Invasive pulmonary aspergillosis and acute leukemia. Limitations in the diagnostic utility of the air crescent sign

The air crescent sign is regarded as an important diagnostic finding in invasive pulmonary aspergillosis (IPA). This study examined the incidence, clinical importance, and natural history of air crescents in 25 patients with acute leukemia and IPA. Twelve (50%) of the patients had cavities (ten with an air crescent) that appeared an average of 15 days after the initial infiltrate. The diagnostic utility of the air crescent sign was relatively minor; cavities developed after the diagnosis was established in 50% of cases and after therapy was started in 75% of cases. In each case, the pneumonia improved at the time of cavitation. In six patients (50%), the cavities resolved over 2-8 months. Three patients (25%), however, experienced massive hemoptysis. Air crescent formation, previously shown to be dependent on granulocyte recovery, was associated with improved survival (67%) compared with the group without cavitation (8%). In the latter group, the pneumonia in ten (77%) of 13 patients progressed to diffuse disease. In patients with leukemia, the diagnostic value of the air crescent sign is limited by cavities that develop relatively late, as the infection improves after white blood cell recovery; cavities that do not occur in patients who remain neutropenic; and associated hemorrhage, at times life-threatening, that obscures the air crescent. The diagnosis of IPA should not await observation of air crescents in these patients.     

胸椎稳定性重建中应用椎间植骨与AO Ventrofix内固定系统联合治疗的特点

目的:探讨AO Ventrofix系统在胸椎结核病灶清除植骨应用的临床效果及胸椎稳定性评价。方法:自2004-10/2006-12河南省人民医院骨科采用手术治疗胸椎结核患者30例,平均年龄34岁。经术前正规抗结核药物化疗后行病椎死骨刮除,周边脓肿、死骨、肉芽组织及干酪样物质等结核病灶清除,椎间大块自体骨植骨或钛网植入自体骨粒植骨,一期行前路内固定术,术后继续抗结核治疗1～1.5年。结果:术后3个月随访1例,6个月随访5例,12个月随访14例,16个月随访5例,18个月随访3例,24个月随访2例。经影像学观察,无结核复发,螺钉松动,内固定物断裂;全部病例植骨呈现骨性融合;其中10例脊髓功能障碍的患者中有7例得到明显改善;术后2例出现肺不张。结论:胸椎结核治疗行病灶清除,植骨融合,内固定系统的联合应用效果确切,脊柱前路固定系统Ventrofix具有固定性强、生物力学稳定及生物相容性良好的特点,在胸椎结核前路手术中有较好的临床疗效。     

烧伤回吸期持续性高钠高氯与侵袭性感染

目的：探讨大面积烧伤患持续性高钠高氯产生的原因及防治措施,动态监测大面积烧伤后血清Ｎａ＾＋高Ｃｌ＾－和６１例严重务后非持续性ａ＾＋,高Ｃｌ＾－患的临床特点。结果：７例严重烧伤后持续高Ｎａ＾＋,高Ｃｌ＾－患的临床特点。结果;７例严重烧伤后持续高Ｎａ＾＋,高Ｃｌ＾－１患均有严重分割生感染。且高ＮＡ＾＋出现止升愈快,则感染愈重,愈后愈差。结论：１．烧伤后持续性高Ｎａ＾＋,高Ｃｌ产生的原因是严重侵     

MEBO与SD-Ag对比治疗会阴部深Ⅱ度烧伤60例临床体会

目的：比较湿润烧伤膏和磺胺嘧啶银在治疗会阴部深Ⅱ度烧伤中的疗效。方法：随机选择６０全有部深Ⅱ度烧伤伤,３０例采用湿润烧伤膏治疗（Ｍ组）,３０例采用１％的磺胺嘧啶银治疗效果。结果：Ｍ组疼痛发生率,疤痕出现率,感染发生率以及手术例数,创面愈合时间均明显低Ｓ组,（Ｐ〈０．００５）,有显性差异。结论：在治疗会阴部深Ⅱ度烧伤时湿润烧成于磺胺嘧啶银。     

The role of neoadjuvant and adjuvant treatment for adenocarcinoma of the upper gastrointestinal tract

