Down syndrome associated with a retroperitoneal teratoma and Morgagni hernia

Down syndrome may be associated with many complications. Among the malignancies associated with Down syndrome, leukaemia is the most common. This is a case report of a patient with Down syndrome associated with both a retroperitoneal teratoma and a Morgagni hernia.     

社区卫生服务定价与补偿机制研究(三)

为了制定适当的社区卫生服务价格，对社区卫生服务进行合理的补偿，本文在对4省12市46个社区卫生服务中心(或站)的项目成本进行测算的基础上，应用标准成本计算方法得出各项服务的建议价格。对社区卫生服务政府补偿额进行了测算，提出了社区卫生服务补偿的政策建议。     

新毕业护士的心理状态调查分析及对策

为了了解新毕业护士的心理状态,采用90项症状自评量表(SCL-90)对64名新毕业护士的心理状况进行了调查。结果发现新护士在SCL-90中的各因子分均高于国内常模,主要表现为焦虑、人际关系敏感。及时了解新护士的心理状态,通过扎实基本功,培养独立处事能力,帮助新护士增强自信心,树立良好的职业意识,才能顺利度过工作适应期。     

The Bicontact cementless primary total hip arthroplasty: long-term results

We report on a prospective series of 201 primary uncemented total hip arthroplasties with a Bicontact prosthesis at a mean follow-up of 12.9 years. The mean Harris hip score improved from 41 before surgery to 89 at final follow-up. Two femoral stems, one each for infection and fracture, and 12 cups were revised. The mean number of years to revision post-primary surgery was 8.7 years (six months to 16 years). The cumulative survival of the prosthesis was 95.42% for any cause at ten years and 93.57% at 12 years. Survivorship for aseptic loosening of the femoral stem was 100%. In our series, the Bicontact uncemented total hip arthroplasty stem without hydroxyapatite coating showed excellent survival and the cup survival was comparable to other leading series.     

Chronic pain and opioid analgesic use: A case report

Relationship‐based medical care is essential in the management of chronic pain. Opioids are often ineffective and can cause significant harm. However, there is significant time pressure, and there are insufficient resources and guidelines for GPs to be able to offer alternatives, putting the NHS at risk of a growing opioid epidemic.     

A rare but potentially lethal complication of dengue

Severe rhabdomyolysis is an uncommon but potentially fatal complication of dengue fever that is not well characterised and may be underreported. With the resurgence and continued rise of dengue cases worldwide, physicians must be aware of the less common but serious complications of dengue. Here, we report a patient who presented with severe rhabdomyolysis secondary to dengue fever with a serum creatine kinase of 742 900 U/L.     

Endocrinology: Pituitary down-regulation prior to in-vitro fertilization and embryo transfer: a comparison between a single dose of Zoladex depot and multiple daily doses of Suprefact

In order to further evaluate the endocrinological, embryologicaland clinical efficacy of a single injection of the gonadotrophin-releasinghormone (GnRH) analogue Zoladex (goserelin), 142 women underwentpituitary down-regulation prior to in-vitro fertilization andembryo transfer: 71 with a single injection of Zoladex depot(group I) and 71 matched controls with multiple daily injectionsof Suprefact (buserelin; group II). Ovarian stimulation wasperformed with human menopausal gonadotrophin (HMG) and ovulationinduction with human chorionic gonadotrophin (HCG). HMG andhydroxyprogesterone caproate depot were given for luteal phasesupport. The mean (± SD) age (34.01 ± 4.42 versus34.81 ± 4.00 years), mean total dosage of HMG (61.25± 26.87 versus 56.17 ± 25.18 ampoules), mean dailydosage of HMG (4.74 versus 4.94 ampoules), duration of HMG stimulation(12.91 ± 3.68 versus 11.31 ± 3.46 days) and oestradiolconcentration on the day of HCG (10 082 ± 8007 versus9440 ± 7840 pmol/l) were similar in both groups but themean total number of injections (GnRH and HMG) (13.55 ±3.35 versus 55.37± 31.92) was significantly lower ingroup I. Furthermore, the proportion of women down-regulatedby 2 weeks and pregnancy rate per embryo transfer were significantlyhigher in the Zoladex group, while miscarriage rates were similar.We conclude that a single dose of Zoladex is quicker, more convenientand should be investigated as an equally effective alternativeto mutiple doses of Suprefact for pituitary down-regulationprior to assisted conception. Further studies are required totest the teratogenicity and effectiveness of Zoladex.