恶性肿瘤患者围手术期情绪分析

目的：探讨恶性肿瘤患者围手术期情绪障碍动态变化特征。方法：用抑郁自评量表(SDS)、焦虑自评量表(SAS),观察55例恶性肿瘤患者住院不同时段情绪障碍的检出率及临床特征。结果：70％左右患者存在抑郁情绪。不同时段的焦虑、抑郁症状不同。结论：恶性肿瘤患者围手术期情绪障碍明显,需要予以干预。     

The ESDQ: a new method of assessing emotional and social dysfunction in patients following brain surgery

The Emotional and Social Dysfunction Questionnaire (ESDQ) has been designed to overcome some of the difficulties of inappropriately applying psychiatric based questionnaires to brain-damaged populations. Two-hundred and twenty-five patients were assessed following brain surgery (BS) using a self-rating patient version of the ESDQ and 211 of these patients were rated by their partner. A factor analysis using a varimax rotation and principal components analysis found the partner results to show eight factors including, Anger, Helplessness, Emotional Dyscontrol, Indifference, Inappropriateness, Fatigue, Maladaptive behaviour, and Insight. The analysis of the Self-rating questions revealed a similar profile, Anger, Emotional Dyscontrol, Helplessness, Inertia, Fatigue, Indifference, Inappropriate, and Euphoria. The scales based on the factors were subjected to discriminant analysis in which the BS patients were compared with a combination control group of neurosurgical outpatients and terminally-ill cancer patients, all of which were without cerebral complaints. The brain surgery results for the partner-rated and the Self-rated version of the ESDQ were compared with control ratings of 42 partners and 54 self-ratings, respectively. The analysis showed a significant discrimination for the Partner-rated version on each of the eight scales individually with an overall significant overall separation (Wilks Lambda=.903, chi=21.1, df=8, p=<.005). The Self-rated version showed less separation on an individual scale basis the Emotional Dyscontrol scale failing to show a significant separation. The overall difference on the Self-rating version was significant [Wilks Lambda=.908, chi=26.2, df=8, p=<.001). The levels of internal consistency of the questionnaire scales were found to be satisfactory (Alpha,.78 -.94). Also the relationship between ESDQ scales and standardised measures of aggression, anxiety, depression, and vigour (STAXI, HADS, and POMS) gave an indication of acceptable levels of concurrent validity.     

Comparison of patients with and without poststroke major depression matched for size and location of lesion

Patients who developed major depression within two years following stroke (n = 13) were compared with patients who did not become depressed in the same period (n = 13) but who did have a similar size and location of lesion as in the depressed group. Although the depressed patients were not significantly different from the nondepressed patients in background characteristics, history of depressive disorder, neurological impairment, or social functioning, the depressed group had greater cognitive impairment as measured by Mini-Mental State score. In addition, the depressed group had significantly larger lateral and third ventricular to brain ratios than nondepressed patients on computed tomographic scan analysis. The results suggest that poststroke depression itself may produce an intellectual impairment; subcortical atrophy, which likely preceded the stroke lesion, may produce a vulnerability for depression following stroke.     

Operated low grade astrocytomas: a long term PET study on the effect of radiotherapy

The role of postoperative radiotherapy in patients with low grade gliomas is not established yet. PET with 11C methionine (MET) and 18F fluorodeoxyglucose (FDG) was used to perform cross sectional comparisons as well as within patient follow up studies in 30 operated patients with fibrillary astrocytoma WHO II. Uptake of tracer by tumour was quantified by radioactivity concentration ratios in tumour over contralateral brain (T/C). Comparing patients who did (n=13) or did not (n=17) receive external radiotherapy subsequent to first tumour resection, no differences in MET and FDG T/C between both groups were found during a postoperative period of 94 months (when recurrence and malignant progression of low grade astrocytomas are expected). Malignant progression occurred at a similar rate in both patient groups at a mean (SD) postoperative interval of 46 (26) months. Irrespective of whether radiotherapy was applied or not, malignant tumour recurrences showed higher T/C values (MET: 1.70 (0.64), FDG: 0.98 (0.23)) than recurrences without signs of malignancy (MET: 1.21 (0.21), FDG: 0.82 (0.08)) (Mann-Whitney: MET p=0.086, FDG p=0.035). The data show a relative lack of radiotherapy administered immediately after first tumour resection. In the course of disease, patients with tumours undergoing malignant progression may be identified with PET tracer methods.     

