Human Herpesvirus 6 in Bronchalveolar Lavage Fluid after Lung Transplantation: A Risk Factor for Bronchiolitis Obliterans Syndrome?

Bronchiolitis obliterans syndrome (BOS) is the limiting factor to long-term survival after lung transplantation. Previous studies suggested respiratory viral tract infections are associated with the development of BOS. To identify the impact of virus detection in bronchoalveolar lavage (BAL) fluid, we analyzed BAL samples from 87 consecutive lung transplant recipients for human herpesvirus (HHV)-6, Epstein-Barr virus, Herpes simplex virus 1/2, Cytomegalovirus, respiratory syncytical virus and adenovirus by PCR. Acute rejection, BOS and death were recorded for a mean follow-up time of 3.27 +/- 0.47 years. Results of PCR analysis and other potential risk factors were entered into a Cox regression analysis of BOS predictors and death. Only acute rejection was a distinct risk factor for BOS of all stages, death and death from BOS. HHV-6 was detected in 20 patients. Univariate and multivariate analysis revealed that HHV-6 was associated with an increased risk to develop BOS > orb = stage 1 and death, separate from the risk attributable to acute rejection. Identification of HHV-6 DNA in BAL fluid is a potential risk factor for BOS. Our results warrant further studies to elucidate a possible causal link between HHV-6 and BOS.     

Minimal Acute Rejection after Lung Transplantation: A Risk for Bronchiolitis Obliterans Syndrome

Bronchiolitis obliterans syndrome (BOS) is a major cause of lung allograft dysfunction. Although previous studies have identified mild to severe rejection (grade>or=A2) as a risk factor for BOS, the role of minimal rejection (grade A1) remains unclear. To determine if A1 rejection by itself is a risk factor for BOS, we performed a retrospective cohort study on 228 adult lung transplant recipients over a 7-year period. Cohorts were defined by their most severe rejection episode (none, A1 only, and >or=A2) and analyzed for the subsequent development and progression of BOS using univariate and multivariate time-dependent Cox regression analysis. In the univariate model, the occurrence of isolated minimal rejection was a risk factor for all stages of BOS. Similarly, multivariate models that included HLA mismatch, cytomegalovirus pneumonitis, community acquired viral infection, underlying disease and type of transplant demonstrated that A1 rejection was a distinct risk factor for BOS. Furthermore, the associated risk with A1 rejection was slightly greater than the risk from >or=A2 and treatment of A1 rejection decreased the risk for subsequent BOS stage 1. We conclude that minimal rejection is associated with an increased risk for BOS development and progression that is comparable to A2 rejection.     

Is focal task‐specific dystonia limited to the hand and face?

Focal task-specific dystonia (FTSD) of the hand and face have been well described; however, FTSD of the leg is exceedingly rare. We describe and demonstrate by videotape 2 patients with FTSD affecting the leg, in both cases triggered specifically by walking down steps. Walking on a level surface, up steps, and down steps backward, and sideways were normal. An interoceptive sensory trick (imagining walking in a different modality) led to temporary improvement. Our patients appear to demonstrated that task-specificity in focal dystonia may not be limited to skilled, rehearsed actions and that FTSD may occur in an activity that is relatively autonomic.     

眼袋整形术并发症的防治

眼袋整形术的并发症主要包括下睑外翻、下睑睫毛外翻、睑球分离、泪小点外翻、眼鼻沟畸形及眶下睑沟凹陷畸形等。皮肤眼轮匝肌及眶隔脂肪切除过多是造成上述并发症的主要原因，另外，手术中失误或操作粗糙也可造成诸如复视、泪小管撕裂甚至球后血肿等严重并发症。防止下睑外翻的发生，主要在于如何测定松弛皮肤的方法，这要把眼球活动、面部肌肉活动以及重力对面部的影响等诸因素进行综合考虑，正确估算出皮肤的切除量，才能有效防止睑外翻的发生。对于轻度外翻可采用热敷、按摩等保守治疗，对于重度睑外翻据不同情况分别采用，眼轮匝肌提紧术，睑板部分切除、结膜囊缩小术及下睑皮肤移植术加以矫正。对于眶下区凹陷及眼鼻沟畸形，术中就应注意避免，特别是要控制好眶脂的切除量，一旦发生可采用脂肪或筋膜脂肪充填，也可行眼轮匝肌提紧加以矫正。总之，在眼袋整形术中避免去除过多的组织，无论是皮肤，还是眶隔脂肪，都可有效防止并发症的发生。     

ECAT angina pectoris study: baseline associations of haemostatic factors with extent of coronary arteriosclerosis and other coronary risk factors in 3000 patients with angina pectoris undergoing coronary angiography

