甲状腺功能减退症的外科干预

目的探讨伴有甲状腺功能减退症（甲减）的甲状腺疾病采用外科手段干预治疗的必要性和可能性。方法回顾2000—2005年甲状腺手术病例，对其中伴有甲减的118例诊治经过及术后疗效进行分析总结。结果桥本甲状腺炎（HT）占甲减的57、6％，医源性甲减占39．8％。HT合并甲状腺乳头状癌2例，合并B细胞淋巴瘤1例。HT手术治疗后，近全切组与峡部切除组相比前者颈部症状明显好转，术后甲状腺球蛋白抗体（TGAb）、甲状腺微粒体抗体（TMAb）下降水平较后者明显，差异具有显著性意义（P〈0．05）。全组病例术后均服用优甲乐（L-T4），随访3个月至4年未出现明显甲减体征。结论重视术前甲减的诊断，选择合理的治疗方案可避免甲减发生。已有甲减的HT并非手术禁忌证，对于药物治疗症状不缓解的病人行甲状腺近全切治疗是合理、可行的，同时可发现和治疗HT合并甲状腺癌。     

The influence of Microgynon and Diane-35, two sub-fifty ovulation inhibitors, on voice function in women

The early days of oral contraceptives showed some evidence that these medications may have caused undesirable side effects on the voice, mainly in terms of virilization. In a random study carried out at the university hospitals of Jena and Berlin (Charité), two more recent drugs were tested in this regard, one containing cyproterone acetate (Diane-35^®) and the other one levonorgestrel (Microgynon^®), both from Schering. Ninety-one patients took part in extensive clinical and instrumental phoniatric investigations of voice function over a period of one year. No significant side effects on the voice could be proven for the two preparations. Gynecological and clinical effects of both Diane-35^® and Microgynon^® were similar during the one-year study period. Women taking Diane-35^® had less intracyclic bleedings and amenorrhea. Also, acne was more favorably influenced by Diane-35^®.     

Intraoperative pulse oximetry: Frequency and distribution of discrepant data

Study Objective: To determine the types of discrepant data during intraoperative pulse oximetry and their frequency and duration.

Design: Prospective study.

Setting: University medical center.

Patients: 46 consecutive ASA physical status I–III patients undergoing general anesthesia for elective surgical operations.

Measurements and Main Results: With an integrated computer algorithm on the pulse oximeter and another computer linked to it, data were screened and the frequency and distribution of the following oximeter signals recorded: absent; low quality or interrupted, as detected by the pulse oximeter algorithm, nonphysiologic, identified by the personal computer as a heart rate change greater than 10 beats per minute within 2 consecutive 2-second samples, with no similar abrupt change reported simultaneously on ECG. The number of episodes per hour of discrepant oximeter data and the duration of the episodes were recorded by phase of anesthesia: induction, maintenance, and emergence. Discrepant data occurred most frequently and lasted longest during emergence (p < 0.05); the majority of episodes of discrepant data during emergence lasted less than 12 seconds. Excluding discrepant data that lasted less than 12 seconds decreased the frequency of discrepant data by 63% and excluding those that lasted less than 30 seconds decreased the frequency of discrepant data by 93%.

Conclusions: Pulse oximeters frequently report discrepant data intraoperatively, most frequently during emergence from anesthesia. An alarm delay triggered by discrepant data and lasting 12 to 30 seconds would keep most discrepant data from becoming false alarms and, thus, may reduce distracting sound pollution in the operating room.     

Repetitive lifting and spinal shrinkage, effects of age and lifting technique

The assumed advantages of the so-called leg-lifting technique over the back-lifting technique are still the subject of much debate. The present study was aimed at studying the consequences of performing both lifting techniques on net lumbar moments and spinal shrinkage. Furthermore, the relation between age and spinal shrinkage was studied. Five subjects approximately 40 years old and six subjects 20 years old performed six 5-min bouts of repetitive lifting using each technique on a separate day. Net lumbar moments were calculated using a two-dimensional dynamic linked segment model. Spinal shrinkage was measured at T₁₂ and at the head after each bout of lifting and every 5 min during 1 h preceding the lifting bouts. The peak moments were marginally but significantly higher in the leg-lift. No differences in mean moments and shrinkage between lifting techniques were found. The shrinkage after the back-lift was more pronounced in the older subjects and a similar tendency was found after the leg-lift. The creep rate, i.e. the rate at which the shrinkage approaches its equilibrium was higher in the older subjects. No clear relations of anthropometrical variables and net moments with shrinkage was found. The common advice of using a leg-lift rather than a back-lift was not supported by the present study. Both the mechanical load on the low back (net moments) and the resulting shrinkage show considerable interindividual variation, the causes of which need further elucidation.

The leg-lifting technique is still widely advocated, thought its merits from a biomechanical point of view have been questioned. In this study spinal shrinkage and lumbar moments calculated by means of a dynamic linked segment model are used to compare the leg-lift to the more commonly used back-lift.     

