垂体腺瘤诊疗过程中应重视对垂体腺瘤患者生命质量评估

垂体腺瘤是一种常见的颅内神经内分泌肿瘤,约占颅内肿瘤的10%~15%,常伴有不同程度的肿瘤占位效应(头痛、视力受损等)、功能性腺瘤引起的激素水平过高和正常垂体受压破坏引起的垂体功能低下等症状,因此多数患者的生命质量受到影响。随着生物-心理-社会医学模式理念的逐步深入,除了关注患者的内分泌紊乱、肿瘤大小以及肿瘤引起的症状外,患者的生命质量也应该受到密切关注。本文将针对国内外对垂体腺瘤患者生命质量评估的相关进展进行综述。     

内镜下经鼻蝶入路垂体腺瘤切除术的临床研究

探讨内镜下经鼻蝶入路垂体腺瘤切除术的临床疗效及并发症的防治措施.回顾性分析我科210例行单鼻孔经鼻蝶入路垂体腺瘤切除术患者的临床资料：男106例,女104例;无功能腺瘤150例,功能性垂体腺瘤60例.存在假包膜的肿瘤行包膜外切除,术后随访3个月～32个月.结果肿瘤全切170例,次全切除5例,大部及部分切除35例.术后尿崩63例（30.0％）,激素水平低下25例（11.9％）,脑脊液鼻漏4例（1.9％）,颅内感染4例（1.9％）,鼻出血2例（0.9％）,视力下降1例（0.5％）,死亡1例（0.5％）.截止随访结束：垂体功能低下18例（8.5％）,永久性尿崩2例（0.9％）,无肿瘤复发.对鞍区解剖结构的熟悉及娴熟的内镜技术有助于安全有效的切除垂体腺瘤,减少并发症发生.     

浅谈垂体腺瘤手术入路的个体化选择

垂体腺瘤的治疗中,外科手术治疗是最佳的选择.本文就各种垂体腺瘤显微手术的入路进行探讨,分析了各种入路的适应证和优缺点.笔者认为,为了提高肿瘤全切率,减少副损伤,改善患者预后,应当根据肿瘤的大小、部位、生长方向,与周围组织结构的关系以及术者的技术和经验,选择合理的个体化手术入路,注重实施个体化的手术治疗方案.     

浅谈垂体腺瘤手术入路的个体化选择

垂体腺瘤的治疗中,外科手术治疗是最佳的选择。本文就各种垂体腺瘤显微手术的入路进行探讨,分析了各种入路的适应证和优缺点。笔者认为,为了提高肿瘤全切率,减少副损伤,改善患者预后,应当根据肿瘤的大小、部位、生长方向,与周围组织结构的关系以及术者的技术和经验,选择合理的个体化手术入路,注重实施个体化的手术治疗方案。     

垂体微腺瘤的诊断和治疗决策

垂体微腺瘤在正常人群中发病率较高,诊断主要依赖于其临床表现,内分泌学改变及放射学检查;治疗因人而异,其方法取决于其内分泌的异常情况及得到的医疗条件.科学的运用医学哲学思维,有助于减少漏诊和误诊,提高治愈率.     

侵袭性垂体腺瘤的个性化治疗

垂体腺瘤是颅内常见的良性肿瘤,但部分垂体腺瘤却呈现恶性生物学行为,呈侵袭性生长,导致手术全切困难,或是虽然手术切除满意,但却存在较高的复发率,使得临床治疗效果不满意。基于此,Jefferson1940年提出侵袭性垂体腺瘤的概念,随后人们对其诊断和治疗进行了深入系统的研究,取得了明显进展,特别是近年来有人提出垂体腺瘤的个性化治疗,使得侵袭性垂体腺瘤的治疗效果大为改观。     

垂体微腺瘤的诊断和治疗决策

垂体微腺瘤在正常人群中发病率较高,诊断主要依赖于其临床表现,内分泌学改变及放射学检查;治疗因人而异,其方法取决于其内分泌的异常情况及得到的医疗条件。科学的运用医学哲学思维,有助于减少漏诊和误诊,提高治愈率。     

垂体瘤侵袭性概念的多元化思考

垂体腺瘤是颅内常见的良性肿瘤,但却存在较高的手术不全切除率和术后复发率,因此1940年Jefferson提出侵袭性垂体腺瘤的概念,认为这部分肿瘤的生物学行为实际上是介于良性垂体腺瘤和恶性垂体癌之间,肿瘤侵袭性生长.随后各个专业的医生们从各自的角度对侵袭性进行了诠释,形成了目前多元化的概念.如解剖学的诊断,影像学的和手术学的标准,还有新近出现的分子生物学和病理学等的诊断等等.使得诊断标准众多,概念混乱,这里做一综述,以期能对侵袭性提出一个相对合理的解释.     

