Traumatic rupture of right hemidiaphragm in a child.

Acute right-sided diaphragmatic ruptures are rare in children. We report a case of traumatic right-sided diaphragmatic rupture in a child that was managed by delayed repair. The clinical presentation and importance of making an accurate diagnosis and confirmation of any associated visceral injury before definitive surgery is highlighted.     

补肾填精方联合西药治疗再生障碍性贫血血小板影响因素的预测研究

目的：观察补肾填精方联合西药治疗再生障碍性贫血（AA）对血小板（PLT）的影响,分析影响PLT的临床因素特征。方法：选取2018年9月至2021年3月中国中医科学院西苑医院、广安门医院等19个分中心的AA患者79例作为研究对象,以补肾填精方联合西药基础治疗,连用3个月为1个疗程,连续服用2个疗程,观察患者PLT变化情况,分析PLT较基线值增长且恢复正常、较基线值增长未恢复正常的AA患者的临床因素特征。结果：AA患者接受补肾填精方联合西药治疗4个月后,PLT较基线值增长且恢复正常的有13例,PLT较基线值增长未恢复正常的有66例。对一般资料分析显示,中医证候积分越低,补肾填精方联合西药治疗,PLT越容易恢复正常（P<0.05）。对治疗前血常规分析结果显示,治疗前血红蛋白≥60 g/L时、中性粒细胞数值越高时、网织红细胞比率＜0.5%时,补肾填精方联合西药治疗,PLT越容易恢复正常（P<0.05）。对治疗前T淋巴细胞亚群结果分析显示,CD3+CD19-＜60%时,以补肾填精方联合西药治疗,PLT更容易恢复正常（P<0.05）。结论：当AA患者的中医证候积分越低、血红蛋白≥60 g/L、中性粒细胞数值越高、网织红细胞比率＜0.5%、CD3+CD19-＜60%且越低时,以补肾填精方联合西药治疗,AA患者的PLT更容易增加并恢复正常（P<0.05）。     

Short-Pouch and Low-Anastomosis Duhamel Procedure Results in Better Fecal Control and Normal Defecation Pattern

PURPOSE The purpose of this study was to analyze the long-term outcome of the short-pouch and low-anastomosis Duhamel procedure and to evaluate the quality of life after pull-through. We also tried to answer the questions: Does the modified Duhamel procedure produce fecal continence? Is the quality of life correlated to normal bowel function (1–3 per day) without the use of laxatives?MATERIALS AND METHODS Between January 1993 and January 2002, 53 patients, 44 (83 percent) males and 9 (17 percent) females, who underwent a Duhamel procedure were assessed retrospectively. Of the 53 children, 36 (67.9 percent) underwent a primary Duhamel procedure at our institute (Group A). Seventeen (32.1 percent) patients had a primary Duhamel pull-through and subsequently a stoma before a redo modified Duhamel procedure (Group B). The technical modification was creation of a short rectal pouch of 35 mm, achieving a low colorectal anastomosis 0.5 cm from or on the dentate line. All 53 patients were assessed prospectively by a disease-specific questionnaire. The total score provided a single index of the quality of life associated with fecal continence.RESULTS For Group A (n = 36), the mean period of follow-up was 71.4 ± 29 months. Constipation was seen in four (11.1 percent) patients. In two (5.6 percent) patients there was a mild degree of soiling. Sensation and urge to defecate was intact in 34 (94.4 percent) children who could wait to go to the toilet until it was socially convenient. For Group B (n = 17), the mean period of follow-up was 73.9 ± 31.2 months. Constipation occurred in 17 (100 percent), encopresis in 14 (82.4 percent), and enterocolitis in 15 (88.2 percent) after the primary Duhamel procedure. In comparison, there was complete absence of constipation (100 percent), encopresis (100 percent), and complete resolution of enterocolitis (100 percent) after the redo modified Duhamel (P = 0.001). Continence to solid stools after primary Duhamel was seen in 5 (29.4 percent) vs. 17 (100 percent) after redo modified Duhamel. After the redo modified Duhamel all 17 (100 percent) patients have retained the sensation and urge to defecate and 15 (88.2 percent) can wait to get to the toilet until it is socially convenient. In all 53 patients, the quality of life was good in 86.8 percent (46/53) and correlated directly with fecal continence (r = 0.977). There was no correlation between age of patient and fecal continence (r = 0.597) and rate of fecal incontinence did not decrease with age. Direct correlation was seen with the presence of constipation and the incidence of late onset enterocolitis (r = 0.942).CONCLUSIONS Short-pouch, low-anastomosis Duhamel pull-through procedure results in fecal continence and complete emptying. The above procedure has a positive impact on the quality of life in these children.     

