糖尿病性视网膜病变5年随访观察

目的　探讨糖尿病性视网膜病变的进展与糖尿病病程及血糖控制水平之间的关系。方法　对确诊为糖尿病的患者散瞳详细检查眼底 ,共有 13 2例 2 5 9眼为无视网膜病变或单纯型糖尿病性视网膜病变 ,定期门诊随访并检测血糖水平。结果　 5年后随访观察眼底 ,发现有 2 5眼进展至增殖型糖尿病性视网膜病变 ,其中在血糖控制满意组的 14 4眼中有 5眼 ,占 3 40 % ,而在血糖控制不满意组的 115眼中有 2 0眼 ,占 17 3 0 % ,两者比较 ,差异有显著性 (P <0 0 0 5 )。结论　糖尿病性视网膜病变随着糖尿病病程的延长而加重 ,并且与病人血糖水平控制的好坏有密切关系     

天津市传染性非典型肺炎康复者健康状况的随访研究

目的 了解天津市传染性非典型肺炎（SARS）康复者健康状况及其主要并发症的转归，并通过特异性抗体检测完成血清学诊断，观察抗体时间变化规律。方法对2003年天津市SARS流行期间经住院治疗康复的220人，进行了发病后14个月内分3个阶段的随访研究。对全部随访者进行了血清SARS-CoV特异性抗体IgG、IgM以及淋巴细胞亚群、血生化等指标检测，同时进行了肺部高分辨CT检测和双侧髋关节MRI检测。结果随访患者中，原SARS临床确诊、临床疑似和临床观察病例的SARS-CoV特异性抗体IgG的阳性率分别为99．34％，87．5％和45．59％，提示临床疑似和临床观察病例中有较多病人漏诊。随访早期发现87人存在肺功能或（和）肺间质性变化，经过8个月观察，影像学显示46人肺部病变自愈，其余41人肺部病变也明显好转。49人发生股骨头坏死，仅在SARS-CoV特异性抗体阳性患者中发生，且多为Ⅰ期病变，经多因素分析显示，股骨头坏死与SARS病毒感染以及住院期间激素的平均使用量的联合作用有关。结论血清学诊断在SARS患者感染确证中不可缺少，应在恢复期早期进行血清抗体检测。康复者肺间质性改变有自愈倾向，股骨头坏死的发生是病毒感染与激素联合作用的结果。     

2004年国际戒烟竞赛天津参加者戒烟效果评估

目的 了解2004年国际戒烟竞赛天津参加者的戒烟效果，探讨影响戒烟成功的相关因素，为有关部门制定相应的戒烟措施提供参考。方法在天津参加2004年国际戒烟竞赛的抽奖候选人中抽取调查对象，通过电话访问或面对面的形式对其进行调查，并进行Logistic回归分析。结果共随访调查300人，1a戒烟成功153人，占51．0％。Logistic同归分析显示，烟龄越长、吸烟量越大，其戒烟成功的可能性越小；另将职业．戒烟前态度进行哑变量分析显示，干部、其他职业者和想戒烟者戒烟成功率较高，差别有统计学意义（P〈0．05）。复吸者中，周围有人吸烟为复吸主要原因，占42．9％；在戒烟后1个月内开始复吸的62人，占52．1％，在1-6个月开始复吸的48人，占40．3％，在6个月后复吸的9人，占7．6％。周围公共场所禁止吸烟的221人，占73．7％，办公场所禁止吸烟的159人，占53．％，家中限制吸烟的134人，占44．7％。结论2004年国际戒烟竞赛天津参加者1a戒烟效果较好，建议针对影响戒烟成功的相关因素，采取相应的干预措施。     

Neonatal follow-up programs and follow-up studies: Historical and current perspectives

The present report reviews some highlights in the history of neonatal intensive care and neonatal follow-up programs, particularly developments and reports that were based on experiences in Canada. Early outcomes reported from ‘preemie baby units’ were distressing, but attention has consistently been paid to preterm infant outcomes, even from the early days of neonatal intensive care units. Most current follow-up programs have goals related to ‘audit’ functions, education and clinical roles, but existing literature related to these functions is limited. Several reports have provided guidance in terms of neonatal follow-up research issues, and these strengthen the place of follow-up studies in outcomes research.     

