Incidence of presumed cytomegalovirus retinitis in HIV-infected pediatric patients.

INTRODUCTION: Large population studies of adult patients suggest an incidence of cytomegalovirus (CMV) retinitis as high as 19% to 20% as a late complication of adult HIV infection. We conducted this prospective study of a large cohort of HIV-infected children to determine the incidence of CMV retinitis in HIV-infected children. METHODS: From January 1984 to August 1997, 173 HIV-infected children were followed up for an average of 55.3 months (13-164 months). The patients were seen in the Department of Pediatrics at least once every 6 months. Ophthalmologic examinations were initiated when a patient's CD4 count dropped below 50 or sooner if required for ophthalmologic or other indications. Ophthalmologic examination was then repeated every 6 months. RESULTS: A total of 116 (67%) of 173 patients underwent ophthalmologic examination. Four (3.4%) of 116 patients had CMV retinitis at a mean time of 17.3 months (8-38 months) after their CD4 counts dropped below 20. None of the 4 patients with CMV retinitis had subjective visual complaints despite advanced retinitis. Three patients had bilateral and 1 patient had unilateral CMV retinitis. CONCLUSIONS: CMV retinitis occurred infrequently in HIV-infected pediatric patients and was diagnosed only in patients with a CD4 count below 20. Routine ophthalmologic screening examinations may not be necessary in pediatric patients until the CD4 count is below 20. Because children may not complain of decreased vision, at-risk children should undergo frequent ophthalmologic examination.     

Electron microscopy observation on pre- and post-treatment skin of dorsum pedis of chyluric patient treated with heat-clearing and hemostatic drugs--the lymphangial wall damage being the pathogenesis of chyluria]

Heat-clearing and hemostatic drugs were effective in treating chyluria. In order to explore the curative mechanism, a group of 10 in-patients with chyluria were chosen and treated with heat-clearing and hemostatic drugs for 45 days. Some pre- and post-treatment skin from dorsum pedis of the patients were taken off and observed under electron microscope. It showed that the walls of lymphatic capillaries were seriously damaged before treatment and rehabilitated wall after treatment. The pinocytotic vesicles were packed tightly in the endothelial cells of capillaries before treatment and their number was decreased remarkably after treatment; the mast cells were rare in number and abnormal as spindle shape before treatment and they increased in number and became round or oval in shape, the nucleus became large, the granules they contained became more in number and larger in size after treatment, lymph edema was noticed before treatment and it disappeared after treatment. The result showed that the extensive lesion of lymphangial walls is the pathogenesis of chyluria, while the rehabilitation of them is the curative mechanism. It seems that in the process of rehabilitation the mast cells act took the role of "soldier-engineer".     

Reconstruction of the thumb and digit by toe to hand transplantation

Since the rapid development of microsurgery it is feasible to replant most severed thumbs and digits. In certain patients, however, the trauma is so severe that replantation cannot be performed, such as crush or burst injuries where the amputated part is badly smashed or broken into pieces. There are many methods used to reconstruct amputated thumbs or digits. In our hospital reconstruction of the thumb is accomplished by second toe transplantation, nail flap of the great toe transplantation and bone graft, and nail flap of the great toe and skeleton from the second toe transplantation. Reconstruction of fingers is undertaken through second toe transplantation and second and third toe transplantation. After total loss of the hand, double second toe transplant is used for reconstruction.

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Resumen Gracias al rápido desarrollo de la microcirugía, actualmente es factible reimplantar la mayor parte de los pulgares y los dedos de la mano que hay an sido amputados. Sin embargo, en ciertos pacientes el trauma es tan severo que la reimplantación no puede ser realizada, tal como ocurre con las lesiones por aplastamiento o por explosión, donde la parte amputada resulta severamente aplastada o fragmentada en pedazos. Existen muchos métodos de reconstrucción; los siguientes son los utilizados en nuestro hospital.

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Résumé En raison du développement rapide de la microchirurgie, il est possible de réimplanter la plupart des doigts amputés. Chez certains patients, cependant, le traumatisme est tellement important qu'aucune réimplantation ne peut être tentée: dans les accidents par écrasement ou les lésions par souffle dans lesquelles la partie amputée est abîmée ou fracasée. Il existe de nombreuses méthodes pour reconstruire un pouce ou un doigt. Les procédés que nous employons dans notre Hôpital sont: (1) pour le pouce, le transfert du deuxième orteil, le lambeau unguéal du gros orteil avec greffon osseux, le lambeau unguéal et le transfert osseux du deuxième orteil; (2) pour les autres doigts, le transfert du deuxième orteil, seul ou combiné avec celui du troisième; (3) pour la main, le transfert bi ou unilatéral du deuxième orteil; et (4) des prothèses de main à visée esthétique.

     

重组人甲状旁腺激素1-34的氨基酸组成分析

分析重组人甲状旁腺激素 1-3 4的氨基酸组成 ,为该品种的结构鉴定提供依据。水解条件含 1%苯酚的6mol L盐酸 ,10 5℃水解 2 4h ;衍生方法异硫氰酸苯酯 (PITC)柱前衍生法 ;氨基酸测定色谱条件色谱柱为PhenomenexprodigyODS 10 0A。 (4 .6mm× 2 5cm ,5 μm) ;流动相A为 0 .1mol L醋酸钠 (pH6.5 ) -乙腈 (93 :7) ,B为水 -乙腈 (1:4) ;二元梯度洗脱 ;检测波长为 2 5 4nm ;流速为 1ml min ;柱温为 40℃。结果 :实验值与理论值一致 ,偏差小于 10 %。本法准确、可靠、重现性好 ,可用于该产品的质量控制。     

