Acute disseminated encephalomyelitis: the importance of early magnetic resonance imaging

The diagnosis of acute disseminated encephalomyelitis (ADEM) is frequently missed or delayed with consequent delay in instituting therapy in the crucial phase of the illness. The role of MRI in the diagnosis of ADEM is well established, however, the value of its early utilization of treatment on the outcome of patients has not been adequately stressed. Three patients with ADEM are described. Delay in the diagnosis of the first was associated with severe sequelae, while in the other two early diagnosis and institution of corticosteroid therapy which was facilitated by MRI, was associated with a better outcome. MRI should be carried out early once the diagosis of ADEM is entertained.     

CROSSOVER COMPARISON BETWEEN THE DEPRESSOR EFFECTS OF LOW AND HIGH WORK-RATE EXERCISE IN MILD HYPERTENSION

1. The relationship between work-rate and the antihypertensive effect of exercise in hypertensives, and the mechanism of that effect, were investigated by a crossover clinical trial. 2. Ten mild hypertensives were randomly divided into two groups. One group performed low work-rate exercise (LWE) on a cycle ergometer for 10 weeks (blood lactate threshold; ～50% of maximum oxygen consumption [V?_O2max]). After a 10 week interval without exercise training, these subjects were then switched to a high work-rate exercise (HWE) regimen (4 mmol/ L of blood lactate; ～75% of V?_O2max) for another 10 weeks. In the other group, the order of exercise training was reversed. Since two patients withdrew from the protocol during HWE periods, statistical analysis was performed on the data from the remaining eight patients. There were no order effects observed in any of the data from the two groups. 3. During both LWE and HWE, resting blood pressure (BP) fell significantly after the initiation of exercise therapy (P<0.05). Furthermore, the overall effects of 10 weeks of LWE and HWE on BP were not significantly different. 4. The work-rate at the lactate threshold, which reflects physical fitness, had increased significantly by 16 W (P<0.01) after the LWE period and by 11 W (P<0.01) after the HWE. 5. During the LWE period, changes in haemodynamic and humoral variables were not significant, except for a reduction in plasma norepinephrine at week 10 (P<0.05). In the HWE period, changes in haemodynamic and humoral variables were not significant. 6. Based on these findings, LWE is recommended for mild hypertensives because of its safety.     

Diastolic function in children and adolescents on dialysis and after kidney transplantation: an echocardiographic assessment

Thirty-seven children and adolescents on renal replacement therapy (11 on haemodialysis, 14 on continuous ambulatory peritoneal dialysis and 12 after renal transplantation) were studied by echocardiography, echo-Doppler and phonocardiography. Right and left ventricular (R/L V) diastolic functions were measured by transmitral and transtricuspid flow velocities and by LV isovolumic relaxation time (LVIRT). Thirty-seven age- and sex-matched healthy subjects served as controls. R/L V diastolic dysfunction was only observed in the dialysis patients. In these patients LVIRT was prolonged. LV and RV peak inflow velocities were increased both in early (E) and late (A) diastole with a reduction in the E/A ratios. This pattern of diastolic dysfunction is compatible with the combined effects of a hypercirculatory state (volume overload, anaemia, arteriovenous fistula) and an abnormality of cardiac relaxation. The transplant patients showed no major cardiac abnormalities.     

Clinical Study on Long-Term Treatment of Ankylosing Spondylitis with Integrative Medicine

Ａｎｋｙｌｏｓｉｎｇｓｐｏｎｄｙｌｉｔｉｓ（ＡＳ）ｉｓａｒｈｅｕｍａｔｉｃｄｉｓｅａｓｅｗｉｔｈｈｉｇｈｉｎｃｉｄｅｎｃｅ，ｉｎｄｕｃ ｉｎｇｄｉｓａｂｉｌｉｔｙａｎｄｉｎｖａｄｉｎｇｔｈｅｓｐｉｎａｌａｘｉａｌｊｏｉｎｔａｓｉｔｓｃｈｉｅｆｃｈａｒａｃｔ     

