The effect of adjuvant therapy with or without tamoxifen on the endocrine function of patients with breast cancer

The ovarian and pituitary functions of 64 operable breast cancer patients undergoing adjuvant therapy with cytotoxic chemotherapy and/or tamoxifen were investigated. The post menopausal patients, divided into 3 treatment groups, one with tamoxifen alone, one with tamoxifen and chemotherapy and the other with chemotherapy alone had serum estradiol 17-β (E2) and progesterone levels lower than the evaluable limits. Although there was no significant difference in the level of estrone sulfate (E1-S) between these three groups, the level of lutainizing hormone (LH) and follicle stimulating hormone (FSH) in the patients treated with tamoxifen alone and tamoxifen and chemotherapy were significantly lower than those treated with chemotherapy alone. The decrease in gonadotropin levels induced by tamoxifen treatment was reversible as it appeared after the initiation of tamoxifen and recovered after its cessation. In the premenopausal patients, a group treated with tamoxifen and chemotherapy had significantly higher E1-S, E2 and progesterone levels and significantly lower gonadotropin levels than a group treated with chemotherapy alone or one treated with a cyclophosphamide regimen. These increases in the levels of estrogen and progesterone were also reversible, and induced by tamoxifen. Thus, adjuvant endocrinochemotherapy causes profound alteration in the hypothalamo-pituitary-ovarian axis and therefore, monitoring a variety of hormonal levels is thought to be necessary for assessing the consequences of adjuvant therapy in breast cancer patients, especially in premenopausal patients using tamoxifen.     

Adenoma malignum (minimal deviation adenocarcinoma) of the cervix responsive to hormonal treatment

Adenoma malignum (AM) is a rare variant of cervical adenocarcinoma with an unfavorable prognosis despite radiation therapy, surgery, or chemotherapy either alone or in combination. Hitherto, however, the effectiveness of hormonal therapy for this condition has not been evaluated. We report on a patient with cervical AM treated with progesterone before surgery. The progesterone therapy resulted in a complete clinical response and partial surgical response. Later on the treatment was changed to tamoxifen because of side effects of the progesterone treatment. The patient is still without evidence of disease 42 months after the start of the hormonal therapy. The progesterone receptor analysis on the biopsy was clearly positive. This is, to our knowledge, the first case of an AM responsive to hormonal treatment. Furthermore, this is the first case of an AM with bone metastases at the time of primary diagnosis.     

Worksite health promotion programs in the United States: progress, lessons and challenges

Worksite health promotion programs have become increasinglyprevalent in the United States, and one or more health promotionprograms are found in two-thirds of all private worksites with50 or more employees. Reasons for recent growth in program frequencyinclude increased concern for worker health, rapidly escalatingemployer payments for health care benefits to workers, and growingevidence of a strong linkage between employee health and productivity.Published results of evaluations to date suggest that worksitehealth promotion programs can have positive impacts on healthbehaviors and health status. In addition, economic analysesare suggesting that some programs can affect the slope of healthcare costs and have the potential of high cost-effectivenesscompared to some clinical interventions. A number of researchchallenges remain, particularly understanding the influencesof the worksite environment and how employee health promotionprograms affect individual and organizational productivity.     

中西医结合治疗肺心病心律失常40例疗效观察

为提高肺心病心律失常的临床疗效,采用中药清肺化痰活血剂配合抗菌素及氧疗法对40例肺心病并发心律失常患者进行了治疗观察,同时与单纯使用抗菌素及氧疗法治疗的40例患者进行对照。临床以心电图改善情况为观察指标,结果两组有效率分别为87.5％和67.5％。Ridit分析结果表明,治疗组疗效明显优于对照组,经显著性检验,两组差异显著(P<0.05)。     

