外伤性胸椎间盘突出症的早期诊断与手术治疗

[目的]探讨外伤性胸椎间盘突出症的临床表现、早期诊断及手术治疗效果。[方法]2000年6月-2005年6月共收治外伤性胸椎间盘突出症患者11例，其中男8例，女3例，年龄15-38岁，平均23．96岁。诊断时间距外伤时间最短的为2d，最长的8个月，平均4．1个月。早期明确诊断后行经关节突入路胸椎间盘摘除术。[结果]11例患者获得1、1-3．8年术后随访，平均随访2．6年。根据Otani’s等分级方法进行疗效评价：优7例，良3例，可1例，差0例，失败0例。手术优良率为90．91％。[结论]外伤性胸椎间盘突出较少见，无典型临床表现，本症的早期诊断及早期手术治疗是远期优良疗效的保证。     

Performance measures for evaluating services for people with a first episode of psychosis

Aim: The purpose of this project was to operationalize and apply a previously identified set of performance measures designed to evaluate services for those experiencing a first episode of a schizophrenia spectrum disorder. Methods: Operational definitions were developed for previously identified measures through an iterative process of discussions between clinical experts and health‐care evaluators. Data were collected from existing sources including corporate databases, clinical databases and chart review. Results: Definitions were developed for 44 measures covering seven of eight domains recommended for service level evaluation by the Canadian Institute for Health Information domains. Forty measures could be calculated. Conclusions: The measures represent a comprehensive set of performance measures suitable for the evaluation of services for people with a first‐episode psychosis. The measures could be used by other services in order to establish standards and norms for routine clinical practice.     

Bipolar disorder in children and adolescents: obstacles to early diagnosis and future directions

Aim: This article reviews research centred around juvenile bipolar disorder with particular reference to diagnostic difficulties. Putative deficits are scrutinized with respect to trait likelihood and the roles of neuropsychology and neuroimaging in enhancing our understanding of juvenile bipolar disorder are discussed. Methods: Search terms including childhood, adolescent, youth and juvenile combined with the terms ‘bipolar disorder’, mania, depression and hypomania were used to identify relevant studies in MEDLINE and PsychLit. Results: Over recent years research into this relatively new disorder has increased phenomenally. Key issues within the field include diagnostic specificity, the heritability of the disorder, the impact of comorbidity and the implications of neuropsychological and neuroimaging findings. Conclusion: Despite concerning controversies in literature the diagnosis of bipolar disorder in children and adolescents as compared with adults, promising future research directions include better neurological characterization of the disorder through the application of findings from clinical populations, neuropsychological and neuroimaging research.     

Is endoscopic one‐piece mucosal resection essential for early gastric cancer?

Background: Endoscopic mucosal resection (EMR) is widely accepted as a minimally invasive treatment for early gastric cancer (EGC) in Japan. However, the criteria for EMR must be strictly adhered to otherwise patients will miss the chance for additional therapy. We assess the important factor in expanding the indication of EMR. Methods: We investigated 1101 EGCs that had been resected by EMR at the National Cancer Center Hospital (NCCH), Tokyo, Japan, according to the indication recommended by Japanese Gastric Cancer Association (JGCA) and the expanded indication proposed by NCCH. Curability and local recurrence of the EMRs were assessed related to the applied indication and the number of resected specimens. Results: The recurrence rate of non‐evaluable resection was higher than that of evaluable resection (P < 0.0001). Eighty‐three lesions among 772 lesions in the JGCA group were non‐evaluable. Thirty‐seven leisons among 329 lesions in the NCCH group were non‐evaluable. There was no difference in the rate of non‐evaluable resection between JGCA and NCCH groups (P = 0.8329). However, the rate of curative resection was lower in the NCCH group than in the JGCA group (P = 0.0009). In piecemeal resection, there was no difference in the rate of non‐evaluable resection between JGCA and NCCH groups (P = 0.0527). In one‐piece resection, the rate of non‐evaluable resection was lower in the NCCH group than the JGCA group (P = 0.0137). Conclusion: Based on our series of cases, we propose one‐piece resection as a gold standard for EMR because it enables accurate histological evaluation, even in the EMR, according to the expanded indication.     

A CASE OF EARLY GASTRIC CANCER ACCOMPANIED BY DIEULAFOY ULCER IN A YOUNG WOMAN

A case of early gastric carcinoma accompanied by Dieulafoy ulcer is presented. The patient, a 26‐year‐old female, visited our emergency room with chief complaints of massive hematemesis and tarry stool. The initial endoscopic examination revealed a superficial depressed lesion with a faded color accompanied by a tiny ulcer with converging folds at the anterior wall of the middle gastric body. Although no active bleeding vessel was found at that time, the patient was admitted to our hospital for further check‐ups and treatment. On the 6th hospital day, she developed massive hematemesis resulting in shock. Urgent endoscopy, this time, disclosed an exposed bleeding vessel at the small ulcer floor previously mentioned, and endoscopic hemostasis was achieved. Since, however, a biopsy at initial examination from the surrounding depressed area proved carcinoma, a partial distal gastrectomy was subsequently carried out. Histological examination of the resected specimen confirmed the diagnosis of carcinoma limited to the mucosa and submucosa along with findings consistent with Dieulafoy ulcer. This is a rare case of combination of early cancer and Dieulafoy ulcer particularly in such a young patient. A review of the literature is also presented.     

