人工耳蜗术后客观调机过程中电诱发听觉脑干反应、电诱发听神经复合动作电位和电诱发蹬骨肌反射的指导作用

目的:探讨使用电诱发听觉脑干反应、电诱发听神经复合动作电位和电诱发蹬骨肌反射指导人工耳蜗术后客观调机的可行性。方法:测试于2002-07/2004-06在郑州大学第一附属医院测听室进行。①对53例Nucleus24型人工耳蜗植入者进行主观阈值以及最大舒适阈值测试,同一天进行电诱发听觉脑干反应、电诱发听神经复合动作电位和电诱发蹬骨肌反射测试。②将主观阈值和最大舒适阈值与电诱发听觉脑干反应、电诱发听神经复合动作电位阈值间进行相关性分析;同时将根据电诱发听觉脑干反应、电诱发听神经复合动作电位阈值推测得出的主观阈值和最大舒适阈值与实际值进行相关性分析。结果:53例受试者均进入结果分析。①电诱发听觉脑干反应阈值和电诱发听神经复合动作电位阈值与主观阈值和最大舒适阈值相关(r=0.585,0.555,0.592,0.630,P<0.001)。②3种检测的阈值在不同患者间变异均较大。但所有电诱发听觉脑干反应阈值和电诱发听神经复合动作电位阈值均大于主观阈值,所有电诱发蹬骨肌反射阈值均低于不舒适阈值。③由电诱发听觉脑干反应、电诱发听神经复合动作电位阈值推测得出的主观阈值和最大舒适阈值与实际值均显著相关(r=0.918,0.924,0.934,0.883,P<0.001)。结论:电诱发听觉脑干反应、电诱发听神经复合动作电位和电诱发蹬骨肌反射测试可用于指导人工耳蜗植入者主观阈值和最大舒适阈值的调试。     

Anaphylatoxins in fresh-frozen plasma

BACKGROUND: Fresh-frozen plasma (FFP) is widely used in patients with coagulation disorders and simultaneous complement activation. Complement activation in FFP itself is poorly investigated. STUDY DESIGN AND METHODS: The concentration of anaphylatoxins C3a and C5a, the complement precursors C1q and factor B, and complement function were measured in 40 consecutively administered FFP units in two pediatric neonatal intensive care units. In 12 samples, the measurements were also performed after incubation with inulin. RESULTS: In 15 of 40 FFP units, both anaphylatoxin concentrations were below the upper cutoff levels reported for healthy humans (C3a, 500 microg/L; C5a, 5 microg/L). Anaphylatoxin levels were higher in FFP units produced by apheresis than in those from blood donation. Complement activation of FFP by inulin increased anaphylatoxin concentration, whereas C1q and factor B levels, and complement function remained unchanged. CONCLUSION: Elevated concentrations of anaphylatoxin are frequently found in FFP units produced by apheresis. Studies are necessary to investigate the reasons for complement activation and the possibilities of prevention during apheresis. As the concentrations of complement precursors and complement function did not change with activation in FFP, these studies should include measurement of the anaphylatoxins C3a and C5a.     

CONGENITAL ABSENCE OF THE GALLBLADDER: WAYS OF AVOIDING LAPAROTOMY

SUMMARY Two cases of congenital absence (agenesis) of the gallbladder seen at one hospital over a 5-year period are presented. One patient presented with ascending cholangitis due to choledocholithiasis, while the other presented with right upper quadrant abdominal pain and equivocal findings on ultrasound and oral cholecystography. Although diagnosis was made at laparotomy in both cases, it is likely that the arrival of laparoscopic cholecystectomy will avoid laparotomy in the future. The place of laparoscopy in establishing the presence of this anomaly is discussed.     

