SonoWand, an ultrasound-based neuronavigation system

OBJECTIVE: We have integrated a neuronavigation system into an ultrasound scanner and developed a single-rack system that enables the surgeon to perform frameless and armless stereotactic neuronavigation using intraoperative three-dimensional ultrasound data as well as preoperative magnetic resonance or computed tomographic images. The purpose of this article is to describe our two-rack prototype and present the results of our work on image quality enhancement. DESCRIPTION OF INSTRUMENTATION: The system consists of a high-end ultrasound scanner, a modest-cost computer, and an optical positioning/digitizer system. Special technical and clinical efforts have been made to achieve high image quality. A special interface between the ultrasound instrument and the navigation computer ensures rapid transfer of digital three-dimensional data with no loss of image quality. OPERATIVE TECHNIQUE: The positioning system tracks the position and orientation of the patient, the ultrasound probe, the pointer, and various surgical instruments. This makes it possible to update the three-dimensional map during surgery and navigate by ultrasound data in a similar manner as with magnetic resonance data. METHODS: The two-rack prototype has been used for clinical testing since November 1997 at the University Hospital in Trondheim. EXPERIENCE AND RESULTS: The image quality improvements have enabled us, in most cases, to extract information from ultrasound with clinical value similar to that of preoperative magnetic resonance imaging. The overall clinical accuracy of the ultrasound-based navigation system is expected to be comparable to or better than that of a magnetic resonance imaging-based system. CONCLUSION: The SonoWand system enables neuronavigation through direct use of intraoperative three-dimensional ultrasound. Further research will be necessary to explore the potential clinical value and the limitations of this technology.     

Allogeneic bone marrow transplantation for adult acute lymphoblastic leukemia: a single-centre experience.

Between 1990 and 1997, we performed 29 allogeneic BMTs for acute lymphoblastic leukemia (ALL) patients with HLA-identical sibs. Their median age was 31 years (range 15 to 43); there were 15 males and 14 females. The conditioning protocol was Cy-TBI (n = 15), VP16-Cy-TBI(n = 12), CBV (n = 1) and Bu-Cy (n = 1). Cyclosporin and methotrexate were used for GVHD prophylaxis. The median disease-free survival (DFS) was 12 months (range 1 to 92) with an actuarial 4-years DFS of 42.3 per cent. Three patients died of transplant-related complications before 100 days. Relapse occurred in 11 cases at a median time of 5 months (range 3 to 14). All nine patients relapsing within one year died form resistant leukemia. Three patients died of late treatment-related complications. There were 13 survivors (median follow-up 38 months, range 12-98), with 12 in remission. Only four had limited cGVHD, and all had 100 per cent performance scores. One patient also cleared her chronic hepatitis B carrier status due to acquired immunity. The DFS rates amongst CR1 cases and R1/CR2 cases were comparable (p = 0.39). No long-term DFS is obtained from patients with resistant disease (n = 4). The survival results for BMT at CR1 were superior to those using intensive chemotherapy consolidation (p = 0.29), mainly due to poor late results in the chemotherapy arm. For young ALL patients with HLA-matched siblings, the option of BMT should be considered in light of local consolidation survival results.     

HIV AND TUBERCULOSIS CO-INFECTION IN A REFERRAL CHEST HOSPITAL

Serving personnel of Armed Forces admitted with tuberculosis between Apr 1996–1999 were evaluated for co-infection of tuberculosis and HIV. Sixty (1.06%) of tuberculosis patients were found to be HIV positive. Initial test was done by spot kits and subsequently confirmed by ELISA on two different samples. Majority of the cases were in sexually active age group 48 (80%). Alcohol and smoking was associated in 80% cases. Thirty six (60%) were sputum smear positive for AFB. Twenty eight (46.7%) gave history of exposure to sex workers. Family members were not available for study. Sero prevalence of HIV in association with tuberculosis is less in Armed Forces compared to civil population.KEY WORDS: HIV, Seroprevalence, Tuberculosis     

注重细节建立人性化质控体系提高医疗质量

通过对89家综合性医院医疗质量控制情况的调查，发现当前医疗机构医疗质控中存在诸多问题。针对问题提出了建立人性化质控体系的目标、方法、步骤，以及时质控进行细化和量化等，在医院应用并取得了较好的效果。     

广州队列研究生物库中条形码技术应用与评价

目的建立大规模人群的分子流行病学队列研究生物库，确保快速、准确地识别每一份生物样本，并保持其活性，以便长时间跟踪研究。方法采用条形码识别技术对血液样品的采集、处理及存储、查询过程进行全程管理。结果创建成功以条形码自动识别技术为核心的新型运作管理模式，建立起10000人份的生物样品库。大型生物样本库实施条形码管理系统可缩短每份样品的处理时间，提高工作效率1．5倍。结论条形码技术的应用可有效地避免样品间的相互混淆，使实验室每一项工作准确、可靠、高效，实现医学研究工作全面信息化，提高基因队列研究的质量。     

