2004年 · 第117卷第03期

Background Keyhole surgery has developed since the 1990s as a less invasive therapeutic strategy for intracranial lesions, initially for the treatment of intracranial aneurysms. The purpose of this study was to describe and evaluate the results of surgical treatment of lesions in the anterior fossa and sellar region via a supraorbital keyhole approach using eyebrow incisions. Methods Between April 1994 and July 2003, 54 patients with lesions in the anterior fossa and sellar region were operated on via the supraorbital keyhole approach. The surgical results were studied retrospectively and compared with that of patients with lesions at the same locations but treated via a conventional subfrontal approach. Results No significant difference in curative effect was found between the conventional subfrontal approach and the supraorbital keyhole approach. However, the supraorbital approach required a much smaller skin incision, causing less surgical trauma, while achieving excellent surgical exposure and good recovery. Conclusion The supraorbital keyhole approach using an eyebrow incision is safe, effective, and both suitable and convenient for treating lesions in the anterior fossa and sellar region, with almost no adverse consequences on the facial features of patients. Chin Med J 2004; 117(3): 323-326

Background Colles' fracture usually associated with osteoporosis is regarded as the predictor of subsequent osteoporotic fracture. However, it is not clear how the local changes of bone mass take place during the course of treatment and whether the changes are related to clinical practice. The objective of the current study was to investigate the local changes of bone mass in patients with Colles' fracture and their possible clinical relevance in a follow-up study. Methods The radiograms of the second metacarpal in 64 patients with Colles' fracture were assessed for bone density immediately after fracture, 6 weeks, 6 months and 1 year after fracture,respectively. Functional results were evaluated at one year. Results Bone mass six weeks after Colles' fracture was significantly decreased without returning to normal at one year though increased bone mass had been identified 6 months after fracture (P <0. 05), (P <0. 01). At one year significant (P <0. 05) or highly significant (P <0. 01) correlations were observed between bone mass indices of metacarpal and functional results, indicating that poor function is associated with lower bone density. Significant differences (P <0. 05) between fracture patterns also suggested that patients with more severe fractures have a more pronounced bone loss. Conclusions Bone loss during the course of treatment will have a direct effect upon the prognosis,so different treatment should be proposed for different patterns of fractures. Active exercise should be made to improve the recovery of bone mass. Chin Med J 2004; 117(3): 327-330

Background Some researchers found that partner-perpetrated physical violence increased in frequency and severity during the postpartum period compared with the antenatal period, however, limited data exists describing abuse of women in China. The purpose of this study was to examine patterns of abuse in China before, during, and after pregnancy, and explore possible factors related to abuse. Methods A community-based face-to-face survey of a representative group of women who had a child aged 6 to 18 months in 32 communities of Tianjin, Liaoning, Henan, and Shaanxi provinces was carried out between November 1, 2001 and February 28, 2002. Results The prevalence of domestic abuse (emotional, sexual, or physical) occurring in any period(before, during, or after pregnancy) was 12. 6%. The prevalence of abuse during the approximate 9months of pregnancy (4. 3%) was relatively lower compared with the prevalence of abuse during the 12 months before pregnancy (9. 1 %) and after delivery (8. 3%) during the mean 11-month postpartum period studied. Abuse before pregnancy was a strong risk factor for abuse during pregnancy and abuse after pregnancy, and abuse during any previous period was a strong risk factor for subsequent abuse. Many women who suffered abuse of any kind generally experienced multiple acts over time and most acts were not severe. The results of logistic regression analysis showed that the factors associated with abuse during pregnancy included women previously witnessing domestic violence, a poor relationship with the partner, socioeconomic level, alcohol consumption, and smoking. Conclusions It is necessary to do in-depth training and to raise awareness of partner abuse among all health professionals. Routine screening of abuse in maternity clinics is advocated to decrease the adverse impact of abuse on women and fetuses. Chin Med J 2004; 117(3): 331-336

