Clinical Classification as a Guide to Treatment of Sinusitis in Children

Evaluation of all 153 children undergoing CT scan of the paranasal sinuses for recalcitrant sinusitis symptoms between January 1988 and July 1992 was performed. Clinical categorization into groups of patients presenting with chronic sinusitis (CS) and recurrent acute sinusitis (RAS) was based upon pattern of disease and presentation. Clinical symptoms and signs, radiological examination, treatment, and outcome were compared between these distinct clinical groups. Eighty-two (55%) children were categorized as RAS and 68 (45%) as CS. Children with CS presented more frequently with a persistent cough, purulent nasal discharge, immune deficiency, and more severe mucosal disease on CT than children with RAS. Medical therapy successfully controlled the symptoms of sinusitis in 79 (96%) with RAS versus 27 (40%) with CS. Surgery was performed in 44 children: 3 (3.6%) with RAS versus 41 (60%) with CS, p<0.01. At a mean follow-up of 2.0 years, >80% of all the children were either asymptomatic or improved regardless of treatment modality. These data support the use of clinical classification as a guide to medical versus surgical therapy in children with sinusitis.     

Safety and efficacy of interferon retreatment in children with chronic hepatitis B

More than 50% of children with chronic hepatitis B do not respond to treatment with alpha-interferon. Since these patients continue to display high viral replication and progressive liver disease, retreatment should be considered. To date it has not been well evaluated whether a second course of treatment could increase the response rate. In two alpha-interferon retreatment trials in adult patients the response rate, defined by seroconversion from HBeAg to anti-HBe, ranged between 11% and 44%. One beta-interferon retreatment study in children reported a seroconversion rate of 32%. Regrettably, none of the studies included a control group observing the `spontaneous' seroconversion rate after a first interferon cycle. Thus, a nonrandomized alpha-interferon retreatment study in children including control patients was performed. Alpha-interferon for retreatment was administered 3 times a week for 16–24 weeks in 15 children (5–16 years) at least 6 months after ceasing the first cycle. Four children received 5 MU/m² of a natural alpha-interferon and 11 children 9 MU/m² recombinant alpha-interferon 2b. Follow up was 18–47 months after initial treatment. In parallel, a control group of 19 un-retreated children with comparable clinical and demographic data was followed for 12–39 months. HBeAg seroconversion was observed in 5 (33%) of the retreated children and in 5 (26%) of the control patients during follow up. The difference is not significant. In the initially nonresponding children, those with high ALT levels before the first treatment showed late HBeAg seroconversion more frequently than those with low ALT levels (P = 0.017) irrespective of retreatment. The ALT level before retreatment was not a predictor for response. Conclusions A second cycle of alpha-interferon during the 3 years following the first treatment in nonresponding children with chronic hepatitis B can be safely performed but did not increase HBeAg/anti-HBe seroconversion compared with the spontaneous seroconversion rate of patients without retreatment. Received: 29 July 1997 / Accepted in revised form: 23 October 1997     

Lung volume measurements in infants with and without chronic lung disease

Infants born prematurely who develop chronic lung disease (CLD) have airways obstruction and hence may have low lung volume. The aim of this study was to test that hypothesis and ascertain whether the nature of the comparison control group influenced the results. Sixteen infants who were oxygen dependent for more than 28 days (CLD) and eight infants without CLD had measurements of functional residual capacity (FRC) at 14 and 28 days. The 16 CLD infants consisted of eight less than 27 weeks gestational age (group A) and eight greater than 26 weeks gestational age (group B). The eight infants without CLD (group C) were each matched for gestational age and gender to infants in group B. Group A compared to group C had lower FRCs both at 14 days (median 18 ml/kg vs 27 ml/kg, P<0.01) and 28 days (median 20 ml/kg vs 26 ml/kg, P<0.05), but group A differed from group C with respect to both gestational age (P<0.01) and birth weight (P<0.01). The FRC results of group B were lower than those of their matched controls (group C) only at 28 days (median 22 vs 26 ml/kg, P<0.05). Overall, the FRC results at 14 and 28 days correlated significantly with the duration of oxygen and ventilator dependence and weakly with gestational age. Conclusion These results support the hypothesis that FRC results are lower in infants with CLD compared to those without CLD when measured in the neonatal period and emphasize the importance of an appropriate control group. Measurement of lung volume may facilitate assessment of the response to therapies for CLD. Received: 5 May 1997 / Accepted in revised form: 29 September 1997     

