动脉瘤性蛛网膜下腔出血的临床诊疗决策

探讨动脉瘤性蛛网膜下腔出血的临床诊疗决策。运用循证医学对动脉瘤性蛛网膜下腔出血早期诊断,及时、合理、有效地选择个性化的治疗方案,降低动脉瘤性蛛网膜下腔出血的病残率和死亡率。     

Cognitive assessment in Chinese patients with aneurysmal subarachnoid hemorrhage

A subgroup of patients who survive aneurysmal subarachnoid hemorrhage (SAH) may have significant cognitive deficits. The aim of the current study was to determine the efficiency of cognitive tests and frequency of cognitive impairments associated with aneurysmal SAH in Chinese. A series of 116 patients with aneurysmal SAH were assessed before surgery. Only 37 patients have completed all tests. The other 79 patients had discontinued because of their clinical conditions, recurring severe headaches, refusing or misunderstanding due to low education. We found that one or more cognitive functions were impaired in 70.3% of the 37 patients, SAH patients were especially impaired in functions that are related to visual reproduction, verbal fluency, and executive functions. The results suggest that the patients have impressive cognitive deficits after aneurysmal SAH. A battery of appropriate cognitive tests should be developed for use by doctors and nurses.     

常染色体显性多囊肾手术治疗的临床决策

多囊肾去顶减压术是目前治疗常染色体显性多囊肾的主要手术方式。为了探讨多囊肾去顶减压术的临床效果,本文对81例常染色体显性多囊肾患者进行研究,分析其术后肾功能和症状改善情况。本文旨在客观评价多囊肾去顶减压术,并指出选择适当的手术时机是获得满意疗效的关键,为临床决策提供了依据。     

Performance in free recall following rupture and repair of intracranial aneurysm

There have been many reports of global memory disorder following rupture and repair of intracranial aneurysms. These reports suggest a more anterior basis for the amnesic syndrome than the various sites in the diencephalon and the temporal lobe that have so far been implicated. Patients from a consecutive series of 76 cases of aneurysmal subarachnoid hemorrhage demonstrated a moderate deficit in free recall, but aneurysms at different sites within the cerebrovascular system did not produce significantly different degrees of impairment. The results are consistent with the idea that aneurysmal subarachnoid hemorrhage gives rise to diffuse cerebral damage, and do not necessitate any revision of conventionally accepted accounts of the neuropathology of amnesic conditions.     

单纯性肾囊肿外科手术适应证的选择

单纯性肾囊肿是临床常见的肾脏疾病之一,临床常采用去顶减压术治疗,但外科治疗的适应证目前尚不统一。除症状性肾囊肿及由囊肿引起尿路梗阻外,对于高血压病合并肾囊肿者,如囊肿直径大于5cm,考虑囊肿有可能对高血压产生影响,因此,有必要采取外科治疗措施;但如果不合并高血压,是否一定需要治疗有待进一步探讨。肾囊肿对肾功能影响目前尚无定论,对于小于60岁的肾囊肿患者其肾功能下降可能与肾脏原发病变有关,应积极查找病因并密切随访。对于肾囊肿Bosniak分型为Ⅰ、Ⅱ、ⅡF型的患者,可以不需要手术治疗,密切随访;对于Ⅲ、Ⅳ型患者,应进行外科手术治疗。     

In vitro studies to elucidate the fibrinolytic activity in cerebrospinal fluid altered by inflammation and hemorrhage and having pathologic protein values]

Using selectively immunological methods, it was possible, through FSP determination, for plasmin activities and plasminogen concentrations to be occasionally and exclusively detected in inflammatorily altered liquores and in bloody liquores, respectively. Thus, bloody cerebrospinal fluid, in contrast with inflammatorily altered liquor, usually shows free fibrinolytic activity, so that antifibrinolytic therapy of intracranial aneurysmal hemorrhage is pathophysiologically justifiable.     

Cancer Problems in Living and Quality of Life After Bone Marrow Transplantation

This study was conducted to develop an objective problems-in-living scale to identify the needs of cancer survivors after a demanding treatment such as bone marrow transplantation (BMT). A total of 99 adult BMT survivors completed questionnaires containing the 29 items included in the Cancer Problems-In-Living Scale (CPILS). These BMT survivors were most concerned about return of their illness or relapsing, the future, fatigue, not physically being able to have sexual intercourse, changes in their physical appearance, being concerned about infection and crowds, difficulty in obtaining adequate insurance, losing health insurance by changing jobs, and difficulty in meeting medical expenses. The CPILS showed a good level of internal consistency ( = .91). The hypothesis that BMT survivors who had lower levels of physical functioning would experience more problems with living was supported by correlation (.48, p < .001) of the CPILS with the Self-Rated Karnofsky Performance Scale. The construct validity of the CPILS was further supported by a significant negative correlation (–.66, p < .002) with the scores of BMT survivors on a quality-of-life measure, the Satisfaction with Life Domains Scale for BMT.     