β-catenin在早期胃癌中的表达

目的：探讨β-catcnin在早期胃癌中的表达及其意义。方法：用免疫组织化学方法检测39例早期胃癌患者胃癌组织中β-catenin的表达情况。结果：39例早期胃癌中有20例存在β-catenin的异常表达，表现为细胞膜的表达缺失及细胞质和细胞核中表达增强。早期胃癌中β-catenin表达阳性率为51．28％。结论：在早期胃癌中存在β-catenin的异常表达，β-catenin的异常表达可能在早期胃癌的发生、发展中发挥重要的作用，可能是胃癌发生的一个早期事件。     

因症就诊检出早期大肠癌的临床及病理学特征

目的探讨在就诊的肛肠病人中如何提高早期大肠癌的检出率。方法在１１家医院推广对肛肠病人的四项检查程序——直肠指检，乙结镜检查，大便隐血试验，和Ｘ线气钡灌肠造影。结果在４８２１例有肛肠症状的病人中，检出大肠癌１８８例，检出率为３．９％，其中１８０例有术后病理诊断。４７／１８０例（２６．１％）属早期癌（ＤｕｋｅｓｓｔａｇｅＡ）。４１／４７例由上述四项检查作出初步诊断。初发症状为：（１）便血（２６例，持续１５．２±９．４周后就诊，肿瘤平均直径２．５８ｃｍ）；（２）大便习惯改变（９例，３３．４±１９．７周，３．３９ｃｍ）；（３）腹痛腹块（１０例，１９．２±１１．２周，５．０ｃｍ）；（４）贫血（２例，１７．２±９．９周，４．７５ｃｍ）。８／１２例的Ａ０和Ａ１期病例属便血组，并多位于直肠。４１／４７例以高、中分化腺癌为主，其中１５例伴有腺瘤癌变。术前曾作活检的２７例中，１２例未检出癌变细胞。结论四项检查对检出早期大肠癌是有效的，便血是提示早期癌最有价值的症状，加强大肠癌防治宣教，采用瘤灶多点或全瘤活检技术，高度重视大肠腺瘤和不典型增生等癌前病变，将有助于提高早期大肠癌的检出率     

蝙蝠葛碱对奎尼丁诱发的豚鼠乳头肌早后去极化及触发活动的作用

用标准微电极技术观察了中药蝙蝠葛的有效成分蝙蝠葛碱对奎尼丁诱发的豚鼠乳头肌早后去极化及触发活动的影响. 结果表明，奎尼丁2 μmol·L^-1能诱发豚鼠乳头肌早后去极化及触发活动,早后去极化的发生率为8/20, 幅值为13.4±2.6 mV, 起始电位为-42±5 mV, 触发活动的发生率为2/20. 蝙蝠葛碱20 μmol·L^-1能明显抑制奎尼丁诱发的早后去极化及触发活动，早后去极化的发生率为4/20，幅值为7.3±1.1 mV，无触发活动. 结果提示蝙蝠葛碱具有抗早后去极化所致心律失常.     

Mothers' discrimination of their neonates' cry in relation to cry acoustics: The first week of life

This study investigated the temporal evolution in the discrimination of the newborn's crying by the mother, from the first to the eighth day after birth. The sample included twenty human mothers who had had an uneventful pregnancy, labour and delivery. They were asked to identify the spontaneous cries of their newborn babies from tape-recorded cries containing cries from their own newborn and from three other newborns. On the first day, the percentage of correct answers was 48#pc, then 81 #pc on the eighth day. Two acoustic features that may underlie this discrimination were analyzed: the maximum Fo values and the average number of cry bursts per second. On the seventh day, these two acoustic variables and the discrimination abilities significantly correlate.     

促红细胞生成素治疗透析前贫血临床分析

目的观察人类重组红细胞生成素(r-HuEPO)对透析前贫血的疗效,探讨早期治疗肾性贫血的意义.方法患者分两组,治疗组应用r-HuEPO皮下注射,补充叶酸、铁剂,给予饮食疗法、大黄散、控制血压等措施.对照组不用r-HuEPO治疗,其它措施相同.观察症状、HGB、HCT、SCr和血清钾、钠、氯水平.结果治疗组症状改善,生活质量提高;HGB、HCT明显升高,与对照组比较有显著性差异(P＜0.01).血清肌酐无明显升高.结论r-HuEPO能明显提高HGB、HCT水平,安全有效治疗透析前贫血,肾性贫血早期治疗值得重视和进一步探讨.