臂丛神经卡压综合征的诊治

目的探讨位于臂丛神经及其前中斜角肌周围的神经卡压综合征的特点及其诊治方法。方法2003年7月～2006年1月,采用门诊收集病例,根据病情轻重分组,分别采用药物、局部封闭及手术方法治疗179例确诊为臂丛神经和(或)其属支卡压综合征的患者。其中采用药物、手法治疗89例；注射治疗74例,其中需要第二次注射32例；手术治疗16例,同时或分别进行双侧手术2例,需要第二次手术者1例。结果128例患者得到1个月～2年5个月随访。其中,药物手法治疗55例,症状均有不同程度改善或能维持现状。局部注射治疗58例(其中接受第二次注射者24例),2例出现心跳减缓,其余病例无并发症发生,VAS评分情况：1分2例,2分16例,3分20例,4分12例,5分3例,6分3例,7分2例；第二次注射结果：2分5例,3分16例,4分3例。手术治疗15例,其中10例术后症状得到明显改善,恢复工作。结论臂丛神经及其属支涉及其周围众多神经,可产生众多症状；明确病因后,治疗上以保守治疗为主,效果欠佳者采用手术治疗,均可取得较好疗效。     

Osteoclastogenesis inhibitory factor exhibits hypocalcemic effects in normal mice and in hypercalcemic nude mice carrying tumors associated with humoral hypercalcemia of malignancy

Osteoclastogenesis inhibitory factor (OCIF) is a novel secreted protein that inhibits osteoclastogenesis both in vitro and in vivo. In this study, we examined the effects of OCIF on serum calcium (Ca) concentrations in normal mice and in hypercalcemic nude mice carrying tumors associated with humoral hypercalcemia of malignancy. In normal mice, a single intraperitoneal injection of OCIF reduced serum Ca levels in a dose-dependent manner. Significant decrease in serum Ca (by 1.6 ± 0.3 mg/dL, n = 5) was observed 2 h after the injection of OCIF at 20 mg/kg and the hypocalcemic effect continued for up to 12 h. Serum phosphate (Pi) concentrations also decreased in response to OCIF. Urinary excretion of Ca, Pi, and creatinine did not change significantly after injection of OCIF or vehicle. In hypercalcemic, tumor-bearing nude mice, a single intraperitoneal injection of OCIF at 20 mg/kg resulted in a dramatic decrease in serum Ca (maximal decrease 2.8 ± 0.37 mg/dL, n = 11), which continued for up to 24 h. The results suggest that OCIF decreased serum Ca through its inhibitory effect on bone resorption. Furthermore, it is suggested that OCIF has therapeutic potential for the treatment of hypercalcemic conditions such as malignancy-associated hypercalcemia.     

9-顺式维甲酸体外诱导神经母细胞瘤细胞分化的研究

目的：为设计维甲酸治疗神经母细胞瘤可能的有效方案，本文对9-顺式维甲酸（9-cis retinoic acid,9-cisRA)体外诱导分化神经母细胞瘤细胞（SK-N-SH）作用进行了研究。方法：SK-N-SH细胞经9-cisRA处理后，采用相差显微镜，神经纤维银染法，透射电镜观察等手段。观察9-cisRA对细胞生长的影响。结果：9-cisRA作用SK-N-SH细胞7d后，细胞形态发生变化；12d时出现神经原性表型，多个细胞形成“神经节”，节间形成粗而长的类神经纤维；尼氏小体和银染法亦证明细胞产生显著分化，透射电镜观察结果表明，9-cisRA对该细胞有分化作用。却无明显凋亡诱导作用。结论：9-cisRA对神经母细胞瘤细胞体外能产生明显诱导分化作用。     

Cytokeratin expression in a congenital multipotential primitive neuroectodermal tumor

A case of an uncommon congenital primitive neuroectodermal cerebellar tumor (PNET) in a 5-month-old child is reported. After subtotal surgical resection, the residual tumor did not respond to radiation and chemotherapy. Histologically, the tumor was composed of small, round, undifferentiated cells and several other patterns like astrocytomatous, oligodendrogliomatous, and ependymomatous structures. Immunostaining was positive for most of the cells for vimentin and S 100, fewer were positive for glial fibrillary acid protein (GFAP) and neuron-specific enolase, and only a few for synaptophysin. Surprisingly, the tumor showed strong expression of several monoclonal cytokeratins (CK) with different molecular weights, together with epithelial membrane antigen. Furthermore, we found a coexpression of the tumor cells for CK and vimentin, while CK-GFAP and CK-S 100 were negative. Ultrastructurally, intracyto-plasmic intermediate filaments could be observed corresponding to immunohistochemical CK expression. The very strong CK and vimentin expression in this case was interpreted as a sign of the embryonic nature of the tumor.     

