Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota

A retrospective review of our population-based medical records linkage system for residents of Olmsted County, Minnesota, revealed 53 patients (34 women and 19 men; mean age, 51 years) with newly diagnosed benign positional vertigo in 1984. The age- and sex-adjusted incidence was 64 per 100,000 population per year (95% confidence interval, 46 to 81 per 100,000). The incidence of benign positional vertigo increased by 38% with each decade of life (95% confidence interval, 23 to 54%). One patient had an initial stroke during follow-up; thus, the relative risk for new stroke associated with benign positional vertigo was 1.62 (95% confidence interval, 0.04 to 8.98) in comparison with the expected occurrence based on incidence rates for an age- and sex-adjusted control population. The observed survival among the 53 Olmsted County residents with benign positional vertigo diagnosed in 1984 was not significantly different from that of an age- and sex-matched general population. Patients with benign positional vertigo seem to have a good prognosis.     

Ursache und Diagnostik der lagebedingten Plagiozephalie

In recent years an increasing incidence of positional plagiocephaly has been observed. The reason for this form of asymmetry of the skull is unclear. From the viewpoint of manual medicine in the majority of cases there is a functional disturbance especially in the region of the C0–C1 and the C1–C2 joint which leads to a preferential positioning of the head. The supine sleeping position for infants, which has been recommended for years, leads to flattening of the back of the head due to gravitation, mostly on the side of the preferred head rotation. Symmetrical central flattening (brachycephaly) has also been reported but is less common. Positional plagiocephaly must be differentiated from craniosynostosis and other diseases linked to asymmetry of the skull. To determine the severity of positional plagiocephaly there are as yet no uniformly used measuring points or standardized measuring methods. The “cranial asymmetry screening” measurement method is recommended in this article as an orientation measurement procedure within the framework of initial diagnostics in practice for evaluation of the extent of skull asymmetry. Non-invasive, economic 3-dimensional procedures are used for studies.     

羊水过多与胎儿畸形的关系及诊断

目的：胎儿畸形是指胎儿在子宫腔内发生结构和染色体异常的一种出生缺陷,有数据表明我国胎儿畸形发生率为5.6%,胎儿畸形严重地影响了人口的出生质量。避免胎儿畸形的发生是提高国民素质的一项非常重要的举措,减少胎儿畸形的发生率以及畸形胎儿的出生刻不容缓。方法：通过查阅图书期刊上的资料,将每个问题的各个方面加以总结,深入研究分析。结果：胎儿畸形与羊水过多有着密不可分的关系,与羊水过多有关的胎儿畸形中,中枢神经系统和消化系统畸形常见。结论：羊水越多,胎儿畸形的发生率越高。     

三维CT成像在先天性马蹄内翻足诊断中的应用

目的 探讨三维CT成像诊断先天性马蹄内翻足的临床应用价值。方法 分析8例马蹄内翻足的三维CT图像并与X线平片比较。结果 8例马蹄内翻足中左下肢2例、右下肢4例、双下肢2例。3DCT较X线平片更能准确地反映马蹄内翻足程度和跗骨的发育异常以及各骨间的异常空间关系。结论 3DCT在马蹄内翻足的术前诊断和疗效评定上可作为X线平片的有效补充手段。     