More than one way to change: a study of course heterogeneity during and after short-term psychiatric in-patient treatment

This study describes differences in course and outcome, defined by GSI (SCL-90) at admission, discharge, and one‐year follow‐up, in 458 patients receiving in‐patient treatment for long‐standing symptom and/or personality disorders.
A K-mean cluster analysis identified seven subgroups of patients, representing four clinical distinct, meaningful patterns of change: early improvement, late improvement, relapsing after discharge, and a severe chronic course.
Main findings: the subgroups had unique correlates among socio-demographic, diagnostic, and treatment-related characteristics. One of the relapsing groups had a high rate of Cluster C personality disorders, whereas the other had low participation in the anxiety programme. The group with severe chronic course showed occupational maladjustment and high number of both Axis I and II disorders.
Implications: anxiety patients should participate in anxiety-treatment programmes, Cluster C patients should be followed and monitored for relapse, and severe chronic patients should be offered specialised treatment for their co‐existing substance abuse and/or eating disorders.     

13例脐尿管囊肿的诊断分析

脐尿管囊肿是一种少见畸形,为探讨其病因、临床表现及诊治方法,对2010年1月～2013年12月于我院诊断为脐尿管囊肿的13例患者进行回顾性分析。结果显示,脐尿管囊肿主要发现于男性患儿,可表现为腹痛、脐部或膀胱不适等合并症,常伴有发热,也可无明显临床表现,由单纯查体发现。B超和CT是推荐检查方法,确诊需依靠组织病理学检查。手术切除是治疗该病的首选方法,临床效果满意。随着技术的发展,治疗脐尿管囊肿可优先选择腹腔镜切除术。     

糖皮质激素治疗系统性红斑狼疮中“度”的把握

系统性红斑狼疮是一种与遗传、免疫、种族、环境等因素有关的侵犯多系统结缔组织的全身性自身免疫性疾病。该病多器官受累,症状重且复杂,病情反复缓解和发作,故本病的治疗是一个长期的过程,需要终身治疗。糖皮质激素在系统性红斑狼疮的治疗中为最关键的药物,糖皮质激素的剂量、合理运用及“度”的掌握是治疗疾病成败的关键。     

Craniosynostosis and criminal behavior

Among 100 patients with turricephalus we found 37 with disorders of social adaption, 54% of them has been punishable, 22% even relapsing. Sexual offenders were dominating. Dysplasia of front cranial fossa with dominating exhibition of radiologic signs of craniostenosis frontal and frontotemporal let consider frontal cortex dysfunctions as basic disorder of psychic maldevelopment and delinquency of turricephalus persons.     

湿疹？还是特应性皮炎？

特应性皮炎（AD）是一种慢性复发性、瘙痒性、炎症性皮肤疾病,常自幼时发病,可持续终生,严重影响患者的生活质量。目前尚无单一特异性的,洛床表现或实验室检查指标可以鉴别诊断AD与湿疹。然而,与湿疹相比较,AD患者常伴有血清免疫球蛋白IgE增高,个人及家族遗传性AD、过敏性哮喘和／或过敏性鼻炎的病史,且皮疹及瘙痒更为严重,还可合并皮肤感染及皮肤屏障功能的损害。因此,区分湿疹还是AD,对于正确诊断及采取合适的治疗方案具有重要意义。     

Symptom substitution: A rational-emotive perspective

Theorists who endorse the concept of symptom substitution reject treatments of psychopathology that do not address the underlying causes of symptoms. They hypothesize that such treatments lead to worsening or relapsing of original symptoms, or the substitution of new for old symptoms. In contrast to behavioristic approaches that dispute this hypothesis, Ellis accepts the concept of symptom substitution. Unlike the psychodynamic positions which are credited with the concept, however, rational-emotive therapy (RET) focuses on changing underlying irrational philosophies and beliefs. Symptom substitution is believed to be prevented in RET by teaching clients to dispute irrational thinking in an ongoing way.The author gratefully acknowledges Leonard G. Rorer for his assistance in the preparation of this article.     

Behavioral interventions may prolong remission in patients with inflammatory bowel disease

Inflammatory Bowel Diseases (IBDs) are chronic, relapsing and remitting gastrointestinal conditions with no known cure. Previous studies have linked behavioral factors, including stress and medication adherence, to relapse.

Purpose

We sought to determine the effect of participation in a behavioral self-management program on incidence of flare within 12 months following behavioral intervention when compared to the natural history of flare incidence prior to program participation.

