肺表面活性物质治疗新生儿呼吸窘迫综合征随访调查

目的：观察肺表面活性物质（PS）治疗新生儿呼吸窘迫综合征（NRDS）的疗效及其对患儿体格发育和肺功能的影响。方法：将160例NRDS患儿根据是否应用Ps治疗分为观察组120例和对照组40例。两组采用相同常规药物及呼吸机治疗，观察组在此基础上加用Ps治疗。两组分别于生后3、6、9个月和1、2、6岁进行体格发育随访，于6岁时检测肺功能，并将随访结果进行比较。结果：（1）观察组平均呼吸机使用时间和平均住院时间分别为（46．5±13．2）h和（26．8±12．5）d，对照组分别为（69．8±27．7）h和（42．6±18．2）d，两组比较差异有统计学意义（P〈0．05）。（2）生后3个月观察组平均身高、体重、头围分别为（57．2±2．6）cm、（4．76±0．45）kg、（38．6±1．3）cm，对照组分别为（56．1±2．4）cm、（4．35±O．37）kg、（38．1±1．6）cm，两组比较差异有统计学意义（t分别为2．36、2．78、2．81，P均〈0．05）；但该三项在患儿出生6个月以后的随访结果组间比较差异均无统计学意义（P〉0．05）。（3）观察组有26例、对照组有16例出现反复呼吸道感染，两组比较差异有统计学意义（P〈0．05）。（4）6岁时观察组最大呼气中段流量为（1．6±0．3）L／s，对照组为（1．4±0．2）L／s，两组比较差异有统计学意义（P〈0．05）。结论：Ps治疗NRDS可缩短患儿呼吸机使用时间和住院时间，改善早期体格发育和肺功能，是提高NRDS患儿生存质量的有效方法。     

Temperament and one-year outcome of gastric bypass for severe obesity

BackgroundThe role of temperament traits in shaping the outcome of gastric bypass for severe obesity has not been established yet. This study evaluated whether temperament traits influence weight loss 1 year after gastric bypass, controlling for the potential confounding effect of Axis I and II disorders.MethodsForty-nine patients with severe obesity (body mass index = 46.4±6.7) undergoing gastric bypass completed a thorough psychiatric evaluation before surgery, including structured interviews, rating scales, and questionnaire assessing the presence and severity of co-morbid Axis I and II disorders. Temperament was evaluated with the Temperament and Character Inventory (TCI). Weight loss 1 year after surgery was calculated as percent total weight loss (%TWL). Predictors of weight loss were investigated with multivariate linear hierarchical regression.ResultsAfter accounting for psychiatric covariates, higher TCI persistence scores independently predicted 1-year outcome of gastric bypass and explained 40% of the variance in %TWL. Patients with low persistence scores showed a significantly lesser weight loss than patients with high scores.ConclusionTemperament traits denoting the ability to persevere in one’s goals in spite of immediate frustration (persistence) are associated with greater weight loss 1 year after gastric bypass. These data suggest the utility of preoperatively assessing and reinforcing such capacity to optimize surgical outcome. Future research will clarify the behavioral mechanisms mediating this relationship as well as the influence of temperament on weight maintenance.     

Feasibility of tailored follow-up for patients with early breast cancer

As the number of breast cancer survivors increases, this study prospectively examined whether tailored follow-up with differentiated number of visits per risk group, based on a prognostic index for local recurrence, is feasible and acceptable for patients and professionals.Between March 2007 and March 2010, 180 breast cancer patients (pT1-2N0-2cM0) were included. Primary endpoint was feasibility of tailored follow-up, based on the number of follow-up visits, patient satisfaction, anxiety and attitude towards follow-up. Secondary endpoints were reasons for visits, incidence, time to detection of local recurrences and the use of alternative care.In the second and third year of follow-up, the results show a 22% reduction in visits per patient in the low-risk group compared to the intermediate-risk group; 2.8 versus 3.6 visits. The majority of interval visits in both groups was initiated by the professional. No significant differences were found in attitude towards follow-up, patient satisfaction, anxiety and depression, alternative health care use or local recurrences between the risk groups.In conclusion, implementation of a tailored follow-up programme with decreased number of visits for low-risk patients is feasible and acceptable to patients. Appointing one coordinating professional, possibly a nurse practitioner, could further reduce the number of follow-up visits.     

On the Natural History of Peptic Ulcer

Lindell G, Celebioglu F, Staël von Holstein C, Graffner H. On the natural history of peptic ulcer. Scand J Gastroenterol 1994;29:979-982.

Background: Three out of 1000 individuals have peptic ulcer every year, and 20% of the ulcer episodes are associated with bleeding. Whether major innovations such as endoscopy and strong acid-suppressing drugs have had any impact on the natural course of peptic ulcer disease is largely unknown.

