表浅性膀胱肿瘤的预后

从１９８０年１月至１９９１年１２月，对１２１例表浅性膀胱肿瘤进行回顾性研究，首次手术采用经尿道肿瘤电灼术，电切术或膀胱部分切除术，术后配合膀胱内灌药辅助治疗。其中６０例术后复发（４９．６％），术后１、２、３和５年的无瘤率分别为８６．８％、７６．８％、７３．５％和６８．６％。资料表明，初诊时呈多发者、直径大于１ｃｍ和细胞恶性分级高的肿瘤术后无瘤率分别低于单发者、直径小于１ｃｍ和细胞恶性分级低的肿瘤，有显著性差异（Ｐ＜０．０５）。术后６个月内肿瘤复发者经治疗后肿瘤再次复发的机会高。术后膀胱内灌药可以预防肿瘤复发，以灌注丝裂霉素和卡介苗效果好。     

Radical radiotherapy for T4 carcinoma of the skin of the head and neck: A multivariate analysis

Sixty-seven patients with 68 stage T4 carcinomas of the skin of the head and neck were treated with radical radiotherapy at the University of Florida between October 1964 and November 1989. Thirty-three lesions were previously untreated and 35 were recurrent. Twenty-nine lesions were squamous cell carcinomas, 37 were basal cell carcinomas, and 2 were basosquamous carcinomas. Minimum follow-up was 2 years. The 5-year local control, local control including surgical salvage, and cause-specific survival probabilities were 53%, 74%, and 75%, respectively. Local control rates with radiotherapy alone were poorer in patients with recurrent lesions (41% vs. 67%, p = .07) or bone involvement (40% vs. 62%, p = .08). Results were analyzed by multivariate methods using local control, local control with surgical salvage, and cause-specific survival as endpoints. The parameters analyzed were histology; size of primary lesion; previous treatment (previously untreated vs. recurrent); involvement of bone, nerve, or cartilage; and skeletal muscle invasion. Three important prognostic factors were identified, each predictive of poorer ultimate local control and cause-specific survival rates: (a) bone involvement (p < .01); (b) recurrent lesions (p < .01); and (c) nerve involvement (p < .02). Radiotherapy alone can control advanced carcinomas of the skin of the head and neck, although lesions that have recurred after prior treatment and those with involvement of bone or nerve are associated with a lower likelihood of cure.     

Complete sequence of the RNA genome of human rhinovirus 16, a clinically useful common cold virus belonging to the ICAM-1 receptor group

We report here the complete nucleotide sequence and predicted polyprotein sequence of HeLa cell-adapted human rhinovirus 16 (HRV16). This virus is more suitable than human rhinovirus 14 (HRV14) for clinical studies, and its growth and physical properties are favorable for biochemical and crystallographic analysis. The complete message-sense RNA genome of HRV16 is composed of 7124 bases, not including the poly(A) tail. An open reading frame, extending from base 626 to 7084 predicts a polyprotein containing 2152 amino acid residues. Comparison with other rhinovirus sequences shows HRV16 is much more representative of human rhinoviruses than HRV14. No apparent relationship was found between receptor group and amino acid sequence in VP1, the capsid protein bearing the binding site for the intercullular adhesion molecule-1 (ICAM-1) in both HRV14 and HRV16.Genbank accession number: L24917.     

Video-assisted thoracoscopic wedge resection of solitary pulmonary metastasis from hepatocellular carcinoma

We report a metastatic pulmonary tumor resected by video-assisted thoracoscopic surgery. A 63-year-old female was found to have four nodules of hepatocellular carcinoma (HCC) in January 1991; after non-surgical treatment, the tumors had become necrotic. In June 1992, a new HCC nodule was found. After infusion chemotherapy, it became necrotic. In September 1993, a solitary lung tumor, 2.4 cm in diameter, appeared at the periphery of the right lung. Because the tumor was considered to be a metastatic HCC rather than a primary lung cancer, it was removed by thoracoscopic wedge resection. Although whether metastasectomy contributes to prolongation of survival is still controversial, thoracoscopic pulmonary resection may be indicated for solitary peripheral metastasis, if the primary HCC is well controlled by multidisciplinary treatment.     

Involvement of NMDA and NonNMDA Receptors in Motor Task--related Activity in the Primary and Secondary Cortical Motor Areas of the Monkey

The involvement of the NMDA and non-NMDA receptors in the task-relatedneuronal activity of the primary motor cortex (MI), premotorcortex (PM), supplementary motor area (SMA), and an area rostralto the SMA (pre-SMA) of two monkeys (Macace fuscata) was examinedduring performance of a trained motor task. The selective NMDAantagonist 0-2-amino-5-phosphonovaleric acid (APV) and the non-NMDAantagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) wereiontophoretically applied to motor task-related neurons. A totalof 568 task-related neurons (435 movement related, 83 set related,50 mixed type) were recorded from the MI, PM, SMA, and pre-SMA,and the effects of APV and CNQX were examined in the individualneurons. In many neurons, APV selectively or preferentiallysuppressed the spontaneous discharge rather than movement-relatedactivity. In many neurons, the movement-related activity wasmore selectively or effectively suppressed by CNQX than by APV.However, the set-related activity was affected by both APV endCNQX. The neurons in layers I and II were affected more stronglyby APV end CNQX than those in layers V and VI. No correlationwas found between the magnitude of task-related activity inthe control (no drug application) period and the effectivenessof APV or CNOX. These results indicate that both NMDA and non-NMDAglutamate receptors are involved in motor task-related neuronalactivity of both primary and secondary motor areas, althoughthe contribution of these two receptors to individual neuronalactivity varies a great deal.     

A Psychosociocultural Perspective, Part 2

Building on the foundation of understanding and comprehensive assessment of battered women, this article addresses service planning and intervention. Strategies are approached within the framework of a Crisis Paradigm developed from field research with battered women and their families. They include mechanisms such as support groups which link crisis service to the long-term needs of battered women, and systematic approaches to removing the obstacles which keep women victimized. An Assessment and Service Planning Guide (ASPG) is proposed for inclusion in routine health care of abused women. The article concludes with strategies for preventing violence at interpersonal and societal levels.     

Leadership in action: students learn with resource persons

The faculty maintain close contact with the resource persons and are aware of their interaction with students on a weekly basis. Faculty and resource persons exchange observations, assessments, suggestions and problems they have either anticipated or experienced. The resource persons report that as students gain from the experiences, so do they. In particular, resource persons state interactions with students have stimulated them to increase their own clinical inquiry. A head nurse, functioning as a resource person, recently told the members of the Nursing Curriculum Committee she wished she had had such a course seven years ago when she was a senior in the program (S. Collier, personal communication, October 1987). She further elaborated that the learning opportunities she sees students experiencing today would have been invaluable to her and her peers as they began their professional nursing careers. We, the authors, believe individual learning opportunities with nurse leaders as resource persons is a unique, invaluable experience for nursing leadership students. These interactions provide a variety of learning opportunities sufficient for undergraduate students to develop beginning leadership skills, while also narrowing the education-practice gap. These experiences enhance the students' orientation to "real-world" nursing leadership and management. Students recognize the uniqueness of this teaching-learning strategy and value the time spent with resource persons. They frequently report never dreaming "that such problems have to be dealt with." They agree that learning with resource persons provides an essential ingredient for reinforcing the theoretical concepts of nursing leadership and putting classroom lectures into action.