Differences in clinical characteristics between Tourette syndrome patients with and without 'generalized tics' or coprolalia

Abstract  The purpose of this study is to examine whether there are differences in clinical characteristics between Tourette syndrome (TS) patients with and without 'generalized tics' (GT) which involve the entire body, and/or coprolalia. Subjects were 64 patients (55 males and 9 females, mean age, 17.4 ± 7.2 years) who visited Tokyo University's outpatient clinic of neuropsychiatry from 1974 to 1993 and who met criteria for Tourette's disorder of DSM-III-R. Data on clinical characteristics, including tic symptoms and courses of their development, complications and developmental histories, treatment and severity, were collected by systematic chart review of all subjects. Tourette syndrome patients with 'generalized tics' tended to show multiple complex vocal tics more frequently than TS patients without GT. Tourette syndrome patients with coprolalia tended to show significantly higher rates of copropraxia, echolalia, and 'cleaning/washing' compulsion than did the TS patients without coprolalia. Tourette syndrome patients with both GT and coprolalia were classified as the severest group in terms of tic symptoms and social impairment. Tourette syndrome patients who had neither of these morbidities were classified into the mildest group in all aspects. Generalized tics and coprolalia seemed to indicate the severest end of the TS spectrum and seemed to be related with a need of intensive treatment.     

Alexithymia in Holocaust Survivors with and Without PTSD

Alexithymia was measured in non-treatment seeking, community-dwelling Holocaust survivors using the Toronto Alexithymia Scale—Twenty Item Version (TAS-20). Scores of survivors with (n = 30) and without (n = 26) posttraumatic stress disorder (PTSD) were compared, and associations among alexithymia, severity of trauma, and severity of PTSD symptoms were determined. Survivors with PTSD had significantly higher scores on the TAS-20 compared to survivors without PTSD. TAS-20 scores were significantly associated with severity of PTSD symptoms, but not with severity of trauma. This study adds to our knowledge of the relationship between alexithymia and trauma by demonstrating that this characteristic is related to the presence of posttraumatic symptoms and not simply exposure to trauma.     

实验性急性胰腺炎肺内细胞凋亡状况及其意义的初步探讨

目的：探讨重症急性胰腺炎时肺内细胞凋亡的状况及其在肺损伤发病机制中的意义。方法：以不同浓度牛磺胆酸钠液逆行胰胆管注射造成大急急性水肿性胰腺炎（AEP)与急性坏死性胰腺炎(ANP)两种模型，测定血浆TNF-α与内毒素水平的动态变化，免疫组化检测肺内TNF-α的表达，并以TUNEL法结合激光扫描共聚焦显微镜检测肺组织切片内细胞凋亡的情况。结果：正常时大鼠肺内偶见淋巴细胞及纤维母细胞等发生凋亡，诱导AEP或ANP后凋亡细胞数量无明显变化。随着肺损伤的出现，少许浸润的炎细胞、肺泡上皮细胞及血管内皮细胞等发生了凋亡。凋亡指数(‰)在ANP组呈一过性下降，在ANP组表现为持续下降，在6h后各时点均显著低于AEP组相应值(P＜0．05)。分析表明，ANP组血中TNF-α、内毒素含量的增加与凋亡指数的变化存在负相关(P＜0.05)。结论：ANP时肺内浸润的以中性粒细胞为代表的大量炎细胞出现延迟凋亡，这种现象可能是肺损伤发生的重要前提，同时内毒素血症及TNF-α的过度合成可能是中性粒细胞延迟凋亡的部分原因。     

350例膝关节镜检查分析

自1981年以来进行了350例膝关节镜检查。明确诊断340例(97.1%),纠正诊断52例(14.7%),补充诊断47例(13.4%)。关节镜检查不仅有助于确定临床诊断,而且提高了手术的准确性。     

Injury Type, Injury Severity, and Repeat Occurrence of Alcohol-Related Trauma in Adolescents

Injury associated with alcohol use is a significant problem among adolescents; however, routine evaluation of alcohol use in this population is not conducted. The purpose of this study was to compare injured adolescents presenting to an emergency room with a positive serum alcohol concentration (SAC+) with those injured adolescents wlth a negative serum alcohol concentration (SAC-). Data were collected retrospectively on 176 injured patients, between the ages of 13 and 18, consecutively admitted to a university hospital from January 1, 1989-December 31, 1990. Information collected included mechanism and severity of injury, outcome, SAC, length of stay, prychiatric history, prior or subsequent admission for injury, and hospital charges. Of those tested with an SAC, more than one-third had a positive SAC. Patients with positive SACs had a greater probability of having a psychiatric history and more frequently had a prior or subsequent injury. Furthermore, only 34% of SAC+ patients were referred for counseling. The results indicate that a SAC should be obtained on all adolescents admitted for trauma, that adolescents presenting with injuries and a positive SAC should be referred for alcohol and psychiatric assessment, and that injured adolescents may be at increased risk for repeat injuries in the future.     

