33例肺上沟癌的临床特点及放疗疗效

目的　探讨肺上沟癌的临床特点及放疗疗效和不良反应。方法　回顾性分析 3 3例肺上沟癌住院病人的临床特征和常规放疗的疗效。结果　肺上沟癌占原发性支气管肺癌的 2 9% ,常见症状为 :患侧肩、背和上肢疼痛 ( 78 8% ) ,后 1,2 ,3肋骨或椎骨破坏( 5 7 6% ) ,Horner’s综合征 ( 3 6 7% ) ;少见的症状为 :咳嗽 ( 2 7% ) ,咯血 ( 9% ) ;中位生存期为 8 4月 ;1,3 ,5年生存率分别为 3 5 6% ,12 3 % ,4 6% ;放疗反应可耐受。结论　肺上沟癌相当少见 ,其临床特征基本符合pancoast综合症 ,本病预后差 ,但放疗可缓解疼痛 ,提高生存质量。     

Framing the child at risk

Risk Assessment Reports are one form of accounting practice which delineate the space of risk considered in a child abuse neglect investigation. The paper analyses two Risk Assessment Reports, contrasting what is reported, what is directly observed and what is hypothesized and implied by child protection practitioners during the assessment of risk. From an analysis of these two reports (each 4 – 5 pages long), the paper identifies the rhetorical strategies and their realizations used by two practitioners in framing the child at risk. The paper problematizes the tension between the institutional need to constrain the exercise of professional judgement through Risk Assessment Models, and the extent to which practitioners actually localize the framing of risk to specific areas of investigation.     

Critical study of hair growth analysis with computer-assisted methods

BACKGROUND: Computer-assisted image analysis has been proposed for human hair growth studies. METHODS: The performances of Trichoscan, a commercially available automated system combining epiluminiscence microscopy with digital image analysis, developed for office-based hair growth measurements, have been evaluated comparatively on the same skin sites using standardized photographic equipment and calibrated processing for contrast-enhanced phototrichogram (CE-PTG) analysis. This reference method has been validated with scalp biopsies and histological examination of serial sectioning. RESULTS: Besides edge effects, hair fibres escaped the Trichoscan analysis for various reasons including, but not limited to, thickness, pigmentation, closeness and crossing. CONCLUSION: Most of these problems have been identified in the late 1980s and remain largely unsolved by the processing software that was evaluated in 2004. Therefore claims promoting the Trichoscan method for accurate hair measurements in clinical trials on scalp and body hair are not supported by the present investigation. The speed at which the analysis is performed is outweighed by the errors in signal detection. Therefore we suggest that improvements must be clearly documented before Trichoscan is established for quantified diagnostic purposes and detailed hair cycle monitoring during hair trials.     

The multiform and variable patterns of onset of orofacial granulomatosis

BACKGROUND: The recurrent chronic orofacial swelling caused by orofacial granulomatosis (OFG) can cause significant cosmetic and functional problems but can be prevented if the disease is diagnosed early and promptly treated. Although the enlargement of the lips is described to be the most common presenting complaint, the clinical onset of OFG may be characterized by minor associated mucosal and neurological manifestations, making early diagnosis very difficult or, sometimes, merely presumable. PATIENTS AND METHODS: We retrospectively analyzed the clinical manifestations of 19 patients with OFG, who were examined at our institution between 1998 and 2002, in order to determine their initial manifestations and presenting symptoms. RESULTS: A total of 10 patients showed classical recurrent enlargement of the lips (six lower; four upper) as presenting symptom. In the other nine patients, OFG onset was characterized by transient unilateral facial nerve palsy (two cases), intraoral manifestations (two cases), recurrent swelling of the periorbital area (two cases), of the chin (one case), of the zygomatic area (one case), and of the cheeks (one case). CONCLUSION: Our data underlined that OFG onset could be frequently characterized by widely variable, multiform, and temporary clinical findings. Involvement of atypical sites of the orofacial region and presence of single minor manifestations may occur as presenting symptoms, often preceding the development of traditional clinical findings.     

Preliminary laboratory based diagnostic criteria for immune thrombocytopenic purpura: evaluation by multi-center prospective study

BACKGROUND: We proposed diagnostic criteria for immune thrombocytopenic purpura (ITP) by modifying the existing guidelines for diagnosis of ITP and by incorporating laboratory tests found useful for predicting its diagnosis, for example erythrocyte count, leukocyte count, anti-GPIIb/IIIa antibody-producing B cells, platelet-associated anti-GPIIb/IIIa antibodies, percentage of reticulated platelets, and plasma thrombopoietin. OBJECTIVE AND METHODS: To validate our criteria, we conducted a multi-center prospective study involving 112 patients with thrombocytopenia and a morphologically normal peripheral blood film at the first visit. Each patient underwent a physical examination, routine laboratory tests, and specialized tests for the anti-GPIIb/IIIa antibody response and platelet turnover. RESULTS: Ninety-one patients (81%) satisfied the proposed criteria at first visit. Clinical diagnosis was made by skilled hematologists > 6 months after the first visit; ITP was diagnosed in 88 patients and non-ITP disorders in 24. The proposed criteria had 98% sensitivity, 79% specificity, a 95% positive predictive value, and a 90% negative predictive value. A relatively low specificity appears to be attributed to a few patients who had both ITP and aplastic anemia or myelodysplastic syndrome. CONCLUSIONS: Our preliminary diagnostic criteria based on ITP-associated laboratory findings were useful for the differential diagnosis of ITP, but additional evaluations and modifications will be necessary to develop criteria that can be used routinely.     

