指背逆行筋膜岛状皮瓣的临床应用

目的探讨I期修复同指中、末节掌、背侧及指端缺损的方法。方法自1997年6月～2006年10月,对59例(63指)手指皮肤缺损的患者,采用指背逆行筋膜岛状皮瓣旋转30°～180°移转修复。结果除2例皮瓣远端部分坏死外,余均成活,经3～6个月随访,功能及外观良好。按TAM法评定,优41指,良18指,可4指,优良率达94%。结论该术式操作简单、疗程短、成功率高,皮瓣血运可靠,柔软耐磨。多指远端同时缺损的修复其优越性尤为明显。     

The Alcohol Beverage Warning Label: When Did Knowledge Increase?

This article presents data on the awareness of the alcohol beverage warning label among a sample of 5,169 inner city African-American gravidas seeking prenatal care. While the label law was implemented in November 1989, a significant increase in knowledge of the label did not occur until March 1990. Women who predominantly consumed wine coolers and beer, and those under age 30 were more likely to know about the label than their counterparts.     

重组骨形态发生蛋白-2结合软骨下钻孔治疗犬关节软骨全层缺损的实验研究

目的 研究重组骨形态发生蛋白-2(rhBMP-2)结合软骨下骨钻孔治疗犬关节软骨全层缺损的可行性，为临床应用提供实验依据。方法 依照软骨缺损处理方法的不同将64侧股骨髁随机均分为4组：①结合组：软骨下骨钻孔 胶原海绵吸附rhBMP-2充填软骨缺损；②BMP组：胶原海绵吸附rhBMP-2充填软骨缺损；③钻孔组：单纯软骨下骨钻孔；④对照组：不作处理或单纯用胶原海绵填塞。术后2、4、8、12周取材观察其大体、光镜、透射电镜、免疫组织化学情况。结果 除对照组仅有纤维组织修复外，其余3组均有不同程度的软骨修复，但结合组的修复在组织细胞形态、超微结构、Ⅱ型胶原含量等方面均明显优于其他两组。结论rhBMP-2结合软骨下骨钻孔能有效修复犬膝关节软骨的全层缺损，该技术可行，有望在临床应用。     

病案首页与编码质量对病种付费的影响

目的探究病案首页与编码质量对病种付费产生的影响。方法2019年1—12月纳入研究的1056例病案首页均为该院产科、颅脑外科、普通外科、肿瘤科及心外科5个科室所收纳,依照回顾性分析方式进行平均分组,病案首页均经针对性措施解决病案首页问题,并经校对手段质控编码确认无误(试验组,n=528),重新编码前病案首页(对照组,n=528),分析两组数据差异及变化情况。结果试验组的病种付费质量包括医院数据统计分数、病案信息利用分数、疾病分组准确分数及医院经济效益分数评估均显著高于对照组,试验组中出现病案内容与病案首页不符、遗漏诊断、不完整诊断和不正确诊断的病案不良事件发生概率显著低于对照组,试验组发生漏填、错填的缺陷问题发生率显著低于对照组,组间数据差异有统计学意义(P<0.05)。结论分析病案首页质量,对影响病案首页的因素进行分析,进行针对性的改进,有利于提升病案质量,降低病案与编码质量对病种付费产生的不良影响。     

THE CONFUSED IDENTITY OF CANTRELL'S PENTAD: ECTOPIA CORDIS IS RELATED EITHER TO THORACOSCHISIS OR TO A DIAPHRAGMATIC HERNIA WITH AN OMPHALOCELE

To find out if Cantrell's pentad is a single entity, four cases of ectopia cordis were studied and compared with cases in the literature. Our cases had the heart outside the thorax and had two to four other features of the association. In one case the thoracic organs had apparently escaped through a diaphragmatic hernia into an omphalocele, and in the others via a thoracoschisis with an abdominal defect, either a supraumbilical hernia or a gastroschisis. According to these cases and those from the literature, it is proposed that there are two major mechanisms leading to ectopia cordis: (1) a reversed diaphragmatic hernia in the case of a large diaphragmatic defect and an omphalocele, and (2) through a sterno-costal defect, with gastroschisis or a supraumbililical abdominal defect. As omphaloceles and major diaphragmatic defects are probably pathogenetically distinct from thoraco- and thoracogastroschisis, it is important to distinguish these groups of anomalies, rather than be concerned as to their relationship with Cantrell's pentad.     

