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Objective To discuss the clinical characteristics and prognosis of 15 children with hand foot and mouth disease (HFMD) and acute flaccid paralysis (AFP) who were admitted to Beijing Ditan Hospital during the outbreak of HFMD in 2008. Method The epidemiology, clinical manifestations, cerebrospinal fluid (CSF),magnetic resonance imaging and prognosis of 15 children with HFMD and AFP were retrospectively reviewed. The recovery of the patients' affected extremities were monitored for 4 weeks. Results The mean age of these patients was (22.47 ± 20.68) months (range: 5～72 months). Acute paralysis developed (3.47 ± 1.68) days after the onset of fever and progressed to maximum severity within (1～2) days. Poliomyelitis-like syndrome was observed in all cases. Of the 15 cases, 10 had monoplegia of lower limbs, two had paraplegia, one had monoplegia of upper limbs and two had quadriplegia. In these cases, the muscle power varied from level 0 to level 4, and six even showed no muscle power in their affected extremities. Thirteen cases developed neurologic complications (encephalitis, meningitis or ataxia) and three had transient urinary retention. Cerebrospinal MRI examination in eight cases showed hyperintense lesions on T2-weighted images, predominantly in the impaired anterior horn regions of the spinal cord (C2～C7 for cases with upper extremity impairments and T12～L1 for cases with lower extremity impairments), and displayed long T1 signals and long T2 signals. In addition, the midbrain, brain-stem or medulla was also involved in four cases who also contracted encephalitis or meningitis. The muscle strength in 11 patients with single lower extremity impairment showed improvements in the distal limb muscles within 4～8 days, and the other cases showed recovery 2～3 weeks later. Conclusions HFMD in combination with AFP most commonly occurs in children aged less than 2 years old. Acute paralysis develops during the early stage of infection and progresses to a maximum severity within 2 days. In most cases described here, paralysis occurred in a single lower extremity and recovered more rapidly than those with all four limbs affected or with single upper extremity impairment . MRI examination is particularly valuable for the diagnosis and prognosis of AFP because of its high sensitivity and accuracy.

9.A survey of elective surgical patients' attitudes toward anesthesia in PUMC hospital.

Yuguang HUANG ; Keqin YANG ; Hongzhi REN ; Ailun LUO

Chinese Medical Sciences Journal 2002;17(2):77-80

OBJECTIVETo assess patients' knowledge, attitudes, and concerns regarding anesthetic management.

METHODA survey of 55 items was developed and administered preoperatively to 500 patients including 190 men and 310 women in our hospital. Patients were interviewed on their knowledge of the role of anesthesiologists, their preferences regarding anesthetic management, and also their concern about potential anesthetic complications.

RESULTSPatients' perceptions of anesthesiologists' training and role have reached a certain level. Most significant preoperative concerns regarding the anesthesiologists focused on experience, qualifications, and presence or absence during the anesthesia. Patients' concerns also included the possibility of not being waken up following anesthesia, experiencing postoperative pain, and becoming paralyzed. The variations of concerns depended partially on patients' sex, type of anesthesia, and proposed surgical procedure, partially on their education and living environments.

CONCLUSIONIt is suggested that anesthesiologist address significant patient concerns during the preoperative visit to enhance their effectiveness in patient care. Efforts to educate the public on the anesthesiologists' role in preoperative care would improve patients' confidence.

Adolescent ; Adult ; Anesthesia ; psychology ; Attitude to Health ; Educational Status ; Elective Surgical Procedures ; psychology ; Female ; Humans ; Male ; Middle Aged ; Patient Education as Topic ; Surveys and Questionnaires