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Many studies have shown that psychophysiological parameters of processing emotional stimuli are associated with different personality traits in children, adolescents, and adults. Individuals with low autonomic baseline arousal, low orienting reaction, accelerated habituation, and reduced excitability particularly to punishing stimuli are characterised by a reduced experience of anxiety, decreased behaviour inhibition, and increased sensation seeking. These characteristics seem to raise the likelihood of dis-social behavior and are perceived as prognostically favourable for the development of antisocial personality disorders in childhood and adolescence. In contrast, an increased disposition towards anxiety, which is associated with increased autonomic reactivity, is recognised as a protective factor. Current data have shown that through special training, child and adolescent autonomic reactivity could be enhanced. Due to its versatility, this biological marker might be used for prevention in children at greater risk of developing antisocial behaviour.     

Cutaneous T-cell lymphoma treated with electron beam irradiation in Indian patients

BACKGROUND: Cutaneous T-cell lymphoma (CTCL) is a rare occurrence in India. Total skin electron irradiation (TSEI) is a well-accepted therapeutic modality for the treatment of CTCL throughout the world. The aim of this study was to retrospectively analyze the treatment outcome of TSEI in Indian patients with CTCL and to determine the different parameters affecting the disease-free survival in these patients. METHODS: Fourteen male patients between 27 and 82 years of age with CTCL (duration of disease, 4 months to 2 years) were treated with TSEI between 1985 and 1998. Seven patients had early stage disease, while the other seven had advanced disease. Two patients had lymph node involvement at the time of presentation. The TSEI was performed according to the Stanford technique delivering a total dose in the range 8-36 Gy. RESULTS: Of the 14 patients, 10 showed complete remission following TSEI. The total follow-up period was 4-110 months (median, 52 months). Five patients were disease free at the end of 5 years. Two patients died due to rapid progression of the disease, while the cutaneous lesions relapsed in three patients after 2-27 months and one patient developed visceral metastasis. CONCLUSIONS: TSEI was an effective therapeutic modality for the treatment of CTCL in this group of patients, both as a curative and palliative measure, although the long-term prognosis is poor.     

ST段抬高心肌梗死（STEMI）的治疗：美国及欧洲更新指南的比较（2）

7抗凝剂——再灌注疗法的辅助疗法更新的指南根据许多新的临床试验的结果,对4种新的抗凝剂提出了新的临床应用建议,见表2,有3项重要的临床试验：EXTRACT—TIMI25,OASIS-6以及CREATE证实,进行纤溶疗法的患者应用新的抗凝剂可以降低死亡率或MI的发生率。     

The FcRgamma chain is not essential for induction of experimental allergic encephalomyelitis (EAE) or anti-myelin antibody-mediated exacerbation of EAE

Macrophages are considered essential mediators in multiple sclerosis (MS) pathogenesis, presumably through myelin phagocytosis and release of inflammatory mediators. Macrophages and microglia express activating Fcgamma receptors (FcgammaRI and FcgammaRIII), which depend on the FcRgamma chain for surface expression and signaling. In MS lesions, crosslinking of FcgammaR by immunoglobulins (IgG) directed against myelin may enhance myelin phagocytosis and inflammation. We studied the role of FcgammaR and anti-myelin antibodies in MOG35-55-induced experimental allergic encephalomyelitis (EAE) in C57BL/6 mice, a model of MS-like disease. Incidence and severity of EAE were similar in FcRy chain-/- (FcRgamma-/-) and wild-type (wt) mice, albeit with delayed onset in FcRgamma-/- mice. This demonstrates that the FcRy chain is not essential for induction of EAE, but that FcRgamma signaling may contribute to the preclinical phase. The role of FcgammaR in antibody-mediated demyelination was addressed by injection of anti-myelin antibodies (Z12 mAb) at onset of MOG35-55-induced EAE. Injection of Z12 mAb rapidly reduced survival time in both wt and FcRgamma-/- mice, demonstrating that antibody-mediated exacerbation of EAE is independent of the FcRgamma chain. Interestingly, Z12-induced exacerbation of inflammation and demyelination persisted longer in wt than FcRgamma-/- mice, suggesting that IgG-FcgammaR interactions may contribute to a sustained pathologic effect of anti-myelin antibodies in the CNS.     