增殖和凋亡的单独与联合检测对垂体瘤侵袭性诊断的价值

垂体瘤是颅内常见的良性肿瘤,但却存在着较高的复发率.Jefferson于1940年提出侵袭性垂体腺瘤的概念,认为这部分垂体腺瘤的生物学行为介于良性垂体瘤和垂体癌之间.随后人们从分子生物学、病理学等多个角度对侵袭性腺瘤的发病机制进行了探讨,以期寻找到特异性的侵袭性指标.众所周知,细胞增殖能力的增强和凋亡的抑制是导致肿瘤恶性生物学行为的重要机制.但对垂体瘤的研究却发现有为数不少的侵袭性垂体腺瘤并不呈现高细胞增殖状态,而凋亡的研究则更是出现了不同甚至相反的结果,那到底是什么原因导致了侵袭性的形成呢?本文从细胞增殖和凋亡各自的临床意义以及其联合检测的角度探讨侵袭性的确切机制.     

垂体瘤侵袭性概念的多元化思考

垂体腺瘤是颅内常见的良性肿瘤,但却存在较高的手术不全切除率和术后复发率,因此1940年Jefferson提出侵袭性垂体腺瘤的概念,认为这部分肿瘤的生物学行为实际上是介于良性垂体腺瘤和恶性垂体癌之间,肿瘤侵袭性生长。随后各个专业的医生们从各自的角度对侵袭性进行了诠释,形成了目前多元化的概念。如解剖学的诊断,影像学的和手术学的标准,还有新近出现的分子生物学和病理学等的诊断等等。使得诊断标准众多,概念混乱,这里做一综述,以期能对侵袭性提出一个相对合理的解释。     

工程中利益冲突问题研究

首先在详细分析工程中利益冲突已有定义的基础上,本文从不同角度提出了一种不同的定义。然后,分析了利益冲突的构成,并列举了利益冲突的情形。接着,分析了利益冲突的伦理问题,并提出解决方法。最后介绍了美国工程社团以及大型企业有关利益冲突的伦理章程和行为规范。     

Conflicts of interest in science in Armenia

The author describes problems facing Armenia in reorganization of the structure of science in the post-socialist era with the aim of utilizing limited state resources more efficiently by reducing the number of separate scientific institutes, concentrating on essential core subjects required by the nation and encouraging all other projects to compete in the international arena for grant sponsorship. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

PTSD在中国的研究进展

PTSD是近十年来在中国精神病学界逐渐引起重视的一种反应性精神障碍。随着国外对PTSD的深入研究以及中国心理卫生事业的发展,相关领域的学者开始从事这一方面的研究并取得了不少成就。文章对中国PTSD的流行病学、神经生物学基础、病因学以及诊断和治疗等各个方面的研究作了初步总结和探讨。     

Visual impressions of penetration in the perception of objects in motion

Observers viewed visual stimuli in which one object moved to a position of partial occlusion by another. The objects were presented as two-dimensional profiles moving in an undefined space, so the partial occlusion supports several different physical interpretations. In fact some stimuli reliably gave rise to a perceptual impression that the moving object penetrated or pierced the stationary one. This kind of interaction impression has not previously been reported. The impression was maximized by rapid deceleration to a halt with minimal occlusion. If the object decelerated more slowly, so that it was completely occluded or projected from the far side of the stationary object, it was perceived as moving behind the stationary object. The shape of the moving object and its speed prior to occlusion had significant but small effects.     

A review of methods in the study of attention in autism

Atypical attention, while not a diagnostic feature, is common in individuals with autism spectrum disorders (ASD). The study of these atypicalities has recently gained in both quantity and quality, due in part to an increased focus on attentional atypicalities as one of the earliest signs of ASD in infancy. A range of attentional processes and components have been investigated, and the methods used are varied, from Posner-type paradigms, to the more recent use of eye-movement recording and change-detection techniques. This methodological complexity is one factor in the production of conflicting evidence on the topic of attention in ASD. This review uses a focus on methodology to clarify the literature to date and provide a resource for researchers wishing to study attention in ASD. Other factors that have contributed to the current discrepancies in findings are discussed, particularly the role of individual and group differences within the population of people with ASD.     

Components of aggression in chickens and conceptualizations of aggression in general

A refined analysis of the peck order in chickens was offered as a test of the notion that for this species, different responses such as leaping and various types of pecking need not be interchangeable indexes of aggression. Indeed, tests showed that particular response types of the birds were differentially mediated by organismic or environmental factors. In large cages pecking at the body was most frequent by birds that had a home-cage advantage. Contrarily, rates of aggressive leaping were independent of this environmental influence, with males having an advantage over females. Males showed more head pecking than females, but the profile for this sex difference did not resemble the profile for leaping. Correlational analyses revealed that whereas head pecking between testmates was not matched in frequency, leaping was positively related. Finally, the behavior of birds tested in small cages differed from that of the large-cage subjects. Although there was more head pecking in the small cages, males did not have an edge, and leaping was infrequent. Such results indicate that these responses cannot be viewed as interchangeable indicators of aggression in fowl.