Nonoperative treatment of Hirschsprung's disease: a new approach.

The approach of the combined traditional Chinese and modern medicinal treatment of Hirschsprung's disease has been applied in 90 cases. Long-term follow-up showed satisfactory results. Of these, 55 cases with a typical history, plus a positive ACHE and x-ray were selected for analysis and discussion, making an over all rate of 78.18%. This treatment is particularly useful for those babies under 1 year of age with a short narrow segment of the rectum. In addition, it would be a good trial procedure for those babies over 1 year old with mild symptoms and the narrow segment just beyond the sigmoidorectal junction.

Bone imaging as an aid for the diagnosis of osteopoikilosis.

An unusual case of osteopoikilosis was found in a 52-year-old black woman. The rather large diffuse focal increased densities involving the ribs, spine, and pelvis as seen in the roentgenograms were believed to represent metastatic bone lesions. The normal nuclide bone images helped revise the diagnosis to osteopoikilosis. Early recognition of osteopoikilosis would have prevented the patient's apprehension and the extensive work-up for the primary tumor.

A simplified method of assessing hemodynamics in technetium-99m sulfur colloid liver imaging.

A total of 204 Tc-99m sulfur colloid hemodynamic studies of the liver taken at 5-second intervals were evaluated. The time when the gradually increasing activity in the liver becomes equal to the reducing activity in the heart pool is defined as the relative half clearance time (RHCT) of cardiac activity to the liver. The RHCT was measured in each scan and was correlated with clinical information, liver function tests, and static scan findings. Normal RHCT was established to be in the range of 40 +/- 20 seconds. This study indicates that the RHCT truly reflects the functional status of the hepatic blood flow as well as the phagocytic activity of the Kupffer cells of the liver when cardiac function is normal. A prolonged RHCT may indicate the presence of a parenchymal disease of the liver or cardiac failure with hepatic congestion, or both. The longer the RHCT, the more severe the pathologic condition of the liver, provided that cardiac function is normal.

An improved technique of loading contrast material for angiography.

The author describes a new technique which facilitates loading of contrast material into the injector syringe without interrupting the angiographic procedure.

Cystometry in infants and children with no apparent voiding symptoms.

OBJECTIVE: To evaluate bladder function in infants and children with no apparent voiding symptoms. SUBJECTS AND METHODS: The study included 83 infants and children (51 boys and 32 girls, aged 3 days to 12 years) with no neurological and lower urinary tract pathology but who had undergone or were about to undergo surgery for upper urinary tract or other pathology. They were evaluated using slow-filling cystometry, with simultaneous electromyography recorded using surface electrodes on the perineum. The voiding variables were compared among groups categorized by age, sex and body weight. RESULTS: In boys and girls, respectively, the mean (SD) post-void residual urine volume (PVR) was 6.3 (3.9) and 5.4 (4.8) mL, the maximum detrusor pressure during voiding was 66.1 (13.1) and 56.6 (14.7) cmH2O and the maximum voiding pressure was 73.9 (16.6) and 62.7 (16.2) cmH2O. There was no significant difference in these variables between the sexes or between infants and children (P > 0.05). Detrusor instability (DI) was apparent in nine of 83 (10.8%) infants and children and occurred in the late filling phase. Bladder capacity increased with age and body weight (from 30 mL in neonates to 350 mL in 12-year-old children), and mean (SD) bladder compliance increased with age, from 3.6 (0.5) mL/cmH2O in infants to 13.3 (3.0) mL/cmH2O in older children, at a filling rate of 5-7 mL/min. CONCLUSIONS: In these infants and children with no apparent voiding symptoms, most bladders were stable, DI could occur in the late filling phase of cystometry, voiding was nearly complete, the PVR being usually < 10 mL, and bladder capacity increased with age and body weight.

Health services needs and quality of life assessment of individuals with brain injuries: a pilot cross-sectional study.

BACKGROUND AND PURPOSE: Quality of Life (QoL) studies have received a substantial amount of attention in medical and rehabilitative practices. However, there is still a paucity of studies in the area, especially on persons with brain injuries (BI). This pilot study, on the QoL of individuals with brain injuries in Hong Kong, attempts to fill this void. It is hoped that the finding of this study will guide the development of programmes and services to people with brain injuries. METHODS: Through the Self-help Group for People with Brain Damage in Hong Kong, 35 subjects (22 men and 13 women) were successfully recruited to participate in this study by convenience sampling. Demographic data were collected through face-to-face interviews guided by a questionnaire and QoL data were gathered using the Comprehensive Quality of Life Scale--Intellectual/Cognitive Disability--5th edition (ComQol-I5). The general emotional condition of the participants over the past 2 months was measured by a validated Chinese version of the Positive and Negative Affect Scale (PANAS). The participants' ratings on the importance of and their satisfaction with 20 health services areas were also collected. RESULTS: Preliminary results show that the overall mean quality of life score, as measured by ComQol-I5, was slightly less than two-thirds of the maximum score. Among the seven QoL domains, health and safety received some of the highest scores, while the lowest scores were obtained in the area of material well-being, place in community and productivity. People whose injuries had occurred relatively recently (less than 5 years ago) were found to have higher intimacy QoL scores than their counterparts injured more than 5 years ago. In the domain of safety, persons with a brain injury who were employed scored significantly higher than those who were not. Positive affect scores and the total affect of PANAS scores correlated significantly with the overall QoL scores. Moreover, persons with a brain injury usually felt satisfied with the services they valued as important. The top five most important services were medical services, occupational therapy, physiotherapy, vocational counselling and social work. DISCUSSION AND CONCLUSION: The QoL profile of people with brain injuries in Hong Kong was initially obtained and low scores in the ComQoL were identified in the domains of material well-being, community activities and responsibility and productivity. These might be the consequences of their physical and cognitive limitations due to brain injury. This implies that appropriate interventions to improve their daily life conditions and their social integration would be necessary to improve their QoL. On the other hand, the BI sample also rated relatively high scores in other ComQoL areas such as safety and health, reflecting a good living environment and probably good health care services. Those whose brain injuries had occurred less than 5 years ago tended to have a higher ComQoL intimacy score than those whose injuries occurred more than 5 years ago. In other words, their social relationships may deteriorate with the longer period post-injury so that this group may need more supportive services. In the safety domain, it was found that subjects who were employed after their brain injury scored significantly higher than those who were not, which matched studies about the significant contribution of work towards life satisfaction. The satisfaction of their needs in the services they received, which may affect their QoL, was also investigated. It is clear that they valued the medical and rehabilitation services they received and felt satisfied with them.

Use of the appendix to replace the choledochus.

Ten cases of choledochal cyst (CC) were treated by biliary-appendicoduodenostomy. The follow-up comprised a patient interview, ultrasonography (US), and single-proton ejected computerized tomography (SPECT) scanning. In all cases an anti-reflux submucosal tunnel was added to the distal appendico-duodenostomy; all showed an uneventful postoperative course. All the dilated intrahepatic bile ducts had normalized on B-US postoperatively. Four children under went SPECT examination; all of them had patent neo-bile ducts. In the authors' opinion: (1) Anastomosing the cecal end of the appendix to the common hepatic duct seemed more favorable than the other way around, because the cecal end could be easily trimmed to the size of the common hepatic duct, which was more or less dilated in the presence of a CC; (2) It is necessary to add a submucosal tunnel to the distal appendicoduodenostomy to achieve a more reliable anti-reflux effect; and (3) Transposing the vascularized appendix through the retro-transverse colon simplified the procedure and might reduce the risk of retroperitoneal complications if bile leakage should occur.