Identifying the affected hemisphere by 1H-MR spectroscopy in patients with temporal lobe epilepsy and no pathological findings in high resolution MRI

Up to 30% of patients with temporal lobe epilepsy (TLE) remain without remarkable changes in MRI. In this study we investigated the role of (1)H-MR spectroscopy ((1)H-MRS) in lateralizing the affected hemisphere in the mentioned patient group. Twenty-two consecutive patients diagnosed with TLE were investigated by high resolution MRI and (1)H-MRS. We examined the incidence and diagnostic accuracy of temporal metabolite alterations determined by Linear Combination of Model Spectra (L C Model) via water reference. Metabolite values of each hemisphere of TLE patients were compared with healthy controls. Results of metabolite alterations were related to intensive video EEG focus localization. Reduction of N-acetylaspartate + N-acetylaspartyl-glutamate (tNAA) in the affected hemisphere revealed identification in six of nine patients (66%) with unilateral TLE. Group comparison revealed a significant reduction of tNAA (6.1+/-0.8*) in the involved temporal lobe compared with controls (6.67+/-0.4*, P=0.026). Choline levels were significantly increased in the affected hemisphere (1.42+/-0.17*) compared with healthy controls (1.22+/-0.17*, P=0.035). The results of our study show that (1)H-MRS is able to identify the affected hemisphere of MRI negative TLE patients and can be used as an additive tool in multimodal focus localization.     

妊娠期肝内胆汁淤积症与血清甘胆酸的关系

检测了７４例正常足月妊娠妇女和５６例妊娠期肝内胆汁淤积症（ＩＣＰ）患血清甘胆酸（ＣＧ）的浓度，结果ＩＣＰ患血ＣＧ浓度显升高（１３．５２±９．５４ｍｇ／Ｌ），为正常孕妇（２．６７±１．９２ｍｇ／Ｌ）的５～１０倍，根据血ＣＧ浓度将ＩＣＰ患分为〈１０、１０～２０，〉２０ｍｇ／Ｌ３组，将３组胎儿出生情况与正常组相对照，结果显示血ＣＧ浓度〈１０ｍｇ／Ｌ组羊水胎粪污染率及新生儿窒息率与正常组无差异，而     

消化道恶性肿瘤确诊初期患者社会支持与生命质量的调查

目的 调查消化道恶性肿瘤确诊初期的患者半年中的社会支持和生命质量变化。方法 采用社会支持评定量表和CARES-SF对146名患者的社会支持和生命质量进行为期半年的追踪调查。结果 消化道恶性肿瘤确诊初期患者的生命质量为中等，其中婚姻关系维度、性关系维度得分半年后下降。患者所获得的社会支持最多的是情感支持，其次是实际支持，信息支持为第三位。情感支持大多来源于家庭成员，信息支持大多来源于医务人员。患者大多很少参与社交活动。在半年中情感支持、实际支持、信息支持的变化模式不一。诊断初期的患者不能有效地利用社会支持。结论 应对确诊初期患者加强咨询，以充分识别和利用社会资源。应持续评估患者的生命质量和社会支持，并制订干预方案，提高消化道恶性肿瘤确诊初期患者的社会支持程度，最终提高其生命质量。     

老年病人鼻饲方法的改进

目的探讨增加置管深度并抬高床头对预防老年鼻饲病人食物反流的效果。方法将 5 75例需鼻饲的卧床老年病人按鼻饲医嘱时间顺序及不平衡指数最小原则分成三组 ,分别给予教科书中的常规置管深度置管 (对照组 )、置管深度延长 10cm(观察 1组 )、置管深度延长 10cm并抬高床头 30～ 45°(观察 2组 )进行鼻饲。结果三组病人食物反流率比较 ,P <0 .0 1;观察 1、2组分别与对照组比较 ,P <0 .0 5、P <0 .0 1;观察 1组与观察 2组比较 ,P <0 .0 1。增加置管深度并抬高床头其食物反流率最低 ,仅增加置管深度次之 ,常规置管最高。结论增加置管深度并抬高床头可显著降低老年鼻饲病人食物反流发生率。     

Prolactin responses to haloperidol in drug-free and treated schizophrenic patients

Summary The prolactin response to 5 mg haloperidol i.m. was studied in 12 schizophrenic patients in a drug-free state and after a month treatment with haloperidol, as a possible index of dopamine receptor sensitivity and occupancy. Blood samples were taken at times 0, 60, 90 and 120 minutes. The increase in PRL observed in the drug-free state disappeared after drug treatment. The PRL plasma levels after treatment with 60 mg haloperidol per os were higher than the maximal PRL responses after 5 mg i.m. The increases in baseline PRL caused by the treatment correlated positively to the reduction in the BPRS score. The test was also performed in a group of 11 patients chronically treated with haloperidol during a daily dose of 60 mg, and 15 days after reduction of the dose to 30 mg. PRL increases after 5 mg haloperidol i.m. were observed only after reduction of the dose. It is suggested that the prolactin response to haloperidol is an index of the occupancy of receptors that are involved in the PRL releasing mechanisms, and could be used to verify their blockade by the neuroleptics, especially in patients that do not respond positively to drug treatment.     

老年患者静脉穿刺常见困难及对策

静脉穿刺是临床常用的护理操作技术。老年人由于各器官生理性老化 ,经常合并多种疾病 ,患病率高 ,患病时间长 ,致使静脉穿刺次数多 ,因此静脉穿刺比较困难。对临床上常遇到的静脉穿刺困难进行分析并给予相应解决方法 ,经过多年实践 ,遵照这些方法 ,穿刺成功率达 97%以上 ,为患者解除了病痛     

单纯性肥胖患儿血清载脂蛋白AI及B含量的改变

测定了３０例单纯性肥胖患儿（年龄７岁～１２岁）和３０例同龄健康儿童的血清载脂蛋白ＡＩ（ａｐｏＡＩ）、Ｂ（ａｐｏＢ）ａｐｏＢ／ａｐｏＡＩ比值，甘油三酯（ＴＧ）和总胆固醇（ＴＣ）。结果肥胖患儿组血清ａｐｏＡＩ明显低于健康儿童组，ａｐｏＢ、ａｐｏＢ／ａｐｏＡＩ、ＴＧ明显高于健康儿童组，差异均非常显著（Ｐ＜０．０１）。肥胖患儿组ＴＣ虽然高于健康儿童组，但差异不显著（Ｐ＞０．０５）。     

Ethical Issues in Psychotherapy

Abstract: The goal of psychotherapy is not only the dissolution of the symptoms, but also to attempt to bring about an improvement in adaptability and deepening the achievement of self-understanding. The nature of psychotherapy is based on the relationship between the therapist and patient. Such a goal and nature mean that some kinds of psychotherapy are beyond the medical model. In this paper ethical issues in psychotherapy are discussed as follows. 1) some complicated matters in informed-consent, 2) the hit or miss techniques of the poorly trained therapist, 3) the protection of privacy, 4) the sexual misconduct of therapists with patients, 5) special consideration for child-adolescent patients.     

老年急性心肌梗塞37例临床分析

对３７例老年急性心肌梗塞与５０例老年前期急性心肌梗塞病人进行临床对比分析．结果显示：部分老年急性心肌梗塞病人发病不典型，并发症多，死亡率高，这可能与并发室颤、房室或束支传导阻滞、心衰等有关．