中西医结合治疗慢性周围动脉闭塞性疾病

慢性周围动脉闭塞性疾病（PAO）治疗较为棘手。闭塞的血管不易再通，手术适应症范围小，且术后可能再度发生闭塞[1]。因此寻求适合的保守疗法非常重要。我院自1995年3月至1997年3月治疗PAO患者35例，其中23例用中药溶栓灵配合西药前列素E（PGE1）、天普乐欣（UK）治疗，与单纯用西药治疗的12例比较，疗效尚满意，现报道如下。1临床资料根据中国中西医结合研究会周围血管病专业委员会制定的诊断和分期标准[2]，收治35例PAO患者，包括血栓闭塞性脉管炎（TAO）19例，动脉硬化性闭塞（ASO）16例。随机分为两组：①溶栓灵结合PGEI、UK…     

Chronic cerebral hypoperfusion: loss of pupillary reflex, visual impairment and retinal neurodegeneration

Adult rats underwent permanent bilateral occlusion of the common carotid arteries (2VO) to determine the effect of chronic cerebral ischemia on vision and retina. They were monitored post-surgically for the presence of the pupillary reflex to light. Some rats were tested for 6 months post-surgically on a radial arm maze task and then tested in another water-escape task which explicitly tested visual function. Another group of rats were tested post-surgically for 3 months on a task which simultaneously assessed visual and tactile discrimination ability. The thicknesses of the retinal sub-layers were then measured for some rats. Fourteen of the 25 rats that underwent 2VO lost the pupillary reflex. This seemed to occur within 5 days. Rats that lost the pupillary reflex but not rats whose reflex was intact, were impaired on all visually guided mazes. Tactile discrimination ability was unaffected. Only rats that lost the pupillary reflex showed reduced thickness of the retinal outer nuclear and plexiform layers, reduced cell density in the retinal ganglion cell layer and astrocytosis and degeneration of the optic tract. We conclude that 2VO can eliminate the pupillary reflex. Photoreceptors and retinal ganglion cells degenerate, but it is unclear if these are the cause(s) or result(s) of the loss of the pupillary reflex. These effects are accompanied by impairment of visually guided behavior. The possibility that visual system damage may also occur in acute ischemia merits further investigation.     

Assessing the Quality of Life of Adults with Chronic Respiratory Diseases in Routine Primary Care: Construction and First Validation of the 10-Item Respiratory Illness Questionnaire-Monitoring 10 (RIQ-MON10)

BACKGROUND: As doctors' judgements about the burden of a disease often differ from patients' own assessments a manageable method to incorporate the latter into routine care might support patient-centered decision-making. For this purpose we shortened the 55-Item Quality of Life for Respiratory Illness Questionnaire (QoL-RIQ). METHODS: Secondary analyses of the data of 3 controlled studies (n = 328, 502 and 555). PROCEDURES: inter-item correlations, scale distributions, Cronbach's alpha and factor analysis. Dyspnoea, forced expiratory volume in 1 s (FEV1), COOP/WONCA charts, the Medical Research Council-ECCS symptoms questionnaire and the MOS-SF 36 served as criteria to test validity and responsiveness. RESULTS: Item-reduction resulted in a 10-item short form (alpha's 0.87-0.90), consisting of 2 5-item factors: (1) physical and emotional complaints and (2) physical and social limitations. The correlations of the short form with dyspnoea (r from 0.57 to 0.60), the generic health status instruments (r from 0.39 to 0.59) and lung function (r from 0.10 to 0.15) fulfilled the criteria. FURTHER RESULTS: a clinical relevant score difference (> 0.5) between upper and lower quartiles of the convergent instruments, an intraclass correlation between repeated scores in a stable group of 0.82 and a standardised response mean of 0.86 in an improved group of patients. CONCLUSIONS: The short form (RIQ-MON10) maintained the psychometric properties of the original instrument and is promising for assessing quality of life (QoL) during routine primary care visits.     