Reoperation for malignant astrocytoma

We evaluated 15 consecutive patients with malignant astrocytomas who were reoperated for functional status and survival. Their Karnovsky Performance Status (KPS) was not changed by surgery. None suffered perioperative death, wound infection, or complications. Patients with glioblastoma maintained KPS unchanged for a mean of 13 weeks (median, 10 weeks); with anaplastic astrocytoma, mean, 37.2 weeks (median, 24 weeks). Life spans were approximately twice that of non-reoperated historical controls. Reoperation for patients with recurrent malignant astrocytoma should be seriously considered when a gross total re-resection can be the goal in a patient whose tumor is in an accessible brain region.     

Comparing self- and expert rating: a self-report screening version (SIAB-S) of the Structured Interview for Anorexic and Bulimic Syndromes for DSM-IV and ICD-10 (SIAB-EX)

Objective: Carrying out structured interviews in larger numbers by well-trained interviewers is costly and time consuming. Therefore, we developed parallel to the existing Structured Interview for Anorexic and Bulimic Syndromes (SIAB-EX) a similarily designed questionnaire for symptoms of disordered eating and related areas (SIAB-S). Method: 377 treated eating disordered patients were assessed within a two-week time period using both the SIAB-EX and SIAB-S. Results: Generally, self-ratings based on the SIAB-S were quite similar to expert ratings. Cohen's kappa showed good agreement between self- and expert ratings. Factor structure based on principal component analyses of expert ratings or self-ratings led to rather similar results confirming the robustness of the subscales in self- and expert ratings. Using expert rating as a criterion, the self-rating (SIAB-S) – which can more easily be used for screening purposes – had a sensitivity of 0.70, a specificity of 0.80 and a PPV = 0.91 for the DSM-IV diagnoses of AN and/or BN (worst ever condition). Diagnostic sensitivity (79/73%) and specificity (66/63%) were in an acceptable range (past/current). If we focus on the differences between the two approaches the following was found: self-rating (compared to expert-rating) resulted in lower scores for items inquiring about binges and inappropriate compensatory behaviour, attitudes towards food and eating, and social interaction. On the other hand, self-rating (compared to expert-rating) led to higher scores for items measuring general psychopathology and atypical bingeing. Conclusion: compared to the “gold standard” of data obtained with investigator-based standardised or structured interviews, data based on self-rating with items formulated clearly and concisely can lead to reliable and valid results. While complex issues (what is a binge) are difficult to assess in self-ratings, some (very personal) questions may even be better asked in a self-report questionnaire. Received: 21 June 1999 / Accepted: 22 March 2000     