NEOPLASTIC DISEASE AND DELETION 22q11.2: A MULTICENTRIC STUDY AND REPORT OF TWO CASES

Deletion 22q11.2 is a chromosomal abnormality detected in young patients with clinical manifestations of the DiGeorge/velocardiofacial syndrome. Conotruncal heart defects are also associated with del22q11.2. An association of these cardiac malformations with neoplasias has been observed. Our series includes two cases of malignancies, a hepatoblastoma and a renal-cell carcinoma, arising in children with complex cardiac malformations. The aim of the study was to determine if the deletion at 22q11.2 was present and could be responsible for both pathological processes. Del22q11.2 was identified in both cases. Comparative genomic hybridization revealed terminal gains on chromosomes 1q and Xq and terminal loss on 1p in the hepatoblastoma, and gains in 1p, 12q, 16p, 20q, 22q, and whole chromosome 19 and loss of Xq in the renal-cell carcinoma. Our results confirm a common genetic basis for cardiac malformations, and del22q11.2 presents a risk factor for the development of pediatric tumours.     

Influence of bone marrow on membrane-guided bone regeneration of segmental long-bone defects in rabbits

Defects 10 mm long were created in long bone in the diaphysis of both radii of 18 rabbits (test and control side). On the test side, ingrowth of bone marrow into the defects was hindered or delayed by: plugging the opening of the cut bone ends with gutta-percha points (n = 7); plugging with Gelfoam (n = 6); or by removing the bone marrow by flushing with saline (n = 5). The defects on both test and control side were covered with an expanded polytetrafluoroethylene membrane, shaped as a tube. Healing was followed with radiographs for four to five months, after which the animals were killed and ground sections of the areas of the defects were prepared for histological examination. On the control side, nine of 18 animals had complete osseous bridging of the defect, and a small transverse non-mineralised zone remained in the centre of the healed defect in the other animals. This zone consisted of loose connective and cartilagenous tissue as well as connective tissue obviously derived from the outside of the membrane. By preventing or delaying the ingrowth of bone marrow we retarded the regeneration of mineralised bone, particularly in the gutta-percha and flushed bone marrow groups. The principle of guided tissue regeneration may be used to achieve regeneration of extensive long-bone defects. Any attempts to delay or prevent bone marrow ingrowth into the defects did retard regeneration of segmental long-bone defects.     

Long-term follow-up of children with prenatally diagnosed omphalocele and gastroschisis

Objective: The aim of this study was to follow up the 19 infants born in Tyrol province with abdominal wall defects between 1985 and 1996 whose malformation had been diagnosed prenatally, who were operated on immediately postpartum and who are alive today. Method: There were seven children in the omphalocele group and 12 in the gastroschisis group; 18 parents of affected infants took part in the study. Results: Four out of seven children with omphalocele had major associated malformations (two Beckwith-Wiedemann syndrome, one porencephalic cyst, one with skeletal defects). These children presented handicaps related to the associated malformations but not to the abdominal wall defect. The three other children with omphalocele are developing normally. Five out of 11 children with gastroschisis had associated intestinal but no extraintestinal malformations. After discharge, ten of 11 children with gastroschisis were developing normally; one child shows signs of mental retardation. Of 14 mothers who had originally planned another pregnancy prior to the birth of the malformed child, nine decided against becoming pregnant again; the others delayed a further pregnancy for several years. Conclusions: In our group, associated malformations were the main factor affecting the long-term quality of life of children with omphalocele and gastroschisis. Although most of the children were developing normally, fear of a repetition of the malformation in a subsequent pregnancy dominated reproductive choices in all couples.