2010～2012年四川省人民医院儿科2148例MRI检查分析

目的 调查和分析四川省人民医院2010～2012年儿科门诊及住院患儿MRI检查情况，为儿童影像学检查的选择提供有利依据。 方法 收集该院PACS系统2010～2012年儿科门诊及住院患儿MRI检查的电子报告资料，并采用国际疾病分类（ICD-10）进行疾病分类，采用Excel 2003 和SPSS 12.0 软件对患儿基本情况、MRI检查部位、MRI检查阳性病例的系统疾病类别等进行统计分析。 结果 ① 2010～2012年四川省人民医院儿科行MRI检查的门诊及住院患儿共2 148例，检查人数逐年增加，男孩多于女孩，检查阳性率逐年略有下降；门诊患儿检查人数多于住院患儿，但检查阳性率低于住院患儿；② 患儿MRI检查部位逐年增加，以单部位检查为主（占85%以上）。MRI检查部位以头部、头MRA、颈椎、膝关节、腰椎、垂体、胸椎、腹部为主，检查部位逐年多样化，检查新技术应用逐年增加；③ MRI检查阳性病例按系统疾病分类可分为9类，占ICD-10标准分类的42.86%，主要以神经系统疾病、肌肉骨骼和结缔组织疾病为主。主要疾病类型总体较为稳定，但疾病类型中膝关节损伤、脑萎缩、软化、颅脑发育异常增幅较大。 结论 四川省人民医院2010～2012年儿科门诊及住院患儿MRI检查人数、检查部位逐年增多，MRI检查在头部、脊柱四肢关节及软组织部位应用较多，儿童MRI检出阳性疾病主要为神经系统疾病、肌肉骨骼和结缔组织疾病。     

Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity

OBJECTIVE: To study the effects of custom-made insoles on plantar pressures and load redistribution in neuropathic diabetic patients with foot deformity. DESIGN: Cross-sectional. BACKGROUND: Although custom-made insoles are commonly prescribed to diabetic patients, little quantitative data on their mechanical action exists. METHODS: Regional in-shoe peak pressures and force-time integrals were measured during walking in the feet of 20 neuropathic diabetic subjects with foot deformity who wore flat or custom-made insoles. Twenty-one feet with elevated risk for ulceration at the first metatarsal head were analysed. Load redistribution resulting from custom-made insoles was assessed using a new load-transfer algorithm. RESULTS: Custom-made insoles significantly reduced peak pressures and force-time integrals in the heel and first metatarsal head regions; pressures and integrals were significantly increased in the medial midfoot region compared with flat insoles. Custom-made insoles successfully reduced pressures in and integrals at the first metatarsal head in 7/21 feet, were moderately successful in another seven, but failed in the remaining seven. Load transfer was greatest from the lateral heel to the medial midfoot regions. CONCLUSIONS: Custom-made insoles were more effective than flat insoles in off-loading the first metatarsal head region, but with considerable variability between individuals. Most off-loading occurred in the heel (not a region typically at risk). The load transfer algorithm effectively analyses custom-made-insole action. RELEVANCE: Because similar insole modifications apparently exert different effects in different patients, a comprehensive evaluation of custom designs using in-shoe pressure measurement should ideally be conducted before dispensing insoles to diabetic patients with neuropathy and foot deformity.     

Horizontal Direction‐Changing Positional Nystagmus and Vertigo: A Case of Vestibular Migraine Masquerading as Horizontal Canal BPPV

Episodic positional vertigo is typically due to benign paroxysmal positional vertigo (BPPV) but may also be a manifestation of vestibular migraine. Distinguishing vestibular migraine from BPPV is essential since the treatment of each disorder is markedly different. The 31‐month clinical course of a 41‐year‐old woman with vestibular migraine causing recurrent positional vertigo is described. During vestibular migraine attacks, she developed left‐beating nystagmus in the upright position with removal of fixation, and geotropic horizontal nystagmus during the supine roll test. Interictally, her exam demonstrated positional apogeotropic horizontal nystagmus with the supine roll test, more intense in the supine head left position. Her vestibular migraine was successfully controlled with topiramate and eletriptan.     

Mechanism of limitation of pronation/supination of the forearm in geometric models of deformities of the forearm bones