Methods: Three hundred and fifty-one patients (median age, 63 years) with endoscopically proven peptic ulcer during 1979-1984 were included in the study and retrospectively followed up via medical records. The total population is based on two different groups of patients, the first comprising 229 consecutively diagnosed ulcer patients during 1979-81 and, to increase the number of bleeders, a second group including 122 bleeding ulcer patients consecutively diagnosed during 1981-84. At the end of the follow-up period all non-ulcer-operated patients were asked to answer a questionnaire on symptoms, investigations, and medication.

Results: The male to female ratio was 2.4:1 in duodenal ulcer patients, but a 1:1 ratio was shown both in gastric and prepyloric/pyloric ulcer patients (p < 0.001). Patients with bleeding ulcers were significantly older than non-bleeders (68 years versus 58 years; p < 0001), as were patients with gastric ulcers compared with prepyloric/pyloric or duodenal ulcer patients (68 years versus 63 and 61 years, respectively; p < 0.01). The 10-year cumulative mortality in the unselected group (median age, 62 years) was 43%, and the annual risk of dying of peptic ulcer disease was 0.6%. No difference in 10-year recurrence rate was seen between patients with bleeding ulcer at inclusion and non-bleeders (46.2% versus 44.3%; p = NS), but the annual risk of bleeding was 5.3% and 0.8%, respectively (p< 0.0001). In the group of patients answering the questionnaire 51% reported upper abdominal pain during the last year of follow-up.

Conclusions: In spite of today's treatment regimens almost half of the patients with peptic ulcer disease experienced recurrence during a 10-year period, and more than half had ulcer symptoms after 10 years. Most probably, maintenance treatment with H₂-receptor antagonists should have been offered more liberally during the 1980s.     

Gastric MALT lymphoma – Update on diagnosis and treatment

Gastrointestinal lymphoma represent a heterogenous group with differences in pathogenesis, treatment and prognosis. Gastric MALT lymphoma is the most common entity. Helicobacter pylori has been identified as its decisive pathogenetic factor. Once a definitive diagnosis has been established a staging procedure is obligatory for defining the stage of disease. H. pylori eradication is the treatment of choice in all MALT lymphoma patients being infected by the bacterium. In some 70–80% of patients with stages I/II complete regression of the lymphoma will develop after successful eradication of H. pylori. Another 20% of patients will reveal minimal histological residuals after eradication. They can be successfully managed by a watch-and-wait strategy if initial endoscopic abnormalities disappear. At present, it is unclear if this strategy can be also offered to patients with persisting minimal endoscopic abnormalities. Why eradication therapy is effective in some patients with negative H. pylori status is highly speculative at present. Non-responders to H. pylori therapy are transferrred to radiotherapy in stages I/II or to immuno-chemotherapy in stages III/IV.     

Norsk Psykiatrisk Forening: Årsberetning for tiden 18. 6. 60.-3. 6. 61

Haver B. Longitudinal study of female alcoholics. Clinical implications.

The article reviews findings from follow-up studies of treated female alcoholics. At a group level, women seem to have an equal or even somewhat better treatment outcome compared with male alcoholics. The presence of psychiatric disorders like anxiety and depression is correlated to a better treatment outcome in women, but not in men. In the individual cases, a complicated interaction between factors related to life events, maturation and living conditions might precipitate turning points in the women's drinking careers. Treatment can possibly instigate turning points as well as reinforce the effects of naturally occurring turning points, by inducing cognitive, behavioural and psychodynamic changes inherent in the process of change. The reported results are mostly based on studies of women alcoholics coming to treatment late in their drinking careers. The treatment programs rarely address the special treatment needs of female alcoholics and their families. Therefore, better results might be obtained by developing special treatment programs for women alcoholics, attracting women to come to treatment earlier in their drinking careers.     

Developmental pathways of language and social communication problems in 9–11 year olds: Unpicking the heterogeneity

This paper addressed relations between language, social communication and behaviour, and their trajectories, in a sample of 9–11-year-olds (n = 91) who had been referred to clinical services with concerns about language as pre-schoolers. Children were first assessed at 2½–4 years, and again 18 months later.Results revealed increasing differentiation of profiles across time. By 9–11 years, 11% of the sample had social communication deficits, 27% language impairment, 20% both, and 42% neither. The size of group differences on key language and social communication measures was striking (2–3 standard deviations). Social communication deficits included autistic mannerisms and were associated with social, emotional and behavioural difficulties (SEBDs); in contrast, language impairment was associated with hyperactivity only. Children with both language and social communication problems had the most severe difficulties on all measures.These distinct school-age profiles emerged gradually. Investigation of developmental trajectories revealed that the three impaired groups did not differ significantly on language or SEBD measures when the children were first seen. Only low performance on the Early Sociocognitive Battery, a new measure of social responsiveness, joint attention and symbolic understanding, differentiated the children with and without social communication problems at 9–11 years. These findings suggest that some children who first present with language delay or difficulties have undetected Autism Spectrum Disorders which may or may not be accompanied by language impairment in the longer term. This new evidence of developmental trajectories starting in the preschool years throws further light on the nature of social communication and language problems in school-age children, relations between language impairment and SEBDs, and on the nature of early language development.