高血压脑出血急诊救治现状与进展

高血压脑出血是指在高血压的情况下发生的脑实质内出血。目前急诊综合救治中内科药物和外科手术治疗为主要的两种方法。内科治疗只适用于轻度脑出血和有手术禁忌证及配合急诊外科手术的综合救治,外科手术多用在中、重度脑出血病人治疗中。近年来开展的一种在CT下三维定位脑内血肿清除术,以其定位准确,脑损伤小,在急诊救治方面取得了一定效果,有待于进一步发展。     

脑出血中医药临床研究的困境与对策

脑出血为临床上的急危重症,目前缺乏有效的中医药治疗。本文从中药汤刺、中药注射剂及针灸三个方面阐述中医药治疗脑出血的临床现状,分析中医药治疗脑出血的优势与不足,从脑出血中医病名的确定、中医病机的多样性及中医重经验、轻理论,重哲学、轻医理等方面剖析中医药治疗脑出血临床困境的原因,并根据所述原因从脑出血相关中医病名研究、脑出血病机研究、中医药新型制弃】研究等方面探讨如何走出中医药治疗脑出血的临床研究困境。     

腹腔镜与开腹肝包虫内囊摘除术的临床对照研究

对腹腔镜和开腹肝包虫内囊摘除术的治疗效果进行比较。选择腹腔镜肝包虫内囊摘除术病例26例及行开腹肝包虫内囊摘除术病例50例,比较其手术时间、术中出血量、胃肠功能恢复时间、术后禁食时间、镇痛药物使用例数、镇痛药物使用时间、并发症发生率及术后住院时间的比较。腹腔镜和开腹组均无手术死亡病例;腹腔镜组术中出血量明显少于开腹组;术后胃肠功能恢复时间、术后禁食时间、镇痛药使用例数及时间、住院天数显著短于开腹组;两组并发症发生率差异无统计学意义。腹腔镜下肝包虫内囊摘除术可以达到与开腹肝包虫内囊摘除术同样的效果,且手术创伤小,恢复快。     

高血压脑出血的治疗策略

高血压脑出血（hypertensive intracerebral hemorrhage,HICH）是一种高发病率、高致残率和高致死率的全球性疾病,一直是神经内、外科治疗的重点和难点。迄今,国际上缺乏对HICH的规范治疗方案,传统方法主要有内科药物和外科手术治疗。本文试图从哲学和临床的角度探讨HICH的治疗策略。     

Mutism in an Adult Following Hypertensive Cerebellar Hemorrhage: Nosological Discussion and Illustrative Case

Mutism after cerebellar injury has been associated with tumors, hemorrhage, and surgery of midline cerebellar structures. Literature review identified 54 cases, primarily in children after surgical splitting of the inferior vermis. We present a 47-year-old who developed transient mutism after cerebellar hemorrhage. This represents the first report of transient mutism in an adult with neither tumor nor brainstem infarction and documents the importance of cerebellar structures for initiation and production of speech in adulthood. This case further differs from those previous because of the long mute period and the subsequent return of continued ataxic and dysarthric speech.     

Roles of Religious Commitment,Emotion Regulation and Social Support in Preoperative Anxiety

Surgery is a relatively commonplace medical procedure in healthcare settings. The mental health status of the person undergoing surgery is vital, but there is dearth of empirical studies on the mental health status of surgery patients, particularly with regard to the factors associated with anxiety in surgical conditions. This study investigated the roles of religious commitment, emotion regulation (cognitive reappraisal and expressive suppression) and social support in preoperative anxiety in a sample of 210 surgical inpatients from a Nigerian tertiary healthcare institution. A cross-sectional design was adopted. Before the surgery, respondents completed the state anxiety subscale of State-Trait Anxiety Inventory, Religious Commitment Inventory, Emotion Regulation Questionnaire and Multidimensional Scale of Perceived Social Support. After controlling for relevant demographic factors, regression results showed that cognitive reappraisal, social support and interpersonal religious commitment were negatively associated with preoperative anxiety, while expressive suppression was positively associated with preoperative anxiety. The emotion regulation strategies made robust and significant explanation of variance in preoperative anxiety. Appropriate interventions to promote interpersonal religious commitment, encourage cognitive reappraisal and enhance social support quality may improve mental health outcomes in surgery.

     

Predictors of subjective age before and after cataract surgery: conscientiousness makes a difference

This study contributes to research on subjective age by examining the interplay of felt age with health, functional limitations, and personality. Individuals undergoing cataract surgery (N=134; 38 to 92 years of age) provided data for an assessment period of 6 weeks surrounding their scheduled surgery. Conscientiousness and repeated measurements of health indicators, functional limitations, and felt age were included in the analyses. Results indicated that functional limitations may be more important to the construction of felt age than their underlying health-related causes. Moreover, conscientious participants felt younger before and after surgery. Their functional status was less dependent on health than the functional status of less conscientious participants. This moderator effect is discussed along with health-related pathways leading to felt age.     

