宫腔镜双极汽化电切术临床分析

目的 探讨宫腔镜双极汽化切割术的安全性和疗效。方法 术前宫腔镜诊断均为黏膜下肌瘤和肌壁间凸向宫腔肌瘤36例，在宫腔镜下施行双极汽化电切术。结果 手术成功率100％，手术时间10-70分钟，平均32分钟；出血量12-100ml，平均28ml；标本重15-42g，平均31g。术中、术后无并发症。术后满意率94．4％。结论 宫腔镜双极汽化切割术具有手术时间短、出血少、无并发症等优点，疗效满意。     

The clinical phenotypes of juvenile bipolar disorder: toward a validation of the episodic-chronic-distinction.

BACKGROUND: Recent research has addressed the issue of subtyping juvenile bipolar disorder (JBD). Accordingly, we set out to find out, in a naturalistic sample of bipolar children and adolescents with mania and mixed mania, whether the most useful subtyping should be based on clinical features (elated vs. irritable) or course (episodic vs. chronic). METHODS: We studied 136 patients, 81 male patients (59.6%) and 55 female patients (40.4%), mean age 13.5 +/- 2.9 years, meeting the DSM-IV diagnosis of bipolar disorder, assessed by a structured clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version [K-SADS-PL]). RESULTS: Regarding course, 77 patients (56.6%) had an episodic course and 59 patients (43.4%) had a chronic course. Patients with chronic course were significantly younger, had an earlier onset of JBD, and presented a more frequent comorbidity with disruptive behavior disorders. According to the prevalent mood disturbance, 75 patients (55.1%) showed an elated and 61 patients (44.9%) showed an irritable mood. Elated mood was more frequent in patients with episodic course, whereas irritable mood was more frequent in the patients with chronic course. CONCLUSIONS: These findings suggest that chronic versus episodic course may be a putative differential feature. Further validation of such a distinction would require prospective studies, temperament evaluation, gender and neurobiologic approaches, and differential psychopharmacologic assignment and response.     

Parvalbumin neurons in the entorhinal cortex of subjects diagnosed with bipolar disorder or schizophrenia.

BACKGROUND: Growing evidence indicates that the entorhinal cortex (ECx) might be affected in schizophrenia (SZ) and bipolar disorder (BD). To test whether distinct interneuronal subpopulations might be altered, numbers of parvalbumin-immunoreactive (PVB-IR) neurons were measured in the ECx of BD and SZ subjects. These neurons play a pivotal role within ECx intrinsic circuits. METHODS: Numbers, numerical density, and soma size of PVB-IR neurons were measured in the ECx of normal control (n = 16), BD (n = 10), and SZ (n = 10) subjects. The volume of the ECx was measured in Nissl-stained sections. RESULTS: In BD, decreases of total numbers (p = .02) and numerical densities (p = .01) of PVB-IR neurons were detected in the ECx. Within distinct subregions, reductions were detected in the superficial layers of the lateral (p = .02), intermediate (p = .04), and caudal (p = .01) ECx. In SZ, total numbers and numerical densities were not altered. A reduction of soma size was present in the intermediate ECx (p = .01). Volume was unaffected in either disorder. CONCLUSIONS: In BD, a decrease of PVB-IR neurons may alter intrinsic inhibitory networks within the superficial layers of the ECx. The likely consequence is a disruption of integration and transfer of information from the cerebral cortex to the hippocampus.     

碳酸锂合并丙戊酸钠预防双相障碍复发的研究

目的比较碳酸锂合并丙戊酸钠与单用碳酸锂对预防双相障碍复发的疗效。方法对82例临床康复的双相障碍患者随机分为碳酸锂合并丙戊酸钠组及单用碳酸锂组,合并用药组44例,单用碳酸锂组38例,随访观察2年。结果合并用药组有效率为88.6%,单用碳酸锂组有效率为68.4%,两组比较差异有显著性(P<0.05)。结论碳酸锂合并丙戊酸钠对双相障碍有较好的预防复发作用。     

Comorbid disorders in hospitalized bipolar adolescents compared with unipolar depressed adolescents

This study examined comorbid psychiatric disorders in adolescents with bipolar disorder. Hospitalized bipolar adolescents (N=10) were compared to hospitalized adolescents with unipolar depression (N=33), and to adolescents with nonaffective psychiatric disorders (N=11). Results showed conduct disorder, attention-deficit hyperactivity disorder, psychosis, and having any DSM-III-R psychoactive substance use disorder were all significantly more common in the bipolar group than the unipolar depressed group. Comorbid anxiety disorder was present in 40–45% of the subjects in the unipolar and bipolar groups, but in none of the control group subjects. This study is supported in part by a grant to Dr. Borchardt from the University of Minnesota Graduate School.     

