Primary aspergillosis of the sphenoid sinus with pituitary invasion – a rare differential diagnosis of sellar lesions

Summary Aspergillosis belongs to the group of mycotic diseases of paranasal sinuses. The invasive forms, and particularly the fulminant forms, are potentially fatal. Isolated aspergillosis of the sphenoid sinus or the clivus is a difficult diagnosis, since the often misleading clinical manifestations of this rare disease develop late. These patients become apparent by neurological signs such as cavernous sinus syndrome, pseudotumor of the pituitary or the orbit. Diagnosis is often made intra-operatively or on histological examination. We report a case of invasive aspergillosis uniquely involving the sellar area revealed by clinical features suggesting a pseudotumor of the pituitary. Although such lesions are almost always seen in immune suppressed subjects, in our case, the patient was immune competent and had no past history of sinusitis. The question of whether, and when to perform limited or extensive surgery remains an issue for discussion, owing to the rarity of this disease honed by lack of experience. It depends on several factors: the kind of disease, the immunity, the subtype of invasive fungal sinusitis and the degree of tissue invasion.     

Does Meningitis Stop CSF Rhinorrhea following Lateral Skull Base Surgery?

In cases of cerebrospinal fluid (CSF) rhinorrhea following lateral skull base surgery, fibrosis and fibrin formation resulting from meningitis has been postulated as a mechanism of spontaneously resolving the CSF leak. This study was undertaken to explore any possible relationship between the cessation of CSF leak and meningitis. A retrospective study at a tertiary referral center of 232 consecutive patients was performed. Out of a total of 232 procedures, 29 patients developed CSF rhinorrhea, of whom 7 subsequently developed meningitis. Bacteria were isolated in CSF obtained at lumbar puncture in 5 cases, with the CSF analysis in the remaining 2 cases suggesting aseptic meningitis. Conservative treatment failed to stop the CSF rhinorrhea in 6 of 7 cases. In this study, the development of meningitis did not appear to aid in the resolution of the CSF rhinorrhea. We conclude that surgical intervention should not be delayed in the expectation that meningitis and conservative interventions may promote CSF leak resolution.     

社区人群糖尿病知识知晓率的描述性及分析性研究

目的了解社区人群对糖尿病知识知晓情况,为城镇居民进行糖尿病干预研究提供依据.方法对广州市荔湾区25岁以上常住居民进行随机抽样问卷,对资料作描述性和分析性研究.结果糖尿病知识知晓情况在年龄、性别、文化程度、糖尿病家族史、糖尿病患病史分布上有显著性差异.多因素分析显示:性别、年龄、文化程度、糖尿病家族史、糖尿病患病史、体力劳动强度、脑力劳动强度、收缩压与糖尿病知识知晓率密切相关,其比值比分别为1.239,0.990,1.223,2.752,1.897,1.373,0.916,0.884和0.996.结论该地区人群的糖尿病知识知晓率较低,要广泛开展全民特别是老年人、男性和文化程度较低人群的糖尿病知识宣传教育.     

对新调入护士进行专科知识教育的体会

目的探讨如何对新调入肿瘤科的护士进行专科教育的有关问题。方法帮助新护士尽快适应工作环境，进行必要的专科知识教育和专科技术传授，熟练掌握肿瘤病人的心理特点及健康教育技巧。结果新护士在调入1个月后能单独完成本职工作，未发生差错和事故，同事对新调入护士评价好，病人满意。结论护士长对新调入护士有目的地进行专科理论知识教育和专科技术操作传授，言传身教，对尽快提高新调入护士的工作能力，确保护理质量起着重要的作用。     

延迟性脑脊液鼻漏病理机制及诊治探讨

目的总结15例经手术治疗的延迟性脑脊液鼻漏的临床资料,探讨脑脊液鼻漏的病理机制及其与诊断治疗的关系。方法本组共15例脑脊液鼻漏患者,其中颅底骨折13例,自发性1例和垂体瘤术后1例。重点分析术前CTMRI扫描,术中所见,以及疗效三者之间的关系。结果术中见14例患者神经组织疝入鼻窦,垂体瘤术后鼻漏为鞍上池下疝,其中后7例的CT扫描显示骨缺损,MRI显示神经组织下疝与术中所见完全一致。15例术后14例治愈,1例无效,无手术并发症。结论神经组织或鞍上池经颅底缺损疝入鼻窦为外伤后或自发性脑脊液鼻漏不能自愈的病理机制的重要环节,由于上述组织的疝入,导致粘膜、硬膜、蛛网膜难以修复。冠状CT扫描和MRI可确定瘘口部位,如果冠状CT有骨缺损,MRI检查相应部位有脑组织下疝,应积极早期手术治疗。     