Results

Results from a 2-level regression model indicated that those participants in the treatment group were 57% less likely to flare in the following 12 months (compared to 18% in the control group). The decline in “flare odds” was about 2 times greater in treatment versus controls (OR = 0.52, t(34) = 2.07, p < 0.05). Office visits, ER visits, and disease severity (all p < 0.05) were identified as moderators of flare risk.

Conclusions

We have demonstrated 1) a statistical model estimating the likelihood of flare rates in the 12 months following a behavioral intervention for IBD (compared to a control condition), and 2) that the introduction of a behavioral intervention can alter the natural course of a chronic, relapsing and remitting gastrointestinal condition such as IBD.     

REVIEW OF HEYMAN'S ADDICTION: A DISORDER OF CHOICE

Gene Heyman's Addiction: A Disorder of Choice (2009) advances the important, albeit controversial, view that addiction is not a chronic, relapsing brain disease, but instead is an example of typical everyday choice that is both voluntary and self‐destructive. This review highlights Heyman's arguments for conceptualizing addiction as choice and discusses the utility of the treatment implications that are derived from the melioration model in which Heyman frames addiction. Self‐control and behavioral economics are presented as additional complementary frameworks for understanding addiction as choice, from which pragmatic, evidence‐based treatments for addiction (e.g., contingency management) might more easily be derived.     

高频超声对膝关节病变的观察

通过超声对髌上囊、股骨髁间软骨情况、胭窝滑囊、髌腱等膝部结构的观察,评价超声对膝关节病变的辅助诊断、观察疗效的价值。通过高频超声对膝关节肿胀、疼痛病例纽与对照组、病例组治疗前后髌上囊液体、滑膜、股骨髁间软骨、胭窝滑囊积液情况以及髌腱厚度及回声进行对比观察。病例组髌上囊液体及滑膜增厚,股骨髁间软骨多有不同程度改变,胭窝滑...     

Multimodal Rehabilitation: A Mind-Body Family-Based Intervention for Children and Adolescents Impaired by Medically Unexplained Symptoms. Part 2: Case Studies and Outcomes

In Part 2, we describe three cases implementing our mind-body, family-based, multimodal rehabilitation approach for treating children and adolescents presenting with medically unexplained symptoms. For each child and family, treatment interventions were selected and implemented, simultaneously or sequentially. In a cohort of 100 consecutively referred children, 56 suffered from, and were treated for, significant physical or chronic school absenteeism. Thirty-five of these children (63%) recovered fully, 10 (18%) had a relapsing course, 7 (12.5%) had chronic symptoms, and 4 (7%) were lost to follow-up. These outcomes suggest that mind-body multimodal rehabilitation is a successful, cost-effective model of treatment.     

Assessing outcome in smoking cessation studies.

Outcome measures for smoking cessation are reviewed and evaluated, including 3 self-report measures and 3 biochemical validation measures. Point prevalence reflects the percentage of participants taking action, prolonged abstinence reflects those in the maintenance stage, and continuous abstinence reflects those who progress from action to maintenance without lapsing or relapsing. Biochemical assessments are primarily measures of point prevalence abstinence. The desirability of biochemical validation is a particularly controversial and critical issue. Three factors affect the accuracy of self-report: Type of Population, Type of Intervention, and Demand Characteristics. False-negative rates are generally low. Three broad issues impact on decisions to use biochemical validation: (a) alternative explanations for false positives, (b) refusal rate problems, and (c) the effect of inaccuracy on intervention assessment.     

Living with a Rare Chronic Illness: A Phenomenological,Systemic Examination of Hemophilia Complicated by an Inhibitor

Abstract

Up to 20% of individuals with hemophilia experience the added complication of an inhibitor. An inhibitor results in severe bleeds, joint damage, impaired mobility, and even death. We conducted a focus group with eight individuals affected by inhibitors (three patients and five caregivers). Data were analyzed using the immersion/crystallization method. The following themes emerged: (a) fear and anxiety within the family, (b) social isolation of the patient, (c) unique impacts on caregivers and siblings, and (d) desired changes in treatment. Similar experiences may be common across comparable disorders that are incapacitating, acute, and relapsing in nature.     

阴式手术在卵巢良性肿瘤手术中的地位

为了探讨阴式手术在卵巢良性肿瘤手术中的重要性,通过回顾性分析解放军总医院2003年～2006年间收治的卵巢良性肿瘤患者60例(阴式、腹腔镜、开腹手术各20例),对3种术式的手术时间、术中出血量、术后病率、术后肛门排气时间、住院时间进行比较,进而拓展到我院多种疑难阴式手术情况和结局。结果显示,对于卵巢良性肿瘤,阴式组手术时间短,恢复快,术后病率少。提示阴式手术在卵巢良性肿瘤手术中居于非常重要的地位。