Results of splenectomy in patients with hypoplastic and aplastic anemia]

The results of spleen exstirpation in 129 patients with hypoplastic and aplastic anaemia are presented. For this purpose the role of splenectomy in connection with blood formation is dealt with on the basis of analysing morphological blood findings. The impact of the duration of the disease, of sex, age, and the dosage of corticosteroids on the postoperative development of the disease is demonstrated. The following observations of the patients which were made within 3 to 14 years after the operation revealed that 63 patients from 129 survived, namely 21 patients up to 5 years, 26 patients up to 10 years, 16 patients up to 14 years. 66 patients died, the highest lethality being observed during the first year after the operation (47 patients).     

Analysis of the causes of increased tremor in thyroid hyperfuction]

The authors present the results of examination of tremor (hand and trunk) of the amplitude of H- and T-reflexes and of the H-reflex inhibition during the contraction of antagonistic muscles and of facilitattion of T- and H-reflexes during the Yendrassik maneuvre in 33 children with hyperfunction of the thyroid gland and 20 normal subjects. It was established that the amplitude of tremor was greater and the frequency was less in these patients than in normal subjects; the amplitude of the H- and T-reflexes was enhanced, and the intensity of reciprocal inhibition of the soleus muscle motor neurons was less in the patients. Comparison of the amplitude of the T- and H-reflexes indicated that against the background of the Yendrassik maneuvre facilitation of the T-reflex was less intense and facilitation of the H-reflex was more intense than in normal subjects. The authors supposed that the enhanced tremor in the patients was due to the motor neurons pool depolarization, to decrease the efficacy of reciprocal inhibition and to diminished suprasegmental influences spread to the gamma-motor neurons.     

Periorbital lymphatic malformation: clinical course and management in 42 patients

Lymphatic malformation in the orbital cavity and surrounding region often causes disfigurement and visual problems. To better clarify the evolution and treatment of this condition, the authors studied a retrospective cohort of 42 consecutive patients seen between 1971 and 2003 and analyzed anatomic features, complications, and management. The ratio of female to male patients was 1:1. Most periorbital lymphatic malformations were noted at birth (59 percent), presenting as either unilateral swelling (60 percent) or a periorbital mass (24 percent). Sixty-two percent of lesions were on the left side. The ipsilateral cheek, temple, and forehead also were involved in 57 percent of patients. Twenty-two percent of lesions were intraconal, 30 percent were extraconal, and 48 percent were in both spaces. Forty-five percent of children had an associated cerebral developmental venous anomaly. Periorbital lymphatic malformation caused major morbidity; 52 percent of patients had intralesional bleeding and 26 percent of patients had a history of infection. Other common complications included intermittent swelling (76 percent), blepharoptosis (52 percent), proptosis (45 percent), pain (21 percent), amblyopia (33 percent), chemosis (19 percent), astigmatism (17 percent), and strabismus (7 percent). Ultimately, 40 percent of children had diminished vision and 7 percent became blind in the affected eye. Management of periorbital lymphatic malformation involved an interdisciplinary team that included an interventional radiologist, a craniofacial surgeon, and an ophthalmologist. The two therapeutic strategies were sclerotherapy (40 percent) and resection (57 percent); most patients required several interventions. A coronal approach was used for subtotal excision of fronto-temporal-orbital lymphatic malformation in 13 patients, whereas a tarsal incision was used for lesions isolated to the eyelid (n = 14). Ocular proptosis was temporarily managed by tarsorrhaphy (n = 9), but expansion of the bony orbit was needed to correct persistent proptosis (n = 8). Orbital exenteration was necessary in two patients.     

Calcitonin test in patients with bone changes during the course of myeloma]

Hypocalcemic response following the administration of 160 units of porcine calcitonin was investigated in 14 patients with bone lesions caused by myeloma and in 9 control subjects. Significant decrease in blood serum calcium level was found in 85 per cent of myeloma patients, both in those with osteolytic bone lesions and those with generalized osteoporosis. Moreover, in all the patients a significant positive correlation was found between hypocalcemic response and the initial blood serum calcium concentration. Calcitonin administration did not cause any changes in blood serum phosphate level in myeloma patients.     

