Zhonghua yi xue za zhi = Chinese medical journal; Free China ed最新文献

Background: Transferrin is a useful index of visceral protein, but it is unknown whether changes in the level of transferrin can be used as a prognostic marker for patients receiving nutrition support.

Methods: Consecutive in one-year period, we recorded the data of 325 patients who with unusable gastrointestinal tract received total parenteral nutrition (TPN) for more than 2 weeks. The data included the levels of serum transferrin, albumin, total bilirubin, hemoglobin and white blood cell before and after 2-week nutrition support. Age, sex, body weight, diagnosis, and hospital outcome were also recorded. A total of 305 patients with complete initial data and 221 patients with data on TPN-induced level change were enrolled and evaluated statistically.

Results: The mortality rate was 47.6% in the group of patients who showed no increase of serum transferrin after 2 weeks of TPN. Univariate analysis revealed that the initial level and TPN-induced changes of serum transferrin, albumin and total bilirubin were significantly correlated with patient survival. However, multivariate analysis showed that the initial level of transferrin, albumin, total bilirubin and the TPN-induced level changes in transferrin were independent factors significantly correlated with patient survival. Two of the most the significant factors among them were initial level of transferrin (p < 0.0001, odds ratio = 2.4838) and change in serum transferrin level after 2 weeks of TPN (p < 0.0001, odds ratio = 2.664).

Conclusions: Changes in serum transferrin level in patients with intestinal failure who received TPN for 2 weeks appear to be a good indicator of patient outcome.

Background: Correct diagnosis of otitis media with effusion (OME) in children is imperative for instituting appropriate treatment. This study aims to establish the diagnostic value of pneumatic otoscopy, tympanometry, acoustic reflectometry and videotelescopy by comparing them with myringotomy findings.

Methods: Between November 1999 and July 2001, we conducted a prospective study on diagnosis of OME in children. The children studied were candidates for ventilation tube insertions or other ENT surgeries. All tests, including acoustic reflectometry, tympanometry, pneumatic otoscopy and videotelescopy, were performed two days before surgery. Myringotomy or tympanocentesis was then performed to confirm the presence or absence of OME. A type B tympanogram was accepted as a predictor of effusion. The curve angle of acoustic reflectometry with cut-point of 69 degrees (< or = 69 degrees) was also used to predict the presence of OME.

Results: Eighty-nine children (58 males and 31 females), ranging in age from 1 to 13 years, participated in the study. Of 172 ears assessed in the study, middle ear effusion was detected in 124; the remaining 47 ears were found to be dry at myringotomy or tympanocentesis. Videotelescopy gave the highest sensitivity, specificity and accuracy, followed by pneumatic otoscopy, tympanometry and acoustic reflectometry.

Conclusions: Videotelescopy seems to have the potential to become the standard for diagnosis of OME in children and for validation of pneumatic otoscopy. When videotelescopy is not available, tympanometry could be an instrumental adjunct to pneumatic otoscopy. Although acoustic reflectometry gave the worst results, it is still useful for assessing and screening OME in children because of the ease and speed of its operation irrespective of crying, cerumen, an air seal in the ear, or lack of cooperation from the young children.

Background: The prevalence of left side superior vena cava (LSVC) is low and usually invasive angiography is necessary to validate its presence. Non-invasive echocardiographic study is important for the diagnosis and definition of associated lesions. The aim of this study is to demonstrate the clinical feasibility and accuracy of diagnosing LSVC by contrast echocardiography.

Methods: Four cases were included in this study. They were aged from 41 to 75 years old, 1 male and 3 female, all in sinus rhythm, with mean heart rate 83 +/- 14 beat per minute. They all received transthoracic echocardiography and transesophageal echocardiography. Contrast material was rapidly infused from both left arm vein and right arm vein to evaluate the diagnostic value of contrast enhancement for LSVC. They also received invasive angiographic study as the diagnostic golden standard. An isolated persistent left side superior vena cava with drainage into the right atrium was considered to be present, supposing the following diagnostic criteria were met: (1) the presence of a dilated coronary sinus in parasternal long axis view of two-dimensional echocardiography; (2) earlier enhancement of the dilated coronary sinus than the right cardiac chambers after contrast material infusion into a left arm vein; (3) right cardiac chambers were enhanced earlier than the dilated coronary sinus after contrast material infusion into a right arm vein.