替莫唑胺治疗颅内恶性胶质瘤疗效观察

目的观察替莫唑胺治疗颅内恶性胶质瘤疗效。方法选择2002-2003年收治的50例经病理证实的恶性胶质瘤患者,其中间变性星形细胞瘤26例,胶质母细胞瘤24例。男32例,女18例;年龄19～67岁,平均年龄42.5岁。随机分为2组,每组各25例患者,替莫唑胺组(试验组)中胶质母细胞瘤12例、间变性星形细胞瘤13例,平均病程为4个月;环己亚硝脲组(对照组)胶质母细胞瘤12例、间变性星形细胞瘤13例,平均病程3.5个月。按照身高及体质量确定体表面积,分别接受下述治疗方案。(1)试验组:按150mg/m2体表面积计算,25例患者于试验第1～5天口服替莫唑胺胶囊。第1天需同时口服环己亚硝脲安慰剂,剂量为130mg/m2。(2)对照组:第1天口服环己亚硝脲,剂量为130mg/m2,第1～5天口服替莫唑胺安慰剂150mg/m2。2组均每疗程服药5d,28d为1个治疗周期,连续治疗3个周期。3个周期后1个月,开始进行疗效观察,并长期随访观察患者的生存期长度。结果(1)生存时间:替莫唑胺组患者平均生存期较环己亚硝脲组明显延长,差异具有显著性意义(P<0.001)。(2)生存质量:经随访,替莫唑胺组患者生活质量提高并保持稳定。(3)药物安全性:替莫唑胺组2例出现白细胞数减少,5例发生恶心、呕吐,均出现于每周期服药第1天,无明显肝、肾功能异常。环己亚硝脲组10例白细胞数减少、血小板     

Spinal cord gliomas: management and outcome with reference to adjuvant therapy.

The authors review their experience with 19 consecutive cases with either astrocytic tumour (glioblastoma multiforme one, anaplastic astrocytoma one, astrocytoma 4, pilocytic astrocytoma 4) or ependymoma (10 tumours in 9 patients) of the spinal cord who were treated during the period from 1982 to 1996. The patients included 10 male and 9 female patients with a median age of 38 years. The main tumour locations included the cervicomedullary region 5 the cervical cord (8), the thoracic cord (5) and one each in the thoracolumbar region and conus medullaris. While a total removal of the tumour was achieved in 8 out of 10 ependymomas, the initial treatment for astrocytic tumours was a partial resection in 5, and biopsy in the remaining 5. As adjuvant treatment, 8 patients received radiation therapy and 2 received chemotherapy. Two patients with an astrocytic tumour received chemotherapy only, while the remaining 9 received neither radiation therapy nor chemotherapy initially. After these treatments, 6 out of the 8 patients with low grade astrocytoma have remained alive for 1.3-12.6 years, while 2 patients with high grade astrocytic tumours died within 15 months following surgery. Eight out of 9 patients with an ependymoma have remained alive for 3.0-12.3 years, while one committed suicide 2 years after surgery. As a result, 14 patients are still alive; half of them are accompanied by a mild neurological dysfunction, while the remaining one has a moderate deficit. The postoperative results and the rationale for surgery is discussed, and an approach for utilising adjuvant therapy for high grade tumours is also suggested.     

Early prognostic factors related to progression and malignant transformation of low-grade gliomas

Objective

Low-grade gliomas (LGGs) are infiltrative tumors characterized by slow growth. However, during early period, LGGs can progress and transform into a malignant pathology. We analyzed the prognostic factors for progression and malignant transformation in LGGs.

Materials and methods

From 2000 to 2009, we operated on 86 patients: 42 oligodendrogliomas, 12 oligoastrocytomas, and 32 astrocytomas. The male:female ratio was 47:39, and the median age was 41 (±17.4) years. The mean follow-up period was 4.25 (±2.8) years. We analyzed the prognostic factors for progression-free survival (PFS), overall survival (OS), and malignant transformation, considering age, sex, KPS, clinical presentation, tumor location, radiologic pattern, extent of removal, pathologic subtype, and adjuvant treatment.

Results

In univariate analysis, non-eloquent location, gross total removal, and oligodendroglial pathology statistically correlated with improved PFS and OS. In multivariate analysis, gross total removal correlated with longer PFS (p = 0.043), and gemistocytic astrocytoma had a poor PFS (p = 0.004). Younger age and non-eloquent area showed an improved OS (p = 0.002 and 0.041), and astrocytic pathology showed a poor OS (p = 0.01). Malignant transformation was pathologically diagnosed in 13 out of 86 patients (15%). Gemistocytic astrocytoma correlated independently with malignant transformation (p = 0.022).

Conclusion

In LGGs, extent of removal associated with tumor progression. The pathology of astrocytoma, especially gemistocytic astrocytoma, was an independent prognostic factor for recurrence and malignant transformation.     

