Arthrocentesis of the Knee in Acute Hemophilic Arthropathy

In 27 children and young adults with hemophilia presenting acutely painful distended intra-articular hemorrhages of the knee, aspiration was carried out and the patients were followed for a minimum of 24 months. Seventeen patients with classical hemophilia were found to have less than 1 percent of normal plasmal level of antihemophilic factor (AHF). Of the remainder, five were Factor IX, plasma thromboplastin component (PTG), deficient, whereas two patients had Von Willebrand''s disease. Aspiration was routinely done in an outpatient clinic, followed by immediate discharge with return to regular activity levels within 48 hours. There were no infections nor rehemorrhages attributable to aspiration technique.     

小肠CT及双气囊小肠镜诊断克罗恩病患者的差异性分析

目的:探究小肠CT及双气囊小肠镜诊断克罗恩病患者的差异性。方法:选择2017年4月至2019年3月于我院接受治疗的60例克罗恩病患者,分别实施小肠CT及双气囊小肠镜检测,对比两种检测方式对克罗恩病患者诊断准确率及病变范围、病变位置、活动度和并发症的检测差异。结果:CT检出克罗恩病的准确率96.67%,双气囊小肠镜检出克罗恩病的准确率为93.33%,其差异无统计学意义(P>0.05)。小肠CT主要表现为肠腔狭窄50例(83.33%),肠壁增厚52例(86.67%),肠外淋巴结46例(76.67%),肠系膜水肿及血管改变21例(35.00%),肠外炎症10例(16.67%),瘘管3例(5.00%),瘘道1例(1.67%);双气囊小肠镜表现为环形溃疡、不规则溃疡、环状溃疡等共计46例(76.67%),阿弗他溃疡22例(36.67%),黏膜充血、水肿等26例(43.33%),结节样增生6例(10.00%),小肠肠腔节段性狭窄16例(26.67%),假性息肉9例(15.00%);经病理学检测表现为淋巴细胞、中性粒细胞、嗜酸性粒细胞等炎性浸润,淋巴组织及肉芽组织出现增生小肠CT发现肠外炎症、瘘道、瘘管等合计14例,而双气囊小肠镜未发现并发症。结论:相比于双气囊小肠镜,小肠CT能够更为准确的判断克罗恩病患者是否处于炎症状态,也能够更有效的发现肠外并发症的存在,但小肠CT及双气囊小肠镜联合应用监测效果更佳。     

Torsion of the testicle: a clinical review of 20 cases

Early diagnosis of testicular torsion is absolutely mandatory for salvage of a viable organ. The classical clinical presentation is a boy in the second decade with sudden onset of testicular pain accompanied by testicular tenderness and swelling as well as scrotal erythema and edema. The management is emergency exploration of the testicle with either orchiopexy or orchidectomy, depending upon the viability of the testis. In this series of 20 cases 90% had exploration with a salvage rate of 72%. Torsion of the testicle is in most cases due to a congenital abnormality; therefore contralateral orchiopexy is always done at the time of the exploration of the scrotum. The critical time interval from onset to exploration of the torsion is approximately 10 hours. In addition to the acute clinical entity, chronic torsion of the testis should be considered in all patients with unexplained orchalgia.     

Influence of angles occlusion in periodontal diseases

It is of interest to document the known relationship between periodontal status and Angle''s malocclusion types. We used 26092 case records of patients between 16 to 50 years of age with no gender restrictions. Variables such as age, gender, periodontal diagnosis and type of Angle''s occlusion were extracted and tabulated. Statistical analysis was completed using chi square test in the SPSS software version 20. Data shows that the majority (95.27%) had Angle''s class I occlusion and less than 5% had class II and Class III occlusion. Statistical analysis of class II and Class III cases with 1000 randomly selected cases of class I occlusion show a significant difference in the periodontal status between different types of Angle''s occlusion. Chronic periodontitis was more in class I (10.4%) and it was the lowest in Class II Div 2 (4.3%) occlusion. Class II Div 1(23.8%) and Class III (17%) had the highest and lowest proportion of clinically healthy periodontium, respectively. Thus, we report that angles occlusion types had significant influence on periodontal status along with the other determinants.     

