Orthotopic liver transplantation in children

Between 1-1-1982 and 1-1-1988 52 children with an end-stage liver disease were evaluated to determine whether orthotopic liver transplantation (OLT) would be appropriate. 24 children were accepted as candidates in the long term. Twelve were not accepted as potential recipients. The parents of 3 decided not to accept OLT as treatment for their children. Two children died before a suitable donor liver was available, so that OLT was carried out in 11 children. Two of these children needed a second transplant. In 3 children only a part of a donor liver was transplanted. Shortage of donor livers of small size is partly alleviated by using a part of a larger liver. The underlying diseases of the transplanted children were cryptogenic cirrhosis (1x), biliary atresia with a hepatoportoenterostomy (8x) and cirrhosis following neonatal hepatitis (2x). Ten children with OLT are clinically and physically well. Postoperatively a primary graft dysfunction occurred in one child. He was retransplanted. The median waiting time for a donor liver was 5 months. The timing for OLT has to take this in account. In treating children with end-stage liver disease (partial) OLT should be considered.     

鸡胚第一对弓动脉的发生

用印地安墨汁注入活体鸡胚心脏，在体现显微镜下观察１１２例第１０～２０期鸡胚第一对弓动脉的发生。第一对弓动脉于第１０期出现，至第２０期退化消失。第一对弓动脉出现时尚无相应的第一咽弓，随着第一咽弓的出现，第一对弓动脉的起始端形成一个突入第一咽弓内的动脉瘤样隆起，此隆起随着第一咽弓的增大逐渐发育成一对贯穿第一咽弓的弓状血管。第一对弓动脉可以分为位于第一咽弓内的近侧段和位于此咽弓之外，与背主动脉相连的远侧段。     

Diagnosis and treatment of bronchial rupture from blunt thoracic trauma

目的　探讨外伤性支气管断裂的诊断与治疗。方法　回顾性分析 196 9年 6月— 1999年 6月我院收治的 31例外伤性支气管断裂的患者 ,全部行胸部X线摄片、支气管断层、支气管镜检查。并对其外科治疗和并发症进行探讨。结果　通过支气管断层、支气管镜检查全部得到明确诊断。 2 6例施行端端吻合术 ,4例施行全肺切除术 ,1例用带血管蒂的肋间肌、肋骨瓣修补破裂成功。 1例术后死于呼吸困难综合症 ,其余 30例效果满意。本给 81% (2 5 31)为延迟诊断与治疗。典型临床表现有 :皮下气肿、呼吸困难、伤后昏迷间期。X线表现 :纵隔气肿、气胸、萎陷肺下垂症、肺的阴影增宽。结论　支气管镜是最实用、最准确的诊断与治疗方法。术中使用支气管镜可较容易地找到支气管破裂处。术后肺功能恢复良好     

An exploration of the disease burden due to Cryptosporidium in consumed surface water for sub-Saharan Africa

The protozoan pathogen Cryptosporidium is an important cause of diarrhoeal disease, but in many contexts its burden remains uncertain. The Global Waterborne Pathogen model for Cryptosporidium (GloWPa-Crypto) predicts oocyst concentrations in surface water at 0.5 by 0.5° (longitude by latitude) resolution, allowing us to assess the burden specifically associated with the consumption of contaminated surface water at a large scale. In this study, data produced by the GloWPa-Crypto model were used in a quantitative microbial risk assessment (QMRA) for sub-Saharan Africa, one of the regions most severely affected by diarrhoeal disease. We first estimated the number of people consuming surface water in this region and assessed both direct consumption and consumption from a piped (treated) supply. The disease burden was expressed in disability adjusted life years (DALYs). We estimate an annual number of 4.3 × 10⁷ (95% uncertainty interval [UI] 7.4 × 10⁶–5.4 × 10⁷) cases which represent 1.6 × 10⁶ (95% UI 3.2 × 10⁵–2.3 × 10⁶) DALYs. Relative disease burden (DALYs per 100,000 persons) varies widely, ranging between 1.3 (95% UI 0.1–5.7) for Senegal and 1.0 × 10³ (95% UI 4.2 × 10²–1.4 × 10³) for Eswatini. Countries that carry the highest relative disease burden are primarily located in south and south-east sub-Saharan Africa and are characterised by a relatively high HIV/AIDS prevalence. Direct surface water consumption accounts for the vast majority of cases, but the results also point towards the importance of stable drinking water treatment performance. This is, to our knowledge, the first study to utilise modelled data on pathogen concentrations in a large scale QMRA. It demonstrates the potential value of such data in epidemiological research, particularly regarding disease aetiology.