Self-ratings of memory dysfunction: different findings in depression and amnesia

An 18-item self-rating test of memory functions was administered to two patient groups: seven patients with amnesia resulting from Korsakoff's syndrome and six other amnesic patients. These results were compared to results obtained previously for depressed psychiatric inpatients (n = 19) and depressed inpatients prescribed electroconvulsive therapy (ECT) (n = 35). The latter group was tested both before and 1 week after completion of the course of ECT. One pattern of memory self-ratings was reported by the two groups of depressed patients. These two groups reported an approximately equivalent level of impairment across all test items. A different pattern of memory self-ratings was reported by the two groups of amnesic patients and by the group tested after ECT. These patients reported considerably more impairment on some items than others, such that performance was not equivalent across test items. Finally, the patients with Korsakoff's syndrome underestimated their memory problems, reporting a less severe impairment than the other amnesic patients. The results show that the memory problems experienced in depression and in amnesia are distinguishable with self-assessment techniques. In addition, the similarity between memory self-ratings reported by patients after ECT and by amnesic patients supports the idea that memory complaints after ECT reflect primarily the experience of amnesia. Self-rating forms like the one described here may have useful application to many diagnostic groups where questions arise about the nature of reported memory problems.     

Cognitive and affective disturbances in children after surgical treatment of cerebellar tumors

BACKGROUND AND PURPOSE: The cerebellum has been associated with motor control, but more recent studies have extended its contribution to other functions, such as modulation of emotions, behavioral organization or language. The cerebellar cognitive affective syndrome was described primarily in adults. In children, cerebellar lesions are relatively frequent and some are due to neoplasm. MATERIAL AND METHODS: Cognitive and emotional functions were studied in 66 children who underwent surgery for cerebellar pilocytic astrocytoma at the Department of Neurosurgery of the Children Memorial Health Institute. 36 children were psychologically examined and parents of 66 children filled in a questionnaire, answering questions about children's linguistic functioning, emotion regulation and ability to initiate, organize and efficiently realize various activities. RESULTS: The disturbances in the initiation and realization of activities were reported most often (77%). Problems in emotional regulation were noticed in 65% of children and were characterized by disinhibition, impulsivity and irritability. Language difficulties were observed in 42%. No significant differences between groups of children with different localization of tumor (vermis or cerebellar hemisphere) were observed. CONCLUSIONS: The present study confirms the psychological deficits following cerebellar lesion in children, similar to the cerebellar cognitive affective syndrome reported in adult patients.     

Pleomorphic xanthoastrocytoma with intraventricular extension and anaplastic transformation in an adult patient: Case report

Pleomorphic xanthoastrocytoma (PXA) is a rare, low-grade astrocytic tumour that usually occurs in the superficial cerebral hemispheres of children and young adults. Although it has a relatively favourable prognosis, malignant progression of these tumours has been described. Therefore, we present an unusual case of a 54-year-old male with a right, multicystic, parietooccipital tumour extending through the ipsilateral ventricle. After surgical resection, histological examination revealed a lesion with pleomorphic cells, cytoplasmic lipidisation, intensely eosinophilic granular bodies, well-delimitated unique nuclei and focal, positive immunoreactivity for synaptophysin, glial fibrillary acidic protein (GFAP), S-100 protein, vimentin and CD56. Once other tumours, such as giant cell metastatic carcinoma or primary lesion like subependymal giant cell astrocytoma, were ruled out, a final diagnosis of XAP was established. After a follow-up period of 9 months, the patient suffered an extensive and local tumour relapse considered inoperable, with progressive neurological deterioration and radiological findings of malignant progression. The brain biopsy procedure revealed anaplastic changes, including necrosis foci, higher mitotic activity (5×10 high-power fields) and a 10% proliferation index measured by Ki67 labelling. The present case showed intraventricular extension and a more aggressive behaviour, both uncommon in these tumours (similar to anaplastic astrocytoma or glioblastoma multiforme), thus demanding an initial, optimal surgical treatment with close clinical and radiological follow-up, due to the high potential for malignant transformation of XAPs.     

