Successful treatment of concomitant pulmonary Nocardiosis and aspergillosis in an immunocompromised renal patient

A case is reported of rapid onset concomitant pulmonary infection withNocardia andAspergillus fumigatus in a patient six weeks after the institution of immunosuppressive therapy for renal vasculitis. Pulmonary lesions completely resolved on treatment with a combination of imipenem, cotrimoxazole and a prolonged course of itraconazole.     

Developmental effects of multiple looks in speech sound discrimination.

PURPOSE: The change/no-change procedure (J. E. Sussman & A. E. Carney, 1989), which assesses speech discrimination, has been used under the assumption that the number of stimulus presentations does not influence performance. Motivated by the tenets of the multiple looks hypothesis (N. F. Viemeister & G. H. Wakefield, 1991), work by R. F. Holt and A. E. Carney (2005) called this assumption into question (at least for adults): Nonsense syllable discrimination improved with more stimulus presentations. This study investigates the nature of developmental differences and the effects of multiple stimulus presentations in the change/no-change procedure. METHOD: Thirty normal-hearing children, ages 4.0-5.9 years, were tested on 3 consonant-vowel contrasts at various signal-to-noise ratios using combinations of 2 and 4 standard and comparison stimulus repetitions. RESULTS: Although performance fell below that which is predicted by the multiple looks hypothesis in most conditions, discrimination was enhanced with more stimulus repetitions for 1 speech contrast. The relative influence of standard and comparison stimulus repetitions varied across the speech contrasts in a manner different from that of adults. CONCLUSION: Despite providing no additional sensory information, multiple stimulus repetitions enhanced children's discrimination of 1 set of nonsense syllables. The results have implications for models of developmental speech perception and assessing speech discrimination in children.     

筛检对肝癌死亡率影响的研究

5581名HBsAg阳性的男性随机分入周期性筛检组(A组,3712人)及对照组(B组,1869人)。A组(19155.4人年)共发生肝癌257例,B组(9785.5人年)为117例,两组的肝癌发生率分别为1342/10万与1196/10万;两组肝癌死亡分别为218与109例,肝癌死亡率分别为1138/10万与1114/10万。两组中Ⅰ期肝癌病例分别为29.6％与6.0％,差异有非常显著性意义。1、3、5年相对生存率A组为23.7％、7.0％、4.0％,B组为9.7％、4.0％、4.1％。用Poisson回归模型拟合显示,在调正年龄、初筛AFP及入列年份后,筛检对于肝癌的相对危险度为0.83,95％CI为0.68～1.03,有较弱的“保护”作用,Cox回归模型拟合结果显示当临床分期未引入模型时,筛检对于肝癌有显著的“保护”作用:危险率为0.6617,95％CI为0.5234～0.8365;而模型经调整后,危险率即接近“1”,95％CI为0.74～1.26。     

Treatment of a Giant Haemangioma of the Liver With Kasabach-Merritt Syndrome by Orthotopic Liver Transplant

We describe a case of giant cavernous haemangioma of the liver with disseminated intravascular coagulopathy (Kasabach-Merritt syndrome) which was cured by orthotopic liver transplant.A 47 year old man presented with bleeding and tender massive hepatomegaly after tooth extraction. Investigations showed disseminated intravascular coagulopathy and a giant hepatic haemangioma involving both lobes of the liver. Initial treatment failed to resolve the coagulopathy and liver resection was attempted. At laparotomy the turnout was unresectable and the only option for cure was to offer a liver transplantation. The orthotopic liver transplant was performed 20 days after initial laparotomy. Subsequently, all coagulation parameters returned to normal and the patient remains well after 12 months. Orthotopic liver transplant can be considered for giant hepatic haemangioma with Kasabach-Merritt syndrome when resection is necessary and a partial hepatectomy is not technically feasible.