早期食管癌的病理形态观察及组织发生学探讨

目的探讨早期食管癌的组织发生学.方法对109例早期食管癌及癌周病变进行病理观察.结果其中20例的一点癌(黄豆大小),3例双原发癌,1例小细胞癌.癌周伴有不同程度的鳞状上皮异形增生和不典型增生.结论早期食管具有多样性生长的特点.提示临床医生在胃镜检查应注意多点取材,以防漏诊;以及正确确定手术范围,防止手术残留.     

Do hospital type or caseload make a difference in chemotherapy treatment patterns for early breast cancer? Results from 104 German institutions, 2008–2017

BackgroundOver the past decade, chemotherapy has been used more selectively in early breast cancer (EBC) due to better risk stratification. Neoadjuvant chemotherapy (NACT) has evolved to the primary treatment option. The type and size of hospitals is known to have a substantial influence on the kinds of treatment they provide, and therefore on patient outcomes (e.g. rates for pathological complete response, pCR), but it is not yet known how this has affected delivery of chemotherapy for EBC in Germany.MethodsThis study analyzed chemotherapy use and pCR rates after NACT for EBC patients treated at 104 German institutions 2008–2017. Institutions were separated into associated hospital type (university hospital; teaching hospital; community hospital) and annual caseload (≤100; 101–250; >250 cases/year).ResultsOverall, 124,084 patients were included, of whom 11.6% were treated at university hospitals, 63.1% at teaching hospitals, and 25.3% at community hospitals. In total, 46,274 (37.3%) received chemotherapy, of whom 44,765 had information available about systemic treatment and surgery. From 2008 to 2017, chemotherapy use declined from 48.3% to 36.4% for university hospitals, from 40.7% to 30.3% for teaching hospitals, and from 42.4% to 33.7% for community hospitals. Furthermore, the proportion of NACT increased the most in university hospitals (from 32.0% to 68.1%); whereas, the rate of pCR (defined as ypT0 ypN0) increased irrespective of institutional type. Analyses regarding annual caseload did not show any differences.ConclusionsThe results from this large, nationwide cohort reflect a more selective use of chemotherapy in Germany, irrespective of institutional type or case load.     

Urinaryα 1 as an index of proximal tubular function in early infancy

Urinary ₁-microglobulin (U-A₁M) was measured in healthy term infants on days 1, 4, 7, 14, 28, 90 and 180 of life. U-A₁M was high until day 14 and declined thereafter. It was significantly correlated with urinary ₂-microglobulin (U-B₂M) throughout the study, but not with serum A₁M on days 1 or 7. Similar to U-B₂M, U-A₁M in the clinically stable term infants with intrauterine growth retardation (n=4–7) was not elevated on days 1–7. In the sick infants who needed immediate resuscitatio at birth (n=4–8), U-A₁M as well as U-B₂M was high on days 1–7 and then decreased to normal levels, suggesting that U-A₁M can be used as a sensitive marker of acute proximal tubular damage and its recovery. These observations indicate that U-A₁M is a useful index of proximal tubular function in early infancy.     

Initial treatment of the early stages (I, II) of supraglottic squamous cell carcinoma: partial laryngectomy versus radiotherapy

The purpose of this study was to define the treatment of choice (partial laryngectomy vs radiotherapy) in the early stage of supraglottic squamous cell cancer (ESSC). One hundred and fifteen patients with ESSC were treated with either partial laryngectomy (25 patients) or with radiotherapy(90 patients) between January 1984 and December 1996. All patients had a follow-up of over ¶29 months. Radiotherapy (RT) had a local control rate of 79%, which increased to 90% with salvage surgery, and a high larynx preservation rate (83%). Partial laryngectomy (PL) offered a better initial local control rate of 84%, which increased to 88% with salvage surgery, and functional results were also good (80%). No statistically significant differences were found between RT and PL. RT was less costly, showed better suitability for treatment, produced moderate morbidity and sequelae, and local recurrence was easier to rescue. However, it is a once-only application technique. PL showed higher immediate postoperative morbidity, higher cost and lower suitability for treatment but had fewer sequelae, offered the best initial local control and is multi-applicable. No clear oncological arguments were found in our series to define whether PL or RT is the treatment of choice for ESSC. Both are effective therapies. Secondary factors such as suitability for treatment, morbidity, cost and applicability should be individually evaluated when choosing the type of treatment. As the laser endoscopic approach decreases morbidity and costs and makes the condition more suitable for treatment, it could be the treatment of choice for ESSC, in cases where local tumoral extent and larynx exposure allow radical excision.     