Intraoperative values of S-100 protein, myelin basic protein, lactate, and albumin in the CSF and serum of neurosurgical patients

OBJECTIVES: To assess the concentrations of S-100 protein, myelin basic protein (MBP), and lactate, and the (CSF)/serum albumin ratio (Qalb) during intracranial neurosurgical procedures. METHODS: Samples of CSF from 91 patients with various CNS diseases were obtained by aspiration of cisternal CSF at the beginning of surgery (before starting surgical manipulation of the brain) and concentrations of S-100 protein, MBP, and lactate, and Qalb were determined. At the same time blood was sampled for determination of serum S-100 protein concentration. Patients were divided into three groups according to the aetiology of their CNS disease (intracranial haemorrhage, n=11; benign intracranial mass lesion, n=52; malignant neoplastic disease, n=28). Radiological and intraoperative characteristics were documented. RESULTS: In each of these three groups median values of all four CSF variables measured were raised. The occurrence of brain oedema and a midline shift correlated significantly with raised concentrations of MBP and Qalb. Breaching of the arachnoid layer, documented at surgery for benign lesions, correlated with higher concentrations of MBP, lactate, CSF S-100 protein, and Qalb. CONCLUSIONS: Intraoperative values of S-100 protein, MBP, lactate, and Qalb are increased in patients with intracranial haemorrhage, benign intracranial mass lesion, and malignant neoplastic disease. Breaching of the arachnoid layer and oedema is associated with higher concentrations of some of the aforementioned proteins. These biochemical data can serve as a basis for further research into CSF specific proteins.     

幕上大脑半球高级别星形细胞瘤预后的影响因素分析

目的探讨与幕上大脑半球高级别星形细胞瘤生存预后相关的临床因素。方法回顾接受手术与术后辅助性放疗及化疗的97例高级别星形细胞瘤的临床资料,其中间变性星形细胞瘤(AA)60例,胶质母细胞瘤(GB)37例。随访其生存状况,用Kaplan-Meier单因素生存分析与COX多元回归分析作统计学处理。结果间变性星形细胞瘤和胶质母细胞瘤的无进展生存时间(PFS)分别为18和10个月,两者总生存时间(OS)分别为21和12个月;年龄“≤40岁”与“>40岁”者PFS各为18和10个月,OS各为21和13个月;治疗前“KPS≥80”与“<80”PFS各为15和10个月,OS为18和12个月;术前有抽搐症状与否的PFS各为21和11个月,OS为24和14个月;术前MR检查肿瘤强化与否的PFS各为11和18个月,OS为14和21个月。单因素分析显示,上述各因素与病人PFS和OS相关(P<0.05)。性别、肿瘤直径、肿瘤部位、肿瘤切除程度与病人PFS、OS关系无统计学意义(P>0.05)。COX回归分析显示年龄大小、肿瘤级别的高低、治疗前KPS评分、术前有无抽搐症状是影响预后的显著因素。结论年龄较小、高KPS评分、低病理级别及术前有抽搐症状被提示是高级别星形细胞瘤患者获得较长生存期的保护因素,而性别、肿瘤部位、肿瘤大小和手术切除程度对预后影响无统计学意义。肿瘤强化与预后的关系有待进一步研究证实。     

The Everyday Functioning Questionnaire: A New Measure of Cognitive and Emotional Status for Neurosurgical Outpatients