Correlates of Young Women’s Interest in Obtaining Cosmetic Surgery

This study examined predictors of young women’s interest in obtaining cosmetic surgery. The sample investigated was comprised of 101 college undergraduates residing in the northeastern U.S. (M age?=?19.99, SD?=?4.79). Participants’ weight status (M BMI?=?24.52, SD?=?5.69), body dissatisfaction, internalization of media messages, reports of physical appearance teasing, and interest in obtaining cosmetic surgery were assessed. Results indicated that all of the predictors examined were correlated with women’s interest in cosmetic surgery. Further, body dissatisfaction mediated the relations between weight status, internalization of media messages, reports of teasing, and women’s interest in cosmetic surgery. Findings are discussed in terms of the importance of understanding cosmetic surgery trends and young women’s susceptibility to body dissatisfaction.     

Damned if You Do,Damned if You Don’t: The Stigma of Weight Loss Surgery

Willpower, as demonstrated through diet and exercise, is constructed as the only acceptable strategy for losing weight. While weight loss surgery (WLS) is an option for morbidly obese individuals, like obesity itself, WLS carries stigma. Using a 40-item survey, we measured 101 participants’ experiences with WLS stigma. We examined whether WLS is stigmatizing, how that stigma is perceived by patients, and tendencies to hide their surgery status in order to manage stigma. Results indicated evidence of perceived stigma despite support from significant others as well as a tendency to hide surgery status from some people as a stigma management technique.     

Subjective Well-Being and Self-Reported Health in Osteoarthritis Patients Before and After Arthroplasty

The main aim of the current study is to examine the changes in the components of subjective well-being (SWB) over time in patients with osteoarthritis who have undergone total hip or knee replacement surgery (arthroplasty). We are also interested in determining whether pre-operative ratings of self-reported health (SRH) status, as well as change in health status, can serve as predictors for postoperative levels of SWB. To this end, 50 participants who had been admitted to a hospital for arthroplasty completed the measures twice—first at the clinic one day before the surgery, and then at home approximately 4.5 months after the surgery. Despite the fact that there were substantial improvements in participants’ health and physical functioning after the arthroplasty, there were no changes in their ratings of general SRH, life satisfaction (LS), or negative affect (NA). The only change in SWB scores was in the level of positive affect (PA), which was significantly higher after surgery compared with the pre-operative measurement. LS, NA, and PA scores after arthroplasty were differentially predicted by health ratings, showing that, it is the cognitive-evaluative component of SWB (i.e., LS) that is mostly responsible for the association between general SRH and SWB while affective components (i.e., NA and PA) are primarily related to more specific health indicators. Our findings can assist physicians in their efforts to provide more realistic expectations for their patients undergoing surgery in terms of the physical and psychological outcome.     

高场强MR和CT在急性脑出血中的诊断价值比较

对临床72例急性期脑出血分别进行CT及MR检查,通过脑内血肿量测定及两住有经验诊断医生的分析诊断,比较两项检查的诊断敏感性,探讨高场强MR在诊断急性脑出血中的价值。测量所得MR各序列和CT血肿量差异无统计学意义。敏感性比较T2＊WI和CT组差异无统计学意义,P〈0．01。T1WI和T2WI序列的敏感性相对较差,与CT组比较差异有统计学意义,P〈0．01。MR梯度回波T2＊WI对诊断急性脑内血肿的敏感性和CT检查相当,结合常规扫描序列在急性期脑内血肿的诊断和鉴别诊断中具有实际应用价值。     

胸外科器械吻合与手工吻合的利弊权衡

胸外科器械吻合技术在临床应用日益广泛,已经影响了传统的手工吻合技术。器械吻合和传统外科在有效治疗病人的同时,面临着复杂的技术和经济问题。外科医生如何面对和选择,已成为临床决策过程中亟待解决的问题。     

Psychosocial studies of surgically treated adults with unilateral total lip-maxilla-palate clefts

The psychological status of 51 adult subjects who had received surgery at the appropriate time for cleft lip-palate was investigated by questionnaire (Giessen test). In respect of social dominance this revealed a significant deviation towards social subordination among those with cleft lips and palates, which is explicable in terms of the lengthy and continuous treatment and appears to be of great importance as a defence and adaptation mechanism to those concerned. The inclusion of psychologists in the interdisciplinary care of cleft lip-palate patients is proposed.     

躯体变形障碍与美容整形术前心理评估

躯体变形障碍是一种并不罕见的精神障碍,其临床表现的特殊性使大多数患者以普通求术者的身份出现在美容整形科医生面前。然而,关容整形手术非但不能解决患者的心理问题,更可能引发复杂的医疗纠纷。基于躯体变形障碍在美容整形科呈高发生率的特点,文章对美容整形术前心理评估的必要性和现状进行分析,并列举了有效的评估工具以提高心理评估的准确性。     

Optimistic personality and psychosocial well-being during treatment predict psychosocial well-being among long-term survivors of breast cancer.

