Prevalence of the Neonatal Autopsy: A Report of the Study Group for Complications of Perinatal Care

Neonatal autopsy findings are valuable additions to the information base for current cases and future perinatal care, so the reported decline in the autopsy rate is disturbing. In order to estimate the prevalence of the neonatal autopsy among a large population of deaths, we surveyed participating institutions of the Study Group for Complications of Perinatal Care. Investigators from 37 neonatal intensive care units, located in 9 children's hospitals, 4 hospitals for women and infants, and 24 full-service pediatric and adult care hospitals, reported their neonatal death and autopsy rates for 1989. The overall neonatal autopsy rate was 51% among 1645 neonatal deaths. The rate was variable, ranging from 22 to 100%. We found the neonatal autopsy rate to be lower than previously reported and not apparently influenced by the type of center or by the type of medical staff at the centers. In order to assess and potentially reverse the current low rate, the influence of neonatal demographic and clinical factors, as well as physician-related factors, must be studied.     

Bilateral Hematogenous Pseudomonas aeruginosa Endophthalmitis After Lung Transplantation

Pseudomonas aeruginosa commonly colonizes the airways of patients with cystic fibrosis (CF). However, the occurrence of bacteremia with metastatic infection to the eye causing endogenous endophthalmitis is very rare. In the setting of lung transplantation, the significance of P. aeruginosa bacteremia in patients with CF whose airways are colonized before transplantation is unknown. We report a case of bilateral P. aeruginosa endogenous endophthalmitis in a patient with CF after lung transplant without documented bacteremia. The patient presented with acute eye symptoms in the presence of a left atrial thrombus and the disease followed a rapidly progressive course requiring aggressive medical-surgical treatment. Typically P. aeruginosa endophthalmitis has been associated with a poor visual prognosis. However, with combined medical-surgical management this patient retained useful vision in one eye without having retinal detachment or requiring enucleation. Endogenous endophthalmitis should be considered in the differential diagnosis of ocular complaints in patients with CF after lung transplant.     

筛检对肝癌死亡率影响的研究

5581名HBsAg阳性的男性随机分入周期性筛检组(A组,3712人)及对照组(B组,1869人)。A组(19155.4人年)共发生肝癌257例,B组(9785.5人年)为117例,两组的肝癌发生率分别为1342/10万与1196/10万;两组肝癌死亡分别为218与109例,肝癌死亡率分别为1138/10万与1114/10万。两组中Ⅰ期肝癌病例分别为29.6％与6.0％,差异有非常显著性意义。1、3、5年相对生存率A组为23.7％、7.0％、4.0％,B组为9.7％、4.0％、4.1％。用Poisson回归模型拟合显示,在调正年龄、初筛AFP及入列年份后,筛检对于肝癌的相对危险度为0.83,95％CI为0.68～1.03,有较弱的“保护”作用,Cox回归模型拟合结果显示当临床分期未引入模型时,筛检对于肝癌有显著的“保护”作用:危险率为0.6617,95％CI为0.5234～0.8365;而模型经调整后,危险率即接近“1”,95％CI为0.74～1.26。