继续医学教育活动的有效性

继续医学教育的目的是通过向医生提供最新的医学知识和技能,使医生在其整个职业生涯中,一直保持较高的医疗水平.但目前还没有充足的证据能证明继续医学教育活动的有效性,以及在继续医学教育活动中哪些教育方法和技术能最有效地传播和记忆医学知识.为了全面、系统地评估继续医学教育活动的有效性,以及了解不同的教育手段对医生知识、态度、技能、临床表现和临床效果的作用.美国约翰·霍普金斯大学医学院、美国医疗保健研究与质量管理署和美国胸科医师学会的专家共同进行了一项系统回顾性研究.     

Iodine nutrition status of exclusively breast-fed infants and their mothers in New Delhi, India

OBJECTIVE: To assess the iodine nutrition status of exclusively breast-fed infants and their mothers. HYPOTHESIS: In the presence of environmental and maternal iodine deficiency, an exclusively breast-fed baby is likely to receive a suboptimal iodine supply during the period of rapid brain growth. METHODS: Spot urinary iodine (UI) and serum TSH levels were measured in 175 healthy, exclusively breast-fed infants and their mothers. Iodine content of salt used by participants for domestic consumption was also analyzed. RESULTS: The median UI levels in mothers and infants was 124 microg/l and 162 microg/l, respectively. 34% of mothers and 21% of infants had UI levels <100 microg/l indicating iodine deficiency. Serum TSH was elevated in 29% of mothers and 2% of infants. No correlation was observed between individual mother-infant UI or serum TSH levels (r = -0.036, r = -0.1 for UI excretion and serum TSH, respectively). 96% of the salt samples tested had adequate iodine concentration, i.e. >15 ppm. CONCLUSION: The present study demonstrated significant iodine deficiency in both mothers and infants despite consumption of adequately iodized salt. The iodine nutrition status of the infants was better compared to the mothers, indicating a preferential iodine supply to the infants over the mothers.     

Liver transplant recipients: portable duplex US with correlative angiography

Twenty patients, aged 4 months to 58 years, were evaluated for liver transplantation by duplex sonography, and 15 transplantations were completed; 42 postoperative examinations were performed. Sonographic findings were correlated with seven preoperative and five postoperative angiographic evaluations. Preoperative duplex US findings included tumors, portal vein occlusion, varices, biliary obstruction, and variant vascular anatomy. Postoperative findings included hepatic artery occlusion, portal vein occlusions (one with cavernous transformation), portal vein stenosis, biliary obstruction, intrahepatic and extrahepatic fluid collections, and air in the portal vein due to ischemic bowel. Use of angiography allowed confirmation of the vascular abnormalities and demonstrated evidence of rejection in patients with normal Doppler waveforms. Duplex sonography is a valuable portable technique for evaluating these patients and can be used in triage of patients requiring angiography.     

Iodine deficiency and neonatal hypothyroidism

The incidence of neonatal hypothyroidism, as reflected in cord-blood thyroxine and thyrotropin levels, varied from 0.6% to 13.3% in iodine-deficient and normal regions of India (selected districts of Uttar Pradesh and Kerala and the city of Delhi), depending on the degree of environmental iodine deficiency. In populations with a high incidence of neonatal hypothyroidism, an increased prevalence of nerve deafness and a shift to the left in the distribution of IQ scores (towards lower scores) have been demonstrated. These indications of mild brain damage suggest that nutritional iodine deficiency can present in other ways than goitre or cretinism. Determination of the incidence of neonatal hypothyroidism using dried cord-blood spot screening appears to be the most useful and reliable method to assess the risk of brain damage in iodine-deficient areas.     

Lipomatous tumors of the liver: evaluation with CT and US

Seven cases of lipomatous masses within the liver parenchyma were demonstrated with computed tomography (CT). Five of these cases were obtained from a retrospective review of 50 cases of renal angiomyolipoma in which the liver was adequately demonstrated. The other two cases were from the files of the Armed Forces Institute of Pathology and had no associated renal lesions. Three of the five cases were associated with tuberous sclerosis. In all seven cases, the fatty tumors appeared on CT scans as a well-defined, 0.8-13-cm mass, with attenuation coefficients of less than -30 HU. On ultrasound studies, the lesions were well circumscribed, highly echogenic, and similar to hemangiomas. While distinctly rare lesions, these lipomatous masses are not as unusual as the literature would indicate. One may anticipate such masses in patients with renal angiomyolipomas and in a relatively high percentage of those with tuberous sclerosis.