伽玛刀治疗听神经瘤(附98例分析)

目的 评价伽玛刀治疗听神经的效果。方法 应用OUR旋转式伽玛刀治疗听神经98例。肿瘤直径512～29．7min．平均18.8mm。采用多个放射中心联合照射，周边等剂量曲线为45％-70％，边缘剂量10-13Gy。结果 81例获14。84个月随访，平均39个月。MRI示41例（50．6％）肿瘤缩小，38例（46.9％）无变化，2例（2．5％）增大；25例（30.9％）肿瘤中心失增强。无面瘫和面部麻木，听力保留率59.2％。结论 伽玛刀对听神经瘤有较高的肿瘤控制率，并能保留有用听力，对面神经、三又神经损伤小，是小至中等大小听神经瘤可供选择的治疗方法，及术后残余和复发肿瘤的重要辅助治疗手段。     

背根神经节内P物质、降钙素基因相关肽免疫阳性神经元与阴茎包皮系带感觉信息的传递

目的：探讨背根神经节（DRG）内P物质（SP）、降钙素基因相关肽（CGRP）免疫阳性神经元与阴茎包皮系带感觉信息传递之问的关系。方法：通过荧光金（FG）逆行标记对大鼠阴茎包皮系带内神经末梢的来源作追踪定位，并结合SP、CGRP免疫荧光标记法，研究大鼠DRG内FG标记阳性神经元中SP、CGRP免疫阳性神经元的形态和分布。结果：FG逆行标记结果发现，大鼠阴茎包皮系带内的神经末梢起源于第6腰髓对应的背根神经节（L6-DRG）和第1骶髓对应的背根神经节（S1-DRG）的神经元。对这些神经元分别作SP、CGRP免疫荧光标记后发现，标记细胞大小不等，分别呈深红色和深绿色，沿神经束成行排列或散在分布。FG／SP、FG／CGRP双标记阳性细胞均为中小型，其数量分别占FG逆行标记阳性细胞总数的1／3和1／2，FG／SP／CGRP三标记阳性细胞占FG逆行标记阳性细胞总数的1／5。结论：大鼠L6-DRG和S1-DRG内的SP、CGRP免疫阳性神经元可能参与阴茎包皮系带感觉信息的传递。     

准分子激光原位角膜磨镶术患者主客观因素与疗效的相关性分析

目的：通过对准分子激光原位角膜磨镶术(LASIK)患者主客观因素与疗效的相关性分析，了解临床影响术后视力的主观、客观因素。方法：对2002年间在我院行ASIK的164例患者325只眼(其中3例为单眼)进行连续性临床观察研究，分别进行术前、术后问卷式主客观因素调查，并对患者手术疗效进行相关性统计学分析。结果：患者术前对手术效果的期望值、手术中疼痛程度与手术后视力有显著相关性。结论：解除患者术前忧虑及避免术中疼痛对提高术后疗效有重要意义。     

Psychiatric considerations in pulmonary disease.

Lung disease is a prominent cause of morbidity and mortality worldwide. When a patient has a common lung disease, such as asthma, or a less prevalent one, such as idiopathic pulmonary fibrosis, psychiatric issues should be considered as an integral part of the care plan for each patient. There have been many studies of psychologic factors and psychiatric syndromes in various lung diseases and their treatment. In this article, the authors focus on an evidence-based approach to reviewing this clinical literature.     

Respiratory problems in children with neurological impairment.

Children with severe neurological impairment have a high incidence of respiratory problems which are multifactorial and may be related to or dependent on the underlying disability. In addition, common respiratory conditions such as asthma will be represented in this group as in the general paediatric population. In order to maximise quality of life and reduce morbidity and mortality, each child should be carefully assessed and treated, making adjustments where necessary in the treatment regime to take account of the disability.     

Glatiramer acetate in the treatment of multiple sclerosis

Glatiramer acetate is an immunomodulating drug used in the treatment of multiple sclerosis. It consists of a copolymer of amino acid residues in the same stoichiometric proportions as in myelin basic protein. Its mechanism of action is not entirely known and is probably multifaceted, with deletion of some immune cell populations and stimulation of others in these patients. Some mechanisms involve neuroprotectant effects. There is ample evidence of its efficacy in relapsing-remitting disease, using both clinical and imaging measures of disease activity, and in this paper we review the clinical and basic studies of this drug. Finally we discuss how some of its neuroprotectant effects may be useful in neurodegeneration such as is seen in more advanced cases of multiple sclerosis and other diseases such as amyotrophic lateral sclerosis and Parkinson’s disease.     

去除外膜的外周神经移植对大鼠脊髓损伤的影响

目的检测大鼠脊髓损伤经显微外科技术处理的自体外周神经移植后神经纤维的再通及后肢功能恢复情况。方法利用改良Allen撞击方法建立脊髓打击损伤模型，12周后，将大鼠分为2组，实验组切取后肢腓肠神经，利用显微外科技术去除神经外膜，将其修剪成小段，游离移植于脊髓损伤处，对照组仅显露脊髓损伤段，不作神经移植。分三个时相点（1、2、3个月）进行辣根过氧化物酶（HRP）逆行示踪，并观察损伤移植处的形态学变化及大鼠后肢运动功能恢复情况。结果损伤移植处脊髓的形态学明显好转；损伤移植处上段脊髓中，移植1个月组有HRP阳性标记物，以后逐渐增多；移植组大鼠后肢运动功能明显恢复。结论经显微外科技术预处理外周神经组织移植后可促进大鼠脊髓结构和功能的恢复。     

Suicide risk and symptom reduction in patients assigned to placebo in duloxetine and escitalopram clinical trials: analysis of the FDA summary basis of approval reports.

BACKGROUND: We assessed suicide and suicide attempt risk as well as symptom reduction among 3,282 depressed patients participating in duloxetine and escitalopram clinical trials assigned to either an antidepressant or placebo. METHODS: We reviewed the FDA Summary Basis of Approval reports for data regarding safety and efficacy for duloxetine and escitalopram. Furthermore, we compared suicide risk among antidepressant clinical trials in this study with our two previous analyses on seven antidepressant clinical trials. RESULTS: Suicide and suicide attempt risk varied considerably among the three analyses, showing up to ten fold differences. Interestingly, the variability exists across the three reports, rather than between treatments (antidepressants versus placebo). CONCLUSIONS: These findings suggest caution in generalizing suicide risk even from a relatively large number of participants and thus, firm conclusions can only be drawn if the number of participants is overwhelmingly large (approximately two million patients). We also noted similar magnitude of response to placebo and antidepressants among the three studies.     

Spilled Gallstones: the Source of an Enigma

Spillage of gallstones may occur in the course of laparoscopic cholecystectomy. The incidence of this mishap and its consequences are variable. Ignored by many surgeons, stone spillage may be the source of significant morbidity many years after surgery. In this report, we describe the clinical course of a patient who presented with upper abdominal pain and swelling. The past history was positive for laparoscopic cholecystectomy 15 years earlier. After excision, the swelling was found to be a pseudocyst formed around spilled gallstones during a previous cholecystectomy. Apart from postoperative wound infection, the patient recovered well and remains so. Here, we discuss the problem and provide suggestions for spillage prevention and stone retrieval once spillage occurs.