鼻部源性突眼的CT分析

目的：为了提高对鼻部源性突眼的认识。材料和方法：本文19例鼻部源性突眼，其中鼻咽癌7例，鼻咽纤维血管瘤2例，鼻腔纤维血管瘤、恶性肉芽肿和嗅神经母细胞瘤各1例，上颌窦癌和软骨肉瘤各2例，上颌窦恶性肉芽肿、纤维肉瘤和恶性纤维组织细胞瘤各1例，全部病例均作轴位CT扫描，12例加作增强扫描，详细分析了它们CT表现。结果：源于鼻咽的放疗前鼻咽癌和纤维血管瘤，其病变主要位于鼻咽腔和咽旁，后者显著增强并有钙斑，与前者不同；源于上颌窦的肿瘤，病变占据上颌窦的全部或大部分，软骨肉瘤有钙斑且无强化，易与其它肿瘤区别，它们破坏上颌窦顶部进入眼眶；鼻腔嗅神经母细胞瘤在鼻腔和筛窦形成肿块，破坏筛骨眶板侵入眼眶。结论：根据CT所见，可判断突眼原因。     

Phase II trial of piroxantrone in patients with recurrent and metastatic squamous cell carcinoma of the head and neck

Summary Twenty-two patients with recurrent or metastatic squamous cell carcinoma of the head and neck were treated with piroxantrone 150 mg/m² intravenously every 21 days. There were no objective responses. The 95% upper confidence bound for response is 15%. Primary toxicity was hematologic.     

Localized proton magnetic resonance spectroscopy of a cerebellar tumor in a two-year-old child

Noninvasive localized proton magnetic resonance spectroscopy (MRS) was used for differential diagnosis of a focal brain lesion in a 2.5-year-old girl. The clinical signs were a mild head tilt and neck pain. Magnetic resonance imaging (MRI) revealed a lesion in the right hemisphere of the cerebellum, but its nature remained obscure. In this lesion quantitative determinations of cerebral metabolites by fully relaxed, short-echo-time proton MRS revealed markedly lowered N-acetylaspartate (NAA) and pronounced elevations of choline-containing compounds (Cho) and myo-inositol (Ins), whereas metabolite concentrations in cortical gray matter and white matter were within normal ranges. The metabolite pattern of the lesion indicated loss of vital neuroaxonal tissue (low NAA) and enhanced glial proliferation (high Cho and Ins), which, together with the MRI morphology, suggested a brain tumor. The diagnosis was established by neurosurgical exploration and total extirpation of the tumor. Histology confirmed an astrocytoma (WHO II). After 2 weeks' recovery the child was discharged with no neurological signs.     

Patient-proxy response comparability on measures of patient health and functional status

The present study evaluates the response comparability between 361 elderly hip fracture patients admitted from the community to seven Baltimore area hospitals between 1984 and 1986 and interviewer selected proxies on items pertaining to patients' pre-fracture health and functional status. Agreement across items ranges from very poor to good and varies with respect to the health or functional area assessed. Proxies tend to overestimate patient disability relative to the patients themselves, especially with regard to capacity to perform instrumental activities of daily living. Although proxies who report the greatest contact with patients respond most comparably to the patients, when they do disagree, proxies with the greatest patient contact tend to overestimate patient disability. The authors suggest that attention to item construction and phrasing may improve response comparability.     

儿童原发性腹膜后恶性肿瘤的诊断与治疗

分析原发性腹膜后恶性肿瘤１２例。８３％以腹块和腹痛为主要症状，体征中腹块占９１．５％，以恶性淋巴瘤居首位占６１％。全组完全切除率为５８％，行脏器联合切除占２５％。完全切除加放疗、化疗３年存活率为２８．５％，部分切除及活检未给其它治疗者５例预后差，均１年内死亡，差别显著。     

Health-related quality of life assessed before and during chemotherapy predicts for survival in multiple myeloma

