Long-term diazepam therapy and clinical outcome

This double-blind study involved the continuous (six to 22 weeks) treatment of 180 chronically anxious outpatients with diazepam, 15 to 40 mg/day. Our findings indicate that a significant number of patients benefit from prolonged diazepam treatment and that tolerance to the anxiolytic effect of diazepam does not develop during a 22-week study period. The duration of continual treatment with sedative-benzodiazepines was clearly the most important determinant of withdrawal reactions. Patients treated continuously for less than eight months with sedative-benzodiazepines had an incidence of withdrawal of 5%, whereas 43% of patients treated for eight months or more demonstrated clear withdrawal reactions. While these withdrawal reactions produced considerable distress, they were neither life threatening nor incapacitating and did not include convulsions or psychotic reactions. In all cases, withdrawal reactions could be readily managed by gradually tapering the dose of the benzodiazepine.     

Uterine sarcoma: Clinico-pathological characteristics and outcome

Objectives:

To investigate the clinical and histopathological characteristics, with the prognostic factors, treatment outcome, pattern of relapse, and survival analysis of uterine sarcoma patient

Methods:

All patients with histologically proven uterine sarcoma were identified using the database at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 2000 and December 2012.

Results:

A total of 36 patients with uterine sarcoma were reviewed. The median age of all patients was 57 years, and the mean age was 57.72±13.17 years. Carcinosarcoma was reported in 21 patients (58%), leiomyosarcoma in 7 (19%), undifferentiated endometrial sarcoma in 6 (17%), and rhabdomyosarcoma in 2 (6%). Approximately half of the patients were stages III and IV (28% and 25%), while 15 patients (41%) were stage I; only 2 patients (6%) were stage II. The surgical treatment was hysterectomy and bilateral salpingoophorectomy (H+BSO) plus staging in 18 patients (50%), while in 4 patients (19%), H+BSO plus debulking was performed. Adjuvant chemotherapy was given in 24 (69%) and adjuvant radiotherapy in 5 (14%) cases, At a median follow-up period of 13.5 months, 8 patients (22%) relapsed. The 2-year disease-free survival (DFS) rate was 22% and the 5-year was 14%. In the multivariate analysis, the advanced stages (p=0.015) and lymph vascular invasion (p=0.0001) were associated with poor DFS, while the use of chemotherapy significantly improved the DFS (p=0.027).

Conclusions:

The poor outcome of high-grade uterine sarcoma patients was identified, and only one third of patients (30%) survived for 2 years. This finding necessitates the need for more aggressive tools to fight this disease.Uterine sarcomas are rare tumors that account for 1-3% of all female genital tract malignancies and 3-8% of all uterine malignancies.1-3 This heterogeneous group of tumors originates from uterine mesodermal tissue. The major uterine sarcomas consist of leiomyosarcoma (LMS) and endometrial stromal tumors (EST), the latter of which are sub-classified into 3 categories by the World Health Organization (WHO): endometrial stromal nodules (ESNs), endometrial stromal sarcoma (ESS, historically referred to as low-grade sarcoma), and undifferentiated endometrial sarcoma (UES, historically called high-grade sarcoma). Carcinosarcoma, previously called malignant mixed mullerian tumor, is considered a deviant of carcinoma, and its behavior, and treatment resembles those of high-grade carcinoma. However, there are still some centers that treat this as sarcoma.4 Uterine sarcomas occur primarily in women who are 40-60 years old.5,6 A history of pelvic irradiation was also considered a risk factor in 5-10% of cases.7 Compared with the more common types of endometrial cancer, women with uterine sarcoma have a poor prognosis due to the aggressiveness of the disease.5-7 The most frequent prognostic factors include the stage, histological subtype, grade, lymph vascular invasion, and menopausal status.8-10 Standard treatment of early stage patients are hysterectomy and surgical staging, and approximately half of these patients develop recurrent disease.10 Post-operative radiotherapy reduces local recurrence and improves local disease but does not affect the overall survival.11,12 Adjuvant chemotherapy with a single agent, isofosamide or doxorubicin, has been used,11 and combination chemotherapy (which did not show any superiority) has non-proven value over a single agent.13 Due to its rarity, heterogeneity, and aggressiveness, there is no consensus regarding the optional therapeutic approaches with considerable variation in the type of surgery and choice of adjuvant treatment. The purpose of this study is to investigate the clinical and histopathological characteristics, with the prognostic factors, treatment outcome, and pattern of relapse and survival analysis of uterine sarcoma patients.     

