Interpreting Medicine: Lessons From a Spanish-Language Clinic

Caring for patients is an act of interpretation: we labor to understand the significance of a particular symptom and, when we have reached a diagnosis, we convert our medical jargon into plain language for the benefit of the patient. Caring for patients of limited English proficiency—a population that needs a very literal form of interpretation—underscores this lesson. Working with predominantly Spanish-speaking patients has shown me the importance of bearing witness to patients’ struggles and has brought me to realize that good physicians must work to forge a common language with all their patients, not only with those who do not speak English.     

Small breast cancers: When and how to treat

Small (T1a, b), lymph node negative breast tumors represent an entity diagnosed with increasing frequency due to the implementation of wide-scale screening programs. Patients bearing such tumors usually exhibit favorable long-term outcomes, with low breast cancer mortality rates at 10 years, even in the absence of adjuvant chemotherapy. However, most available data derive from retrospective studies. Additionally, a subset of patients with these tumors experience recurrence of the disease, indicating that early tumor stage itself is not a sufficient prognosticator. It is of paramount importance to refine the prognosis of this population, identifying patients with high risk of recurrence, for whom adjuvant treatment is needed. The underlying biology of the disease provides relevant information, such as grade and status of hormone receptors and HER-2 (human epidermal growth factor receptor 2), with high grade, triple negative and HER-2-positive tumors having worse prognosis. Additionally, multigene signatures may improve further the prognostication of patients with small, node negative breast cancers. Further research for this increasingly frequent group of patients is urgently needed, so that better informed clinical decision making, in particular regarding adjuvant chemotherapy, can occur.     

T‐helper cells and liver fibrosis in hepatitis C virus‐monoinfected patients

Summary. Limited data suggest that low T‐helper cell levels may be observed in hepatitis C virus (HCV) monoinfected patients with decompensated liver disease. We sought to determine the distribution and relationship of T‐helper cells (CD4) to liver fibrosis in HCV‐monoinfected patients before and during pegylated interferon (PegIFN) therapy. CD4 populations were prospectively determined using flow cytometry. All subjects had compensated liver disease. Baseline and subsequent CD4 counts at treatment weeks 12, 24, 36 and 48 and at two time points following treatment discontinuation (weeks 60 and 72) were evaluated. Ishak score was determined by a central pathologist. At baseline, data from 267 subjects were available. Mean age was 50 and 68% were male/Caucasian. HCV viral load was >800 000 IU/mL in 55%. Nearly half (48%) were Ishak 4–6 with all stages represented. Mean CD4 count was 1004 cells/mm³ ± 400, and 6% had counts <500. There was a trend towards lower CD4 counts among cirrhotic subjects (P = 0.07). A CD4 decrease was noted following PegIFN initiation. Mean CD4 decline was 38.9% and was statistically significant for all fibrosis stages compared with baseline levels, but not between fibrosis levels. CD4 counts <500 cells/mm³ are seen in <10% of HCV‐monoinfected subjects. A trend towards lower CD4 counts in subjects with advanced fibrosis was observed. However, at baseline and during/after PegIFN therapy, no significant differences were observed between groups. CD4 counts declined during PegIFN treatment, but returned to baseline after completion. The significance of these findings in terms of disease progression and treatment response requires further evaluation.     

神经内科重症患者肠内营养时机与并发症的分析及护理

目的探讨神经内科重症患者肠内营养时机与并发症的分析及护理对策。方法随机选取来我院ICU病房行肠内营养支持治疗的重症患者84例,并对其平均分为两组,即观察组和对照组(各42例)。观察组患者采用早期肠内营养治疗并给予相应的护理对策,对照组采用常规营养治疗法治疗,观察并记录两组患者的生化指标、住院时间及不良反应情况。结果经观察得知,观察组患者有效治疗37例,有效率为88%,对照组有效治疗26例,有效率为62%,观察组治疗效果明显高于对照组,差异具有统计学意义;观察组腹胀6例(14%),对照组腹胀18例(43%),差异显著,两组患者的饮食时间、排气、排便时间及呕吐、腹泻情况均无明显差异。生化指标血清白蛋白(ALB)、K+、Na+、Ca2+2两组无明显差异(P>0.05)。结论临床对重症患者给予早期肠内营养同时配合相应的护理治疗,可降低并发症的发生概率,对促进患者术后肠胃功能恢复具有一定的临床价值。     

新产程标准对产程中剖宫产指征及妊娠结局的影响

目的:分析新产程标准对经阴道试产中转剖宫产指征及妊娠结局的影响。方法:选取本院经阴道试产的产妇作为观察对象,按照自愿选择的原则分成原产程及新产程组,比较两组间中转剖宫产率、剖宫产前试产时间及剖宫产指征的差异,分析两组间产后出血、产后尿潴留、新生儿窒息及巨大儿发生率的不同。结果:原标准转剖宫产比率高于新标准组(χ~2=19.238、P=0.000),而剖宫产前试产时间两组无差异(P=0.359)。在剖宫产指征方面,潜伏期延长、活跃期停滞、相对头盆不称及胎儿窘迫等发生比率原标准组高于新标准组(P=0.011、0.005、0.000、0.015),宫内感染及社会因素比率在两组间无差异(P=0.161、0.078)。产后出血及产后尿储留比率原产程低于新产程组(P=0.027、0.008),新生儿窒息及巨大儿发生比率两组间无差异(P=0.535、0.305)。结论:新产程标准可以降低经阴道试产中转剖宫产率,改变剖宫产指征构成,同时也可能会增加产后出血及尿潴留的风险。     

终末期癌症患者疲倦感与希望感的相关性研究

目的 了解终末期癌症患者的疲倦感与希望感的现状,探讨癌症患者疲倦感与希望感的相关性及影响因素,为临床护理人员提高癌症终末期患者的护理质量提供参考和依据.方法 以我院肿瘤科80名终末期癌症患者为研究对象,采用疲倦量表和希望量表进行调查分析,用SPSS 13.0对量表数据进行统计分析.结果 终末期癌症患者的整体疲倦感为5....     

Postoperative radiation therapy for major salivary gland malignancies

Between 1966 and 1982 there have been 46 patients treated with surgery plus post-operative radiation therapy for malignant tumors of salivary gland origin. The indication(s) for radiotherapy included positive margins (42%), advanced local tumor (37%), positive nodes (33%), or high grade histology (48%). Overall actuarial local control at 5 years was 73%, being 100% for T1, 83% for T2, 80% for T3, and 43% for T4. Actuarial survival at 5 years was 80% for T1, 83% for T2, 60% for T3, and 48% for T4. Patients with positive nodes (N+) did worse than those with negative nodes (No), with locoregional control and survival at 5 years being 58% vs. 83%, (P = 0.025) and 38% vs. 80% (P = less than .01), respectively. We found no need for contralateral neck treatment even for those with positive nodes. Also, to date, none of eight patients with adenoid cystic histology has failed locally, as opposed to three of eight failures in patients treated with surgery alone. We believe that post-operative irradiation provides excellent locoregional control for appropriate patients with malignant tumors of major salivary glands.     

艾滋病无症状HIV感染期称谓的探讨与建议

文章讲述了无症状HIV感染期称谓的来历和此称谓带来的困扰,探讨了无症状HIV感染期不仅有症状体征,并且所表现出来的症状体征与感染HIV有关。无症状HIV感染期称谓与中医药防治艾滋病的研究形势和研究内容很不协调,不仅不能科学反映该期本质,还极易引起歧义。因此为能更符合该期的临床和病理实际,建议将称谓改为慢性进展期。