氯沙坦对糖尿病大鼠肾小球肥大及肾小球毛细血管基底膜厚度的影响

目的观察氯沙坦对糖尿病大鼠肾小球肥大及肾小球毛细血管基底膜厚度的影响。方法将SD大鼠制成链脲佐菌素糖尿病模型,12w后观察氯沙坦对糖尿病大鼠肌酐清除率(Ccr)、尿白蛋白排泄率及肾小球平均体积、肾小球毛细血管基底膜平均厚度的影响,并观察血、尿转化生长因子-β1(TGF-β1)的变化。结果氯沙坦可降低糖尿病大鼠Ccr、尿白蛋白排泄率及肾小球平均体积、肾小球毛细血管基底膜平均厚度,并可降低尿TGF-β1水平。结论氯沙坦可抑制糖尿病大鼠肾小球肥大及肾小球毛细血管基底膜厚度,此作用可能与氯沙坦降低肾脏局部TGF-β水平有关。     

Effect of a structured asthma education program on hospitalized asthmatic children: A randomized controlled study

BACKGROUND: The aim of this study was to compare the effectiveness of an intensive asthma education program (group B) with that of a standard asthma education program (group A). METHODS: A prospective randomized single blinded study was conducted in the pediatric department of a public hospital in Hong Kong. Children aged 2-15 years admitted to the pediatric department with an acute attack of asthma were recruited. A standard asthma education program (group A) or an intensive asthma education program (group B) for children were offered. The main outcome measures include the number of visits to the emergency department and the number of hospitalization for asthma during the 3 month follow-up period. RESULTS: A total of 45 children were in group A and 55 in group B. Group B had statistically significant reductions in the number of visits to the emergency department and the number of hospitalizations. Drug compliance was also significantly improved in group B. Parents' satisfaction rate was also higher in group B. CONCLUSION: The intensive asthma education program might be more cost effective than the standard asthma education program in the management of asthmatic children admitted to hospital in Hong Kong.     

纳洛酮治疗急性酒精中毒46例疗效观察

目的:总结纳洛酮(naloxone)治疗急性酒精中毒的疗效和经验。方法:对用纳洛酮治疗的46急性酒精中毒患者的临床资料进行分析。结果:纳洛酮治疗轻、中度患者症状消失时间为(0.6±0.1)小时,重度中毒患者神志清醒时间为(3.0±0.3)小时,与传统的治疗相比有明显的优势。结论:纳洛酮是治疗急性酒精中毒的有效药物,使用简单,疗效快速可靠。     

Long-term results in children with AML: NOPHO-AML Study Group--report of three consecutive trials.

In all, 447 children with acute myeloid leukaemia (AML) have been treated on three consecutive NOPHO studies from July 1984 to December 2001. NOPHO-AML 84 was of moderate intensity with an induction of three courses of cytarabine, 6-thioguanine and doxorubicin followed by four consolidation courses with high-dose cytarabine. The 5-year event-free survival (EFS), disease free survival (DFS) and overall survival (OS) were 29, 37 and 38%. NOPHO-AML 88 was of high intensity with the addition of etoposide and mitoxantrone in selected courses during induction and consolidation. The interval between the induction courses should be as short as possible, that is, time intensity was introduced. The 5-year EFS, DFS and OS were 41, 48 and 46%. In NOPHO-AML 93, the treatment was stratified according to response to first induction course. The protocol utilised the same induction blocks as NOPHO-AML 88, but after the first block, children with a hypoplastic, nonleukaemic bone marrow were allowed to recover before the second block. Consolidation was identical with NOPHO-AML 88. The 5-year EFS, DFS and OS in NOPHO-AML 93 were 48, 52 and 65%. The new NOPHO-AML protocol has been based on experiences from previous protocols with stratification of patients with regard to in vivo response and specific cytogenetic aberrations.     

高效液相色谱法测定甲诺参洗剂中甲硝唑及诺氟沙星的含量

目的:建立同时测定甲诺参洗剂中甲硝唑和诺氟沙星含量的高效液相色谱法.方法:采用Kromasil C 18 色谱柱(250 mm× 4.6 mm,5 μm),0.7%三乙胺(以磷酸调pH至 3.0 )-甲醇(200∶300)为流动相,流速为 1.0 mL·min -1 ,检测波长为290 nm.结果:甲硝唑在 20.0 ～ 150.0 mg·L -1 范围内,峰面积与其浓度线性关系良好(r= 0.999 9 ),平均回收率为 100.4% ,重复性试验RSD为 0.4% (n=5),检测限为 4.0 ×10 -3 μg;诺氟沙星在 10.0 ～ 75.0 mg·L -1 的范围内,峰面积与其浓度线性关系良好(r= 0.999 9 ),平均回收率为 98.6% ,重复性试验RSD为 0.5% (n=5),检测限为 2.0 ×10 -3 μg.结论:本法准确、简便、快速,具有专属性强,灵敏度高的特点,适用于含甲硝唑及诺氟沙星制剂的含量测定.