Primary linitis plastica of the descending colon: A case report

A rare case of primary linitis plastica carcinoma of the colon seen in a 44 year old Japanese man is described herein. The patient had a complete obstruction of the descending colon and was treated with a loop colostomy followed shortly afterward by a left hemicolectomy. At the time of the second operation, the entire thickness of the colonic wall was found to be infiltrated by cancer cells, however, the other intraabdominal organs were free of cancerous involvement. The histopathological diagnosis made at this time was primary linitis plastica carcinoma of the descending colon. Nine months later, the patient developed an intestinal obstruction and relaparotomy revealed diffuse peritoneal dissemination. Two years after the first operation, upper GI films and a gastrofiberscopic examination revealed gastric involvement. The patient died 28 months after his initial operation, and autopsy revealed widespread metastases in the peritoneal surface, paraaortic lymph nodes, small intestine, remaining colon and stomach.     

Effects of STA-MCA anastomosis for ischaemic oculopathy due to occlusion of the internal carotid artery

Summary Effects of STA-MCA anastomosis on two patients with neovascular glaucoma due to occlusion of the internal carotid artery are presented. Both patients improved in visual acuity and central retinal artery pressure as well as in signs of transient ischaemic attack. Postoperative angiography showed a marked decrease in collateral flow through the ophthalmic artery, which is reversed from the normal direction, with the development of blood flow through the anastomosis. Discussion is offered indicating that the lack of collateral flow through both the anterior and posterior communicating arteries is important in addition to occlusion of the internal carotid artery in order to produce full-blown ischaemic oculopathy such as venous stasis retinopathy, neovascular glaucoma or rubeosis iridis. It is stressed that EC-IC bypass surgery should be performed soon after the appearance of ischaemia and before the development of neovascular glaucoma or rubeosis iridis in order to obtain normal vision. In ischaemic oculopathy the results of EC-IC bypass can be evaluated objectively and quantitatively by many noninvasive neuro-ophthalmological tests which are important in discussing the efficacy of the bypass surgery.     

Primary orthostatic tremor is an exaggeration of a physiological response to instability.

Primary orthostatic tremor (POT) is a rare disorder characterised by an intense sense of unsteadiness upon standing and a 16-Hz tremor in which the timing between tremor bursts in different muscles (unilateral and bilateral) remains constant. Hitherto, similar EMG activity has not been described in healthy subjects and it has been postulated that the oscillations seen in POT are primarily pathological. In this study, EMG was recorded from tibialis anterior in healthy subjects who were made unsteady through vestibular galvanic stimulation or leaning backwards. Under these conditions, a peak at approximately 16 Hz was seen in the coherence between the left and right tibialis anterior. This bilateral coherence was absent when the subjects activated the same muscles when not unsteady. These data indicate the existence of a physiological system involved in organising postural responses under circumstances of imbalance and characterised by a highly synchronised output at approximately 16 Hz. In addition, the results suggest that the core abnormality in POT may be an exaggerated sense of unsteadiness when standing still, which then elicits activity from a 16-Hz oscillator normally engaged in postural responses.     

Empowering practice nurses in the follow-up of patients with established heart disease: lessons from patients' experiences

This paper reports on the views of patients with established heart disease of a structured programme of follow-up care provided by practice nurses (PNs) in general practice in England. It is based on in-depth interviews with 22 patients receiving an integrated primary and secondary care intervention being developed and piloted for patients following heart attack or diagnosis of angina. Patients identified the important features of follow-up care to be easy access to a health professional who possessed knowledge and social and emotional skills. A range of views about the ability of PNs to provide such care emerged from patients' accounts. patients' perceptions about the seriousness of their condition and the way PN follow-up care was provided in practices emerged as important issues affecting patients' views. In addition, perceptions about the practice nurse's role, status and knowledge, existing relationships with general practitioners, and issues of communication were also important factors. It is concluded that in order to develop high-quality PN-led services for patients with established heart disease, four issues need to be taken into account: practice nurse training; continuity of follow-up care; the integration of the primary and secondary care interface; and development of the practice nurse's status within the primary health care team.     