2018年石家庄市疟疾流行病学特征及转归分析

目的了解石家庄市2018年疟疾疫情及流行特征,为完善全市疟疾疫情防控策略,制定切实可行的措施提供科学依据。方法通过中国疾病预防控制信息系统收集2018年石家庄市疟疾疫情资料,对其进行统计分析。结果2018年石家庄市共报告疟疾病例34例,均为境外输入病例,其中97. 06%的病例来源于非洲,各病例类型中恶性疟、卵形疟占、三日疟和间日疟分别占82. 35%、11. 76%、2. 94%和2. 94%。34例病例均为男性,发病年龄范围为18～56岁,职业构成以农民(58. 82%)为主,全年各月均有病例报告,其中7月报告病例最多(20. 59%),裕华区报告病例数占全市报告病例总数的97. 06%。34例病例中境外居留期间预防服药的仅占5. 88%,88. 24%的病例经过正规治疗痊愈出院。结论石家庄市境外输入性疟疾病例逐年增多,非洲输入性病例是最主要的防控对象。应加强对出国务工人员疟疾防治知识宣传,提高其自我防护意识十分必要。     

Necrotizing fasciitis: microbiological characteristics and predictors of postoperative outcome

Objective

Necrotizing fasciitis is a life threatening soft-tissue infection with a high morbidity and mortality. Prompt treatment based on extensive surgical debridement and antibiotic therapies are the therapeutic principles.

Methods

The medical records of patients with necrotizing fasciitis (n = 26) from 1996 to 2005 were retrospectively analyzed.

Results

The localization of necrotizing fasciitis was most commonly the trunk (42.3%). Type I polymicrobial infection was the dominating infection. The involvement of anaerobic bacteria was associated with an increase in the number of surgical revisions (p = 0.005). Length of postoperative intensive care unit stay, duration of postoperative ventilation and mortality were significantly increased in the ASA IV-V group. Computed tomography displayed only a limited significance as diagnostic tool for initial diagnosis.

Conclusions

In severe cases the combination of necrotic skin and soft tissue gas facilitates the correct diagnosis, which should than be followed by immediate - and most often - repeated debridement. If anaerobes are isolated an early and aggressive second look is necessary.

     

吸入性肺炎56例临床特点及转归的临床研究

目的:观察吸入性肺炎的临床特点及其转归。方法:我院2008年1月至2009年6月确诊为吸入性肺炎的住院病例56例,对其年龄、基础疾病、临床特点、合并症、治疗与转归进行分析和总结。结果:吸入性肺炎患者均有基础疾病,以老年、脑血管疾病最多,临床表现不典型,病原学检出率低,影像学表现多样,尽早诊断、积极治疗、关键的支持治疗是保证疗效的重要环节。该病病情较重,容易反复发作,预后不良。结论:重视吸入性肺炎的早期诊断、消除或减少发病诱因可降低该病的发病及病死率。     

重庆地区不同时期严重胸部创伤流行病学特征及救治结局的回顾性分析

目的探讨重庆地区不同时期严重胸部创伤(severe chest trauma,SCT)的流行病学特征及临床特点。方法对重庆市急救医疗中心1990年1月至2009年12月救治的SCT1 834例(胸部AIS≥3且ISS≥16)进行回顾性分析。按不同时期分为2000年前组(1990年1月至1999年12月)和2000年后组(2000年1月至2009年12月),按结局分为生存组和死亡组。结果 2000年前后比较,钝性伤构成比分别为68.5%和74.7%(P<0.01);交通伤构成比分别为54.37%和58.94%(P=0.069);锐器伤构成比分别为12.21%和15.9%(P<0.05);2000年后院前时间缩短(P<0.01),转院率增高(P<0.05);胸简明损伤定级标准(abbre viated injury injury scale,AIS)、修正创伤评分(revised trauma score,RTS)增高(P<0.01);严重心脏大血管损伤、严重胸腹联合伤及合并严重脑外伤例数、年平均例数明显高于2000年前组(P<0.01)。2000年前严重并发症发生率(314/565,55.58%)比2000年后(673/1 269,53.03%)高,但差异无统计学意义(P=0.338);2000年后肺部感染及创伤性休克治疗效果有显著性提高(P=0.019,P=0.008);死亡率由7.07%降至4.81%(P<0.05);住院天数减少,但差异无统计学意义(P=0.063);首要致死原因为低血容量休克(59.41%);各评分指标在生存组和死亡组间有显著性差异(P<0.01)。结论 2000后SCT的发生率增多,病情更重,但救治水平明显提高。     

Chronic fatigue in primary care. Prevalence, patient characteristics, and outcome

Although fatigue is one of the most common complaints in ambulatory care, research has been minimal. Of the 1159 consecutive patients surveyed in two adult primary-care clinics, 276 (24%) indicated that fatigue was a major problem. Fatigue was more prevalent in women than in men (28% vs 19%). Extensive clinical, laboratory, psychometric, and functional data were gathered for 102 fatigued patients and 26 controls. Laboratory testing was not useful in detecting unsuspected medical conditions or in determining the cause of fatigue. Depression or somatic anxiety or both were suggested by screening psychometric instruments in 82 fatigued patients (80%) compared with three controls (12%). Global dysfunction was marked, as reported by patients on the Sickness Impact Profile. The mean score on the Sickness Impact Profile of 11.3 for fatigued patients is similar to that reported for patients with major medical illnesses. After one year of follow-up, only 29 fatigued patients (28%) had improved. The high prevalence, persistence, and functional consequences of fatigue mandate a search for effective therapy.     