Expression of a 10.5 kDa inhibin in the endometrium of bonnet monkey on treatment with an antiprogestin ZK 98.299: An immunocytochemical study

Immunocytochemical localization of inhibin was carried out in paraffin embedded tissue sections of the control and antiprogestin (ZK 98.299)-treated bonnet monkey endometrium using polyclonal antibodies generated against human seminal plasma inhibin (10.5 kDa). The study shows that administration of low doses (5 mg/ week) of antiprogestin results in an increase in the expression of inhibin by the endometrium. Treatment with higher doses (20 mg/week) caused a decrease in the expression. Since treatment with higher doses also caused atropic changes in the endometrium, the decrease in inhibin could be the result of morphological damage to the endometrium rather than the effects of antiprogestin on the expression of inhibin. The potential involvement of endometrial inhibin in the process of nidation is speculated.     

Responsiveness and calibration of the general well-being adjustment scale in patients with hypertension

We examined the discriminant ability and responsiveness of the General Well-Being Adjustment Scale in patients enrolled in a randomized clinical trial of antihypertensive therapy. We also tried to translate the effects of physical symptoms on general well-being. This secondary analysis used demographic, clinical, physical symptom, and general well-being data for 545 white, male hypertensive patients. General well-being was measured by the General Well-Being Adjustment Scale (GWB) collected on 2 occasions over 8 weeks of treatment. Patients with any one of 14 physical symptoms or problems, compared to those without symptoms, had lower GWB scores (p < 0.003 to p < 0.0001). Decreases of 2.83–8.76 points in GWB scores were observed in patients developing physical symptoms over the 8 week study period (p < 0.05 to p < 0.0001). These effects were demonstrated in patients developing cold sensitivity, sexual problems, chest pain, shortness of breath, loss of taste, nausea, hot or cold spells, numbness and tingling, dry mouth, blurred vision, and dizziness. We conclude that the GWB is responsive to clinically meaningful changes in symptoms and may provide a more complete evaluation of the effects of medical treatment. The GWB is a valid and responsive measure of health status outcomes in the evaluation of antihypertensive treatment.     

The disability rating index: An instrument for the assessment of disability in clinical settings

The purpose of this study was to evaluate an instrument for assessment of physical disability, mainly intended for clinical settings, the Disability Rating Index (DRI). Healthy persons (n = 1092), both white and blue collar workers, and patients (n = 366) with different levels of physical capacity, were assessed. Most of the patients (n = 303) underwent rehabilitation programmes for neck/shoulder/low-back pain but some (n = 47) were arthritis patients waiting for hip or knee replacement surgery, or wheelchair patients with multiple sclerosis (n = 16). The reliability was investigated by test-retest studies, intra- and inter-rater and internal consistency studies. Five construct validity tests were carried out: a discrimination study; a converging validity test; a test for sensitivity to small alterations in health status; and two correlational validity tests. Correlation of the self-reported DRI to the actual performance in similar activities was carried out. Responsiveness was tested by correlation of the DRI before/after replacement surgery for arthritis. The test-retest correlations were 0.83–0.95 in the studies, including correlation of different versions. The intra- and inter-rater reproducibility was 0.98 and 0.99 respectively. The Kruskal-Wallis test in the discrimination study yielded p < 0.0001. More than 90% of the respondents completed the questionnaire correctly. Correlation of the DRI to the Functional Status Questionnaire was 0.46. The responsiveness was excellent, p = 0.0001. The DRI proved to be a robust, practical clinical and research instrument with good responsiveness and acceptability for assessment of disability caused by impairment of common motor functions.     

Malnutrition and subsequent ischemic heart disease in former prisoners of war of world war II and the Korean conflict

The harsh treatment of former prisoners of war (POWs) of World War II and the Korean conflict resulted in severe malnutrition. Although rarely linked to specific long-term medical problems, a specific marker of malnutrition, self-reported lower limb edema (presumably due to a vitamin B deficiency) was associated with a three-fold increase in subsequent death attributed to ischemic heart disease (IHD) during the follow-up period from 1967 through 1975. Although there is at present no medical basis for linking edema, which is perhaps a marker for some unmeasured risk factor, to subsequent IHD, this finding may nonetheless have medical implications for the group of former POWs and other populations with severe dietary deficiency. It also suggests there may be a need to reexamine currently held theories on malnutrition and subsequent chronic disease.     

A method for partitioning cancer mortality trends by factors associated with diagnosis: An application to female breat cancer

U.S. cancer mortality data derived from information recorded on death certificates are frequently relied upon as an indicator of progress against cancer. A limitation of this measure is the lack of information pertaining to the onset of disease, such as year-of-diagnosis, age-at-diagnosis, stage of disease at diagnosis and histology of lesions. However, population-based cancer registries collect these types of data and allow the calculation of an incidence-file based mortality rate. This incidence-based mortality rate allows a partitioning of mortality by variables associated with the cancer onset. Breast cancer incidence-based mortality measures are created and compared to mortality rates based on death certificates over a comparable time period. Novel mortality measures, such as mortality rates by stage-at-diagnosis, age-at-diagnosis and year-of-diagnosis, are used to illustrate the value of this approach.