Results: All 4 patients received the complete studies without any complications during the study procedures. Correct diagnostic yields could be obtained even with or without other associated cardiac lesions.

Conclusions: According to the experiences obtained from this study, contrast echocardiography is safe and highly informative for the definite diagnosis of left superior vena cava with drainage into coronary sinus. Correct diagnosis could be obtained by contrast echocardiography in all four cases within this study. The accuracy was 100%, if the above three echocardiographic diagnostic criteria were adopted.

Background: Hydrofluoric acid (HF) is one of the strongest inorganic acids and is used widely in industry. It differs from other acids in the mechanism of injury. The hydrogen ion readily penetrates the skin and causes destruction of deep tissue layers and even bone.

Methods: If HF burns to the digital skin, keep washing with large amounts of tap water for a minimum of 15 minutes. Then topically apply 2.5% calcium gluconate gel and massage for at least 40 minutes. Locally inject with 10% calcium gluconate solution if the pain persists. We studied the cases with HF finger burns in our hospital.

Results: In general, this procedure is effective in the treatment of fingertip hydrofluoric acid burns. In 2 cases, due to attentive treatment, posttreatment conditions were red swelling of the skin only. The posttreatment conditions of the 10 cases have good prognosis. In one case, the worker had very poor sense of first-aid awareness; after her burn was treated with running water, she didn't receive proper treatment immediately. The wound took 20 days to heal. In the last 2 cases, low concentrations of hydrofluoric acid entered the eyes, but after treated with running water, no aftereffects were suffered.

Conclusions: An accurate occupational history and physical examination are important aspects in patient assessment. We hope that this report will assist practitioner to properly manage HF burns.

Scientific development of acupuncture is described to increase its therapeutic efficacy and ultimate utilization. Acupuncture may have central, local and placebo effects. Little is known about the local effects of acupuncture specific to needle penetration and/or movement. Acupuncture points, muscle trigger points and motor end-plate zones are identical. Therefore, the benefit of acupuncture in musculoskeletal pain relief for which it is most commonly used, would not be limited to classical acupuncture points on the meridians. Intramuscular movements of the needle causes insertional activity which can be recorded on electromyography (EMG). The insertional activity occurs from depolarization of innervated single or grouped muscle fiber discharges which are micro-twitches and this is the basis of pain relief with EMG and intramuscular stimulation methods. Occasionally, needle penetration or manipulation in classical or electrical acupuncture may also evoke small local twitches. These observations suggest that needle induced local muscle twitches mediate musculoskeletal pain relief in acupuncture. These micro-twitches are capable of producing micro stretch effects on the adjacent shortened muscle fibers undergoing varying stages of denervation. This reduces the mechanical traction effect produced by these shortened muscle fibers on pain sensitive structures including intramuscular nerves and blood vessels. This theory of stretching shortened muscle fibers to produce pain relief would be justified when even more significant musculoskeletal pain relief can be obtained through inducing larger force twitches. Therefore, automated and electrical twitch-obtaining intramuscular stimulation methods were invented to elicit larger twitches. These methods allow the objective localization of the motor end-plate zones and allow recording of the number, frequency and force of the twitches. Therefore, by mechanism of action and associated therapeutic relief, the twitch may be the local key to pain relief, notjust a diagnostic sign for the localization of myofascial trigger points.

Background: Pain is often inadequately treated in patients with cancer. Previous studies have demonstrated the effectiveness of the World Health Organization (WHO) analgesic ladder in cancer pain management.