鼻窦真菌球的CT影像学特征和治疗

目的探讨鼻窦真菌球的CT影像学特征及临床治疗,提高该病的术前诊断率和疗效。方法选择1999年1月至2005年6月经手术、病理证实并且随访6个月以上的鼻窦真菌球32例,回顾性分析这些患者的鼻窦CT及临床资料。结果CT表现为多为单窦发病,以上颌窦最多见,22例,蝶窦次之,7例,累及上颌窦和筛窦1例,上颌窦和蝶窦1例,同时累及上颌窦、筛窦和额窦1例。所有病变窦腔密度不均匀增高,27例软组织密度团块影内见点状、絮状、斑片状不规则高密度钙化影,类似金属异物影。上颌窦内侧壁骨质破坏吸收13例,残存骨端伴有骨质硬化;上颌窦内壁明显向鼻腔膨胀2例。治愈30例,2例好转。结论鼻窦真菌球CT具特征的表现为,单窦发病,以上颌窦为主,蝶窦次之;窦腔内密度不均匀增高,软组织密度团块影内见点状、絮状、斑片状不规则高密度钙化影及上颌窦内侧壁破坏吸收。术前鼻窦CT结合鼻内镜检查是提高本病术前诊断率的有效便捷的方法。鼻内镜下充分开放病变鼻窦窦口,完全清理出病灶,同时保留窦腔黏膜完整是目前最有效的治疗方法。     

婴幼儿巨细胞病毒感染138例临床及治疗观察

目的：探讨婴幼儿巨细胞病毒（ CMV）感染的临床特点及治疗。方法：对在我院确诊、住院治疗的138例CMV感染患儿的临床资料进行回顾性分析。结果：138例患儿（男80例,女58例）血清CMV-IgM阳性和（或）血、尿CMV-DNA-PCR阳性,入院年龄9 d～3岁。临床表现为肺炎99例,伴有肺功能改变18例;婴儿肝炎62例,其中肝硬化1例,肝豆状核变性1例,高胆红素血症30例（2例合并核黄疸,3例胆道闭锁,1例胆总管囊肿,3例肝糖原累积症）;溶血性贫血10例,特发性血小板减少症6例;脑发育异常15例,其中脑积水1例、脑结节硬化2例、运动落后3例、智力低下3例、癫痫2例;脑干听觉诱发电位异常16例（双侧听力受损10例、青光眼1例）;先天性心脏病8例,多发畸形3例,迁延性肠炎5例,营养不良7例,喉软骨发育不良3例,选择性IgA缺乏症1例,遗传代谢性疾病1例,同时合并多重感染11例,合并呼吸衰竭、休克2例。治疗后好转114例,放弃治疗19例,死亡5例。结论：婴幼儿CMV感染临床表现多样化,以肺炎最多见;其次是肝胆系统受累。中枢神经系统受损可导致脑发育异常、听神经受损、运动落后等,少数病例可伴发其他畸形甚至多发畸形。绝大部分CMV感染病例预后良好,少数病例预后差甚至死亡。     

Prevalence, clinical characteristics and outcome in patients with chronic heart failure and diabetes

Background Chronic heart failure（CHF）and diabetes mellitus portend high morbidity and mortality because of an interrelated pathophysiologic process.This large cohort study aimed to analyze the prevalence,clinicaI characteristics and long-term outcome of patients with CHF and diabetes.Methods A totaI of 1119 patients with NYHA functionaI class Ⅱ-Ⅳ and left ventricular ejection fraction（LVEF）〈45% between January 1995 and May 2009 were recruited.Clinical variables, biochemical and echocardiographic measurements were retrospectively reviewed,and composite major cardiac events （MCE） including death,headtransplantation, and refractory heart failure requiring multiple hospitalizations were recorded.Results The prevalence of CHF with diabetes was progressively increased with time （16.9% in 1995-1999;20.4% in 2000-2004,and 29.1% in 2005-2009）and age（1 8.5% in〈60 years,26.6% in 60-80 years,and 26.6% in〉80 years）.Compared with CHF patients without diabetes,those with diabetes had worse cardiac function,more abnormal biochemical changes.and higher mortality.Treatment with glucose-lowering agents significantly improved LVEF and decreased MCE.An elevated serum HbA1c level was associated with large left ventricular end-systolic diameter （P〈0.05）,decreased LVEF（P〈0.01）and reduced survival（P〈0.05）.Multivariable Logistic regression analysis revealed that after adjustment for confounding factors,NYHA functional class（OR2.65,95%CI 1.14-6.16,P=0.024）and HbA1c level≥7%（OR2.78, 95%CI 1.00-7.68,P=0.049）were independent risk factors for adverse outcomes in CHF patients with diabetes.Conclusions Prevalence of CHF with diabetes was increasing during past decades,and patients with CHF and diabetes had worse clinical profiles and prognosis.Aggressive anti-CHF and diabetes therapies are needed to improve overall outcomes for these patients.     

