Severe odontogenic infections

Background : Severe odontogenic infections are serious potentially lethal conditions. Following the death of a patient in the authors' institution this study was initiated to determine the risk factors, management and outcome of a consecutive series of patients.
Methods : All patients admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with odontogenic infections in calendar year 2003 were investigated. Detailed information relative to their pre-presentation history, surgical and anaesthetic management and outcome was obtained and analysed.
Results : Forty-eight patients, 32M, 16F, average age 34.5, range 19 to 88 years were treated. All presented with pain and swelling, with 21 (44 per cent) having trismus. Forty-four (92 per cent) were as a result of dental neglect and four (8 per cent) were regular dental patients having endodontic treatment which failed. Of those known to have been treated prior to presentation, most had been on antibiotics. Most patients had aggressive surgical treatment with extraction, surgical drainage, high dose intravenous antibiotics and rehydration. The hospital stay was 3.3 (range 1–16) days. Patients requiring prolonged intubation and high dependency or intensive care (40 per cent) had longer hospitalization. No patient died and all fully recovered.
Conclusion : Severe odontogenic infections are a serious risk to the patient's health and life. Management is primarily surgical with skilled anaesthetic airway management. Antibiotics are required in high intravenous doses as an adjunct and not as a primary treatment.     

Outpatient Initiation of Insulin: A Nurse Practitioner Protocol

Noninsulin dependent diabetes (type II diabetes) is a chronic disease characterized by hyperglycemia. Clients can generally be controlled by diet and exercise or a combination of diet, exercise, and oral hypoglycemic agents. When this therapy is not effective in controlling the hyperglycemia, the health care provider must choose to initiate insulin therapy. Outpatient initiation of insulin is an alternative to hospitalization in the type II diabetic client. Clinical guidelines for the initiation of insulin on an outpatient basis and management of the diabetic client are presented.     

特发性震颤的临床特点分析

目的探讨特发性震颤（essential tremor,ET）的临床特点。方法回顾性分析98例ET患者的临床资料。结果98例ET中男56例,女42例。发病年龄6～72岁,平均43．08±18．18岁。病程1～48年,平均14．04±11．39年。48例（48．98％）患者有阳性家族史。临床主要表现为单症状的姿势性震颤,累及部位依次为手98例（100％）、头38例（38．78％）、下肢28例（28．57％）、咽喉部16例（16．33％）、下颏10例（10．20％）等。64例患者做了饮酒试验,其中58例（90．63％）有酒精反应。84．62％的患者服用盐酸阿罗洛尔治疗有效。结论特发性震颤的临床表现以单症状姿势性震颤为主,手及头部受累明显,多数患者对酒精有反应,盐酸阿罗洛尔治疗有效。     

Foreign metallic pellet in the heart

Foreign bodies in the heart are a rare but serious form of cardiac injury. The objects usually are sharp pointed. Such as acupuncture needles,sewing needles, coat hangers, fragments of Kirschner wires, pins, etc. 1 We report a patient with a metallic pellet lodged in the heart, which was accurately diagnosed and successfully removed.     

Prevalence and geographic distribution of Hepatitis C Virus genotypes in Indian patient cohort

Viral hepatitis represents a major global health problem with 170 million Hepatitis C Virus (HCV) carriers worldwide, and 12–13 million HCV carriers in India. HCV genotypes are of clinical significance in indicating drug responsiveness and prognosis of the patient. The HCV genotypes are of epidemiologic significance as well, as they are indicative of transmission route of infection and have not been extensively studied in the Indian context. In the current study, HCV genotyping was examined in 2118 patients from different geographic regions of India. HCV was detected by PCR amplification of 5′ UTR and core-envelope1 regions, followed by genotyping using nucleotide sequencing and analysis with NCBI tool (http://www.ncbi.nlm.nih.gov/projects/genotyping/formpage.cgi). HCV genotype distribution in the 2118 Indian patients demonstrated prevalence of HCV3 (3a/3b primarily) in 62% and HCV1 (1a/1b primarily) in 31% patients. The predominance of HCV3 was significant in northern (p = 0.01) and eastern (p = 0.008) regions of India. HCV types 2, 4, 5, and 6 were detected in 0.05–4.5% of the patient group. Thus, our studies demonstrate HCV genotype prevalence in the cohort group in different regions of India.     

含链霉素短程化疗方案的痰结核菌转阴时间观察

目的对比短程化疗含链霉素(SM)、乙胺丁醇(EMB)两组方案在抗结核治疗中的效果。方法选初治菌阳肺结核100例,予含SM方案(2HRZS/7HR)化疗50例,含EMB方案(2HRZE/7HR)化疗50例。每月检查痰结核菌一次(涂片三次,培养一次)。停药后继续追踪两年。结果痰菌2个月内转阴者,SM组29例,占63%;EMB组18例,占38%,p<0.05,有显著性差异。需延长强化期者:SM组16例,占35%;EMB组26例,占55%,p<0.05,有显著性差异。复发病例,SM组2例,占4%;EMB组3例,占6%,p>0.05,无显著性差异。结论使用含SM方案化疗的病例其痰菌转阴时间比含EMB方案短。     

Middle ear pathology in day-care centre children

BACKGROUND: Middle ear pathology, either otitis media with effusion or tubal dysfunction, is frequently seen in day-care centre children. Recognition and early treatment of this condition is crucial to the prevention of chronic otitis media, which is a major cause of hearing loss in later life. OBJECTIVES: We aimed to reveal the incidence of silent otitis media in day-care centre children and to determine the predisposing factors, risk factors and the awareness of the parents of the middle ear disease of their children. METHOD: Two hundred and thirteen children, aged 3-6 years, were screened in four daycare centres. A questionnaire was prepared that would reveal the predisposing factors. Information was gathered from both the parents and teachers. Children were examined by otoscopy, pneumotoscopy, tympanometry and X-rays for sinus pathology. RESULTS: Forty-three of 213 children had middle ear pathology; 39 of them were confirmed by tympanometry; 56.1 % of children had some degree of sinus pathology. We revealed that, although most of the children do not have the risk factors, they develop middle ear pathology. Among the parents, 81.4% of them were unaware of the condition. CONCLUSION: Early diagnosis of middle ear pathologies is necessary for prevention of future complications. In early stages the condition is silent. We emphasize the importance of the primary care physician's role in diagnosing the early stages of middle ear pathologies and recommend that teaching of otoscopic and pneumotoscopic skills should be part of the training for family physicians.      

树突状细胞在胆囊癌组织内浸润的研究

目的通过对胆囊癌组织中树突状细胞浸润情况的研究,阐述树突状细胞与肿瘤免疫之间的关系。方法采用免疫组化SP法。结果树突状细胞在胆囊癌组织的浸润程度与年龄、性别和病理组织学类型无关,与病理分化程度呈负相关关系(P<005)。结论树突状细胞在胆囊癌组织的浸润程度与病理分化程度、Nevin分期、肝浸润及淋巴结转移存在密切的关系。树突状细胞的定量检测可作为估计胆囊癌预后的标志。     

评“McCall观察方法”——对一种色谱系统分配效果观察方法的商榷

本文通过理论分析和文献数据的分析,对McCall提出的色谱系统分配效果的观察方法提出了不同的看法,认为McCall方法中的所谓logK并不是常数。McCall的方法无论在理论上和实践上都是不妥的。