Quality of life in surgically palliated complex congenital heart disease

The outcome of surgical palliation was evaluated in 26 children with complex cyanotic congenital heart disease. Outcome was examined in terms of ongoing symptoms, exercise tolerance, and the ability to participate in normal childhood activities. An activity score was calculated and each child performed graded treadmill exercise testing. Breathlessness (24 (92%) children), respiratory infections (nine (35%) children), and leg cramps (eight 31%) children) were the most common physical disorders. Although formal exercise testing showed a clear reduction in exercise tolerance compared with age and sex matched controls, palliation had allowed 23 (89%) to function with moderate exercise limitation, three (11%) having severely limited activity. Parents underestimated the child's exercise tolerance in 80% of cases. Sixteen (62%) patients attended school full time, eight (31%) attended part time, and two (8%) received only home tuition. Palliative surgery can give children with a single functional ventricle a level of activity which allows them to take part in most childhood activities. Subjective estimates of exercise tolerance are inaccurate in this group of children, and formal exercise testing can contribute useful information to decision making about further surgical intervention.     

不稳定型心绞痛病人β-血小板球蛋白浓度的检测

目的检测不稳定型心绞痛（UA）病人在标准药物治疗前后β-血小板球蛋白（β—TG）浓度、血小板计数（PLT）、血小板平均体积（MPV）和巨大血小板（LPLT）数量。方法UA病人（UA组）66例被分为两组：A组42例有过心绞痛病史；B组24例为初发性心绞痛。以22例健康人为对照。β—TG及其他活化标志物分别在治疗前测量（A组和B组）以及治疗8～10d后测量（B组）。结果A组及B组（治疗前后）血浆β—TG浓度比对照组明显升高，具有统计学意义（F=34．17，q=9．837～13．457，P〈0．05）。UA组LPLT数量比对照组显著升高（F=21．49，q=9．468～10．619，P〈0．05），而治疗对于PLT和MPV无影响（P〉0．05）。结论UA病人的β—TG和LPLT浓度由于血小板活化而升高，正规的临床治疗未能明显引起β-TG和其他活化标志物量的变化。     

两种根管长度测量方法对根管充填质量的影响

目的探讨两种根管长度测量方法对根管充填质量的影响。方法随机选择需行根管治疗术的单根管恒前牙352颗,随机分为A、B两组,A组采用TRRY根管测量仪测量根管长度,根管预备后加试主尖摄牙片,侧方加压充填根管,摄牙片;B组采用根管器械探测法测量根管长度,根管预备后加试主尖摄牙片,侧方加压充填根管,摄牙片。结果在实际工作长度±1.0范围内,TRRY测量准确率为94.32%,根管器械探测法测量准确率为78.40%,两种方法差异显著(P<0.01)。适充率:A组90.37%,B组75.82%,两种方法充填根管X片结果差异显著(P<0.01),A组明显优于B组。结论用TRRY根管测量仪加试主尖摄牙片的方法可明显提高根管充填的质量,值得临床推广应用。     

Paediatric elective surgical conditions as seen at a referral hospital in Kumasi,Ghana

Background: Data on paediatric surgical conditions in sub‐Saharan countries, including Ghana, are scanty and sketchy. Using hospital‐based data, it is possible to assess the epidemiology of diseases among children, and the morbidity and mortality rates. Methods: Between January 1997 and December 2000, records of 1200 children treated consecutively with elective surgery at Komfo Anokye Teaching Hospital in Kumasi, Ghana, were analysed for name, age, sex, postoperative diagnosis, procedure carried out and outcome of treatment Results: The ages of the children ranged from 0 to 14 years, with a mean age of 3.5 years (95% confidence interval: 3.3?3.7) with a boy/girl ratio of 3.1:1. Congenital anomalies were the most common problem (83%), followed by tumours (4%), cysts (3%), uncircumcised penis (2%), and lymphadenopathy of varying aetiologies (2%). The most common congenital anomaly was inguinal hernia, and the rarest, biliary atresia. Eighty‐two percent of the children in this series were treated as day‐care cases. Overall mortality in the series was 0.8%. Conclusions: The data reviewed here demonstrate that there is a wide range of surgical conditions among children in the developing world. This poses a significant health‐care problem and calls for improved management of such paediatric surgical problems to prevent high morbidity and mortality rates in African children.     

56例心脏肿瘤外科治疗

目的 本文总结了56例心脏肿瘤外科治疗经验及体会。方法 所有患者均在体外循环下进行肿瘤切除，心肌保护方法采用温血心麻液连续灌注，如果肿瘤侵犯心脏重要的组织结构应该做姑息切除，以免出现严重的并发症。结果 心脏良性肿瘤54例，其中53例为心脏黏液瘤，1例为心脏脂肪瘤，心脏恶性肿瘤2例，均为肉瘤。良性肿瘤均能彻底切除。术后心功能能迅速恢复，长期随访无复发，有良好的临床效果。恶性肿瘤不能彻底切除，手术效果差，术后并发症多。结论 心脏肿瘤是性黏液瘤多见，手术效果好。心脏恶性肿瘤以肉瘤多见，因广泛侵润难以彻底切除。