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.     

Proteus syndrome

Abstract: This female Asian (Malay) baby had clinical features of Proteus syndrome. She had a large right facial lipolymphangioma with hyperpigmentation of the overlying skin. There was a smaller lymphangioma over the left side of her neck with excess nuchal folds, macrodactyly and bilateral talipes equinovarus. Despite the extensive hemifacial swelling, there was no evidence of upper respiratory tract obstruction. Generalized seizures developed on the sixth day of life which were controlled with phenobarbital. The lymphangiomas were excised without recurrence.     

Comparing sulindac with indomethacin for closure of ductus arteriosus in preterm infants

Objectives: A prospective study comparing the efficiacy and side-effects of oral sulindac with intravenous indomethacin in clinically stable preterm infants (<1750 g) requiring non-invasive closure of haemodynamically significant patent ductus arteriosus.
Methodology: As maturity and birthweight are the two major determinants of ductal closure, infants were matched as closely as possible for these parameters. An eligible patient was first assigned to the sulindac group and a subsequent patient with similar gestational age (± 1 week) and birthweight (±100 g) to the previously recruited infant would automatically receive indomethacin. A total of eight infants were enrolled in each group.
Results: The ductus arteriosus was successfully closed in all eight infants receiving indomethacin, and in seven of eight infants receiving sulindac. No significant differences were found with regards to the ductal size between the two groups at diagnosis or on each of the consecutive days of treatment ( P >0.25). More renal adverse effects were encountered in the indomethacin group. Significant differences in changes from baseline value for urine output, plasma sodium, urea and creatinine concentrations were noted at 24, 48 and 72 h after commencement of treatment between the two groups ( P <0.05). All the parameters returned to normal or pre-treatment levels 48 h after stopping therapy. Unexpectedly, severe gastrointestinal complications were encountered in the sulindac group.
Conclusions: Sulindac is capable of promoting ductal constriction in clinically stable preterm infants without compromising the renal function. The spectrum of gastrointestinal complications observed in sulindac treated infants were similar to those described for indomethacin. The use of sulindac for ductal closure in the preterm infant should remain experimental.     

Fetal umbilical artery velocity waveforms and subsequent neonatal outcome

Summary. Flow velocity waveforms (FVWs) from the fetal umbilical artery were recorded from 2178 pregnant women over a 6-year period. All of them had an obstetric factor indicating increased risk of fetal compromise. A total of 6749 studies was recorded. The systolic diastolic (AB) ratio was measured and classified as normal (<95th centile), elevated (95–99th centile), high (>99th centile) or extreme (absent diastolic flow). The results of these studies have been related to subsequent fetal and neonatal outcome. An abnormal umbilical artery FVW was associated with shorter gestation and infants with lower birthweight, shorter length and lower ponderal index. There was a highly significant association between an abnormal FVW and the birth of an infant small for gestational age. The significance of the association increased with the increased abnormality of the umbilical artery FVW and this was independent of gestational age. Preterm infants associated with high or extreme AB ratios spent twice as long in the neonatal nursery than those with normal AB ratios. Analysis of 794 pregnancies studies serially indicated that an abnormal FVW in which the AB ratio was increasing, in contrast to a decreasing AB ratio, predicted a poor outcome for both size at birth and duration of neonatal intensive care. We conclude that in high risk pregnancy Doppler umbilical artery FVW studies predict the most compromised fetuses in terms of growth retardation and requirements for neonatal intensive care.     

Case Report: Intracerebral Hemorrhage After γ-Knife Surgery for Metastatic Brain Tumor

The authors report a case of a 69-year-old man with metastatic brain tumors who died of spontaneous intracerebral hemorrhage 3 days after -knife surgery. He had been suffering from lung cancer with multiple systemic metastasis. Preoperative magnetic resonance images showed two well-defined round lesions with intratumoral hemorrhage in the left frontal and right occipital lobe. There was no bleeding tendency in the hematological examination and the patient was normotensive. -Knife surgery was performed on both lesions in a single session. However, the patient died of massive intracerebral hemorrhage from the left frontal lesion 3 days after the surgery. There have been no previous reports of mortality resulting from spontaneous intracerebral hemorrhage after -knife surgery in metastatic brain tumors documented in the literature. It is likely that the two events, -knife surgery and spontaneous intracerebral hemorrhage, occurred separately and were not associated. However, it is worth noting that there is a possibility of bleeding after -knife surgery, especially in a metastatic brain tumor with preexisting intratumoral hemorrhage as in our case.     