OBJECTIVE: To clarify the mechanism of limitation of pronation/supination of the forearm associated with the angular deformity of the forearm bones and narrowing of the interosseous space. DESIGN: A three-dimensional geometric model of the forearm bones with the interosseous membrane and its axial section were used. BACKGROUND: Limitation of pronation/supination associated with the deformity of the forearm bones is one of the significant problems encountered in the treatment of the forearm fracture. Elucidation of its mechanism is important for its prevention and treatment. METHODS: In the axial section, the effects of the positional relationship between the axis of pronation/supination and the forearm bones on the range of pronation/supination was studied using analytic geometry in each model with non-narrowing or narrowing of the interosseous space. Subsequently, in the three-dimensional model each forearm bone with the same angular deformity, the direction and magnitude of the angular deformity which would lead to limitation of pronation/supination were calculated using analytic geometry. Each parameter of the models was obtained by the radiographic measurements of the normal forearms. RESULTS: When the axis of the pronation/supination passed through the interosseous region (less than 2 cm radioulnarly and 0.8 cm anteroposteriorly) in the model of the axial section without narrowing of the interosseous space, more than 40 degrees of pronation and supination were possible. When the axis deviated from this region, significant loss of pronation/supination was observed associated with restriction by the interosseous membrane rather than impingement. Furthermore, the area of this region decreased according to narrowing of the interosseous space with shortening of the interosseous membrane. In the three-dimensional model, the direction and magnitude of the angular deformity which would lead to significant loss of pronation/supination was more than 14 degrees radially, 7 degrees ulnarly, 5 degrees anteriorly, 4 degrees posteriorly. CONCLUSIONS: The positional relationship between the axis of pronation/supination and the forearm bones with the interosseous membrane may play an important role regarding pronation/supination of the forearm. RELEVANCE: Evaluation of the bone deformities based on understanding this mechanism of limitation of pronation/supination would lead to an appropriate treatment of malunion of the forearm bones.     

一体化三维探头产科临床使用102例结果及评价

目的:评价一体化三维超声探头在产科临床的使用价值.方法:采用一体化三维探头扫查方式,对102例孕妇进行三维重建,结果:一体化三维探头扫查在一定液体环绕下能很好地显示胎儿表器官立体形态,及时检出胎儿头,面部及肢体畸形,但有其一定的局限性,对部分体表畸形检出不及二维探头.结论:一体化三维超声探头,显示胎儿头,面部及体表立体形态,清楚,直观并及时检出部分畸形.     

Craniosynostosis

Skull deformity in infants continues to be a diagnostic and therapeutic challenge. Deformational plagiocephaly is a common and somewhat benign cause of skull deformity in infants that must be distinguished from the more serious craniosynostosis, which occurs alone or as a syndrome. Examining an infant's head from above can help the physician distinguish true lambdoid synostosis from deformational plagiocephaly. In infants with lambdoid synostosis, the posterior bossing is in the parietal area contralateral to the flat part of the head. Deformational plagiocephaly causes frontal bossing ipsilateral to the flat part of the head. In infants with lambdoid synostosis, the ear is displaced posteriorly toward the fused suture. In infants with deformational plagiocephaly, the ear is displaced anteriorly. Isolated sagittal synostosis is the most common type of craniosynostosis. Of the more than 150 craniosynostosis syndromes, Crouzon's disease and Apert's syndrome account for the majority of cases. The diagnosis of craniosynostosis relies on physical examination, plain radiography, and computed tomography. Untreated progressive craniosynostosis leads to inhibition of brain growth, and an increase in intracranial and intraorbital pressure. Infants should be evaluated as soon as they are diagnosed.     

Finite element analysis of the foot: Model validation and comparison between two common treatments of the clawed hallux deformity

Background

Clawed hallux is defined by first metatarsophalangeal joint extension and first interphalangeal joint flexion; it can increase plantar pressures and ulceration risk. We investigated two corrective surgical techniques, the modified Jones and flexor hallucis longus tendon transfer.

Methods

A finite element foot model was modified to generate muscle overpulls, including extensor hallucis longus, flexor hallucis longus and peroneus longus. Both corrective procedures were simulated, predicting joint angle and plantar pressure changes.

Findings

The clawed hallux deformity was generated by overpulling: 1) extensor hallucis longus, 2) peroneus longus + extensor hallucis longus, 3) extensor hallucis longus + flexor hallucis longus and 4) all three together. The modified Jones reduced metatarsophalangeal joint angles, but acceptable hallux pressure was found only when there was no flexor hallucis longus overpull. The flexor hallucis longus tendon transfer reduced deformity at the metatarsophalangeal and interphalangeal joints but may extended the hallux due to the unopposed extensor hallucis longus. Additionally, metatarsal head pressure increased with overpulling of the extensor hallucis longus + flexor hallucis longus, and all three muscles together.

