Renal growth after neonatal urinary tract infection

This study presents the result of 12–21 years' follow-up in a group of children with neonatal urinary tract infection (onset within 1 month after birth) in whom early renal growth retardation was noted without concomitant classical renal scarring. In all cases the neonatal infection was diagnosed and treated within a few days of onset and the patients were closely supervised thereafter. Renal length, parenchymal thickness and area were measured at urography. At first follow-up (22 children, mean age 4.1 years) a significant reduction of renal parenchymal thickness was noted. Long-term follow-up (18 patients, mean age 17 years) demonstrated a normalization of renal size in the entire group, although less complete in the subgroup with reflux. There were two major findings in the present study. Firstly, renal growth retardation was seen after neonatal infection, both with and without reflux. Secondly, normalization of renal size in previously small kidneys was demonstrated, suggesting that growth retardation can be a reversible phenomenon. The tendency for such normalization was slightly more marked in children without reflux. Reduction of parenchymal thickness without calyceal deformity, therefore, does not necessarily mean irreversible damage, and differentiation between permanent scarring and temporary growth retardation can thus only be made at later follow-up, possibly not until after puberty. The demonstration of renal growth retardation in spite of early diagnosis and treatment emphasizes the great vulnerability of the kidney in the newborn.     

腔隙性脑梗死的MRI与CT的诊断价值

目的:探讨腔隙性脑梗死的影像学特点及其临床意义,比较MRI和CT的诊断价值。方法:对120例经临床、MRI诊断明确为腔隙性脑梗死患者的病灶形态大小、部位、数量进行统计。结果:①120例行MRI检查患者共发现病灶890个,最多见于豆状核(占40.8%),其次为放射冠、丘脑、内囊、尾状核、桥脑,可为圆形、椭圆形、条索状病灶。②32例既做CT,又做MRI患者中,MRI检出的病灶数为CT的5.1倍,其中绝大多数CT漏检病灶直径≤5mm或位于幕下。结论:①腔隙性脑梗死常为多发,且第一次临床发病时多数患者颅内已存在无症状性腔隙性脑梗死病灶;②腔隙性脑梗死灶易为CT忽略,尤其是幕下病灶或≤5mm的病灶,这是造成既往文献报道腔隙性脑梗死好发部位差异较大的一个主要原因;③尽管腔隙性脑梗死病灶较小(≤10mm),但大部分(60.0%)急性期存在在周边水肿,需要相应的临床治疗。     

Tumor-Like Meniscal Cyst

A 50-year-old woman presented with a 5-year history of mild pain in her right knee, which had increased over the last 2 years. A palpable mass over the anterolateral aspect of the knee was obvious and the last 3 months she was experiencing locking episodes with consequent knee effusion. The differential diagnosis was driven between meniscal cyst, pigmented villonodular synovitis, synovial sarcoma, synovial chondromatosis, and aneurysm. After a diagnostic arthroscopy, the lesion was excised by a limited lateral arthrotomy. The pathologic findings revealed a synovial cyst. Intra-articular synovial cysts are uncommon, nonsymptomatic, and mostly incidental findings on magnetic resonance imaging (MRI) and arthroscopy. This lateral meniscus synovial cyst (2.5 × 2.5 cm) was enlarged within the intracondylar notch and produced disabling knee symptoms. The peculiarity of this lesion was the tumor-like appearance: its large size, the progress of symptoms, and the multilobulated, nonhomogenous signal on the MRI scan. One year postoperatively, the patient is asymptomatic and the MRI obtained at 6 months revealed no remnant of the fully excised cyst.     

Bile leak after laparoscopic cholecystectomy

Summary Laparoscopic cholecystectomy has now become the preferred surgical approach to symptomatic cholelithiasis. With the widespread use of this technique there have appeared reports of complications. We report the case of a patient who developed a cystic duct stump bile leak after laparoscopic cholecystectomy. Percutaneous drainage of the biloma, endoscopic retrograde cholangiopancreatography and papillotomy led to resolution of the problem. The literature on cystic duct stump leaks after laparoscopic cholecystectomy is reviewed and the various therapeutic modalities are outlined.     

Wertigkeit der EKG-Telefon-Telemetrie in der Erfassung symptomatischer Herzrhythmus-Störungen

Summary The ECG-telephone-transmission (TTM) was used to record an ECG-strip during a typical symptomatic period in patients complaining of symptoms possibly caused by arrhythmias (palpitations, dizziness, paroxysm tachycardia, pulse irregularities; angina and dyspnea only if other reasons could be excluded). Patients complaining of syncope only were not admitted, because of the inability to make a telephon call successfully during such a symptomatic period. The ECG was transmitted to the CCU using a frequency modulation technique. In 60% of 196 patients an ECG-TTM could be achieved during a typical symptomatic period, whereas arrhythmias as cause for the symptoms could be excluded in 51 patients (26%). The remaining 66 patients (34%) demonstrated various arrhythmias ranging from simple SVPB and PVC to total AV-block and sustained VT.TTM, an easy-to-perform and cost-effective method allowed a successful ECG registration during a symptomatic period in almost two-thirds of symptomatic patients. In these patients arrhythmias could be verified or excluded as cause of the symptoms.

