Children With Chronic Physical Disorders: Maternal Reports of Their Psychological Adjustment

Advances in biomedical science have resulted in dramatic improvementsin the medical care of chronically ill and handicapped children.Past measurement problems have resulted in a lack of clarityregarding the psychological adjustment of these children. Themothers of 270 chronically ill and handicapped children wereadministered the Child Behavior Checklist in an attempt to identifypatterns of behavioral functioning across six pediatric chronicdisorders: juvenile diabetes, spina bifida, hemophilia, chronicobesity, juvenile rheumatoid arthritis, and cerebral palsy.In general, it was found that children in all chronic disordergroups were perceived by their mothers as evidencing on theaverage more behavioral and social competence problems thanexpected based on norms for children in general. However, theirbehavioral and social adjustment was reported as better thanthat of a normative sample of children referred to mental healthclinics. There were essentially no differences between childrenwith different chronic disorders in terms of behavior problemsand social competence. The results were taken to support theview that these children were as a group at risk for adjustmentproblems. They were also discussed in terms of the noncategorialapproach, which suggests that similar psychosocial challengesare faced across pediatric chronic physical disorders.     

胃癌患者红细胞免疫功能的变化

运用简单形态学方法测定了３０例胃癌患者红细胞免疫功能，结果表明：胃癌患者红细胞Ｃ３ｂ受体花环率及肿瘤红细胞花环率显著低于正常对照（Ｐ＜０．０１）及慢性良性胃病患者（Ｐ＜０．０１），而免疫复合物花环率则高于正常人（Ｐ＜０．０１）及慢性良性胃病患者（Ｐ＜０．０１）；Ⅲ、Ⅳ期胃癌患者肿瘤红细胞复合物花环率明于低于Ⅰ、Ⅱ期患者（Ｐ＜０．０１）；贲门癌肿瘤红细胞花环率显著低于胃窦（体）癌患者（Ｐ＜０．０１）     

内镜治疗老年总胆管结石30例体会

目的：探讨内窥镜治疗老年总胆管结石的安全性和有效性。方法：对我院普外科收治的30例70岁以上的老年总胆管结石患者进行回顾性分析，所有患者均经B超或螺旋CT明确诊断并接受内镜治疗，治疗方法包括逆行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP)，鼻胆管引流（endoscopic nasobiliary drainage,ENBD)，乳头括肌切开（endoscopic shincterotomy,est)和取石术，碎石术，测定患者内镜治疗前后的生化指标变化。结果：30例老年总胆管结石患者行ERCP检查，成功率100％，28例行EST，总胆管结石直径＜1.0cm者成功率100％，结石直径1.0-1.5cm者成功率86％，结石直径≥1.5cm者需进行机械碎石取石，成功率75％；另有2例患者植入塑料支架作长期引流。1例患者发生与内镜有关的并发症，死亡例，30例患者治疗后各项生化指标较治疗前均有明显改善（P＜0．001）。结论：内镜治疗老年总胆管结石成功率增高，避免了手术创新，安全性好，缩短住院时间，是当前治疗老年总胆管结石的首选方法。     

老年心房颤动病人华法林抗凝治疗的有效性安全性评价

目的　评价华法林用于老年心房颤动病人抗凝治疗的有效性、安全性。方法　选择符合本研究抗凝标准的132例老年心房颤动病人随机分为两组 ,华法林治疗组 (治疗组 ) 5 8例 ,给予华法林 3mg/ d开始 ,监测凝血酶原时间(PT)及国际标准化比值 (INR) ,7～ 15 d使 INR达到 1.8～ 2 .5范围内 ,以后每月查 1次 INR。若病人增加或减少药物有出血倾向时随时再测 INR。阿司匹林对照组 (对照组 ) 74例 ,给予阿司匹林 30 0 mg/ d,分 2次口服 ,密切随访。结果　治疗组 7～ 15 d,平均 (9.1± 2 .8) d,INR达 1.8～ 3.0 (平均 2 .1± 0 .13) ,其中 INR在 1.8～ 2 .5 (平均 1.92±0 .2 3)之间者占 92 .7% ,治疗组有 1例心瓣膜病人出现脑梗死 ,而对照组有 7例发生脑梗死 ,差异显著 ,其余不良反应率两组差异无显著性。结论　老年心房颤动病人选择华法林 2～ 3mg/ d时 ,加强服药后监测及各药物间的相互作用 ,使 INR保持在 1.8～ 2 .5之间是有效、安全的     