Interpretation

The modified Jones was effective in correcting clawed hallux deformity involving extensor hallucis longus overpull without flexor hallucis longus overpull. The flexor hallucis longus tendon transfer was effective in correcting clawed hallux deformity resulting from the combined overpull of both extensor and flexor hallucis longus, but not with isolated extensor hallucis longus overpull. An additional procedure to reduce the metatarsal head pressure may be required concomitant to the flexor hallucis longus tendon transfer. However this procedure avoids interphalangeal joint fusion.     

The "baseball cap orthosis": a simple solution for dropped head syndrome

Dropped head syndrome (DHS) is a well-recognized condition characterized by gradual sagging of the head. At the extreme, the condition may lead to a "chin on chest deformity" where the chin rests on the chest wall and the patient is unable to look straight ahead. Dropped head syndrome tends to develop in patients with severe weakness of the neck extensors. Various neuromuscular disorders and surgical procedures may compromise the stability of the cervical spine and lead to this disorder. The condition may severely compromise the patient's quality of life and result in significant disability. A simple device-the "baseball cap orthosis"-was developed to help patients maintain their head in the upright position. Two patients with DHS who were provided with the baseball cap orthosis are presented.     

Ultrasonographic diagnosis of second-trimester skeletal dysplasias: a prospective analysis in a high-risk population.

Sixteen pregnancies in 15 women at high genetic risk for having fetuses with skeletal dysplasias were examined by use of ultrasonography during the second trimester. In addition to the routine examination of fetal head and body, the fetal calvarium, spine, ribs, pelvis, and long bones were specifically evaluated for bone brightness, deformity, fractures, and inappropriate growth. It was determined that 11 of the 16 fetuses were normal and five were abnormal. At birth, all 11 ultrasonographically determined normal fetuses were normal, and at birth or elective termination of pregnancy the other five were abnormal. All abnormalities detected by ultrasonography in the affected fetuses were found at delivery, including decreased bone brightness, deformity of the head and long bones, and fractures and abnormal growth of the long bones. On the basis of this study, it is felt that ultrasonography is highly accurate for the diagnosis of many second-trimester skeletal dysplasias.     

Posttraumatic cerebral atrophy as a risk factor for delayed acute subdural hemorrhage

It has long been appreciated that chronic alcoholics and the elderly with generalized cerebral atrophy are at increased risk for the development of acute subdural hematomas. The reported incidence of cerebral atrophy after severe head injury is significant. However, the incidence of late morbidity and mortality from acute subdural hematoma is not well documented. Acute subdural hemorrhage is attributed to rupture of bridging cerebral veins. In the presence of cerebral atrophy, the bridging veins are stretched and traverse a greater distance in the subdural space. They are therefore more susceptible to tearing with minor trauma. In addition, there is a delayed tamponade effect since the atrophied brain is shrunken away from the inner table of the skull. A case report is presented which suggests that survivors of severe head injury may be at increased risk for the development of acute subdural hematomas from relatively minor injuries months or even years after their initial trauma.     

某三级甲等医院临床护士工作成瘾与其职业承诺水平、护士长关怀程度的相关性研究

目的了解临床护士工作成瘾现状,分析工作成瘾与职业承诺水平、护士长关怀程度之间的关系。方法采用横断面调查法,以方便抽样的方式于2019年3月选取滨州医学院烟台附属医院临床注册护士600名为研究对象,采用一般资料调查表、工作成瘾量表、职业承诺量表和护士对护士长人文关怀满意度评价量表进行调查,分析工作成瘾与职业承诺水平和护士长关怀程度的相关性。共发放问卷600份,有效回收574份,有效回收率95.7%。结果574名临床护士工作成瘾量表总得分为(53.25±7.84)分,处于中度工作成瘾状态;职业承诺量表总分(74.38±10.31)分;护士长关怀程度总分(151.27±24.75)分。单因素分析显示,不同工作年限、职称、学历和婚姻状况的临床护士工作成瘾得分比较差异均有统计学意义(P<0.05)。Pearson相关分析显示,临床护士工作成瘾与职业承诺水平呈正相关(r=0.437,P<0.01),临床护士工作成瘾与护士长关怀程度呈正相关(r=0.397,P<0.01)。分层回归分析结果显示,工作年限、职称、经济成本承诺和促进个人发展是临床护士工作成瘾的主要影响因素。结论临床护士处于中度工作成瘾状态,工作年限、职称、经济成本承诺和促进个人发展可影响其工作成瘾状态。护理管理者应根据临床护士工作成瘾现状,合理调节职业承诺水平和组织关怀支持程度,采取措施帮助临床护士以积极、健康的状态应对临床工作。     

