnosis. Distinct psychological profiles appear to exist for children with RAP. Targeting treatments to these profiles may improve the effectiveness and efficiency with which health professionals address pediatric abdominal pain. This study was supported in part by a grant from the Hall Family Foundation. Portions of this work were presented at the annual convention of the American Psychological Association in July 2004 (Honolulu, HI) and at Digestive Diseases Week in May 2004 (New Orleans, LA).     

三维适形放疗治疗晚期腹部恶性肿瘤的临床受益和毒副反应

为观察三维适形放疗治疗晚期腹部恶性肿瘤的临床受益情况和毒副反应。对38例晚期腹部恶性肿瘤患者进行三维适形放疗,疗中和疗后进行临床受益情况和毒副反应的观察和评价。结果临床受益情况：有效为28．9％,稳定为42．1％,疼痛缓解率为28．9％;毒副反应主要为骨髓抑制、胃肠道反应、生化指标改变,除少数病例出现Ⅳ度生化指标改变外,其余均在Ⅲ度以下。结论三维适形放疗可以提高晚期腹部恶性肿瘤患者的生存质量,毒副反应轻微,是一种有效的姑息治疗手段。     

急腹症2例误诊分析

急腹症是外科常见病和多发病,它是一种以急性腹痛为主要表现的临床急症,临床上常有误诊发生,最终造成严重后果。因而在诊疗过程中,必须对急性腹痛尽快作出定位、定性及病因诊断,以防误诊误治。现将我科收治的子宫穿孔误诊为消化道穿孔和输卵管卵巢脓肿误诊为阑尾周围脓肿的2例以急腹症表现为首发症状的患者在我科室的诊治过程及经验进行总结并进行分析,为临床能够提高急腹症的诊率断,降低误诊率提供借鉴,提高临床医生的鉴别能力,保证患者的身心健康。