前后联合入路微创治疗合并神经损伤的不稳定骶骨骨折

目的:探讨前后联合入路锁定加压钢板(LCP)微创治疗合并神经损伤的骶骨不稳定骨折的效果。方法:前后联合入路按照杜明奎等方法[1]采用LCP固定治疗合并神经损伤的不稳定骶骨骨折患者5例:L5神经根损伤2例,骶丛神经损伤3例。前方入路暴露骨盆前环重建钢板固定,后方入路经皮下锁定加压钢板骨折复位固定术,椎管探查减压以MRI显示有无神经压迫为据。结果:5例均获随访,时间3～20(14.8±7.2)个月。2例L5神经根损伤和3例骶丛神经损伤者Frankel分级由C级恢复至E级,术后功能根据Matta评分标准评定:优3例,良2例。结论:前后联合入路LCP微创治疗合并神经损伤的骶骨不稳定骨折是一种简单微创有效的方法,值得临床推广。     

The use of interviews with surrogate respondents in a case-control study of oral cancer

The purpose of this study was to assess the possible bias that may occur in case-control studies when exposure information is not collected from all potentially eligible cases. The data used in this study were collected in the metropolitan area of Atlanta as part of a multicenter, population-based, case-control study of oropharyngeal cancer. In-person interviews were conducted with 112 cases (67.9 percent) and information on an additional 23 ill or deceased cases (13.9 percent) was collected through surrogate respondents. The cases about whom information was collected from surrogate respondents had more advanced disease at the time of diagnosis and were more likely to be black and less educated than cases who were interviewed in person. Cigarette smoking and consumption of hard liquor were more common among the cases about whom information was collected through surrogates. Therefore, failure to include such information would have resulted in underestimates of the strength of association between these exposures and the risk of oropharyngeal cancer.     

Cholera enterotoxin production in Vibrio cholerae O1 strains isolated from the environment and from humans in Japan.

Vibrio cholerae O1 strains isolated from various sources in Japan over the years 1977 through 1987 were examined to confirm the presence or absence of the cholera enterotoxin (CT) gene and production of CT and to determine the kappa-phage type. The CT gene was detected in none of 225 isolates from natural waters but was present in all of the 10 isolates from environmental waters implicated in domestic cholera cases, in 64 strains (26.6%) of the 241 isolates from imported seafoods, in 43 strains (95.6%) of the 45 isolates from domestic cholera cases, and in 119 strains (93.7%) of the 127 isolates from imported cholera cases. The results suggest that the CT gene-positive strains of V. cholerae O1 have been imported into Japan through seafoods and/or by travelers. Sporadic cholera cases have resulted in contamination of the surrounding environment, but the CT gene-positive strains may not have persisted in natural waters to serve as a reservoir for epidemic cholera. The commercially available VET-RPLA kit (a latex agglutination kit for immunological detection of CT) detected production of CT in all of the CT gene-positive strains, indicating that there was no silent CT gene in the test strains. There was a strong correlation between the kappa-phage type and the presence or absence of the CT gene, suggesting a significant clonal difference between CT gene-positive and -negative strains. Five CT gene-negative strains isolated from imported cholera cases (travelers with mild diarrhea) induced a considerable amount of fluid accumulation in rabbit and/or suckling mouse intestines, indicating production of an enterotoxic factor(s) other than CT.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cholera enterotoxin production in Vibrio cholerae O1 strains isolated from the environment and from humans in Japan.

Vibrio cholerae O1 strains isolated from various sources in Japan over the years 1977 through 1987 were examined to confirm the presence or absence of the cholera enterotoxin (CT) gene and production of CT and to determine the kappa-phage type. The CT gene was detected in none of 225 isolates from natural waters but was present in all of the 10 isolates from environmental waters implicated in domestic cholera cases, in 64 strains (26.6%) of the 241 isolates from imported seafoods, in 43 strains (95.6%) of the 45 isolates from domestic cholera cases, and in 119 strains (93.7%) of the 127 isolates from imported cholera cases. The results suggest that the CT gene-positive strains of V. cholerae O1 have been imported into Japan through seafoods and/or by travelers. Sporadic cholera cases have resulted in contamination of the surrounding environment, but the CT gene-positive strains may not have persisted in natural waters to serve as a reservoir for epidemic cholera. The commercially available VET-RPLA kit (a latex agglutination kit for immunological detection of CT) detected production of CT in all of the CT gene-positive strains, indicating that there was no silent CT gene in the test strains. There was a strong correlation between the kappa-phage type and the presence or absence of the CT gene, suggesting a significant clonal difference between CT gene-positive and -negative strains. Five CT gene-negative strains isolated from imported cholera cases (travelers with mild diarrhea) induced a considerable amount of fluid accumulation in rabbit and/or suckling mouse intestines, indicating production of an enterotoxic factor(s) other than CT.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluating the Learning Curve for Percutaneous Nephrolithotomy under Total Ultrasound Guidance

Objectives

To investigate the learning curve of percutaneous nephrolithotomy under total ultrasound guidance.

