经皮穿刺导管引导下泡沫硬化剂疗法治疗卵巢静脉曲张

目的 探讨导管引导下的泡沫硬化剂疗法治疗卵巢静脉曲张的临床效果.方法 选择2008至2009年间就诊于解放军总医院血管外科,诊断为卵巢静脉曲张的患者共13例,平均年龄39.4岁(31～52岁),病史1～20年不等,经皮穿刺导管引导左侧卵巢静脉主干内注射1%聚桂醇泡沫硬化剂,观察脉主干的闭合情况.结果 所有病例均在导管引导下成功注射硬化剂,平均应用泡沫硬化剂总量6.2 ml(4～ 9 ml).术后随访时间1～12个月(平均5.3个月),12例患者站立时盆腔坠胀不适感消失,1例减轻,5例性交痛2例消失,3例减轻,3例大腿内侧曲张静脉较前减轻,复查超声提示未见卵巢静脉主干,闭塞满意.结论 经皮穿刺导管引导的泡沫硬化剂疗法治疗卵巢静脉曲张主干闭合率较高,是微创治疗中一种有效的新方法.

Abstract：

Objective Foam sclerotherapy of ovarian varicocele is a relatively new and promising treatment option for patients with axial reflux. But its usefulness may be limited by low primary occlusion rates. Here a standard technique for catheter-directed foam sclerotherapy was presented to facilitate a precise delivery of foam to its intended site of action so as to potentially improve the occlusion rates. Methods A selective series of 13 females with ovarian varicocele were treated with foam sclerotherapy through a standard technique for foam delivery from 2008 to 2009. With a mean age 39.4 years, the patients were treated with 1% polidocanol foam through a catheter inserted percutaneously over a guidewire into the trunk of vena ovarica. All successfully treated patients were examined by colour duplex at 1 to 12 months post-procedure. Results Thirteen patients with an insufficiency reflux of vena ovarica were treated with catheter-directed foam sclerotherapy. Primary technical success was achieved in all patients. A dose of polidocanol 1.0% at 4-9 ml was administered. The mean follow-up period was 5.3 months. Pelvic cavity flatulency was totally released in 12 patients and 1 partially released. Two of 5 patients with algopareunia recovered and 3 with perineal region varicosis became relieved. On the follow-up ultrasonic examination, all trunks of vena ovarica became occluded. Conclusion This type of foam sclerotherapy is feasible with a high rate of primary occlusion.     

Analysis of inborn errors of metabolism: disease spectrum for expanded newborn screening in Hong Kong

Background  Data of classical inborn errors of metabolism (IEM) of amino acids, organic acids and fatty acid oxidation are largely lacking in Hong Kong, where mass spectrometry-based expanded newborn screening for IEM has not been initiated. The current study aimed to evaluate the approximate incidence, spectrum and other characteristics of classical IEM in Hong Kong, which would be important in developing an expanded newborn screening program for the local area.

Methods  The laboratory records of plasma amino acids, plasma acylcarnitines and urine organic acids analyses from year 2005 to 2009 inclusive in three regional chemical pathology laboratories providing biochemical and genetic diagnostic services for IEM were retrospectively reviewed.

Results  Among the cohort, 43 patients were diagnosed of IEM, including 30 cases (69%) of amino acidemias (predominantly citrin deficiency, hyperphenylalaninemia due to 6-pyruvoyl-tetrahydropterin synthase deficiency and tyrosinemia type I), 5 cases (12%) of organic acidemias (predominantly holocarboxylase synthetase deficiency) and 8 cases (19%) of fatty acid oxidation defects (predominantly carnitine-acylcarnitine translocase deficiency). The incidence of classical IEM in Hong Kong was roughly estimated to be at least 1 case per 4122 lives births, or 0.243 cases per 1000 live births. This incidence is similar to those reported worldwide, including the mainland of China. The estimated incidence of hyperphenylalaninemia was 1 in 29 542 live births.

Conclusions  Our data indicate that it is indisputable for the introduction of expanded newborn screening program in Hong Kong. Since Hong Kong is a metropolitan city, a comprehensive expanded newborn screening program and referral system should be available to serve the neonates born in the area.