Both locally advanced adenocarcinoma of the stomach and gastro-esophageal junction are associated with poor prognosis due to the lack of effective treatment. Recently multimodal treatment consisting of neoadjuvant chemotherapy in combination with radiotherapy is reported to improve survival when compared to surgery alone. Neoadjuvant therapy in these locally advanced tumors allows for early tumor responses and the extent of tumor regression that can be achieved is considered a significant prognostic factor. This, in turn, increases the resectability of these tumors. Also due to the high frequency of lymph node metastasis, patients with locally advanced adenocarcinoma should undergo a D2 lymphadenectomy. Postoperative chemoradiation and perioperative chemotherapy have been studied in gastric adenocarcinomas and showed a survival benefit. However, the surgical techniques used in these trials are no longer considered to be standard by today''s surgical practice. In addition, there are no standard recommendations for adjuvant chemotherapy or chemoradiation after R0 resection and adequate lymph node dissection.     

The mediating role of health professionals' recommendation in the uptake of colorectal cancer testing among older Chinese adults

The purpose of this study is to examine the mediating effect of health professionals' recommendations on the relationship between the characteristics of older Chinese adults and the use of colorectal cancer testing. This was a cross‐sectional population‐based telephone survey. A total of 2004 Chinese adults aged 50 or above were recruited between 2 and 28 May 2007 to complete an anonymous telephone survey. The survey covered demographics, perceived health status and susceptibility to cancer, utilization of complementary medicine, family history of cancer, and cancer screening behaviour. The uptake of flexible sigmoidoscopy/colonoscopy was 12%, of which only 3.4% had been recommended by health professionals. The effects of gender, a history of serious disease, perceptions related to health status and visiting doctor regularly on the flexible sigmoidoscopy/colonoscopy uptake were mediated by a health professional's recommendation. A health professional's recommendation can be a catalyst for the decision of undergoing a colorectal cancer screening test in older adult people, in particular for those who are more health‐conscious. As health professionals can play a crucial role in the development of successful population‐based colorectal cancer screening program, efforts should be made to facilitate them in making recommendations for colorectal cancer screening to targeted high‐risk group.     

指浅屈肌腱、1/2指浅屈肌腱、掌腱膜矫正爪形指畸形的生物力学实验

目的:指浅屈肌腱,1/2指浅屈肌腱,掌腱膜是常用的矫正爪形指畸形的固定腱,分析比较三者的生物力学特性,为临床提供实验基础。方法:实验于2005-09/2006-01在吉林大学力学实验室进行。①正常国人新鲜尸体上肢标本(吉林大学基础解剖教研室提供),男6侧,女4侧,分别取示、中、环、小指指浅屈肌腱及掌腱膜游离体,同一尸体对称上肢取其中一侧的示、中、环、小指指浅屈肌腱分别平均分成1/2。②利用游标卡尺测量各试样的初长度、厚度、宽度,计算横截面积,然后用电子万能实验机分别作拉伸实验,测量出最大载荷、最大伸长、应力、应变数据,并计算出弹性模量,绘制负荷-伸长曲线。结果:①1/2指浅屈肌腱的抗张强度较强,可承载较大负荷,其最大载荷强度明显高于掌腱膜(P<0.01),接近掌腱膜最大载荷强度值的10倍。②掌腱膜的最大伸长明显高于1/2指浅屈肌腱(P<0.01),约是1/2指浅屈肌腱最大伸长的2倍。③1/2指浅屈肌腱的弹性模量明显高于掌腱膜[示指:(268.52±18.94),(95.58±17.96)MPa;中指:(319.75±21.51),(113.85±16.17)MPa;环指:(259.86±11.74),(89.09±11.65)MPa;小指:(185.13±21.64),(73.27±13.58)MPa;P均<0.01],与完整指浅屈肌腱无明显差异(P>0.05)。结论:1/2指浅屈肌腱是良好的固定腱,从生物力学角度来说,其生物效能明显优于掌腱膜,同时还可避免牺牲多条指浅屈肌腱,造成手部生理性紊乱,引发新的畸形。