奥兰扎平治疗精神分裂症58例临床观察

目的观察奥兰扎平治疗精神分裂症的临床疗效与安全性.方法选择58例精神分裂症病人,开始给予奥兰扎平5mg*d-1,3d后根据临床疗效、副反应情况酌情增加剂量,最大剂量不超过20mg*d-1,治疗8周.治疗前及治疗后每2周用PANSS、CGI、TESS量表评定1次.结果治疗后PANSS总分、各因子分较治疗前显著下降(P<0.01),副反应主要有抗胆碱症状、过度镇静、体重增加、一过性丙氨酸氨基转移酶升高.结论奥兰扎平是一种安全、有效、副作用较轻的抗精神病药.     

增骨健步汤预防激素性股骨头坏死的实验研究

目的：探讨增骨健步汤防治激素性骨头坏死的作用机理。方法：将24只健康兔随机分为3组：激素组、中药组及正常对照组。激素组和中药组分别给予醋酸强的松龙肌注造模型,中药组同时喂服增骨健步汤,激素组喂服等量生理盐水。10周后全部动物处死取血,行血液流变检测和取股骨头进行形态组织学观察。结论：增骨健步汤能显著降低血粘度、血脂水平,改善肌骨头血运、防治激素性肌骨头坏死。     

心律平治疗室性及室上性心律失常疗效分析

目的 观察心律平治疗室性及室上性心律失常的疗效及副作用。方法 对于107例经心电图及临床确诊的室性及室上性心律失常患者，按口服心律平剂量不同分为：300mg／d组(33例)、450mg/d组(66例)、600mg/d组(8例)三组，10d为1个疗程；分析心律失常类型、心律平剂量与疗效的关系、副作用及原因。结果 心律平对室性及室上性心律失常总有效率分别为89．6％与79．7％(P＞0．05)；3种剂量与疗效关系不大(P＞0．05)；发生副反应19例，占17．8％，无效17例，占15.9％。结论 心律平对室性及室上性心律失常均；有良好治疗作用，较为安全。     

Psychosis in geropsychiatric inpatients with and without dementia

Psychotic symptoms are commonly encountered in elderly patients both with and without dementia. The authors compared presentation and treatment response between these two groups. Of 206 consecutive admissions to an inpatient geropsychiatry unit, 52 (26%) had psychotic symptoms. Thirteen of these had dementia and 22 had a primary Axis I psychotic disorder without dementia. Both groups presented similarly, improved significantly from admission to discharge and demonstrated equivalent medication side-effect profiles. Elderly psychotic patients with and without dementia improve significantly on antipsychotics and tolerate their side-effects; however, those with dementia receive lower dosages of medication to treat their symptoms.     

大剂量孕激素在年轻患者早期子宫内膜癌治疗中的应用

目的 探讨年轻女性子宫内膜癌的诊断、治疗及预后的特点.方法 口服大剂量孕激素,根据子宫内膜逆转情况调节药物用量.结果 子宫内膜癌逆转,并IVF-ET受孕成功,分娩1个正常女婴.结论 年轻妇女子宫内膜癌多与月经不调、不孕不育、多囊卵巢综合征等高危因素有关;以手术治疗为主,分化好病理分期Ⅰ期、有迫切生育要求者,可在严密观察下行药物保守治疗并助孕.     

Double-peaked time distribution of mortality for breast cancer patients undergoing mastectomy

