Psychological responses of patients receiving a diagnosis of cancer.

BACKGROUND: Current recommendations on how to break bad news are primarily based on expert opinion. Little is known about the association between communication practices and patients' psychological response. PATIENTS AND METHODS: One-hundred and thirty-one patients with newly diagnosed melanoma were surveyed 4 months after the initial consultation at the Sydney Melanoma Unit regarding their communication experiences and their satisfaction with these experiences. They completed the Hospital Anxiety and Depression Scale (HADS) at this time, and 4 and 13 months later. RESULTS: Both patients' satisfaction with communication and their psychological morbidity were found to be associated with particular communication practices. Practices linked to lower anxiety included preparing the patient for a possible diagnosis of cancer; having the people wanted by the patient present to hear the diagnosis; giving the patient as much information about the diagnosis as desired; providing written information; presenting the information clearly; discussing the patient's questions the same day; talking about the patient's feelings; and being reassuring. Practices linked with lower levels of depression included using the word 'cancer'; discussing the severity of the situation, life expectancy and how the cancer might affect other aspects of life; and encouraging the patient to be involved in treatment decisions. CONCLUSIONS: This study provided preliminary evidence that communication strategies recommended in the literature produce positive patient outcomes. Further studies are needed which document actual communication.     

舌诊指导临床辨证论治初探

望舌能够测知体质禀赋强弱；察舌能够准确地进行临床辨证；舌诊可帮助鉴别诊断；望舌能够预测疾病的进退预后；舌诊还能够指导临床定治则、遣方药。如能将舌诊和其他诊法有机地结合起来，将进一步提高临床诊断准确率和治愈好转率。     

提高中风病辨治水平的探讨

从中风病的定义、病机、临床分期、辨证施治等方面对提高中风病辨治水平进行探索。明确界定中风病为急性脑血管病，是气血逆乱、痰瘀内阻造成脑络破裂出血或脑络痹阻所致的局限性功能异常，其病机是脑络破裂血溢瘀血浸淫压迫脑髓，或脑络痹阻而致脑髓失荣所致的脑髓损害。临床分为急性期、缓解期、恢复期、后遗症期。并将中风后昏迷超过24小时者定为中风重症，辨证首辨闭证与脱证，再辨闭证之顺与逆。强调中风病取效关键在于急性期和缓解期及时正确的治疗和护理，而并发症应防重于治。     

2340例胰腺癌临床病例分析

目的 探讨提高胰腺癌治愈性切除相关因素和获得更佳疗效。方法 中国抗癌协会胰腺癌专业委员会回顾性分析了8省2市14大医院的1990年-2000年诊治的2340例胰腺病例。多因素生存分析采用Cox比例风险模型找出可能影响胰腺癌病人预后的独立因素。单因素生存分析用寿命表法计算,以生存曲线描述生存率,并进行Gehan比分检验。结果 COX单因素分析表明在a=0.05水平上有意义的有年龄、职业、病程、肿瘤部位、手术方式、术后胰瘘、术后肝衰、化疗、TNM分期、免疫治疗、有无肝转移、肠系膜上血管有无侵犯等变量。COX多因素分析表明在a=0.05水平上有意义的有患者年龄、手术方式、术后胰瘘、术后肝衰、化疗、免疫治疗等变量,这些变量为影响胰腺癌预后的独立因素。根治性手术者相对于未手术者,以及化疗、免疫治疗均为保护性因素。其中40岁以上的占了92.91％,40岁以下的仅占7.09％。胰头癌根治性手术组中位生存时间为 17.11个月,1年、3年和5年生存率分别为54.36％、13.47％、8.47％。结论 有必要将40岁以上的人群视为高危人群,能及时发现早期病例。各种综合治疗措施的结合都将有助于改善胰腺癌患者的生活质量和延长生存期。     

急性阑尾炎术前漏诊右半结肠癌14例分析

目的 探讨预防或减少急性阑尾炎术前漏诊右半结肠癌的措施及二者并存的术中处理。方法 对我院1990年1月～2002年10月收治的14例急性阑尾炎术前漏诊右半结肠癌的原因及并存机理进行回顾性分析。结果 14例漏诊患者中，5例行Ⅰ期右半结肠切除术；3例行Ⅰ期右半结肠切除、回肠造瘘术；2例行I期可疑病灶切除、回肠或盲肠造瘘术，Ⅱ期行右半结肠切除术；3例行回肠造瘘、腹腔引流术，Ⅱ期行右半结肠切除术；1例单纯行阑尾切除术，漏诊肝曲结肠癌，术后并发肠梗阻，剖腹控查行Ⅰ期右半结肠切除、回肠造瘘术。结论 掌握外科基本理论，遵循外科基本原则，避免惯性思维，减少漏诊机会，常能够避免急性阑尾炎术前漏诊右半结肠癌导致处理不当而带来的一系列问题。     

