空心钉配合缝线张力带技术治疗移位的肱骨大结节骨折

目的:探讨使用空心钉配合缝线张力带技术治疗移位的肱骨大结节骨折的效果。方法:2008年3月-2010年3月,收治12例肱骨大结节骨折病人,男10例,女2例,年龄21-71岁,平均年龄46.3岁。其中8例摔伤,2例车祸外伤,2例运动中损伤并伴有盂肱关节脱位。受伤至手术时间5小时-1周。X线显示大结节骨折移位大于5mm。大结节骨折块采用空心钉配合5-Ethibond缝线构成的张力带技术进行固定。结果:患者伤口均一期愈合无感染等并发症发生,所有患者均获随访,随访时间9-33个月,平均14个月。X线显示术后2-4个月骨折愈合,平均2.5个月。美国加州大学洛杉矶分校评分标准评分为(33.65±3.83)分;优9例,良2例,可1例,优良率91.7%。结论:采用切开复位空心钉配合缝线张力带技术治疗肱骨大结节骨折疗效满意,功能恢复良好,疼痛缓解明显。     

Cox-2和Suvrivin蛋白在眼睑基底细胞癌组织中的表达

目的探讨Cox-2和Suvrivin蛋白在眼睑基底细胞癌组织中的表达及临床意义。方法收集武汉大学人民医院和武汉大学中南医院病理科1999-2006年手术切除及活检的眼睑基底细胞癌（basal cell carcinoma,BCC）标本共40例,另取癌周围组织5例作对照。眼睑基底细胞癌发病年龄20-68岁。采用免疫组织化学方法观察各组细胞内Cox-2和Suvrivin蛋白表达的变化。利用HPIAS-2000图像分析系统测定Cox-2和Suvrivin蛋白在以上各组中表达的平均光密度和平均阳性面积率。结果眼睑基底细胞癌组织中COX-2蛋白呈高表达;癌旁组织中COX-2蛋白呈低表达。眼睑基底细胞癌组织中Suvrivin蛋白呈高表达;癌旁组织中Suvrivin蛋白呈低表达。图像分析结果显示：眼睑基底细胞癌组织与癌旁组织之间COX-2和Suvrivin蛋白的平均光密度及阳性面积率的差异有显著性意义（P〈0.01）。结论COX-2、Survivin在眼睑BCC中的异常表达,对眼睑BCC的发生和发展起了重要作用。     

21例胫骨近端骨肉瘤保肢治疗临床分析

目的：探讨胫骨上端骨肉瘤保肢手术中使用人工关节重建的疗效和并发症。方法：回顾性分析2000年6月-2010年6月对21例胫骨上段骨肉瘤患者行根治性切除人工关节重建手术的临床资料,其中男性13例,女性8例,年龄21—62岁,平均34．1岁。依据Enneking分期：ⅡA期12例、ⅡB期9例。均采用广泛性边缘切除手术治疗。所有患者均接受术前、术后化疗。结果：1例患者发生术后胫前肌群坏死。所有患者均随访6—72个月,平均45．1个月。ⅡA期12例患者中,1例因肺转移死亡（占8．3％）,局部复发1例,行股骨下段截肢,10例无病生存;ⅡB期9例,4例死亡,5例存活;Enneking分期明显影响预后。结论：胫骨上段人工关节重建对胫骨上段骨肉瘤的保肢治疗具有良好的疗效。     

Cardiac Manifestations During a Coxsackie B5 Epidemic

During a widespread Coxsackie B5 epidemic which occurred in Finland in the autumn of 1965 18 patients with acute myopericarditis were admitted to Kuopio Central Hospital (530 beds, representing a hospital district with 270,000 inhabitants) within a period of three months.The mean age of these patients was 28 years. Twelve were males and six were females.In 12 cases Coxsackie B5 virus and in one case Coxsackie A9 virus were isolated from the faeces. A significant increase in neutralizing antibodies or high antibody titres (≥1:128) were noted in 16 cases against Coxsackie B5 and in one case against Coxsackie A9. In two cases the cause of the myopericarditis remained obscure.All the patients had fever. Six showed all classical criteria of pericarditis: chest pain, pericardial rub, E.C.G. changes, and radiologically observable enlargement of the heart. As regards the various criteria, E.C.G. changes were found in all cases. Signs of cardiac tamponade were observed in one patient. Five, in addition, showed aseptic meningitis.All the patients recovered. Twelve were re-examined at an average of seven months after discharge from hospital. All were symptom-free except one, who still showed E.C.G. changes.     

