侵袭性垂体腺瘤1例

患者女,31岁.右眼痛,头痛鼻塞1月余.临床查体及实验室检查均无阳性结果.MRI检查:蝶鞍扩大,鞍区内见一等T1、长T2的实质性占位(图1),大小约3.3 cm×2.8 cm×3.1 cm,肿块内见一小圆形长T1、长T2信号.肿块向前侵及蝶窦,向两侧侵及海绵窦,包绕颈内动脉.枕骨斜坡信号弥漫性减低,肿瘤与斜坡界限不清,但骨皮质无膨胀及破坏.增强后肿瘤和斜坡一致性明显强化,小圆形低信号无强化(图2).术后病理诊断:垂体瘤(嫌色细胞瘤).     

经口咽前后入路一期手术治疗颅颈区畸形的护理

颅颈区畸形主要分为环枕型、斜坡齿状突型及环枕型合并斜坡齿状突型,对经口咽前、后路一期手术治疗环枕型合并斜坡齿状突型的术后护理未见报道。我科1998年6月～2008年6月采用经口咽前、后路一期手术治疗环枕型合并斜坡齿状突型37例,现将护理体会报告如下。     

中耳内翻性乳头状瘤恶变1例

患者男,46岁,左耳间歇性流脓伴听力下降20年,未经治疗,近1个月进行性加重,伴发作性耳痛;既往无特殊病史.入院查体:左耳外耳道口见黏稠无味的黄色脓液,外耳道外1/2段肿胀、狭窄,未窥及外耳道内1/2段及鼓膜;右耳未见明显异常,颈部浅表淋巴结无明显肿大.实验室检查:左耳脓液分泌物培养示金黄色葡萄球菌(+).     

地塞米松、金纳多联合高压氧综合治疗特发性突聋临床观察

目的:探讨地塞米松与金纳多联合高压氧综合治疗特发性突聋的临床效果。方法:选取2014年9月～2017年11月我院收治的特发性突聋患者130例,以抽签法将其随机分为对照组和研究组各65例。对照组予以地塞米松与金纳多联合治疗,研究组在对照组基础上联合高压氧综合治疗。比较两组临床治疗效果、症状改善时间、听力值恢复时间、住院时间及不良反应发生情况。结果:研究组治疗有效率为86.15%,明显高于对照组的70.77%,P0.05;研究组症状改善时间、听力值恢复时间及住院时间均短于对照组,P0.05;对照组不良反应率为9.23%,观察组为7.69%,组间比较无明显差异,P0.05。结论:地塞米松与金纳多联合高压氧综合治疗特发性突聋临床效果明显优于单纯药物治疗,有助于促进患者疾病转归,且未增加不良反应的发生率,安全性及可行性较高。     

地塞米松联合高压氧治疗突聋患者的临床效果及对听力的影响

目的分析地塞米松联合高压氧治疗突聋患者的临床效果及对听力的影响。方法选取我院2018年3月至2020年3月收治的86例突聋患者作为研究对象,依据治疗方法将其分为对照组与研究组,各43例。对照组给予地塞米松治疗,研究组在对照组的基础上给予高压氧治疗。比较两组患者治疗前、后的血液流变学指标、听力阈值及临床疗效。结果治疗后,两组的PV、RCAI、FIB水平均降低,且研究组低于对照组(P<0.05)。治疗后,两组的1、2、4 kHz听力阈值均降低,且研究组低于对照组(P<0.05)。研究组的治疗总有效率高于对照组(P<0.05)。结论地塞米松联合高压氧治疗突聋的效果显著,可改善患者的血液流变学指标与听力功能,值得临床推广应用。     

突聋病人的常见护理问题及其护理干预措施

[目的]探讨护理干预对突聋病人的辅助治疗效果.[方法]对2012年1月-2013年2月收治的30例突聋病人进行护理干预,并对治疗效果进行回顾性分析总结.[结果]30例病人中有10例听力恢复至正常,15例听力部分恢复,5例听力无明显改变;治愈率33.33%,好转率50.00%,无效率16.67%.[结论]突聋病人经过护理干预,使治疗疗程缩短,治愈效果得到提高.     