腺病毒介导的HSV—tk基因治疗大鼠脑胶质瘤实验研究

目的：带有ＨＳＶ－ｔｋ基因的重组腺病毒（ＡｄＨＣＭＶ－ｔｋ）结合核苷类似物（ＮＡ）治疗大鼠Ｃ６脑胶质瘤。方法：用Ｘ－ｇａｌ染色测定ＡｄＨＣＭＶ－ｌａｃＺ转染大鼠Ｃ６胶质瘤细胞的效率。用ＡｄＨＣＭＶ－ｔｋ／ＡＣＶ、ＧＣＶ离体及活体治疗大鼠Ｃ６胶质瘤。结果：ＡｄＨＣＭＶ－ｌａｃＺ感染Ｃ６细胞效率达１００％，ＡｄＨＣＭＶ－ｔｋ感染Ｃ６细胞，在病毒感染复数为１０００时，ＧＣＶ和ＡＣＶ半致死剂量分别为３μｇ／ｍｌ和２０μｇ／ｍｌ，Ａｄ－ＨＣＭＶ－ｔｋ／ＡＣＶ治疗大鼠Ｃ６胶质瘤模型，大鼠生存期超过９０天，而对照组分别为１７．０±１．６天（生理盐水组）、１４．５±１．３天（ＡｄＨＣＭＶ－ｌａｃＺ组），Ｐ＜０．００１。结论：重组腺病毒对靶细胞感染效率可达１００％，ＡｄＨＣＭＶ－ｔｋ用ＧＣＶ的杀伤Ｃ６胶质瘤细胞比ＡＣＶ强，而ＨＳＶ－ｔｋ／ＡＣＶ用腺病毒介导治疗大鼠脑肿瘤疗效显著。     

On the Limitations of Therapy Manuals

While the benefits of training manuals can hardly be questioned, they are exceedingly limited in reducing variability attributed to the "therapist factor." We propose that manuals provide a useful outline of the general principles of a therapeutic approach, but can only reduce therapist variability at the expense of other essential therapeutic phenomena. Manuals cannot adequately convey, for example, how the effective therapist functions as a model of adult living and as a person who provides guidance. We suggest that such an experience cannot readily be packaged in manualized form, though manuals may serve as a useful beginning. Recommendations for therapist manualized training include greater attention to the subtleties of human relationships and adequately conveying that any technique is effective only when catalysed by a living, relational process.     

Long-term effect of estradiol implants on the female urinary tract during the climacteric

The incidence of lower urinary tract dysfunction increases during the climacteric, and there is embryological, biochemical and epidemiologic evidence to suggest that depleted estrogen status is at least partially responsible. Twelve climacteric women underwent full assessment before and 1 year after treatment with a 50 mg subcutaneous estradiol implant +5 mg norethisterone for 7 days per month. Assessment consisted of a symptoms questionnaire, midstream urine sample, uroflowmetry, videocystourethrography with pressure flow studies, and urethral pressure profilometry. Subjectively, only the symptom of nocturia significantly improved. There was no change in flow variables but there was a significant decrease in residual urine and the degree of bladder base descent. Cystometric capacity was slightly but significantly decreased, and two patients developed genuine stress incontinence whilst on treatment. Nonetheless, there was a significant improvement in urethral pressures at rest but not under stress. This effect was predominantly in the proximal urethra. These data do not support the contention that estrogen replacement therapy is beneficial for lower urinary tract dysfunction during the climacteric.     

两种剂量的7-甲异炔诺酮对60例绝经后妇女症状控制的比较

目的:探讨两种剂量的7-甲异炔诺酮(OrgOD14,利维爱)对绝经症状控制的比较。方法:60例绝经后妇女随机分为两组:①A组30例,每日口服7-甲异炔诺酮2.5mg。②B组30例,隔日口服7-甲异炔诺酮2.5mg,共6个月。观察服药前后的Kupperman评分变化及血雌二醇、促卵泡激素水平的改变。结果:两组服药后绝经症状明显改善,Kupperman评分明显降低(P<0.01),雌二醇水平显著上升(P<0.01),促卵泡激素水平明显下降(P<0.05),而两组之间差异无显著性。结论:7-甲异炔诺酮可有效地控制绝经症状,每日口服2.5mg并不比隔日口服2.5mg有较好的控制效果(除控制失眠外),故推荐隔日口服2.5mg7-甲异炔诺酮。     

38例非小细胞癌脑转移的综合治疗分析

目的探讨非小细胞肺癌脑转移的有效治疗方案.方法对38例非小细胞肺癌脑转移患者进行头部、胸部放疗并结合全身化疗的综合治疗.结果近期疗效的有效率为76.3%(29/38).神经精神症状缓解率73.7%(28/38),肺部症状缓解率60.5%(23/38).1年生存率31.5%(12/38),2 a生存率10.5%(4/38).结论合理采用综合治疗可有效提高非小细胞肺癌脑转移患者的生存率.