大鼠子宫内膜抗菌成分的初步分析

作者以１％乙酸冲洗ＳＤ大鼠子宫内膜，获得子宫内膜酸溶性提取物。利用琼脂糖弥散法和电泳凝胶琼脂糖弥散法抗菌试验发现，子宫内膜提取物有三条主蛋白带对致病性大肠杆菌ＭＬ－３５Ｐ耐药株有强抗菌活性，这三条抗菌蛋白带命名为ＲａｔＵＰ－１，ＲａｔＵＰ－２和ＲａｔＵＰ－３，分别占子宫内膜提取物总蛋白量的４．５％，５．７％和６．６％。虽然提取物存在溶菌的活性，但其含量甚微，在ＡＵ一ＰＡＧＥ图谱上亦未能显现溶菌酶条带。本实验的结果提示子宫内膜合成一类抗菌多肽，可能在子宫抗菌机制中发挥重要作用。     

Practices of reading and writing: the constitutive role of the patient record in medical work

This paper contributes to a reappraisal of the sociological significance of the medical record. Building upon re-evaluations of the notion of ‘representation’ in ethnomethodological and science and technology studies, it attempts to portray the medical record as an artefact which mediates the social relations that act and work through it. Through practices of reading and writing, it is argued, the medical record figures as a fundamental, constitutive element of medical practice. To address some of the dimensions that are involved, three case fragments are discussed. The way the medical record enters into the process of ‘medical decision making’ in the doctor-patient interaction, and into that interaction itself, is discussed first. Subsequently, some aspects of how the record mediates medical work as it is performed in the wards of a hospital are outlined. A third instance of its prominent role demonstrates how practices of reading and writing tend to produce particular renderings of patients’ histories - including notions of how medical work is structured.     

Computerized diagnosis: implications for clinical education

The advent of the small computer as a basic clinical tool will have a significant impact on clinical practice and medical training. The application of probability theory to clinical diagnosis has led to the development of several practical diagnostic programs which run on small computers. Expert systems--interactive programs which function as 'electronic consultants'--have now been successfully developed for a number of clinical situations. Experience with two of these, INTERNIST/CADUCEUS and MYCIN, has provided insight into problems and prospects for expert systems in medicine. Less complex programs, particularly those employing clinical prediction rules, and expert system shells, seem well suited for clinical environments. Although computerized medical diagnosis holds great promise as an aid to clinicians, its success will largely be determined by the quality of the information that clinicians provide for analysis. A brief review of the status of bedside diagnosis reveals that data-gathering strategies and techniques must be better understood. In order to take full advantage of computer programs for diagnosis, basic diagnostic skills must be more heavily emphasized in clinical training.     

从脾论治磺脲类降糖药继发性失效

对 64例 2型糖尿病继发磺脲类降糖药失效患者 ,在继续口服磺脲类药的基础上加用健脾中药 ,结果显效 1 5例 ,有效 3 6例 ,无效 1 3例 ,总有效率 85 .2 4% ;治疗前后血糖明显下降 ,有显著性差异 ( P<0 .0 0 1 )     

哺乳妇女单次注射迪波盖司通~长效避孕针后血清和乳液中MPA浓度变化

目的:探讨中国妇女哺乳期使用迪波盖司通后血清和乳液醋酸甲羟孕酮(MPA)浓度变化。方法:10名产后哺乳妇女单次注射迪波盖司通(含MPA150mg),在注射后的第1、2、4、6、8、10和12周采集血样和乳液样本,用放射免疫方法测定MPA。结果:血清MPA浓度于注射后第1周最高,到第2、4周时下降明显,第4周后浓度下降趋势逐渐缓慢。乳液MPA浓度在第1周为最高,第2周比第1周降低了约1/2,之后10周平均浓度变化波动在5.09-8.15ng/ml之间。观察期间乳液/血清MPA浓度比值和曲线下浓度面积比值均为0.55。对象之间和同一对象不同时间点乳液/血清MPA浓度存在明显个体差异。结论:哺乳期使用迪波盖司通,将导致血液和乳液中含有一定量的MPA。