Relationship between anterior fontanelle pressure measurements and clinical signs in infantile hydrocephalus

The treatment of choice in progressive hydrocephalus is drainage of cerebrospinal fluid in order to reduce elevated intracranial pressure (ICP). Defining the right moment for surgical intervention, however, in a hydrocephalic infant on the basis of clinical signs alone can be a difficult task. Clinical signs of raised ICP are known to be unreliable and sometimes even misleading. In the present study, the relationship between long-term anterior fontanelle pressure (AFP) measurements and clinical signs was investigated in 37 infants with hydrocephalus. The decision as to whether to operate or not was based on clinical signs alone; AFP values were not taken into account. There was an overall difference between the non-operated group and the preoperative measurements in the operated group, and also between the preoperative and the postoperative measurements in the latter, in regard to both AFP measurements and clinical signs. Almost all preoperative AFP values were increased. The direct correlation () between most individual clinical signs and AFP levels, however, was low (=0.15–0.41). The clinical sign tense fontanelle showed the best correlation with the AFP levels (=0.75). Furthermore, using logistic regression analysis, no combination of clinical signs could be found which reliably predicted the AFP. The relationship between the AFP pressure variables and clinical signs was also examined. The pathological A-waves occurred only in the presence of raised (baseline) AFP, a situation in which considerably more frequent B-waves were observed as well. It was concluded that clinical signs of raised ICP in infantile hydrocephalus are not very reliable and AFP monitoring can therefore provide valuable information on intracranial dynamics in patients with dubious neurological manifestations of progressive hydrocephalus.     

Hypertension in the elderly: Age- and disease-related complications and therapeutic implications

Summary Effective treatment of hypertension in the elderly requires an understanding of both the progressive course of the disease and the impact of aging on the cardiovascular system, including physiological, genetic, lifestyle, and environmental factors. Review of the literature that has attempted to define the impact of an aging process on cardiovascular structure and function reveals a diversity of findings and interpretations. However, in general, normotensive elderly subjects exhibit the heart and vascular characteristics of muted hypertension, including many features of younger hypertensive patients: cardiac hypertrophy, diminution in resting left ventricular early diastolic filling rate, increased arterial stiffness and aortic impedance, diminution in the baroreceptor reflex, a diminished response to catecholamines and diminished renal blood flow, and an increase in peripheral vascular resistance (PVR). Treatment of elderly hypertensives is more challenging because of the greater likelihood of the presence of concomitant diseases, most importantly, coronary and peripheral atherosclerosis, renal dysfunction, and diabetes mellitus. Isolated systolic hypertension (ISH), the most common form of hypertension in the elderly, has also been clearly shown to be an important predictor of cardiovascular morbidity and mortality, including coronary artery disease, congestive heart failure, and stroke. Treatment of ISH has been shown to lower systolic pressure safely and effectively in the elderly. By reducing PVR, and possibly the arterial stiffness, and thus the early reflected pulse waves, vasodilators, including calcium antagonists, may lower these three components of arterial impedance, and hence lower the arterial load on the heart. The cardiac hypertrophy and reduced left ventricular filling rate associated with hypertension in older individuals can also be ameliorated, to some extent, by calcium channel blockers.Proceedings of a symposium held in Atlanta, Georgia on March 2, 1991.     

Epidemiologic aspects of latent and clinically manifest carcinoma of the prostate

Summary The worldwide incidence of prostate cancer differs greatly. The black population of the USA is at the head, while the Asian populations have the lowest incidence and mortality rates. Comparative geographic-pathologic autopsy studies on frequency and growth type of latent prostate carcinomas show that in populations with a lower incidence, for example Japan and Singapore, latent carcinomatous foci are not considerably rarer than in regions with high incidence. However, obvious differences are seen when comparing the size of the foci and the growth types. In countries with low incidence and mortality rate, the foci of the latent prostate carcinoma are small and show a slight proliferating tendency, whereas in countries with high incidence and mortality rate, they are frequently larger and more aggressive. Consequently, the different incidence of prostate cancer is not based on different initiation of malignant transformation, but on different promoting factors. In histologic-bioptical specimens from regions with high incidence and mortality rate, pluriform tumor types of malignancy grade G III and G II prevail. Definite causes of prostate cancer could not be detected by case control and migration studies up to now.Supported by the campaign Kampf dem Krebs e.V. der Deutschen Krebsgesellschaft     

