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51.
Background:
Wound closure is accomplished in most cases of myelomeningocele (MMC) by undermining of the skin edges surrounding the defect. However, large defects cannot be closed reliably by this simple technique. Due to the technical challenge associated with large MMC, surgeons have devised different methods for repairing large defects. In this paper, we report our experience of managing large defects, which we believe bears a direct relationship to decrease the incidence of wound complications.Materials and Methods:
Forty children with large MMCs underwent surgical repair and represent our experience. We recommend using all hairy skin around the defect as a way to decrease the tension on the edges of the wound and the possible subsequent necrosis. It is our experience that vertical incision on one or two flanks parallel to the midline can decrease the tension of the wound. Moreover, ventriculo-peritoneal shunting for children who developed hydrocephalus was performed simultaneously, which constitutes another recommendation for preventing fluid collection and build up of pressure on the wound.Results:
Patients in this study were in the age range of 2 days to 8 years. The most common location of MMC was in the thoracolumbar area. All but four patients had severe weakness in lower extremities. We used as much hairy skin around the MMC sac as possible in all cases. Vertical incisions on one or both flanks and simultaneous shunt procedure were performed in 36 patients. We treated children with large MMC defects with acceptable tension-free closure. Nonetheless, three patients developed superficial skin infection and partial wound dehiscence, and they were managed conservatively.Conclusions:
We recommend using all hairy skin around the MMC defect for closure of large defects. In cases that were expected to be at a higher risk to develop dehiscence release incisions on one or two flanks towards the fascia were found to be useful. Simultaneous ventriculo-peritoneal shunting is also recommended in this cohort of patients, according to our experience. These recommendations neither prolong the time of surgery nor increase the cost, but facilitate a successful closure. 相似文献52.
E.I. Nweze 《Journal of health, population, and nutrition》2010,28(3):245-252
Diarrhoeal diseases are one of the most important causes of illness and death all over the world. In Nigeria, the aetiology of diarrhoeagenic bacteria and the virulence of various Escherichia coli pathotypes have not been well-studied because most currently-published data were from the southwestern axis of the country. In total, 520 stool samples were collected from infants, young children, and other age-groups with acute diarrhoeal diseases in Enugu and Onitsha, southeastern Nigeria. Stool samples were collected from 250 apparently-healthy individuals, with similar age distribution and locality, who were considered control subjects. The stool samples were screened for diarrhea-causing bacterial agents. E. coli strains were isolated from both the groups and were examined by polymerase chain reaction (PCR) for 16 virulence genes. Of the 520 stool samples in the diarrhoea group, 119 (44.74%) were E. coli. Fifty (49.02%) were enteropathogenic E. coli (EPEC), 22 (21.57%) were enterotoxigenic E. coli (ETEC) while 7.84% was enteroaggregative E. coli (EAEC). Sex had no effect on the distribution of diarrhoeagenic bacteria, except for EIEC. The E. coli strains isolated from the diarrhoea and healthy asymptomatic age-matched control groups examined by PCR for 16 virulence genes indicate that the detection of EAEC, ETEC, EPEC, and EIEC was significantly associated with diarrhoea (p=0.0002). The study confirmed that several bacterial pathogens, such as E. coli, play an important role in the aetiology of acute diarrhoea in southeastern Nigeria. A routine surveillance, especially for diarrhoeagenic E. coli, would be useful in identifying outbreaks and help identify the potential reservoirs and transmission routes.Key words: Diarrhoea, Escherichia coli, Virulence, Nigeria 相似文献
53.
论高等医学院校普及医院信息系统课程 总被引:2,自引:0,他引:2
在我国,医院信息系统已是现代化医院工作的支撑环境。高等医学院校的医院信息系统课程留白,可能削弱医学生临床工作能力和职业适应力。文章阐明了高等医学院校开设医院信息系统专业课的重要性,讨论了教学目标、教学内容;详细介绍了高校与医院合作建立HIS实验室、实地教学和针对专业掌握实际操作技能的教学方法。 相似文献
54.
This study presents the ultrastructural characteristics of sporogenesis in the genus Myxobolus which infects four economically important Egyptian fishes: Oreochromis niloticus niloticus, Barbus bynni, Labeo niloticus and Hydrocynus forskalii, specimens of which were collected at Giza city. Although the cysts were observed in different organs, the pattern of sporogenesis was the same. Moreover, the sporogenesis found in the present study followed the usual pattern valid for most of the myxosporean genera studied. 相似文献
55.
Alzheimer's disease associated with mutations in presenilin 2 is rare and variably penetrant 总被引:7,自引:3,他引:7
Sherrington R; Froelich S; Sorbi S; Campion D; Chi H; Rogaeva EA; Levesque G; Rogaev EI; Lin C; Liang Y; Ikeda M; Mar L; Brice A; Agid Y; Percy ME; Clerget- Darpoux F; Piacentini S; Marcon G; Nacmias B; Amaducci L; Frebourg T; Lannfelt L; Rommens JM; St George-Hyslop PH 《Human molecular genetics》1996,5(7):985-988
Missense mutations in the presenilin 2 (PS-2) gene on chromosome 1 were
sought by direct nucleotide sequence analysis of the open reading frame of
60 pedigrees with familial Alzheimer's disease (FAD). In the majority of
these pedigrees, PS-1 and beta-amyloid precursor protein (beta APP) gene
mutations had been excluded. While no additional PS-2 pathogenic mutations
were detected, four silent nucleotide substitutions and alternative
splicing of nucleotides 1338-1340 (Glu325) were observed. Analysis of
additional members of a pedigree known to segregate a Met239Val mutation in
PS-2 revealed that the age of onset of symptoms is highly variable (range
45-88 years). This variability is not attributable to differences in ApoE
genotypes. These results suggest (i) that, in contrast to mutations in
PS-1, mutations in PS-2 are a relatively rare cause of FAD; (ii) that other
genetic or environmental factor modify the AD phenotype associated with
PS-2 mutations; and (iii) that still other FAD susceptibility genes remain
to be identified.
