J Formos Med Assoc
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It has been proposed that first-trimester Down's syndrome screening has a higher detection rate compared to second-trimester biochemical screening. This study investigated the accuracy of Down's syndrome screening during gestational weeks 10 to 13 using the combination of fetal nuchal translucency (NT) measurement with maternal serum concentrations of free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A). ⋯ This study demonstrated that Down's syndrome screening using the combined test in the first trimester had a higher detection rate than that of serum screening in the second trimester. Implementation of NT measurement in the first trimester provides substantial advantages for Down's syndrome detection and early diagnosis of fetal structural abnormalities.
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Reconstruction of ruptured anterior cruciate ligament (ACL) using the middle-third of the patellar tendon has become an established procedure. However, current studies of donor site morbidity have reported discrepant results. This study used ultrasound imaging to evaluate morphologic changes in the patellar tendon after harvest for ACL reconstruction. ⋯ The donor site of the patellar tendon was significantly wider and thicker and was heterogenous when examined on sonogram more than 1 year postoperatively.
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Case Reports
Life-threatening refeeding syndrome in a severely malnourished anorexia nervosa patient.
Overzealous refeeding in chronically malnourished anorexia nervosa patients may cause life-threatening complications. We describe a 14-year-old girl with anorexia nervosa who had a decrease in body weight from 45 kg to 25.5 kg over an 18-month period. She received 40 kcal.kg-1.d-1 carbohydrate-rich nutrition via enteral and parenteral routes. ⋯ After intravenous phosphate supplementation and fluid restriction, the symptoms of refeeding syndrome gradually resolved within 2 weeks. In chronically malnourished anorexia nervosa patients, nutritional support should be instituted gradually to avoid rapid electrolyte shifts and fluid overload. Serum phosphate concentrations, fluid status, and blood cell counts should be closely monitored.