卫星搭载药用植物曼陀罗遗传变异的随机扩增多态性DNA分析

以曼陀罗种子为材料探讨太空环境对药用植物的影响。方法利用返回式卫星搭曼陀罗的种子,返回地面后播于实验田中,应用随机扩增多态性ＤＮＡ（ＲＮＡ（ＲＡＰＤ）分子标记技术分析不同组曼陀罗基因组的变异情况。结果从６５个供试引物中筛选出１５个能够产生可重复多态性增产物的引物。与地面对照组相比,失重组共产生３９条多态性片段,基因组的多态性频率为２３．１％,击中组共产生４５条多态性片段,基因组的多态性频率为２４．     

Longitudinal monitoring of bone mineral density in thalassemic patients. Genetic structure and osteoporosis

The changes in bone mineral density (BMD) measured by single photon absorptiometry (SPA) using two observations conducted over a period of 2 years were examined in 54 thalassemic subjects [ 30 F(A)and 24 M (B)] with a chronological age ranging from 2.6 to 22.6 years and in 27 sex- and age-matched controls (C). Each category (A. B and C) was divided into three groups according to pubertal signs: pre-pubertal subjects (A1, B1 and C1): peri-pubertal subjects (A2, B2 and C2) and pubertal subjects from the first observation (A3, B3 and C3). Furthermore, each group of patients was divided into sub-groups on the basis of haematological phenotypes, those with a more severe form were called β⁰/β⁰ while those with other forms were called "others". The most significant findings were the following: the presence of a more severe reduction of the bone mineral density in patients with the β⁰/β⁰ phenotype than in patients with the "others" phenotype; patients with hypogonadism corresponded to the β⁰/β⁰ phenotype, while those with spontaneous puberty corresponded to the "others" phenotype. In conclusion, since puberty and the degree of bone mineral density are related to the haematological phenotype, puberty (spontaneous or induced) positively influences the bone mineral density only at the start of puberty, while subsequently, the degree of osteoporosis is the expression of widespread and chronic systemic damage due to the haematological phenotype.     

Incidence and outcome of chromosomal mosaicism found at the time of chorionic villus sampling

OBJECTIVE: Chromosomal mosaicism has been reported in about 1% to 3% of chorionic villus sampling specimens. This report provides incidence and outcome information that should be useful in counseling patients found to have mosaicism on chorionic villus sampling.STUDY DESIGN: A retrospective analysis of 11,200 consecutive patients undergoing chorionic villus sampling at the University of California, San Francisco, during the period from Jan. 1, 1984, to June 1, 1996, was undertaken.RESULTS: A total of 140 cases of mosaicism were identified for an incidence of 1.3%. Follow-up information was available for 130 cases, 26 of which (20%) were confirmed in fetal tissue. Confirmation rates for specific types of mosaicism were as follows: autosomal trisomy 7.6%, sex chromosome 25%, structural abnormality 27.3%, and marker chromosome 77.8%. Neonatal outcome was normal in all cases for which pregnancy continued.CONCLUSION: The data indicate that in most cases of chromosomal mosaicism found by chorionic villus sampling the mosaicism is unlikely to be clinically significant in the fetus. (Am J Obstet Gynecol 1997;176:1349-53.)     

Clinical features of Japanese children and adolescents with systemic lupus erythematosus: Results of 1980–1994 survey

Marked advances have been made in the past decade in the management of adults with systemic lupus erythematosus (SLE). Therefore, a nationwide retrospective survey was conducted between 1980 and 1994 to investigate the clinical manifestations of SLE in Japanese children and adolescents. Questionnaires were sent to 340 hospitals. Of 405 patients reported by 176 hospitals, 373 patients, diagnosed by the criteria established by the Pediatric Study Group of the Japanese Ministry of Health and Welfare in 1985, were enrolled in the study. Forty-nine of the 354 patients (13.8%) had relatives with a connective tissue disease within the third degree of consanguinity. The frequent manifestations in 373 patients were the presence of antinuclear antibody (98.9%), immunologic disorders (93.0%), hypocomplementemia (87.1%), malar rash (79.6%) and fever (74.0%). Lupus nephritis was present in 148 of the 309 patients (47.9%) at their first visit to a clinic, and 261 of the 373 patients (70.0%) developed renal involvement during the observation period. Of 370 patients, 92 patients (24.9%) exhibited central nervous system lupus. Of 368 patients, 192 patients (52.2%) were treated by methylprednisolone pulse therapy and 148 patients (40.2%) received immunosuppressants in combination with steroid therapy at some stage during the observation period. Survival rate at 5 years from onset was 95.9%. Management of infection, coagulopathies, and central nervous system involvement is essential to improve the prognosis of SLE in Japanese children and adolescents.     

Recent advances in molecular analysis of skeletal dysplasia

Recent advances in molecular and cellular biology have contributed significantly to the elucidation of the pathogenesis of many kinds of skeletal dysplasia. The number of skeletal dysplastic diseases that are identified to have associated abnormalities in genes has increased. Some diseases such as achondroplasia, thanatophoric dysplasia and hypochondroplasia are shown to be allelic. In addition to those diseases associated with mutations of the fibroblast growth factor receptor 3 gene, the abnormalities in collagen, Gsα, vitamin D receptor and tissue nonspecific alkaline phosphatase genes are briefly reviewed in this article.