A five-year immunological follow-up study of the institutionalized handicapped children vaccinated with live varicella vaccine or infected with natural varicella

Twenty-two institutionalized handicapped children who were susceptible to varicella were vaccinated with live varicella vaccine of the Oka strain and their immune status was followed for 5 years under conditions without exposure to natural varicella. Simultaneously, 7 children infected with natural varicella were followed. Of the 22 vaccinees, 16 showed sero-positive conversion by the fluorescent antibody to membrane antigen (FAMA) test, the other 6 remaining seronegative during 5 years of observation period. All the 16 cases showing seroconversion had detectable antibody for 5 years after vaccination, and 14 of them gave a positive reaction in the varicella skin test. All the 7 cases after natural varicella gave positive reactions in both the FAMA and skin test. These results suggest that immunity conferred by the vaccination would persist long even in the absence of exposure to natural varicella, though further follow-up studies are needed.     

The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity

From April of 2000 to May of 2003, 28 consecutive patients with chronic osteomyelitis of the lower extremity underwent surgical debridement and reconstruction with anterolateral thigh perforator flaps (six cases were combined with vastus lateralis muscle flaps). All wounds were open for a minimum period of 6 weeks (average, 24.7 months; range, 6 weeks to 52 months). The average patient age was 42.8 years (range, 18 to 71 years), there were 21 male and seven female patients, and the average follow-up period was 18.2 months (range, 5 to 41 months). The cause of injury was an open fracture in 10 cases, secondary wound complications after reduction in eight cases, and diabetic foot in 10 cases. The surface defects ranged from 50 to 153 cm. The wounds were debrided an average of 2.5 times and then reconstructed with flap and treated with antibiotics for 6 weeks. Antibiotic beads were used in six cases and secondary bone graft procedures were performed in seven cases 3 months after the flap coverage. All 28 flaps were successful without any signs of recurrences or persistent osteomyelitis, but partial wound dehiscence was observed during early rehabilitation in two cases suspected of delayed healing caused by diabetes. These wounds healed spontaneously. All patients achieved acceptable gait function after rehabilitation. No debulking procedure was necessary in any case. Although the muscle flap is known to provide superior vascular supply, the type of flap used for coverage seems to be less critical in the final outcome, provided that total debridement and obliteration of dead spaces are achieved. A well-vascularized anterolateral thigh perforator flap was successfully used to combat infection and bring stability to wounds with chronic osteomyelitis.     

肺硬化性血管瘤的CT表现及病理学分析

目的：回顾性分析肺硬化性血管瘤（PSH）的CT及病理学特点,提高对PSH的影像诊断水平。方法：收集2008年4月至2012年7月由病理证实的PSH共22例,女21例,男1例,年龄15-72岁,平均48岁。所有病例均行CT平扫,其中17例行CT增强扫描。影像学征象由两名资深胸部影像诊断医师共同讨论完成。结果：CT显示病变直径平均（3.0±1.3）cm,形状呈类球形15例（68%）,不规则形7例（32%）,所有病例均显示边缘光滑（100%）;平扫2例（9%）病灶内有斑点状钙化,1例呈混合磨玻璃影,其余19（86%）密度均匀,CT值为（35±7）HU;17例增强扫描中,10例显示均匀强化,7例呈明显不均匀或延迟强化,平均强化值约为（80±5）HU。结论：总结分析以下指标有助于对PSH的诊断：（1）女性患者,边缘光滑的类球形或卵圆形肺结节,周围无毛刺及卫星灶;（2）CT平扫密度较均匀,有时病灶呈磨玻璃影和内可见点状钙化,（3）增强扫描根据病灶大小可呈均匀强化或明显不均匀强化。     

A 10-year experience in the treatment of intraabdominal cerebrospinal fluid pseudocysts