小儿复合型先天性心脏病的介入治疗

目的:研究小儿复合型先天性心脏病经导管介入治疗的方法及疗效。方法:1994年3月至2003年12月适合经导管介入治疗的复合型先天性心脏病患儿15例,肺动脉瓣狭窄(PS)伴房间隔缺损(A SD)或动脉导管未闭(PDA)者,先行PS瓣膜成形术,再堵塞A SD或PDA;主动脉缩窄(COA)伴PDA者,先行COA血管成形术,4~15个月后再行PDA堵塞术;主动脉瓣狭窄(A S)伴PDA者,先行瓣膜成形术,再行PDA堵塞;室间隔缺损(V SD)伴PDA采用弹簧圈封堵。结果:15例患者经导管介入治疗均获成功。除2例PDA术后即刻有少量紊流,余均无残漏。随访(3.57±2.61)年,跨瓣(或跨缩窄段)压差经超声心动图或导管测压除A S外均正常。围术期机械性溶血、弹簧圈脱落和动脉栓塞各1例。结论:复合型先天性心脏病经导管介入治疗只要恰当掌握指征,操作规范,可获得良好的治疗效果;对合并A S者,适应证的掌握及球囊大小的选择需进一步摸索。     

Diagnóstico y seguimiento de los pacientes con hipotiroidismo congénito diagnosticados por cribado neonatal

The screening program of congenital hypothyroidism (CH) is probably one of the best achievements in paediatrics. Thyroid hormones are essential for brain development and brain maturation that continue through the neonatal period. Hypothyroidism that begins in the first months of life causes irreversible damage to the central nervous system, and is one of the most frequent and preventable causes of mental retardation. As children with congenital hypothyroidism are born with a normal appearance, analytical studies are required to immediately start the appropriate therapy.This article analyses the aims, diagnostic procedures, tests required, aetiology, and differential diagnosis in this disorder. Especially relevant is to perform frequent monitoring to ensure dose adjustments of L-Thyroxine therapy, avoiding infra- or supra-dosing that negatively affects neurosensory functions. Re-evaluation of the aetiology permanent vs transient hypothyroidism is always recommended after 3 years of chronological age.The relevance of this screening program should be widely discussed in paediatrics. The main objective is to avoid cerebral damage in these patients, and has been highly successful and economically beneficial.Other aspects are required to optimise patient outcomes, to perform all the controls according to the recommendations and to include, in the near future, the diagnosis of central hypothyroidism. Implementation of this program is necessary to progress in accordance with current scientific knowledge.     

Long-term morbidity of congenital diaphragmatic hernia: A plea for standardization

Congenital diaphragmatic hernia (CDH) survivors present long-term morbidities in several systems, including the neurodevelopmental, gastrointestinal, pulmonary, and musculoskeletal ones, and CDH long-term sequelae are increasingly being recognized. Due to high co-morbidity, health related quality of life in a significant proportion of CDH patients might be compromised. As a consequence of consciousness on the long-term sequelae of CDH survivors, and their consequences for life, several follow-up programs were brought to life worldwide. In this review, we will summarize the long-term sequelae of CDH survivors, the impact of new treatments, and analyze the consistency of follow-up programs.     

Patient preferences for clinical follow-up after primary treatment for soft tissue sarcoma: A cross-sectional survey and discrete choice experiment

BackgroundPatients treated for soft tissue sarcoma (STS) require long-term follow-up to detect recurrent or metastatic disease, yet marked differences exist in clinical approaches to the length of follow-up, frequency of consultations and investigations undertaken at follow-up visits. There has been no published work assessing patient expectations or the acceptability of post-treatment follow-up strategies. This study aimed to assess the patient acceptability of different follow-up strategies following curative surgery for soft tissue sarcoma and to investigate the hypothetical levels of recurrence risk at which different follow-up regimes were acceptable.MethodsPatients were recruited from the Royal Orthopaedic Hospital in Birmingham. The study used a cross-sectional survey incorporating a best-worst scaling discrete choice experiment to assess patient preferences regarding different aspects of follow-up.Results132 patients participated (47% response). The nature of investigations undertaken during follow-up was the most important aspect of post-surgical care. Patients typically preferred appointments routinely consisting of clinical examination and chest X-ray, and for follow-up to remain in secondary care rather than general practice.ConclusionClear protocols for STS patient follow-up can improve consistency and equity of care. In determining the optimum follow-up plan for STS patients from the patient perspective, this study provides valuable information that should be considered alongside the clinical effectiveness of follow-up strategies to maximise patient outcomes and use NHS resources appropriately.