10Kg以下法乐氏四联症的急诊手术治疗

目的 总结低体重法乐氏四联症急诊或亚急诊手术的治疗经验。方法 15例体重小于10kg的法乐四联症患儿因合并有严重缺氧发作、感染性心内膜炎、心衰等，经积极的心内科治疗后转行急诊或亚急诊根治手术。结果 死亡1例，病死率6．7％；存活14例，但术后有较多、较重的并发症，其中1例的术前脑缺氧损害后遗表现仍然明显。结论 急诊或亚急诊根治术是救治合并有危急并发症低体重法乐氏四联症患儿的有效方法。     

颞骨岩部胆脂瘤

目的：探讨岩部胆脂瘤的临床特征及手术方法。方法：经迷路前上径路手术治疗1例，经迷路-耳蜗径路手术治疗8例。结果：术后8例随访2-9年，局部无胆脂瘤复发，其中2例面神经全程减压，术后未能恢复；1例术后2个月出现面肌运动，7个月后恢复正常，1例术后仅2个月，有待随访。结论：根据病变部位及侵犯范围选择适当的手术途径；术腔内填塞脂肪，封闭外耳道可防止脑脊液外漏。     

215例正常新生儿瞬态诱发耳声发射测试分析及随访研究

目的：进一步了解正常新生儿瞬态诱发耳声发射（TEOAE）的特征，为新生儿听力筛查提供帮助。方法：采用ILO96型耳声发射仪，对出生后0（出生当天）-8d的215例（425耳）正常新生儿进行TEOAE测试，并跟踪随访结果：TEOAE总检出率为89%，检出率与检测时的天龄有一定的关系。新生儿出生后0-3d检出率平均为72%，4-8d为97%，分娩方式，左右耳，孕龄36至41周间的差异对检出率无明显影响；女性的检出率显著高于男性，快速扫描较TEOAE测试敏感，经随访确诊有1耳听力损害。结论：新生儿听力筛查应在出生后≥4d出院前进行；分娩方式对耳蜗功能无明显影响；人耳蜗毛细胞的成熟是在怀孕36周以前；快速扫描不能代替TEOAE测试；对于1耳或双耳未检出TEOAE的受测者必须跟踪随访和复检，并结合ABR测试尽早确诊。     

氯氮平在体内代谢与细胞色素P450 1A2-2964位点多态性的关系

目的：探讨氯氮平在精神分裂症患者体内代谢和细胞色素P450 1A2－2964位点多态性关系，指导临床对不同患者合理使用氯氮平。方法：采用固定剂量给药，用高效液相色谱法（HPLC）测定血药浓度，用限制性片段长度多态性（RFLPs）分析基因型。结果：吸烟组和非吸烟组之间比较，吸烟组血浆氯氮平浓度低，去甲氯氮平／氯氮平比值高（P＜0．05，P＜0．01），P450 1A2-2964位点等位基因G的频率为0．75，A的频率为0．25，在非吸烟患者中，去甲氯氮平／氯氮平在w/w基因型与非w/w基因型(w/m m/m)之间无显著的统计学意义（P＞0．05），在吸烟患者中，w/w基因型去甲氯氮平／氯氮平要高于非w/w基因型（P＜0．05），在吸烟患者和非吸烟患者中w/w基因型之间比较，吸烟患者的去氯氮平／氯氮平明显高于非吸烟患者（P＜0．01）；而非w/w基因型之间无显著的统计学意义（P＞0．05），结论：吸烟能诱导P450 1A2的活性。P450 12-2964位点等位基因均为G（w/w)时诱导能力最强，发生G→A突变时，诱导能力降低，分析患者P450 1A2 G－2964A的多态性，对合理使用氯氮平有意义。     

三十年子癎的变化趋势

目的探讨30年来我院子的变化特点. 方法回顾性分析1971～2000年期间发生的98例子病例. 结果子的发生率由70年代0.3%降至90年代0.1%(P<0.01),产前子占子总数的比率由70年代52.1%降至90年代26.3%(P<0.05),产后子由70年代20.8% 升至90年代47.4%(P<0.05).围产儿死亡率由70年代203.7‰下降至90年代100.0‰. 三个年代子所致孕产妇的死亡占同期子的比率依次为4.2%、6.5%、5.3%(P>0.05 ). 结论 30年来子的发生率明显下降,子类型构成比发生明显变化 ,产前子减少,产后子相对增多,子患者的围产儿死亡率逐渐下降,子致孕产妇死亡率未降低.     

Facilitating effect of histamine on spatial memory deficits induced by dizocilpine as evaluated by 8-arm radial maze in SD rats

AIM: To investigate whether or not histamine is involved in spatial memory deficits induced by dizocilpine (MK-801) as evaluated by 8-arm radial maze of rats. METHODS: 8-Arm (4-arm baited) radial maze was used to measure spatial memory in rats. RESULTS: Bilaterally intrahippocampal (ih) injection of MK-801 (0.3 μg/site) impaired working memory and reference memory in rats. Both histamine (50, 100 ng/site, ih) and intraperitoneal (ip) injection of histidine (100, 200 mg/kg) markedly improved the spatial memory deficits induced by MK-801. On the other hand, the ameliorating effect of histidine (100 mg/kg, ip) was completely antagonized by α-fluoromethylhistidine (α-FMH, 5 μg/site, ih), a potent and selective histidine decarboxylase (HDC) inhibitor, and H_1-antagonist pyrilamine (1 μg/site, ih), but not by H_2-antagonist cimetidine, even at a high dose (2.5 μg/site, ih). CONCLUSION: The hippocampal histamine plays an important role in the ameliorating effect on MK-801-induced spatial memory deficits,