Primary and preventive care in a university obstetrics and gynecology group practice

Objective: Our purpose was to determine whether primary and preventive care is practiced by a university obstetrician-gynecologist group practice.Study design: A retrospective chart review spanning 2 years of four academic physicians' private practices was performed. A total of 335 patients were reviewed with 739 patient encounters and 1032 patient problems identified. The definition of a primary care physician according to The American College of Obstetricians and Gynecologists was used to standardize data collection and evaluation.Results: Obstetric complaints accounted for 27.7% of all visits, whereas 65.4% were for gynecologic problems. Almost 7% of all complaints were neither obstetric nor gynecologic, and of those 74.6% were primary care problems completely managed by the obstetrician-gynecologist. Only 19.7% of these were referred for management. More than 89% of all encounters () involved some element of primary care.Conclusion: This study provides evidence that the majority of health care provided by the obstetrician-gynecologists is primary care.     

Inflammation-induced changes in peripheral glutamate receptor populations

The ionotropic glutamate receptors N-methyl-d-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and kainate (KA) have been localized on subpopulations of unmyelinated and myelinated sensory axons in normal skin. Behavioral studies indicate that activation of these receptors results in nociceptive behaviors and contributes to inflammatory pain. The goal of the present study was to determine if these glutamate receptors might contribute to the peripheral hypersensitivity observed in inflammation. The major findings were that 48 h following complete Freund's adjuvant (CFA)-induced inflammation, the proportions of unmyelinated axons labeled for NMDA, AMPA or KA receptors were 61%, 43% and 48%, respectively, in cutaneous nerves in the inflamed paw compared to 48%, 22% and 27%, respectively, in the non-inflamed paw. The proportions of myelinated axons labeled for NMDA, AMPA or KA receptors were 61%, 61% and 43%, respectively, compared to 43%, 42% and 28%, respectively, in the non-inflamed hindpaw. These increases were all significant. These data indicate that the number of sensory axons containing ionotropic glutamate receptors increases during inflammation, and this may be a contributing factor to peripheral sensitization in inflammation.     

Morphological and functional demonstration of rat dura mater mast cell-neuron interactions in vitro and in vivo

The effects of changes in temperature on primary and secondary endings of isolated cat muscle spindles were investigated under ramp-and-hold stretches and different degrees of pre-stretch. Temperature-induced alterations of the discharge frequency were compared over a temperature range of 25–35°C. Both primary and secondary endings responded to warming with increasing discharge frequencies when the spindle was pre-stretched by 5–10% of its in situ length. The following differences between the temperature effects on primary and secondary endings were observed: (1) The temperature coefficients (Q₁₀) obtained from the discharge frequencies during the dynamic and static phase of a stretch were similar for endings of the same type, but they were larger in primary endings (range of Q₁₀: 2.3–3.3; mean: 2.9) than in secondary endings (range of Q₁₀: 1.6–2.2; mean: 2.0); (2) With primary endings, but not with secondary endings, the temperature sensitivity (imp s⁻¹ °C⁻¹) was larger during the dynamic phase than during the static phase of a stretch; (3) In primary endings, the fast and slow adaptive components occurring in the discharge frequency during the static phase of a stretch clearly increased with warming while in secondary endings, the slow decay was less affected, and the fast decay showed no change; (4) In relaxed spindles, the excitatory effect of warming was overlaid by a strong inhibitory effect as soon as the temperature exceeded about 30°C, resulting in an abrupt cessation of the background activity in most secondary endings, but not usually in primary endings. In general, warming induced an enhanced stretch sensitivity in both types of ending, and additionally an inhibitory effect that is obvious only in secondary endings of relaxed spindles. The different effects of temperature on the discharge frequency of primary and secondary afferents are assumed to be caused by different properties of their sensory membranes.     