A group of 40 neurosurgical patients and their partners reported on the patients' everyday cognitive and emotional problems following brain surgery using the everyday functioning questionnaire (EFQ). These results were compared with a control group of 23 patients who had undergone surgery to extra-cerebral areas. Factor analysis found a sound construct validity in which all the subscales Memory, Emotion, Concentration and Communication were well defined and a new subscale referring to “Lack of Insight” emerged. The subscales had satisfactory inter-item consistencies (Cronbach alpha > .85). A separate analysis of the questionnaires revealed that the partners' questionnaire gave a better separation [Wilks' l = .62, df = 6, P = .001] with 81% of subjects classified compared to the patients' questionnaire [Wilks' l = .8, df = 6, P = .058] with only 72% correctly classified. With the exception of the Communication subscale, all the individual subscales showed a significant discrimination between the two groups on the partners' version of the EFQ questionnaire. A subgroup comparison of aneurysm patients (n = 9) showed generally less impairmentcompared to tumour patients (n = 26), with a significant separation on the subscales of Emotion, Insight, and Concentration. The relationship between the EFQ and the neuropsychological test results on a subsample of patients (n = 10) found the partners' judgements on the EFQ to have greater concurrent validity when compared to the patients' self-report. The rehabilitation and assessment applications of the EFQ are discussed.     

Quality of life in patients with stable disease after surgery, radiotherapy, and chemotherapy for malignant brain tumour

OBJECTIVES: to evaluate quality of life in patients with malignant brain tumour with stable disease after combined treatments in comparison to patients with other chronic neurological conditions, and to explore the relation of quality of life to clinical, pathological, affective and cognitive factors. METHODS: fifty seven patients who were stable after surgery, radiotherapy and chemotherapy and 24 controls with spastic paraparesis, peripheral neuropathies, myasthenia, ataxia, Parkinson's disease, or multiple sclerosis, were studied. Patients were evaluated by functional living index-cancer, Karnofsky performance status, activity of daily living, self-rating depression scale, state-trait anxiety inventory, and tests for cognitive abilities. RESULTS: separate Mann-Whitney test comparisons did not show any difference in measures of health related quality of life (functional living index-cancer), autonomy in daily life (activity of daily living), or mood between tumour and control patients, although the first had slower mental speed and worse attention. Seventy three per cent of patients with brain tumour and 58% of the control patients continued or resumed previous work activity. Quality of life was significantly associated with depression, state anxiety, and performance status in the patients with brain tumour, whereas in control patients, state anxiety was the only factor related to quality of life. CONCLUSIONS: after intensive multimodality treatments, selected patients with brain tumour with stable disease may have satisfactory quality of life that may be not worse than in patients with other chronic neurological illnesses. During the period of stable disease, depressed mood, possibly a reaction to impaired physical and cognitive performance, seems to play a major role in determining quality of life.     

Aphasia in patients after brain tumour resection

Background: It is has been estimated that aphasia occurs in one‐third to half of patients who have had a left hemisphere brain tumour resection. While studies have documented aphasia before malignant brain tumour resection, little is known about the type and severity of aphasia after tumour resection.

Aims: The aims of this study were (1) to describe the subtypes and severity of aphasia during the acute recovery period after malignant brain tumour resection; (2) to describe potential associations between acute language outcomes and tumour characteristics; and (3) to compare our findings to those reported in the literature to identify possible language differences between patients who suffer stroke and patients who undergo brain tumour resection.

Methods & Procedures: We retrospectively reviewed the Western Aphasia Battery (WAB) scores during the acute recovery period of individuals who underwent resection of malignant brain tumours to determine patterns of aphasia severity and subtype.

Outcomes & Results: We found that aphasia was usually mild (63% of patients) and that anomic aphasia was the most common subtype (48% of patients) during the acute recovery period after brain tumour resection, regardless of lesion location or tumour grade.

Conclusions: The patterns of postoperative language functioning that we observed during the acute recovery period after surgery for a brain tumour support the perspective that acute aphasia profiles may be fundamentally different in patients with brain tumours compared with patients who have had a stroke.     

Photodynamic therapy of high grade glioma - long term survival.