Relationship of foot deformity to ulcer location in patients with diabetes mellitus

The purpose of this study was to determine whether a relationship existed between type of foot deformity and the location of ulcers in patients with diabetes and insensitive feet. Forty-two ulcerated feet were examined in 40 patients. All patients had severely decreased or absent sensation. Foot deformities were classified according to operational definitions as 1) Charcot's foot, 2) a compensated forefoot varus, or 3) an uncompensated forefoot varus or forefoot valgus. The plantar surface of the midfoot and forefoot was divided into three regions. Six of the 7 patients with a Charcot's foot showed ulceration at the midfoot. Nine of 18 patients with a compensated forefoot varus showed ulceration at the second, third, or fourth metatarsal head. Fifteen of 17 patients with an uncompensated forefoot varus or forefoot valgus showed ulceration at the first or fifth metatarsal. A significant relationship was found between foot deformity and location of ulcer. These results support the hypotheses 1) that insensitivity, coupled with increased, repetitive pressure, is a primary cause of plantar ulcers and 2) that certain foot types are associated with characteristic patterns of pressure distribution and callus formation.     

Migrainous Vertigo: Results of Caloric Testing and Stabilometric Findings

Background.— Association between migraine and vertigo has been widely studied during the last years. A central or peripheral vestibular damage may occur in patients with migrainous vertigo. Despite much evidence, at present the International Headache Society classification does not include a specific category for migrainous vertigo. Objectives.— To assess the prevalence of central and peripheral vestibular disorders and postural abnormalities in patients diagnosed as affected by definite migrainous vertigo according to Neuhauser. Methods.— Thirty patients with migraine and acute vertigo lasting from minutes to hours underwent a full otoneurological screening for spontaneous, positional, and positioning nystagmus with head‐shaking and head‐thrust (Halmagyi) tests, an audiometric examination, and videonystagmography with bithermal stimulation according to Freyss. Videonystagmographic findings were compared with those of 15 migraineurs without lifetime vertigo (group M). Next day, a static posturography was performed; posturographic results have been compared with those of a second control group of 30 healthy patients matched for age and sex (group C). Results.— In total, 14 subjects with migrainous vertigo showed otovestibular disorders; 6 subjects showed impaired vestibulo‐oculomotor reflexes (20%). Five more patients had bilateral increased responses (16.6%). Five patients showed signs of central brainstem or cerebellar disorders for altered pursuit or saccades or positional direction changing nystagmus. Stabilometric results returned higher values of Length and Surface above all when testing was performed in eyes closed conditions compared with the normal control group. The subgroup of 14 subjects with migrainous vertigo and vestibular abnormalities performed poorly in stabilometric exams and seemed to rely more on visual cues in balance control than the subgroup of 16 subjects with migrainous vertigo but without abnormalities. Discussion.— Our results indicate that vestibular functional damage may occur in all vestibular pathways; central and peripheral signs are equally represented. Our data are not inconsistent with the hypothesis that a vestibulo‐spinal dysfunction is the causal factor for the posturographic results. Moreover, the Visual Romberg Index is significant for increased visual cue dependence in migraineurs.     

