急性淋巴细胞白血病(上)

急性淋巴细胞白血病是淋巴前体细胞异常引起的恶性疾病,儿童与成人均可能发生。儿童发病高峰2～5岁。有效治疗的稳步进展使本病在儿童中的治愈率80％以上,同时为新的治疗方案提供了良机,新方案将保留我们在白血病无病生存病例中获得的治疗经验,同时减轻当前强化治疗方案中的毒副作用。     

Intramuscular inoculation of Sin Nombre hantavirus cDNAs induces cellular and humoral immune responses in BALB/c mice.

To examine whether genetic immunization with Sin Nombre (SN) hantavirus genes could elicit immune responses, nine fragments spanning the envelope glycoprotein genes G1 and G2, and the complete N gene were cloned into a CMV expression vector. To ensure representation of all potential epitopes, adjacent fragments of the glycoprotein genes overlapped one another by 100 nucleotides. Vectors containing the gene fragments were inoculated intramuscularly into BALB/c mice and splenocyte proliferation and western blot-detectable antibodies and neutralization titers were determined. The N gene and seven of the nine M segment-derived cDNAs tested produced significant specific lymphoproliferative responses, and many of the constructs elicited either neutralizing or western blot-detectable antibodies. These promising results encourage the development of infection models for SN virus that will be capable of detecting protective responses.     

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.     

Evaluating the effectiveness of neonatal intensive care. What can the literature tell us?

This article reviews the characteristics of 69 clinical research studies of the effectiveness of neonatal intensive care (NIC). Emphasis is on the availability of important information in the studies, and on their scientific quality. The analysis suggests that these studies cannot answer several of the most important questions about the usefulness of NIC, because of poor study design or implementation. Guidelines for assessing the usefulness of existing studies and suggestions for future research are provided.     

Hysteroscopic endomyometrial resection.

OBJECTIVE: To determine the efficacy of hysteroscopic endomyometrial resection in treating women with intractable uterine bleeding. METHODS: A retrospective analysis was carried out on 304 women with intractable uterine bleeding treated between August 1, 1991, and December 31, 1997. The average patient was 41.3 +/- 8.0 years old and was followed for a mean of 31.8 +/- 22.1 months (range 6-75 months). RESULTS: Eighty-three percent of women were amenorrheic at the time of their one-year follow-up. The overall amenorrhea rate was 85.5%. Only 0.8% of subjects reported no improvement during the study period. Histologic analysis of the endomyometrial specimens revealed that 17 (5.6%) women were found to have significant endometrial pathology not previously identified with routine preoperative screening. There was a total of 20 complications (6.6%), although only 2 (0.7%) were considered severe. Twenty-seven women (8.9%) eventually required subsequent surgery during the study period. Finally, 69 (22.7%) women with adenomyosis were identified. They did not appear to be at increased risk for subsequent surgery. CONCLUSIONS: Hysteroscopic endomyometrial resection produces superior results as measured by amenorrhea rates, the need for subsequent surgery and its low incidence of associated complications; and it produces an important histologic specimen. For patients with significant comorbidity, endomyometrial resection can be adapted to a single-stage procedure incorporating the diagnostic and treatment phases in women with abnormal uterine bleeding.     

Psychological functioning in a cohort of gay men at risk for AIDS. A three-year descriptive study

This study describes the mental health of a large cohort of gay men participating in the Chicago Multicenter AIDS Cohort Study/Coping and Change Study. Six biannual questionnaires were self-administered between 1984 and 1988. General mental health was determined by the Hopkins Symptom Checklist (HSCL). An abbreviated version of the Center for Epidemiologic Study Depression Scale (CESD-5) and an adapted Diagnostic Interview Schedule (DIS) question also measured depression. Suicidal ideation was assessed by one question in the HSCL. AIDS-specific distress was determined by three subscales specifically developed for this study. While mean HSCL and CESD-5 scores were stable during the observational period, AIDS-specific distress increased over time. The HSCL scores for the cohort were somewhat elevated above general population norms but considerably below psychiatric outpatient norms. Fewer than 12% of the men reported elevated HSCL or CESD-5 scores three or more times. A self-reported episode of depression of two weeks or more, measured by the DIS screening question, was experienced by 40.1% of the sample. Suicidal ideation was reported on three or more visits by 18.8% of the men. The younger members of this cohort exhibit greater general and AIDS-specific distress. Income was inversely associated with general distress. HIV-seropositive participants had generally higher AIDS-specific distress scores than those who were seronegative, but their scores were equivalent on the HSCL and CESD-5.     

Psychotropic medication in adolescents: a review

All published articles of double-blind, controlled studies of drug treatment of mental disorders in adolescents are reviewed. The evidence for efficacy ranges from suggestive to nonexistent, without any match of drug and disorder showing definitive evidence, either because of the limited number of studies available or because these studies have less than clear findings. Special considerations in the study of adolescent psychopharmacology are addressed, and a practical approach to drug treatment making the best use of the limited information available is offered.