类风湿关节炎拇长屈肌腱病变的超声特点

目的:总结类风湿关节炎(RA)患者拇长屈肌腱(FHL)病变的超声特点及二者间的相关性。方法:回顾性分析2010年2月至2011年6月因足部疼痛于我院就诊的60例(120足)RA患者资料。应用彩色多普勒超声诊断仪探查拇长屈肌腱,根据超声探查拇长屈肌腱病变情况的结果将患者分为3组:肌腱完整组(A组,45足),肌腱周围炎症组(B组,49足),肌腱断裂组(C组,26足)。对拇长屈肌腱病变的特点及部位进行描述,并将拇长屈肌腱病变严重程度与患者年龄及病程进行相关性分析。结果:45足肌腱完整,49足出现不同部位的肌腱周围炎症(内踝转折处17足,henrry’s结节处11足,第一跖趾关节跖侧21足),26足发生肌腱断裂(9足发生于内踝转折处,17足发生于跖趾关节跖侧)。肌腱病变的发生率71%。A组平均年龄49.9±9.2岁,病程4.7±2.6年;B组平均年龄56.2±9.2岁,病程16.2±7.4年;C组平均年龄54.7±8.0岁,病程20.9±4.4年。三组间上述参数差异具有统计学意义(P0.05)。结论:拇长屈肌腱是类风湿关节炎足部结构的常见受累部位,其病变多发生于内踝转折处,henrry's结节处及第一跖趾关节跖侧,但henrry’s结节处的断裂少见。在对类风湿关节炎平足患者进行肌腱转位手术时,应充分考量拇长屈肌腱的病变。     

Les gangrènes des organes génitaux externes: à propos de 102 cas

Objectives

To describe the epidemiological, clinical, biological and therapeutic features of Fournier’s gangrene and identify the prognostic factors.

Patients and methods

We conducted a retrospective study on 102 cases of Fournier’s gangrene treated at the urology department of the university teaching hospital Aristide- Le-Dantec (Dakar) between January 2001 and December 2007.

Results

The mean age of the patients was 50.0 ± 15.7 years (range: 20–93 years). The mean duration of hospital stay was 8.0 ± 7.1 days (range: 1–33 days). The lesions were located on the scrotum in 61.7% of cases, on the scrotum and penis in 17.6% of cases and on the penis alone in 3.9% of the cases. Perineal involvement was found in 14.7% of the cases. No etiologic factors (idiopathic) were found in 26 cases (25.5%) and 70 patients (68.6%) had Fournier’s gangrene secondary to urethral stricture. The most common predisposing factors were diabetes mellitus (13.7%), hypertension (5.9%), and renal failure (5.9%). Biological examination revealed that 79.4% of patients had a leukocytosis higher than 12,000/ml and the mean rate of haemoglobin was 9.8 ± 2.8 g/dl (range: 3.3–13.9 g/dl). The most common antibiotherapy associated a third generation cephalosporin, aminoside and metronidazole (46.1%). Twenty-one patients (20.6%) underwent extensive debridement only and eighty-one (79.4%) underwent extensive debridement and cystostomy. The death rate was 15.7%. Among the patients whose Fournier’s gangrene was idiopathic or secondary to urethral stricture, the statistically significant factors for a poor outcome were age, the secondary character of the gangrene, the extent of the lesions, and association with diabetes mellitus and/or hypertension.

Conclusion

Fournier’s gangrene is still a frequent and lethal disease. Its good management requires a multidisciplinary approach.     

Characteristics of patients found not to have multiple sclerosis.

Of 400 consecutive patients referred to Dalhousie University''s multiple sclerosis research unit 52 (13%) were found not to have multiple sclerosis. Forty-one (79%) of the patients were female and 11 (21%) were male. About half of the patients had raised the suspicion of multiple sclerosis, and about half had either a medical background or a close association with a patient with the disease. Although in many cases a diagnosis was made at the initial visit, in difficult cases the most effective diagnostic technique was repeated assessment of the patient over a long period. It is important to keep an open mind when assessing patients suspected of having multiple sclerosis and to apply the recognized criteria for diagnosis of the disease.     

振幅整合脑电图aEEG对新生儿缺氧缺血性脑病患儿病变程度及远期预后的监测分析

目的:研究振幅整合脑电图aEEG对新生儿缺氧缺血性脑病(Hypoxic ischemic encephalopathy,HIE)患儿病变程度及远期预后的监测分析。方法:从2012年3月到2013年3月,48例胎龄在37至41周的HIE患儿,作为观察组。另选同期50例住院治疗的非颅脑病症足月儿作对照组。分别对两组行aEEG诊断,对比两组连续性及SWC。并分析aEEG的监测结果和HIE相关性,以及远期预后情况。结果:观察组脑电图呈现为连续型者占比33.33%(16/48),SWC为成熟者占比20.83%(10/48),均显著低于对照组的100%(50/50)及100%(50/50)。差异均有统计学意义(均P0.05)。观察组的最高电压为56.54±19.33 LV,显著高于对照组的37.77±2.79 LV;最低电压为4.26±1.25 LV,显著低于对照组的7.75±0.67 LV。差异均有统计学意义(均P0.05)。依据Spearman法行相关性分析后发现,aEEG的监测结果和HIE临床分级呈正相关。随访6个月,48例患儿中,有11例伤残(含智力缺陷及脑瘫),占比22.92%。结论:aEEG操作简便,诊断有效,且可连续监测,能够反应出新生儿HIE病变程度以及远期预后。效果显著,值得临床推荐。     

