双裂隙角膜、眼底反光同时摄影仪在近视眼普查中的应用

应用作者自行设计的双裂隙角膜、眼底反光同时摄影仪对215名中、小学生进行近视普查,结果发现常规拍摄灵敏度为95.31％,戴 2.00D眼镜拍摄时灵敏度为100％。证明该仪器具有较高的敏感性、特异性和实用性。     

The utility of routine emergency department chest radiography in a population at high risk for tuberculosis

The purpose of this study was to determine the utility of performing routine screening chest radiography on all asymptomatic admissions from the emergency department in an urban population at high risk for contracting tuberculosis (TB). Chest radiographs were obtained on all asymptomatic patients admitted through the emergency department for drug detoxification or psychiatric illness at two urban hospitals in an area endemic for multidrug-resistant TB. The chest radiographs were interpreted prospectively by one of two radiologists, and the results were correlated with age, sex, and clinical outcome. A total of 481 chest radiographs were evaluated (407 men, 74 women; average age, 38 years). Of these, 436 (91%) were negative. Of the 45 with abnormalities, 35 (7%) were chronic, requiring no further work-up, whereas 10 (2%) had changes considered of immediate consequence. Of those with acute abnormalities, five patients presented with nodular densities, ranging from 5 mm to 3 cm in diameter; two patients had lobar infiltrates; and subsegmental atelectasis, congestive changes and an abnormal aortic contour were noted on one examination each. Of the six patients not lost to follow-up, five improved with medical therapy, and one was scheduled for surgical excision. The individuals with radiographic findings were significantly older than those with negative chest radiographs (47 years vs. 37 years). Only one patient had active TB; three others had chronic calcified granulomas. We conclude that routine chest radiography in young, asymptomatic individuals considered at high risk for contracting TB rarely detects significant pulmonary abnormalities or evidence of active TB.     

先天性弓形虫病筛查时间的探讨

弓形虫是危害胎儿或新生儿健康的主要病原体之一，现就先天性弓形虫病的筛查时间及其治疗的研究进展进行扼要的综述。     

Asymptomatic vesicoureteral reflux detected by neonatal ultrasonographic screening

Renal ultrasonography was performed in 2,384 healthy and asymptomatic neonates. The definition and grading of hydronephrosis was according to the system of the Society for Fetal Urology. Voiding cystourethrography was performed in the cases with moderate to severe hydronephrosis or persistent mild hydronephrosis. In cases with vesicoureteral reflux (VUR), a dimercaptosuccinic acid (DMSA) renal scan was arranged immediately to evaluate the renal parenchyma. VUR was diagnosed in 30 infants with a prevalence of 1.26%; 7 had bilateral VUR. The male/female ratio was 4:1 and the right/left ratio was 1.85:1. Comparing with the abnormal ultrasonographic findings, VUR appeared ipsilaterally in 23 ureters and contralaterally in 14 ureters. Using ultrasonography for diagnosing VUR, the sensitivity, specificity, positive predictive value, and negative predictive value were 62.2%, 36.1%, 11.0%, and 88.2%, respectively. DMSA renal scan was perfomed in 31 refluxing kidneys, and congenital renal scarring was found in 9 (29.0%) kidneys. Six neonates underwent reimplantation surgery. We conclude that although ultrasonography is not a reliable tool for diagnosing VUR, it can detect many cases of VUR during the newborn stage using our screening program, which thus makes early treatment from the neonatal period possible. Whether our screening program can improve the outcome of VUR will require further follow-up. Received January 10, 1997; received in revised form September 2, 1997; accepted September 3, 1997     

Identifying Students with Self-Report of Asthma and Respiratory Symptoms in an Urban,High School Setting

Strategies for identifying urban youth with asthma have not been described for high school settings. African-American high school students are rarely included in asthma studies, despite a high risk of asthma mortality when compared to other age and race groups. Identification and follow-up of children with uncontrolled respiratory symptoms are necessary to reduce the burden of asthma morbidity and mortality, especially in underserved areas. We describe a process used to identify high school students who could benefit from intervention based on self-report of asthma and/or respiratory symptoms, and the costs associated with symptom-identification. Letters announcing a survey were mailed to parents of 9th-11th graders by an authorized vendor managing student data for the school district. Scan sheets with student identifiers were distributed to English teachers at participating schools who administered the survey during a scheduled class. Forms were completed by 5,967 of the 7,446 students assigned an English class (80% response). Although prevalence of lifetime asthma was 15.8%, about 11% of students met program criteria for enrollment through report of an asthma diagnosis and recent symptoms, medication use, or health care utilization. Another 9.2% met criteria by reported symptoms only. Cost of symptom-identification was $5.23/student or $32.29/program-eligible student. There is a need for school-based asthma programs targeting urban adolescents, and program initiation will likely require identification of students with uncontrolled symptoms. The approach described was successfully implemented with a relatively high response rate. Itemized expenses are presented to facilitate modifications to reduce costs. This information may benefit providers, researchers, or administrators targeting similar populations.     

Testing approaches to assess immunotoxicity of chemicals

Direct toxicity of chemicals for components of the immune system may lead to altered host defence to infectious diseases. For this reason, it is important to screen for potential immunotoxicity. Screening can be best performed within the context of general toxicity screening, such as short term toxicity tests, subchronic toxicity testing, chronic toxicity testing or reproductive testing. General parameters of the immune system are useful to identify potential immunotoxicity. Confirmatory and more in depth information can be retrieved from functional studies. Such studies may include host infection models that have been proven to be very valuable for the process of risk evaluation.     

儿童中神经母细胞瘤的早期筛查及实用价值

本文介绍1989年～1993年在国内首次采用Spot点片法对辽宁地区正常儿童进行神经母细胞瘤(Neuroblastoma,NB)的早期筛查。在50350例正常儿童中,筛查出无临床症状的可疑病人4例。其spot点片法均为阳性,层析结果分别出现香草扁挑酸(VMA),高香草酸(HVA),香草乳酸(VLA);VMA定量超过正常值。经B超、磁共振(MRI)检查,3例均在左肾上腺发现肿物(3.5cm×2.0cm,2.0cm×2.0cm,2.0cm×2.5cm)诊断为NB.1例接受手术治疗。2例放射治疗,目前均健康生存。另1例经B超、磁共振多部位探查,未发现肿物,列为追踪观察对象。初得辽宁地区小儿NB发病率约为6/10万。     

Screening for Alcoholism Among Medical Inpatients: How Important Is Corroboration of Patient Self-Report?

Little Is known about the utility of collateral reports in substantiating self-report for individuals assessed in nonalcoholism treatment contexts. This study examined the concordance of 581 pairs of medical patient and collateral responses to a commonly used alcohol screening instrument, the CAGE Questions, as well as to reports of the patient's drinking consequences and alcohol consumption. Results demonstrated that patient/collateral concordance was marginal, but acceptable, on CAGE cut-off scores and, that similar to reports from alcoholism treatment settings, patients generally reported more drinking consequences than collaterals. Patient and collateral reports of the patient's alcohol consumption did not differ significantly. This pattern of patient and collateral reporting of alcohol consequences and consumption was found for both men and women, as well as for patients with a DSM-III-R diagnosis of alcohol dependence. The findings support the validity of patient self-report on alcoholism screening measures in medical settings. Furthermore, results demonstrated that the addition of collateral reports to information directly obtained from patients only modestly improved the Identification of alcohol dependence. The overall findings indicate that alcohol screening can be done effectively and efficiently in medical settings.