Liver and intestine transplantation

The most significant development in liver transplantation in the USA over the past year was the full implementation of the MELD- and PELD-based allocation policy in March 2002, which shifted emphasis from waiting time within broad medical urgency status to prioritization by risk of waiting list death. The implementation of this system has led to a decrease in pretransplant mortality without increasing post-transplant mortality, despite a higher severity of illness at the time of transplant.
The trend over the last few years of rapidly increasing numbers of adult living donor liver transplants was reversed in 2002 by a decline of more than 30% in the number of these procedures. In 2002, a greater percentage of women received livers from living donors (43%) than deceased donors (34%), possibly because of size considerations.
From 1993 to 2001, the waiting list increased more than sixfold, from 2902 patients to 18 047 patients. For the first time since 1993, the waiting list size decreased in 2002, dropping 6% to 16 974 candidates. The percentage of temporarily inactive liver candidates also increased from 2001, thus the net decrease in the active waiting list for 2002 was 12%. This may reflect a trend toward less pre-emptive listing practices under MELD.
Intestine transplantation remains a low-volume procedure limited to a few transplant centers and is still accompanied by significant pre- and post-transplantation risks. As this procedure matures, its application may increase to include recipients at an earlier stage of their disease with better likelihood of success.     

Noonan syndrome associated with central giant cell granuloma

We report a case of Noonan syndrome associated with central giant cell granuloma. The patient was a 101/2-year-old boy with the chief complaint of proptosis of the right eye. He also had various malformations such as short stature, webbed neck, pectus excavatum, cubitus valgus, pulmonary valve stenosis and patent foramen ovale, a characteristic face appearance and cryptorchidism and so on. Chromosome analysis showed a 46, XY karyotype. A computed tomographic scan and magnetic resonance imaging showed a mass originated from the lateral wall of the right maxillary sinus. The patient underwent Caldwell-Luc operation. Histological examination of the mass showed the characteristics of central giant cell granuloma. This case report describes a patient with the features of the recently described Noonan-like/multiple giant cell lesion syndrome.     

脑立体定向术临床应用

目的：探讨以脑立体定向术治疗震颤麻痹、癫痫、癌性疼痛、慢性精神病及颅内金属异物的方法和疗效。方法：用多功能脑立体定向仪对不同疾病毁损其不同的核团。结果：震颤麻痹１６６例共１８２次手术中治愈１３例次，显效１４５例次，有效１１例次，无效１２例次，死亡１例，有效率达９２９％；癫痫１８例，显效１１例，有效４例，无效３例，有效率达８３３％；癌性痛疼５例均显效；精神病３例，显效２例，有效１例；颅内异物２例均治愈。结论：脑立体定向术对以上疾病均取得了较为满意及良好的疗效，总有效率达９２４％，并且比传统开颅术简便安全     

Delayed sleep phase syndrome: A placebo-controlled cross-over study on the effects of melatonin administered five hours before the individual dim light melatonin onset

In a double-blind placebo-controlled cross-over study, 30 patients with Delayed Sleep Phase Syndrome (DSPS) were included, of whom 25 finished the study. Melatonin 5 mg was administered during two weeks in a double-blind setting and two weeks in an open setting successively or interrupted by two weeks of placebo. The study's impact was assessed by measurements of the 24-h curves of endogenous melatonin production and rectal temperature (n=14), polysomnography (n=22), actigraphy (n=13), sleep log (n=22), and subjective sleep quality (n=25). Mean dim light melatonin onset (DLMO) (±SD), before treatment, occurred at 23.17 hours (±138 min). Melatonin was administered five hours before the individual DLMO. After treatment, the onset of the nocturnal melatonin profile was significantly advanced by approximately 1.5 hour. Body temperature trough did not advance significantly. During melatonin use, actigraphy showed a significant advance of sleep onset and polysomnography, a significant decreased sleep latency. Sleep architecture was not influenced. During melatonin treatment patients felt significantly more refreshed in the morning. These results show that analysis of DLMO of patients suffering from DSPS is important both for diagnosis and therapy. These results are discussed in terms of the biochemistry of the pineal.     