Background Both real-time three-dimensional echocardiography (RT3DE) and myocardial contrast echocardiography (MCE) are novel imaging techniques. The purpose of this study was to confirm the feasibility and accuracy of RT3DE combined with MCE for quantitative evaluation of myocardial perfusion defects. Methods Thirteen dogs underwent ligation of the left anterior descending artery (LAD, n=6) or distal branch of the left circumflex artery (LCX, n=7) under general anaesthesia. Three to four ml of a perfluoropropane (C3F8) microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with a commercially available Philips SONOS-7500 ultrasound system. After removal of the dog hearts, Evans blue dye was injected via the left and right coronary arteries to stain the myocardium at risk. In vitro anatomic measurements of myocardial mass after removal of the animals' hearts were used as controls. Results Left ventricular (LV) mass determined by RT3DE ranged 36. 7 - 68. 9 g [mean,(54.6±9. 6)g] before coronary artery ligation, and correlated highly (r=0. 99) with in vitro measurement of LV mass [range, 38. 9 -71. 1 g; mean, (55. 6 ±9. 3) g]. There was no significant difference between RT3DE and in vitro measurements of LV mass [range, 36. 7 -68. 9 g; mean,(51.3 ±12. 5) g. Or range, 38. 9 - 71. 1 g; mean, (53.7 ±12.3) g, respectively] and under-perfused mass [range, 0 -21. 4 g; mean, (12. 0 ±6. 9) g. Or range, 0 -19. 8 g; mean, (10. 8 ±6. 3) g, respectively] after the LAD ligation (P> 0. 05). Likewise, no significant difference was present between RT3DE and in vitro measurements of LV mass [range, 50. 1 -65. 4 g; mean, (57. 5±5. 9) g. Or range, 51. 5 -65. 8 g; mean, (57. 3 ±6. 4) g, respectively] and under-perfused mass[range, 0 - 25. 6 g; mean, (13. 3 ± 9. 6) g. Or range, 0 - 22. 7 g; mean, (12. 8 ± 8. 1) g,respectively] after the LCX ligation (P>0. 05). For all the animals with coronary ligation, LV mass measured by RT3DE ranged 35. 9 -68. 6 g [mean, (54. 8 ±10. 0) g] and there was no significant difference between RT3DE and in vitro measurements of LV mass and under-perfused mass (P>0. 05, r=0. 99). Further, the under-perfused mass derived from RT3DE [range, 0 -25. 6 g; mean, (12.7 ±8.2) g] correlated strongly with the in vitro measurements [range, 0 -22. 7 g; mean,(11.9±7.2) g] (r=0. 96). Conclusion RT3DE with MCE is a rapid and accurate method for estimating LV myocardial mass and quantifying perfusion defects. Chin Med J 2004; 117(3): 337-341

Background Studies on selected patients undergoing off-pump versus on-pump coronary artery bypass surgery have produced inconsistent results, especially in patients with multiple coronary artery disease. This study compared the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease. Methods A total of 300 consecutive isolated, multiple coronary artery bypass grafting (CABG)patients were assigned to the off-pump coronary artery bypass (OPCAB, n=150) or CABG with cardiopulmonary bypass (CCABG, n=150) groups. There were no significant differences regarding degree of angina, history of myocardial infarction or diabetes, and presence of left main coronary artery disease between the two groups. Ejection fraction in the OPCAB group before surgery was lower than in the CCABG group (P<0. 01). In addition, more patients had a history of stroke and abnormal renal function preoperatively in the OPCAB group(P <0. 01). In OPCAB patients, single deep pericardial stay suture with a sling snared down was used to expose the target vessels, along with a stabilizer and a coronary shunt. A Medi-Stim Butterfly Flowmeter was used to measure blood flow through grafts in both groups. Results No OPCAB patient was converted to the CCABG group. The average numbers of distal anastomoses and the indexes of completeness of revascularization (ICR) were similar in both groups. Postoperative respiratory support time and the volumes of chest tube drainage and of blood transfusions were less in the OPCAB group than in the CCABG group (both P <0. 01) . The postoperative incidences of pulmonary dysfunction and renal insufficiency were lower in the OPCAB group than in the CCABG group (both P <0. 05). There were no significant differences between the two groups in mortality and other causes of morbidity (periopetative myocardial infarction, stroke,atrial fibrillation). Conclusions OPCAB can be applied to patients with triple-vessel coronary artery disease and can achieve similar completeness of revascularization and similar early surgical results, with shorter respiratory support, reduced transfusion requirement, and fewer cases of pulmonary dysfunction and abnormal renal function. Chin Med J 2004; 117(3): 342-346