双手微小切口白内障超声乳化术的临床疗效观察

目的探讨双手微小切口白内障超声乳化吸除术的临床疗效。方法将患者分为两组:对照组使用常规超声乳化吸除术,研究组使用双手微小切口白内障超声乳化吸除术,观察术中平均超声乳化能量、时间、术后视力和手术并发症,并分析对比术后第1周、第1个月及第3个月的角膜内皮计数。结果两组病例术中超声乳化能量及时间差异有显著性(P<0.05),研究组平均超声能量为11.5%,平均超声时间为(0.68±0.62)min,术后第1天、第1周及第1个月时,裸眼视力≥0.5的术眼分别占51.85%、81.48%及90.47%,术后第1个月最佳矫正视力≥0.5和0.8者占88.98%及74.07%。所有术眼术中前房稳定,无切口热损伤,术后并发症主要为后囊破裂2眼(占3.70%),轻度虹膜损伤4眼(占7.40%);术后第1周,研究组平均角膜内皮密度明显高于对照组,术后第1个月及第3个月平均角膜内皮密度差异则无显著性。结论双手微小切口白内障超声乳化吸除术是一种新型的手术方法,具有安全、有效、微创的临床特点。     

Intra‐operative cardiac arrests during liver transplantation – a retrospective review of the first 15 yr in Asian population

Although many report intra‐operative cardiac arrests (ICAs) in liver transplantation (LT), the incidence, major causes, and outcome remain unclear. We aimed to investigate retrospectively, the incidence, nature, and outcome of ICA in Asian population and to identify risk factors for ICA. Consecutive 1071 LTs in an institution during 1996–2011 (adult 920, pediatric 151/living donor liver transplantation, LDLT 841, deceased donor liver transplantation, DDLT 230) were reviewed. ICA occurred in 14 adult LTs (1.5%), but none in pediatrics. ICA occurred 1.0% and 3.3% in LDLT and DDLT, respectively. Stages of ICA incidence were three at pre‐anhepatic, one at anhepatic, and 10 at neohepatic stage. Post‐reperfusion syndrome (PRS) with hyperkalemia and bleeding were the major causes of ICA. While LDLT showed miscellaneous causes for ICA at various stages, DDLT incurred ICAs at neohepatic stage only. Interestingly, we did not find pulmonary thromboembolism (PTE) to incur ICA. Risk factor analysis showed no association of pre‐operative patient condition, donor types, and intra‐operative parameters. In this review, the incidence of ICA was low in Asian population with LDLT predominance, and while PTE was not the cause of ICA, the neohepatic stage with PRS and bleeding was the most vulnerable period to anticipate ICA.     

术中超声在脑肿瘤切除术中的应用价值

摘 要 目的：采用术中超声观察颅脑肿瘤的超声图像特点，探讨其在神经外科手术中的应用价值。材料与方法：2007年3月～2008年3月，11例颅脑肿瘤患者在手术中接受了术中超声检查，以确定肿瘤的位置，手术切除范围，及切除术后是否有肿瘤残余。结果：术中超声清晰的显示了肿瘤的部位，形态及回声，11例患者全部经手术完整切除肿瘤，均未损伤颅脑功能区。术后病理提示星形胶质细胞瘤5例、胶质增生1例、海绵状血管瘤2例、转移性肿瘤2例、恶性淋巴瘤1例。结论：术中超声作为一种实时、无创、简便的辅助检查方法，可帮助手术医师确定肿瘤的部位及边界，避开功能区，提高手术安全性及治疗效果。     

保留乳头及附件改良根治术治疗乳腺癌的临床护理

目的 总结15例早期乳腺癌行保留乳头履附件乳腺癌改良根治手术的护理经验。方法 采用临床资料和国内外相关文献结合的分析方法，针对此种手术特点，提出术后防止乳头、乳晕受压，保持引流通畅，防止皮下积液。促进皮辩和深部组织粘附愈合。保持局部良好血液微循环等改进方法。结果 保留乳头及附件改良根治术治疗乳腺癌的近期效果良好，15例患者切口愈合良好，均获无瘤生存。结论 通畅引流、改善乳头局部血运有里利于配合手术治疗提高手术成功率，以期获得更好的二期乳房重建效果。