Congenital bile duct dilatation: review of 35 cases

Thirty-five patients with congenital bile duct dilatation or choledochal cyst were seen in the General Hospital, Kuala Lumpur, during a 10-year period from 1981 to 1990. The highest incidence occured in the group less than 1 year of age. Jaundice was the commonest symptom, occuring in 69% of patients. In most it was mild and intermittent, but a small group (29%) had persistent jaundice and acholic stools. These patients were all less than 1 year of age and represented a poor-prognosis group (30% mortality). Ultrasonography was the most useful diagnostic procedure, having an accuracy of 94%.The treatment of choice was total excision of the cyst and Roux-en-Y hepaticojejunostomy. Internal drainage procedures are not recommended because of the high incidence of cholangitis and the potential for malignancy occuring in the remnant cyst later in life. Operative mortality and morbidity were uncommon, and a good prognosis can be expected on long-term follow-up. Correspondence to: H. K. Goon     

肝郁痰凝型乳腺癌的钼靶X线表现及病理分析

目的：研究肝郁痰凝型乳腺癌的钼靶X线影像特点，探讨其病理基础。方法：观察41例中医证型为肝郁痰凝型、术后病理检查结果为乳腺癌患者的钼靶X线影像表现，对其病理学基础进行分析。结果：41例肝郁痰凝型乳腺癌中，乳腺类型以致密型及混合型居多（占78％）。异常血管征及透环征出现频率较高（占80％以上）。腋淋巴结转移出现频率偏低（占12％）。结论：（1）肝郁痰凝型乳腺癌患者，乳腺密度多偏高，可能与较多发生在绝经期前有关。（2）肿瘤周围透亮环征象及异常血管征象出现频率较高，表明此型患者肿块周围脂肪代谢异常较为普遍及血管生长刺激因子分泌较多。（3）腋窝淋巴结转移者所占比例较小，可能是由于此类患者多属于癌变早、中期，相对气血不足或脾肾虚弱等正虚表现不明显。     

中心静脉导管胸腔留置治疗胸腔积液

目的评价中心静脉导管留置治疗胸腔积液的疗效。方法257例胸腔积液患者分为两组，治疗组207例，应用胸腔留置中心静脉导管治疗；对照组50例，常规胸穿抽液治疗，观察并比较不同治疗方法的疗效、并发症等指标。结果两组对比多项指标差异有显著性（P〈0．05）。结论采用中心静脉导管治疗胸腔积液可减少胸穿次数、降低反应，提高治愈率。     

Antibodies to diphtheria, tetanus and pertussis in infants before and after immunization with DTP (Triple Antigen) vaccine

Objective : To determine antibody levels to the Australian manufactured combined diphtheria, tetanus and pertussis (DTP) vaccine (Triple Antigen, CSL Ltd) in infante before and after their primary immunization course.
Methodology : Serosurvey (antibody prevalence study) in two groups: infants aged 5-9 weeks who had not received any immunizations ( n = 25), and infants aged 7-10 months who had received two ( n = 25) or three immunizations ( n = 57) with DTP, sampled from infants attending the Royal Children's Hospital, Melbourne, either as inpatients or outpatients between February and April 1993. The immunization history for each infant was determined from hospital records, the parent-held child health record, or the local council or family doctor who immunized the infant.
Results : Enzyme immunoassay (EIA) of antibodies to diphtheria and tetanus showed all infants to have adequate protective levels after two or three vaccinations (£0.01 IU/mL). All subjects who had received all three DTP vaccinations had detectable antibody to at least one pertussis antigen. Antibodies to the pertussis antigens filamentous haemagglutinin and pertussigen (pertussis toxin) were comparable to levels determined for whole cell pertussis vaccines used elsewhere in the world. EIA-determined antibodies to pertussis agglutinogen type 2 and agglutinogen type 3 showed substantially higher geometric mean titres when results for pre-immunization and post-immunization subjects were compared.
Conclusions : These data show that the Australian manufactured DTP vaccine has immunogenic properties similar to those of vaccines used elsewhere, and that antibody concentrations following immunization are at levels consistent with efficacy.     

The pudendal thigh fasciocutaneous flap for vaginal atresia reconstruction

Vaginal defects can either be congenital or acquired due to tumor or trauma. The reconstructions are aimed in producing a good physical and functional result with the least donor site morbidity. The pudendal thigh flap is a sensate fasciocutaneous flap based on the terminal branch of the superficial perineal artery, the continuation of the internal pudendal artery. Although various flaps have been described for vaginal reconstruction, the pudendal thigh flap offers a very attractive alternative.     

Treatment of pulmonary hemorrhage in childhood systemic lupus erythematosus with mycophenolate mofetil

Systemic lupus erythematosus is a chronic autoimmune disease of unknown etiology with multisystem involvement. Pulmonary hemorrhage is a major life-threatening manifestation in children and adolescents with systemic lupus erythematosus, as well as in adults. Treatment has traditionally been with high-dose corticosteroids, with or without the addition of cytotoxic agents. We report the response of a patient with childhood systemic lupus erythematosus with recurrent pulmonary hemorrhage to treatment with mycophenolate mofetil.