急性心肌梗塞错误溶栓治疗12例分析

自1993年12月至1995年8月，对155例急性心肌梗塞（AMI）病人进行溶栓治疗，12例发生误溶(7．7％）。其中早期复极综合征4例，室壁瘤2例，心肌炎1例，心肌病1例，完全性左束支阻滞1例，间歇性左前分支阻滞互例，其它2例。本文分析了误溶病例与AMI的鉴别要点，并提出了减少误溶，提高诊疗水平的措施。     

A New Derived and Highly Polymorphic Chromosomal Race of Liolaemus Monticola (Iguanidae) from the 'Norte Chico' of Chile

A multiple Robertsonian fission chromosomal race of the Liolaemus monticola complex in Chile is described and is shown to be the most derived and the most complex among the Liolaemus examined thus far. The 29 karyotyped lizards analysed from the locality of Mina Hierro Viejo, Petorca, Provincia de ValparaUso, Chile, exhibited a diploid chromosomal number ranging from 42 to 44, and several polymorphisms. The polymorphisms included: a pair 1 fission; a pair 2 fission plus a pericentric inversion in one of the fission products, which moved the NOR and satellite from the tip of the long arm of the metacentric 2 to the short arm of the fission product; a fission in pair 3; a polymorphism for an enlarged chromosome pair 6; and a polymorphism for a pericentric inversion in pair 7. This population is fixed for a fission of chromosome pair 4. A total of 76% of the lizards analysed were polymorphic for one or more pairs of chromosomes. We have compared these data with other Liolaemus monticola chromosomal races and calculated the Hardy–Weinberg ratios for the polymorphic chromosome pairs in this Multiple-Fission race. Karyotypic differences between the Northern (2n = 38–40) and the Multiple-Fission (2n = 42–44) races were attributed mainly to Robertsonian fissions, an enlarged chromosome and pericentric inversions involving the macrochromosomes and one microchromosome pair.     

哈尔滨市动力区7—10岁儿童多动症流行病学调查

目的了解市动力区７～１０岁儿童多动症的发病情况及其有关因素。方法采用分层整群抽样法对１３７７名儿童进行多动症的流行病学调查，主要以ＤＳＭ—Ⅲ中的ＡＤＤ诊断标准为参考综合诊断病例。结果多动症检出率为６．８９％（９５例／１３７７）；父母为工人、父文化为小学或文盲的，检出率最高，分别为７．３４％、７．７２％及８．７７％；父母大学文化的检出率最低（５．１６％和２．８３％）；母孕期经受负性生活事件及家庭环境不良是多动症发病的危险因素。结论哈市动力区７～１０岁多动症检出率较高；与发病有关的因素复杂多样。     

成人原发性肾病综合征患者尿视黄醇结合蛋白的测定及意义

采用酶联免疫法检测１００例正常人及７９例成人原发性肾病综合征治疗前后尿视内醇结合蛋白的变化。追踪随访２年，发现经治疗后病理类型为ＥＣＰＧＮ，ＭＣＮ，ＩｇＡ ＧＮ者，尿蛋白及ＲＢＰ均明显减少，其肾功能不全的发生率较低，而ＭＧＮ，ＦＳＧＳ，ＳＧＮ者，尿蛋白及ＲＢＰ无明显减少，肾功能不全的发生率较高，ＭｓＰＧＮ因其增生程度的不同，治疗效果及预后有所不同，轻度增生者治疗效果及预后较好，中，重度增生者，基     

新生儿多器官功能衰竭93例临床分析

本文报告新生儿多器官功能衰竭（ＭＯＦ）９３例，其中治愈２８例，死亡６５例（病死率为６９．８９％）。阐述了ＭＯＦ的发生机制，对其器官衰竭的数目、患儿的成熟度及体温与预后的关系进行了分析。指出新生儿器官功能衰竭发生率最高者为呼吸衰竭（９４．６２％）；认为器官衰竭的数目越多，患儿成熟度（日龄、胎龄、体重）越差，体温越低病死率越高；强调新生儿ＭＯＦ的预后和器官衰竭的不同组合密切相关。     

Adie's syndrome in childhood

An 8-year-old girl with a history of mild amblyopia who had occlusion therapy, but her anisocoria went unnoticed, was studied. Old photographs of the patient were reviewed and a 0.1% pilocarpine test was performed. Review of her old photographs suggested that she had anisocoria at least since she was 3 years old. The 0.1% pilocarpine test confirmed a diagnosis of Adie's syndrome. In light of this case, it must be kept in mind that though rare, Adie's syndrome can be encountered in early childhood.