缔造地区卫生文化版图--牡丹江市卫生文化战略管窥

曾经有人对中国近十年的医院发展总结出这么一条法则,即中国医院经营中存在着三种层次:生存、扬名、做文化、其中“做文化”是医院经营的最高境界。对于医院文化,我们早已不陌生。但如果认真了解文化在经济中的作用本质时,就会发现,现在许多医院的所谓“文化”不过是一种形式、一种摆设,与文化治院的最终目的相去甚远。作为主管部门的地方卫生局,如何让“有形的手”发挥作用,以引导、推动医院文化进一步提升?牡丹江市就为我们提供了一个可贵的启示。     

Objective definition and measurement method of ground-glass opacity for planning limited resection in patients with clinical stage IA adenocarcinoma of the lung

Objective: The standard operation for patients with stage IA lung adenocarcinoma is considered to be a lobectomy. Recently, some researchers have reported that patients with tumors showing greater proportions of ground-glass opacity (GGO) at computed tomography (CT) could be candidates for limited resection, because of its less aggressive nature. However, the lack of a precise definition or standard measuring method of GGO prevents its general use as an index for planning limited resection. Therefore, we attempted to define GGO based on CT number and measured it more objectively. Methods: Between 1998 and 2001, 90 patients with clinical stage IA adenocarcinoma, who underwent standard or intentional limited resection and whose images of chest high-resolution CT were preserved in Digital Imaging and Communications in Medicine (DICOM) format, constituted the study population. The tumor shadow seen on the solid window (WL, −160 HU; WW, 2 HU) was regarded as the central solid area of the tumor seen on the lung window, and GGO was defined as the whole tumor area with the exception of the central solid area. Each area was measured using Scion Image (Scion Corp., Frederick, MD). We analyzed the relationship between the proportion of GGO and both of pathologic findings and recurrence. Results: Among the 90 tumors, 31 (34.4%) were calculated to have a GGO area greater than or equal to 50%. Of these, 27 (87%) tumors were bronchioloalveolar carcinoma. Lymphatic and vascular invasions, or nodal involvement were found only in patients with a smaller proportion of GGO (<50%) (P<0.05). During the follow-up period (median 36 months), recurrences occurred in eight patients who were diagnosed as having tumors showing smaller proportion of GGO (<50%). Conclusions: Tumors with a greater proportion of GGO measured by our method are thought to have a less invasive nature. Our objective measuring method of GGO could be useful for future multicenter trials to elucidate the value of limited resection for clinical stage IA adenocarcinoma based on the proportion of GGO.     

Small extra-adrenal pheochromocytoma causing severe hypertension in an elderly patient.

We report the case of a 67-year-old woman with severe hypertension caused by an extra-adrenal pheochromocytoma. The tumor was detected by 131I metaiodobenzylguanidine scintigraphy and it was found to be small (2 cm ?) by enhanced CT. After the extirpation of the tumor, the blood pressure of the patient immediately normalized. It should be taken into account that a small extra-adrenal pheochromocytoma can be one of the causes of secondary hypertension in elderly patients. Since small extra-adrenal pheochromocytomas are difficult to detect, it is also important to perform suitable examinations to establish the diagnosis. Furthermore, we emphasize the importance of an accurate diagnosis in elderly patients with pheochromocytoma, for they often have less symptomatology and more severe cardiovascular complications due to refractory hypertension than younger patients.     

Increase of striatal dopamine turnover by stress in MPTP-treated mice

The characteristics of motor function and brain dopamine (DA) metabolism in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated mice after immersion immobilization stress were investigated. There was no significant difference in locomotor activities between MPTP-treated and saline-treated mice, but locomotor activities of MPTP-treated mice after stress decreased more remarkably than those of saline-treated mice. Immediately after stress, striatal DA concentrations of MPTP-treated mice were significantly lower than those of saline-treated mice. Striatal DA levels improved when 24 h passed after stress. The striatal and cortical (DOPAC + HVA)/DA ratios of MPTP-and stress-treated mice was significantly higher than that of saline-and stress-treated mice. It is due to the decreased DA level and the enhancement of DA turnover that MPTP-treated mice became remarkably akinetic after stress, and that L-DOPA therapy is not effective when the symptoms in patients with Parkinson's disease worsen due to stress.     

Single photon emission computerized tomography in childhood hydrocephalus

Single photon emission computerized tomography (SPECT) is now widely used as one of the tools in evaluating cerebral blood flow (CBF). The authors report the CBF changes in childhood hydrocephalus. Five pediatric cases studied by ¹²³I-IM SPECT in children are presented. The authors counted radioactivities both in early and delayed images in each patient, and calculated the reabsorption ratio (RR). Two negative-RR cases and three positive-RR cases were found. All of the negative-RR patients had a poor prognosis, while all of the positive-RR patients had a favorable outcome.     

In vivo detection by microscopic chromocystoscopy of concurrent urothelial atypia in superficial bladder cancer.

Microendoscopic observation of methylene blue-stained urothelial surfaces, so-called microscopic chromocystoscopy (MCC), was undertaken in 65 patients with superficial bladder cancer (Ta and T1) and its effectiveness in detecting concurrent urothelial dysplasia or carcinoma in situ was studied. A total of 166 biopsy samples were taken from 75 stained and 91 non-stained portions. Of 75 methylene blue-stained areas, 21 were judged to be abnormal (MCC-positive) by microscopic observation. Fourteen of these 21 MCC-positive areas (67%) were proven to be abnormal histologically, while 7 of 54 MCC-negative portions (13%) were histologically abnormal. Only 4 of 91 biopsies (4%) from non-stained mucosa were proven to have urothelial atypia. In per patient figures, 1 or more concurrent field changes were detected in 15 of 65 cases (23%). MCC contributed to the diagnosis in 10 of these 15 patients.     