Methods

One hundred and twenty consecutive PCNL operations under total ultrasound guidance performed by a novice surgeon in a tertiary referral center were studied. Operations were analyzed in cohorts of 15 to determine when a plateau was reached for the variables such as operation duration, ultrasound screening time, tract dilation time, stone-free rate and complication rate. Comparison was made with the results of a surgeon who had performed more than 1000 PCNLs. Fluoroscopy was not used at all during procedure.

Results

The mean operation time dropped from 82.5 min for the first 15 patients to a mean of 64.7 min for cases 46 through 60(P = 0.047). The ultrasound screening time was a peak of 6.4 min in the first 15 cases, whereas it dropped to a mean of 3.9 min for cases 46 through 60(P = 0.01). The tract dilation time dropped from 4.9 min for the first 15 patients to a mean of 3.8 min for cases 46 through 60(P = 0.036). The senior surgeon had a mean operating time, screening time and tract dilation time equivalent to those of the novice surgeon after 60 cases. There was no significant difference in stone free rate and complication rate.

Conclusions

The competence of ultrasound guided PCNL is reached after 60 cases with good stone free rate and without major complications.     

National epidemiologic study on hydatidosis

The results of an epidemiological survey on surgical cases of human hydatidosis in 9 italian regions (Central, Southern and Insular Italy) with the highest incidence of disease and a population of 27,054,000 inhabitants are reported. The period considered was from 1980 through 1984. 2,592 cases have been collected and related to sex, age, occupation, residence of surgically treated patients and cyst localization. Comparison of results from the present and a previous survey was carried out.     

Amniotic membrane graft: histopathological findings in five cases

Amniotic membrane transplantation (AMT) is an effective treatment for ocular surface reconstruction; however, the mechanisms through which amniotic membrane (AM) exerts its effects as well as its fate after transplantation have not been entirely elucidated and have been investigated only in part. We evaluate the integration of AM in the host cornea in five patients who underwent AMT as the result of Bowen's disease, band keratopathy, radio- or cryotherapy-induced keratopathy, chemical burn or post-herpetic deep corneal ulcer with descemetocele. Due to persistent opacification in four cases and a progressing tumor in one case, penetrating keratoplasty (PK) and enucleation were performed as early as 2 months and up to 20 months after AMT. The corneas were analyzed histopathologically. To evaluate AM remnants, corneas were stained with periodic acid Schiff's reaction (PAS), Alcian blue, and Gomory and Masson trichrome; immunostaining including collagens III and IV antibodies was also performed. None of the corneas showed remnants of AM. In all cases, we observed discontinuity of Bowman's membrane. In three cases, the corneal epithelium was completely restored, ranging from three to six cell layers. In the other two cases, we detected an intense inflammatory reaction with rich neovascularization; the epithelial surface of the central cornea was completely restored, while at the periphery of the cornea goblet mucus-producing cells were present. Although clinically useful in all cases, restoration of a stable corneal epithelium through AMT is limited by the extent and severity of limbal stem cell deficiency (LSCD). The lack of histologically documented AM remnants in our cases seems to explain the efficacy of AMT more through its biological properties than through its mechanical properties.     

Costs and outcomes of active and passive case detection for visceral leishmaniasis (Kala-Azar) to inform elimination strategies in Bihar,India