Purpose. To gather information on the natural history of breast cancer from the time-distribution of deaths of patients undergoing mastectomy alone. Patients and methods. A total of 1173 patients, who entered controlled clinical trials carried out at the Milan Cancer Institute and underwent radical or modified radical mastectomy without any adjuvant therapy for operable breast cancer, were examined. The risk of death at a given time after surgery was studied utilizing the death-specific hazard rate. The risk distribution was assessed relative to tumor size, axillary lymph node involvement, and menopausal status. Results. The hazard rate for death presented an early peak at about the 3rd–4th year after surgery and a second late peak near the 8th year. The double-peaked pattern was almost completely generated by N+ patients, while N– patients did not show relevant structures. Pre-menopausal patients showed an initial mortality wave covering about 6 years, with maximum height at the 4th year, followed by a peak 8 years after surgery, while post-menopausal patients showed an early high mortality surge peaking at the 3rd year, followed by a modest increase at the 8th year. Detailed analysis revealed that post-menopausal patients with early mortality had significantly larger tumors and higher nodal involvement, while no special trait characterized the corresponding pre-menopausal patients. Moreover, patients of the late mortality peak were more likely to have suffered early local-regional or contra-lateral recurrence or to be pre-menopausal patients recurring anywhere at the second recurrence peak. Conclusion. The double-peaked hazard curve confirmed the occurrence of discontinuous features in the natural history of breast cancer for patients undergoing mastectomy. Indeed, the mortality pattern maintained definite signs of the previous double-peaked structure of recurrences. However, death events did not parallel the corresponding recurrence events and, moreover, pre and post-menopausal patients revealed dissimilar survival after recurrence, at least for early deaths. These findings, showing disconnection of mortality pattern from recurrence pattern for subsets of patients, suggest that parameters other than those influencing the recurrence risk may determine the survival of recurred patients.     

静默疗法对肿瘤化疗病人恶心、呕吐的防治作用

目的探索静默疗法对肿瘤化疗副反应的作用。方法将300例进行化学治疗的肿瘤病人随机分为对照组和试验组,每组各150例病人。对照组进行治疗时,只用常规的恩丹西酮预防恶心、呕吐等副作用;而试验组除了用恩丹西酮外,在受过专门训练护理人员的指导下用静默疗法辅助治疗来预防恶心、呕吐等副作用。结果试验组胃肠道等副反应控制率为57%,与对照组(43%)比较,有显著性差异(P<0.05)。结论静默疗法有减轻或防止化疗药物引起的胃肠道反应等副反应的作用。     

Differences of satisfaction with medication between patients with schizophrenia treated with typical antipsychotics and atypical antipsychotics

Many studies have demonstrated that atypical antipsychotics are superior to typical antipsychotics in that they have fewer side-effects and produce better improvement of cognitive deficits and quality of life in patients with schizophrenia. However, most of these studies dealt with objective indices assessed by researchers rather than subjective indices that are indeed important to patients themselves. In 126 patients with schizophrenia, annoyance of side-effects and psychotic symptoms, satisfaction with medication, wish to change medication, and knowledge of atypical antipsychotics were assessed using questionnaires. Patients treated with typical antipsychotics complained less of annoyance of poor attention and concentration than those treated with atypical antipsychotics, which can be explained by increased awareness of these symptoms by the patients due to the improvement of cognitive function. There were no significant differences between the two groups in other variables. The present results that satisfaction and annoyance were similar between patients treated with typical antipsychotics and those with atypical antipsychotics, may partly explain why patients hesitated and rejected changing or shifting from typical to atypical antipsychotics. But because 98 of 126 patients did not know about atypical antipsychotics, it is important to educate the patients on the merits of atypical antipsychotics.     

Long lasting impaired cerebral blood flow after ecstasy intoxication

Four hours after having taken 10 ecstasy tablets a Grand Mal seizure occurred in a 19-year-old woman followed by coma, hyperthermia, tachycardia, tachypnea, and renal failure. After awakening she was oriented but presented with helplessness, disconcertion, hallucinations, panic attacks, and amnesic syndrome. Computed tomography and magnetic resonance imaging scans of the brain were normal. [99Tc]-hexamethylpropyleneamine oxime (HMPAO)-single photon emission computed tomography (SPECT), 20 days after intoxication, showed reduced, inhomogeneous, supratentorial tracer uptake bilaterally. Electroencephalography (EEG) disclosed diffuse slowing and occasionally generalized sharp waves. Valproic acid was begun. Except for slight amnesia, neuropsychological deficits had disappeared and [99Tc]-HMPAO-SPECT normalized, 29 days later. Decreased cortical blood flow was explained by vasoconstriction following ecstasy-induced depletion of serotonin.