过敏性紫癜并发少见临床表现12例报告

过敏性紫癜(AP)除常见的皮肤、关节、肾脏、消化道及心血管表现外,还可出现少见的神经系统、肺脏、睾丸等损害。我院儿科于1990～1994年收治的AP并发少见的临床表现12例,现如报告如下。 临床资料 一、一般资料 12例具少见临床表现患儿,男10例,女2例。年龄3～14岁。其中6例为一过性神经系统受累,4例为肺脏受累,2例并发睾丸炎。

Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery

AIM:To determine the relationship between pre-operative hypoalbuminemia and the development of complications following rectal cancer surgery, as well as postoperative bowel function and hospital stay. METHODS:The medical records of 244 patients undergoing elective oncological resection for rectal adenocarcinoma at Siriraj Hospital during 2003 and 2006 were reviewed. The patients had pre-operative serum albumin assessment. Albumin less than 35 g/L was recognized as hypoalbuminemia. Postoperative outcomes, including mortality, complications, time to first bowel movement, time to first defecation, time to resumption of normal diet and length of hospital stay, were analyzed. RESULTS:The patients were 139 males (57%) and 105 females (43%) with mean age of 62 years. Fifty-six patients (23%) had hypoalbuminemia. Hypoalbuminemic patients had a significantly larger tumor size and lower body mass index compared with non-hypoalbuminemic patients (5.5 vs 4.3 cm;P < 0.001 and 21.9 vs 23.2 kg/m2;P = 0.02, respectively). Thirty day postoperative mortality was 1.2%. Overall complication rate was 25%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (37.5% vs 21.3%;P = 0.014). In univariate analysis, hypoalbuminemia and ASA status were two risk factors for postoperative complications. In multivariate analysis, hypoalbuminemia was the only significant risk factor (odds ratio 2.22,95% CI 1.17-4.23;P < 0.015). Hospitalization in hypoalbuminemic patients was significantly longer than that in non-hypoalbuminemic patients (13 vs 10 d, P = 0.034), but the parameters of postoperative bowel function were not significantly different between the two groups. CONCLUSION:Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following rectal cancer surgery.

Severe thrombocytopenia before liver transplantation is associated with delayed recovery of thrombocytopenia regardless of donor type

AIM： To compare the recovery of thrombocytopenia and splenomegaly during long-term follow-up after liver transplantation in patients receiving a living donor transplant or a cadaveric donor transplant. METHODS： This was a retrospective cohort study of 216 consecutive liver transplant patients who survived for 〉 6 mo after transplantation; 169 received a liver transplant from a living donor and 47 from a cadaveric donor. The platelet counts or spleen volumes were examined before transplant, i, 6, and 12 mo after transplant, and then annually until 5 years after transplant. RESULTS： The mean follow-up period was 49 mo （range, 21-66）. Platelet counts increased continuously for 5 years after orthotopic liver transplant. The restoration of platelet counts after transplant was significantly slower in patients with severe pretransplant thrombocytopenia （〈 50000/μL） until 4 years after transplant （P = 0.005）. Donor type did not significantlyaffect the recovery of platelet count and spleen volume in either patient group. In multivariate analysis, pretransplant severe thrombocytopenia （〈 50000/μL） was an independent factor associated with sustained thrombocytopenia （P 〈 0.001, odds ratio 6.314; confidence interval, 2.828-14.095）. Thrombocytopenia reappeared after transplant in seven patients with portal flow disturbance near the anastomosis site. CONCLUSION： Our study suggests that severe thrombocytopenia before transplant is closely associated with delayed recovery of platelet count after transplant and donor type did not affect the recovery of thrombocytopenia. The reappearance of thrombocytopenia after transplant should be considered a possible indicator of flow disturbance in the portal vein.

Clinical Observation of Combined Acupuncture ＆ Medications in Treating Dysspermia Infertility

Objective： To observe the curative effect of combined acupuncture and medication on infertility due to seminal abnormality. Method： Thirty-eight patients with seminal abnormality were separately treated by acupuncture and traditional Chinese medications （“Erxian Decoction”） plus Clomiphene. Results and Conclusion： The total effective rate was 96.0% in the acupuncture plus traditional Chinese medication group （26 cases） and 66.7% in the acupuncture and western medication groups （12 cases）. Statistical analysis showed a significant difference （P〈0.05）. The cure rate and the pregnancy rate were 38.5% and 30.8% respectively in the acupuncture and traditional Chinese medication group. Both of them were higher than 8.3% and 8.3% in the acupuncture and western medication group respectively, but there were no statistically significant differences. In the two groups of patients, seminal volume, liquefaction time and viscosity and spermatozoal density, death rate and one-hour survival rate took a significant turn for the better after treatment as compared with before treatment （P〈 0.05）. In the acupuncture and traditional Chinese medication groups of patients, symptoms markedly improved after treatment as compared with before treatment.