An experience of renal replacement therapy in a combined neonatal and paediatric intensive care unit of Hong Kong

Intensive care services are expensive. The experience of developing a combined paediatric and neonatal intensive care unit (ICU) in a regional hospital is reported with reference to the provision of renal support for the critically ill patients. The combined unit is staffed by a team of paediatric intensivists, each of whom has special interest in a subspecialty, including cardiology, respiratory medicine, nephrology and neonatology. In the past 7 years, renal replacement therapy (peritoneal dialysis and haemofiltration) was provided to 40 patients, with comparable mortality and complication rates to other reports. This arrangement has been feasible and might be more efficient than running separate paediatric and neonatal ICUs or combining the paediatric ICU with the adult ICU.     

Effect of deoxynivalenol on neurotransmitters in discrete regions of swine brain

The effect of deoxynivalenol (DON, vomitoxin) on brain amine levels was investigated in swine. DON, a trichothecene mycotoxin, causes suppression of feed intake (anorexia) in susceptible species. Following acute administration of DON to pigs (0.25 mg/kg, IV), concentrations of endogenous catecholamines norepinephrine (NE), dopamine (DA), 3,4-dihydroxyphenyl-acetic acid (DOPAC), and homovanillic acid (HVA), and the indoleamines, 5-hydroxytryptamine (5HT, serotonin) and 5-hydroxyindoleacetic acid (5HIAA) were determined in five brain regions, periodically during the 24 h post-dosing. Analysis was carried out by high performance liquid chromatography, using electrochemical detection.Effects of DON in the swine brain were transmitter, time and region-specific. It was observed that levels of the major transmitters (NE, DA and 5HT) were statistically different from controls in the hypothalamus (Hypo), frontal cortex (FCX) and cerebellum (Cb) up to 8 h post-dosing. Overall, DON administration elevated NE and depressed DA concentrations in these regions, and levels of 5HT which increased initially in Hypo (1 h), had dropped significantly below controls in both Hypo and FCX at 8 h. These alterations, however, were not indicative of known neurochemical changes associated with chemical-induced anorexia. Instead, this data suggested that the neurochemical effects of acute DON exposure might be due to peripheral toxicological events (i.e., vomiting), which overwhelmed its more subtle feed refusal activity.Animal Research Centre; Contribution No. 1743.Research Program Service; Contribution No. R082.     

Rectus sheath haematoma requiring laparotomy

Rectus sheath haematoma is a well‐documented but unusual cause of acute abdomen. Combination of clinical features and appropriate radiological investigations can make for a prompt diagnosis. Most authors advocate conservative management and it has been reported that patients were directly discharged from the emergency department. We report a case of rectus sheath haematoma which progressed with clinical deterioration and necessitated surgical intervention for clot evacuation. Causes, physical signs, radiological features and classification of rectus sheath haematoma are discussed. It may be necessary to continue close clinical monitoring after diagnosis of rectus sheath haematoma.     

卵巢癌中蛋白激酶C的表达及其临床意义

目的　探讨上皮性卵巢癌组织蛋白激酶C (proteinkinaseC ,PKC)的表达和化疗耐药的关系 ,以及与P -糖蛋白 (P -gp)的相关性。方法　用免疫组化S -P法检测 35例卵巢上皮性肿瘤组织、 2 0例卵巢良性肿瘤组织和 2 0例正常卵巢组织中PKC和P -gp的表达 ,并进行相关临床因素分析。结果　①PKC、P -gp在卵巢恶性肿瘤中的表达明显高于在良性及正常组织中的表达 ;并且PKC和P -gp的表达有相关性 (P <0 0 5 ) ;②卵巢癌PKC的表达与临床病理因素无直接关系 ;③恶性肿瘤中 ,初治和复发的PKC表达阳性率分别为 34 8%和 75 % ;④化疗对PKC表达阳性和阴性卵巢癌患者的有效率分别为 2 3 5 %、 6 6 7% (P <0 0 5 ) ;⑤PKC表达阴性患者的预后优于阳性者 (P =0 0 39)。结论　PKC表达与卵巢癌组织化疗耐药明显相关 ,可能在P -gp介导的卵巢癌多药耐药中起重要作用。     