超声导向微波消融治疗平滑肌肉瘤1例

患者女,55岁,因左胸壁平滑肌肉瘤4年,胸壁包块2年入院.于4年前无意间发现左侧胸壁一约"鸡蛋"大小的包块,周围无红肿、无压痛,半年间肿物迅速肿大,遂在某省级医院行左胸壁肿物切除术,术中见病变侵及胸膜及肋骨.病理示:左侧胸壁平滑肌肉瘤.术后多次行左胸壁瘤床放射治疗.于2年前原左侧胸壁切口上方见一大小约7 cm×5 cm的肿块,质硬,经CT检查示左侧胸壁平滑肌肉瘤术后复发,并突人胸腔.病理结果同前.予顺铂单药一周期及左侧胸壁瘤床放疗,效果欠佳,遂来我院行微波消融治疗.     

髁状突周围型骨瘤伴听力下降1例报告

患者,男,53岁,因发现左耳屏前无痛性包块伴听力下降2周于2014年5月15日至四川省人民医院就诊。既往史：10年前于外院行左颞下颌关节封闭治疗;“高血压病”史15年。专科检查：左侧耳屏前较对侧略显丰满,可扪及一2.5 cm ×2.5 cm大小质硬包块,无触压痛,边界欠清,左侧髁状突动度较对侧弱。张口度3.0 cm,张口型正常。 CT示：左侧颞下窝内结构模糊,高密度影,其内少量积气,翼肌肿胀。动脉造影示：左侧颞颌关节区域占位性病变,左侧颌内动脉受压推移,未见明显肿瘤血供,见图1。听力检查提示左耳听力障碍。临床诊断：左髁状突周围型骨瘤。     

滑车神经行经小脑幕侧方区域的应用解剖学研究

目的：通过对滑车神经行经小脑幕侧方区域的应用解剖学研究,寻找小脑幕侧方区域手术时避免损伤滑车神经的临床解剖标志。方法：对15例（男10例,女5例）防腐固定无畸形、无病变的成人头颅标本用红色乳胶灌注后,10倍手术显微镜下观察滑车神经在小脑幕侧方区域的行径,及其与周围重要神经、血管结构的毗邻关系,测量滑车神经长度、宽度、厚度及其与周围标志点的距离,并对所得结果进行统计学分析。结果：滑车神经在小脑上动脉和大脑后动脉之间向前行,进入小脑幕侧方区域,在动眼神经三角的后部穿越游离缘硬膜,其长度为（6．78±1．87）mm,宽度为（1．09±0．21）mm,厚度为（0．78±0．11）mm。滑车神经进入小脑幕侧方区域的人口处位于前床突、颈内动脉床突上段起始部、动眼神经人口后方,位于后床突后外方;距离前床突（23．24±3．18）mm、颈内动脉床突上段起始部（17．57±3．26）mm、动眼神经人口（11．42±3．32）mm;距离后床突（14．21±3．25）mm。结论：行小脑幕侧方区域手术时,为避免损伤滑车神经,前床突：后床突、颈内动脉床突上段起始部和动眼神经人口可以作为寻找滑车神经人口的重要标志,同时注意区分小脑上动脉和大脑后动脉。     

原发左侧髁状突原始神经外胚瘤1例

患者男,25岁,3个月前无明显诱因出现左耳前疼痛,伴面部略肿及张口疼痛,不敢食硬物。1个月前出现左智齿疼痛,发现左耳前一包块,患者感左口角麻木,左耳前包块增大,张口困难,无舌麻木,无味觉改变,无视物不清,遂来院就诊。CT所见:左髁状突及部分下颌支溶骨性骨质破坏,以髁状突为中心见团状软组织影,与该侧咬肌及翼外肌分界不清晰,同侧咽旁间隙窄,左腮腺受压。增强所见以左髁状突为中心的团状软组织影周围见血管影包绕,有欠均匀强化(图1)。MRI显示:以左髁状突为中心见4.3 cm×3.8 cm×3.9 cm的T1等低、T2及FLAIR序列高低混杂信号改变,边界欠…     

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.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

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.