原发性青光眼的激光治疗

目前在青光眼的临床治疗中，激光治疗已成为介于药物和手术治疗之间的一种方法，本文仅就原发性闭角型青光眼的激光周边虹膜透切术和开角型青光眼的激光滤帘成形术做一介绍。     

青光眼患者相对性瞳孔反射传入障碍与其两眼视野面积差值的比较

对伴有相对性瞳孔反射传入障碍（RAPD）的26例非对称性青光眼（17例原发性开角型青光眼和9例青睫综合征）患者，将RAPD定量值与其两眼视野面积差值（VFAD）进行相关分析。结果显示Ⅰ2e、Ⅰ4e和Ⅲ4e等视线VFAD与RAPD值的相关系数分别为0.70、0.81和0.88，各相关系数经统计学检验均有极显著意义（P＜0.001）。表明RAPD测量在揭示青光眼不对称性视功能损害方面与视野检查具有一致性。因而RAPD可以作为非对称性青光眼视功能损害的重要体征之一。     

第二原发胰腺癌临床特征分析

目的:探讨第二原发胰腺癌的临床特征.方法:以96例普通原发胰腺癌作为对照,回顾性分析了病理确诊的32例第二原发胰腺癌的临床特征.结果:32例第二原发胰腺癌15例(46.9％)发生于乳腺癌、胃癌之后.性别、年龄、部位、临床症状、常规实验室检查及肿瘤标志物检测与普通进展期胰腺癌具有可比性,仅年龄略为提前,消化不良稍多,腹痛、黄疸比例稍降.B型超声、CT、MRI、逆行胰胆管造影诊断敏感率较普通胰腺癌高.处于Ⅰ期者仅2例(6.3％).总体半年存活率为50.0％,较普通胰腺癌略低.病理显示84.4％为腺癌,分化差.结论:第二原发胰腺癌症状更不典型,诊断更为滞后,预后更差,故应加强联系与第一次癌肿的早期检测手段(如肿瘤标志物)研究.     

Executive cognitive deficits in primary dystonia.

Primary dystonia is a disorder of movement for which no consistent pathophysiology has been identified; in the absence of evidence to the contrary, it is assumed to be cognitively benign. We have studied a clinically heterogeneous group of 14 patients with primary dystonia on a battery of neuropsychological tests. Despite well-preserved speed of information processing, language, spatial, memory and general intellectual skills relative to normal controls, we have identified a constellation of attentional-executive cognitive deficits on the Cambridge Neuropsychological Test Automated Battery (CANTAB). Specifically, patients demonstrated significant difficulties negotiating the extra-dimensional set-shifting phase of the IED task. The implications of these findings for the pathophysiology of primary dystonia are discussed. This is, to the best of our knowledge, the first report of a significant cognitive deficit in patients with primary dystonia.     

中国食管癌高发区食管原发性腺癌组织病理学研究Ⅰ．食管原发性腺癌的临床病理学分析

中国食管癌高发区河南省近１５年（１９８０～１９９４）病理确诊的７３６４例食管癌中，其中食管原发性腺癌（ＰＥＡ）２３９例，占３．２５％。通过对２３９例ＰＥＡ手术标本（包括早期癌２０例，其余为中、晚期癌）切片系统观察，指出中国食管癌高发区ＰＥＡ主要起源于食管固有腺体的各级导管部分。ＰＥＡ的病理组织学可分６型：腺导管癌（１０９例）、腺鳞癌（５４例）、腺样囊性癌（２９例）、粘液表皮样癌（２０例）、基底细胞样癌（１５例）、胃型腺癌（１２例）。每型的组织图象及预后均各有特点，提示ＰＥＡ组织学再分型有意义。     

周边视网膜冷凝联合睫状体冷凝治疗新生血管性青光眼

目的评价周边视网膜冷凝联合睫状体冷凝治疗新生血管性青光眼的效果。方法总结68例(72眼)的临床资料，对术后效果进行分析、评价。结果68例(72眼)患者术后1周～1年平均眼压19．83mmHg(2．65kPa)，术后1月大部分新生血管萎缩退化。结论周边视网膜冷凝联合睫状体冷凝治新生血管性青光眼是一种比较有效的方法。