The ECAT Angina Pecioris Study is a European multicentre studyinvestigating the pathogenetic and possibly predictive roleof the haemostatic system in the progress of coronary heartdisease. In this paper we report the cross-sectional analysisof haemostatic factors in 3043 patients, who underwent coronaryangiography due to angina pectoris. Fibrinogen levels were higherin patients with one or more coronary stenoses of at least 50%than in patients without, by an average of 0.16 g. l^–1(P <0.0001). Depressed fibrinolytic activity due to higherlevels of PAI was also associated with the presence of coronarystenoses. There was no association with the extent of coronaryarteriosclerosis, as assessed by the number of involved arteries,except that patients who had more vessels with total occlusionshad higher fibrinogen levels. Depressed fibrinolytic activitywas also clearly associated with diabetes, obesity, higher triglyceridelevels, smoking and impaired cardiac pump function as assessedby ejection fraction. Cholesterol levels were particularly correlatedwith protein C and plasminogen.     

The lateral arm free flap in lower extremity reconstruction

Reconstruction of skin defects of the distal third of the leg and foot is often a difficult task. Shape, resistance to shearing stresses in the weight-bearing surface and sensibility are the main features that have to be restored. For coverage of this region, the authors have used, in selected patients, the lateral arm flap (LAF) since 1994. This flap is thin, easy to dissect and has the possibility to be innervated through the posterior cutaneous nerve of the arm. Fourteen cases are presented. The drawbacks of this flap are the loss of sensibility in the forearm (partially transient) and the scar on the arm, which can be rather unsightly in young ladies and when big flaps are harvested skin graft is needed.     

Detecting cumulative trauma disorders in workers performing repetitive tasks

On-site testing of 157 poultry processors disclosed that 50% had three or more abnormal upper extremity findings out of a total of 22 possibles. The average worker had five to six abnormal findings. Impaired pinch strength, decreased vibration sensitivity in the fingertips, and reports of current numbness were the most prevalent. Of workers with signs, 25% reported no symptoms, whereas only 8% of workers reported symptoms but had no signs. The investigators concluded that this measurement method has utility for assessments of worker populations to determine prevalence of CTDs and, potentially, for preclinical detection of these disorders to permit early intervention, reduce medical costs, and minimize disability. The need for accurate measurement to enhance early detection and prevention is discussed.     

人工全髋置换术中拉钩对下肢深静脉血栓影响的研究

目的：通过对髂外动静脉及股动静脉与髋臼解剖学与临床的研究，探讨在全髋臼置换术中拉钩在髋放置位置对下肢深静脉血栓的影响。方法：通过解剖学研究56具成年骨盆标本中髂外动静脉及股动静脉来源及走行、与髋臼的关系进行测量分析；并通过临床观察22例（股骨颈骨折12例、股骨头缺血性坏死6例、类风湿性关节炎4例）在人工全髋置换术（THR）中拉钩放置安全区，经下肢静脉超声多普勒检查观察下肢深静脉血栓发病率。结果：在左侧3-5点间、右侧7-9点、左侧9点、右侧3点使用拉钩用力要适度，牵拉时间过长，会造成臀下血管、股动脉的牵拉过度或时间过长，易引起下肢深静脉血栓；通过临床22例THR拉钩放置安全区的观察，无一例下肢深静脉血栓，仅有2例轻度深静脉血流缓慢、但无明显的症状体征，经过口服活血通络中药后消失。结论：通过解剖学与临床观察研究，确定在THR中拉钩放置位置、深度是避免下肢深静脉血栓的重要因素。     

负压疗法治疗肢体缺血

目的：评价负压疗法对肢体缺血的治疗效果，方法：１９８５－０７￣１９９５－０３，我们应用自行研制的治疗机，对１６７例（２３１个肢体）肢体缺血患者进行了负压治疗，其中动脉硬化性闭塞症６２例（９１肢），血栓闭塞性脉管炎７５例（９３肢），雷诺综合征３０例（４７肢），治疗时将患肢置入密闭舱内，压力范围为－８．６６ｋＰａ￣－１７．３ｋＰａ，一般上肢为－１０．７ｋＰａ，下肢为－１３．３ｋＰａ。结果：显效１１７肢     

Lower Lid Blepharoplasty—The Transconjunctival Approach: Extended Indications

The transconjunctival blepharoplasty is an elegant and secure technique especially in young people and helps to avoid the hazard of a scar. In older patients, it saves them the possible sequelae such as rounding sclero show or possible ectropion after a classical operation. Because there is no visible scar, the transconjunctival approach respects the integrity of the functional structure of the orbital septum and the orbicular muscle, the active support of the lower eyelid.