Apolipoprotein levels in preeclamptic pregnancies]

Lipoprotein is known to increase during pregnancy but the factors responsible for the change have not been established. In addition, the lipoprotein concentration in preeclamptic pregnancy is significantly higher than in normal pregnancy. The apolipoproteins are an important determinant of metabolism and the structure of plasma lipoproteins. In normal pregnancies, non pregnancies and preeclamptic pregnancies the levels of blood apolipoproteins AI, AII, B and E were determined by TIA methods. (1) In normal pregnancies, the concentrations of apolipoproteins AI, AII, B and E were 182.6 +/- 20.9 mg/dl (n = 12, mean +/- S.D.), 33.3 +/- 5.7 mg/dl, 128.6 +/- 20.8 mg/dl, and 6.8 +/- 1.9 mg/dl, respectively. (2) In the pregnancies, the concentrations of apolipoproteins AI, AII, B and E were 135.6 +/- 9.3 mg/dl (n = 5), 30.8 +/- 1.9 mg/dl, 76.0 +/- 19.7 mg/dl, and 4.4 +/- 0.7 mg/dl, respectively. (3) In the preeclamptic pregnancy, the concentrations of apolipoproteins AI, AII, B and E were 181.0 +/- 27.6 mg/dl (n = 22), 33.2 +/- 4.8 mg/dl, 145.7 +/- 41.6 mg/dl and 5.8 +/- 1.4 mg/dl, respectively. The concentration of apolipoprotein B in preeclamptic pregnancy was significantly higher (p less than 0.001) and apolipoprotein E was significantly lower (p less than 0.01) than in normal pregnancies. These data suggest that the measurement of apolipoprotein is useful for the evaluation of preeclamptic pregnancy.     

Maintenance of Androgen-, Glucocorticoid- or Estrogen-responsive Growth in Shionogi Carcinoma 115 Subline Sustained in Castrated Mice with High Dose of Estrogen for 30 Generations (3 Years)

Shionogi carcinoma 115 (SC115), an androgen-dependent mouse mammary tumor, rapidly loses its androgen responsiveness after androgen withdrawal. The growth of this tumor can also be stimulated by high doses of estrogen or glucocorticoid. In the present study, the maintenance of hormone-responsive growth of SC115 tumors with a high dose of estrogen was examined in castrated male mice using an SCI 15 subline obtained by serial transplantations of SCI 15 tumors in estrogen-treated castrated mice for 3 years (30 generations) (subline E₂). Seed tumors from both SC115 and subline E₂ could rapidly grow in castrated mice given daily injections of testosterone propionate (TP), 17β-estradiol (E₂), or dexamethasone (Dex) (100 μg/mouse/day) but not in those given vehicle alone. Although SCI 15 and subline-E₂ tumors grown with TP or Dex showed temporary regression after steroid withdrawal, the tumors grown with E₂ did not show such temporary regression. The TP-, E₂-, or Dex-induced growth of subline-E₂ tumors was almost the same as that of the original SCI 15 tumors. However, responsiveness to androgen, estrogen or glucocorticoid of both tumors disappeared within one passage in steroid-depleted castrated mice. The present findings demonstrate that the loss of responsiveness to androgen as well as to high doses of estrogen or glucocorticoid of SCI 15 tumors can be prevented in castrated mice not only with androgen but also with high doses of estrogen.     

Disinhibition of somatosensory evoked potential recovery in alcoholics

The pathogenesis of cognitive impairment in alcoholics remains unclear. Previous studies suggested that diffuse white matter atrophy is associated with cognitive impairment in alcoholics. To elucidate this issue, the present study evaluated alcoholics with cognitive impairment using the somatosensory evoked potential (SEP) recovery method, which is suitable for detecting subtle dysfunction at the cortical level. Subjects comprised 12 alcoholics with mild cognitive impairment [Mild group: Mini Mental State Examination Score (MMSE), ≥24; mean, 27.9 ± 1.6], 12 alcoholics with moderate to severe cognitive impairment (Moderate group: MMSE score, < 24; mean, 21.0 ± 2.5) and 12 normal subjects (Control group). SEP was recorded from the hand sensory area contralateral to the median nerve stimulated at the wrist. Single-pulse or paired-pulse stimuli at various interstimulus intervals (10–300 ms) were administered. Recovery functions of N9 (a peripheral nerve component), N20, N20-P25 and P25-N33 (cortical components) were studied. N20 recovery curves of both alcoholic groups were less suppressive than those of Controls, and P25-N33 recovery curves of the Moderate group were more excitatory than those of the Mild or Control groups. A disinhibited recovery pattern of N20 indicates subcortical dysfunction, and a disinhibited pattern of P25-N33 would be induced by cortical dysfunction. Therefore, subcortical dysfunction indicated by an abnormal N20 recovery pattern may contribute to the early cognitive impairment of alcoholics, whilst the cortical dysfunction indicated by an abnormal P25-N33 recovery pattern may contribute to the later cognitive impairment of alcoholics.