^125I放射微粒微创植入治疗前列腺癌

目的观察^125I放射微粒植入对前列腺癌的治疗效果。方法对26例临床确诊为前列腺癌患者经皮穿刺在癌组织植入^125I放射微粒，每例平均36粒，术后复查肛诊、B超、影像学及血生化指标。结果患者植入治疗经过顺利，2例少量出血，留置导尿后愈合，3个月后经肛诊、直肠B超示结节缩小，前列腺特异性抗原（PSA）降低，多普勒超声显示结节内动脉收缩期最大血流速度（VS）、阻力指数（RI）及动脉搏动指数（PI）均明显下降。结论^125I放射微粒植入对前列腺癌的治疗安全性好、效果可靠。     

T cell immunodeficiency in dyskeratosis congenita.

Dyskeratosis congenita has been found to be associated with abnormal immune function. In this study we report a patient with this association. He developed Pneumocystis carinii interstitial pneumonia, and impaired cell mediated immunity was confirmed by the presence of depressed lymphoproliferative responses to in vitro stimulation with mitogen. Enumeration of T cell subsets showed a severely depressed CD4:CD8 ratio (0.38), which is the likely cause for impaired cell mediated immunity. The T cell activation pathway appeared intact, as his T lymphocytes were able to express activation markers (CD25 and HLA-DR) after mitogen stimulation.     

The patient's right to know: some sociological considerations

This is a discussion of the implications of "the right to know" from the perspective of the patient and the physician. Three aspects are explored: Some overlooked premises of the doctor-patient relationship; the assumed benefits of the patient's ignorance; and the link between the right to know and informed consent.     

Bochdalek diaphragmatic hernia presenting with acute gastric dilatation

Congenital diaphragmatic hernia through the foramen of Bochdalek may present after infancy. A 21/2-year-old Malay girl presented with acute respiratory distress. Chest examination showed reduced chest expansion and decreased breath sounds on the left side. Chest radiograph showed a large "cyst" in the left chest, which was thought to be a lung cyst under tension. Tube thoracostomy resulted in clinical improvement. Results of a barium study showed that the cyst perforated by the thoracostomy tube was the stomach, which had herniated through a Bochdalek diaphragmatic defect. Surgical repair of the diaphragmatic defect and closure of the perforated stomach was performed successfully. Congenital diaphragmatic hernia should be included in the differential diagnosis of respiratory distress in young children. Nasogastric tube placement must be considered as an early diagnostic or therapeutic intervention when the diagnosis is suspected.     

MILITANCY TRAUMA : MAXILLOFACIAL INJURY,ANAESTHESIA AND CRITICAL CARE

Eighty four out of 2151 militancy trauma patients sustained severe maxillofacial injury from Jan 1990 to March 1993. The resuscitation, stabilisation and intensive care of these patients was based on management priorities of primary resuscitation, care of airway, management of haemodynamics, oxygenation and monitoring. Anaesthesia was administered in a situation when the airway was likely to be compromised and the patients were critically sick. Initial ventilation and oxygenation was the most difficult and could be achieved with satisfactory seal around the face mask by applying water-soaked guaze pieces around the mouth and nose to “fill-in” the defects. Tracheal intubation could be accomplished with intravenous sedation by an experienced anaesthesiologist. Dental occlusion and wiring necessiated the placement of nasotracheal tube for 48-72 hours after surgery.KEY WORDS: Trauma, Maxillofacial injury, Trauma anesthesia, Anaesthesia and critical care     

Prospective,Randomized Trial Comparing Diathermy Excision and Diathermy Coagulation for Symptomatic,Prolapsed Hemorrhoids

PURPOSE This study was designed to compare diathermy excision and diathermy coagulation in the treatment of symptomatic prolapsed piles.METHODS Forty-five consecutive patients were randomly assigned to diathermy excision hemorrhoidectomy (Group A, n = 25) and diathermy coagulation (Group B, n = 20) under general anesthesia.RESULTS The median duration of surgery was ten minutes for both groups. There was no statistical difference in the severity of postoperative pain at rest between the two groups, but Group A patients felt less pain during defecation on the third postoperative day (median, 5 (interquartile range, 3–7) vs. 8 (4–9); P = 0.04) and on the sixth postoperative day (median, 5 (interquartile range, 2–6) vs. 9 (5–10); P = 0.02). There was, however, no statistical difference in postoperative oral analgesics use and patients satisfaction scores between the two groups. Complication rates were similar except that diathermy coagulation tended to leave some residual skin components of external hemorrhoid especially in very large prolapsed piles. Group A patients resumed work earlier (mean, 12 (range, 4–20) vs. 17 (11–21) days); however, this was not statistically significant (P = 0.1).CONCLUSIONS Diathermy coagulation of hemorrhoids is a simple technique and may be considered in suitable cases.     

