外伤性胸椎间盘突出症的早期诊断与手术治疗

[目的]探讨外伤性胸椎间盘突出症的临床表现、早期诊断及手术治疗效果。[方法]2000年6月-2005年6月共收治外伤性胸椎间盘突出症患者11例，其中男8例，女3例，年龄15-38岁，平均23．96岁。诊断时间距外伤时间最短的为2d，最长的8个月，平均4．1个月。早期明确诊断后行经关节突入路胸椎间盘摘除术。[结果]11例患者获得1、1-3．8年术后随访，平均随访2．6年。根据Otani’s等分级方法进行疗效评价：优7例，良3例，可1例，差0例，失败0例。手术优良率为90．91％。[结论]外伤性胸椎间盘突出较少见，无典型临床表现，本症的早期诊断及早期手术治疗是远期优良疗效的保证。     

Performance measures for evaluating services for people with a first episode of psychosis

Aim: The purpose of this project was to operationalize and apply a previously identified set of performance measures designed to evaluate services for those experiencing a first episode of a schizophrenia spectrum disorder. Methods: Operational definitions were developed for previously identified measures through an iterative process of discussions between clinical experts and health‐care evaluators. Data were collected from existing sources including corporate databases, clinical databases and chart review. Results: Definitions were developed for 44 measures covering seven of eight domains recommended for service level evaluation by the Canadian Institute for Health Information domains. Forty measures could be calculated. Conclusions: The measures represent a comprehensive set of performance measures suitable for the evaluation of services for people with a first‐episode psychosis. The measures could be used by other services in order to establish standards and norms for routine clinical practice.     

Bipolar disorder in children and adolescents: obstacles to early diagnosis and future directions

Aim: This article reviews research centred around juvenile bipolar disorder with particular reference to diagnostic difficulties. Putative deficits are scrutinized with respect to trait likelihood and the roles of neuropsychology and neuroimaging in enhancing our understanding of juvenile bipolar disorder are discussed. Methods: Search terms including childhood, adolescent, youth and juvenile combined with the terms ‘bipolar disorder’, mania, depression and hypomania were used to identify relevant studies in MEDLINE and PsychLit. Results: Over recent years research into this relatively new disorder has increased phenomenally. Key issues within the field include diagnostic specificity, the heritability of the disorder, the impact of comorbidity and the implications of neuropsychological and neuroimaging findings. Conclusion: Despite concerning controversies in literature the diagnosis of bipolar disorder in children and adolescents as compared with adults, promising future research directions include better neurological characterization of the disorder through the application of findings from clinical populations, neuropsychological and neuroimaging research.     

关节镜下改良张力带固定治疗髌骨骨折患者的康复护理

对38例新鲜髌骨骨折患者行关节镜直视下骨折复位,改良张力带固定,术前和术后给予及时有效的功能康复和护理指导,取得满意的效果。平均随访18.6个月,骨折平均愈合时间7.5周,所有病例愈合良好,无并发症出现。关节镜治疗髌骨骨折为髌骨骨折提供了一种新的治疗方法。应针对其解剖特点制订科学、有效的护理方法。     

Management of adult patients with a left ventricular assist device.

The number of left ventricular assist device (LVAD) implantations is growing as a result of increased waiting periods for cardiac transplantation and the decreased availability of organ donors. Furthermore, the Food and Drug Administration (FDA) has approved permanent LVAD support. After an acute hospitalization, patients with LVADs may need prolonged convalescence in a healthcare facility because they have complex medical needs and are physically disabled. Admission criteria need to be developed as essential patient and nursing competencies need to be defined as a part of a successful LVAD program in an acute rehabilitation center. Acute rehabilitation centers can help patients with LVADs transition to a home setting.     

