慢性胰腺炎的内镜治疗

慢性胰腺炎(CP)是一种进行性、不可逆性炎症疾病,可引起慢性腹痛、营养不良及其他并发症,药物、内镜、外科手术的治疗均很重要。内镜治疗可运用包括胰管括约肌切开术、支架置入、狭窄扩张、ESWL、取石、囊肿引流和超声内镜引导下的治疗等多种方法,为药物治疗失败及不适合外科手术的患者提供了治疗手段。本文对内镜治疗CP所致胆胰管结石及狭窄、胰漏、胰腺假性囊肿的效果进行了综述,对EUS引导下腹腔神经丛阻滞术治疗胰性疼痛也进行了讨论。     

300例异位妊娠的疗法分析

目的探讨异位妊娠的疗法分析。方法回顾性分析300例异位妊娠患者的诊治情况。结果 300例异位妊娠中采用非手术治疗65例,成功51例,成功率78.46%,失败14例;手术治疗249例,成功率100%。经病史、症状、体征、超声及血人绒毛膜促性腺激素检查来综合确定,手术病例均经病理证实,诊断符合率达100%。结论在目前的医疗条件,患者就诊及时,除少数需剖腹手术治疗外,绝大多数采用非手术治疗及熟练的腹腔镜手术治疗,效果良好。     

老年人肝内胆汁瘤6例治疗体会

目的 探讨老年人胆汁瘤的治疗方法及其效果.方法 患者共6例,术中均将相通胆管关闭后,行囊肿开窗引流术.结果 6例患者均痊愈出院,随访无复发.结论 将相通胆管关闭后行囊肿开窗引流术是治疗部分老年人胆汁瘤的一种安全有效的方法.     

多囊卵巢综合征诊断与治疗的新进展

多囊卵巢综合征(PCOS)的发病机制目前仍不完全清楚,临床主要表现为月经失调、排卵障碍、肥胖等。该病的诊断标准尚存争议,大多认为鹿特丹准则比较适用于我国PCOS的诊断。治疗方法也繁多各异,包括非手术治疗(调整月经周期、促排卵治疗、应用胰岛素增敏剂和他汀类药物)、手术治疗(卵巢楔形切除术、经阴道超声引导的卵巢间质水凝术)和中西医结合治疗。     

Reducing Psychological Distress in Patients with Inflammatory Bowel Disease by Cognitive-Behavioural Treatment: Exploratory Study of Effectiveness

Background: This prospective study aimed to determine whether cognitive-behavioural group treatment accompanying medical standard care is effective in reducing psychological distress in patients with inflammatory bowel disease. Methods: Twenty-eight outpatients with Crohn disease or ulcerative colitis completed the treatment programme. Psychological treatment consisting of 12 weekly sessions was conducted in a group setting. Medical and psychometric assessments were taken at the beginning of the 3-month pretreatment waiting period, at pretreatment, at post-treatment and at the 3, 6 and 9-month follow-ups. Results: During baseline, no change was observed in psychological distress. Disease-related worries and concerns decreased significantly from pretreatment to the follow-ups. The disease groups differed in the decline of concerns between pre- and post-treatment, with a significant reduction of concerns in patients with ulcerative colitis but not Crohn disease. This difference did not occur at the follow-ups, indicating long-term improvement for both disease groups. Depressive coping decreased significantly in women and remained stable at the follow-ups, whereas depressive coping did not change in men. The same gender difference was found for depressive symptoms. Conclusions: The exploratory findings suggest that psychological group treatment for outpatients is a feasible and effective approach for the short- and long-term reduction of psychological distress for patients with inflammatory bowel disease. However, the revealed gender differences on coping and depression might indicate the necessity to consider gender-specific aspects of inflammatory bowel disease when designing and evaluating psychological interventions.     

Locomotor Behavioral Response of Mosquitofish (Gambusia affinis) to Subacute Mercury Stress Monitored by Video Tracking System

Locomotor behavior is commonly affected by contaminants, and the pattern of fish swimming is a highly organized species-specific response. In the current study, we examined the locomotor behavioral response of the mosquitofish, Gambusia affinis, which was exposed to a sublethal concentration (LC₅, 20 μg/L) of mercuric chloride (HgCl₂) for 28 days and monitored using a computer vision system. The EthoVision video tracking system for automation of behavioral studies at regular intervals revealed abnormal locomotor behavior such as reduction in swimming speed (cm/s) and distance traveled per unit time. The effects of this metal on the gill morphology and bioaccumulation in different body parts were also investigated. High-resolution microscopy studies revealed abnormal gill morphology, with fusion of primary lamellae along with deep lesions and erosions in the secondary lamellae. The bioaccumulation concentrations in head, body, and viscera were determined by cold vapor atomic absorption spectrometric technique at regular intervals. The results indicated that the accumulation of mercury was the highest in viscera followed by head and body, with bioconcentration factors (BCFs) of 3.99, 2.18, and 1.57 and uptake rate constants (k₁) of 17.91, 11.02, and 8.13, respectively. These observations indicate that alterations in fish behavior under subacute stress can provide important information useful in predicting the stress.     

The Herniated Thoracic Disc: A Review of Literature

Abstract

This literature review discusses the epidemiology and etiology of thoracic disc lesions and describes signs and symptoms, diagnostic procedures, differential diagnosis, and treatment. Data presented in case series reports published between 1985-2001 is summarized: Thoracic disc herniations are more common than previously thought. They may cause mild, moderate, severe or confusing symptoms or be asymptomatic; 49% of cases were in men and 51% in women. Trauma was a precipitating factor in 31%; multiple herniations were reported in 9%. In symptomatic cases, 57% of patients presented with radicular pain, 48% with back pain, 63% with weakness, 60% with sensory complaints, 25% with bowel or bladder symptoms, and 59% with hyperreflexia. Typical presentations of upper, middle, and lower thoracic disc are summarized. Diagnosis is made by correlating clinical signs and symptoms with the results of diagnostic imaging. Surgery is recommended for patients with progressive neurological dysfunction. Research on the efficacy of conservative treatment is lacking in the literature.     

Leaping in the Dark

The paper describes some of the pathology of seriously disturbed young people. It implies that the residential setting can be designed to accomplish psychotherapy, to which those people would usually be too resistant. Its primary discussion concerns the problem of how changes to the comrnunity-especially changes of leadership-affect the youngsters once they have become necessarily dependent on it. It suggests that the staff group has an essential transitional task, which is to maintain contact wth the residents' emotional world and to withstand the youngsters' increased testing out of the staff's reliability. It describes how dificult it is for staff not to get emotionally embroiled in the residents' issues and how essential good consultancy is to help the staff maintain their professional focus. The paper is optimistic though it emphasises how stessful such changes are.