发挥中药在肿瘤症状处理中的作用——兼谈结直肠癌的中医“病证结合辨治”

改善症状是中医治疗晚期恶性肿瘤的优势,但简单的对症治疗显然体现不了中医的特色;辨证论治虽然是中医治疗的核心,但在对癌病本质的把握上缺乏理论和实践的支撑;单一的辨病论治强调以毒攻毒,却不能改善症状及预后。本文作者以对结直肠癌的治疗为例,认为抓主症,将病证与辨治相结合,有望较好地解决“症”“证”“病”三者的关系,在改善症状...     

Delirium and isolated angiitis of the central nervous system: a case report and review

Central nervous system (CNS) vasculitis is a rare entity, especially when it occurs in isolation; it is seen more commonly as part of a multisystem vasculitis. Common presenting symptoms include persistent headache, encephalopathy, and multifocal signs. We discuss the case of a 68-year-old female who presented twice in 1 month with confusion and choreaform movements. Extensive workup was negative for a connective tissue disease or other conditions in the differential, including neurosarcoidosis, Creutzfeldt-Jakob disease, and neurosyphilis. The only significant findings were elevated erythrocyte sedimentation rate, inflammatory signs in the CNS, and diffuse slowing of the electroencephalogram. A presumptive diagnosis of isolated angiitis of the central nervous system (IACNS) was made and the patient was successfully treated with steroids. She recovered fully with no residual symptoms. The diagnosis of IACNS is often difficult given there are no definitive laboratory investigations or pathognomonic presentation. However, a series of signs, symptoms, and laboratory findings have been proposed that are helpful in making the diagnosis. To our knowledge, IACNS presenting primarily with delirium has not been previously reported in the literature. The diagnosis of IACNS is purely speculative for this case, as the gold standard for diagnosis, a leptomeningeal cortical biopsy, was not performed.     

中医疗效的确定性与不确定性的比较思考

中医对于疾病的认识带有厚重的价值论色彩,昭示了强烈的主体尺度的特色。在辨证论治方面,它强调主体对于输出信息的价值判断,而非事实性认识;辨证论治标准的非客观化、非量化,会使不同主体在直觉体悟下产生不同的辨证结果,因而也就会产生不同的论治方法;中药饮片和中成药质量的现状也使中医经验的拷贝效果往往难以得到预想的重复。中医疗效表现出复杂的确定性与不确定性的矛盾。     

Is alcoholism a disease? A critical review of a controversy

Commentators have repeatedly attacked the traditional view that alcoholism is a disease. Their arguments that alcoholism is a central aspect of life, a deviant life style, or a form of learned behavior are examined in the light of the history and philosophy of medicine as well as current bio-behavioral research. Our conclusion is that alcoholism, as a lawful pattern of observable signs and symptoms that deviate significantly from a norm of health, is a bio-psychosocial disease.     

Is alcoholism a disease?

Commentators have repeatedly attacked the traditional view that alcoholism is a disease. Their arguments that alcoholism is a central aspect of life, a deviant life style, or a form of learned behavior are examined in the light of the history and philosophy of medicine as well as current bio-behavioral research. Our conclusion is that alcoholism, as a lawful pattern of observable signs and symptoms that deviate significantly from a norm of health, is a bio-psychosocial disease.     

糖尿病周围神经病变临床研究进展

糖尿病周围神经病变(DPN)患者可无临床症状,通常结合症状、体症、10g单尼龙丝、128HZ音叉检查、神经电生理学、定量感觉检查、温度阈值、足底压力测定等检查判断。10g单尼龙丝、128HZ音叉检查、神经电生理学检查是最常用的临床检查。临床上经常应用一些简单的筛查性问卷调查来描述症状的严重性。近年来神经活检有创性检查,MRI、角膜共聚显微镜等无创性检查,以及对自主神经病变的早期诊断进展较快。由于流行病学研究中多不同程度采用上述检查方法,对于研究结果的一致性值得关注。     

The Relationships of Stress to Angioneurotic Edema:

Hereditary angioneurotic edema is a disease characterized by attacks of swelling of the extremities, face, and airways, frequently accompanied by abdominal pain and gastrointestinal symptoms such as vomiting and nausea. The possibility of improving the management of hereditary angioneurotic edema through psychological interventions was raised by the fact that stress has been implicated as a potential precipitant for acute attacks as well as a common psychological sequala to them. The current case evaluates efficacy of Psychological interventions in reducing the frequency and intensity of symptoms associated with this disorder in a 16-year-old white female. The combination of family therapy and behavior management was more successful than an initial effort utilizing stress management techniques in combination with positive reinforcement alone.     

试论张仲景辩病结合辩证的辨证论治方法的先进性

张仲景辩病结合辩证的辨证论治方法,与现代医学认识疾病的思想非常近似,通过比较现代医学认识疾病思想与张仲景疾病认识概念在疾病诊治过程中的相似性,为研究<金匮要略>古代疾病与西医现代病的对应性结合、提高病证结合论治在临床的效验,有很大意义.     