THE Q WAVE IN L III AND aVF OF THE ELECTROCARDIOGRAM—A Vectorcardiographic Analysis With the Use of the Frank System

Seventy-three consecutive patients with a Q wave in Lead III and aVF in the electrocardiogram were studied. Vectorcardiograms were recorded with the use of the Frank system.In 32 cases the ECG''s were compatible with the diagnosis of an inferior myocardial infarction based on a Q wave in Lead III and/or aVF greater than 0.04 second duration and greater than 25 per cent of the amplitude of the R wave. In this group, there were 16 patients with coronary disease and the VCG confirmed the electrocardiographic diagnosis of an infarction in 14 cases. In 13 of the other 16 cases without history of coronary disease the VCG did not suggest the presence of an infarction.In all 17 cases with questionable electrocardiographic diagnosis of an inferior infarction, and without history of coronary disease, the VCG denied the presence of an infarction. In 18 cases with small Q III or Q aVF the VCG''s were within normal limits. In two cases with normal Q III and Q aVF the VCG''s did not detect the presence of an infarction in both cases.The vectorcardiographic diagnosis of an inferior myocardial infarction was based on the superior orientation (at or above 360 degrees) of the 10, 20, 25 and 30-msec vectors in the frontal plane, superior displacement of the maximum QRS vector and clockwise rotation. In the left sagittal plane the 10, 20, 25 and 30-msec vectors were oriented at or above 180 degrees with the loop rotating counterclockwise.The data presented suggest that vectorcardiography is a useful adjunct to electrocardiography in the diagnosis of an inferior myocardial infarction.     

Gangrène des organes génitaux externes (GOGE): traitement chirurgical et reconstruction plastique

Objective

To present the various types of surgical reconstruction of Fournier’s gangrene and their outcome.

Patients and methods

It is a retrospective study conducted on 14 patients with Fournier’s gangrene treated at the Urology Department of Teaching Hospital of Cocody (Abidjan-Côte d’Ivoire) between January 2000 and June 2009.

Results

The mean age of the patients was 39 years (range: 20–67 years). All the patients were black and presented infectious symptoms, which were treated by hydroelectrolytic reanimation and ant biotherapy. The lesions reached down all the penis and the scrotum in 64.29% of the cases (N = 9) and on the scrotum and perinea in 35.71% of the cases (N = 5). The lesions require extensive debridement and local bandages. All of the patients were cured (100%). In three patients (21.43%), the lesions with bandages only to tiny scrotum lesions healed spontaneously. In nine patients (64.29%), it got healed after debridement suture without tension of the scrotum skin, and in the two patients (14,28%), the one with wide wound of penis, scotum and perinea, then the other with penile skin loss, were healed after skin graft taken with inner face of the thigh.

Conclusion

Fourniers gangrene still remains a severe disease. Management of this gangrene requires a multidisciplinary approach. The plastic surgical reconstruction restores an adequate environment to penis and scrotum, which does not compromise the quality of the sexual relations and the reproductive function of the testicles, especially in young men.     

Accuracy of registration of invasive cervical cancer.

The quality of the data recorded by the British Columbia Cancer Registry for 521 new cases of invasive cervical cancer was evaluated. The registry''s pathological diagnosis in all new registrations of invasive cervical cancer diagnosed in British Columbia between 1977 and 1979 was compared with a best estimate of the true diagnosis, which was determined from the results of the provincial cervical cytology screening program and the clinical charts at the Cancer Control Agency of British Columbia. The registry''s data overestimated the true incidence of invasive cervical cancer by approximately 55%, since 184 (35%) of the cases were incorrectly registered. Of the 184, 141 (77%) were cases of preinvasive cervical cancer, 26 (14%) did not meet the criteria for a true case (i.e., they were not newly diagnosed in British Columbia between 1977 and 1979) and 17 (9%) were cases of invasive cancer of another primary site. In addition, 28 cases of invasive cervical cancer diagnosed in the province during the study period had not been reported to the registry. Thus, both over-reporting and under-reporting occurred. There is a need for constant evaluation of registry data if cancer registries are to fulfil their potential contribution to cancer control programs and research.     

