The multiform and variable patterns of onset of orofacial granulomatosis

BACKGROUND: The recurrent chronic orofacial swelling caused by orofacial granulomatosis (OFG) can cause significant cosmetic and functional problems but can be prevented if the disease is diagnosed early and promptly treated. Although the enlargement of the lips is described to be the most common presenting complaint, the clinical onset of OFG may be characterized by minor associated mucosal and neurological manifestations, making early diagnosis very difficult or, sometimes, merely presumable. PATIENTS AND METHODS: We retrospectively analyzed the clinical manifestations of 19 patients with OFG, who were examined at our institution between 1998 and 2002, in order to determine their initial manifestations and presenting symptoms. RESULTS: A total of 10 patients showed classical recurrent enlargement of the lips (six lower; four upper) as presenting symptom. In the other nine patients, OFG onset was characterized by transient unilateral facial nerve palsy (two cases), intraoral manifestations (two cases), recurrent swelling of the periorbital area (two cases), of the chin (one case), of the zygomatic area (one case), and of the cheeks (one case). CONCLUSION: Our data underlined that OFG onset could be frequently characterized by widely variable, multiform, and temporary clinical findings. Involvement of atypical sites of the orofacial region and presence of single minor manifestations may occur as presenting symptoms, often preceding the development of traditional clinical findings.     

Relationship between serum albumin level before initiating haemodialysis and angiographic severity of coronary atherosclerosis in end-stage renal disease patients.

BACKGROUND: In patients with chronic kidney disease (CKD), although strong associations have been observed between malnutrition and atherosclerosis, the relationship between serum albumin concentration and angiographic changes of coronary artery disease (CAD) remains poorly explored. The goal of the present study was, in patients with CKD, to clarify the relationship between the angiographic severity of CAD and serum albumin concentration reflecting either inflammation or nutrition or both. METHODS: In this study, 100 end-stage renal disease (ESRD) patients were enrolled, who commenced long-term dialysis therapy at our hospital and underwent coronary angiography within 3 months of the first haemodialysis (HD) session. Mean age was 63+/-11 years, 20% of the subjects were female and 62% had diabetes. Severity of CAD was evaluated in terms of (i) number of vessels exhibiting CAD (>or=75% stenosis) and (ii) Gensini score (GS). Clinical characteristics and laboratory findings were recorded at initiation of long-term HD therapy. We then evaluated a possible association with the presence and degree of CAD. RESULTS: Sixty-four patients exhibited signs of CAD. Forty-one among them (64%) had multivessel disease. On univariate logistic regression analysis, age, diabetes and hypoalbuminaemia were significantly associated with multivessel CAD. Univariate linear regression analysis demonstrated a positive correlation of age and diabetes with GS, and an inverse correlation of BMI and serum albumin level with GS. Stepwise regression analysis showed age and serum albumin level to be independently associated with multivessel CAD and GS. The ROC curves demonstrated best cut-off levels of age and albumin for predicting multivessel CAD to be 70 years and 3.15 g/dl, respectively. CONCLUSION: Hypoalbuminaemia at the initiation of dialysis is an important predictor of advanced CAD, particularly in male and in diabetic patients. It may reflect mainly a state of inflammation. However, malnutrition as a confounding factor cannot be entirely excluded.     

早期干预对高危儿在婴儿早期发育的影响

目的：探讨早期干预对高危儿在婴儿早期发育的影响。方法：采用自行设计的一套早期干预方法通过指导家长对实验组实施，分别在3个月、6个月时进行格体生长和行为发育的评估，另设对照组进行比较。结果：实验组和对照组在体重、身长、头围方面均无统计学差异，但实验组的5个能区行为发育商均值都高于对照组，除3个月的语言能区外，其余均有统计学差异。结论：早期干预在婴儿早期就能促进高危儿的行为发育，但对促进高危儿的体格生长无明显效果。     

Patient readiness for return to home: Discord between expectations and reality

This study examined the interface between acute hospital care and return to home in relation to elderly patients' perceived ability and preparedness to cope at home. Seventy-six (n = 76) elderly patients aged 60 years and over were randomly recruited from a large Queensland hospital and interviewed prior to discharge about their perceived health, functional status and their ‘readiness’ to cope at home. They were followed up at home 7–10 days post-discharge. Comparisons were made between a number of measures at discharge and post-discharge. Although the majority of patients indicated that they would cope very well upon discharge, a large number of patients reported experiencing considerable difficulty with activities of daily living, particularly instrumental activities of daily living prior to and especially after discharge. The self-reported health status of patients similarly deteriorated between discharge and follow-up. Despite a large number of patients experiencing functional limitations, few were referred to hospital or community-based therapy services. Some policy implications are explored.     