The aim of this retrospective study was to assess a ten-year experience in the treatment of rare complications of ventriculoperitoneal shunting--intraabdominal cerebrospinal fluid pseudocysts. At this time there are no data about incidence, clinical course and treatment of these complications in Croatia. Cerebrospinal fluid (CSF) abdominal pseudocyst is an uncommon but important complication of ventriculoperitoneal shunts. Retrospective data were obtained from 5 children with abdominal CSF pseudocysts, treated between 1996 and 2007. The incidence of intraabdominal CSF pseudocysts in our study is 2.9%. All patients were girls ranged in age from 4 to 12 years old (mean 8.8 years). In most cases etiology of hydrocephalus was congenital, idiopathic. Abdominal pain and distension were the most frequent clinical finding (4/5). Although infection has been reported as responsible for pseudocyst formation, we did not found it in our series. Laparotomy with cyst wall excision and catheter replacement was performed in 2/5 cases, and only cyst fluid aspiration with catheter replacement in 3/5 cases. Recurrence of the abdominal cyst was observed in one girl who was in terminal stadium of anaplastic ependymoma. It is our opinion that only catheter replacement and cyst fluid evacuation, as one of the treatment modalities, may be successful, even in large CSF intraperitoneal pseudocysts.     

Pilot studies on the occurrence of some infectious diseases in two different areas in south Yemen (Aden) (part II. Microbiology).

This paper is the second part of the article dealing with intestinal bacteria. The findings are relatively poor in comparing with the frequency of intestinal protozoa. Among 83 stool specimens taken for bacteriological examination 14 isolations of different bacteria were proved. One S. muenchen was isolated from a 3 year old boy with fever, diarrhoea. Five cases of Alkalescens dispar 05 manit negative and 05 manit positive were identified. Two of these cases were without clinical symptoms. All were males aged 10-17 years. One isolation of E. coli EPEC 086 K6 H11 was in a 10 year-old boy with diarrhoea, four watery stools daily and cramps. Six cases of other E. coli were of different types, all with clinical symptoms. Of them three were males and three females at the age from 3-46 years. One case had a mixed infection of Citrobacter, E. coli and Klebsiella with diarrhoea, about 5 watery stools daily and abdominal pain. The frequency of intestinal bacteria in males was nearly three times higher than in females. The occurrence in age groups 10-20 was almost equal 20.0-22.2%, in 0-4 it was 42.9% and surprisingly low in 5-9 years old--3.4% only.     

新辅助化疗联合人工膝关节置换治疗膝关节附近骨肉瘤

目的:评价新辅助化疗联合人工膝关节置换治疗膝关节附近骨肉瘤的临床疗效。方法:38例膝关节附近骨肉瘤采用新辅助化疗和人工膝关节置换,所有病例均进行肿瘤细胞坏死率、5年内肿瘤局部复发率、5年生存率和膝关节功能评估。结果:38例患者新辅助化疗后肿瘤细胞坏死率平均95.8%;随访6-9年,38例患者中5年内肿瘤局部复发12例(31.6%),5年后生存31例(81.6%),膝关节功能优良率92.1%。结论:新辅助化疗联合人工膝关节置换治疗膝关节附近骨肉瘤可有效提高骨肉瘤5年生存率,保存患肢功能,是骨肉瘤保肢治疗的一种较好的方法。     

Nosocomial meningitis in neonates caused by Streptococcus agalactiae

Streptococcus agalactiae is a rare cause of neonatal meningitis in the era of peripartum prophylaxis with prophylaxis with ampicillin in colonized/infected mothers. However 5 cases of meningitis among 171 cases of pediatric nosocomial meningitis database within last 15 years occurred. All 5 children were neonates (one VLBW and early gestation newborn), 2 after neurosurgery. All 5 cases were successfully cured with a combination of cefotaxim (or ceftazidim) plus aminoglycosides, in one case also with addition of vancomycin or ampicillin. However 3 of 5 cured patients had neurologic sequellae, two of them reversible hydrocephalus and in speech retardation.     

Clinical and genealogical characteristics in families with Nijmegen breakage syndrome

Nijmegen breakage syndrome (NBS) is a rare autosomal recessive disorder characterized by microcephaly, immunodeficiency and high predisposition for malignancies, particularly B-lymphoma. Clinical and genealogical analysis has been conducted in 7 families with NBS. Eight children with NBS (5 boys and 3 girls) were observed at the age from 7 months to 11 years. All the children were homozygous carriers for mutation 657del5. Oncohematological complications developed in 5 cases (4 cases of lymphoma and one case of lymphohystiocytosis) at the age of 6-12 years. NBS in probands is often accompanied with birth defects, especially with kidney pathologies. Considerable reproductive losts in the families with NBS were noted mainly among males who died at the age less than one year (4-6 events in the families). The cases of digestive system cancers (stomach, rectum, duodenum) were revieled in the family-trees. Consanguineous couple was observed in 1 case (marriage between third cousins) and 2 children had developed NBS in this family. Genealogical analysis seems to be very informative to predict somatic and reproductive disturbances in NBS families.     

