Recent advances in the management of non-Hodgkin's lymphomas

The non-Hodgkin's lymphomas are a diverse group of diseases with distinctive natural histories and responsiveness to therapy. Each of these diseases represents the arrest and proliferation of malignant lymphocytes at a particular stage of normal lymphocyte differentiation. Cytogenetic and gene rearrangement studies have established the clonal nature of these disorders. The majority of the non-Hodgkin's lymphomas that occur in adults are of B cell origin. Exceptions to this are lymphoblastic lymphoma, mycosis fungoides, Sézary syndrome, and HTLV-1 associated leukemia--lymphomas that are diseases of T cell origin. As a group, the non-Hodgkin's lymphomas are diseases that are very responsive to radiation therapy and chemotherapy. There are major differences, however, in the durability of these responses. From a clinical standpoint, the non-Hodgkin's lymphomas may be divided into those that are indolent and those that are aggressive in their clinical behavior. Ironically, the aggressive non-Hodgkin's lymphomas are frequently curable, while the indolent non-Hodgkin's lymphomas are presently incurable in the majority of cases.     

肋骨常见病变的X线及CT诊断

目的探讨肋骨常见病变的X线及CT表现特征。方法回顾性分析了43例肋骨病变的X线及CT表现。包括转移瘤11例,多发性骨髓瘤7例,骨纤维异常增殖8例,骨软骨瘤6例,内生软骨瘤4例,骨化性纤维瘤3例,骨瘤2例,动脉瘤样骨囊肿1例,结核1例。结果肋骨的常见肿瘤、肿瘤样病变及感染在X线及CT上各有自己的形态特征和影像表现。结论X线及CT能对肋骨常见病变的诊断及鉴别诊断提供重要证据。     

Prenatal diagnosis and Down's syndrome: PART 1. Review of possible procedures

There have been many recent advances in techniques for prenatal diagnosis. The direct diagnostic procedures of amniocentesis and chorionic villus sampling, which involve analysis of foetal material, are described and indications of their risks and reliability are given. Other direct procedures are briefly mentioned. Indirect biochemical analyses that identify groups at increased risk are also considered and their individual reported relationships with Down's syndrome are discussed. Technical problems and reported acceptability of maternal serum alpha fetoprotein screening are briefly mentioned. Studies reporting the potential of ultrasonography in the prenatal detection of Down's syndrome are reviewed. Other indications of increased risk are briefly mentioned.     

Mergers and acquisitions in professional organizations: a complex adaptive systems approach

Nurse managers face unique challenges as they cope with mergers and acquisitions among health care organizations. These challenges can be better understood if it is recognized that health care institutions are professional organizations and that the transformations required are extremely difficult. These difficulties are caused, in part, by the institutionalized nature of professional organizations, and this nature is explicated. Professional organizations are stubborn. They are repositories of expertise and values that are societal in origin and difficult to change. When professional organizations are understood as complex adaptive systems, complexity theory offers insight that provide strategies for managing mergers and acquisitions that may not be apparent when more traditional conceptualizations of professional organizations are used. Specific managerial techniques consistent with both the institutionalized characteristics and the complex adaptive systems characteristics of professional organizations are offered to nurse managers.     

常见肋骨肿瘤和肿瘤样病变的CT诊断

目的:讨论肋骨肿瘤和肿瘤样病变的CT表现以及各自的特点。材料与方法:取经手术和病理证实,或临床动态观察证实的肋骨病变50例。所有病例均行X线、CT检查。2例行MRI检查。结果:32例为良性病变,其中12例为骨岛,9例为骨纤维异常增殖症,7例为软骨类良性肿瘤,4例为骨感染性病变(2例为结核,2例为非特异性感染)。恶性病变18例,其中转移瘤10例,骨髓瘤4例,骨巨细胞瘤4例。结论:常见的肋骨肿瘤和肿瘤样病变一般都具有某些有助于我们诊断的特征性的CT表现。多数情况下,我们都能通过这些CT表现较好的区分常见的肋骨肿瘤和肿瘤样病变。     

Viral Vaccines in India: An Overview

Viruses cause a large number of diseases in humans, some of which are fatal, while others are highly debilitating. A majority of viral diseases attack infants and young children, while others strike people in their prime. Development of preventive measures against viral diseases is, therefore, of paramount importance. Vaccination is the most cost-effective medical intervention for preventing mortality and morbidity against infectious diseases. A number of effective and safe vaccines are currently available against several viral diseases of significant medical importance. Many of these manufactured in India, are at par with international standards and are affordable. For many other viral diseases, for which vaccines are currently not available, research is underway at various national laboratories, as well as in the private sector companies in India. The present overview highlights the various vaccine preventable viral diseases that are of special importance to India and aims to provide a glimpse of the various vaccines that are currently available, or are under development in India.     

