选择性血流阻断配合超声乳化吸引刀切除中央型肝肿瘤

目的 探讨选择性血流阻断配合超声乳化吸引刀切除中央型肝肿瘤的效果.方法 选择性阻断肿瘤所在肝叶的进出血流,超声乳化吸引刀解剖,行中央区肝段切除.结果 自2006年7月至2008年1月,采用这种外科技术治疗中央型肝肿瘤46例.本组患者术前肝功能Child A级43例,Child B级3例.39例患者一次性肝区域性全血流阻断8～33 min.术中出血量100～2400ml,平均490ml.43例术后在一周内肝功能恢复至A级;3例术后出现腹水,其中1例并发黄疸;2例发生胆瘘;1例胃瘫,1例术后第3天并发大面积心梗死亡.35例恶性肿瘤患者中位随访9个月,1例患者术后10个月因肿瘤腹腔及肝内转移死亡,34例患者至今无瘤生存.结论 肝区域性进出血流阻断能有效控制切肝时的出血;应用超声乳化吸引刀切肝,解剖清晰,综合应用这两种技术,能较安全地切除肝脏任何部位的肿瘤.     

Difficulties in diagnosing intrinsic spinal cord tumours

Thirteen children with intrinsic spinal cord tumours were seen between 1984 and 1995. In only one was this the presumptive diagnosis at referral, despite a high incidence of characteristic features. Eight had presented to their local paediatrician, four to local orthopaedic teams, and one to a general surgeon. Eleven had back pain. Eleven had either spinal curvature or change in gait. The interval between onset of symptoms and diagnosis ranged from one week to six years, with a mean of 17.5 months. In nine children symptoms had been present for four or more months. In nine, unrewarding investigations had been carried out. This paper highlights typical presenting features of these tumours and how earlier diagnosis can be achieved.     

Timing of intraventricular haemorrhage

The detection of the onset of intraventricular haemorrhage (IVH) during life is a necessary preliminary to understanding the cause of this condition. In 10 infants of very low birthweight treated with serial transfusions of adult blood the proportions of transfused cells circulating after each transfusion were compared with the proportion of transfused cells found in the intraventricular clot at necropsy. This allowed the timing of IVH to be restricted retrospectively to the period between consecutive blood transfusions. In addition, the proportional changes of transfused cells produced by infusion of a known red cell mass allow changes in the babies' original red cell mass to be followed during life. A fall in this value occurred in 8 infants dying with IVH and was taken to indicate haemorrhage. Comparison of the two methods in 9 infants suggested that, while in some cases intraventricular bleeding occurs rapidly, in others it takes place over a period of time. The interval between birth and the onset of haemorrhage was directly proportional to the gestational age of the infant.     

Blount's disease

Out of a total of 40 patients affected with Blount's disease treated at the Pediatric Orthopaedic Division of the Rizzoli Orthopaedic Institute between 1965 and 1996, 29 were affected with the infantile type, and 11 with the adolescent type. In the group affected with infantile Blount's disease, the mean age was 5.5 years, 11 were bilateral, for a total of 40 limbs affected, with a mean TMD angle of 24 degrees. All of the patients were treated by valgus osteotomy obtaining a percentage of poor results (insufficient correction or recurrence) equal to 25% according to Schoenecker's criteria. Mean follow-up was 3.6 years. In the group affected with adolescent Blount's disease, mean age was 12.6 years, the affection was always monolateral, the mean TMD angle was 15 degrees. All of the patients except 1 were treated by valgus osteotomy with elevation, and the results were constantly favorable. Mean follow-up was 2 years. The authors believe that the type of osteotomy used must be modulated based on the anatomopathologic findings of compromise in the proximal tibial metaepiphysis.     

The context of HIV/AIDS surveillance

HIV surveillance and diagnostic testing for HIV infection share elements in common, yet differ notably in context. Clinical testing provides vital information for individual medical and behavioral decisions, whereas surveillance, which focuses on populations, provides information to develop policy, direct resources, and plan services. HIV/AIDS surveillance has evolved over the course of the epidemic, reflecting changes in scientific knowledge, populations affected, and information needs. Likewise, the benefits of early diagnosis of HIV have become increasingly apparent with advances in HIV treatment. This article examines the changing context of HIV/AIDS surveillance and discusses the potential impact of HIV surveillance practices and policies on HIV testing behaviors. Special emphasis is placed on the importance of protecting the confidentiality of HIV/AIDS surveillance data and on the role of health department in monitoring the impact of surveillance policies on test-seeking patterns and behaviors.     

Fluid resuscitation in infantile hypertrophic pyloric stenosis

The purpose of this analysis was to investigate biochemical disturbances at presentation and initial fluid resuscitation before surgery in infantile pyloric stenosis. The charts of 139 consecutive infants (113 boys and 26 girls) between 7 d and 20 wk of age with hypertrophic pyloric stenosis were reviewed. The infants were treated at the Department of Pediatric Surgery, University of Bern, Switzerland, in the period between 1987 and 1997. A trend towards hypokalaemia (13 of the 139 patients), hypochloraemia (39 patients) and especially metabolic alkalosis (98 patients) was frequently noted on admission. In 84 patients, data on fluid management and on circulating sodium, potassium, chloride and the acid-base balance immediately before surgery were also available. In these patients a significant correlation was found between the parenteral chloride dose given for fluid repair (y = 0.310 x; r = 0.54; p < 0.001) and the changes in plasma bicarbonate. The equation indicates that a chloride dose of 10 mmol/kg body weight is required to reduce plasma bicarbonate on average by 3 mmol/. CONCLUSION: Since assessment of the fluid volume stated by physical examination and history is inaccurate in infants with vomiting, the severity of metabolic alkalosis helps to define the amount of fluid required for repair.