Haemetaporphyrin derivative (HpD) mediated photodynamic therapy (PDT) has been investigated as an adjuvant treatment for cerebral glioma. This study records the survival of patients at the Royal Melbourne Hospital with residences in the State of Victoria, utilizing the Victorian Cancer Registry database for patients treated with adjuvant PDT following surgical resection of the tumour. For primary (newly diagnosed) tumours, median survival from initial diagnosis was 76.5 months for anaplastic astrocytoma (AA) and 14.3 months for glioblastoma multiforme (GBM). Seventy-three percent of patients with AA and 25% with GBM survived longer than 36 months. For recurrent tumour, median survival from the time of surgery was 66.6 months for AA and 13.5 months for GBM. Fifty-seven percent of patients with recurrent AA and 41% of patients with recurrent GBM survived longer than 36 months. Older age at the time of diagnosis was associated with poorer prognosis. Laser light doses above the sample median of 230 J/cm2 were associated with better prognosis in the 136 patients studied (primary tumour patients - (HR=0.50[0.27,0.95],p=0.033); recurrent tumour patients (HR=0.75[0.42,1.31],p=0.312). There was no mortality directly associated with the therapy, three patients had increased cerebral oedema thought to be related to photodynamic therapy that was controlled with conventional therapies.     

Factors associated with dysmorphic concern and psychiatric morbidity in plastic surgery outpatients

OBJECTIVES: To compare new referrals to a plastic surgery clinic for cosmetic (non-medically explained) reasons with a control group of equal size with medically explained symptoms. METHOD: Patients attending for cosmetic (non-medically explained) reasons were compared with the controls using the general health questionnaire (GHQ), and dysmorphic concern questionnaire (DCQ). Patients were divided into high and low DCQ scores on the basis of their median scores. RESULTS: Ninety subjects were approached of whom 84 (93%) participated giving 42 patients each in the cosmetic (non-medically explained) and control groups. Forty-four per cent were referred for mammoplasty (n = 37) and 8% for rhinoplasty (n = 7). The other 40 cases (48%) were for other procedures including excision, abdominoplasty and blepharoplasty. Thirty-two per cent of the sample were GHQ cases (n = 27). Patients presenting for cosmetic (non-medically explained) reasons were 13 times more likely to be female (95% CI = 4.3-41), nine times more likely to have high DCQ scores (95% CI = 3.3-24), six times more likely to be GHQ cases (95% CI = 2.1-17), and seven times more likely to present for mammoplasty. The same factors were associated with high DCQ scores. Patients with high DCQ scores were 32 times as likely to be GHQ cases (95% CI = 6.8-151). On multivariate analysis, dysmorphic concern emerged as the only independent predictor of GHQ caseness rather than sex, surgical diagnosis or procedure (adjusted OR = 32.0, 95 % CI = 6.5-156). Similarly, only GHQ caseness and presentation for cosmetic (non-medically explained) surgery independently predicted DCQ score. CONCLUSIONS: Patients presenting for cosmetic (non-medically explained) surgery have high rates of dysmorphic concern and psychiatric morbidity     

血管内皮生长因子与星形细胞瘤病理分级和瘤周水肿的相关研究

目的　通过观察VEGF在星形细胞瘤中的表达 ,探讨VEGF与肿瘤分化程度和瘤周水肿的关系。方法　星形细胞瘤手术标本 39例 ,用免疫组化方法显示VEGF在组织中的分布。用RT PCR的方法测定VEGFmR NA在组织中的表达。根据影像学检查结果计算脑肿瘤瘤周水肿指数。结果　VEGF主要着色于肿瘤细胞的胞浆。偶见血管内皮或细胞间质有VEGF着色。分化较差的星形细胞瘤VEGFmRNA表达及瘤周水肿的程度均高于分化较好的星形细胞瘤 (P <0 0 1 )。VEGFmRNA表达与瘤周水肿的程度呈正相关 (r =0 6 6 2 ,P <0 0 1 )。结论　星形细胞瘤分化差者VEGF表达较高且瘤周水肿较重。瘤周水肿的形成与VEGF关系密切