改良《颈性眩晕症状与功能评估量表》在椎动脉型颈椎病中医临床中的应用及评价

目的探讨改良《颈性眩晕症状与功能评估量表》在椎动脉型颈椎病(CSA)的中医临床中的应用可行性。方法151例CSA患者随机分为针灸推拿治疗组和单针灸对照组,治疗前后采用改良《颈性眩晕症状与功能评估量表》进行量化评估,并对该量表在本次中医临床中的效度及信度进行初步检验。结果治疗组治疗后症状与功能评分比治疗前有显著提高(p<0.01),治疗组改善指数明显高于对照组(p<0.05)。经检验,该量表也有可以接受的准则效度(r在0.8-0.9之间,p<0.01)和再测信度(r在0.6-0.9之间,p<0.01)。结论针灸推拿结合治疗CSA具有确切的临床疗效,能明显改善患者症状、颈椎功能和生活质量。改良《颈性眩晕症状与功能评估量表》在CSA中医临床中具有可信性、有效性。     

Is endoscopic one‐piece mucosal resection essential for early gastric cancer?

Background: Endoscopic mucosal resection (EMR) is widely accepted as a minimally invasive treatment for early gastric cancer (EGC) in Japan. However, the criteria for EMR must be strictly adhered to otherwise patients will miss the chance for additional therapy. We assess the important factor in expanding the indication of EMR. Methods: We investigated 1101 EGCs that had been resected by EMR at the National Cancer Center Hospital (NCCH), Tokyo, Japan, according to the indication recommended by Japanese Gastric Cancer Association (JGCA) and the expanded indication proposed by NCCH. Curability and local recurrence of the EMRs were assessed related to the applied indication and the number of resected specimens. Results: The recurrence rate of non‐evaluable resection was higher than that of evaluable resection (P < 0.0001). Eighty‐three lesions among 772 lesions in the JGCA group were non‐evaluable. Thirty‐seven leisons among 329 lesions in the NCCH group were non‐evaluable. There was no difference in the rate of non‐evaluable resection between JGCA and NCCH groups (P = 0.8329). However, the rate of curative resection was lower in the NCCH group than in the JGCA group (P = 0.0009). In piecemeal resection, there was no difference in the rate of non‐evaluable resection between JGCA and NCCH groups (P = 0.0527). In one‐piece resection, the rate of non‐evaluable resection was lower in the NCCH group than the JGCA group (P = 0.0137). Conclusion: Based on our series of cases, we propose one‐piece resection as a gold standard for EMR because it enables accurate histological evaluation, even in the EMR, according to the expanded indication.     

A CASE OF EARLY GASTRIC CANCER ACCOMPANIED BY DIEULAFOY ULCER IN A YOUNG WOMAN

A case of early gastric carcinoma accompanied by Dieulafoy ulcer is presented. The patient, a 26‐year‐old female, visited our emergency room with chief complaints of massive hematemesis and tarry stool. The initial endoscopic examination revealed a superficial depressed lesion with a faded color accompanied by a tiny ulcer with converging folds at the anterior wall of the middle gastric body. Although no active bleeding vessel was found at that time, the patient was admitted to our hospital for further check‐ups and treatment. On the 6th hospital day, she developed massive hematemesis resulting in shock. Urgent endoscopy, this time, disclosed an exposed bleeding vessel at the small ulcer floor previously mentioned, and endoscopic hemostasis was achieved. Since, however, a biopsy at initial examination from the surrounding depressed area proved carcinoma, a partial distal gastrectomy was subsequently carried out. Histological examination of the resected specimen confirmed the diagnosis of carcinoma limited to the mucosa and submucosa along with findings consistent with Dieulafoy ulcer. This is a rare case of combination of early cancer and Dieulafoy ulcer particularly in such a young patient. A review of the literature is also presented.     

β-catenin在早期胃癌中的表达

目的：探讨β-catcnin在早期胃癌中的表达及其意义。方法：用免疫组织化学方法检测39例早期胃癌患者胃癌组织中β-catenin的表达情况。结果：39例早期胃癌中有20例存在β-catenin的异常表达，表现为细胞膜的表达缺失及细胞质和细胞核中表达增强。早期胃癌中β-catenin表达阳性率为51．28％。结论：在早期胃癌中存在β-catenin的异常表达，β-catenin的异常表达可能在早期胃癌的发生、发展中发挥重要的作用，可能是胃癌发生的一个早期事件。