B型超声对诊断半月板损伤的临床价值

自１９８７年以来，我院采用Ｂ超对半月板进行实验研究并对２６４例病人进行检测，结果表明Ｂ超不仅能显示半月板图象还能区分正常与异常半月板。Ｂ超诊断的临床符合率为８６．３６％，手术符合率为９５％。本检查具有无创性，不接触ｘ射线，操作简便等优点。     

微创内固定系统在高能量胫骨平台骨折中的应用

目的:探讨微创内固定系统治疗高能量胫骨平台骨折的方法和临床疗效。方法:本组27例,男19例,女8例;年龄21~59岁,平均36岁;其中左侧12例,右侧15例。按Schatzker分型:Ⅴ型9例,Ⅵ型18例。其中合并前交叉韧带撕脱骨折3例,后交叉韧带断裂2例,半月板损伤3例。用改良内外侧联合切口,行微创内固定系统结合有限接触加压钢板(LC-DCP)内固定,其中3例半月板损伤,2例给予修补,另1例部分切除;3例前交叉韧带撕脱骨折给予钢丝固定;2例后交叉韧带断裂行Ⅱ期手术。术后2周、1、3、6个月、1年随访,行摄片及关节活动度检查,测定胫骨平台内翻角(TPA)及后倾角(PA);术后1年行膝关节HSS评分。结果:术后与术后1年TPA及PA平均值的差异无显著性统计学意义(TPA:t=1·012,P=0·356;PA:t=0·667,P=0·521)。术后1年膝关节HSS评分平均为86·9分(56~98分),根据此评分标准:优15例,良7例,中4例,差1例。结论:微创钢板治疗高能量胫骨平台骨折是理想、有效的方法,它具有手术创伤小、并发症少,骨折愈合率高,长期稳定性良好,膝关节功能恢复满意等优点。     

Gd-DTPA动态增强MRI评价心肌微血管损伤

目的：探讨Gd-DTPA动态增强MRI评价心肌微血管损伤的可行性。方法：制作急性犬心肌梗死动物模型，在活体上用放射微球^99Tc—MAA测量心肌血流量，0．5％伊文蓝染色区分缺血心肌；心脏离体后用3％TTC染色区分梗死心肌，SP免疫组化染色观察心肌微血管并计算微血管体积分数。犬离体心脏左冠状动脉插管后作MRI平扫及Gd—DTPA动态增强扫描，测量正常、缺血和梗死心肌的信号强度，绘制时间-信号强度曲线。结果：在T1WI上，心肌信号强度无明显差异；在T2WI上，病变心肌信号强度较正常增高；Gd-DTPA灌注动态增强扫描，正常心肌时间-信号强度曲线呈下降形，危险心肌呈上升形，梗死心肌呈平直形，灌注晚期病变区呈明显环状强化。正常、危险和梗死心肌血流量、微血管体密度差异显著。结论：急性心肌梗死后心肌间质水肿、心肌含水量增加致T2WI信号增高。Gd-DTPA动态增强时间-信号强度曲线上升的斜率及峰值可以反映心肌微血管损伤及组织水肿的程度。     

Respiratory tract infections due to different rhinovirus serotypes and the influence of maternal antibodies on the clinical expression of the disease in infants.

Rhinoviruses were isolated from nasopharyngeal secretions of 49 children hospitalized because of severe respiratory tract infection. The isolates were typed using 90 type-specific antisera. No obvious relation between certain serotypes and the severity of illness was found. Serum samples were drawn from all children simultaneously with the nasopharyngeal secretions and screened for the presence of type-specific neutralizing antibodies. Children aged 1 week to 6 months had higher neutralizing antibody titers and revealed a lower degree of morbidity than older children. The decline of neutralizing serum antibodies with increasing age was correlated with a higher incidence of severe disease in those aged 7-12 months. Nevertheless, also in this age group children with mild clinical courses of disease were observed despite a low concentration or an absence of neutralizing serum antibodies. This indicates that not only neutralizing serum antibodies, but other factors also influence the clinical expression of RHV-induced disease.     

三块游离组织组合移植I期修复复杂手外伤

研究复杂性手外伤的修复方式和游离组织组合移植的方式。方法：对36例严重手外伤采用在块游离组织组合移植修复。共有4种组合类型。结果：36例108块游离组织组合移植，全部成活，所覆盖的创面全部愈合，经过1年以上随访，移植足趾和Mu甲瓣恢复触痛、温度觉，两点瓣别觉在6-12mm，所有病例恢复了对掌、对指功能，能完成日常生活功能。结论：用三块游离组织组合移植修复复杂手外伤，虽手术时间长、创伤大，但可减少手术次数和减轻患者精神和经济负担，缩短疗程，并能早期进行康复训练，最大程度恢复手指的功能治疗。