Double trisomy in spontaneous abortions

Cytogenetic data on products of conception from spontaneous abortions studied over a 10-year period have been reviewed for double trisomies. A total of 3034 spontaneous abortions were karyotyped between 1986 and 1997. Twenty-two cases with double trisomy, one case with triple trisomy, and a case with a trisomy and monosomy were found. The tissues studied were mostly sac, villi, or placenta. The gestational age ranged from 6 to 11 weeks and the mean age was 8.2 ± 1.7 (SD) weeks. The mean maternal age in years was 35.9 ± 5.3. Of the twenty-two cases, four were mosaics. All but two of the cases involved autosomal aneuploidies. The double trisomies included chromosomes 2, 4, 5, 7, 8, 12, 13, 14, 15, 16, 17, 18, 20, 21, and 22. The chromosomes that were trisomic in more than one double trisomy case were numbers 16 (8 cases), 8 (5 cases), 15 (4 cases), 2, 13, and 21 (3 cases each), and 5, 7, 14, 18, 20, 22, and X (2 cases). The triple trisomy involved chromosomes 18, 21, and X. The monosomy and trisomy case was a mosaic, with a monosomy 21 in all cells and some cells also with a trisomy 5. The double trisomies cited for the first time in this study were 4/13, 5/16, 8/14, 8/15, 14/21, 15/20, and 7/12. The pooled mean maternal age for double trisomy cases (34.1 ± 5.7 years) was higher than that for single trisomy cases (31 ± 6.1 years). The difference was statistically significant at P = < 0.001. The pooled mean gestational age of spontaneous abortions was lower for double trisomy (8.7 ± 2.2 weeks) than for reported single trisomy cases (10.1 ± 2.9 weeks). This difference is also statistically significant at P = < 0.001. The sex ratio among double trisomies was 15 females to 13 males. This difference was not statistically significant from the expected 1 : 1. Received: 27 June 1997 / Accepted: 4 September 1997     

Male intergroup mobility in a wild population of the Barbary macaque (Macaca sylvanus), Ghomaran rif mountains,Morocco

In this two-year study of a Barbary macaque population (n = 162) in the Ghomaran region of Morocco, 13 cases of males separated from their assumed natal groups were observed (nine visits of nonresident males to groups, two males isolated from groups as much as one day and one night, and two sets of snow tracks indicating males travel +7 km as isolates). Males left their assumed natal groups primarily in the mating season (12 cases), focused their interactions on estrous females of other groups, and were observed to copulate with these females in two cases. All males leaving their assumed natal groups were estimated to be between 5 and 8 years of age, with one exception (+ 15 years). It could not be determined whether males younger than 5 years moved between groups, or whether any males made permanent intergroup transfers. Regardless, the data from this study indicate that male intergroup mobility (and intergroup gene flow) was higher than has been previously assumed for this species. A prior theory that Barbary macaque groups are highly inbred, and that this is causally related to the evolution of male-infant care in this species, is not supported by the data of this study.     

Register of newly diagnosed diabetic children.

In November 1972 the British Diabetic Association sponsored a register to which notification was invited of all new cases of diabetes occurring in children aged 0-15 years in Great Britain and Ireland. More than 2000 cases were notified in the first two years. Notification suggested that there was a minimum yearly incidence of 7-67 cases per 100 000, though incidences varied from year to year and by geographical area. Several reports of simultaneous onset of diabetes in sibs of different ages provided evidence of clustering. A seasonal variation in incidence was found in children aged 5-15 years with peaks in the autumn and winter. The age distribution was bimodal with a main peak at about 11 years and a secondary peak at about 5 years. The sex ratio showed a male excess from 0-4 years and from 11-15 years and a female excess from 5-10 years. Overall there were slightly more male cases. Altogether 11% of patients had a first-degree relative with diabetes. The register and several investigations based on it will continue.     

新生儿Ⅰ期胃代食管术治疗Ⅲa型食管闭锁的疗效观察

目的:探讨Ⅰ期胃代食管术治疗Ⅲa型食管闭锁的疗效。方法:对2008年3月至2013年6月我院采用Ⅰ期胃代食管术治疗的8例Ⅲa型食管闭锁进行回顾性分析。其中男6例,女2例,食管两盲端距离均大于3 cm。结果:所有患儿均顺利完成手术。6例治愈出院,1例死亡,1例家长放弃治疗。术后5例有严重肺炎,近期吻合口瘘2例。随访6个月至5年,吻合口狭窄2例,均行食管扩张术治愈,轻度胃食管反流4例,均未行抗反流手术,采用少量多餐及体味喂养治疗后症状缓解。结论:新生儿期采用Ⅰ期胃代食管术治疗Ⅲa型食管闭锁临床可行,避免了分期手术,缩短了治疗周期,有助于提高治愈率。     

Intentional iron overdose: an institutional review.