Diabetic and nondiabetic hyperglycemia in the ICU

Hyperglycemia is a common feature in critically ill patients, whether they are diabetic or not, and it is associated with unfavorable outcome. The more severe the underlying disease, the more important the hyperglycemia appears to be although, we still cannot define whether hyperglycemia is just a marker of the severity of the acute illness or rather an active contributor to poor outcome. The review of the literature on this subject published from 2001 up today conveys a massive amount of information the interpretation of which is equivocal, due to the heterogeneity of patients (nondiabetic vs. diabetic, medical intensive care unit (ICU) pts vs. surgical ICU pts) and of interventions (dose and modality of insulin infusion).The association between high glucose level and mortality is strong in critically ill patients without a previous history of diabetes. Admission hyperglycemia seems to be an independent risk factor of in-hospital mortality in patients both with and without diabetes in cardiac, cardiothoracic and neurosurgical ICUs. No data are still available on general surgical ICU patients.Tight control of blood glucose levels has been demonstrated to improve outcome in both diabetic and nondiabetic critically ill patients. In surgical ICUs, tight glucose control improves mortality and reduces morbidity only among patients admitted in ICU for more than 5 days, while outcome is not improved in patients who stay in ICU for less than 3 days.However, it is not yet understood if such favorable effect is secondary to glucose control itself or if insulin plays a part, by means of its nonglucose, anabolic effects. More randomized controlled trials are needed, addressing specific issues—such as the optimal target glucose concentration and the most effective insulin regimen—especially in the general surgical patient.     

Mortality and suicide rates of involuntarily committed patients

The mortality and suicide rates for involuntarily committed patients in Denmark are presented. Two cohorts of psychiatric patients committed to a mental hospital from January 1, 1971 to December 31, 1975 (8322 people) and January 1, 1981 to December 31, 1985 (5253 people) have been followed. The standard mortality rate (SMR) in relation to the total Danish population were 4.9 (4.5–5.4) and 5.2 (4.7–5.8), respectively, for the two cohorts, during the first year after involuntarily commitment to a mental hospital. During the same period, the SMR for suicide among the committed patients were 44.9 (37.1–53.9) and 30.9 (24.2–38.9), respectively. The crude suicide rates among the committed patients during the first year after the commitment were 14.3 and 14.0, respectively, per 1000 years, unchanged between the cohorts. Short length of stay in hospital (< 14 days), a nonpsychotic main diagnosis, male sex, and age 35 years or more were equally related to high risk of suicide in the 1971 cohort as evaluated to proportional hazard methods (Cox regression), and short length of stay and commitment on the danger indication provided the most information in relation to high suicidal risk in the 1981 cohort. Methodological problems and the reasons for the results are discussed.     

手术显微镜下上颌窦自然口扩大术

手术显微镜下行上颌窦自然口扩大术治疗３３例慢性上颌窦炎患者，报告其手术方法及疗效，并与同期行传统上颌窦根治术（柯陆二氏手术）的疗效进行比较，结果表明该手术疗效明显优于柯陆二氏手术。     

Geriatric care on a ward without nurses

The Multiphasic Environmental Assessment Procedure (MEAP; Moos and Lemke, 1984) was used to assess three long-stay settings within a geriatric hospital, one of which is a non-nursing unit committed to the philosophy of residents viewing the setting as their own home. Findings suggest positive outcomes for residents on the nonnursing unit, and support the view that types of care fostering independence and personal responsibility of elderly residents in their setting may be associated with increased mental functioning and activity. The lack of trained nursing staff had no detrimental effect on any measure of resident life, and some specific caring practices on the unit may be interpreted as having a positive outcome for residents.     

联合切口径路全翻内置法鼓膜成形术

对各种慢性化脓性中耳炎采用联合切口径路全翻内置法行鼓膜成形术１１８例，取得良好效果，介绍了联合切口、全翻外耳道皮瓣和内置移植物的操作技术，探讨了该法取得良好效果的各种因素。     

老年人颅脑外伤后缺血性脑卒中发作特点及治疗

目的探讨老年人颅脑外伤后缺血性脑卒中发作特点及个性化治疗方案。方法针对7例颅脑外伤后急性期出现缺血性脑血管病症状的老年患者，通过脑血管造影检查分析其发病原因并根据不同的脑血管特点决定治疗方案。结果大多数患者（6／7）受伤前已存在不同程度的颅内外血管狭窄、血管壁溃疡以及附壁血栓形成等改变，提示脑缺血发作主要与这些病变为基础的脑血流下降、血栓脱落等因素密切相关。而外伤后脑灌注降低、脑血管痉挛是脑缺血发作的诱发因素。结论老年人外伤后的缺血性脑卒中发作主要与原有的脑血管基础疾病有关，预防和治疗老年人外伤后缺血性脑卒中发作，应基于这些病变特征并选择个体化治疗方案。