骨转移癌不同分割放射治疗比较

目的比较不同分割放射治疗骨转移癌患者的时间效应,评价不同分割放疗的止病疗效。材料与方法对1992年5月～1997年5月我院收治的123例骨转移癌患者分别给予常规分割组、超分割组及大剂量低分割组不同的放射治疗,观察各组姑息止痛的放疗有效率．结果放疗1周时,止痛有效率为5．41％、10．3％及65．2％;放疗结束时为70．3％、77．3％与77．3％;放疗结束后3个月为65．0％、67．6％及74．2％．经统计学分析发现放疗1周时大剂量低分割组止痛有效率与其它组比较有明显差异。结论大剂量低分割放疗止痛率高,疗效出现早,而放疗结束时及结束后3月3组止病率无差异。故在骨转移癌的放疗中可考虑采用先大剂量低分割放疗后继常规或超分割的放疗方式。     

Primary cranial vault lymphoma mimicking meningioma

Primary lymphomas of the cranial vault are rare; only six patients have been described in the literature. We report a 75-year-old woman who was admitted to our hospital after a focal seizure. CT showed a homogeneous mass which, on contrast enhancement, was similar to a meningioma. The tumour was excised and found to be a centroblastic, centrocytic non-Hodgkin's lymphoma. Treatment was completed with radiotherapy and chemotherapy.     

Strategies in the treatment of diffuse pontine gliomas: the therapeutic role of hyperfractionated radiotherapy and chemotherapy

This article will review the current treatment of pediatric patients with diffuse pontine gliomas (DPG) and discuss three potential avenues of therapeutic research including (i) radiotherapy (RT) in combination with radiation sensitizers, (ii) dose-intensive, induction chemotherapy with hematopoietic support followed in sequence with RT applied as a consolidation therapy, and (iii) the interleafed application of phase-specific chemotherapeutic agents and hyperfractionated external beam radiotherapy (HFEBRT) referred to as chemoradiotherapy.     

Abnormal length of cilia—a cause of primary ciliary dyskinesia—a case report

A 7-year-old Turkish boy had suffered from chronic coughing from early childhood. Severe bronchiectasis in the right lung was confirmed by bronchography. Ciliary beat frequency determined in a bronchial mucosal biopsy was markedly decreased (5.7 Hz). Electron microscopy revealed cilia with a length of 15 m. No structural abnormality was found. A possible link between the abnormally long, slow beating cilia and the clinical symptoms is discussed.     

放射治疗中的摆位误差

随着放射治疗向高精度方向发展 ,研究放射治疗中的摆位误差具有重要意义。就摆位误差的定义、来源、表示方法、测量予以综述 ,并总结了以往的研究数据 ,提出临床工作中需注意的问题。     

三维适形低分割放射治疗老年非小细胞肺癌疗效观察

目的　探讨三维适形低分割放射治疗老年非小细胞肺癌的疗效。方法　 4 5例患者均采用低分割治疗 ,处方剂量为 4～ 5Gy,隔日 1次 ,总量 4 8～ 5 5Gy。结果　CR 2 3例 ( 5 1.1% ) ,PR 15例( 33.3% ) ,NC 5例 ( 11.1% ) ,PD 2例 ( 4 .4 % ) ,RR 38例 ( 84 .4 % )。 1、2、3年生存率分别为 6 6 .7%、4 8.9%、39.1%。结论　三维适形放射治疗对于老年非小细胞肺癌是一种反应较小 ,痛苦较轻 ,安全有效的治疗措施     

高温热疗加放射粒子植入及化疗治疗转移性盆腔肿瘤

目的观察高温热疗加放射粒子植入及化疗治疗转移性盆腔肿瘤的疗效.方法将转移性盆腔肿瘤患者分为A、B两组,A组19例,B组22例.A组给予射频加热的同时从电极处灌注2.5%的盐水以扩大肿瘤凝固性坏死的范围.不能热疗的肿瘤边缘组织内植入碘-125粒子.术后第15天开始化疗.奥沙利铂100 mg/m2,静脉滴注,第1天;CF 200 mg/m2,在5-Fu滴注前经静脉滴注2 h,继以5-Fu 200 mg/m2经静脉推注,5-Fu 400 mg/m2经静脉滴注22 h,连续5 d,3周为1周期.B组只给予化疗,化疗用药、剂量及天数与A组相同.结果第6个周期末,A组与B组的有效率分别为84.2%和36.4%,两组有效率比较差异有显著性(P＜0.01).两组的毒副反应发生率差异无显著性.结论高温热疗加放射粒子植入及化疗治疗转移性盆腔肿瘤的近期疗效好,并发症少.