低剂量石英对大鼠肺泡灌洗液的早期影响

用支气管肺泡灌洗法研究低剂量石英对大鼠肺脏的影响。大鼠分别注尘2、10mg观察1、7、21天。结果表明低剂量石英可使灌洗液中细胞总数、有核细胞/红细胞比值、肺泡巨噬细胞显著增高,特别是泡沫型肺泡巨噬细胞随时间延长而明显增高。染尘动物灌洗液中蛋白、乳酸脱氢酶、碱性磷酸酶呈一过性升高,酸性磷酸酶在2mg石英组呈一过性升高,但在10mg石英组却持续上升。实验结果表明,肺泡巨噬细胞及其溶酶体膜的破坏在矽肺发生早期可能起一定的作用。     

改良的HAMPT方案治疗难治性急性淋巴细胞性白血病

我们将常规的ＨＡＭＰＴ方案中的氨甲喋呤（ＭＴＸ）剂量改为大剂量组成良的ＨＡＭＰＴ方案治疗难治性急性淋巴细胞白血病（ＡＬＬ）２０例，１７例完全缓解，３例部分缓解。其中１６／１７例一疗程则获完全缓解（ＣＲ），ＣＲ率８５％，诱导缓解时间平均１７天。本方案疗效较满意，副作小用，可作为难治作ＡＬＬ治疗的较好方法。     

尼罗罗非鱼肉营养成分分析

<正> 尼罗罗非鱼(Tilapia nilotica)是我国从非洲引进的热带鱼类,具有刺少肉味鲜嫩、食性广、生长快、繁殖力强、养殖周期短等特点。已快速地养殖到全国各地。作者对利用地热资源人工喂养条件下的尼罗罗非鱼肉的氨基酸和肉内的粗蛋白、脂肪、维生素等成分进行分析,评估尼罗罗非鱼肉的营养价值,从营养学的角度为人们提供科学依据。     

染色内镜和放大内镜技术是提高早期大肠癌诊治水平的重要手段

应用常规内镜技术难以发现大肠平坦型病变和凹陷型病变。近年来染色内镜和放大内镜技术已经发展成熟,在国外已获广泛应用,可以发现大肠微小病变和早期大肠癌。应用腺管开口分型方法可以预测肿瘤病变的组织学类型及肿瘤的浸润深度,据此可确定行内镜下粘膜剥离术或分片粘膜剥离术将肿瘤切除,抑或行外科手术治疗。在当前我国的胃肠内镜医疗界,应广泛开展染色内镜和放大内镜的临床应用,以早期发现大肠病变,提高我国大肠癌的内镜诊治水平。     

荷包环扎式结直肠吻合保肛术治疗低位直肠癌*

目的 :评价荷包环扎式结直肠吻合保肛术治疗低位直肠癌的价值。方法 :对低位直肠癌采用荷包环扎结直肠吻合保肛术治疗 2 3例 (A组 ) ,采用Miles手术治疗 2 6例 (B组 )。结果 :A组术后 1、3年生存率分别为 10 0 % (2 3/ 2 3) ,95 7% (2 2 / 2 3) ,术后无局部复发病例 ;排便功能优 16例 (6 9 6 % ) ,良 7例 (30 4 % )。B组术后 1、3年生存率分别为 10 0 % (2 6 / 2 6 ) ,96 2 % (2 5 /2 6 ) ,术后局部复发率 3 8% (1/ 2 6 )。两组术后 1、3年生存率 ,局部复发率经统计检验 ,均无显著差异 (P值均 >0 0 5 )。术后并发症 :A组无吻合口瘘及吻合口狭窄发生 ,盆腔感染 1例。B组 :切口感染 1例 ,人工肛门狭窄 1例。结论 :采用螺纹支架管荷包环扎结直肠吻合保肛术治疗低位直肠癌既能达到根治目的 ,又有保留肛门的良好排便功能 ,且并发症少 ,操作简便易行 ,不用特殊器械 ,值得推广应用