Background The incidence of HIV-1 -related infection diseases and the mortality of AIDS have dramatically decreased since highly active antiretroviral therapy began to be used clinically in China in 1999. And we initiated a second clinical trial using a combination of Efavirenz and Indinavir to observe the effects of the immunoreaction. Methods Twenty patients with laboratory-confirmed chronic HIV-1 infection were recruited. Blood samples were collected initially and during the weeks after initiation of treatment. Within 48 hours of blood sampling, peripheral blood plasma and mononuclear cells were separated using routine methods. HIV-1 viral load was measured in thawed plasma samples. Within 48 hours of peripheral blood sampling, CD4+ and CD8+ T cell subsets were enumerated. Results The drug regimen was efficient in reducing HIV-1 plasma viral load and increasing total CD4+ T cell counts. The percentage of CD4+ and CD8+ T cell subsets expressing CD38 and HLA-DR activation markers was positively correlated with plasma viral load and tended to normalize. Conclusions The combination of Efavirenz and Indinavir was generally well tolerated and efficient at reducing HIV-1 RNA. Furthermore, the treatment improved the immunological function. Chin Med J 2004; 117(3): 347-352

Background This study was to assess certain epidemiological and clinical characteristics of astrovirus infection in children with diarrhea below 5 years old hospitalized at the Beijing Children's Hospital. Methods From September 1999 to August 2001, a total of 288 children with diarrhea below 5 years old hospitalized at Beijing Children's Hospital were studied. Fecal specimens collected from each patient were tested for astrovirus by using enzyme immunoassay (EIA) and further serotyped by reverse-transcription polymerase chain reaction (RT-PCR) using serotype-specific primers. Results Astrovirus antigen was positive in 9. 0%of the patients, and the rate of coinfection with rotavirus was 19. 2%among the astrovirus positive patients. The patients with astrovirus infection were at the age of 7 days to 17 months, most (92. 3%) of them were less than 12 months. Astrovirus infection occurred mainly between October and March of the following year. Main symptoms included watery stool, vomiting, fever, and dehydration. Increased activity of myocardial enzyme was seen in 4patients. Of the 22 astrovirus positive specimens, 14 were successfully serotyped by RT-PCR and they were all serotype 1. Conclusions The overall incidence of astrovirus infection in young children with diarrhea hospitalized at the Beijing Children's Hospital was 9. 0%. The predominant serotype was type 1. Astrovirus may play an important role in viral diarrhea in young children in Beijing, China. Chin Med J 2004; 117(3): 353-356

Background This paper aimed to elucidate the changes of hypothalamus-pituitary hormones in patients after total removal of craniopharyngiomas. Methods A total of 40 patients with craniopharyngiomas received surgery. The levels of triiodothyronine (T3), thyroxine (T4), thyrotropic hormone (TSH), antidiuretic hormone (ADH),and adrenocorticotropin (ACTH) were measureed in the 40 patients before surgery and one week after surgery respectively. Results Twenty-eight patients (70%) had hypothyroidism before surgery, but 38 (95%) had hypothyroidism after surgery (P <0. 01). Twenty-three patients (57. 5%) had diabetes insipidus (DI)before surgery and 38(95%) had DI after surgery (P <0. 001). The pre- and post-operative levels of ADH were (2. 49 ±0.30) pg/ml and (2. 80 ±0.29) pg/ml respectively (P> 0. 05), whereas those of ACTH were (23. 97 ±2. 69) pg/ml and (15. 60 ±1. 91) pg/ml respectively (P <0. 05). Conclusions Hormone deficits after total removal of craniopharyngioma appear to be the common complication of surgery. Hypothyroidism and diabetes insipidus are more frequent after surgery than before surgery. Thyroxine and glucocorticoids should be administered routinely after total removal of craniopharyngioma. Chin Med J 2004; 117(3): 357-360