三黄软膏皮肤用药毒性实验研究

为观察三黄软膏药物外用的安全性 ,进行了动物完整皮肤及破损皮肤长期接触三黄软膏 ,经皮肤渗透对局部及全身产生的毒性和反应的恢复程度 ,用三黄软膏 2g·kg-1、10g·kg-1剂量 (分别相当于 6 0kg人临床用量的 10、5 0倍 )连续对家用兔外用给药4周及停药恢复性观察 2周。结果表明给药期动物的皮肤状况、全身症状、行为活动、摄食、粪便性状、体重增长、血液学均未见明显的毒性反应 ,而高剂量组动物血液生化指标AST、ALT明显增高 ,病理组织学检查时肝水肿明显 ,可见有一定的毒性反应 ;停药期动物的血液生化指标AST、ALT肝组织病理组织学检查恢复正常 ,其他各项指标均未见明显的毒性反应 ,可见该毒性反应是可逆恢复的。表明三黄软膏在临床用药范围内连续使用是比较安全的。     

骨折与中医食疗

骨折病人食疗的基本原则是整体观念和辨证施食。本文以骨折的三期分治为原则,再根据不同的病因,病程的久暂以及病人的体质等情况分别立法施食,以加快骨折愈合及功能恢复。食疗的组方原则为理气活血,培元益气,化痰祛湿,利水消瘀。     

The Role of Therapeutic Alliance in Network Therapy: A Family and Peer Support-Based Treatment for Cocaine Abuse

The therapeutic alliance is a well-studied construct factor that is important to outcome in many forms of individual therapy. Therapeutic alliance has been rarely studied in group therapy and results in addiction treatment have been mixed. In this paper, we studied the presence of a therapeutic alliance in Network Therapy: an approach that uses peer and family support in addiction treatment. Twenty-one participants undergoing Network Therapy for cocaine addiction were observed on videotape, and were rated on therapeutic alliance using the Working Alliance Inventory and the Penn Helping Alliance Rating Scale. Results showed a significant positive correlation between therapeutic alliance and outcome as measured by the percentage of cocaine-free urine toxicology screens and by eight consecutive cocaine-free urines.     

中医药治疗恶性肿瘤的研究进展

阐述了中医对恶性肿瘤病因病机的认识及治则治法，对目前中医药治疗恶性肿瘤的几种新思路进行了探讨．在指出中医药治疗恶性肿瘤中存在的问题的同时，提出了笔者的几点建议。     

挑刺阳性反应点治疗腰椎骨质增生38例

试用三棱针挑刺腰部阳性反应点,治疗腰椎骨质增生38例,结果有效率100%,具有疗效好,费用低,疗程短,应用方便的特点.     

ROLE OF ACULASER THERAPY IN CEREBRAL PALSY CHILDERN （INITIAL DATA ＆ RESULTS）

1　BACKGROUNDTheincidenceofCPis 0 .7per 1 0 0 0livebirths[1 ] .Becausecerebralpalsyinfluencesthewaychildrendevelop,itoftenresultsindevelop mentaldisability .Today ,more peoplehavecerebralpalsythananyotherdevelopmentaldis ability ,includingDownsyndrome,epilepsy ,andautism .Accordingtoasurveyconductedin1 986,2 .6%ofthepopulationofPakistaniaredisabled (includingbothphysicalandmentaldis abilities) .Childrenbetween 0～1 4 yearsinageconstitute 40 %ofthedisabled populationinPakistan .Routineme…