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难治性癫痫患者颞叶切除的预后因素

世界核心医学期刊文摘(神经病学分册) 2006年第12期 9-9页

作者： Jeha L.E. Najm I.M. Bingaman W.E. 牛亚利 Dr.Department of Neurology S51Cleveland Clinic Foundation9500 Euclid AvenueClevelandOH 44195United States

To assess short-and long-term seizure freedom,the authors reviewed 371 patients who underwent anterior temporal lobectomy to treat pharmacoresistant *** mean follow-up duration was 5.5 years(range 1 to 14.1 years).Fifty-three percent of patients were seizure free at 10 *** authors identified multiple predictors of *** of EEG performed 6 months postoperatively correlated with occurrence and severity of seizure recurrence,in addition to breakthrough seizures with discontinuation of antiepileptic drugs.

关键词：癫痫发作患者药物

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C-反应蛋白浓度与心脏电复律后房颤复发

世界核心医学期刊文摘(心脏病学分册) 2006年第2期 55-55页

作者： Wazni O. Martin D. O. Marrouche N. F. Natale A. 刘文秀 Center for Atrial Fibrillation Department of Cardiovascular Medicine Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland OH 44195 United States Dr.

Background: To test the hypothesis that a high C reactive protein(CRP) concentration would predict recurrence of atrial fibrillation(AF) after cardioversion in patients taking antiarrhythmic drugs. Methods: 111 patients who underwent direct current cardioversion for symptomatic AF were enrolled. Blood was drawn for CRP determination before cardioversion on the same day. All patients were taking antiarrhythmic drugs before and after electrical cardioversion. Results: After a mean follow up of 76 days, 75 patients had recurrence of AF. In univariate analysis, the median CRP concentration was significantly higher in patients with AF recurrence(3.95 mg/l v 1.81 mg/l, p=0.002). Among the 55 patients with CRP in the upper 50th centile, 44(80% ) experienced recurrence of AF over a total follow up of 8.98 patient years, whereas among the 56 patients with CRP in the lower 50th centile, 31(55% ) experienced recurrence of AF over a total follow up of 14.3 patient years(p< 0.001). The adjusted hazard ratio comparing the upper 50th centile of CRP with the lower 50th centile of CRP was 2.0(95% confidence interval 1.2 to 3.2, p=0.007). Conclusions: CRP is independently associated with recurrence of AF after electrical cardioversion among patients taking antiarrhythmic drugs. These results suggest that inflammation may have a role in the pathogenesis of AF resistant to antiarrhythmic drugs.

关键词：心脏电复律患者房颤心房纤颤抗心律失常药物抗心律失常药

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糖尿病足部溃疡的治疗

世界核心医学期刊文摘（皮肤病学分册） 2006年第2期2卷 3-3页

作者： Cavanagh P.R. Lipsky B.A. Bradbury A.W. Botek G. 党倩丽 Diabetic Foot Care Program Department of Biomedical Engineering Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland OH 44195 United StatesDr.

People with diabetes develop foot ulcers because of neuropathy (sensory, motor, and autonomic deficits), ischaemia, or both. The initiating injury may be from acute mechanical or thermal trauma or from repetitively or continuously applied mechanical stress. Patients with clinically significant limb ischaemia should be assessed by a vascular surgeon to determine the need for angioplasty, stenting, or femorodistal bypass. When infection complicates a foot ulcer, the combination can be limb or life- threatening. Infection is defined clinically, but wound cultures reveal the causative pathogens. Tissue specimens are strongly preferred to wound swabs for wound cultures. Antimicrobial therapy should be guided by culture results, and should aim to cure the infection, not to heal the wound. Alleviation of the mechanical load on ulcers (off- loading) should always be a part of treatment. Neuropathic ulcers typically heal in 6 weeks with total contact casting, because it effectively relieves pressure at the ulcer site and enforces patient compliance. The success of other approaches to off- loading similarly depends on the patients’ adherence to the effectiveness of pressure relief. Surgery to heal ulcers and prevent recurrence can include tenotomy, tendon lengthening, reconstruction, or removal of bony prominences. However, these procedures may result in secondary ulceration and other complications. Ulcer recurrence rates are high, but appropriate education for patients, the provision of posthealing footwear, and regular foot care can reduce rates of re- ulceration.

关键词：足部溃疡溃疡复发率下肢远端旁路手术血管成形术神经功能缺陷机械压力肢体缺血支架术局部

1型糖尿病患者血糖严格控制后心室扭转和收缩期扭转速度反常增加

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世界核心医学期刊文摘（心脏病学分册） 2006年第5期2卷 49-49页

作者： Chung J Abraszewski P S.A. Wickline 王亭忠 Division of Cardiology Washington University School of Medicine Box 8086 660 South Euclid Avenue St. Louis MO 63110 United StatesDr.

