甲状腺机能亢进症危险因素病例对照研究

目的 探讨各危险因素与甲亢的关系。方法 对三亚地区110例甲亢采用1：2配比的病例对照研究,资料处理采用条件Logistic回归分析.结果 甲亢发病与下列5因素关系密切：家庭年收入(OR=2．055)、食用碘盐(OR=2．133)、喜食海产品(OR=2．183)、感染(OR=2．382)、家庭生活事件(OR=3．017) 结论 家庭生活事件、感染、喜食海产品、食用碘盐、家庭年收入增高等是甲亢的危险因素。     

海南省性罪错妇女11年性病感染情况调查分析

目的 通过对11年来性罪错人员性病感染情况的调查分析,掌握性病在性罪错妇女中流行的特点,为政府部门对性病防治政策的制定提供科学依据。方法 对1990年元月至2000年12月海南省妇女收容教育所被收教的性罪错妇女进行性病检查,统计其各种性病的发病人数,然后进行分析。结果 11年中共收教4780人,其中感染淋病、非淋菌性尿道炎(宫颈炎)、尖锐湿疣、梅毒、生殖器疱疹、HIV共2967例,阳性率为62．07％,其中非淋菌性尿道炎(宫颈炎)1826例(38．20％)、淋病469例(9、81％)、梅毒414例(8．7％)、尖锐湿疣246例(5．14％)、生殖器疱疹11例(0．23％)、HIV阳性1例(0．02%)。结论 性罪错妇女六种性病的患病率很高,达62．07％,其中非淋菌性尿道炎(宫颈炎)为其主要病种,淋病的患病率逐年下降,梅毒的患病率逐年上升,尖锐湿疣基本稳定,其流行特点值得我们重视。     

Emergency treatment and long-term follow-up of posterior urethral valves

Posterior urethral valves have a broad spectrum of clinical severity determined by the degree and reversibility of the long stepwise sequence of secondary pathology. Neonatal azotemia and severe bilateral reflux are particularly important negative prognostic factors. In the mild cases, valve ablation with or without delayed reconstruction is good therapy. In the very severe cases, our interpretation of all the clinical and experimental information now available suggests that the time interval and the level of decompression are extremely important. Achievement of consistent low caliceal pressure without stasis and infections should be achieved as soon as possible. We do not agree with the philosophy of "valve ablation and wait and see" for secondary reconstruction as applied to the severe cases. An analogous philosophy would be treating all respiratory infections as upper respiratory infections and applying aggressive appropriate therapy for pneumonia only if the patient does not respond clinically. However, all controversy aside, the management of neonatal infants with posterior urethral valves remains a difficult and challenging problem for us all. The real challenge will be to improve published management results to the point that the family faced with decisions regarding an in utero diagnosis of posterior urethral valves will have enough hope to continue the pregnancy.     

Spontaneous regression of a false aneurysm of the ascending aorta following surgery for dissection

We report the case of a 50-year-old man admitted to hospital for a type A aortic dissection. After conventional surgical repair, he was asymptomatic and underwent computed tomography imaging at 15 days, 3 and 6 months. The first CT scan showed a small perigraft circulating false aneurysm which totally disappeared on the last exam. This case emphasizes the potential role of CT scan in the follow-up of patient after aortic surgery and the likely favorable outcome of some false aneurysm.     

Recycling of arterial grafts during reoperative coronary artery operations

BACKGROUND: To overcome problems of lack of conduit and to maximize the number of arterial anastomoses in coronary reoperations we reused previously placed arterial grafts. METHODS: Sixteen patients were identified from February 1994 to July 1997. Mean age was 62.8 years (range, 44 to 75 years). Fifteen (94%) were in Canadian Cardiovascular Society angina class III or IV. The mean interval from primary to secondary operation was 8.5 years (range, 3 to 12 years). Eleven patients had a patent internal mammary artery graft used as the recipient for a proximal Y anastomosis. In 3 cases an arterial graft was reimplanted distally on the same coronary vessel and in 2 onto different coronary vessels. One patient had a combination of these techniques. Five patients required venous conduit. RESULTS: There were no deaths. Mean length of intensive care stay was 69 hours (range, 24 to 144) and mean hospital stay was 14 days (range, 10 to 28 days). All patients were discharged home. Follow-up averages 13 months (range, 2 to 43 months). Twelve patients (75%) are now in Canadian Cardiovascular Society angina class I and 3 (19%) in class II. CONCLUSIONS: Reusing arterial conduits during coronary reoperations is possible with minimal in-hospital morbidity and satisfactory results in terms of freedom from angina. Using these techniques can help overcome the problems of inadequate conduit and maximize the number of arterial anastomoses that can be made per patient.     

Hypertension secondary to progressive vascular neurofibromatosis

A 4 year old girl with neurofibromatosis type 1 (NF1) was referred for hypertension. An aortogram showed narrowing of the left main renal artery. An angiogram three and a half years later showed coarctation of the abdominal aorta. She underwent aortoplasty but the stenosis recurred. Vascular involvement in NF1 may be progressive and requires long term follow up.     

Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures.

OBJECTIVES: To describe an outbreak of hospital-acquired MRSA in a NICU and to identify the risk factors for, outcomes of, and interventions that eliminated it. SETTING: An 18-bed, level III-IV NICU in a community hospital. METHODS: Interventions to control MRSA included active surveillance, aggressive contact isolation, and cohorting and de-colonization of infants and HCWs with MRSA. A case-control study was performed to compare infants with and without MRSA. RESULTS: A cluster of 6 cases of MRSA infection between September and October 2001 represented an increased attack rate of 21.2% compared with 5.3% in the previous months. Active surveillance identified unsuspected MRSA colonization in 6 (21.4%) of 28 patients and 6 (5.5%) of 110 HCWs screened. They were all successfully decolonized. There was an increased risk of MRSA colonization and infection among infants with low birth weight or younger gestational age. Multiple gestation was associated with an increased risk of colonization (OR, 37.5; CI95, 3.9-363.1) and infection (OR, 5.36; CI95, 1.37-20.96). Gavage feeding (OR, 10.33; CI95, 1.28-83.37) and intubation (OR, 5.97; CI95, 1.22-29.31) were associated with increased risk of infection. Infants with MRSA infection had a significantly longer hospital stay than infants without MRSA (51.83 vs 21.46 days; P = .003). Rep-PCR with mec typing and PVL analysis confirmed the presence of a single common strain of hospital-acquired MRSA. CONCLUSION: Active surveillance, aggressive implementation of contact isolation, cohorting, and decolonization effectively eradicated MRSA from the NICU for 2 1/2 years following the outbreak.     

Aberrant cervical thymus in an infant: an unusual cause of stridor

We report an 8-month-old infant presenting with stridor caused by a nonpalpable neck mass discovered at imaging and surgery. The diagnosis of aberrant thymic tissue was confirmed at histopathology. The authors reviewed the literature and discuss the embryology, imaging findings and differential diagnosis of this rare disorder. Received: 1 July 1999; Revised: 3 September 1999; Accepted: 6 September 1999