Obstructive sleep apnea and depression

Is there an association between obstructive sleep apnea (OSA) and depression? OSA is a common breathing-related sleep disorder. There have been reports that depressive symptoms can be associated with this sleep disorder. A number of investigations have addressed this issue. Although some have found no correlation, most studies have concluded that there is an association between OSA and depressive symptoms. Other investigations have shown that depressive symptoms improve with treatment of OSA, and that untreated OSA may contribute to treatment resistance in some cases of mood disorders. Within the framework of current psychiatric diagnostic criteria, the depressive symptoms associated with OSA can be viewed as a combination of a mood disorder secondary to a primary medical condition and an adjustment disorder with depressed mood. The question of whether OSA causes depressive symptoms can perhaps be best answered by viewing OSA and depression as having certain symptoms that are common to both disorders.     

Non-motor aspects of Parkinson's disease

Parkinson's disease is primarily considered to be a movement disorder and is defined by its motor signs. Yet, the behavioral manifestations of the disease are often more debilitating than its motor complications. This review will focus on the non-motor aspects of Parkinson's disease, including mood, psychosis, cognitive, sleep, fatigue, apathy, delirium, and repetitive disorders, that may occur. The phenomenology, pathology, and treatment of the behavioral symptoms of Parkinson's disease will be discussed.     

Developing ways to encourage early detection and presentation of oral cancer: what do high-risk individuals think?

The aim of this pilot research was to improve understanding of individuals at risk of oral cancer, to determine their attitudes towards and responses to early detection interventions. In-depth interviews with the target group (n = 25) were used to determine their views, attitudes and requirements for an intervention to encourage early detection of oral cancer. This data was used in combination with theory-based constructs to develop written material that aimed to increase awareness of oral cancer, encourage mouth self-examination (MSE) and early presentation. A second pilot study used a think-aloud protocol to assess the target groups' (n = 14) reactions to the written information. In both studies the tape-recorded responses were analysed using framework analysis. The target group had limited knowledge about oral cancer, particularly the signs and symptoms. Participants saw benefits in performing MSE but noted the main barriers were not knowing what signs to look for or where to look. The written information was generally well-received but required some modifications. In particular, the target group required further persuasion that their lifestyle contributed to an increased risk of oral cancer. The results of these pilot studies have informed the development of a theory-based intervention for the early detection of oral cancer.     

Systematic approach to the diagnosis of lysosomal storage disorders

Disorders that arise as a result of lysosomal dysfunction represent some of the most challenging diagnostic problems in medicine. Not only are these disorders infrequently seen, but they may also present with signs and symptoms that mimic perinatal injury, food intolerance, or the sequellae of neonatal infection. Misidentification can lead to significant delay in diagnosis. Ironically, as the prevailing economic climate places increasing time constraints on practicing physicians, medical research is providing treatment strategies and management techniques that are most effective if applied early in the course of the disease. Most lysosomal storage disorders can now be definitively diagnosed once the signs are recognized. In many cases the benefits of early diagnosis, enlightened management, and appropriate referral are considerable. The aim of this paper is to demystify this elusive class of diseases, to promote clinical vigilance in their detection, and to provide a systematic approach to diagnosis when clinical suspicion is aroused.     

Psychiatric symptoms associated with brain tumors: a clinical enigma

Patients in psychiatric settings may present with medical conditions, such as brain tumors, which may or may not be associated with neurological symptoms. In some cases, patients may only have psychiatric symptoms, such as mood changes (depression or mania), psychotic symptoms, panic attacks, changes in personality, or memory difficulties. Brain tumors may be detected in patients at their first presentation to mental health services or sometimes in patients with well-established psychiatric diagnoses. This article presents the case of a 29-year-old woman who was treated for >4 years for posttraumatic stress disorder and borderline personality traits, who developed depressive symptoms and memory difficulties. However, she did not develop any major neurological signs or symptoms. Brain imaging showed the presence of a left thalamic tumor, later confirmed as glioblastoma multiforme. She underwent surgical treatment and radiation therapy. With this we show that in some cases, brain tumors can be neurologically silent and only present atypical psychiatric symptoms. We emphasize the need for neuroimaging studies in a patient with atypical changes in mental status, even without neurological signs or symptoms.     

Developing ways to encourage early detection and presentation of oral cancer: What do high-risk individuals think?

The aim of this pilot research was to improve understanding of individuals at risk of oral cancer, to determine their attitudes towards and responses to early detection interventions. In-depth interviews with the target group (n?=?25) were used to determine their views, attitudes and requirements for an intervention to encourage early detection of oral cancer. This data was used in combination with theory-based constructs to develop written material that aimed to increase awareness of oral cancer, encourage mouth self-examination (MSE) and early presentation. A second pilot study used a think-aloud protocol to assess the target groups’ (n?=?14) reactions to the written information. In both studies the tape-recorded responses were analysed using framework analysis. The target group had limited knowledge about oral cancer, particularly the signs and symptoms. Participants saw benefits in performing MSE but noted the main barriers were not knowing what signs to look for or where to look. The written information was generally well-received but required some modifications. In particular, the target group required further persuasion that their lifestyle contributed to an increased risk of oral cancer. The results of these pilot studies have informed the development of a theory-based intervention for the early detection of oral cancer.     