     

上海市住院医师规范化培训实施

本文对上海市开展的住院医师规范化培训,从培训考核机制、基地和师资队伍建设、人事管理制度及外界支持等方面进行分析,反映上海市住院医师规范化培训的优越性和创新性,对在军队和全国范围内建立住院医师规范化培训制度具有借鉴意义.     

Strengthening health research capacity from within Samoa

This article reflects on the challenges of strengthening health research capacity from within Samoa. It examines the status of health research and related curricula in Samoa and discusses the outcomes of a new postgraduate applied social and health research methods course taught in Samoa for the first time from 5 January to 12 February 2010 by the Department of Preventive and Social Medicine, University of Otago in collaboration with the Centre for Samoan Studies, National University of Samoa. The article argues that collaborative health research courses such as this methods paper can fill a curriculum gap in New Zealand and Samoa and contribute directly toward strengthening Samoa health research capacity in ways that benefit both Samoa and New Zealand. This initiative can be a flagship for strategies operating from within Samoa that can build real win-win type partnerships. These can be ably led by Samoans for the ultimate development of an affordable and sustainable quality health and education infrastructure for Samoa.     

Epidemiology and Control of Legionellosis, Singapore

To determine trends and clinical and epidemiologic features of legionellosis in Singapore, we studied cases reported during 2000–2009. During this period, 238 indigenous and 33 imported cases of legionellosis were reported. Cases were reported individually and sporadically throughout each year. Although the annual incidence of indigenous cases had decreased from 0.46 cases per 100,000 population in 2003 to 0.16 cases per 100,000 in 2009, the proportion of imported cases increased correspondingly from 6.2% during 2000–2004 to 27.3% during 2005–2009 (p<0.0005). The prevalence of Legionella bacteria in cooling towers and water fountains was stable (range 12.1%–15.3%) during 2004–August 2008.     

Right-Ear Advantage for Speech-in-Noise Recognition in Patients with Nonlateralized Tinnitus and Normal Hearing Sensitivity

Despite having normal hearing sensitivity, patients with chronic tinnitus may experience more difficulty recognizing speech in adverse listening conditions as compared to controls. However, the association between the characteristics of tinnitus (severity and loudness) and speech recognition remains unclear. In this study, the Quick Speech-in-Noise test (QuickSIN) was conducted monaurally on 14 patients with bilateral tinnitus and 14 age- and hearing-matched adults to determine the relation between tinnitus characteristics and speech understanding. Further, Tinnitus Handicap Inventory (THI), tinnitus loudness magnitude estimation, and loudness matching were obtained to better characterize the perceptual and psychological aspects of tinnitus. The patients reported low THI scores, with most participants in the slight handicap category. Significant between-group differences in speech-in-noise performance were only found at the 5-dB signal-to-noise ratio (SNR) condition. The tinnitus group performed significantly worse in the left ear than in the right ear, even though bilateral tinnitus percept and symmetrical thresholds were reported in all patients. This between-ear difference is likely influenced by a right-ear advantage for speech sounds, as factors related to testing order and fatigue were ruled out. Additionally, significant correlations found between SNR loss in the left ear and tinnitus loudness matching suggest that perceptual factors related to tinnitus had an effect on speech-in-noise performance, pointing to a possible interaction between peripheral and cognitive factors in chronic tinnitus. Further studies, that take into account both hearing and cognitive abilities of patients, are needed to better parse out the effect of tinnitus in the absence of hearing impairment.     

卵巢囊性病变蒂扭转的MSCT表现与诊断价值

目的:探讨卵巢囊性病变蒂扭转的MSCT表现与诊断价值。方法:回顾分析10例经手术病理证实的卵巢囊性病变蒂扭转的CT资料。结果:10例CT平扫均出现盆腔内囊实性双肿块,实性肿块与一侧子宫角或输卵管相连;囊壁均匀或不均匀增厚,合并囊内出血2例;卵巢明显肿大2例;6例子宫偏向扭转侧;2例合并腹盆腔积液,其中1例为血性渗液。结论:卵巢囊性病变蒂扭转的CT表现具有一定特征性,MSCT扫描作为超声检查的一种补充检查方法,对卵巢囊性病变蒂扭转的诊断及鉴别诊断具有重要的临床价值。