Colocalization of glutamate and glycine in bipolar cell terminals of the human retina

Human retinae from surgical specimens rapidly fixed in a glutaraldehyde/formaldehyde mixture were subjected to postembedding, immunogold immunocytochemistry of glutamate and glycine, and subsequently analysed in an electron microscope. The two amino acids were visualised in the same tissue sections by the use of two different gold particle sizes. All bipolar cell perikarya and terminals showed significant glutamate labelling with mean gold particle densities 3–4 times higher than those of the retinal, non-neural pigment epithelial and Müller cells. Bipolar cell terminals displayed significantly higher glutamate labelling density than the bipolar cell bodies, as would be expected of glutamatergic neurons. A subpopulation of the glutamate-immunolabelled bipolar cell bodies (18%) and terminals (32%) also exhibited strong glycine labelling (7–8 times that of pigment epithelial and Müller cells). These glutamate-glycine positive terminals established contacts with amacrine cell processes and ganglion cell dendrites and were localised almost exclusively at between 44% and 88% depth of the inner plexiform layer, indicating that they belong to the ON cone bipolar system. This subpopulation of terminals was endowed with significantly higher glycine labelling density than the glycine positive bipolar cell bodies. These results show that human bipolar cell terminals colocalise glutamate and glycine and provide the first direct demonstration of an enrichment of these two amino acids in the same presynaptic element.     

Tritiated imipramine binding to platelets in manic subjects

We studied 21 patients with bipolar affective disorder and 25 healthy controls in order to determine if tritiated imipramine binding to platelets distinguished the manic from the depressed phase of bipolar disorder. Depressed patients had a significantly lower mean Bmax value (754 +/- 149 fmole/mg protein) than the manic and control groups (1112 +/- 248 and 1237 +/- 201 fmole/mg protein, respectively), which did not differ from each other. These differences could not be attributed to differences in age, sex, menopausal status, the presence of psychotic features or medication history among the subject groups. These findings confirm that decreased imipramine binding to platelets is a state marker for bipolar depression and not a trait marker of bipolar disorder.     

Vasoactive intestinal peptide and bipolar affective illness. Evidence for an effect of lithium

In an attempt to evaluate the role of VIP in affective disorder, measurements of lymphocyte VIP receptors, and plasma and CSF VIP levels were made in unmedicated and lithium-treated euthymic bipolars and controls. Lithium decreased plasma (P = 0.01) and CSF (P = 0.05) VIP levels and increased the affinity (decreased the KD) of the VIP lymphocyte receptor (P less than 0.01). This effect may be relevant to the psychotropic action of lithium in manic-depressive illness.     

Conventional computed tomography software can be used for accurate pre-operative templating in bipolar hip arthroplasty: A preliminary report

BackgroundThe aim of this study was to investigate the use of pre-operative templating for bipolar hip arthroplasty (BHA) for displaced femoral neck fracture using multiplanar reconstruction (MPR) of computed tomography (CT) images.MethodsNineteen patients who underwent BHA were enrolled in this study. For pre- and post-operative evaluation, a CT scan was performed from the pelvis to the knee joints. MPR of the CT image was done using software to measure the femoral head cup diameter, offset, stem size, length of the modular neck, distance from the neck osteotomy, and femoral anteversion. We compared these parameters pre- and post-operatively.ResultsBoth the femoral head cup diameter and length of the modular neck were found to be significantly different between pre- and post-operative measurements, although the differences were minor. Other parameters, including the femoral offset, were not significantly different between the pre- and post-operative measurements. The size of the femoral stem, cup diameter, and length of the modular neck were consistent with the planned size and accurate (within ±1 size) in more than 84% cases.ConclusionOur pre-operative templating approach for BHA using MPR of CT has potential clinical utility as a complementary tool for pre-operative planning using three-dimensional templating software. Moreover, this technique could be feasible in most hospitals without additional expenditure.