First electrocardiogram in recent myocardial infarction.

The admission electrocardiogram (ECG) was studied in 898 patients admitted to a coronary care unit over two years. The diagnosis made from this tracing was compared with that made at the end of the patient''s stay. About half the cases of recent myocardial infarct were diagnosed from the admission ECG, but accuracy rose to 83% with serial ECG''s in the unit. The ECG is important but not entirely reliable in the early detection of acute myocardial infarction, which should be largely a clinical diagnosis.     

200例先天性尿道下裂患儿的临床特征及其危险因素分析

目的:研究200例先天性尿道下裂患儿的临床特征及其危险因素。方法:选择2016年1月~2019年12月我院收治的先天性尿道下裂患儿200例进行研究,记作观察组,另取同期于我院接受体检的健康儿童200例作为对照组,分析观察组患儿的临床分型情况,比较两组儿童父母的一般情况、儿童出生情况,并采用多因素Logistic回归分析先天性尿道下裂的影响因素。结果:200例先天性尿道下裂患儿临床分型按照占比从高到低的顺序依次为阴茎体型46.50%(93/200)、阴茎阴囊型28.00%(56/200)、冠状沟型17.00%(34/200)、阴囊型4.50%(9/200)、阴茎头型3.00%(6/200)、会阴型1.00%(2/200)。观察组父亲生活性接触化学物、母亲流产史、母亲孕期饮食缺乏肉类、母亲孕期饮食缺乏鱼类、母亲孕期应用保胎药、母亲孕期吸烟或被动吸烟人数占比均高于对照组(均P<0.05)。观察组早产、低出生体重人数占比高于对照组(均P<0.05)。经多因素Logistic回归分析显示,父亲生活性接触化学物、母亲流产史、母亲孕期饮食缺乏肉类、母亲孕期饮食缺乏鱼类、母亲孕期应用保胎药、母亲孕期吸烟或被动吸烟、早产、低出生体重均是先天性尿道下裂的危险因素(均P<0.05)。结论:先天性尿道下裂患儿临床分型以阴茎体型为主,双亲不良生活习惯、化学物接触史以及早产、低出生体重均是先天性尿道下裂的危险因素,值得临床重点关注。     

Computed tomography of abdomen in staging and clinical management of lymphoma.

During July 1976 to Demember 1977, 150 patients with Hodgkin''s disease and 138 with non-Hodgkin''s lymphoma were examined by computed tomography (CT). In 45 cases 50 repeat examinations were conducted. Concurrent laparotomy and lymphography were performed on 68 and 56 patients respectively. The overall incidence of false-positive CT examinations as confirmed by laparotomy was 7.4%. In 18 patients with non-Hodgkin''s lymphoma in the abdomen there was good correlation between the two techniques. Of the 50 patients with Hodgkin''s disease who underwent laparotomy, 17 had splenic disease and 14 minimally enlarged lymph nodes in 20 areas; CT, however, detected only four diseased spleens and five minimally enlarged lymph nodes. Nevertheless, CT often detected enlarged lymph nodes missed by lymphography and was 23% more efficient than lymphography in detecting unsuspected disease. CT also detected unsuspected disease in patients with relapse of lymphoma. CT may replace other non-invasive investigations of abdominal disease in patients with lymphoma and give a reliable guide to prognosis. It does not, however, eliminate the need for laparotomy in staging Hodgkin''s disease.     

妊娠期卵巢过度刺激综合征合并卵巢蒂扭转行腹腔镜下保留卵巢术的可行性及安全性研究

目的:研究妊娠期卵巢过度刺激综合征合并卵巢蒂扭转行腹腔镜下保留卵巢术的可行性及安全性。方法:对本院2010年1月-2017年12月妇科住院的9例妊娠期卵巢过度刺激综合征合并卵巢蒂扭转患者进行腹腔镜下保留卵巢术,观察其发病时间、卵巢扭转情况、手术时间、术中出血量、术后并发症及妊娠结局等。结果:9例患者术后均无明显并发症发生,术后随访9例患者妊娠结局均良好,其中,8例患者足月产,1例早产。结论:腹腔镜下妊娠期卵巢过度刺激综合征合并卵巢蒂扭转保留卵巢术对患者维持妊娠及生育功能的影响小、术后并发症低,是一种安全、可行性强的手术。     