表面角膜镜片术治疗儿童外伤性白内障术后无晶体眼

本文报告了１０例儿童外伤性白内障术后无晶体眼，不适宜作人工晶体植入而接受了表面角膜镜片术。术后角膜屈光力平均增加９．２５Ｄ，裸眼视力均达０．２以上，矫正视力在０．４￣０．８之间，并恢复了双眼单视功能且矫正了弱视。经１￣３年追踪观察，表面角膜镜片保持透明，视力稳定且未出现并发症。结果表明该手术是一项近年来逐渐发展起来的操作简便、安全可靠、疗效确切的屈光性角膜手术。     

Detection of C. pneumoniae by polymerase chain reaction-enzyme immunoassay in abdominal aortic aneurysm walls and its association with rupture.

OBJECTIVE: Serological studies have suggested that one of the risk factors for aneurysm development is C. pneumoniae infection. The purpose of this study was to evaluate whether there is an association between the presence of C. pneumoniae DNA in aneurysms and ruptured abdominal aortic aneurysms. METHODS: Aortic walls were collected consecutively from 30 patients with intact AAA, 16 patients with ruptured AAA and 19 healthy organ donors (control). Purified DNAs from all aortas were analyzed for the presence of C. pneumoniae DNA in parallel by polymerase chain reaction-enzyme immunoassay (PCR-EIA) and agarose gel electrophoresis. PCR-EIA has a high sensitivity in detecting low DNA copy number in clinical atherosclerotic samples. RESULTS: C. pneumoniae DNA was detected more frequently in patients with aneurysms, particular with ruptured aneurysms. The incidence of positive C. pneumoniae DNA was 73.3% in intact AAA and 10.5% in control aortas, with the highest frequency in ruptured AAA (100%) (p < 0.05). CONCLUSION: Giving the high specificity and sensitivity of PCR-EIA, these findings support the association of C. pneumoniae in the pathogenesis of aneurysm development, growth and rupture.     

人体尺神经显微结构三维可视化研究

目的 将人体尺神经行连续冰冻组织切片,经染色、扫描后获取尺神经连续断面二维图像信息,通过3D Nerve三维可视化软件系统勾画出完整的尺神经干三维解剖图谱.方法 取自愿捐献死亡3 h内38岁男性左侧尺神经全长(自臂丛内侧束至腕横韧带)标本1例,长约50cm,经定位、包埋、连续冰冻组织切片、乙酰胆碱脂酶组织化学染色,获取尺神经连续二维图像信息,应用3D Nerve三维可视化软件系统对尺神经内部结构进行三维重建.结果 尺神经在不同断面神经束的数量、位置及内部神经纤维的性质均有变化.应用尺神经3D Nerve三维可视化软件系统可在任意断面、任意角度观察尺神经内部的显微结构,追踪各神经束的立体行径,动态地展示尺神经内部神经束的复杂结构.结论 尺神经的3D Nerve三维可视化软件系统可真实地再现尺神经干全长及其内部各神经束的三维立体行径,为医学教学与临床修复尺神经损伤提供精确的神经任意断面三维立体解剖图像,有助于提高神经修复的疗效.     

子宫内膜异位症猕猴动物模型的建立

目的构建子宫内膜异位症(EM)猕猴动物模型。方法选择5只健康、月经规律的雌性猕猴(4只实验猴、1只对照猴),在月经第8~15天,雌激素高峰的第3~5天,手术将猕猴的子宫内膜种植到盆腔子宫腔以外的部位,对照猕猴用大网膜取代内膜种植。在术后第2、4个月动物月经周期的第8~15天开腹或腹腔镜探查。结果术后第2个月探查,4只实验猴中,3只异位内膜种植存活,其中2只形成异位囊肿。术后第4个月,对2只已形成EM的猕猴行腹腔镜再次探查,其盆腔粘连,异位内膜生长情况与术后第2个月基本相似;3只形成EM的猕猴精神状态、饮食、体质量增长情况均较对照猕猴差,2只发生肠套叠死亡。结论本研究根据种植学说原理成功地构建了子宫内膜异位症猕猴动物模型,但猕猴的个体差异是模型是否成功的一个关键因素,因而认为遗传因素是子宫内膜异位症发病中的另一重要机制,子宫内膜异位生长对机体的整体机能有较为明显的影响。