首诊于眼科的糖尿病261例分析

目的：探讨糖尿病患者的早期眼部症状和体征,为糖尿病的早期诊断提供参考。方法：对首诊于眼科的261例（473眼）糖尿病患者的临床资料进行回顾性分析。结果：261例患者最终确诊均为2型糖尿病。眼部症状主要是不同程度的视力下降、眼前黑影、斜视、复视、干眼症等;并发症以视网膜病变、白内障、球结膜下出血、眼肌麻痹等多见。结论：部分糖尿病患者早期会因眼部不适而首诊于眼科,应引起眼科工作者的重视。     

首诊眼科的颅内病变20例临床分析

颅内病变时可出现多种临床表现 ,部分病人以眼部症状 ,而首诊于眼科。现将首诊眼科并证实为颅内病变 2 0例 ,进行总结分析。1　临床资料1.1　一般资料　本院 1990年 1月至 2 0 0 0年 10月首诊眼科的颅内病变 2 0例 ,男 15例 ,女 5例 ,平均年龄4 9(2 0～ 78)岁。单眼 18例 ,双眼 2例。首诊后转入神经内科治疗 11例 ,转入脑外科 8例 ,收眼科治疗 1例。首诊诊断 :视盘血管炎 3例 ,原发性青光眼 1例 ,视盘水肿原因待查 3例 ,原发性视神经萎缩 2例 ,眶尖综合征 1例 ,眼肌麻痹性偏头痛 1例 ,动眼神经麻痹 4例 ,痛性眼肌麻痹综合征 (Ｔｏｌｏｓａ-…     

急慢性鼻窦炎误诊586例临床分析

急慢性鼻实炎多可引起眼眶周围疼痛、眼痛、偏头痛和鼻窦及其放射区痛等症状，大多痛点明确，规律性强，一般可明确诊断并作相应治疗。部分病人因眼部症状明显而首诊于眼科，如不作详细检查，易造成误诊误冶。我科自1985～2004年共发现586例眼科误诊病例，现报告如下：     

颅内肿瘤致后视路病变的临床特点分析

正视路疾病的涵盖范围包括神经科和眼科,而眼科症状如视野缺损等也是许多视路疾病的早期症状,更可以因眼部症状作为主诉而就诊~([1])。临床工作中视交叉之前的疾病常常能够做到首诊于眼科就能明确诊断,而后视路疾病首诊于眼科时往往很难立即明确诊断。所以对于后视路病变临床表现的充分认识,能够避免对于视路疾病的漏诊、误诊,使得首诊眼科的视路病变能得到早期诊断、准确分诊、早期治疗。     

首诊于眼科的颈动脉海绵窦瘘2例

颈动脉海绵窦瘘(carotid cavernous fistula,CCF)是临床少见的脑血管疾病,常因眼部症状和体征而首诊于眼科.对于眼部症状不明显或仅表现为结膜充血、突眼或复视等的CCF患者,临床诊断较困难,易误诊为其他眼部疾病.     

首诊于眼科的儿童抽动障碍漏诊31例分析

儿童抽动障碍又称抽动秽语综合征,是一种以运动、言语和抽搐为特点的综合征或行为障碍。有些病例首发症状为频繁眨眼等眼部不适症状而首诊于眼科,极易被眼科医生单纯就结膜充血情况仅诊断为眼部疾患。我们对2007-2009年在当地医院首诊于眼科而仅诊断为眼部疾患患儿31例进行回顾性分析,总结既往诊治经过,现将其漏诊情况报告如下。     

首诊眼科的脑梗死临床分析

脑梗死患者的临床症状与血管病变部位、程度、血栓形成速度和侧支循环的情况有关.有些脑梗死病人早期没有出现明显的神经内科症状,而是以眼部首发症状来眼科就诊.现将我院2001年以来门诊遇到首诊眼科的脑梗死患者28例,报告如下.     

眼科首诊的2型糖尿病66例分析

部分糖尿病患者因未出现多食、多饮、多尿、消瘦（三多一少）的典型临床表现，而以眼部病变为首发表现，首诊于眼科，易导致误诊和漏诊，有的甚至造成严重后果。我院眼科2006-01～2006-12共发现以眼部病变为首发表现的2型糖尿病患者66例，现分析如下。     

以头痛首诊于神经内科的急性青光眼19例

目的:探讨以头痛为首发症状的急性闭角型青光眼的临床特点.方法:回顾性分析19例资料完整的以头痛为主要症状首诊于神经内科的急性闭角型青光眼患者的临床特点,包括全身症状体征、眼部临床特点以及预后.结果:19例中,头痛伴有眼痛、恶心、呕吐等14例,头痛、眼痛但无恶心、呕吐5例.神经科检查未发现阳性体征,影像学检查未发现明显的异常病变.眼部表现,常单眼发病,视力差,球结膜充血明显,角膜水肿,前房浅,瞳孔中等散大,眼压明显升高,降眼压治疗症状很快好转.结论:急性闭角型青光眼患者常以头痛为首发症状首先就诊于神经内科,仔细进行眼部检查或请眼科会诊可以有效减少误诊漏诊,提高诊断的正确率.     

首诊于眼科的面神经麻痹12例分析

目的探讨临床上首诊于眼科的面神经麻痹患者早期诊断和治疗的价值。方法对12例(12眼)首诊于眼科的面神经麻痹患者总结并分析其临床特点。结果 12例患者早期流泪症状明显,均得到明确诊断并得到及时治疗。结论临床上容易误诊漏治首诊于眼科的面神经麻痹患者,以流泪症状就诊患者要常规检查面部运动功能。     

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.     

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.