住院患者医疗收费差错原因分析与对策

目的减少住院患者医疗收费差错,降低费用差错引起的医患纠纷,提高患者满意度。方法通过抽查我院2014年1月~2015年1月的病历资料720份,其中发现收费差错病历162份,并对收费差错发生的原因进行分析。结果通过组织相关人员学习医疗收费标准,加大审核力度和及时指导,制定奖惩制度等管理措施,差错率显著降低,由实施改进方法前的22.5%降至改进后的10.58%。结论针对收费差错实施有效的管理措施,明显降低差错率的发生,提高了病人满意度。     

Iron deficiency anemia in the elderly: the diagnostic process.

OBJECTIVE: To determine the effectiveness of physician probability estimates calculated on the basis of findings from history-taking and physical examination in the diagnosis of iron deficiency anemia in elderly patients. DESIGN: Prospective study. SETTING: Two community hospitals offering secondary and tertiary care. PATIENTS: A total of 259 patients over 65 years of age found to have previously undiagnosed anemia. MEASURES: Physician estimates of the likelihood of iron deficiency before (pretest probability) and after (post-test probability) the laboratory test results were available. The hemogram was available to the physicians when they made their pretest probability estimates. Because the serum ferritin level proved to be the most powerful of the laboratory test results studied, the likelihood ratios associated with the post-test estimates were compared with the ratios associated with the serum ferritin level. MAIN RESULTS: The post-test probability estimates were influenced by the serum ferritin level and the pretest estimates. The post-test estimates derived from the findings obtained through history-taking and physical examination and the laboratory test results (including the serum ferritin level) were slightly less accurate in predicting iron deficiency than the serum ferritin level alone. Nevertheless, a model in which the pretest estimates were used in addition to the serum ferritin level to predict iron deficiency proved to be more powerful than the serum ferritin level alone (p = 0.006). This indicated that the limitations of the post-test estimates were due to a misinterpretation of the serum ferritin level and that the findings from history-taking and physical examination added important diagnostic information. CONCLUSIONS: Physicians must be aware of test properties to provide optimal care to their patients. If test results are properly interpreted, pretest probabilities derived from findings obtained through history-taking and physical examination can add useful information that will lead to more accurate diagnoses.     

Analysis of heterogeneity in Fanconi's anemia patients of different ethnic origin

Summary Complementation studies based on mitomycin C sensitivity were performed on somatic cell hybrids between cells of a German patient with Fanconi's anemia and a Turkish, Arab, and Black African proband, respectively. Though the underlying genetic defects are expected to go back to different mutational events, the high rate of induced chromosomal aberrations in the hybrids clearly points to allelic mutations.     

The role of E. coli adhesiveness in the pathogenesis and clinical course of urinary tract infections]

An infection with E. coli is the most frequent cause of the urinary infections in childhood. Virulence depends on several factors out of which a principal role is played by the adhesion of bacteria to the urinary tract epithelium. Such a property have E. coli strains with adherence mannose-positive fimbriae of type P with antigens recognizing and binding glycolipid receptors on epithelial cells in the urinary tract. Children with such infections owe their "sensitivity+" (10% of the population) to genetically determined large number o receptors binding E. coli strains. Incidence and clinical course of the urinary tract infections have been analysed in the group of 184 children. Moreover, sequelae of the urinary tract infections with E. coli have been analysed in dependence on E. coli strain characteristics, i.e. presence or absence of adherent fimbriae from cases of cystitis and significant asymptomatic bacteriuria. Considering pathogenesis of the urinary tract infections as the result of interactions between bacteria and host, antigenic properties of adherent fimbriae might be used for preparation of a vaccine preventing such infections.