The Monster in Between: Working with Couples in Intensive Group Treatment

ABSTRACT

In this article we elaborate on an inpatient clinical group program for couples suffering from nonpsychotic psychiatric disorders, personality disorders, and/or complex partner relational problems. In general, one of the partners has a long history in mental health care. The intervention history often includes at least some sessions of couple therapy but without sufficient success. These couples are part of that group of mental health patients that can be described as, or describe themselves as, “everything was done but nothing really helped.” The clinical inpatient couple group program was initiated in 1991 and to date (February 2004) 415 couples have been treated in 91 groups. Although our Center for Relational Problems is situated in a rural area in the northern part of the Netherlands, these couples are referred from all over the country. This proves that there is a need for highly intensive couple treatment in an inpatient setting. Nevertheless, as far as we know, this type of treatment does not exist anywhere else in the world. In this article we give details of the program and the rationale behind it.     

枕正中入路相关静脉的显微解剖及其临床意义

目的对枕下后正中入路相关静脉的显微解剖研究为临床在后颅窝病变手术中减少静脉损伤和减轻术后并发症提供形态学依据。方法利用20具成人尸头标本,动、静脉分别用红蓝色乳胶灌注,在显微镜下模拟枕下后正中入路,观察与此入路密切相关的静脉及其的属支,并对其进行统计和测量相关的数据。结果小脑下蚓静脉和小脑半球下静脉出现率100.0%,小脑延髓裂静脉出现率87.5%,小脑下脚静脉出现率77.5%,延髓后正中静脉出现率55.0%,小脑延髓池静脉出现率35.0%。结论枕下后正中入路相关静脉及其属支的构成复杂,变异大,提高对静脉显微解剖学的认识,可减少术中不必要的出血和降低术后并发症的发生。     

儿科专业护生在病房实习中教学程序改革的初探

随着护理学的发展和医学模式的转变,把当今以疾病为中心的功能制护理转变为以病人身心健康为中心的系统化整体护理已成为护理工作的目标。我们儿童医院护校自1993年开始在护生毕业实习中安排功能制护理和系统化整体护理两种护理模式,采用这种新的教学程序,使护生毕业后既能熟练掌握各种护理技能,又能在临床工作中开展系统化整体护理,使我国的护理水平尽快与世界接轨。     

Nasopharyngeal angiofibroma: staging and management - a review of the case series report

Juvenile angiofibroma is a rare, highly vascular, histologically benign but locally invasive tumor, affecting predominantly male adolescents. Here we present a case series of 45 patients of nasopharyngeal angiofibroma, their clinical presentation, staging and the various surgical approaches for their excision.     

内镜辅助的眶上锁孔人路显微手术切除鞍区病变（附52例报告）

目的总结内镜辅助的眶上锁孔入路显微手术切除鞍区病变的经验、手术方法与技巧。方法对52例鞍区病变均采用内镜辅助的眶上锁孔入路显微手术切除。此52例鞍区病变中，垂体腺瘤22例，颅咽管瘤8例，脑膜瘤7例及前循环不同类型动脉瘤15例。结果37例鞍区肿瘤中，肿瘤全切除31例（83．8％，31／37），次全切除或部分切除6例（16．2％，6／37）。15例动脉瘤均准确完全夹闭瘤颈，预后优良者13例（86．7％13／15）和轻残2例（1313％，2／15）。全组病人无手术死亡及重残，且术前原有症状在术后均有明显不同程度的好转。结论内镜辅助的眶上锁孔入路显微手术能清楚显露鞍区病变与周围结构，创伤小，避免了重要结构的损伤，术后并发症少，效果好。     

用改良翼点、颅颧或颅眶颧入路显微手术切除大型及巨大型蝶骨嵴内侧脑膜瘤

目的 :研究探讨改良翼点、颅颧或颅眶颧入路显微手术切除大型及巨大型蝶骨嵴内侧脑膜瘤的技术要求及效果。方法 :本组男 7例 ,女 13例 ,临床症状和体征为典型的蝶骨嵴内侧脑膜瘤表现 ,行CT或MR检查确诊。肿瘤体积为 5cm× 4cm× 4cm～ 11cm× 9cm× 7cm。采用改良翼点入路 11例 ,颅颧或颅眶颧入路 9例。行肿瘤全切 12例 (6 0 % ) ,次全切除 5例 (2 5 % ) ,大部切除 3例 (15 % )。结果 :本组无死亡。术后 14例恢复良好 ,保持术前状态 3例。随访 6月～ 5年 ,有 4例肿瘤复发。结论 :根据肿瘤大小及生物学特征 ,采用这三种入路能够较好地处理这类病变     

