Prenatal diagnosis of left-sided aortic arch,right descending aorta and right-sided ductus arteriosus associated with anomalous origin of left pulmonary artery from ascending aorta

Left-sided aortic arch (LAA), right descending aorta (rDAo), and right-sided ductus arteriosus (RDA) constitute a rare aortic arch anomaly. Moreover, anomalous origin of the pulmonary artery from the ascending aorta, especially that of the left pulmonary artery, is also a rare anomaly of the pulmonary artery branches. Because of the presence of the ductus arteriosus, prenatal ultrasound is an optimal diagnostic tool for the LAA with rDAo. Four-dimensional color Doppler can clearly demonstrate the spatial relationship between the LAA, rDAo, and RDA and the anomalous origin of the left pulmonary artery from the ascending aorta.     

复发性肝癌临床病理特点与发生方式探讨

【摘要】 目的 探讨首次切除的原发性肝细胞癌（P-HCC）与再次切除的术后复发性肝细胞癌（R-HCC）之间在临床病理学特点上的差异与起源方式之间的可能关系。方法 根据其首次切除前与术后复发再次切除前两次血清甲胎蛋白（AFP）含量检测差异的状况,将第二军医大学东方肝胆外科医院1986年5月至1998年6月106例R-HCC分为两组,A组（n=29）血清AFP含量差异明显,B组（n=77）血清AFP含量相似。根据106例R-HCC的复发部位分为3型,Ⅰ型：相同肝叶肿瘤复发;Ⅱ型：不同肝叶肿瘤复发;Ⅲ型：同时累及多个肝叶的肿瘤复发。对A、B两组中各型R-HCC的复发间期、瘤体直径和组织学类型等进行比较。 结果 A、B两组R-HCC的平均复发间期分别为（34.1±3.8）个月和（24.6±2.7）个月（ P <0.05）,其中A组Ⅱ型病例为（39.4±5.9）个月,明显长于 B组Ⅰ型病例的（25.0±3.5）个月和Ⅱ型病例的（21.3± 4.1）个月（ P <0.05）;A组Ⅱ型R-HCC的瘤体平均直径为（4.6±1.3）cm,明显小于B组R-HCC的（6.2±0.4）cm ( P <0.05),各组R-HCC之间在组织学类型、细胞分化及生长方式上无明显差异。结论 约25%的R-HCC具有多中心（多克隆）起源的特点,提示来自新生肿瘤细胞克隆性生长;约75%的R-HCC具有单中心（单克隆）起源的特点,提示来自首次切除后肿瘤残留或肝内转移灶导致的残癌生长,该分析可为临床评估R-HCC的来源提供有用的参考依据。     

Variation in the progression of diabetic nephropathy according to racial origin.

BACKGROUND: In the United Kingdom, diabetic nephropathy is a leading cause of end-stage renal disease. There is a higher incidence amongst subjects of Indo-Asian and African-Caribbean origin compared with Caucasians that is not wholly explained by the differences in the prevalence of diabetes. Therefore, we postulated that this observation could be related to variations in the rate of progression of renal disease according to racial origin. METHODS: We conducted a retrospective case-note review of 1684 adult attendees of the diabetes clinic. Forty-five patients were found with renal impairment (serum creatinine > or = 170 micromol/l) due to diabetic nephropathy. The patients were of Indo-Asian (n=10), African-Caribbean (n=11), and Caucasian (n=24) origin. Progression of nephropathy was assessed by analysing (i) the doubling of serum creatinine through construction of Kaplan-Meier curves and (ii) the slope (beta) of the rate of change in serum creatinine using linear regression analysis in relation to demographic variables, putative risk factors for nephropathy and antihypertensive drug therapy. RESULTS: There were no statistically significant differences between systolic and diastolic blood pressure, glycaemic control, smoking habit, baseline proteinuria, and usage of angiotensin-converting enzyme inhibitors between the three groups. The proportion of patients doubling their creatinine was significantly higher in the Indo-Asian compared with the African-Caribbean and Caucasian groups (100, 45 and 50%; P=0.025 respectively). In addition, the mean (95% CI) of beta (micromol/l/month) was highest in the Indo-Asian (5.36 (2.21-8.52)) compared with the African-Caribbean (3.14 (0.82-5.46)) and Caucasian (2.22 (1.31-3.14)) groups (P=0.035). The mean ranks of beta were highest in the Indo-Asian group (P=0.038) after adjusting for marginal differences in blood pressure age, gender, baseline proteinuria, anti-hypertensive treatment, and smoking habit. CONCLUSIONS: In this small cohort of type 2 diabetic subjects with established renal disease, the rate of decline in renal function is accelerated in Indo-Asian subjects. This observation could be related to differences in renoprotection from antihypertensive therapy.     

The role of family of origin food-related experiences in bulimic symptomatology.