行为干预及生物反馈治疗对老年高血压患者降压疗效的影响

目的 研究应用行为干预治疗及生物反馈治疗对老年高血压患者降压药物的影响。方法 在应用降压药物的基础上,增加行为干预及生物馈治疗,观察综合性行为干预措施对降压疗效的影响。结果 增加行为干预及生物反馈治疗后,降压和情绪障碍矫正的效果比单用药物明显改善。结论 老年高血压患者给予综合性行为干预措施可增加降压药物的疗效。     

High balloon dilatation pressures in percutaneous transluminal coronary angioplasty are not associated with higher rate of significant complications

To examine the results of high balloon dilatation pressures during percutaneous transluminal coronary angioplasty (PTCA), we retrospectively reviewed 482 angioplasty cases from our institution and divided them into three groups by the peak inflation pressure used during the procedure. Group one was defined by inflation pressures of 1–6 atmospheres (atm), group two by 7–12 atm, and group three by 13–20 atm. There were 166 patients in group 1 (34.4%), 235 in group 2 (48.8%), and 81 (16.8%) in group 3. The success rates were not statistically different; 90% in group 1, 96% in group 2, and 95% in group 3. Large dissections occurred in 27 patients in group 1 (16.3%), 19 in group 2 (8.1%), and 4 (4.9%) in group 3 (P > 0.006). There were no differences in the rates of death (1.2% vs. 0.9% vs. 1.2%), myocardial infarction (3.0% vs. 1.3% vs. 3.7%), or in-hospital CABG (3.0% vs. 1.7% vs. 1.2%) in groups 1, 2, and 3, respectively. Six-mo target vessel revascularization rates also were not different: 19% vs. 13% vs. 18%. In summary, selectively using high balloon pressures during PTCA does not result in increased complications. © 1995 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America.

     

Confrontations with reality: Crisis intervention services for traumatized families after a school bus accident in Norway

In August 1988 a Swedish schoolbus with 23 children and 11 adult passengers crashed into a tunnel wall in Norway. Twelve children and four parents died, 18 of the passengers survived. The victims' relatives (parents, spouses, siblings, and others) were transported to Norway and given a confronting support program at the University hospital in Bergen. The crisis intervention program is described: how the relatives were helped to confront and actively cope with some of the stressful situations from which traumatized families very often are protected. One year later 42 of the relatives answered a questionnaire evaluating the confronting support program that was offered during their stay in Norway. A majority of the respondents did not regret their participation in the program. The answers indicate that passivity and helplessness can be counteracted through a combination of confrontation with reality and emotional support.The study has received financial support from Skandia Insurance Co. (Sweden), Haukeland University Hospital and Norwegian Research Council for Science and the Humanities (377.92/021).     

An experimental model of the production of early after depolarizations by injury current from an ischemic region

An ischemic myocardial region contains cells with a depolarized resting membrane potential. This depolarization leads to an intercellular current flow between the ischemic region and the surrounding normal myocardial cells which has been termed an injury current. We have devised an experimental model system in which an isolated guinea pig ventricular cell is electrically coupled to a model depolarized cell in order to evaluate the effects of this injury current on the electrical properties of a normal ventricular cell exposed to drugs which increase calcium current or decrease potassium current. Using low doses of isoproterenol, forskolin, or Bay K 8644 (or 8-bromo-cyclic adenosine monophosphate in the pipette) we found that the action potential duration of the isolated cell was lengthened, but that early after depolarizations (EADs) were not produced unless the cell was also coupled to a depolarized cell model representing an adjacent ischemic region. A similar prolongation of the action potential was produced by low doses of quinidine, but EADs were not produced unless coupling to a depolarized cell model was added. EADs could not be produced in any cells in the absence of the drugs even though the coupling to the depolarized cell model was increased up to the level at which the action potential was indefinitely prolonged. At higher isoproterenol concentrations, EADs or spontaneous activity were produced without coupling to the depolarized cell model. Under these conditions, coupling of the cell to a cell model with normal resting membrane potential stopped the spontaneous activity and prevented the occurrence of EADs even with high levels of resistive coupling. These findings suggest that the electrotonic influences of a localized depolarized region can produce EADs if the calcium current magnitude is increased, which would be the case for sympathetic innervation.     

睡眠呼吸暂停综合征患者夜间睡眠呼吸参数的变化及护理对策(英文)

目的：探讨睡眠呼吸暂停综合征（ＳＡＳ）患者夜间睡眠呼吸参数的变化及相应护理对策。方法：对１６例ＳＡＳ住院患者在治疗前、睡眠姿势训练、气道持续正压（ＣＰＡＰ）呼吸机治疗三种状态下,进行整夜多导睡眠仪监测。结果：在ＳＡＳ整夜呼吸紊乱中,零点以后其危险因素大大增加,出现严重低氧血症,血压升高,心律失常,尤其是呼吸暂停时间延长,次数增加。而侧卧位可显著地改善低氧血症,最低血氧饱和度（ＳａＯ２）从（６２±１９）％升高至（８３±１１）％（Ｐ＜０．０１）,ＣＰＡＰ呼吸机治疗能使呼吸调节障碍得到明显的恢复,呼吸暂停由（４４．３±２２．６）次降至（０．２５±０．５４）次（Ｐ＜０．０１）。结论：护理上应密切观察病情变化,特别是零点以后应加强巡视,除观察呼吸运动外还应警惕脑血管病及心脏疾病的发生,对不具备ＣＰＡＰ呼吸机治疗条件者宜采取睡眠时督促取侧卧位。对ＳＡＳ患者进行健康教育也是减少危险因素的重要护理措施。