结直肠癌患者的临床、内镜、病理学特点

目的探讨结直肠癌患者临床、内镜、病理特点。方法对1991—2005年肠镜及病理证实的结直肠癌患者,按年龄分为青年组(≤30岁),中年组(31~59岁),老年组(≥60岁),从临床表现、内镜表现和病理学三方面进行回顾性分析。结果(1)本组结直肠癌患病高峰为50~65岁,男性结直肠癌构成比高于女性。(2)青年组以腹痛就诊者占70.73%,中老年组以便血就诊者占65.50%,说明临床症状具有不典型性。(3)各组直肠癌均有较高的比例,青年组右半结肠癌的发病率(34.15%)明显高于中老年组(16.33%)。(4)青年组以低分化腺癌、黏液腺癌为多,肿瘤分化程度低,恶性程度高;中老年组以高分化腺癌多见,肿瘤分化程度高,恶性程度低。结论不同年龄组结直肠癌患者有不同的临床、内镜、病理特点,对有下消化道症状的患者,应尽早、全面地进行结肠镜检查。     

进展期胃印戒细胞癌患者的临床病理特点与预后

目的研究进展期胃印戒细胞癌患者的临床病理特点及预后.方法对571例进展期胃癌患者的临床病理特点及术后5年生存率进行回顾性分析.结果进展期胃印戒细胞癌75例,多见于中老年女性（70.0%）,胃中部多发（46.7%）.肿瘤大小、淋巴结转移、肝脏转移、腹膜转移等方面与进展期胃非印戒细胞癌相比差异无统计学意义（P＞0.05）;大体分型以BorrmannⅢ型、Ⅳ型多见（P＜0.01）,且浸润深度T3、T4比胃非印戒细胞癌多见（P＜0.01）;行根治性手术后5年生存率为44%,与其他类型进展期胃癌根治性手术后5年生存率相比差异无统计学意义（P＞0.05）.结论进展期胃印戒细胞癌与其他组织学类型的胃癌相比恶性程度无差异.     

改变督导方式促进临床教学质量

目的:发挥教学督导的作用,提高医学院校临床教学的质量.方法:对教学督导工作进行了大胆的改革:①督导前移,加强了教学的环节质量;②疏通反馈通道,保证教学督导效果;③言传身教,加强对青年教师的培养和指导;④扩大督导范围,促进各层次教学质量;⑤全程随机评价,客观评价教学效果.结果:保证了教学效果,使教学质量有了明显的提高.结论:加速我军现代化建设,培养高素质医学人才,教学督导的作用显的尤其重要.     

Fetal neural grafts for Huntington's disease: a prospective view.

Intrastriatal transplantation of striatal neuroblasts from human fetuses is a promising approach for treatment of Huntington's disease, on the basis of many experimental animal studies and, most recently, pilot clinical trials. Technically, several issues remain to be resolved (e.g., the precise site of dissection of the fetal tissue; the number and location of the fetal striatal implants; or the use of immunosuppressive therapy), and await larger-scale trials and purposely designed protocols. Further clinical data must also be obtained, and preliminary promising results must be replicated in a patient group large enough to provide conclusive results. It is important to establish (1) the amount of clinical benefit provided to the patient by the grafted cells; (2) the anticipated duration of clinical benefits; and (3) the secondary rate of decline after the benefit of the graft has been overbalanced. Evaluation of these parameters will require very long-term follow-up of the patients involved, over several years after grafting, before the technique can eventually be proposed widely to patients.     

Prevalence of Candida tropicalis in clinical specimens from patients with variable clinical syndromes over a 5-year period

Summary. In this study, we have examined our records for the isolation of Candida tropicalis from clinical specimens of patients with heterogeneous clinical presentations during the past 5 years. We have found that this species ranks third among all yeasts in frequency of isolation from clinical specimens and that the trend of recovery from the specimens is rising over the years. The isolation rate of C. tropicalis was highest from urine specimens (36%) followed by respiratory specimens (22%). The frequency of isolation of C. tropicalis from vaginal specimens was relatively high (14%), however the trend was declining over the years. In general, the high recovery of Candida tropicalis from clinical specimens of patients with variable disease supports the views of this organism being a major pathogen.
Zusammenfassung. Die Studie basiert auf einer Durchsicht der Patientenarchive der letzten fünf Jahre auf die Isolationshäufigkeit von Candida tropicalis aus klinischen Untersuchungsmaterialien von Patienten mit unterschiedlichen klinischen Krankheitsbildern. Diese Hefeart war die dritthäufigste mit steigender Tendenz über die Jahre. Die Isolierungsrate von C. tropicalis war am höchsten aus Urin (36%), gefolgt von Respirationstrakt-Materialien (22%). Die Isolationshäufigkeit aus dem hinteren Scheidengewölbe war relativ hoch (14%), nahm jedoch mit den jahren ab. Allgemein unterstreicht die hohe Isolationsrate von C. tropicalis aus klinischen Untersuchungsmaterialien die ätiologische Bedeutung dieses Erregers.