引起AECOPD 精神神经异常的原因及治疗对策

目的：探讨引起慢性阻塞性肺疾病合并精神神经异常的原因,以制订有针对性的治疗对策。方法：回顾性分析我院自2010 年1 月到2013 年1 月期间收治的250 例慢性阻塞性肺疾病急性发作期患者的临床资料。结果：32 例患者出现精神神经异常症 状,占12.80%。其中17 例为肺性脑病,占53.13%（17/32）,8 例为低渗性脑病,占25.00%（8/32）,5 例为药物的不良反应,占15.63% （5/32）,2 例为脑梗死,占6.25%（2/32）。所有患者均给予慢性阻塞性肺疾病急性发作的常规治疗方案进行治疗,同时肺性脑病患 者给予积极纠正二氧化碳潴留;低渗性脑病患者给予积极纠正电解质紊乱;脑梗死的患者根据情况给予溶栓、脱水、营养脑神经、 抗凝、抗血小板聚集等治疗;药物不良反应的患者则给予停止应用相应的药物。经过治疗后,29 例症状恢复,占90.63%,3 例最终 死亡,死亡率为9.38%,其中2 例为肺性脑病患者,1 例为低渗性脑病患者。结论：对于慢性阻塞性肺疾病急性发作合并精神神经 异常的治疗,应根据患者的症状、体征以及辅助检查结果,尽早明确诊断,及时干预,尽快控制病情,防止病情恶化。     

Patients with suspected Lassa fever in London during 1984: problems in their management at St Thomas's Hospital.

During 1984, 23 patients in whom a diagnosis of viral haemorrhagic fever was considered presented to the accident and emergency department at St Thomas''s Hospital. There were no confirmed cases of viral haemorrhagic fever. Nine patients were transferred to Coppett''s Wood Hospital, the nearest specially designated high security isolation unit. Malaria was the final diagnosis in 14, and in six this diagnosis was confirmed only after examining repeated smears at Coppett''s Wood Hospital. Transferral of patients to such units is time consuming, expensive, and often unnecessary. Specially designated isolation units in district general hospitals and all teaching hospitals would simplify and improve the care not only of patients with a possible viral haemorrhagic fever but also patients with tuberculosis, multiply resistant staphylococcal infections, and viral infections that may be hazardous if transmitted to immunocompromised patients.     

Malignant Lymphomas of Waldeyer's Ring: Natural History and Survival after Radiotherapy

The natural history of 292 consecutive cases of reticulum cell sarcoma and lymphosarcoma of Waldeyer''s ring and the survival rate after radiotherapy are reported. In our institute since 1928 from 30 to 35% of pharyngeal neoplasms have been lymphomas, and of these 55% have been reticulum cell sarcomas, 21% lymphosarcomas, and 1% Hodgkin''s disease. This high incidence may probably be ascribed to the fact that in all malignant lymphomas, irrespective of the clinical presentation, a systematic biopsy of the whole Waldeyer''s ring was carried out. Pharyngeal lymphomas were confined to Waldeyer''s ring in 19·6% of cases, with initial spread to contiguous cervical nodes in 43·8%, to distant nodes in 24·2%, and to extranodal tissues in 12·4%. Lymphography showed abnormal retroperitoneal lymph nodes in 38·3% of cases. There was gastrointestinal involvement either initially or later in 17·6% of cases. High-energy radiation therapy to both sides of the neck was the treatment of choice for local and regional disease. It achieved a five-year survival rate of 41·9% in the group of 97 patients treated during the past decade. The incidence of relapse (recurrence and new manifestations) was highest in the first year after treatment.     

Errors in the diagnosis of testicular torsion]

Two cases of testicular torsion are presented. The diagnosis was late. It led to the castration of testicular necrosis in both patients. This pathology is recognizable most easily within the first hours following onset. Later, there are still chances to spare affected organ. This report indicates the importance of the first contact with physician and his prompt intervention.     

Traumatic vasospastic disease in chain-saw operators.

Raynaud''s phenomenon is commonly induced in chain-saw operators by vibration; the hand guiding the tool is the more severely affected. The condition tends to persist after use of the chain-saw is stopped but compensation is rarely sought. Among 17 cases of Raynaud''s phenomenon in lumberjacks the condition was found to be related to use of the chain-saw in 14, 10 of whom had to give up their work in colder weather because the disease was so disabling. Two criteria essential to establish the condition as vibration-induced Raynaud''s phenomenon are the presence of symptoms for at least 2 years and a history of at least 1 year''s constant use of the chain-saw. Careful physical examination and simple tests of vascular function will provide objective evidence of permanent damage by which the patients may be classified and compensated.