Studying Help-Seeking for Symptoms: The Challenges of Methods and Models

Although the detection and experience of symptoms often stimulates an appropriate decision as to whether to visit to a healthcare professional (HCP), there are many occasions when it does not. Sometimes, people seek help for minor, transient conditions which would have resolved without the attention of a HCP, whereas at other times help is not sought for signs of life-threatening disease. Help-seeking behaviour concerns not only the decision of whether to seek help or not, but also the timing of that decision. The timing of consultations with HCPs has implications for our health, quality of life, treatment options and for the cost of healthcare services. This article discusses research and theory on help-seeking behaviour, with attention to the challenges of methods and models used in this area of research. One particular model, the ‘General Model of Total Patient Delay’, is outlined and critiqued to demonstrate the complex processes involved and highlight areas in need of further research and development.     

Disease Rarity,Carrier Status,and Gender: A Triple Disadvantage for Women with Fabry Disease

Fabry disease is a multi-systemic X-linked genetic disorder which has progressive and deadly consequences for those it afflicts. Fabry disease symptoms are widely recognized as a substantive burden for affected males. In comparison, female heterozygotes have traditionally been viewed as relatively symptom-free, though a debate continues about whether and how much they suffer with the disease. Previous research suggests that females with Fabry disease may be triply disadvantaged in healthcare settings owing to: (1) disease rarity, (2) devalued carrier status, and (3) gender. The combined effects of these three factors suggest that female heterozygotes may suffer substantially with Fabry disease symptoms. A qualitative analysis of a brief disease-specific questionnaire provides supportive evidence. The female Fabry disease participants described experiencing significant symptoms that interfered with their lives. They also described unsatisfying experiences with healthcare professionals related to disease rarity, carrier status, and gender. The results of this study corroborate the suggestion that this triple disadvantage exists and may preclude appropriate management and treatment of females with Fabry disease. The role of healthcare professionals, including genetic counselors, in remedying this disadvantage is reviewed.     

An atypical anxious‐impulsive pattern of social anxiety disorder in an adult clinical population

An atypical subgroup of Social Anxiety Disorder (SAD) with impulsive rather than inhibited traits has recently been reported. The current study examined whether such an atypical subgroup could be identified in a clinical population of 84 adults with SAD. The temperament dimensions harm avoidance and novelty seeking of the Temperament and Character Inventory, and the Liebowitz Social Anxiety Scale were used in cluster analyses. The identified clusters were compared on depressive symptoms, the character dimension self‐directedness, and treatment outcome. Among the six identified clusters, 24% of the sample had atypical characteristics, demonstrating mainly generalized SAD in combination with coexisting traits of inhibition and impulsivity. As additional signs of severity, this group showed low self‐directedness and high levels of depressive symptoms. We also identified a typically inhibited subgroup comprising generalized SAD with high levels of harm avoidance and low levels of novelty seeking, with a similar clinical severity as the atypical subgroup. Thus, higher levels of harm avoidance and social anxiety in combination with higher or lower levels of novelty seeking and low self‐directedness seem to contribute to a more severe clinical picture. Post hoc examination of the treatment outcome in these subgroups showed that only 20 to 30% achieved clinically significant change.     

The causal explanatory functions of medical diagnoses

Diagnoses in medicine are often taken to serve as explanations of patients’ symptoms and signs. This article examines how they do so. I begin by arguing that although some instances of diagnostic explanation can be formulated as covering law arguments, they are explanatory neither in virtue of their argumentative structures nor in virtue of general regularities between diagnoses and clinical presentations. I then consider the theory that medical diagnoses explain symptoms and signs by identifying their actual causes in particular cases. While I take this to be largely correct, I argue that for a diagnosis to function as a satisfactory causal explanation of a patient’s symptoms and signs, it also needs to be supplemented by understanding the mechanisms by which the identified cause produces the symptoms and signs. This mechanistic understanding comes not from the diagnosis itself, but rather from the theoretical framework within which the physician operates.     

DIFFERENTIATION OF CHARACTER NEUROSIS AND SYMPTOM NEUROSIS ON THE BASIS OF DIFFERENCES BETWEEN TWO SERIAL EXPERIMENTS

The difference between two serial tests as regards signs of hysteria and obsession-compulsion is compared with differences in number of symptoms reported by the patient. Signs in the more formal colour-word test, measuring habitual behaviour patterns, correspond to fewer symptoms than signs in a tachistoscopic test revealing more of the perceptual representation (content) of behaviour disorders. This difference is supposed to reflect important aspects of the difference between character neurosis and symptom neurosis.     

妊娠期甲亢诊疗决策

由于甲亢的一些症状和体征类似于正常妊娠中发生的正常生理变化,且孕期甲亢及其治疗对妊娠结果和胎儿可能的不良影响,所以给孕期甲亢的诊疗带来困难。孕期甲亢患者应尽快接受抗甲状腺药物（antithyroid drugs,ATD）的治疗并应经常接受胎儿和孕妇甲亢及甲减征象的监测。孕妇和围产期的并发症发生率直接与母亲甲亢的控制有关...