In considering well-being among survivors of life-threatening illnesses such as breast cancer, 2 important questions are whether there is continuity between initial adjustment and longer term adjustment and what role personality plays in long-term adjustment. In this research, a sample of 163 early stage breast cancer patients whose psychosocial adjustment was first assessed during the year after surgery completed the same measures 5-13 years after surgery. Initial reports of well-being were relatively strong predictors of follow-up well-being on the same measures. Initial optimism and marital status also predicted follow-up adjustment, even controlling for earlier adjustment, which exerted a substantial unique effect in multivariate analyses. In contrast, initial medical variables played virtually no predictive role. There is substantial continuity of subjective well-being across many years among survivors of breast cancer, rooted partly in personality and social connection.     

The acceptability of prophylactic mastectomy among lay people and health professionals: A pilot study

IntroductionWomen with certain genetic mutations have a risk of up to 85% of developing breast cancer. Bilateral prophylactic mastectomy is the most effective way to reduce risk of cancer.ObjectiveThis pilot study focuses on the acceptability of prophylactic breast surgery and examines, in a series of concrete cases, the cognitive processes by which health professionals and lay people make their judgments. This research also aims to identify the factors involved in these judgments. An additional objective is to determine whether there are groups with different patterns of responses.MethodWe recruited two samples in France, one comprising 90 lay people and the other 30 health professionals (n = 120) and asked them how acceptable it would be for a woman at a high risk of breast cancer to undergo a prophylactic surgery (mastectomy), in each of the 64 scenarios presented to them. The scenarios were all combinations of two levels of age, of marital status, of parenting status, of body appearance investment, of reconstructive surgery and also two levels of the person suggesting oncogenetic diagnosis.ResultsWe found that lay people and health professionals structured the factors in the scenarios in nearly the same way. They assigned importance to three factors: the most important one was reconstructive surgery, and then the age of the woman. The least important factor was the person who requested the genetic test. Furthermore, the age of the participants, and knowing a person who had cancer impacted the degree of acceptability assigned by participants. Being a lay person or a health professional did not have a direct impact on acceptability but influenced the integration of factors. In addition, cluster analysis showed that only a small group was opposed to mastectomy.ConclusionThis pilot study demonstrated that three factors have to be considered when judging the acceptability of prophylactic mastectomy and showed a common cognitive foundation for future discussion, at the levels of both clinical care and health policy, of the conditions under which prophylactic surgery might be acceptable.     

新尝试“假设法脑出血测量”与常用方法的对比

介绍一种CT脑血肿体积测量的新方法——假设法。制作水模进行CT扫描,分别用CT脑出血测量之假设法与多田公式法、CT定量法对其测量,比较结果的准确性。该方法较多田公式法、CT定量法更便捷准确。此假设法,计算简单、快速、准确,比多田公式法、CT定量法更具优势。     

Patients' interpretations of verbal expressions of probability: implications for securing informed consent to medical interventions

Physicians often use verbal expressions of probability to characterize their uncertainty about outcomes and the risks or side effects of proposed therapies. However, there is an extensive literature that documents the inherent vagueness of such expressions. Because of the potential importance of probability terms to physician-patient communication and decision-making, we asked patients to tell us the odds they thought applicable to the term "rare," as used by their physician to discuss the likelihood of an adverse outcome from surgery. Patients were randomly assigned to one of three outcome groups: death, severe heart attack, or severe pneumonia. Demographic data were elicited from each subject, as were indicators of present health status, medical history for certain diseases and surgery, and life expectancy. Linear regression and ANOVA analyses of the responses indicate that patient age, education level, perceived health status, and recency of experience with disease and medical care influence patients' numeric interpretations. We discuss the implications of these results.     

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.     

The impact of obesity surgery and the paradox of control: A qualitative study

In light of the failure of psychological approaches to obesity some clinicians and patients are turning to surgery. The present qualitative study aimed to explore patients' experiences of having obesity surgery and in-depth interviews were carried out with 15 men and women, who had had surgery in the past four years. The data were analysed using Interpretative Phenomenological Analysis (IPA). The patients described their experiences in terms of four broad themes: personal weight histories; the decision-making process, which involved general motivations such as worries about health and specific triggers such as symptoms; the impact of surgery on eating behaviour and their relationship with food; the impact of weight loss on health status, self-esteem and relationships with others. The central theme of control permeated all areas of the interviews. The current clinical climate highlights the importance of self-control and patient choice as the path to patient empowerment. Obesity surgery illustrates that in contrast to this perspective, imposed control and limited choice can sometimes paradoxically result in a renewed sense of control.