Temporal relationship between cancers of the lung and upper aerodigestive tract

We retrospectively reviewed the chart records at the Veterans General Hospital-Taipei for the period between January 1985 and December 1994 to examine the temporal relationship between cancers of the lung and upper aerodigestive tract. A total of 56 patients (54 males, 2 females) with histocytologically proven double primary cancers, with either lung cancer or upper aerodigestive tract cancers appearing first, were found. Squamous cell carcinoma was the most frequent histologic type of lung cancer (squamous 57%, adenocarcinoma 27%, poorly differentiated carcinoma 9%, small cell lung cancer 7%). The incidence of lung cancer patients with upper aerodigestive tract cancer was 0.9% (56/6412). There was no significant difference in the occurrence of upper aerodigestive tract cancer between non-small cell and small cell lung cancer (P > 0.05). However, the incidence of squamous cell lung cancer with upper aerodigestive tract cancer was higher than that of non-squamous cell lung cancer (P < 0.05). With regard to the location of lung cancer, the right lung was more commonly affected than the left (P < 0.001). The locations of upper aerodigestive tract cancers in these lung cancer patients were as follows: larynx 24, nasopharynx 11, esophagus 10, hypopharynx 4, pharyngeal tonsils 2, oral cavity 5. Most upper aerodigestive tract cancers were diagnosed before lung cancer (36/56, 64%), and lung cancer was diagnosed within 3 years in more than half of cases after the diagnosis of upper aerodigestive tract cancer (58.3%). Most lung cancers that preceded upper aerodigestive tract cancer were at an early stage at diagnosis (stage I 4, stage Illa 1), whereas the others, appearing either synchronously or after the diagnosis of upper aerodigestive tract cancer, were mostly at the late stage. There was no difference in survival between lung cancer patients with upper aerodigestive tract cancer and those without (P > 0.05).      

The failed thoracocentesis

How often do we consider a differential diagnosis of diaphragmatic hernia in cases of failed thoracocentesis? How many of us remember that omental fat in the chest can behave in a fluid manner, layering along the chest wall, resulting in the misinterpretation of a decubitus view. A case is presented of a diaphragmatic hernia that was missed on conventional chest radiographs resulting in CT having to be performed. A high degree of suspicion is mandatory to reach the final diagnosis. Radiographs could be used more effectively and CT avoided.     

Use of routine computed tomography brain scanning of psychiatry patients*

The aim of this study was to evaluate the usefulness of CT of the brain in patients presenting with a psychiatric condition without focal neurological signs. The reports of 397 consecutive CT brain scans of patients presenting to two acute tertiary hospital psychiatric services over a 2‐year period were assessed retrospectively. Of the 397 patients, 241 had psychosis, 87 had depression, 44 had bipolar affective disorder, seven had alcohol dependence, five had dementia, and the remaining 13 had a variety of diagnoses including personality disorder and transient ischaemic attack. Findings on 377 (95%) of the CT scans showed no abnormality. Specific abnormalities were described in 20 (5%) of the CT scans. Three scans showed non‐specific minor abnormalities, which, when followed up by MRI, showed no relevant abnormality. All the abnormalities shown on CT were considered to be clinically unrelated to the patient's psychiatric condition. In conclusion, the pretest probability of finding a space‐occupying lesion or other pertinent abnormality in patients presenting with psychiatric illnesses in this retrospective study appears not to be greater than that of the general population. The outcome of this study could be implemented to develop a clinical pathway for limiting assessment by CT for possible organic pathology in acute psychiatric illness.