Adenoid hypertrophy presenting with systemic hypertension

A two and half year old male child was seen with systemic hypertension, left ventricular dysfunction, mitral regurgitation and congestive cardiac failure. Examination revealed adenoid hypertrophy. He was also suffering from obstructive sleep apnea. He was being treated with anti-hypertensive and anti-failure drugs. Adenoidectomy was performed following which obstructive sleep apnea symptoms disappeared and his cardiac status improved markedly. Subsequently he was weaned off anti-hypertensive and anti-failure therapy.     

腹腔热灌注化疗在卵巢癌术后的应用探讨

目的：探讨卵巢癌术后腹腔热灌注化疗的可行性、安全性及短期疗效。方法：对2002年7月至2005年12月收治的25例卵巢癌，术中均行根治或姑息性切除；对直径≥0．5cm的腹腔内转移灶用电刀减量戮灭。术后第1d开始，每日腹腔热灌注化疗1次，每次60-90min，一般4次为1疗程，共计做98次。结果：循环通畅率96．9％（62／64），治疗时间内腹腔内温度82％达到41℃以上，各出水管温度均超过41℃，并保持60～90min。并发症及毒副反应有：轻度腹腔感染2例，腹痛4例，恶心呕吐2例，转氨酶轻度升高1例。随访6～27个月，术后每3个月复查1次B超或CT，腹腔转移3例，腹腔转移率为18．8％，1例术后6个月死于全身广泛转移，另1例术后13个月死于腹腔转移及肝转移。最长1例随访时间为29个月，现仍存活。结论：术后早期腹腔热灌注化疗安全，腹腔内温度较均匀，可多次进行，并发症少且毒副反应小，有利于卵巢癌术后腹腔内较小的残余癌或游离癌细胞的杀灭。     

Factors leading to long-term hospitalization after laparoscopic appendectomy.

BACKGROUND: Randomized studies demonstrate that laparoscopic appendectomy yields better results compared with open techniques. We sought to identify factors that determine an extended hospital stay among patients undergoing laparoscopic appendectomy. METHODS: This was a prospective study including 669 patients undergoing laparoscopic appendectomy. We analyzed variables that can predict the length of hospital stay. RESULTS: Of 669 patients undergoing laparoscopic appendectomy, 141 stayed in the hospital for > or = 5 days (Group 1), and 97 stayed in the hospital for < or = 1 day after surgery (Group 2). The univariate analysis demonstrated that fever (P<0.0001), nausea and vomiting (P=0.060), leukocytosis (P<0.0001), gangrened or perforated intraoperative appearance of the appendix (P<0.0001), and appendix position behind the ileocecal junction (P<0.001) were related to a longer hospital stay. The multivariate analysis through logistical regression showed that the factors independently and significantly associated with an extended hospital stay were presurgical fever, appendix position behind the ileocecal junction, and intraoperative gangrened or perforated appearance of the appendix. CONCLUSION: Fever, appearance, and position of the appendix are factors related to an extended hospital stay.     

中老年晚期非小细胞肺癌射频损毁治疗与化疗的临床比较

目的:探讨射频损毁治疗晚期非小细胞肺癌的疗效及应用价值。方法:自1999年12月至2000年8月收治73例晚期中老年非小细胞肺癌患者,分别给予射频损毁治疗和以铂类为主的联合化疗;观察比较其近期疗效、中位生存期、1年及2年生存率;并分析其治疗后生存质量。结果:射频损毁治疗组有效率(CR+PR)为71.5％(30/42),明显高于化疗组的43.3％,差异呈显著性,(x2=4.63,P<0.05)。射频损毁治疗组中位生存期、1年及2年生存率及治疗后生存质量均高于化疗组。结论:射频损毁治疗对晚期非小细胞肺癌治疗,具有较好的中期疗效,且能明显提高生存质量。     