Identification of Patients with High-Risk Stage II Colon Cancer for Adjuvant Therapy

Purpose Adjuvant therapy for Stage II colon cancer remains controversial but may be considered for patients with high-risk features. The purpose of this study was to assess the prognostic significance of commonly reported clinicopathologic features of Stage II colon cancer to identify high-risk patients. Methods We analyzed a prospectively maintained database of patients with colon cancer who underwent surgical treatment from 1990 to 2001 at a single specialty center. We identified 448 patients with Stage II colon cancer who had been treated by curative resection alone, without postoperative chemotherapy. Results With median follow-up of 53 months, 5-year disease-specific survival for this cohort was 91 percent. Univariate and multivariate analyses identified three independent features that significantly affected disease-specific survival: tumor Stage T4 (hazard ratio (HR), 2.7; 95 percent confidence interval (CI), 1.1–6.2; P = 0.02), preoperative carcinoembryonic antigen >5 ng/ml (HR, 2.1; 95 percent CI, 1.1–4.1; P = 0.02), and presence of lymphovascular or perineural invasion (HR, 2.1; 95 percent CI, 1–4.4; P = 0.04). Five-year disease-specific survival for patients without any of the above poor prognostic features was 95 percent; five-year disease-specific survival for patients with one of these poor prognostic features was 85 percent; and five-year disease-specific survival for patients with ≥2 poor prognostic features was 57 percent. Conclusions Patients with Stage II colon cancer generally have an excellent prognosis. However, the presence of multiple adverse prognostic factors identifies a high-risk subgroup. Use of commonly reported clinicopathologic features accurately stratifies Stage II colon cancer by disease-specific survival. Those identified as high-risk patients can be considered for adjuvant chemotherapy and/or enrollment in investigational trials. Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007. Reprints are not avaliable.     

显微镜辅助下颈前路椎间盘切除植骨融合术治疗多节段脊髓型颈椎病

目的探讨显微镜辅助下颈前路椎间盘切除植骨融合术(anterior cervical discectomy with fusion,ACDF)治疗多节段脊髓型颈椎病的疗效。方法回顾性分析2011年1月~2012年8月本院行颈前路手术治疗的60例脊髓型颈椎病患者的临床资料,根据手术方式分为常规ACDF组(A组,30例)和显微镜辅助ACDF组(B组,30例)。比较2组的手术时间、术中出血量、住院天数及并发症,以日本骨科学会(Japanese Orthopaedic Association,JOA)评分(17分法)及其改善率评价术后神经功能改善情况。结果 A组手术时间为(132.5±8.9)min,B组为(137.0±9.1)min,差异无统计学意义(P0.05)。A组术中出血量为(113.6±8.0)m L,B组为(93.7±5.3)m L,差异有统计学意义(P0.01)。A组住院(7.37±1.73)d,B组(6.63±1.13)d,差异无统计学意义(P0.05)。A组术前JOA评分为6.60±1.21,术后12个月为13.83±0.91,改善率为(69.72±7.66)%;B组术前JOA评分为6.87±1.46,术后12个月为14.23±1.17,改善率为(72.51±11.26)%。A组和B组改善率差异有统计学意义(P0.05)。结论显微镜辅助ACDF和常规ACDF是治疗多节段脊髓型颈椎病有效的方法,但显微镜辅助ACDF可减少术中出血量,是治疗多节段脊髓型颈椎病优先选择的手术方案。     

Managing vaccines: defining the remit of primary care and specialist HIV clinics in the delivery of immunization to individuals with HIV infection

The British HIV Association (BHIVA) has published guidelines for immunization of HIV-infected adults. A chart review of 200 HIV-infected patients diagnosed was conducted to determine shortcomings in previous practice and determine which vaccines should routinely be given in specialist HIV clinics and which might be able to be delegated to primary care clinics. Data were collected on administration of three categories of vaccinations: (1) vaccines used in all individuals with chronic disease (pneumococcal, influenza, swine flu H1N1); (2) targeted vaccinations used in non-immune individuals with HIV who are at risk of exposure (hepatitis A and hepatitis B); (3) routine vaccines traditionally delivered to the whole population (measles/mumps/rubella [MMR], diphtheria/tetanus/pertussis and meningitis C/ACWY). Pneumococcal vaccine was delivered to 54% of eligible patients, 52% of eligible individuals completed a full hepatitis B programme of vaccination and 21% (42/200) were naturally immune; hepatitis A vaccine was delivered to 36% of eligible individuals. With increasing demands on resources, it seems likely that HIV services will have to harness resources of primary care in vaccine programmes in relation to routine vaccines. By improving communication between primary and secondary care mistakes with live vaccination decisions could be avoided; HIV services should continue to perform targeted and chronic disease vaccines, i.e. for category 1 and category 2 vaccines.     

Comparative effectiveness analysis of amlodipine/renin-Angiotensin system blocker combinations

J Clin Hypertens (Greenwich). 2012; 14:601–610. © 2012 Wiley Periodicals, Inc. A comparative effectiveness analysis of antihypertensive therapy amlodipine (AML) and angiotensin receptor blocker (ARB) fixed‐ and loose‐dose combinations (FDCs and LDCs) in achieving blood pressure (BP) reduction and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) goal attainment was made using retrospective electronic medical record (EMR) data. Treatment goal rates ranged from 35.0% for LDC AML/losartan to 45.7% for FDC AML/olmesartan (OM). FDC AML/OM achieved significantly greater reductions in systolic BP than FDC AML/benazepril (BEN), FDC AML/valsartan (VAL), and LDC AML/ARBs, respectively, and significantly greater reductions in diastolic BP than FDC AML/VAL and LDC therapy, respectively. Compared with patients treated with AML/OM, patients prescribed AML/VAL and LDC AML/ARB were significantly less likely to attain JNC 7 BP goal. Among subpopulations, AML/OM yielded higher rates of goal attainment among both African Americans and obese/overweight patients relative to AML/VAL and combined LDCs. Switchers from monotherapy with AML, OM, or VAL to AML/OM were significantly more likely to attain JNC 7 goals than those switching to AML/VAL or AML/BEN.