X综合征的临床诊断与分析

目的；探讨临床医师对X综合征的临床诊断水平并了解其发病机制；方法：对186例有胸痛的女性患者（平均年龄53.2岁）通过运动试验，左室功能及冠状动脉造影来评估X综合征患者冠脉微循环功能及发病机制；结果：186例中86人（46％）冠脉造影阴性，运动试验阳性，左室功能无明显失调；结论：X综合征多见于女性，X综合征可能是由于冠脉微血管功能异常所致。     

妊娠与柯兴氏综合征--附1例病案分析

目的 :提高妊娠合并柯兴氏综合征的诊治水平。方法 :结合国内外文献 16例 ,分析讨论妊娠与柯兴氏综合征的相互影响所导致的各种临床结局。结果 :肾上腺皮质腺瘤位于妊娠合并柯兴氏综合征的病因首位 ,而高肾上腺皮质激素刺激征和特征性腹部、大腿宽大紫纹 ,结合B超、CT可以诊断妊娠合并柯兴氏综合征 ;严重的并发症威胁母婴安全 ,积极进行手术治疗和并发症的处理可以降低母婴死亡率、延长孕周。结论 :妊娠合并柯兴氏综合征是极度的高危妊娠 ,妊娠期的早期诊断、早期治疗能改善妊娠质量。     

Caring for the Involuntarily Hospitalized Adolescent: The Issue of Power in the Nurse-Patient Relationship

TOPIC: The power relations between involuntarily hospitalized adolescents and their caregivers from the viewpoint of theory development in nursing and the concept of medicalization. PURPOSE: To contribute to the development of nursing theories that can guide nursing care of involuntarily hospitalized adolescents by examining the power relations between the adolescents and their caregivers. SOURCES: Published literature in medical sociology, and nursing and psychiatric ethics. Nursing and psychiatric literature, in which Michel Foucault's theories are used to explicate the disciplinary power of psychiatry. CONCLUSIONS: To empower involuntarily hospitalized adolescents nurses must both recognize the inevitable power imbalance and seek guidance from the egalitarian ideals of nursing. Nurses can draw from postmodern thinkers who dismiss the idea that one theory can explain human relationships.     

Le syndrome de Lazare: une problématique de la rémission. Réflexions autour de la maladie cancéreuse chez l’adulte

Résumé: La rémission du cancer peut être l’occasion pour certains patients d’une réelle détresse émotionnelle ainsi que d’une désadaptation psychologique appelées: syndrome de Lazare. Nous émettons trois hypothèses explicatives quant à la survenue de tels troubles. La première confronte l’issue du cancer aux concepts psychanalytiques de dette et de masochisme. La deuxième envisage les symptômes sous l’angle d’une réaction de sevrage. Et la dernière évoque le contrecoup traumatique des traitements.Dossier: «Cliniques du cancer»     

腮腺舍格伦综合征与非霍奇金淋巴瘤相关性分析

目的:了解腮腺非霍奇金淋巴瘤与舍格伦综合征的临床及发病机制的相关性，正确诊断和治疗舍格伦综合征，尽早明确有无恶性变。方法：对142例口腔颌面部的非霍奇金淋巴瘤中21例发生在腮腺的非霍奇金淋巴瘤，及3例从合格伦综合征演变成淋巴瘤的病例进行分析。结果：21例腮腺区非霍奇金淋巴瘤的局部表现主要为肿块、反复肿胀，与类肿瘤型舍格伦综合征的一般特征和腮腺表现有相关性，其中3例腮腺淋巴瘤患者有明确的舍格伦综合征病史。结论：舍格伦综合征与腮腺非霍奇金淋巴瘤的发生发展，以及临床表现有相关性，部分类肿瘤型舍格伦综合征可演变为淋巴瘤，临床表现和免疫学改变可早期判断舍格伦综合征有无恶性变。