Background Because of lacking skills in scanning the normal fetal facial structures and their corresponding ultrasonic features, misdiagnoses freguently occur. Therefore, we studied the appearance features and improved displaying skills of fetal facial anatomy in order to provide basis for prenatal diagnosis. Methods Twenty fetuses with normal facial anatomy from induced labor because of other malformations except facial anomalies were immersed in a water bath and then scanned ultrasonographically on coronal, sagittal and transverse planes to define the ultrasonic image features of normal anatomy. The coronal and sagittal planes obtained from the submandibular triangle were used for displaying the soft and hard palate in particular. Results Facial anatomic structures of the fetus can be clearly displayed through the three routine orthogonal planes. However, the soft and hard palate can be displayed on the planes obtained from the submandibular triangle only. Conclusions The superficial soft tissues and deep bony structures of the fetal face can be recognized and evaluated by routine ultrasonographic images, which is a reliable prenatal diagnostic technique to evaluate the fetal facial anatomy. The soft and hard palate can be well demonstrated by the submandibular triangle approach. Chin Med J 2004; 117(3): 361 -365

Background The stage-specific expression of genes is one of the most characteristics of parasites. It has been found that a lot of genes of Spriometra erinaceieuropaei are specifically expressed in pleroceroid in large amount, but not expressed when the plerocercoid development into adult worm. The study is to screen other stage-specific ecpression genes of plerocercoid of Spirtmetra erinceieuropaei. Methods RNA was separately extracted by acid guanidinium thiocyanate-phenol-chloroform from plerocercoids and adult worms of Spirometra erinaceieuropaei, DNA contaminated in the RNA was digested by RNase-free DNase. After the RNA was reverse transcripted to cDNA using T12 MA, T12MC, T12 MG and T12 MT anchor-primers, PCR was done using the same T12 MN and one random primer with a 35S-dATP in the system. The PCR products were fractionated on an 8%denatured polyacrylamide gel. Differential bands of the plerocercoid found in the gel were cut out, amplified by PCR and sequenced. Northern hybridization was used to identify the stage-specific expression genes. Results Eleven differential bands were selected from the gel and classified into 3 kinds of gene fragments by hybridization, after they were amplified by PCR. Fragments 1 (238 bp) and 2 (383bp), were confirmed by Northern hybridization, as being expressed in the plerocercoid. However, fragment 3 (433 bp), was expressed in both the plerocercoid and the adult worm. Data from the 3gene fragments underwent homological analysis in GenBank. The sequence which was homologous with fragments 1 and 2 was not found, but fragment 3 had high homology with many kinds of 28S rRNA. Conclusions The gene expressions of plerocercoids are different from adult worms because they live in different hosts. Two types of different gene fragments from the plerocercoid were found by mRNA differential display technique. Chin Med J 2004; 117: (3)366-370

Objective To evaluate the efficacy and safety of misoprostol in term labour induction. Data sources Data from published English and Chinese literatures about misoprostol in term labour induction were identified from Medline and CBMdisk (using the search terms "misoprostol" and "labour induction") before 2001; hand searches of reference lists of original studies and reviews(including meta-analyses) and contact with investigators in this field before 2001. Study selection Studies were included if they had data on misoprostol and labour induction. Altogether 623 articles were found and 124 were admitted, including 19 287 cases. Data extraction Data were collected on efficacy and incidence of side-effects of misoprostol and oxytocin. Data were checked for consistency within the published articles and converted into a standard format for incorporation into a central database. Data synthesis The average successful induction rate, rates of caesarean section; incidence of tachysystole, hypertonus of uterus and precipitous labour, and rates of meconium stained amniotic fluid between the misoprostol and oxytocin groups were significantly different (P <0. 05). There were no significant differences between the two groups concerning the average interval from the administration of misoprostol and oxytocin to the onset of labour, duration of the total stage of labour,incidence rate of foetal distress, neonatal asphyxia (1 -minute Apgar score ≤ 7), postpartum haemorrhage or amount of blood loss in postpartum. Conclusions Misoprostol is a superior agent over oxytocin on the induction of term labour, but its application might increase the risk of precipitatous labour, abnormal uterine contractions or meconium stained amniotic fluid. Therefore, the doasges and regimens of the agent need further investigation. Chin Med J 2004; 117(3): 449-452