Legionellosis associated with artesian well excavation

In October 1990 pneumonia due toLegionella pneumophila was diagnosed in two employees working in the area of Apulia, southern Italy, where artesian wells were in construction. Although the exposure to excavation has been associated with Legionnaires' disease, in our investigation the illness occurred only in those employees who were present when the water emerged from the ground under high pressure. On the basis of this report, water appears as the most likely reservoir of the organism and the main route of infection.Corresponding author.     

肝尾叶切除

肝尾叶深藏于肝门结构与下腔静脉之间，具有独立的管道系统，手术切除风险较大，作者结合２例肝尾叶切除的体会，复习文献，对肝尾叶的解剖、影像学特征、切除指征及手术方法进行了讨论。     

OUTCOME AFTER FRACTURES OF THE FEMUR IN PAGET'S DISEASE

We reviewed ninety-three patients who had one hundred and seven complete fractures of the femur between them and were treated over a twenty-five year period in Western Australia and South Australia. Operative surgical management of complete fractures in the middle and distal thirds was usually successful. In contrast, fractures proximal to the middle third were regularly associated with non-union, implant failure and requirement for revision surgery. In view of this significant difference in outcome after fracture of the pagetic femur in different sites, a comprehensive surgical management strategy is recommended in order to avoid complications.     

Gastro-oesophageal reflux disease: Medical or surgical treatment? Report of an interactive workshop

Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper.     

肺血流图预测肺动脉压探讨

报告９７例慢性阻塞性肺疾病（ＣＯＰＤ）及慢性肺心病（ＣＣＰ）患者与右心导管对照评价肺阻抗血流图（ＩＰＲ）预测肺动脉平均压（ｍＰＡＰ）的意义。分析ＩＰＲ各单项参数与ｍＰＡＰ的相关性，提示ＩＰＲ主要参数Ｐ＿２－Ｙ间期，Ｂ－Ｙ间期及Ｑ－Ｂ／Ｂ－Ｙ与ｍＰＡＰ呈中度相关。建立ＩＰＲ预测ｍＰＡＰ多元回归方程式，ｒ＝０．７７４。结果提示ＩＰＲ可作为临床近似预测ＣＯＰＤ及ＣＣＰ患者ｍＰＡＰ的简便方法，但尚不能取代右心导管作出精确诊断。     

Comparison of stress-only vs. stress/rest with technetium-99m methoxyisobutylisonitrile myocardial perfusion imaging

Unlike conventional thallium-201 myocardial imaging, technetium-99m methoxyisobutylisonitrile (MIBI) requires separate stress and rest injections. We prospectively studied 148 consecutive patients referred for myocardial perfusion studies to determine the diagnostic value of rest images once normal exercise or dipyridamole tomographic images had been obtained. In patients referred with no history of previous myocardial infarction in whom the diagnosis of coronary artery disease was suspected, 45 of 109 (41%) patients had normal stress tomographic images. Obtaining rest images did not alter the final interpretation in any of these cases. From this we infer that in patients with normal images after exercise or dipyridamole administration and no past history of myocardial infarction, ^99mTc-MIBI rest images are not required. This provides several advantages including increased speed of diagnosis, decreased patient radiation exposure, improved cost efficiency and decreased demand on tomographic camera time. Offprint requests to: A.Y. Fung     

Development and experimental in vivo validation of mathematical modeling of laser coagulation

Most clinical procedures using the laser are based on thermal laser-tissue interactions. The treatment often consists of inducing damage of given degree and extent by heating the tissue. The aim of this study was to develop a model called HELIOS. The ability of HELIOS to predict thermal coagulation was evaluated by comparison with in vivo experimental results. Conversion of laser light in tissue was studied using the beam-broadening model. Temperature was described by the heat conduction equation solved using the finite difference method. The tissue dena-turation was modeled by the Henriques equation leading to the determination of the damage coefficient ω. For a given set of laser and tissue parameters, HELIOS makes a graphic representation of coagulation necrosis and temperature evolution in tissue. HELIOS was validated by experimental studies in vivo on rat liver using a CW Nd:YAG laser, a CO₂ laser, and an argon laser. For given sets of laser parameters, temperature measurements were performed using an infrared camera. Histological examinations were carried out on samples to quantify the depth of coagulation necrosis. Experimental data obtained in vivo were compared with those calculated using HELIOS and similar sets of parameters. The difference between the predicted temperature evolution on tissue surface and that measured by the infrared camera was < 5°C in all cases. The difference between the predicted coagulation necrosis depth and the corresponding experimental one was < 10%. In conclusion, HELIOS allows good prediction of tissue temperature and coagulation necrosis. © 1994 Wiley-Liss, inc.     

高血压病,冠心病患者血浆内皮素水平及其临床意义初探

本文检测了原发性高血压和冠心病患者血浆内皮素水平，结果发现原发性高血压Ⅰ、Ⅱ期组和冠心病心功代偿组血浆ＥＴ值与正常对照组无著差异；高血压Ⅲ期组及冠心病心衰组血浆ＥＴ值明显高于正常对照组，１２例冠心病心衰患者治疗后血浆ＥＴ水平明显降低。提示ＥＴ参与了原发性高血压严重并发症及冠心病心衰的发生和发展。冠心病患者血浆ＥＴ浓度与心功不全程度有关；高血压病患者血浆ＥＴ浓度与血压高低无关。     

Extracardiac Right Atrium-to-Right Ventricle Homograft for Uncorrectable Tricuspid Valve Disease

Surgically uncorrectable tricuspid valve disease in children is rare. However, when it happens the surgical options are very limited. Tricuspid valve replacement using a mechanical valve or stented bioprosthesis is impractical. Use of homografts in the “anatomic position” has its limitations. We report here the use of an extracardiac homograft connection between the right atrium and right ventricle in a 16-month-old boy in whom severe tricuspid valve stenosis developed after surgical repair of a complex ventricular septal defect associated with dextrocardia and anomalous systemic venous drainage. The patient remains well receiving no cardiac medication 12 months after the procedure.     

磁共振尿路成像对泌尿系疾病的诊断价值

目的评价磁共振尿路成像(Magneticresonanceurography,MRU)对泌尿系疾病的诊断价值。方法对36例泌尿系疾病患者进行MRU检查,并结合临床手术、病理资料和其他影像学资料进行回顾性分析。结果36例患者中,均有MRU阳性结果,3例肾盂、肾盏癌,4例前列腺癌,8例前列腺增生症,2例输尿管癌定性、定位明确;9例肾盂、输尿管移行段梗阻定位明确,定性有帮助;10例输尿管下段梗阻中6例诊断明确,4例未能确诊。结论MRU在泌尿系疾病的诊断中,对肿瘤的定位、定性参考价值较高,对尿路梗阻定位诊断有价值,对定性诊断帮助有其局限性。