Determination of a reference interval in a population

The reference interval is the most widely used medical decision-making tool that separates healthy from diseased individuals. We briefly discuss the methods used to determine reference interval and its limitations.     

Hyponatremia in a patient with a sellar mass

A 59-year-old man with confused mental status was admitted to our hospital. Laboratory reports showed him to have severe hyponatremia, and additional studies revealed panhypopituitarism. Brain magnetic resonance imaging showed a sellar cystic lesion, which consisted of a Rathke cleft cyst. Thus, the mass effect of the Rathke cleft cyst resulted in panhypopituitarism and finally induced euvolemic hyponatremia. On the basis of these results, supplementation with thyroid hormone and glucocorticoid was started, and the patient's serum sodium level was gradually corrected and maintained within the normal range. Here, we report this case of euvolemic hyponatremia caused by a Rathke cleft cyst.     

生物等效性试验中口服托吡酯致中性粒细胞减少1例

 托吡酯临床常用于癫痫和偏头痛的治疗,中性粒细胞减少是其罕见的不良反应,在中国或健康人中未见报告。本文报道了1例中国成年男性健康志愿者在参加托吡酯片生物等效性（bioequivalence,BE）试验过程中发生中性粒细胞减少的病例,并讨论了该病例的处理及转归,以期引起对托吡酯相关血液系统不良反应及临床试验中健康志愿者安全性保护的关注,为特异性药物诱导的中性粒细胞减少症（idiosyncratic drug-induced neutropenia,IDIN）的早期诊疗提供一些参考。     

Recurrent pyoderma in a family with a defect in leucocyte locomotion

Granulocyte functions including leucocyte locomotion and chemoluminescence were studied in three generations of a family in which all male members had presented with recurrent pyoderma. While parameters of humoral immunity including serum concentrations of IgG, IgA, IgM, and IgE and of complement components C3 and C4 as well as the response of mononuclear leucocytes to mitogens proved to be within the normal range, leucocyte locomotion was found to be severely impaired in all affected subjects. Moreover, granulocyte dysfunction in male members was associated with the occurrence of a single haplotype (HLA-A2, B13, DR7). These findings suggest that the defect in leucocyte locomotion and the pyoderma might not only have been inherited in an X linked manner but might also have been linked to a gene within the inherited HLA haplotype.     

Development of a sarcoma in a surgical scar

The development of a malignant soft tissue tumour (malignant fibrous histiocytoma) in a surgical wound is reported. Although rare, this occurrence has important diagnostic implications and the management is discussed.     

Mastocytoma in a cow: a case report

Mastocytoma was diagnosed in a four year old Holstein cow. The enlarging mass was clinically determined to be metastatic to the right superficial cervical lymph node. Cytological examination of both sites revealed mast cell neoplasia. Histopathological examination confirmed the presence of this tumor in these same sites as well as in liver, kidney and adrenal. Ultrastructurally, the mass contained round cells with electron dense granules in the cytoplasm.     

一起小学生食物中毒调查报告

丹东市宽甸县某小学发生一起食用课间餐（油炸糕）的食物中毒事件。中毒人数300人，经临床症状分析，流行病学调查及实验室检验证实，此次食物中毒是由油脂酸败引起的。     

Management of a patient with a complete rupture of a main bronchus in a community hospital

We describe the successful use of a portable extracorporeal membrane oxygenation machine for a patient with complete rupture of the left main bronchus after a road crash. The machine was used before and during left main bronchus reanastomosis at a community hospital 30 km from Melbourne, and then during acute interhospital transfer.     

一起幼儿园毒鼠强集体中毒调查与分析

目的 总结毒鼠强中毒调查经验。方法 采用流行病学法对中毒进行调查，采用气质联用仪进行检验。结果 国贸幼儿园67名幼儿及5名教职工进食糖水地瓜汤中毒是由毒鼠强引起的中毒。结论 必须加强学校食品卫生安全意识和日常监管，严禁非法制售剧毒鼠药的行为。     

Peliosis hepatis in a renal transplant recipient and in a haemodialysis patient

Peliosis hepatis is described in a renal transplant recipient and in a patient who was receiving long-term haemodialysis. This uncommon liver lesion has been reported in a number of patients, including 18 renal transplant recipients and two patients with chronic renal failure. However, its cause, clinical features, natural history and clinical significance remain to be determined. We emphasize that, although it is rare, peliosis hepatis should be considered in long-term haemodialysis and renal transplant patients who exhibit hepatomegaly and/or splenomegaly and/or disordered liver function (in particular, elevation of hepatic alkaline phosphatase levels).     

Cost accounting in a surgical unit in a teaching hospital--a pilot study

INTRODUCTION: Economic constraints remain one of the major limitations on the quality of health care even in industrialised countries. Improvement of quality will require optimising facilities within available resources. Our objective was to determine costs of surgery and to identify areas where cost reduction is possible. PATIENTS AND METHODS: 80 patients undergoing routine major and intermediate surgery during a period of 6 months were selected at random. All consumables used and procedures carried out were documented. A unit cost was assigned to each of these. Costing was based on 3 main categories: preoperative (investigations, blood product related costs), operative (anaesthetic charges, consumables and theatre charges) and post-operative (investigations, consumables, hospital stay). Theatre charges included two components: fixed (consumables) and variable (dependent on time per operation). RESULTS: The indirect costs (e.g. administration costs, 'hotel' costs), accounted for 30%, of the total and were lower than similar costs in industrialised nations. The largest contributory factors (median, range) towards total cost were, basic hospital charges (30%; 15 to 63%); theatre charges fixed (23%; 6 to 35%) and variable (14%; 8 to 27%); and anaesthetic charges (15%; 1 to 36%). CONCLUSION: Cost reduction in patients undergoing surgery should focus on decreasing hospital stay, operating theatre time and anaesthetic expenditure. Although definite measures can be suggested from the study, further studies on these variables are necessary to optimise cost effectiveness of surgical units.