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Abkürzungsverzeichnis TTM EKG-Telefon-Telemetrie - HF Herzfrequenz - SA-Block sinu-aurikulärer Block - AV-Block atrio-ventrikulärer Block - SVES supraventrikuläre Extrasystole(n) - VES ventrikuläre Extrasysteole(n) - KHK koronare Herzkrankheit - VH-Flimmern Vorhof-Flimmern - parox. paroxysmal - C.C.I.T.T. Internationale Post-Organisation - Ö.P.T. Österreichische Post- u. Telegraphen-Verwaltung - LZ-EKG Langzeit-EKG     

洛赛克治疗症状性胃食管反流病95例临床观察

目的了解洛赛克强力抑酸作用对胃食管反流病(GERD)患者临床症状改善及胃镜下食管炎症改善情况.方法将95例GERD病人随机分为两组,用洛赛克(20mg qd)50例,雷尼替丁(150mg Bid)45例,疗程4周,停药2周后胃镜复查,观察临床症状及食管炎症改善情况.结果治疗组临床症状改善有效率为91.6%,对照组为50.4%.治疗组胃镜下食管炎症改善有效率为70%,对照组为29.2%.治疗组明显优于对照组.结论对GERD病人抑制胃酸分泌,减轻其对食管粘膜的损伤和改善临床症状洛赛克有较好的疗效,其作用已被公认,但在食管炎症愈合方面疗效不太满意,如与促动力药物合用,可望更高疗效.     

Immune cell landscape in symptomatic and asymptomatic SARS-CoV-2 infected adults and children in urban Dhaka,Bangladesh

ObjectivesThe study of cellular immunity to SARS-CoV-2 is crucial for evaluating the course of the COVID-19 disease and for improving vaccine development. We aimed to assess the phenotypic landscape of circulating lymphocytes and mononuclear cells in adults and children who were seropositive to SARS-CoV-2 in the past 6 months.MethodsBlood samples (n = 350) were collected in a cross-sectional study in Dhaka, Bangladesh (Oct 2020-Feb 2021). Plasma antibody responses to SARS-CoV-2 were determined by an electrochemiluminescence immunoassay while lymphocyte and monocyte responses were assessed using flow cytometry including dimensionality reduction and clustering algorithms.ResultsSARS-CoV-2 seropositivity was observed in 52% of adults (18–65 years) and 56% of children (10–17 years). Seropositivity was associated with reduced CD3⁺T cells in both adults (beta(β) = ?2.86; 95% Confidence Interval (CI) = ?5.98, 0.27) and children (β = ?8.78; 95% CI = ?13.8, ?3.78). The frequencies of T helper effector (CD4⁺T_EFF) and effector memory cells (CD4⁺T_EM) were increased in seropositive compared to seronegative children. In adults, seropositivity was associated with an elevated proportion of cytotoxic T central memory cells (CD8⁺T_CM). Overall, diverse manifestations of immune cell dysregulations were more prominent in seropositive children compared to adults, who previously had COVID-like symptoms. These changes involved reduced frequencies of CD4⁺T_EFF cells and CD163⁺CD64⁺ classical monocytes, but increased levels of intermediate or non-classical monocytes, as well as CD8⁺T_EM cells in symptomatic children.ConclusionSeropositive individuals in convalescence showed increased central and effector memory T cell phenotypes and pro-resolving/healing monocyte phenotypes compared to seronegative subjects. However, seropositive children with a previous history of COVID-like symptoms, displayed an ongoing innate inflammatory trait.     

仙附,芪地强心口服液治疗老年人慢性心功能不全

目的：寻求老年人心功能不全有效、安全的治法方药。方法：用仙附、芪地强心口服液与巯甲丙脯酸对照治疗老年心功能不全,观察心脏功能和血浆血管活性肽、临床症状、体征及药物安全性。结果：仙附、芪地强心口服液和巯甲丙脯酸治疗心功能不全总有效率分别为８７．５％（２８／３２）、９０．３％（２８／３１）、９０．６％（２９／３２）,三者差别无显著性（Ｐ＞０．０５）;在临床近期治愈率方面,分别为４３．８％（１４／３２）、５１．６（１６／３１）、２５．０％（８／３２）,芪地组优于巯甲丙脯酸对照组;对改善患者临床症状、体征、心脏功能和血浆血管活性肽指标等方面都显示明显效果。结论：老年人心功能不全可以益气养阴、温阳治本、活血利水治标为基本大法,仙附、芪地强心口服液是治疗本病的安全有效方药     

Outcomes of Carotid Revascularization in Patients with Contralateral Carotid Artery Occlusion

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