经前囟侧脑室横切面尾侧偏斜法在11~13+6周胎儿颜面部筛查中的应用

目的总结早孕期（11~13^{+ 6}周）胎儿颜面部异常超声声像图特征,分析颈项透明层（NT）增厚与颜面部异常相关性。 方法对2008年10月至2012年12月在深圳市妇幼保健院产前检查的10 518例胎儿行早孕期常规NT测量和经前囟侧脑室横切面尾侧偏斜法颜面部扫查,与活产儿产后检查或引产胎儿尸检结果对照,对早孕期颜面部异常胎儿的超声图像特征、NT增厚与颜面异常相关性进行总结和分析。 结果10 518例胎儿产前超声检查结果：运用经前囟侧脑室横切面尾侧偏斜法早孕期超声检出颜面部结构正常胎儿10 343例（98.3%,10 343/10 518）,颜面部异常28例（唇腭裂8例、鼻骨缺失14例,全前脑面容5例,不规则面裂1例）;引产或出生后检查及随访证实胎儿颜面部异常49例（发生率0.47%,49/10 518）,早孕期超声漏诊21例（唇腭裂11例,耳异常7例,小下颌2例,不规则面裂1例）;中孕期超声补充检出颜面部异常11例（唇腭裂10例,不规则面裂1例）;产前超声共检出颜面部异常39例（79.6%,39/49）;超声检查后失访126例。49例颜面部异常胎儿合并NT增厚和其他超声软指标异常34例（69.4%,34/49）,其中合并NT增厚23例（46.9%,23/49）,合并其他结构异常22例,合并染色体异常2例。颜面部异常与NT增厚相关性：本组超声检出颜面部异常合并其他结构异常的胎儿NT平均测值[（4.7±3.1）mm]>单纯颜面部异常胎儿[（2.0±1.6）mm]>正常胎儿[（1.8±0.4）mm],表明颜面部异常与NT增厚有一定相关性。 结论经前囟侧脑室横切面尾侧偏斜法是早孕期诊断胎儿颜面部异常准确、可靠的检查方法,早孕期发现胎儿全前脑、心脏异常、结构畸形伴NT增厚,应仔细检查有无颜面部异常,并于中孕期补充检查以减少漏诊。唇腭裂表现为鼻后三角形态改变,侧脑室横切面、正中矢状切面及双眼球冠状切面的改变则为全前脑面容的表现。     

Crash Scene Photography in Motor Vehicle Crashes without Air Bag Deployment

OBJECTIVE: To determine whether vehicle characteristics, measured using crash scene photography, are associated with anatomic patterns of injury and severity of injury sustained in motor vehicle crashes (MVCs) without air bag deployment. METHODS: A prospective observational study was conducted over 22 months, using 12 fire departments serving two hospitals. Two vehicle photographs (exterior and interior) were taken at each MVC. Vehicular variables were assigned by grading the photographs with a standardized scoring system, and outcome information on each patient was collected by chart review. RESULTS: Five hundred fifty-nine patients were entered into the study. Frontal crashes and increasing passenger space intrusion (PSI) were associated with head, facial, and lower-extremity injuries, while rear crashes were associated with spinal injuries. Restraint use had a protective effect in head, facial, and upper and lower extremity injuries, yet was associated with higher odds of spinal injury. Lack of restraint use, increasing PSI, and steering wheel deformity were associated with an increased hospital length of stay and hospital charges, yet only steering wheel deformity was associated with increasing injury severity when adjusting for other crash variables. CONCLUSIONS: Out-of-hospital variables, as obtained from crash vehicle photography, are associated with injury site, injury severity, hospital length of stay, and hospital charges in patients involved in MVCs without air bag deployment.     

The place of valgus extension femoral osteotomy in the late management of children with Perthes' disease

Despite considerable research into the aetiology and management of Perthes' Disease, patients late with symptoms related to serious femoral head deformity. The process of progressive deformity is discussed and the clinical signs which recognize it identified. The clinical signs of the established condition are shortening, loss of abduction proceeding to a flexion/adduction contracture with unstable movement and hinge abduction on the dynamic arthrogram. Treatment must result in stable movement as the child stand and walks. This is achieved by a valgus/extension upper femoral osteotomy. The advantage of this procedure is that it relieves pain, improves leg length, restores the normal abductor lever and in consequence improves the limp, which is one of the patient's chief complaints. The results in the long term are discussed.