Methods: A total of 131 consecutive patients with advanced cancer referred to a hospice home care program were enrolled over one year period from Jan. 1 to Dec. 31, 2000. We assessed the adequacy of prescribed analgesic drugs using guidelines developed by the WHO. Age, gender, Eastern Cooperative Oncology Group performance status, pain mechanism at referral, pain and symptom intensity, and doses and days of drug administration during the course of treatment were recorded at regular intervals.

Results: Eighty-two percent of the patients (107 of 131) had pain symtoms at referral. Forty-seven patients were excluded from this study due to inadequate follow-up times or inability to express the pain intensity. Sixty patients who had measurable pain intensity requiring analgesic therapy were followed up until death for a mean duration of 65 days. At referral, 46% of the patients (28 of 60) received inadequate treatment. In the last week of life, 2%, 26% and 70% of patients were taking non-opioid drugs, moderate opioids and strong opioids, respectively. A significant improvement in pain and symptom intensity was achieved after referral. A minority of the patients (10%) had inadequate pain control in the last week of life.

Conclusions: This study demonstrates that a managed hospice home care system enables patients to receive adequate pain treatment, according to WHO guidelines.

Background: Remnants of thyroid tissue are always present after surgery performed for thyroid cancer, and their ablation with I-131 is associated with decreased recurrence rates and probably increased survival. Administration of a single dose in excess of 50 mCi of I-131 requires hospitalization. In an attempt to obviate the necessity for hospitalization, the ablative dose was divided into three fractions given at weekly intervals. The purpose of this study was to assess the effectiveness of this approach.

Methods: We retrospectively analyzed the success rate of ninety-nine patients from 1995 to 1999 with thyroid carcinoma who received fractionated dose of ablation. Iodine-131 whole body scan was done 6 months after ablation to evaluate treatment efficacy. In addition, measurement of serum thyroglobulin (Tg) was obtained in 81 patients.

Results: "Successful ablation" has been defined as the absence of all residual thyroid uptake in the I-131 whole body scan. Ablation of thyroid remnants was successful in 71 of 99 (71.7%) patients (papillary cell type 89%; follicular cell type 53%). In 54 patients with negative I-131 whole body scan, 39 patients had undetectable serum Tg, and 11 patients were with serum Tg level below 10 ng/ml. In 27 patients with positive I-131 whole body scan, 15 patients had undetectable serum Tg.

Conclusions: We suggest that the use of fractionated doses of 1-131 is a reasonable approach to ablation therapy. Tg measurement appears to be superior to I-131 whole body scan in follow-up of patients with differentiated thyroid carcinoma. However, Tg measurement can certainly not replace I-131 whole body scan. A combined application of I-131 whole body scan and Tg radioimmunoassay is thus advisable.

Background: Correct tracheal intubation in critically ill patient is very important in intensive care medicine. The purpose of this study is to evaluate the value and accuracy of the flexible fiberoptic bronchoscopy (FFB) in confirming the endotracheal tube (ETT) position and to compare with the chest radiograph method in intubated pediatric and neonate patients.

Methods: We prospectively used the FFB to evaluate the ETT position in the pediatric and neonate intensive care units (ICUs) from January 2000 to December 2000. The distance between the ETT tip and the trachea carina measured by FFB (TC-FFB) was recorded and compared with that by the chest radiograph (TC-CR). The consuming time needed for checking the ETT position was also compared between these two methods.

Results: There were 74 cases enrolled. There was a significant correlation between TC-FFB and TC-CR (r = 0.898, p = 0.000). It took less time to confirm the ETT position by using the FFB than by the post-intubation chest radiograph (0.3 +/- 0.1 min vs. 103.8 +/- 45.2 min, p < 0.05). No major complication was noted in performing the FFB measurement.

Conclusions: FFB is an accurate, convenient, timesaving and less traumatic technique in confirming the correct ETT position for the critical and emergent patients in the pediatric and neonate ICUs.