关附甲素对豚鼠乳头肌动作电位最大除极速度的频率依赖性抑制作用

应用标准微电极技术，研究了关附甲素对豚鼠右心室乳头肌动作电位最大除极速率(V_max)的频率依赖性抑制作用(RDB)，并与美西律，奎尼丁，劳卡尼进行了比较. 在相同刺激间隔(300 ms)，产生50%左右RDB的药物浓度下，美西律的RDB开始最快，其第2个V_max所产生的抑制已占RDB的64%，奎尼丁，劳卡尼和关附甲素的RDB开始速率常数分别为每个动作电位0.165, 0.076和0.136. 美西律，奎尼丁，劳卡尼和关附甲素产生RDB的恢复时间常数分别为1.4, 9.0, 18.2和44.0 s，而且它们的恢复时间常数是不依赖于药物浓度而变化的，结果提示，关附甲素是一个慢动力学钠通道阻滞剂.     

改良额颞-颞下窝入路切除中颅凹底内外沟通瘤

目的：为了更完全地切除中颅凹底内外沟通性肿瘤。方法：采用经过改良的Ｍｉｃｋｅｙ额颞颞下窝入路。其改良主要是将额骨瓣连同其表面附着的颞肌以及游离后的眶颧骨块一并向下翻开，并将手术程序作了相应改变。结果：成功切除了１３例肿瘤。术后３例恢复了轻工作，６例能自主生活，３例生活仍需别人照顾，１例复发未再次手术。结论：采用改良的额颞颞下窝入路对中颅凹底内外沟通性肿瘤暴露充分，切除广泛。Ｍｉｃｋｅｙ入路改良的优点：颞肌血运的保留，有利于骨瓣与正常颅骨的早期融合。同时颞肌附着点的保留，有利于咀嚼功能。     

对500名广州妇女关于激素替代疗法态度的调查

【目的】了解广州妇女对激素替代疗法 (HRT)的态度。【方法】对 5 0 0名妇女进行面对面的问卷调查 ,记录她们对绝经症状以及激素替代疗法的认识和态度。【结果】 5 9%的妇女认为对绝经症状应该求医 ,41%妇女采取消极忍耐的态度 ,76 2 %的人选择妇科就诊 ,19 8%的妇女选择内外科或精神科 ;仅有 2 2 1%的妇女听说过HRT。绝经后妇女应用HRT的有5 9% ,2 4 4%的人不知道HRT的益处 ,知道可以预防骨质疏松和心血管疾病的分别有 17 8%和 10 8% ,5 9 8%的人不知道HRT的副作用 ,13 6 %的人不知道在哪科医生的指导下应用HRT ,40 4%的人不知道何时开始应用HRT。【结论】我们认为广州妇女的围绝经期保健意识不强 ,对HRT的了解很少 ,对HRT的利弊认识不足 ,有必要开展这方面的科普教育工作。     

Credentialed Persons, Credentialed Knowledge

The vast experimental literature on human error agrees with history of medicine, folklore, and superstition In discrediting knowledge claims based solely on anecdotal impressions. Since clinical experience consists of anecdotal impressions by practitioners, tt Is unavoidably a mixture of truths, half-truths, and falsehoods. The scientific method is the only known way to distinguish these, and it is both unscholariy and unethical for psychologists who deal with other persons' health, careers, money, freedom, and even life itself to pretend that clinical experience suffices and that quantitative research on diagnostic and therapeutic procedures is not needed. Disputes about philosophy of science (e.g., logical positivism) are irrelevant to this issue, which is simply one of distinguishing knowledge claims that bring reliable credentials and others that do not.