Conceptual problems in current research on cognitive vulnerability to psychopathology

Four problems with the concepts used in research on the role of cognitions in psychopathological conditions are identified. The concepts are too intricate or too isolated, are too indistinguishable, and are too incontrovertible. The difficulties presented to the researcher by the use of such concepts are described and alternative approaches are recommended.     

Asthma in pregnancy

The main pregnancy-induced changes in respiratory physiology are increased minute-ventilation, due primarily to an increase in tidal volume; a 20 per cent decrease in the functional residual volume; and a decrease in the arterial pCO2 resulting from increased alveolar ventilation. The management of acute asthma is changed very little by pregnancy. Beta-adrenergic agonists, theophylline, and glucocorticoids are all as safe as they are in the nonpregnant state; they are not teratogenic. Iodides are contraindicated in pregnancy. Ephedrine and combination products containing theophylline are best avoided during pregnancy, not because they are dangerous but because better preparations are available.     

Faszien und Aponeurosen des Bewegungsapparats

Fasciae are the connective tissue sheath of muscles, tendons and ligaments and are interesting for diagnostic and therapeutic approaches in many medical disciplines. Fasciae are the guiding structures for blood vessels, lymphatic ducts and the innervation of certain muscle groups. The interstice forms complex spaces which act as storage areas for fluids and transport passages for chemical and cellular signal pathways, particularly in connection with the immune system. Numerous ailments of the musculoskeletal system are reflected by changes in the fasciae of the muscle systems affected. Especially in the back and the abdomen but also in the extremities, fasciae are functionally and topographically closely related to tendons and aponeuroses which are connected with other muscle systems. They contain sensory organs which are important for proprioceptive perception and pain perception. These receptors, which are innervated by dorsal spinal ganglia, are probably involved in the control of reflexes of the corresponding muscle groups. Knowledge about these interactions can be helpful for various diagnostic and therapeutic approaches.     

Prevention of childhood injuries. Part I: Motor vehicle injuries.

Unintentional (accidental) injuries are the leading cause of death in childhood and adolescence. In this article, interventions to reduce death and disability among children from motor vehicle injuries are identified. The major categories of injury are listed, the magnitude of the problem is defined, the risk factors are described, and selected interventions of the National Committee for Injury Prevention and Control are summarized. Recommendations for practice are discussed.     

Hypertension in the emergency department

Hypertensive emergencies are now rare and are recognized by the deleterious effect on end-organs. Prompt, efficacious treatment is critical, and the current drug of choice for most episodes is sodium nitroprusside. Hypertensive urgencies are more common than are emergencies, and are distinguished by diastolic pressures greater than 115 mm Hg without end-organ dysfunction. Although there are many efficacious agents, one excellent choice is nifedipine.     

钠离子紊乱病因及神经系统并发症

钠离子紊乱是临床常见的电解质紊乱,其可导致神经系统并发症;神经系统表现多为功能性改变,如果及时合理纠正,症状通常可逆。相反,如果不恰当处理,则可导致症状加重,出现不可逆性损害,甚至导致患者死亡。因此,有效的识别和治疗钠离子紊乱以及积极处理导致电解质紊乱的原发疾病极为重要。本章主要阐述低钠血症与高钠血症的病因,所致神经系统并发症的相关机制、临床表现及其治疗。     

The management and care of people with stoma complications

There are a variety of complications that are associated with stomas. These are described and their causes explained. A number of solutions are presented and advice that the nurse can give is offered. Some of the complications are commonly seen by the nurse, such as sore skin, whereas others are rare, such as an allergy to the stoma appliance. There may be sexual dysfunction after surgery, which may be temporary or permanent. These and many other potential problems are elaborated upon to aid the nurse when caring for people with stomas.     