相似文献
56.
Infections caused by dermatophytes are a global problem and a major public health burden in the world today. In Africa, especially in the northern geographical zone, dermatophytic infections are being reported at an alarming rate. This is mostly because of some local but unique cultural practices, socioeconomic and environmental conditions, lack of reliable diagnostic personnel and facilities and ineffective treatment. Interestingly, the pathogen spectrum and the clinical manifestation are most times different from what is seen in other continents. Several epidemiological studies have been performed on the incidence and aetiology of dermatophytoses in northern Africa. However, there is currently no review article with up‐to‐date information on the relevant findings reported so far in this region. This information is necessary for clinicians who treat dermatophytic infections all over the world since agents of dermatophytes are no longer restricted because of the rapid mobility of humans from one part of the world to another. Moreover, the epidemiology of dermatophytoses is known to change over time, thus requiring the update of information from time to time. A review of relevant studies published on dermatophytoses in northern Africa is presented. This covers all of old Sudan, Algeria, Egypt, Libya, Tunisia and Morocco. 相似文献
57.
The Kallmann syndrome gene product expressed in COS cells is cleaved on the cell surface to yield a diffusible component 总被引:2,自引:0,他引:2
Kallmann syndrome is characterized by hypogonadotropic hypogonadism and
anosmia and caused by a defect of migration and targeting of
gonadotropin-releasing hormone-secreting neurons and olfactory axons during
embryonic development. We previously cloned the gene responsible for the
X-linked form of the disease encoding a 680 amino acid protein, KAL, which
displays the unusual combination of a protease inhibitor domain with
fibronectin type III repeats. Previous expression studies by northern blot
and RNA in situ hybridization in human and chick indicated that the gene is
expressed at very low levels in the olfactory bulb during development.
Therefore, low abundance of the protein has hampered a detailed biochemical
characterization. By overexpressing both the human and chick KAL cDNAs in
eukaryotic cells, we now provide evidence that KAL is a glycosylated
peripheral membrane protein with an apparent molecular weight of
approximately 100 kDa. We show that this 100 kDa protein is proteolytically
processed on the cell membrane to yield a 45 kDa diffusible component,
which is detectable with an antisera against the C-terminal part of the
protein and binds tightly to cell surfaces. These data provide a first step
toward understanding KAL function in neuronal interactions and neurite
extension in the olfactory bulb and suggest that KAL might be a diffusible
chemoattractant molecule for olfactory axons.
相似文献
58.
Nwakaego Ernestina Nweze Boniface M. Anene Isaac U. Asuzu Wilfred S. Ezema 《Comparative clinical pathology》2012,21(5):967-974
The methanol extract of Buchholzia coriacea seed has shown some anti-trypanosomal activity against Trypanosoma brucei brucei. The acute toxicity test of this extract showed no signs of toxicity. This present study was designed to assess its sub-acute toxicity in rats. Rats of both sexes were dosed daily with 125, 250 and 500?mg/kg body weight of the extract by oral gavage for 28?days. Dosing with the extract showed no significant effect on body weights. The temperatures of extract-treated rats were significantly (p?<?0.05) higher during the first and last weeks of the experiment. There were also significant reductions (p?<?0.05) of red and white blood cell counts, packed cell volumes and haemoglobin concentrations in the extract-treated animals. Blood biochemistry revealed no significant changes. On necropsy, pale mucous membranes, bile stains on spleen, congestion of the lungs and caudal lobes of the liver were evident in the extract-treated rats. There were significant (p?<?0.05) reductions in relative liver weights of the extract-treated male rats. Twenty-eight days dosing of rats with the methanol extract of B. coriacea seed caused signs of toxicity at the tested doses. 相似文献
59.
Claudio Manna A Rahman M Sbracia S Pappalardo EI Mohamed R Linder 《Gynecological endocrinology》2013,29(4):188-194
Gonadotrophin-releasing hormone analogues (GnRH-a) are used widely in controlled ovarian stimulation (COS) cycles for assisted reproduction. At present, there is great debate about the influence of exogenous hormone activity on the hypothalamus–pituitary axis following pituitary desensitization. The objective of this comparative study was to investigate the pattern of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and oestradiol in women undergoing ovarian stimulation with different GnRH-a preparations. We retrospectively analysed 201 women, aged between 27 and 43 years, who were referred consecutively to our infertility clinic between January 2002 and January 2003. All women had no endocrinopathies or occult ovarian failure as assessed by day-3 hormone profile. Women were enrolled in one of the following COS protocols: depot triptorelin long protocol (n?=?38), buserelin long protocol (n?=?101) or buserelin short protocol (n?=?62). Recombinant FSH was used to induce ovulation. Treatment was monitored by transvaginal ultrasound scan and serum measurement of FSH, LH and oestradiol. Among the women initially included, 30 had cancelled cycles due to poor ovarian response. Serum LH levels were significantly higher in the short-protocol group compared with the long-protocol groups (p?<?0.001). The number of follicles, oocyte yield, number of grade-I embryos and fertilization rate were significantly lower in the short-protocol group than in the long-protocol groups. These findings showed that LH concentrations are significantly higher in women undergoing reversible medical hypophysectomy with a GnRH-a short protocol than in women treated with a long protocol. The hypothesis of an LH ceiling is confirmed. 相似文献
60.