OBJECTIVES: This study sought to characterize the early features of diabetic cardiomyopathy by magnetic resonance imaging(MRI) tagging. BACKGROUND: The earliest manifestations of diabetic cardiomyopathy have not been well established, especially under tight glycemic management. We hypothesized that torsion measurements would identify subclinical contractile alterations in type I diabetics with normal left ventricular ejection fraction, mass, blood pressure, and aggressive glycemic control. We also sought to characterize the influence of elevated resting heart rates(HRs) of diabetics on torsion. METHODS: Sixteen patients with type I diabetes and 10 control patients underwent cine and tagged MRI with a 1.5-T scanner. Torsion, strain, and their rates were measured. To quantify the influence of chronotropic and inotropic stimulation on torsion, nine healthy volunteers underwent MRI tagging at rest, after atropine injection, and after exercise. RESULTS: Diabetic patients(hemoglobin A1c, 6.8± 0.4% ) had a higher resting HR(77.0± 12.4 beats/min vs. 59.0± 5.6 beats/min; p< 0.01), higher maximal torsion by 23% (3.5± 0.9° /cm vs. 2.7± 0.4° /cm; p< 0.01) and higher maximal systolic torsion rate(TR-s) by 25% (0.013± 0.003° /cm/s vs. 0.010± 0.002° /cm/s, p=0.01). Torsion did not significantly change with chronotropic stimulation(p=0.30). CONCLUSIONS: In diabetics under tight glycemic control, we observed a surprising increase in torsion and TR-s unrelated to chronotropic influences of HR. We propose that increased torsion and TR-s could represent early predictive markers of the propensity to cardiac dysfunction in asymptomatic type I diabetics. Furthermore, these findings seem fundamental to the diabetic state itself and unaccounted for by other comorbidities.

关键词：糖尿病患者扭转控制血糖 1型速度严格收缩期糖尿病心肌病 MRI检查

后部葡萄膜黑色素瘤^(125)I板放射治疗后的脂质渗出

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世界核心医学期刊文摘（眼科学分册） 2006年第6期2卷 18-18页

作者： Mills M. D. Harbour J. W. 王大江(译) 不详 Department of Ophthalmology and Visual Sciences Washington University School of Medicine Campus Box 8096 660 South Euclid Avenue St Louis MO 63110 United States

PURPOSE: To investigate factors associated with lipid exudation after plaque radiotherapy for uveal melanoma. DESIGN: Retrospective interventional case series. METHODS: Records of 139 consecutive uveal melanoma patients treated with I-125 plaque radiotherapy were reviewed. Lipid exudation was the major outcome measured. RESULTS: Lipid exudation was detected in 19 patients (13.7% ). Mean time from plaque therapy to lipid exudation was 10 months (range,3-23 months). Lipid exudation was associated with younger patient age (P=.0002),increased low-density lipoprotein (P=.004),decreased highdensity lipoprotein (P=.026),increased tumor thickness (P=.024),and exudative retinal detachment (P=.016). Patients with lipid exudation had worse visual outcome (P < .0001) and increased neovascular glaucoma (P=.01). CONCLUSIONS: Lipid exudation after plaque radiotherapy for uveal melanoma is associated with poor ocular outcome. Factors associated with this lipid exudation are distinct from those associated with radiation retinopathy,and they may suggest interventions to combat this complication.

关键词：渗出性视网膜脱离葡萄膜黑色素瘤放射治疗后 ^125I 脂质新生血管性青光眼患者年龄低密度脂蛋白高密度脂蛋白视网膜病变

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葡萄膜丛状色素性神经鞘瘤

世界核心医学期刊文摘（眼科学分册） 2006年第8期2卷 62-62页

作者： Saavedra E. Singh A.D. Sears J.E. Ratliff N.B. 安胜 Department of Ophthalmic Oncology Cole Eye Institute (i3- 129) Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland OH 44195 United States Dr.

Schwannoma is a slow growing solitary tumor that preferentially involves spinal nerve roots, and sympathetic, cervical, and vagus nerves. There are several clinico-pathologic variants of schwannoma, including schwannoma with a degenerative change (ancient schwannoma), cellular schwannoma, plexiform schwannoma, epithelioid schwannoma, and melanotic schwannoma. About 10% of cases of schwannomas are associated with multi-system disorders such as neurofibromatosis, schwannomatosis, multiple meningiomas, and Carney complex. Schwannoma rarely present as an intraocular tumor and is often misdiagnosed as malignant melanoma. Immunohistochemical positivity with S-100 stain and demonstration of long-spaced collagen (Luse bodies) are helpful in establishing the diagnosis. In this article, we review the clinical and histopathological findings of a sporadic plexiform pigmented schwannoma involving the iris, ciliary body, and the choroid.