俯卧位双镜联合微通道经皮肾镜同期治疗复杂性肾结石的有效性与安全性

目的:探讨俯卧位输尿管软镜联合微通道经皮肾镜同期治疗复杂性肾结石的有效性与安全性。方法:选取2017年7月至2019年3月于本院就诊的30例复杂性肾结石患者。其中15例患者一期均采取俯卧位输尿管软镜联合微通道经皮肾镜钬激光碎石术(双镜联合组),另外15例采取截石位单一微通道经皮肾镜钬激光碎石术治疗(对照组)。结果:双镜...     

Gaussian source model based iterative algorithm for EEG source imaging

Estimation of the neural active sources from the scalp electroencephalogram (EEG) is an ill-posed inverse problem. In this paper, we propose a new source model: Gaussian distributed Source Model (GSM), to model the activations in brain. GSM may imitate an Isolated Source Model (ISM) or a Distributed Source Model (DSM) by adopting different supporting range parameter of the Gaussian function. Using GSM, an iterative Gaussian source Imaging Algorithm (GIA) is developed to detect the EEG sources. As GIA dynamically reduces the solution space, the solution may gradually converge to a desired distribution. A comparative evaluation among LORETA, FOCUSS and GIA was conducted for both isolated point sources and distributed sources, the results demonstrate that GIA is more flexible and efficient for various actual sources configurations. Finally, GSM was applied to real recordings obtained from a visual spatial attention task; the corresponding source activation areas of the early component are localized in contralateral occipital cortices, consistent with the retinotopic organization of early visual spatial attention effects.     

Foreign body ingestion causing gastric and diaphragmatic perforation in a child

Foreign body ingestion is a common problem in children. Most ingested foreign bodies pass through the gastrointestinal tract without difficulty once they reach the stomach. Perforation of the gastrointestinal tract very rarely occurs. This case report discusses the clinical presentation and management of a very unusual case of an eyeliner pencil ingested by a child that perforated the stomach and diaphragm, causing empyema.     

Tracheobronchopathia osteochondroplastica in a patient with silicosis: CT, bronchoscopy, and pathology findings

A case of tracheobronchopathia osteochondroplastica in a patient with silicosis is reported, showing a rare association of disease. Etiological hypotheses and clinical aspects are discussed. Radiologic, bronchoscopic, and pathologic findings are demonstrated with emphasis on the role of computed tomography (CT) in the diagnosis of this disease.     

Detecting child sexual abuse in general practice: a retrospective case-control study from Wales

OBJECTIVE: To investigate if routine medical contacts provide indicators that would assist general practitioners in detecting male child abuse. DESIGN: A case-control study of the general practice records of male victims of a major episode of school-based child abuse and matched controls. SETTING: General practices serving cases and controls from two South Wales schools. SUBJECTS: 107 abused boys and 107 aged-matched controls. RESULTS: No boys had disclosed sexual abuse to general practitioners. Somatic and behavioural symptoms were reported by small numbers in both groups (18 cases/25 controls). Odds ratios showed no significant positive association between abuse and numbers of boys presenting with symptoms (odds ratio 0.66; 95% confidence interval 0.32-1.37), and no difference could be found in the nature of the symptoms complained of by boys from the two groups. However, abused boys were more likely than controls to present with symptoms that persisted for more than a year (eight cases compared with one control). The two-tailed p-value calculated using the Fisher exact test was 0.035, suggesting a statistically significant association between abuse and persistent symptoms. CONCLUSIONS: Sexually-abused boys are unlikely to visit general practitioners with open requests for help, and do not appear to present with behavioural or somatic symptoms different from those presented by non-abused boys. However, where boys complain of persistent, inexplicable, somatic or behaviour problems over a period of time, the possibility of abuse should be considered.