Cancer, emotional responses and cognitive behavioural psychotherapy

Cancer and its treatment is known to have a substantial psychological morbidity and, while adjuvant psychological therapy (APT) is well established, relatively little work has been done to investigate the effectiveness of psychotherapy, particularly cognitive behaviour therapy (CBT), for patients with cancer.
This article focuses initially on emotional responses to the diagnosis of cancer, individual vulnerability and the prevalence of psychological problems in patients with cancer. The use of cognitive behaviour therapy is then described, together with key issues in its application and specific problems. The work concludes by considering differences in applying CBT to patients with cancer compared to patients with other physical illnesses and the notion of 'relapse inoculation'.     

彩超对尿路结石彩带形成的原理和诊断价值的探讨

目的：探索尿路结石彩带形成的原理及其对诊断的价值。方法：离体猪输尿管内小石块、单独小石块和压舌板用彩超检测，结合病例分析研究。结果：轻震水中有小石块的猪输尿管，可见小石面上出现彩图，静置数分钟后，彩图逐渐消失；独用小石块、压舌板实验，它们的近场或远场可出现彩带。在没有完全梗阻的人体输尿管口结石的彩超图中，间歇性地先见结石远场出现彩带，接着输尿管口喷出红色的尿流。结论：尿路内结石的彩带，是由于结石受外力震动，石与探头相对运动形成的彩色多普勒效应图，因回声混响构成的。彩带的出现，有助尿路结石的诊断。     

Focal segmental necrotizing glomerulonephritis in rheumatoid arthritis

We report ten patients with rheumatoid arthritis (RA) who developed a focal segmental necrotizing glomerulonephritis (FSNGN) and extracapillary proliferation typical of vasculitic glomerulonephritis. Five patients also had extrarenal vasculitis. Renal presentation was with renal impairment (n = 9) (median creatinine 726 mumol/l, range 230- 1592 mumol/l), microscopic haematuria (n = 8) and proteinuria (n = 10). Nine patients were seropositive for rheumatoid factor and nine had bone erosions. Serum from four of five patients tested by indirect immunofluorescence was positive for antineutrophil cytoplasmic antibody (ANCA) with perinuclear staining. Only three patients had penicillamine or gold therapy. Treatment was with prednisolone and cyclophosphamide (six patients, two of whom were also plasma-exchanged), prednisolone and azathioprine (two patients) and prednisolone alone (two patients). There was a marked improvement in renal function in eight patients. Two patients with dialysis-dependent renal failure recovered renal function, although in one patient this was transient and she required further dialysis 4 months later. Two other patients progressed to dialysis at 3 months and 1 year respectively. Four patients died, one remains dialysis-dependent, and four continue to have good renal function at 5 year follow-up (median creatinine 148.5 mumol/l, range 120-193 mumol/l). One patient was lost to follow-up at 5 years. FSNGN should be considered in all patients with RA and renal impairment, proteinuria and/or microscopic haematuria. This diagnosis appears to be more likely in patients with clinical extrarenal vasculitis, bone erosions or who are seropositive. In these cases, an urgent renal biopsy is indicated.      

Ineffectiveness of neurokinin-1 antagonist in acute migraine: a crossover study

Lanepitant is a high-affinity selective neurokinin⁻¹ receptor (NK-1) and is effective in the dural inflammation model of acute migraine. Lanepitant 30, 80, and 240 mg given orally was evaluated in a double-blind, placebo-controlled crossover study to determine its effect in reducing migraine pain and severity of associated symptoms. Outpatients treated four migraine headaches of moderate or severe pain intensity with study drug according to a randomization schedule. They recorded their pain intensity and severity of migraine-associated symptoms at 30, 60, 90, and 120 min. Although 53 patients were randomly allocated to a treatment sequence, only 40 patients , completed all treatments. There was no statistically significant difference in improvement in migraine pain at any time for any of the treatments. Additionally, there was no change in severity of migraine associated symptoms associated with lanepitant therapy. No adverse events could be attributed to lanepitant Lanepitant was ineffective orally in treating acute migraine in this trial. This may be due to poor bioavailability during a migraine attack. Alternatively, the neurogenic inflammation hypothesis may not apply to migraine.