Integrated regional services: are working process changes desirable and achievable?

In the hospital district of Helsinki and Uusimaa, 32 municipalities with one or more health centres provide primary care to their residents. Legal and organizational barriers between primary care and hospital care impede the continuity of patient care. Integrating primary and secondary care with the aid of information technology may facilitate a virtual electronic patient record, in which the viewing of images and other patient data is possible regardless of the organization that produced them. For example, in one trial, diabetic patients sent their home blood glucose measurements by modem to their health centre. Preliminary observations suggest that they could increase their glucose testing largely because they were able to transmit the results to the database and receive teleconsultations. Also, a picture archiving and communication system (PACS) has been in operation in two clinics of the Helsinki University Central Hospital for over two years and seven hospitals had become filmless by the end of 2001. A regional PACS is planned to be completed by the year 2004.     

老年性骨质疏松所致骨折患者血清钙磷和TGF-β 1分析

1临床资料2003-06／2004—12收治髋部骨质疏松性骨折患20(男14，女6)例，年龄58—80(平均68．5)岁，股骨颈骨折13例，粗隆间骨折7例．对照组为老年性骨关节病或颈腰椎病患20例．均抽空腹静脉血4mL，3000r／min离心5min分离血清，4h内测定血清钙、磷，留血清-20℃保存备用，测定TGF-β1．用Au-2700全自动生化分析仪测定血清钙、磷，试剂由日本欧林巴斯公司提供．血清TGF-β1检测采用ELISA法，     

Monitoring microvascular free flaps with tissue oxygen measurement and pet

Snoring occurs as a major symptom in patients with sleep disordered breathing (SDB). The aetiology of snoring remains still unclear despite various attempts to localize snoring. The correlation between different snoring sounds and the severity of SDB has not yet been investigated in a larger population. The aim of this study was to record and analyse snoring sounds and to correlate the obtained data with clinical and polysomnographical parameters. Sixty male patients with suspected SDB and reported snoring underwent a clinical examination and night time polysomnography. The parallel digitally recorded snoring sounds were analysed by fast fourier transformation (FFT). Peak intensity was determined from the power spectrum. The periodicity of snoring was classified into rhythmic and non-rhythmic snoring according to the presence of air flow interruptions due to obstructive apneas. Patients with primary snoring revealed peak intensities between 100 and 300 Hz. Patients with an obstructive sleep apnea syndrome (OSAS) revealed peak intensities above 1,000 Hz. Polysomnographical data (AHI, mean and minimum SpO₂) as well as body mass index (BMI) correlated with peak intensity of the power spectrum. None of the parameters of the clinical examination correlated with peak intensity. Frequency analysis of snoring sounds provides a useful diagnostic tool to distinguish between different patterns of snoring and respective SDB. The topodiagnosis of snoring is not possible by means of frequency analysis or clinical examination alone. Acoustical analysis of snoring sounds seems a promising additional diagnostic tool to verify different types of SDB in snoring patients.     

Secondary thrombocytosis

To estimate the incidence and causes of secondary thrombocytosis in children, a 12 month study of all patients attending a children's hospital and discovered to have a platelet count over two times the upper normal limit (> 800 x 10(9)/l) was undertaken. Data so obtained were analysed both separately and together with those from two previous studies to gain as broad a perspective as possible. Of 7916 children who had platelet counts during the study period, 36 (0.5%) produced a value > 800 x 10(9)/l; there were 19 boys and 17 girls. There was a preponderance of young infants (median age 13 months). Twenty seven of the 36 had some sort of associated infection, bacterial in 18 and viral in nine. The other nine were either recovering from anti-neoplastic chemotherapy (n = 6), were post-operative (n = 2), or simply iron deficient (n = 1). Combining these patients with those described in previous studies allowed a review of 139 unselected children with very high platelet counts. Fifty three (38%) had infections, 29 (20%) had traumatic or surgical tissue damage, 16 (11%) had malignant disease undergoing chemotherapy or surgery, and 13 (9%) had connective tissue or autoimmune disorders. Secondary thrombocytosis is not rare and is most frequently seen in very young infants after infection. It can arise in a wide variety of other circumstances including rebound from myelosuppression, iron lack, or as part of an acute phase response. It is clinically unimportant in terms of morbidity and requires no treatment other than that for the primary condition.     

Congenital thiopurine methyltransferase deficiency and 6-mercaptopurine toxicity during treatment for acute lymphoblastic leukaemia

Two children with acute lymphoblastic leukaemia (ALL) taking daily 6-mercaptopurine as part of a national UK therapeutic trial repeatedly developed profound myelosuppression on 25% of the standard protocol dose. Both were found to have undetectable intracellular activity of thiopurine methyltransferase (TPMT), an enzyme controlling one of the major alternative catabolic pathways of 6-mercaptopurine, and both produced higher concentrations of cytotoxic drug metabolites at 10-25% of the protocol dose than other patients taking 100%. It is supposed that these patients represent the 0.33% of the normal population constitutionally lacking TPMT. It is important to recognise such individuals both to avoid fatal bone marrow failure through inadvertent overdosage, and to be reassured that an adequate drug effect can be achieved at around 10% of the standard dose.     

Multiple myeloma: evaluation by CT

Although patients who have multiple myeloma usually have straightforward clinical symptoms and corroborative radiographs, in some instances, these patients will present atypically, with symptoms suggesting active disease but radiographs that are normal or nonspecific. We reviewed the records of 32 patients who had documented multiple myeloma and had undergone CT examinations, assessing the value of those examinations. Although CT is not indicated in all patients who have multiple myeloma, it is especially useful in patients who have bone pain and normal or nonspecific radiographs. CT provided confirmatory information in all cases in which lesions were seen on radiographs. CT also frequently demonstrated a greater extent of disease than could be appreciated on the radiographs.     

巫山淫羊藿的化学研究

从小檗科Berberidaceae淫羊藿属Epimedium植物巫山淫羊藿Epimedium wushanense T.S.Ying的地上部分中分得两种黄酮甙单体,经理化性质鉴定及紫外、红外、质谱、氢谱、碳谱等光谱分析,确定甙Ⅰ是新化合物,命名为巫山淫羊藿甙(wushanicariin)。甙Ⅱ是已知化合物淫羊藿甙(icariin),系首次从该种植物中分离。     

The Moore vitallium femoral-head prosthesis in fractures of the femoral neck.

A follow-up is given of early and late results in 109 arthroplasties with the self-locking Austin T. Moore vitallium femoral head prosthesis in fractures of the femoral neck on 106 patients. Operative indication was usually fresh medical fracture of the femoral neck in an elderly woman, or its late complication. The surgery was performed in a unit for general surgery also engaged in pre- and postgraduate teaching activities. Many operations were performed by residents engaged in general surgery or orthopaedics. Point scores according to a modification of Merle D'Aubigné's classification showed excellent or at least good results in 81 per cent of the 69 mobile patients. Because of deteriorated general physical condition 11 patients were chronically bed-ridden. Five patients could not be reached. In three instances the prosthesis was removed. 21 patients died, three during the stay in hospital and 18 later for reasons not connected with the operative procedure. The mortality during 40 months of observation corresponded fairly well to that expected in the age group for the population as a whole.