442例不同年龄段抑郁症患者的临床特征及治疗回顾性分析

目的:调查分析重庆地区不同年龄段抑郁症患者的I临床特征及治疗药物特点,探寻在不同年龄段抑郁症患者临床特征及治疗是否存在差异.方法:采取回顾性分析方法,调阅2006～2009年重庆医科大学附属第一医院585例抑郁症患者住院病历,选择其中病历资料完整并符合本研究要求的442例进行分析,青少年组37例,中青年组338例,老年组67例,应用抑郁症病历回顾资料调查表,采用SPSS13.0软件统计分析.结果:3组患者在年龄、文化程度及婚姻差异有统计学意义,在性别、性格及家族史阳性差异无统计学意义;青少年组生活事件发生率高于老年组(X2=5.63,P<0.05);老年组合并躯体疾病发生率高于中青年组(X2=20.17,P<0.01),中青年组合并躯体疾病比率高于青少年组(X2=5.12,P<0.05);老年组焦虑症状发生率高于青少年组和中青年组(X2=12.43,P<0.01;X2=15.23,P<0.01),3组患者在药物治疗方面差异无统计学意义.结论:不同年龄段的抑郁症患者在发生诱因上有差异,随着年龄的增长,以躯体疾病为诱因引发抑郁症的比例会增大.不同年龄段抑郁症患者在临床症状也存在差异,相对青少年患者及中青年患者,老年期患者有更多的焦虑症状.不同年龄段患者在抗抑郁药物选择上差异无统计学意义.     

冠状动脉内支架植入术治疗不稳定型心绞痛的临床观察

目的 评价支架植入术对不稳定型心绞痛(UAP)的治疗效果.方法 对22例不稳定型心绞痛患者行经皮冠状动脉腔内成形术(PTCA)及支架植入术,同期20例住院的不稳定型心绞痛患者做对照组,观察两组患者1年内心绞痛、急性心肌梗死、死亡、再次住院的发生率及出院后患者左室功能.结果 介入治疗组手术全部成功,未见与手术有关并发症,1年内无死亡、无急性心梗、无接受冠脉搭桥术(CABG)者,其左室射血分数较对照组明显改善(P＜0.01);对照组1年内1例死亡、3例发生急性心梗、1例接受外科搭桥术.结论 支架植入术是目前对不稳定型心绞痛的一种安全、有效的治疗手段.     

心脏再同步治疗药物难治性充血性心力衰竭的长期疗效

目的观察心脏再同步化治疗（CRT）对药物难治性充血性心力衰竭的长期疗效。方法13例充血性心力衰竭患者,心功能NYHAⅢ-Ⅳ级,完全左束支传导阻滞。左室射血分数（LVEF）≤35％,左室舒张末期内径（LVEDD）≥55 mm,中度以上的二尖辦反流（MR）。组织多普勒超声显像（TDI）证实存在左、右心室和左室内机械活动不同步。对上述药物治疗无效患者行CRT治疗。术后随访内容包括临床症状、心电图和心脏超声,平均随访时间15±6个月。结果（1）手术：10例为经心脏静脉植入左室电极,2例经心外膜植入左室电极,1例行右心室双部位起搏,均无并发症。（2）心功能：术后心功能改善Ⅰ-Ⅱ级。左室射血分数由术前（27．00±3．84）％增加至术后12个月时的（40．36±7．87）％（P〈0．05）。（3）死亡率：因心室颤动猝死1例。（4）QRS时限：由术前（176±10．4）ms缩短为术后即刻的（148±8．4）ms（P〈0．05）,左右心室及左室内同步性能明显好转,且随着时间的延长有持续改善。结论CRT可改善患者症状,提高心功能,并使患者长期获益。     

反复流产妇女夫妇双方染色体核型分析

近20年来细胞遗传学的研究发现染色体异常是自然流产的重要原因之一。Daniely M,Stephenson MD[1,2]等曾经报道在流产胚胎组织中发现染色体异常率高达45%~50%,反复流产夫妇的个体染色体异常率为3·3%~12·0%,远高于正常群体(0·5%),而流产胚胎的染色体异常率高达47·8%。由此可