−141C insertion/deletion polymorphism of the dopamine D2 receptor gene is associated with schizophrenia in Chinese Han population: Evidence from an ethnic group‐specific meta‐analysis

Accumulate evidence has implicated dopamine D2 receptor gene polymorphisms in the etiology of schizophrenia. A single nucleotide polymorphism, ?141C insertion/deletion (Ins/Del) (rs1799732), in the promoter region of the dopamine D2 receptor gene has been linked to schizophrenia; however, the data are inconclusive. This study investigated whether the ?141C polymorphism is associated with the risk of schizophrenia in different ethnic groups by performing a meta‐analysis. A total of 24 case–control studies examining the association between ?141C Ins/Del polymorphism and schizophrenia were identified according to established inclusion criteria. Significant association was revealed between ?141C Ins/Del polymorphism and schizophrenia risk in dominant genetic model (Ins/Ins + Ins/Del versus Del/Del) (odds ratio = 0.33, 95% confidence interval = 0.14–0.81, z = 2.41, P = 0.02) in Chinese Han but not in Caucasian, Japanese or India populations. Our results indicate that ?141C Ins/Del polymorphism might be a susceptibility factor for schizophrenia in Chinese Han population.     

Sonographic diagnosis of splenogonadal fusion in a 2‐year‐old boy

Splenogonadal fusion (SGF) is a rare congenital abnormality. It is typically identified during orchiectomy for a suspected testicular tumor or during orchiopexy. We describe the sonographic findings in a case of SGF that could help with correct diagnosis preoperatively. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45 :179–182, 2017     

Aggressive Use of Diagnostic Services is Counterproductive

Background

Medical fraternity requisitions diagnostic tests for multiple reasons. More often than not, the tests lead to more tests either to exclude or to confirm doubts raised by the test results. These tests have an inherent morbidity, discomfort and cost. Growing expenditure on diagnostic tests without matching improvement in the health status warrants an internal audit of the laboratory utilization.

Methods

A retrospective utility audit was done for certain routinely advised laboratory tests at a hospital. Blood urea estimation in annual / periodic medical examination (AME/ PME), bleeding and clotting time in pre-anaesthetic check-up and aspartate aminotransferase (AST) and antibodies to hepatitis C virus (anti-HCV) in diagnostic work-up of acute onset jaundice were included in the audit.

Results

During the study period, 793 individuals underwent AME / PME and urea estimation did not provide any additional information in these cases which was not inferred by serum creatinine. Similarly, in diagnostic workup of acute onset jaundice, 6049 aspartate aminotransferase (AST) estimations in 1024 patients did not contribute anything more than what was inferred by alanine aminotransferase (ALT). Prevalence of anti HCV antibodies in acute onset jaundice in serving soldiers (11 out of 1225; 0.89%) though more than that in the blood donors from the same population (17 out of 4105; 0.41%) was less than anticipated false positives (18 out of 1225; 1.5%) as per the claimed specificity (98.5%) of the test kit. None of the 2766 bleeding and clotting time tests detected a bleeding or coagulation disorder.

Conclusion

The study reveals significant overuse of the laboratory that may not be good for the patient and the organization in terms of direct and indirect costs due to false positive results. This laboratory overload adversely affects the quality and availability of laboratory results. Therefore, a test should only be advised, if positive or negative result would dictate a change in patient management.Key Words: Laboratory overuse, Aspartate aminotransferase, Anti HCV, Bleeding time, Clotting time, Blood urea     

Management of Combat Related Vascular Injuries in a Zonal Hospital

Background

The extremity gunshot wound (GSW) and penetrating splinter injuries from mine blast present a surgical challenge in the treatment of arterial trauma especially at non-vascular surgery centre. Adherence to specific principles of management is required for optimal limb salvage.

Methods

Fourteen vascular injuries in patients of GSW and mine explosions were managed at a zonal military hospital with successful outcome in two years. The diagnosis of arterial injury was done clinically.

Results

The commonest site of vascular injury was femoral. The methods of choice for repair were autogenous vein interposition or end-to-end anastomosis. All except for two patients retained a functional limb.

Conclusion

All surgeons in peripheral hospitals should be trained in vascular injury repair to save life and limb. Our series shows that right timing and prompt treatment of vascular injuries in a peripheral hospital, can give satisfactory results.Key Words: Gunshot wounds, Mine blast injuries, Vascular trauma, Autogenous vein interposition, Fasciotomy