Disability,depression and somatization in a low back pain population

Objective: The aim of this study was to determine the prevalence of low back pain (LBP) in a primary care setting population and examine its association with the symptoms of depression and somatization. Methods: This is a cross‐sectional study, utilising a survey carried out in primary health care clinics (PHCs) in Al‐Ain, United Arab Emirates (UAE). A multistage stratified sampling design was used and a representative sample of 1304 UAE nationals aged 18–65 years who attended PHC clinics for any reason were included and 1103 (84.5%) subjects agreed to participate and responded to the questionnaire during a period from June 2001 to January 2002. A specially designed questionnaire with three parts was used for the data collection: socio‐demographic information of the studied subjects, modified version of the Roland‐Morris scale for evaluating back‐related functional disability and SCL‐90 R for depression and somatization subscales was used to assess depressive and somatic symptoms. Results: Of the total number of subjects surveyed (1103), 586 (53.1%) were men and 517 (46.9%) women. The mean age was 34.9 ± 13.4 years for men and 33.5 ± 11.8 years for women. The prevalence of LBP in the studied subjects was 64.7% (95% CI, 60.7–68.5] with 46.7% among men and 53.3% among women. There were a significant differences between the subjects with LBP and without LBP with respect to gender (P < 0.001), body mass index (BMI) (P < 0.001), occupational status (P < 0.001) and living environment (P = 0.016). Functional disability was higher in patients with LBP. Young patients in aged 15–34 years, patients with preparatory/secondary educational level and students showed higher depressive symptoms. A similar pattern was found in patients with somatic symptoms. Factor analysis revealed a strong association between depression and somatization in LBP patients. Conclusions: Functional disability was higher in with LBP. Furthermore, symptoms of depression and somatization are prevalent among LBP patients.     

Measuring staff perceptions of challenging behaviour: the Challenging Behaviour Attributions Scale (CHABA)

Causal attributions may interact with other variables to determine staff responses to challenging behaviour. Furthermore, staff perceptions of the causes of challenging behaviour are likely to change as a result of theoretical and practical training. However, there is no established simple method for measuring staff attributions that could facilitate research in these areas. The present paper describes the development and preliminary psychometric analysis of the Challenging Behaviour Attributions Scale (CHABA).     

Rb1基因第16内含子内21个碱基缺失1例

目地研究双眼视网膜母细胞瘤患者Rb1基因杂合性突变的分子生物学特性。方法应用PCR—SSCP直接测序技术检测双眼视网膜母细胞瘤患者白细胞DNA中Rb1基因杂合性突变。结果50例证实有Rb1基因杂合性突变的病例中有1例发生于第16内含子中可以用3种定位方法解释、具有相同序列的21个碱基缺失。结论这种极为少见的Rb1基因突变方式可能是由于破坏了正常拼接位点的结构而激活了“隐蔽拼接位点”，导致异常的Rb1基因mRNA产生或由此影响整个拼接过程。     

Ocular findings in familial adenomatous polyposis

Background: Retinal pigment epithelium (RPE)lesions are predictive congenital phenotypic markersfor familial adenomatous polyposis (FAP). Thisprospective screening study aims at assessing theincidence and significance of these lesions in FAPpatients and their family members.Methods: Sixty-two members from three familiesincluding five patients with the diagnosis of FAP havebeen ophthalmologically surveyed. All RPE lesions weredocumented with fundus photography and fluoresceinangiography was performed in 13 subjects.Sigmoidoscopy and/or radiological examination wereperformed annually in 9 family members with typicalRPE lesions during 4 years to allow early diagnosis ofFAP.Results: Typical RPE lesions were present infive FAP patients and 15 family members.Telangiectatic dilatations in the retinal peripherywith small dot-like hemorrhages were detected in 6subjects from 3 families These lesions wereparticularly evident on fluorescein angiography.Annual colon analysis showed polyps in 3 out of 9subjects who were positive for RPE lesions.Conclusion: RPE lesions are valuable as aclinical marker in predicting FAP. The co-existingperipheral vascular alterations which have not beenreported before, are probably related to FAP.     

论《金匮要略》基本学术思想及辨病与辨证——从《脏腑经络先后病脉证第一》谈起

研究《金匮要略》的重点应该放在对于各种疾病的辨证论治上，而不是某些证或某些方。这里涉及到如何看待病与证以及辨病与辨证的关系。以《金匮要略》的基本学术思想立论，从四个方面阐述了在整体论思想指导下的辨证论治体系，首先注重的是病；辨证方法的确立是由在发病学上具有不同性质特点的疾病所决定的；四诊所得的各种临床信息是为了辨病然后辨证；只有正确把握病与证的关系，才有可能真正理解和掌握“治未病”的实质。     

金地鼠颊囊癌前病变的细胞增殖动力学研究

目的研究口腔上皮组织癌和癌前病变的细胞动力学变化特征。方法采用Ｓａｌｅｙ的ＤＭＢＡ涂布诱导法，建立金地鼠颊囊癌前病变模型，并用溴脱氧尿苷流式细胞动力学检测方法，对３０只叙利亚种金地鼠进行分组对照研究。结果涂药组光镜下的细胞病变程度随涂药时间延长而逐渐加重，而空白对照组无变化；ＦＣＭ检测显示涂药组与对照组在Ｓ期阳性细胞检出率存在显著差异。即使在光镜下表现为轻度不典型增生时，ＦＣＭ检测结果也有显著差别。结论金地鼠颊囊癌前病变具有细胞异常增殖的细胞动力学特征