Growth of the uterus

BACKGROUND: The pattern of growth of the uterus was examined by ultrasound examinations of 358 girls who attended a paediatric endocrine outpatient department but were shown not to have any endocrine defect. METHOD: The uterus was measured in length and width at the cervix and at the fundus (cm). Endometrial thickness was measured (mm). Scans were divided by Tanner breast stage and the dimensions compared by one way analysis of variance (ANOVA, with the Student Newman Keuls post hoc test). RESULTS: There was an increase in uterine length, diameter of the fundus, and endometrial thickness at each breast stage from 1 to 5 (ANOVA, p < 0.05), and in the diameter of the cervix with each breast stage from 1 to 4 (ANOVA, p < 0.05). The ratio of the fundus to the cervix increased from 0.95 to 1.29 between breast stages 1 and 4. CONCLUSION: The onset of puberty is marked by an increase in the dimensions of the uterus and in endometrial thickness, but also by a change in the shape of the uterus from a tubular to a pear shaped organ.     

Heterotopic bone formation affecting the hip joint is preventable in high risk patients by post-operative radiation

Between 1984 and 1993, 40 high risk patients (45 hips) received postoperative irradiation as prophylaxis against heterotopic ossification (HO). Radiotherapy was commenced within 5 days of the surgery in 43 of 45 hips. The development of HO was assessed by comparison of radiographic films prior to irradiation and at least 2 months after treatment (median interval 12 months). Progression of HO was observed in only two of 45 hips (4.3%) and of clinical significance in one (2.2%). Treatment was well tolerated with no acute complications or loosening of prosthetic components attributable to irradiation. During the study period, the treatment programme changed from 20 Gy in 10 fractions to 6–8 Gy in a single fraction, without loss of treatment efficacy. As well as improving resource utilization, single fraction techniques allow fewer patient transfers thereby reducing patient discomfort and risk of hip dislocation. This procedure is uncomplicated and should be considered more widely in the management of this disabling non-malignant condition.     

Scintigraphic pattern in missed testicular torsion

The testicular scintigraphic findings of nine patients with surgically and pathologically proved torsion of the testis of over 24 hours duration are reviewed. In the delayed blood-pool images each showed the classical avascular twisted testicle with a variable peripheral rim of hyperemia. In the dynamic blood-flow phase, eight revealed a perceptible increase of vascular perfusion in the scrotal region on the affected side, in addition to the testicular radionuclide angiogram peculiarities previously described for missed testicular torsion. This pattern of perfusion was seen only in torsion of over one day duration. A low salvage probability is expected in these cases.     

E. coli virulence factors in children with neurogenic bladder associated with bacteriuria

The value of E. coli virulence factors in patients with neurogenic bladder has not been established. The aim of this study is to correlate E. coli virulence factors with asymptomatic and symptomatic UTI in children with neurogenic bladder. Fifty E. coli strains, which were collected in sequence, underwent analysis in relation to: the association to pyuria, serotype (O:H), the presence of genes and expression of fimbriae P, type 1, S and hemagglutinin Dr, the presence of the gene and production of hemolysins and cytotoxins (CNF1). We also analyzed the cell adherence capability and pattern and presence of usp (uropathogenic-specific protein). Pyuria was present in most of the positive urine cultures, with 86% AB and 97% UTI. Low rates of uropathogenic strains were observed in the two groups, with 18% AB and 21% UTI. Type 1 fimbria predominated in 44% of the E. coli strains. Of the bacteria studied, 30% (15 strains) exhibited papG genotypes (11 class II and 4 class III). Of these, 12/15 patients presented AB. Production of hemolysins was detected in 38% of the strains (16 AB and 3 UTI) and usp in only 18% of the strains, with 8 AB and 1 UTI. Adherence tests demonstrated the adhesive capacity in all samples analyzed. Neither group (AB or symptomatic UTI) presented a statistically significant difference in relation to the virulence factors studied. E. coli clones that caused symptomatic UTI in children with neurogenic bladder expressed few virulence factors, with no statistically significant difference in comparison to the AB group.     

