Adrenocortical responsiveness in neonates weaned from the ventilator with dexamethasone

Adrenocortical responsiveness was assessed in eight very low birthweight neonates who had bronchopulmonary dysplasia and had been weaned from mechanical ventilation using dexamethasone. Three of the eight infants did not respond to ACTH stimulation during the first week after cessation of dexamethasone, but all three responded normally when retested at least 1 month later. The present authors have thus demonstrated that some infants have at least temporary adrenocortical unresponsiveness after prolonged courses of glucocorticoid therapy, and suggest that adrenocortical function should be assessed in all infants who are weaned from mechanical ventilation using dexamethasone.     

唇腭裂患者上颌骨牵引成骨术后发音方式的变化

目的:通过对行颅外支架式上颌骨牵引成骨术(rigidexternaldistraction,RED)唇腭裂患者治疗前后的错误发音数量变化、不同发音部位、不同发音方法以及不同类型错误发音发生特点及其变化评价,分析上颌骨RED对患者发音方式的影响。方法:1999年至2001年行上颌骨RED的唇腭裂术后上颌发育不足患者21例,其中男性13例,女性8例,平均年龄15.05岁。所有患者RED前后进行语音测听并分类。治疗前后错误发音的差异性用非参数检验。结果:RED术后42.9%患者错误发音数较RED前增加,19.0%减少,38.1%无变化。从发音部位,舌尖前音错误发音发生率最高,其次为舌面音。从发音方法,错误发音多发于塞擦音。错误发音类型以咽喉摩擦/爆破音为主,其次为腭化构音和声门爆破音。上颌骨RED后腭化构音累及音节数减少,但咽喉摩擦/爆破音和声门爆破音反而增加,尤其是咽喉摩擦/爆破音。结论:唇腭裂患者经RED前移上颌骨后,会对患者发音方式产生影响,在行语音治疗前需考虑全面。     

Success determining factors in percutaneous transluminal balloon valvuloplasty of pulmonary valve stenosis

Twenty-two percutaneous transluminal balloon valvuloplasty procedures were performed on 21 patients with congenital pulmonary valve stenosis. The peak systolic pressure gradient was immediately reduced from 79.1 +/- 7.4 to 22.2 +/- 1.8 mmHg, (P less than 0.0001) and follow-up cardiac catheterization at 5.3 +/- 0.4 months in 19 patients revealed no further significant change in gradient (23.5 +/- 3.2 mmHg). The best results were obtained when balloons larger than the pulmonary annulus were used, i.e. an immediate residual transvalvular gradient of 22.0 +/- 2.2 mmHg with a balloon/annulus ratio greater than 1, as opposed to 44.2 +/- 5.4 with a balloon/annulus ratio = 1 (P less than 0.001). The angiographically determined cusp thickness of the stenotic pulmonary valves was significantly greater than that of the control group of 24 patients without pulmonary valve stenosis (1.21 +/- 0.09 vs 0.59 +/- 0.02 mmHg, P less than 0.00001). The relationship between this parameter and the residual transvalvular gradient at follow-up was found to be significant (r = 0.77, P less than 0.001). It is concluded that balloon size is a determinant factor in achieving good results with percutaneous balloon valvuloplasty although cusp thickness, a factor to which scant regard has hitherto been paid, also plays a significant role in the residual transvalvular gradient measured at follow-up.     

Pathology of the lung in the fetus and neonate, with particular reference to problems of growth and maturation

The major forms of lung pathology in the perinatal period are reviewed with emphasis on disturbances of growth and maturation. Lung hypoplasia results from impairment in the physiological control of lung growth during the fetal period. It is more common than organogenetic defects which are discussed only briefly. Hyaline membrane disease is now seldom seen in a pure form due to improvements in perinatal care. However, its complications and sequelae such as interstitial emphysema, pneumothorax and bronchopulmonary dysplasia are encountered more frequently. In addition, a wide variety of pathological processes may localize to, or be expressed in, the lung of the newborn, notably asphyxial changes, persistent pulmonary hypertension, haemorrhage and infection.     

