EFNS Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force

The objectives have been to establish evidence-based guidelines and identify controversies regarding the management of patients with brain metastases. The collection of scientific data was obtained by consulting the Cochrane Library, bibliographic databases, overview papers and previous guidelines from scientific societies and organizations. A tissue diagnosis is necessary when the primary tumor is unknown or the aspect on computed tomography/magnetic resonance imaging is atypical. Dexamethasone is the corticosteroid of choice for cerebral edema. Anticonvulsants should not be prescribed prophylactically. Surgery should be considered in patients with up to three brain metastases, being effective in prolonging survival when the systemic disease is absent/controlled and the performance status is high. Stereotactic radiosurgery should be considered in patients with metastases of 3–3.5 cm of maximum diameter. Whole-brain radiotherapy (WBRT) after surgery or radiosurgery is debated: in case of absent/controlled systemic cancer and Karnofsky Performance score of 70 or more, one can either withhold initial WBRT or deliver early WBRT with conventional fractionation to avoid late neurotoxicity. WBRT alone is the treatment of choice for patients with single or multiple brain metastases not amenable to surgery or radiosurgery. Chemotherapy may be the initial treatment for patients with brain metastases from chemosensitive tumors.     

Nursing Assessment of Altered Sexuality: A Review of Salient Factors and Objective Measures

TOPIC. Nursing assessment of altered sexuality.
PURPOSE. To review salient factors affecting assessment and objective measures available for use in assessment.
SOURCE. Literature specific to nursing assessment of sexuality and to instruments measuring altered sexuality.
CONCLUSIONS. Many standards of care include the assessment of sexuality, and nurses believe it to be an important aspect of care. However, the assessment of altered sexuality does not often occur in actual practice. The use of an objective measure of sexuality is recommended for both initial and on-going assessments in acute-care and community-based settings.     

脾脏肿块的超声诊断

目的 :探讨脾脏肿块的超声表现及鉴别要点。材料和方法 :回顾性分析 76例脾脏肿块患者的超声检查资料 ,分析脾脏肿块的大小、数目、边界、内部回声等多种超声表现。结果 :76例脾脏肿块中有 3例错构瘤 ,10例血管瘤 ,16例淋巴瘤 ,2例淋巴管瘤 ,4例血管肉瘤 ,11例脾转移瘤 ,16例脾囊肿 ,4例脾梗死 ,3例脾血肿 ,5例脾脓肿 ,2例付脾 ,其超声表现各具特征。结论 :超声检查可早期发现并区别脾脏肿块的囊、实性 ,借助彩色血流显像可进一步鉴别良、恶性病灶。     

The Hampshire Depression Project: development and piloting of clinical practice guidelines and education about depression in primary health care

This paper describes the development and piloting of a comprehensive educational programme about recognition and management of depressive illness in primary care. Full evaluation of the effectiveness of the programme is currently underway in a randomized controlled trial, the Hampshire Depression Project (HDP), involving 56 general practices. The programme consists of clinical practice guidelines, practice-based seminars and follow-up sessions. Each part of the programme has been designed to be flexible, clinically oriented and relevant to all members of the multidisciplinary primary care team. The pilot study established the need for a systematic approach to the access of practices and practice teams, and the organization and process of the seminars. Application of this approach was associated with excellent attendance in the main programme.     

Early Stroke Recognition: Developing an Out-of-hospital NIH Stroke Scale

Objective : To develop an abbreviated and practical neurologic scale that could assist emergency medical services or triage personnel in identifying patients with stroke.
Methods : A prospective, observational, cohort study was performed at university-based EDs. Participants were 74 patients treated in a thrombolytic stroke trial and 225 consecutive non-stroke patients evaluated during 4 random 12-hour shifts in the ED. Scores on the NIH Stroke Scale were obtained for all patients by physicians. Items of this scale were modified and recoded to a binomial (normal or abnormal) scale. Serial univariate analyses using χ² were performed to rank items. Recursive partitioning was then performed to develop the decision rule for predicting the presence of stroke.
Results : Three items identified 100% of patients with stroke: facial palsy, motor arm, and dysarthria. An Abbreviated NIH Stroke Scale based on these items had a sensitivity of 100% and a specificity of 92%. A proposed Out-of-hospital NIH Stroke Scale consisting of facial palsy, motor arm, and a combination of dysarthria and best language items (abnormal speech) had a sensitivity of 100% and a specificity of 88%.
Conclusion : Using the derivation data set, a proposed Out-of-hospital NIH Stroke Scale had a high sensitivity and specificity for identifying patients with stroke when performed by physicians in this group of 299 ED patients. Prospective studies of other health care professionals using the scale in the out-of-hospital arena are needed.     

羊水细胞培养宫内诊断的应用(附120例分析)

报告120例羊膜腔穿刺羊水细胞培养结果:在成功的99例中,发现二例染色体异常,核型为47,xy,+18和46,xx/47,xx,+F,在21例失败中出现一例眼球畸形。培养成功率为82.5%;染色体异常检出率为2.02%。无一例因羊膜腔穿刺而导致流产,但出现一例轻度羊水栓塞合并症。并对羊水细胞培养在产前宫内诊断中应用价值及术后并发症进行了讨论。     

白内障显微囊外摘除联合小梁切除术

报告20例(21眼)青光眼白内障并存患者采用显微囊外摘除联合小梁切除术.术后眼压控制满意,滤过泡形成,视力不同程度提高,无明显并发症.并对有关机制,手术优点及不易控制的眼压问题进行了讨论.     

病毒性肝炎60例临床与病理分析

对６０例病毒性肝炎患者进行肝穿刺活检，结果发现，临床与病理诊断的符合率为４６．６％，其中，急性肝炎的诊断符合率最低（２３．８％），慢性迁延型肝炎（慢迁肝）为４４．８％；ＨＢｓＡｇ阳性首次发病的患者中，急性乙型肝炎仅为１１．２％（２／１８）；临床诊断的慢性活动型肝炎（慢活肝）仅为病理检出的２５．７％（９／３５）；肝炎患者中脾肿大，凝血酶元时间延长、Ａ／Ｇ值＜１．２、抗ＨＢｃＩｇＭ阳性可作为慢活肝与慢迁肝鉴别的重要指标。这些对提高病毒性肝炎临床分型诊断的准确率及指导临床治疗有意义。     

A Study on Using Improved Methenamine-silver Stain to Diagnosis of Pneumocystis carinii

ＡＳｔｕｄｙｏｎＵｓｉｎｇＩｍｐｒｏｖｅｄＭｅｔｈｅｎａｍｉｎｅ－ｓｉｌｖｅｒＳｔａｉｎｔｏＤｉａｇｎｏｓｉｓｏｆＰｎｅｕｍｏｃｙｓｔｉｓｃａｒｉｎｉｉＣｈｅｎＸｉｗｅｉ（陈锡慰）（ＤｅｐａｒｔｍｅｎｔｏｆＰａｒａｓｉｔｏｌｏｇｙ，ＮａｎｊｉｎｇＭｅ...