Life Satisfaction in a Sample of Outpatients with Severe Mental Disorders: A Survey in Northern Italy

This paper presents a cross-sectional survey of subjective quality of life in a sample of 40 Italian patients with disabling mental disorders living in the community. The patients self-rated their quality of life by the Satisfaction with Life Domains Scale. They were satisfied in relation to basic needs, such as housing, food or clothing and appreciated to some extent the services received, but were very unhappy about their income and their intimate sexual relationships. This Italian sample appeared less satisfied than most samples of people with severe mental disorders investigated by the same instrument in other countries. This may be related to the high level of psychopathology and disability shown by patients for whom survival in the community is in itself an achievement. However, lack of money and poor sexual life are common concerns of long-term mentally ill. How to address such problems is a major challenge for community psychiatric services.     

小剂量人重组红细胞生成素不同给药途径治疗慢性肾衰贫血临床观察

目的:观察小剂量人类重组红细胞生成素 (rhu -Epo)皮下注射与静脉注射两种给药途径对慢性肾衰贫血的疗效。探索更为有效、安全、经济的给药途径。方法 :用随机数字表法将20例慢性肾功能衰竭贫血病人分为两组 :分别采用皮下注射 (治疗组 )与静脉注射 (对照组 )两种给药途径 ,比较两种不同给药途径疗效的差异。结果 :两组病人RBC、Hb、Hct均有明显上升 ,与治疗前比较差别均有很显著性 (P<0.01)。6周内两组之间比较差别无显著性 (P>0.05)。皮下注射组治疗后2周与6周RBC、Hb、Hct差别有很显著性 (P<0.01)。两组均有血压增高。结论 :小剂量rhu -Epo皮下注射与静脉注射均能有效改善慢性肾衰病人的贫血,两种给药途径相比较,皮下注射更安全、经济、适用。     

三种不同病因不孕症患者黄体血肿发生情况比较

目的 :比较 3种不同病因的不孕症患者黄体血肿的发生情况。方法 :回顾性分析了行排卵监测的不孕妇女2 4 0例 ,根据其不孕病因分为 3组 ,子宫内膜异位症组 77例 ,慢性盆腔炎组 (盆腔粘连、结核 ) 4 8例 ,对照组 (女方无明显异常的不孕妇女 ) 115例。比较此 3组患者的黄体血肿发生情况。结果 :子宫内膜异位症组、慢性盆腔炎组、对照组黄体血肿发病率分别为 2 7.2 %、16 .7%、0 .87% ,前两组高于第 3组 ,差异具有非常显著性 (P <0 .0 1)。子宫内膜异位症组黄体血肿发生率高于慢性盆腔炎组 ,但差异无显著性。子宫内膜异位症组与慢性盆腔炎组黄体血肿的直径、黄体血肿形成前卵泡的直径差异无显著性。结论 :子宫内膜异位症和慢性盆腔炎患者黄体血肿的发生率较高 ,诊断为子宫内膜异位症或慢性盆腔炎 (盆腔粘连或结核 )的不孕患者 ,如排卵监测时出现黄体血肿 ,可作为选择腹腔镜检查与手术的参考因素之一。     

Chronic subdural haematomas in patients aged under 50

The clinical findings in 31 patients with chronic subdural haematoma (CSH), aged between 20 and 50, are described. Aetiopathogenetic factors responsible for the formation of CSH match those of patients aged over 50 with CSH. A history of cranial trauma was present in 77% of the cases. In the remaining patients, a defect of haemostatic mechanisms was responsible for the subdural blood collection. On the computed tomography (CT) the haematoma generally appears as a thin subdural layer. The reliability of magnetic resonance imaging for detection of CSH makes it the most desirable investigation in such patients. Prognosis is influenced by preoperative clinical status and by the disease responsible for the formation of CSH.