BackgroundEffective case identification strategies are fundamental to capturing the remaining visceral leishmaniasis (VL) cases in India. To inform government strategies to reach and sustain elimination benchmarks, this study presents costs of active- and passive- case detection (ACD and PCD) strategies used in India’s most VL-endemic state, Bihar, with a focus on programme outcomes stratified by district-level incidence.MethodsExpenditure analysis was complemented by onsite micro-costing to compare the cost of PCD in hospitals alongside index case-based ACD and a combination of blanket (house-to-house) and camp ACD from January to December 2018. From the provider’s perspective, a cost analysis evaluated the overall programme cost of each activity, the cost per case detected, and the cost of scaling up ACD.ResultsDuring 2018, index case-based ACD, blanket and camp ACD, and PCD reported 1,497, 131, and 1,983 VL-positive cases at a unit cost of $522.81, $4,186.81, and $246.79, respectively. In high endemic districts, more VL cases were identified through PCD while in meso- and low-endemic districts more cases were identified through ACD. The cost of scaling up ACD to identify 3,000 additional cases ranged from $1.6–4 million, depending on the extent to which blanket and camp ACD was relied upon.ConclusionCost per VL test conducted (rather than VL-positive case identified) may be a better metric estimating unit costs to scale up ACD in Bihar. As more VL cases were identified in meso-and low-endemic districts through ACD than PCD, health authorities in India should consider bolstering ACD in these areas. Blanket and camp ACD identified fewer cases at a higher unit cost than index case-based ACD. However, the value of detecting additional VL cases early outweighs long-term costs for reaching and sustaining VL elimination benchmarks in India.     

Intracranial abscessation in white-tailed deer of North America.

From January 1996 through April 1997, the geographic distribution, etiology, demographics, seasonality, and prevalence of an intracranial abscessation/suppurative meningoencephalitits syndrome in white-tailed deer (Odocoileus virginianus) were evaluated by surveying wildlife disease diagnostic laboratories and by examining both natural mortality and hunter-harvested deer skulls from North America. Intracranial abscesses were diagnosed as the cause of death or illness in 97 of nearly 4,500 (2.2%) white-tailed deer examined from 12 states and four Canadian provinces by the diagnostic laboratories. The bacterium Arcanobacterium pyogenes was isolated from 61% of cases; 18 other genera of bacteria also were isolated. The disease was strongly gender-biased (P < 0.01) with 87% of cases occurring in males, and the overall prevalence among males was 4.9%. Cases were most common among antlered males (> or = 1 yr) with few cases among male fawns. Among antlered males, cases were seasonal, primarily occurring from September through April. Four hundred eighteen skulls from deer found dead in the field were examined from southeastern USA, and of the 119 used for further evaluation, 9% had characteristic lesions. Skulls from hunter-harvested males in the southeastern USA had a lesion prevalence of 1.4%. The similarity of disease prevalence among male deer found dead in the field (9.0%) and deer examined as southeastern diagnostic laboratory cases (8.4%) suggests that this disease accounts for slightly < 10% of the natural mortality for yearling and adult male white-tailed deer in the southeastern region. The strong bias for occurrence among males suggests this disease may affect quality deer management strategies.     

个性化后侧入路治疗胫骨平台后髁冠状面骨折

目的:探讨个性化后侧入路治疗单纯性胫骨平台后髁冠状面骨折手术方法。方法:12例单纯性胫骨平台后髁冠状面骨折的患者,采用后内侧或后外侧以及后内后外联合入路切开复位内固定治疗。结果:12例均获随访,随访时间8-24个月,平均13个月。患者膝关节功能评定按Hohl评分标准:优10例,良2例。复查X线片:骨折复位良好,关节面未见明显塌陷。结论:个性化后侧入路治疗单纯性胫骨平台后髁骨折冠状面可直视下暴露胫骨平台后髁,提供了更广阔的操作空间,有利于骨折的解剖复位内固定。     

New cases of thalidomide embryopathy in Brazil

Thalidomide is the best known human teratogen. Although withdrawn from the market in 1961, thalidomide was remarketed after 1965 in several countries, for the treatment of erythema nodosum leprosum. Thalidomide has a potent immunomodulatory property and has now a number of approved and off-label uses in dermatologic, oncologic, infectious and gastrointestinal conditions. In the U.S., FDA approved the use of thalidomide in 1998, but no cases of thalidomide embriophaty were registered after that. Since 1996 no new cases were reported in Latin America. However, the Teratogen Information Service (TIS) Porto Alegre, recorded three new cases of thalidomide embriophaty born in Brazil since 2005. Considering that these three cases were not registered through a systematic surveillance system, but that came to our attention through a series of coincidental random events, it can be assumed that the actual occurrence of affected babies by thalidomide continues being as frequent as denounced ten years ago.     

THE CALIFORNIA TUMOR REGISTRY

The California Tumor Registry, in which 71,215 cases have been entered, provides data for professional and public education which is specific to the state. It has suggested leads for epidemiological investigation of cancer. Participating agencies are assisted in maintaining adequate follow-up systems through annual listing of cases by the State Department of Public Health and removal from the list of cases in which death occurs. Among the first cases analyzed, the diagnosis was confirmed microscopically in 70.6 per cent. Only 36.2 per cent of patients had visited a physician within two months after onset of symptoms. Survival of patients with cancer is compared with their expectancy calculated from life-tables, thus taking account of deaths from causes other than cancer.     