膝关节损伤MRI应用价值

目的:研究膝关节损伤MRI的临床应用价值。材料与方法:回顾分析40例经临床或关节镜证实的膝关节损伤患者,分析其MR征象特征。结果:40例患者半月板损伤数为36(22.50%),其中,内侧半月板损伤数为24(15.00%),外侧半月板损伤数为12(7.50%),韧带损伤数为31(19.38%),其中,前交叉韧带损伤数为14(8.75%),后交叉韧带损伤数为3(19.37%),其中,胫骨16(10.00%),股骨12(7.50%),髌骨3(1.87%),关节腔积液数为38(23.75%),软组织挫伤数为24(15.00%)。结论:MRI能较正确地诊断膝关节损伤的部位、形态,是膝关节损伤最佳的检查手段。     

Species and type phages of lactococcal bacteriophages

Lactococcal phages are classified according to morphology and DNA homology. Phages are differentiated into 12 phage species, and type phages of each species are proposed. Members and possible members of each species are named. Available data on type phages are tabulated including morphology, DNA characteristics and phage protein bands.     

Transitions in American hospitals: the necessary reshaping is taking place. "Turnaround" processes in organizations

American hospitals are reshaping and redefining the way they are managed and the way they provide care. More American healthcare organizations are stating that they are in a turnaround situation. Although there are no definite guidelines or criteria that place an organization in a turnaround situation, there are certain circumstances that are frequently present. These circumstances most often include a somewhat sudden change from a financially favorable situation. This may include revenue lost and/or increases in cost from operations, decreases in volumes that are most positive and favorable to the organization, sudden changes in key management or board representation, and sudden loss of key managers and staff needed for the successful operation of the organization. Any one of these factors or several can place an organization in such jeopardy that quick and decisive actions must be taken to ensure survival and future success. The specific conditions of a turnaround and the effectiveness of quick and decisive actions are critical for the survival of an organization or a system.     

Human fibrinogen

The structure and physical properties of human fibrinogen and fibrin are reviewed along with methods for the detection of products of their metabolism. Interactions of human fibrinogen with thrombin, factor XIII, plasminogen, glycoprotein IIb/IIIa, and other proteins are related to their relevance to thrombosis and hemostasis. To the extent information is available, the structural determinants of these interactions are delineated, and kinetic and thermodynamic parameters associated with the interactions are listed. Individual steps in the reaction pathway for the conversion of fibrinogen to cross-linked fibrin are characterized. The altered hemostatic properties of mutational variants of fibrinogen are related to their altered structure. The structures of the genes coding for the polypeptide chains of fibrinogen are discussed along with the current state of knowledge of the control and regulation of fibrinogen synthesis. Fibrinogen catabolism and fibrinolysis are also reviewed.     

Hypnosis and chronic pain. Two contrasting case studies

Some of the theoretical and technical problems associated with the use of hypnosis for chronic pain are discussed in the context of two similar case studies, one of which had an unsuccessful outcome. Different hypnotic strategies are discussed which depend on a careful, direct evaluation of the role of secondary gain and depression in maintaining the pain in the two patients. Specific hypnotic interventions are described, based on dissociation, imagery and the non-specific components of the hypnotic relationship. Self-hypnotic procedures are described stressing the development of mastery and self-control over pain. Differences in the kinds of hypnotic intervention that are appropriate when secondary gain or depression are central to the pain problem, compared to the more direct techniques available when they are not, are discussed.     

Diagnosis and management of parasomnias

Parasomnias are unpleasant or undesirable behavioral or experiential phenomena that occur predominately or exclusively during sleep. These phenomena were initially thought to represent a unitary event, often attributed to psychiatric disease. Recent clinical and polygraphic analysis has revealed that they are, in fact, the result of a large number of very different conditions, most of which are diagnosable and treatable. In fact, most are not the manifestation of psychiatric disorders, and they are far more prevalent than previously suspected. Although there are many parasomnias (1,2), from a practical standpoint only the few that comprise the overwhelming majority will be discussed in this review. These include disorders of arousal, rapid-eye-movement sleep behavior disorder, nocturnal seizures, and restless legs syndrome. Most parasomnias are readily diagnosable and, more importantly, are treatable.     

Resorbable polyesters: composition, properties, applications

Synthetic polymers, in particular polyesters based on lactic acid, glycolic acid and other raw materials are described for medical and technical applications. Their main advantages are compatibility and safety. As they are degradable in the human body they are particularly suitable for implants needed only temporarily for the healing process. Resorbable polyesters are produced by direct polycondensation or ring opening polymerization resulting in a broad range of polymers with different features. The main properties such as degradation (hydrolytic and thermal), crystallinity and mechanical strengths are discussed. These polyesters, which can be processed like other thermo-plastic polymers by extrusion and injection moulding, are used mainly for wound closure products (sutures, staples, clips), fracture fixation devices (nails, screws, plates) and parenteral depot systems for the sustained release of drugs. Possibilities for polymer and process improvement to develop better implants and additional applications are presented.