关键词：神经鞘瘤色素性葡萄膜丛状眼部肿瘤恶性黑色素瘤脑膜瘤脊髓神经根色素沉着性纤维胶

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内科医师的健康理念对结肠直肠癌筛查的影响

世界核心医学期刊文摘（胃肠病学分册） 2005年第9期1卷 13-13页

作者： Shieh K. Ristvedt S. D. Early 王志宇 Division of Gastroenterology Washington University in St. Louis Campus Box 8124 660 South Euclid Avenue St. Louis MO 63110 United States Dr.

Primary-care physicians have significant influence on whether or not their patients participate in colorectal cancer screening (CRCS). This study explored the association of physicians’personal health beliefs, medical history, and personal participation in CRCS with their practice patterns regarding CRCS. Perceived personal risk for colorectal cancer (CRC) was associated with compliance with American Cancer Society (ACS) guidelines for CRCS for their patients (P = 0.03). For physicians at low risk for CRC, their perception of the seriousness of CRC was significantly associated with compliance (P = 0.047). For physicians at, at least, average risk for CRC, personal participation in CRCS did not predict whether they recommend CRCS to their patients. Efforts to improve physicians’understanding about their own susceptibility to CRC and the seriousness of CRC may improve their compliance with making recommendations for CRCS to their patients and may improve their participation in CRCS.

关键词：结肠直肠癌内科医师美国癌症协会依从性筛检医史参与状况指导方针

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眶底骨折的碎骨引起眼内异物

世界核心医学期刊文摘（眼科学分册） 2005年第8期1卷 30-30页

作者： Garg S.J. Benson W. Fineman M. Bilyk J.R. 刘玮 Barnes Retina Institute Dept. of Ophthalmol. and Vis. Sci. Washington University 660 South Euclid Avenue St. Louis MO 63144 United States Dr.

PURPOSE: To describe the ophthalmoscopic and radiologic findings of a patient who sustained blunt orbital trauma. A piece of bone from the fractured orbital wall caused an intraocular foreign body. DESIGN: Case report. METHODS: An 18-yea r-old man underwent full ophthalmoscopic examination 1 week after sustaining bl unt ocular trauma to the right eye while playing basketball. B-scan ultrasonogr aphy and computed tomography of the orbits were also performed. RESULTS: Visual acuity, intraocular pressure, and anterior segment examination were normal. Fund uscopic examination revealed a fragment of bone that had penetrated the sclera, choroid, and retina. A hole in the sclera was visible. No treatment was performe d. Three months later, the patient had no ocular complaints or complications as a result of this injury. CONCLUSION: Bone from a patient’s orbit may cause an i ntraocular foreign body that may be followed conservatively in certain circumsta nces.

关键词：眼内异物眶底碎骨眼外伤检眼镜检查眶壁眼前节放射检查保守性眼部症状

行不孕症检查的男性患者中吸烟与精子质量的关系

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世界核心医学期刊文摘（妇产科学分册） 2006年第1期2卷 35-35页

作者： Said T. M. Ranga G. Agarwal A. 张剑萍(译) Dr. A. Agarwal Center for Advanced Research in Human Reproduction Infertility and Sexual Function Glickman Urological Institute Department of Obstetrics and Gynecology 9500 Euclid Avenue Cleveland OH 44195 United States 不详

Male fertility is affected by a variety of lifestyle habits that include tobacco use. A large population of Indian men is addicted to tobacco chewing. The Abstract of our study was to assess the relationship between tobacco chewing in these Indian men - who were part of an infertile couple and their sperm characteristics. Design: Retrospective study. Setting: Private infertility clinic. Patient(s): Six hundred thirty-eight male patients undergoing infertility evaluations were grouped according to the frequency of their tobacco chewing habit: mild (6 times/day, n = 197). Intervention(s): None. Main Outcome Measure(s): Sperm characteristics (concentration, motility, morphology, and viability). Result(s): Sperm concentration, percentage motility, morphology, and percentage viability were significantly higher in the mild group vs the moderate group and in the moderate group vs the severe group. The percentage of men with azoospermia rose with the level of addiction (1% , 3% , and 14% ) as did the percentage of men with oligoasthenoteratozoospermia (2% , 8% , and 29% ), although the differences were not statistically significant. Conclusion(s): In our study, use of chewing tobacco by a group of Indian men who were undergoing infertility evaluation was strongly associated with a decrease in sperm quality and to a lesser extent with oligoasthenozoospermia or azoospermia. Infertile men should be counseled about the adverse effects of tobacco chewing on sperm quality.

关键词：不孕症患者重度吸烟男性患者精子质量检查少弱畸形精子症男性生育能力精子浓度生活方式观察指标