Laparoscopic transhiatal treatment of large epiphrenic esophageal diverticulum

BACKGROUND: Epiphrenic diverticulum is an uncommon disorder of the distal third of the esophagus. We report the case of a 73-year-old woman with a large symptomatic esophageal epiphrenic diverticulum, diffuse nonspecific esophageal dysmotility, and a hiatal hernia. METHODS: Surgery was indicated by the patient's symptoms, the size of the diverticulum (maximum diameter 10 cm), and the associated esophageal motor disorder. Preoperative study included barium swallow, upper gastrointestinal endoscopy, and esophageal manometry. A laparoscopic transhiatal diverticulectomy associated with a Heller myotomy, hiatoplasty, and a Dor's fundoplication was carried out. The overall operative time was 230 minutes. RESULTS: No intraoperative complications occurred. Gastrografin swallow performed on postoperative day 4 did not show any signs of leakage from the staple line. The postoperative hospital stay was 5 days. The patient was readmitted 10 days after discharge complaining of fever and chest pain. A new Gastrografin swallow demonstrated a small leak from the staple line successfully treated with 3 weeks of total enteral nutrition. CONCLUSION: The laparoscopic approach to epiphrenic diverticulum is feasible. Postoperative Gastrografin swallow is not 100% sensitive in detecting small suture-line leaks if a preexisting esophageal motility disorder is present. In case of late postoperative fever and pleural effusion, a suture-line leak should be suspected. Conservative management of the small suture-line leak should be considered as an effective therapeutic option.     

Resection of the tracheal bifurcation through a left thoracotomy

The surgical management of tumors of the left main bronchus with involvement of the lower trachea is one of the most difficult problems of tracheobronchial surgery. Two cases of adenocystic carcinoma in this location are presented, where resection of the tumor and reconstruction of the airway were performed through a left thoracotomy. In one case reconstruction of the tracheobronchial tree could be accomplished without loss of lung parenchyma; in the second case the left lung had to be removed since the lobar bronchi were infiltrated by the tumor. Such extensive left tracheobronchial resections have so far not been reported in the literature.     

Food, nutrition, physical activity and the prevention of cancer: a global perspective – the WCRF/AICR second report

Summary   The 1997 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) report, Food, Nutrition and the Prevention of Cancer: a global perspective, has become the most authoritative statement on the topic. Since then, new evidence has emerged, and more sophisticated methods of reviewing and assessing the literature have been developed. As a result, WCRF/AICR has invited a new expert panel of scientists, with observers from the United Nations and other international agencies, to work on the production of a second report, due to be published in 2006. In addition, a special methodology task force, commissioned by WCRF, has established a methodology to systematically review the evidence. No such methodology has, up to now, been used for assessing mainly observational data on causation of disease. A portfolio approach to the evidence is used, in which all types of study, with their advantages and disadvantages, contribute to the inference of causation. Seven academic centres from the UK, the USA and continental Europe are using this new methodology to comprehensively review evidence in systematic literature reviews. In a separate process, an expert panel will make conclusions from the systematic literature reviews. Together with other relevant evidence, the panel will use these conclusions as the basis for formulating recommendations. Set against this backdrop, the new report will act as the most authoritative global report ever to be published on the subject of food, nutrition, physical activity and the prevention of cancer. It will form the basis for coherent strategies for cancer prevention and control and will set the scientific agenda for years to come.     

Unusual approaches for insertion of the greenfield vena cava filter: the value of its approach through the jugulosubclavian junction

During the last four years, we have attempted 249 insertions of the Greenfield inferior vena cava filter using the right internal jugular vein. This approach was impossible in 31 patients (12.5%). Our first alternative was the insertion of the filter through the venous junction between the right internal jugular and right subclavian veins. If this latter technique was not possible we attempted the insertion of the Greenfield filter through the left internal jugular vein before using the retrograde femoral route which is associated with high morbidity. By these techniques we have been able to reduce the number of patients in whom it is impossible to achieve mechanical endocaval partial interruption to 2.4%.