OBJECTIVE: With the goal of developing a model relating family of origin experiences to maladaptive cognitions to bulimic symptom formation, the authors developed a measure of family of origin food-related experiences called the Family History Inventory. METHOD: A number (N = 662) of sixth to eighth-grade adolescents completed the inventory, eating and dieting expectancy measures, and the Bulimia Test-Revised (BULIT-R). RESULTS: Fourteen scales were identified in the inventory. They emphasized family teasing about weight, negative maternal modeling regarding food, and family rules concerning eating. Eleven of the 14 scales correlated with the BULIT-R. Two superordinate factors called Family Teasing and Negative Maternal Modeling summarized 8 of the 14 subscales. Statistical tests were consistent with the hypothesis that eating and dieting expectancies mediate the influence of Family Teasing and Negative Maternal Modeling on bulimic symptomatology. DISCUSSION: There was good evidence for the validity of the Family History Inventory. The theoretical implications of the mediation tests are discussed.     

Fever of unknown origin in 185 paediatric patients: a single-centre experience

Aim: We conducted a prospective study to evaluate the causes and outcome in children with fever of unknown origin (FUO). Methods: From 1990 to 1999, 185 children with FUO were evaluated. Initial evaluation included routine haematological analysis, Epstein-Barr virus (EBV) serology, urine, stool or blood cultures, chest X-ray and tuberculin probe. Results: In 131 (70%) patients diagnosis was established, and 70 (37.8%) had infectious disease. EBV infection was the most common infection followed by visceral leishmaniasis (VL), urinary tract infection (UTI) and tuberculosis. Autoimmune disorders were diagnosed in 24 (12.9%), Kawasaki disease in 12 (6.4%), malignant diseases in 12 (6.4%) and miscellaneous conditions in 15 (8.1%) patients. In the remaining 54 (30%) patients, diagnosis was not established and most of them had self-limited disease. During the investigation, 26 (14%) patients developed serious organ dysfunction and five patients (two with virus-associated haemophagocytic syndrome, one with VL and two unknown) died.

Conclusion: The most important infectious causes of FUO in our study were EBV infection and VL. Kawasaki disease represented a significant cause of FUO at the beginning of our study because it was not recognized by primary-care physicians. We report myelodysplastic syndrome as another emerging cause of paediatric FUO. Repeated clinical examination and careful use of specific laboratory examinations, invasive diagnostic procedures or imaging are crucial in approaching paediatric FUO.     

317例儿童不明原因发热的临床分析

目的：探讨儿童不明原因发热(FUO)的病因,诊断方法和思维方式。方法：回顾性地总结分析1996年1月至2000年12月符合FUO诊断标准的住院患儿317例。结果：317例中明确诊断有298例,确诊率为94.0%。感染性疾病160例(53.7%),非感染性疾病138例(46.3%),两者之比为1.15∶1。最终确定诊断的方法分别为：临床综合诊断140例(47.0%);血清和骨髓细菌培养检查64例(21.5%);组织活检37例(12.4%);影像学检查35例(11.7%);尸体解剖11例(3.7%);骨髓形态学确诊6例(1.9%);回顾性诊断5例(1.7%)。结论：根据临床经过和必要的实验室检查大部分FUO病例可以明确病因诊断,病理学检查对疑难病例的诊断提供重要依据,极少数病人最终只能依赖尸检明确诊断。感染性疾病、结缔组织病和恶性肿瘤性疾病是该组FUO的主要原因。     

Values grading among nursing students – Differences between the ethnic groups

This study was aimed at measuring professional and personal values among nursing students. The participants were 180 students tested according to 36 personal values and 20 professional values. The findings indicated that passing time has not harmed the fundamental values on which the nursing profession is based: human dignity, the prevention of suffering, reliability, and faithful relationships. Devaluation was observed in the values of equality among patients, and altruism, which were graded only in fifth and sixth place, respectively. It is necessary to consider the regression in the values: imagination, ambition, and cleanliness, which were graded among the bottom values on the list. Significant differences were found in the grading of several personal and professional values, as a function of ethnic origin. Results may help understand motives of nursing students and assist in promoting bachelor of nursing programmes while taking into consideration the unique characteristics of the student group.     

Influence of the Jewish religion and Jewish dietary laws (Kashruth) on family food habits in an ultra‐orthodox population in Montreal

Two hundred and fifty families, comprising 1,438 individuals, from the major ultra‐orthodox, fundamentalist Jewish (Hassidic) communities in Montreal, were randomly selected from community lists for a study of the influence of Judaism and its dietary laws on their food habits. Data were collected by means of self‐administered, mailed questionnaires developed for this survey. Highly significant differences relating to participant group (Outremont Hassidim versus Lubavitcher Hassidirn) were noted for the consumption of certain basic foodstuffs (fish, poultry, eggs, some vegetables, sources of fat, processed foods), as well as some cooking methods and miscellaneous food habits. These differences can be explained by the latter community's more heterogeneous composition, differing philosophies and wider experience of the secular world. The sabbath, fast‐days and numerous holidays contributed to particular dietary habits within the Hassidic population. Examination of usual food group consumption patterns revealed eating habits which closely approximate North American healthy eating guidelines, despite possible marginal intakes of vitamin D, zinc and iron among children and pregnant women. This study has reinforced existing anecdotal impressions as to the importance of religion and the religious dietary laws in the daily life of this community.     

Congenital ophthalmoplegia due to fibrosis of the external ocular muscles

Familial congenital ophthalmoplegia (four cases). Clinical study; ophthalmoplegia, amblyopia, bilateral blepharoptosis, anatomical and histopathological findings; fibrosis of the extraocular muscles. Discussion: only a few reports are available, terminology, associated abnormalities. Etiology; myogenic? Surgical results.