OBJECTIVE: To document the frequency of admissions and the outcome of patients with a diagnosis of intentional iron overdose to a large urban hospital. DESIGN: Retrospective review of hospital records. SETTING: Health Sciences Centre, Winnipeg, an 1100-bed primary and tertiary care centre serving a regional population of about 1.2 million. PATIENTS: All patients with a discharge diagnosis of iron overdose who were admitted from Jan. 1, 1979, to July 1, 1991. Of these 113 cases 66 (58%) represented an intentional iron overdose on the basis of information derived from the patient, family or friends. MAIN OUTCOME MEASURES: Frequency of admissions, length of hospital stay and survival rate. RESULTS: Most (53 [80%]) of the 66 patients were females. The mean age was 19.8 (standard deviation [SD] 6.1) years (range 9 to 48 years). One third of the cases were associated with excess alcohol intake. The frequency of hospital admissions increased during the study period (1.4 cases per year in the first 5 years and 9.8 cases per year in the last 5; 5.3 cases per year overall). The mean length of hospital stay was 6.8 (SD 12.1) days, and the mortality rate was 10%. CONCLUSIONS: Hospital admissions because of intentional iron overdose are becoming more frequent in this centre and are associated with appreciable morbidity and mortality rates. Prospective studies are required to delineate clearly the signs, symptoms and abnormal laboratory findings associated with this problem.     

原发性腹膜后肿瘤46例诊疗分析

目的：总结并探讨原发性腹膜后肿瘤（PRPT）的诊断及治疗方法。方法：回顾并分析2004年1月至2009年12月收治的46例腹膜后肿瘤患者的临床资料及随访结果。结果：良性肿瘤17例,完整切除15例,部分切除2例,复发4例,均再次手术;恶性肿瘤29例,完整切除10例,部分切除15例,活检2例,复发6例,再次手术4例。随访时间0.5至5年,良性肿瘤死于其他疾病3例,死于原发性腹膜后肿瘤1例;恶性肿瘤死亡22例,其中1年内死亡8例,3年内死亡12例,5年内死亡2例。结论：对原发性腹膜后肿瘤,B超、CT及MRI检查是目前诊断PRPT方便、有效的诊断手段,手术治疗是治疗PRPT的首选治疗方式,完整切除肿瘤是影响PRPT治疗效果及其预后的重要因素。对于复发病例应选择再次手术治疗。     

Should high-dose-rate brachytherapy boost be used in early nasopharyngeal carcinomas?

BackgroundRadiation with or without chemotherapy is the main treatment of nasopharyngeal carcinomas (NPC). Local recurrence is difficult to manage. Local control is dose-dependent.AimTo analyze the effect of an endocavitary brachytherapy boost after external beam radiation (EBRT) to decrease local recurrence.Material and methodsThirty patients with T0-T2 NPC were treated: 70% T1, 20% T2 and 10% T0; 33.3% N0, 20% N1, 43.3% N2 and 3.3% N3; 90% were undifferentiated carcinoma. All they received a 192-Ir high dose rate brachytherapy (HDR-BT) boost after 60 Gy of EBRT. The Rotterdam applicator was used in most cases, 3-4 fractions of 3.75-3 Gy in two days.ResultsWith median follow-up (FU) of 63 months, a single parapharyngeal failure resulted in local control of 100% at 3 years and 95% at 5 years. Local control for T0-1 was 100% and for T2 67% at five years (p = 0.02). Regional-free recurrence survival was 92% at 5 years. Metastasis-free survival was 84% at 5 years. All cases of metastasis had histopathology of undifferentiated. The overall and cause-specific survival was 96% and 86% at 3 and 5 years. No late complications related to brachytherapy were described.ConclusionA HDR-BT boost is useful to decrease the incidence of local recurrence of NPC to 5%. With a fractionated schedule of 3-4 fractions in two days, Rotterdam applicator and 3-D planning, no late complications are described. Therefore we recommend to use brachytherapy boost in all early NPC.