胃粘膜癌变初发点及其组织背景的病理学：癌变初发点的一般组织病理学

本文通过对228例各种类型胃粘膜上皮异型增生的病理切片的复查,发现并详细地描述了不同类型异型增生腺管和上皮细胞癌变的初发点(Start point)。其形态有的是从再生腺管的腺颈部或底部以“发芽”形式,向质内浸润并分枝生长;有的是从再生腺管基底膜向侧方的间质浸润。从再生的胃上皮型异型腺管所出现的癌变多为低分化型腺癌;从肠上皮型异型腺管所发生的癌变则为高分化型腺癌。强调了胃粘膜再生性异型增生有些具有癌前性质。     

Histopathology of the teeth in segmental odontomaxillary dysplasia: new findings

Histological examination of the deciduous teeth in two cases of segmental odontomaxillary dysplasia (SOMD) showed fibrous enlargement of the pulps, an irregular pulp/dentine interface displaying many pseudoinclusions and pulp stones. There were tubular defects in the coronal dentine from pulp horn to cusp tip, an irregular tubular structure to the circumpulpal dentine of the apical half, a focally deficient odontoblast layer and widespread external resorption. Together with the clinical features of unilateral maxillary enlargement, upper alveolar expansion in the distal segment, increased spacing and delayed eruption of the deciduous molars and absence of premolar teeth, these histological appearances allow distinction of this condition from fibrous dysplasia (FD), segmental hemifacial hypertrophy (SHH) and regional odontodysplasia (ROD).     

Aplasia of submandibular salivary glands associated with ectodermal dysplasia.

We describe a 28-year-old white Caucasian man displaying many of the physical signs of ectodermal dysplasia (ED). An unusual finding was his presentation with xerostomia. Salivary gland imaging techniques revealed aplasia of both submandibular salivary glands and relatively small parotids. The case highlights that hypoplasia and aplasia of exocrine glands could be rare features of ED. In the management of ED, early detection of xerostomia is important to limit any potential damage to the already hypodontic dentition.     

早产儿血清表皮生长因子水平与脑发育相关研究

目的探讨早产儿血清表皮生长因子水平与脑发育的关系。方法依据入选标准观察对象为自2005年8月起连续收治入本院新生儿病房、出生24h内的胎龄为34周±3d的“正常”早产适于胎龄儿30例。采用酶联免疫吸附测定(ELISA)法,分别测定30例早产儿生后24h内和出生第8天空腹股静脉血清表皮生长因子(EGF)水平,分别为t0和t1值,计算血清EGF浓度变化的速率(Δt)。同时,在新生儿出生后6周(纠正胎龄接近40周)和纠正1月龄时进行NBNA评分测定。并将以上实验室数据与新生儿行为神经测定(NBNA)评分值及差值、早产儿出生后的头围增长值及增长速率进行Pearson相关分析。如果P值<0.05,则认为差有统计学意义。结果30例早产儿观察对象t0为(234.71±58.07)pg/ml,t1为(347.81±87.49)pg/ml,Δt为(16.16±9.94)(12.14、15.20)pg/ml/d;Pearson相关分析显示2次NBNA评分结果及差值、出生后6周和纠正1月龄时的头围增长值/增长速率与t0值无相关性(P>0.05);2次NBNA评分结果及差值、出生后6周和纠正1月龄时的头围增长值/增长速率与t1和Δt之间有相关性(P<0.05)。结论研究结果表明,早产儿出生后血清EGF浓度呈上升趋势,提示早产儿出生后体内EGF合成和释放增加,可能促进脏器成熟和组织修复;更重要的是,早产儿出生1周时高水平血清EGF浓度和/或较快上升速率者,其出生后头围增长速度也快,可能有较好的脑发育水平、远期预后良好。     

胃恶性上皮核仁组成区相关蛋白的研究

用嗜银染色技术对34例良性胃溃疡、40例胃粘膜异型增生、46例胃腺癌组织石蜡切片中的核仁组成相关蛋白(AgNOR)进行研究,25例正常胃粘膜组织作对照。发现对照组、良性溃疡组,异型增生组和腺癌组的细胞核AgNOR平均计数差异有显著性(P<0.01)。恶性细胞中AgNOR的体积、形状及在细胞核内的位置也不相同。作者认为此法有助于区别胃的良性和恶性病变。