Measurement of health-related quality of life was integrated into a randomized trial (NMSG 4/90) comparing melphalan/prednisone to melphalan/prednisone + interferon α-2b in newly diagnosed multiple myeloma. One of the aims of the study was to assess the prognostic significance of quality-of-life scores, using the EORTC QLQ-C30 questionnaire. Univariate analysis showed a highly significant association with survival from the start of therapy for physical functioning as well as role and cognitive functioning, global quality of life, fatigue and pain. In multivariate analysis, physical functioning and W.H.O. performance status were independent prognostic factors ( P values=0.001 for both) when analysed in a Cox regression model with the somatic variables β-2 microglobulin, skeletal disease and age. The best prediction for survival from the start of therapy was obtained by combining the β-2 microglobulin and physical functioning scores in a variable consisting of three risk factor levels with an estimated median survival of 17, 29 and 49 months, respectively. At a 12 months landmark analysis, the relative risk for patients with physical functioning score 0–20 v 80–100 was 5.63 (99% CI 2.76–11.49), whereas the relative risk for patients without an objective response to chemotherapy compared to those with at least a minor response was 2.32 (99% CI 1.44–3.74). Quality-of-life assessment may be an independent and valuable addition to the known prognostic factors in multiple myeloma.     

Constraints on Social Activities of Care-Givers: A Sociological Perspective

Newer policies of community care for those with disabilities have resulted in the home becoming the usual site of care. Policy makers must now give attention to the needs of those at home giving this care. This article explores the constraints on sociability opportunities of 73 mothers who were caring for children with disabilities. These opportunities are often built into leisure pursuits for women without caring responsibilities. However, choice of out-of-house leisure activity was circumscribed for the mothers in this study and their reported leisure activities revolved around home and neighbourhood. Even these sites offered limited scope for sociability because of the way in which caring affected domestic space and because of the characteristics of the modern Australian suburb. It is argued in this paper that personal time and personal domestic space are needed by care-givers so their sociability needs can be fulfilled. An understanding of the constraints imposed by use of the home as a place of care may make possible the planning of a rearrangement of domestic space to increase sociability opportunities for carers.     

Angiodysplasia as the cause of massive lower gastrointestinal hemorrhage in a young adult

PURPOSE: This study was undertaken to clarify the importance of bleeding vascular ectasia of the colon as the etiology of massive lower gastrointestinal hemorrhage in patients 40 years of age or younger. METHODS: An otherwise healthy 21-year-old male was admitted to a tertiary medical center with massive lower gastrointestinal hemorrhage. Technetium-labeled red blood cell scan, selective visceral angiography, and colonoscopy identified the source of bleeding as vascular abnormality of the descending colon. Segmental colonic resection was performed. RESULTS: Histologic review of the specimen demonstrated a vascular ectasia. The patient recovered uneventfully and has had no further stigmata of hemorrhage. A review of the literature was undertaken to make clear the significance of vascular ectasia as the source for massive colonic hemorrhage in the young adult. CONCLUSION: This is the first report that documents histologically a vascular ectasia as the source of massive lower gastrointestinal hemorrhage in an otherwise healthy patient less than 40 years of age. Vascular ectasia is an uncommon cause of lower gastrointestinal hemorrhage in the young adult.The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigation Program sponsored this report #84-16-1968-532, as required by HSETCINST 6000.41A. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.     

460例胃癌纤维胃镜活检标本的病理观察

本文分析了460例胃癌胃粘膜活检资料,结果:男:女为2.36:1:51～60岁年龄组发病率最岛(37.17％);发生部位以胃窦部最多见,占46.74％;组织学分类以低分化腺癌最多,占51 52％;在伴随病变中,畅化生的检出率为21.74％,胃腺囊为35％,胃粘膜上皮异型增生为32.61％。本组材料提示,不完全性大肠型肠化生、异型胃腺囊及胃粘膜中度以上异型增生与胃癌有密切关系。     

小儿内伤头痛辨治

74例小儿慢性头痛经辨证治疗,显效80.95%,好转16.67%,无效2.38%。痰浊头痛二陈汤或半夏白术天麻汤加减;肾虚头痛,杞菊地黄汤加减;淤血头痛,补阳还五汤;气血虚头痛八珍汤加减。指出了小儿内伤头痛的病因病机,并指出脑电图,脑阻抗血流图、CT、甲皱微循环可做为此病的诊断及疗效指标。