腺性膀胱炎伴重度不典型增生13例临床分析

日的分析腺性膀胱炎伴重度不典型增生的临床治疗方法。方法介绍2006年12月∽2009年5月在北京大学首钢医院收治的13例腺性膀胱炎伴重度不典型增生患者的治疗经过并随访其预后。术前膀胱镜检均显示膀胱颈部、三角区或／和相邻的左右侧壁多发滤泡和乳头样病变}三角区单发实性块状隆起;病变活检病理为腺性膀胱炎伴重度不典型增生（肿块）、腺性膀胱炎（滤泡及乳头状突起）。结杲12例行经尿道膀胱肿物电切术,术后盐酸吡柔比星30mg膀胱灌注1次／周,连续8次;3、6、9、12个月复查时累计复发病例数分别为2、7、11、11例,此11例在膀胱灌注化疗1次／月后病变消失,随访至2010年2月无复发。1例患者拒绝肿物电切术而接受盐酸吡柔比星30mg长期膀胱灌注1次／周,肿物体积和性质无变化。砖论腺性膀胱炎伴重度不典型增生的治疗宜首选病变切除;不能耐受或不愿行切除手术者可维持长期膀胱灌注化疗,但是必须严密随访并定期活检;首次治疗后未见复发者可继续观察,对于反复复发者可规律膀胱灌注,多数有效。     

移植肾上尿路结石的腔内治疗

目的评估内镜治疗肾移植术后尿路结石的疗效。方法 5例肾移植并发上尿路结石患者接受了内镜手术治疗。其中肾结石2例,输尿管结石3例（其中输尿管膀胱吻合口狭窄并结石1例,金属支架结石2例）。结石最大直径11~52mm,发病时间为接受肾移植术后10个月~6年。结果 2例肾结石及1例金属支架结石患者接受钬激光经皮肾镜碎石取石术成功,2例输尿管结石行输尿管镜取石成功。无一例患者出现严重并发症。结论微创内镜手术在治疗移植肾术后并发尿路结石具有良好的效果。     

同型半胱氨酸致动脉粥样硬化的机制研究

目的通过观察不同浓度同型半胱氨酸(Homocysteine,Hcy)干预对人脐静脉血管内皮细胞(HumanUmbilical Vein Endothelial Cells,HUVEC)和氧化应激的影响,探讨其在动脉粥样硬化(Atherosclerosis,AS)中的作用。方法体外培养HUVEC,将其分为正常对照组(Hcy 0μmol·L-1)、Hcy干预组(浓度分别为50、100、200、500μmol·L-1)、100μM Hcy+叶酸+VitB12治疗组,每个浓度组再分为24、48、72h三个时间组。MTT法检测各组细胞增殖抑制率,测定各浓度Hcy干预HUVEC 72h的氧化应激损伤指标。结果各浓度Hcy干预组随着Hcy浓度增高及干预时间延长HUVEC的细胞增殖抑制率增加,500μM Hcy 72h干预组最明显(P<0.05)。HUVEC内H2O2和MDA含量随Hcy浓度的增加而增加,Hcy100～500μM组与对照组比较差异均有统计学意义(P<0.01);Hcy100～500μM组HUVEC内SOD活性和T-AOC活性均较对照组降低(P<0.01),并且Hcy的浓度越高降低程度越明显。100μM Hcy+叶酸+VitB12治疗组与对照组比较上述各指标的差异均无统计学意义(P>0.05)。结论 Hcy抑制HUVEC增殖的作用呈剂量依赖关系,病理水平Hcy可以增强氧化应激损伤反应,而叶酸和VitB12对Hcy所致氧化应激损伤有一定的拮抗作用。     

Microbiological assessment of indoor air of a teaching hospital in Nigeria

Objective

To investigate the quality of indoor air of different wards and units of Olabisi Onabanjo University Teaching Hospital, Sagamu, to ascertain their contribution to infection rate in the hospital.

Methods

The microbial quality of indoor air of nine wards/units of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria was conducted. Sedimentation technique using open Petri-dishes containing different culture media was employed and samplings were done twice daily, one in the morning shortly after cleaning and before influx of people/patients into the wards/units and the other in the evening when a lot of activities would have taken place in these wards. Isolates were identified according to standard methods.

Results

Results showed that there was a statistically significant difference (χ² = 6.016 7) in the bacteria population of the different sampling time whereas it was not so for fungi population (χ² = 0.285 7). Male medical ward (MMW) and male surgical general (MSG) recorded the highest bacterial and fungal growth while the operating theatre (OT) was almost free of microbial burden. The bacteria isolates were Staphylococcus aureus, Klebsiella sp., Bacillus cereus, Bacillus subtilis, Streptococcus pyogenes and Serratia marscences while the fungi isolates included Aspergillus flavus, Penicillium sp., Fusarium sp., Candida albicans and Alternaria sp. Staphylococcus aureus was the predominantly isolated bacterium while Penicillium sp. was the most isolated fungus.

Conclusions

Though most of the microbial isolates were potential and or opportunistic pathogens, there was no correlation between the isolates in this study and the surveillance report of nosocomial infection during the period of study, hence the contribution of the indoor air cannot be established. From the reduction noticed in the morning samples, stringent measures such as proper disinfection and regular cleaning, restriction of patient relatives'' movement in and out of the wards/units need to be enforced so as to improve the quality of indoor air of our hospital wards/units.