类风湿病中左心室收缩功能障碍：一种未被认识的负荷？

目的:本研究旨在明确左心室收缩功能障碍在临床类风湿病(RD)患者中是否较正常人群中更常见,并评价脑利钠肽(BNP)的诊断价值。背景:RD患者罹患缺血性心脏病的风险增加,而采用超声心动图评估RD患者心功能不全的大型研究却少见。假定左心室收缩功能障碍在RD患者中较正常人群中更为     

Extrapelvic colon--areas of failure in a reoperation series: implications for adjuvant therapy

A total of 230 patients had planned single or multiple reoperative procedures following "curative" resection of colorectal cancer at the University of Minnesota. The site of the primary lesion was extrapelvic in 91, and later evidence of cancer was found in 58 patients (64%) at re-operation and/or other follow-up. Eight of the 58 (14%) were converted to disease-free status. Incidence and patterns of failure were correlated with initial operative-pathologic extent of disease (87 of the 91 at risk had initial tumor extension beyond the bowel wall, involved nodes or both) and comparisons were made with the previously analyzed rectal reoperation patients. While a component of local-regional failure was more common with rectal lesions (48/74 at risk, 65%), it was not uncommon with extrapelvic primaries (44/91-48%). The incidence of hematogenous metastasis (DM) was equal, but the pattern of initial DM differed (extrapelvic colon--primarily liver; rectum--liver and lung). Peritoneal seeding was a more common component of failure with the extrapelvic primaries (19/91--21% vs 3/74-4%). Since surgery alone is inadequate treatment for many patients with colon as well as rectal cancer, the rationale of adjuvant radiation and systemic therapy, alone or in combination, is discussed.     

The mental health system and the etiology of homelessness: A comparison study

Previous research suggests that former psychiatric hospital patients become homeless due to (1) their inability to make use of treatment services, (2) the lack of available services, or (3) the lack of available tangible economic supports. However, supportive studies tend to examine the homeless in isolation and therefore do not fully determine whether the three factors differentiate those former patients who become homeless from the large group who do not. They also fail to undertake multivariate analysis that can separate determinants from factors that are only spuriously related to the lack of a domicile. The current study thus compares homeless and other domiciled but vulnerable former psychiatric patients within a multivariate framework. Results suggest that, except for age, few measures representing the inability to use services or the lack of treatment services predict homelessness. In contrast, homelessness is related to traits that reflect the lack of tangible resources, including the lack of Supplemental Security Income (SSI), the lack of other income maintenance benefits, and the lack of work income. Such results suggest that homelessness might be avoided if vulnerable former patients receive special but not traditional types of care, if young people are retained in treatment, and if the vulnerable receive help in obtaining material support.     

Rheumatoid disease and the heart: from epidemiology to echocardiography

Rheumatoid disease (RD) is a common chronic inflammatory condition associated with progressive joint destruction. Sufferers of RD experience reduced life expectancy, reflected in the increased standardised mortality rates reported in several studies over the last 50 years. Most studies indicate that the increased mortality affecting this population is mainly due to cardio-vascular disease. Epidemiological data have revealed an increased risk of developing ischaemic heart disease and heart failure in RD. The increased risk of ischaemic heart disease may result from traditional risk factors but data suggest that RD may confer risk independently. Although pericardial involvement, valvopathy and myocarditis are the most well-recognised cardiac manifestations of RD, and constitute a rheumatoid heart disease, these features are relatively benign. The current prevalence of rheumatoid heart disease in the era of early administration of disease-modifying therapy requires evaluation.