华南常见毒鹅膏菌及其中毒事件分析

根据文献报道和实际调查对华南地区的有毒鹅膏种类进行统计分析,确认了21种常见有毒鹅膏菌,包括急性肝脏损害型的剧毒鹅膏、急性肾脏损害型和神经精神型的毒鹅膏各7种。对2000-2019年20年间发生的有毒鹅膏中毒事件进行统计分析显示,华南地区有毒鹅膏中毒事件共发生45起,163人中毒,60人死亡,病死率为36.8%;毒鹅膏的中毒事件主要发生在3-9月,其中3月份最多。致命鹅膏Amanita exitialis引起的中毒起数、中毒人数和中毒死亡率均占中毒事件总数的70%左右,是华南毒蘑菇中毒的“头号杀手”。本研究对华南地区毒蘑菇中毒的科学精准防控、有效减少中毒事件的发生、以及降低中毒死亡率具有重要意义。     

The California tumor registry

The California Tumor Registry, in which 71,215 cases have been entered, provides data for professional and public education which is specific to the state. It has suggested leads for epidemiological investigation of cancer. Participating agencies are assisted in maintaining adequate follow-up systems through annual listing of cases by the State Department of Public Health and removal from the list of cases in which death occurs. Among the first cases analyzed, the diagnosis was confirmed microscopically in 70.6 per cent. Only 36.2 per cent of patients had visited a physician within two months after onset of symptoms. Survival of patients with cancer is compared with their expectancy calculated from life-tables, thus taking account of deaths from causes other than cancer.     

Legionnaires' disease caused by Legionella dumoffii in distilled water.

Five cases of Legionnaires'' disease caused by Legionella dumoffii were identified within an 11-month period in a hospital in the Quebec City area. In four cases bacterial isolates were obtained from clinical specimens, and in one case seroconversion was demonstrated. All the patients had been admitted to hospital within 10 days before diagnosis. Two of the patients were immunosuppressed children. Only 1 of the 40 hot water samples from the hospital yielded L. dumoffii; however, 6 of 11 distilled water samples contained the bacterium. All the patients had been exposed to distilled water, four through respiratory therapy equipment and one through a room humidifier. Following the use of sterile distilled water in the apparatus, no further cases were identified. This is the first reported outbreak of Legionnaires'' disease caused by L. dumoffii, and it is the first time that nosocomial legionellosis has been linked to contaminated distilled water in Canada.     

Decarboxylation of branched-chain alpha-ketoacids in hepatocytes from alloxan-diabetic rats. The effect of insulin

The flux through branched-chain alpha-ketoacid dehydrogenase and the activity of the branched-chain alpha-ketoacid dehydrogenase complex were measured in hepatocytes isolated from fed, starved and alloxan diabetic rats. The highest rate of branched-chain alpha-ketoacid oxidation was found in hepatocytes isolated from starved rats, slightly lower in those from fed rats, and significantly lower in diabetic hepatocytes. The amount of the active form of branched-chain alpha-ketoacid dehydrogenase was only slightly diminished in diabetic hepatocytes, whereas the flux through the dehydrogenase was inversely correlated with the rate of endogenous ketogenesis. The same was observed in hepatocytes isolated from starved rats when branched-chain alpha-ketoacid oxidation was measured in the presence of added oleate. In both cases the diminished flux through the dehydrogenase, restored by a short preincubation of hepatocytes with insulin, was paralleled by a decrease of fatty acid-derived ketogenesis. The significance of these findings is discussed in relation to the role of insulin in branched-chain alpha-ketoacid oxidation in liver of diabetic rats.     

Arterial and venous anatomical features of the pectoralis minor muscle flap pedicle

The pectoralis minor muscle has been used as an innervated, vascularized, free-muscle graft in the field of facial reanimation for 20 years. Throughout this period, several centers have demonstrated consistent success with functional muscle transfer; however, opinions regarding the arterial pedicle of the flap have varied. The lateral thoracic and thoracoacromial arteries have been proposed as the predominant arterial sources. It has been the experience of our unit that a vessel (not described in anatomy textbooks) arising directly from the axillary artery and entering the muscle from its dorsal surface provides the dominant supply to the flap and is capable of sustaining it for free-tissue transfer. The vascular pedicle encountered was recorded and photographed in 97 consecutive cases in which the pectoralis minor muscle flap was raised. The findings demonstrated that the dominant supply to the muscle was from a single artery in 77 percent of cases and took the form of an artery arising directly from the axillary vessel in 72 percent of cases. More than one major arterial source was noted in the remainder of the cases. The venous outflow was usually through single or multiple veins running directly from the muscle into the axillary vein.     

