先天性阴道斜隔综合征7例超声诊断与临床分析

目的：探讨先天性阴道斜隔综合征（CVRS）的声像图特征,提高准确率以指导临床采取正确术式。方法：回顾性分析7例CVRS声像图及临床特征,总结该病的诊断要点。结果：所有患者均为双子宫、双宫颈,右侧斜隔3例,左侧斜隔4例。7例均伴斜隔侧肾缺如。Ⅰ型CVRS,其声像图特异,术前均能明确诊断,Ⅱ、Ⅲ型CVRS超声可为临床作出提示性诊断。结论：超声检查可作为诊断CVRS的首选方法。     

先天性阴道斜隔综合征7例超声诊断与分析

目的 通过对7例先天性阴道斜隔综合症(CVRS)的超声诊断与临床分析,提高对CVRS的认识.方法 对经超声检查并经临床证实的7例为CVRS的资料进行回顾性分析.结果 7例中,6例为典型双子宫,1例子宫外形为类双角子宫状.7例病例中均为双宫颈,其中右侧斜隔4例,左侧斜隔3例,7例均伴有斜隔侧肾缺如,所有患者术前诊断与术后所见均吻合.结论 超声可作为诊断CVRS的首选方法,可为临床选择治疗方案提供准确的信息.     

腔内三维超声诊断阴道斜隔综合征

目的 探讨腔内三维超声诊断先天性阴道斜隔综合征(OVSS)的临床价值。 方法 收集经手术证实的154例双子宫及完全性纵隔子宫患者的临床资料,回顾性分析其中15例OVSS的临床表现及声像图特征。 结果 15例阴道斜隔综合征中,8例首诊行二维超声检查漏误诊,后复诊时经腔内三维超声检查获得正确诊断,余7例首诊经腔内三维超声检查即获得正确诊断。OVSS声像图表现为双子宫或完全纵隔子宫、双宫颈、斜隔侧隔后阴道腔积液,14例伴斜隔侧肾脏缺如。 结论 腔内三维超声有助于提高OVSS的诊断准确率。     

超声诊断阴道斜隔综合征13例分析

目的：探讨超声在阴道斜隔综合征中的诊断价值,较少误诊率。方法：对唐山市妇幼保健院2006—01／2009-06收治的13例阴道斜隔综合征患者的声像图特点及临床特点进行回顾性分析。结果：阴道斜隔综合征患者声像图共有特点是双子宫双宫颈、一侧宫腔及宫颈下方积液、同侧肾缺如。13例中7例超声及时诊断,6例延误诊断。结论：超声是诊断阴道斜隔综合征首选可靠的方法,但对该病要有足够的认识和鉴别诊断。     

阴道斜隔综合征的超声诊断价值

目的探讨超声检查对阴道斜隔综合征的诊断价值,分析超声图像特点,提高诊断率,为临床选用最佳的手术方式提供依据。方法回顾性分析2008年1月2010年6月经手术确诊为阴道斜隔综合征的15例患者的临床资料及超声检查结果,总结阴道斜隔综合征的声像图特点。结果 15例经临床确诊为阴道斜隔综合征的患者,超声诊断14例,均表现为双子宫、双宫颈、阴道或宫颈积液/血,9例左肾缺如,5例右肾缺如。误诊1例,为单子宫伴一侧附件巨大囊肿。结论超声具有诊断准确、简便、无创、重复性好、价格实惠等优点,对于临床诊断生殖系统畸形具有十分重要的意义,应列为首选检查方式。     

先天性阴道斜隔的超声诊断与鉴别诊断

目的　评价超声诊断阴道斜隔的价值。方法　对 7例阴道斜隔患者的临床表现、声像图特点及术中所见进行分析 ,从中找出声像图特征。结果　进行性加重的痛经是各型阴道斜隔患者均有的症状 ;双子宫双宫颈畸形、宫腔及宫颈下方积液、一侧肾缺如是各型阴道斜隔患者均具有的声像图特点 ;手术可见阴道内隔膜。结论　二维超声检查应为诊断阴道斜隔首选而可靠的方法 ,但应注意提高操作技巧和识别能力。     

阴道斜隔综合征的超声诊断价值

目的 分析阴道斜隔综合征的声像图特征,以提高其超声诊断率.方法 回顾性分析6例经手术证实为阴道斜隔综合征患者的声像图特征.结果 阴道斜隔综合征声像图表现为双子宫畸形、斜隔侧宫腔积液、宫颈管扩张、阴道上段积液、肾脏缺如及同侧附件包块等.结论 超声检查对阴道斜隔综合征有较高的诊断价值.     

产前超声诊断胎儿三尖瓣下移畸形的应用价值

目的 探讨产前超声诊断胎儿三尖瓣下移畸形的临床价值。方法 回顾性分析6例经胎儿超声心动图诊断为三尖瓣下移畸形的超声诊断资料与随诊结果，总结其异常声像图特点。结果6例胎儿均经尸体解剖证实为三尖瓣下移畸形，其中三尖瓣隔叶下移2例，隔叶及后叶下移3例，隔叶、后叶及前叶下移1例。6例三尖瓣下移畸形中4例伴有功能右室缩小，合并房间隔缺损1例，肺动脉狭窄1例；4例伴有胸、腹腔及心包积液。胎儿三尖瓣下移畸形主要声像图表现为右心扩大，三尖瓣叶附着点下移，心尖到二尖瓣前叶附着点的距离与到三尖瓣隔叶附着点的距离比值≥1．8，形成典型房化右室特征；彩色血流显示三尖瓣重度反流，其反流起源点低，反流面积大，但反流速度低，平均反流速度217．0cm／s。结论 胎儿三尖瓣下移畸形具有特征性声像图表现，产前超声诊断胎儿三尖瓣下移畸形具有重要临床价值。     

先天性阴道斜隔综合征的超声诊断

目的：对阴道斜隔综合征再认识。方法：对我科6年间所有经超声检查诊断为阴道斜隔综合征的病例进行分析。结果：共诊断该综合征15例,14例为双子宫、双宫颈、双阴道,一侧阴道完全或不完全闭锁,1例为双角子宫、一侧阴道不完全闭锁;15例全部伴一侧肾脏缺如,对侧肾脏代偿性增大。结论：该先天性畸形并非少见;认识该综合征是正确诊断的重要前提;超声检查应列为首选方法。     

阴道斜隔综合征六例临床诊治分析

目的:探讨阴道斜隔综合征的临床特点和治疗方法。方法:回顾性分析我院2003～2008年间收治的6例阴道斜隔综合征的临床资料并复习相关文献。结果:本组阴道斜隔Ⅰ型3例,Ⅱ型2例,Ⅲ型1例。5例行手术治疗,术后症状缓解,无复发;1例因合并肾功能不全未行手术,仅行阴道血肿穿刺,后转他院治疗。结论:阴道斜隔综合征主要由隔后腔积血、引流不畅、梗阻而诱发一系列临床症状,只要正确认识本病,诊断不困难,手术是该病的主要治疗方法。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."