Persistent high burden of invasive pneumococcal disease in South African HIV-infected adults in the era of an antiretroviral treatment program

Background

Highly active antiretroviral treatment (HAART) programs have been associated with declines in the burden of invasive pneumococcal disease (IPD) in industrialized countries. The aim of this study was to evaluate trends in IPD hospitalizations in HIV-infected adults in Soweto, South Africa, associated with up-scaling of the HAART program from 2003 to 2008.

Methods

Laboratory-confirmed IPD cases were identified from 2003 through 2008 through an existing surveillance program. The period 2003-04 was designated as the early-HAART era, 2005–06 as the intermediate-HAART era and 2007–08 as the established-HAART era. The incidence of IPD was compared between the early-HAART and established-HAART eras in HIV-infected and–uninfected individuals.

Results

A total of 2,567 IPD cases among individuals older than 18 years were reported from 2003 through 2008. Overall incidence of IPD (per 100,000) did not change during the study period in HIV-infected adults (207.4 cases in the early-HAART and 214.0 cases in the established-HAART era; p = 0.55). IPD incidence, actually increased 1.16-fold (95% CI: 1.01; 1.62) in HIV-infected females between the early-and established-HAART eras (212.1 cases and 246.2 cases, respectively; p = 0.03). The incidence of IPD remained unchanged in HIV-uninfected adults across the three time periods.

Conclusion

Despite a stable prevalence of HIV and the increased roll-out of HAART for treatment of AIDS patients in our setting, the burden of IPD has not decreased among HIV-infected adults. The study indicates a need for ongoing monitoring of disease and HAART program effectiveness to reduce opportunistic infections in African adults with HIV/AIDS, as well as the need to consider alternate strategies including pneumococcal conjugate vaccine immunization for the prevention of IPD in HIV-infected adults.     

The role of fine needle aspiration cytology (FNAC) in the investigation of superficial lymphadenopathy; uses and limitations of the technique

Aspirates (n = 163) from 157 patients with enlarged superficial lymph nodes were obtained over a 5-year period in a combined surgical/FNAC clinic. A definitive diagnosis was achieved in over 77% of the cases: benign 52.7%, malignant 25.1%. The diagnostic accuracy was 94.4%, sensitivity 85.4%, and specificity 100%. The false-negative rate was 12.5% but decreased to 3.5% when lymphoma cases were excluded. There were 36 cases of metastatic disease, the majority of which were from a primary breast carcinoma. The main diagnostic difficulty was in distinguishing low-grade lymphoma from reactive hyperplasia. An added advantage was that aspirated material could be used in ancillary tests to help with the differential diagnosis. FNAC has a well-defined role in the investigation of superficial lymphadenopathy. Used in the proper setting it will provide a definitive diagnosis in the majority of cases, especially relating to recurrent malignancy or metastatic disease. Patients with a reactive cytological picture and no clinically suspicious symptoms could be spared unnecessary surgery and reviewed through follow up. This technique is cost-effective, of high diagnostic accuracy, and results in considerable resource savings.     

Holoprosencephaly in human embryos: epidemiologic studies of 150 cases

One hundred fifty embryos with holoprosencephaly were found among the total of 36,380 conceptuses obtained through induced abortion in the period from 1962 to 1974, giving an overall incidence of 0.4 percent. The occurrence was period from 1962 to 1974, giving an overall incidence of 0.4 percent. The occurrence was largely at random through time, and no "epidemic" was noted in particular years or months, but there appeared more cases derived from conceptions in winter than in summer months. The mean maternal age did not differ significantly from that of the general embryonic population, indicating that, although none of our cases were karyotyped, chromosome aberrations such as trisomies 13 and 18 that are closely associated with maternal age may not constitute a major part as causes of holoprosencephaly in human embryos. Materal age did not differ by the presence or absence of associated external anomalies. No association was found with paternal age, parental consanguinity nor with maternal medical history, including irregularity of menstrual cycles, and smoking and drinking habits. There was an indication that the mothers were prone to have repeated miscarriages, supporting the view that some kind of maternal predisposition is responsible for the causation of holoprosencephaly. Argument was made that, apart from various chromosome aberrations well documented as causes of this malformation, polygenic mechanism probably accounts for the majority of the cases with normal karyotype.