胸椎神经病变的物理疗法

所谓脊柱相关疾病，是指由于脊柱力学不平衡而引起身体各系统的一系列病症 [1]。胸椎神经病变即是脊椎遭受损害后，胸椎的力学改变造成脊柱胸段脊髓、周围神经、血管及内脏神经损害引起的一系列病症 [2]。 1 病因 胸椎的骨、关节、椎间盘及椎周软组织遭受损伤或退地性改变在一定诱因条件下，发生关节错位、椎间盘突出、韧带钙化或骨质增生，直接或间接地对神经根、椎动（静）脉、脊髓或 /和交感神经等产生刺激或压迫，而引起临床上所说的植物神经紊乱、神经官能症等。其发生机制可能为交感神经的节前纤维在椎骨通道中受到压迫或受到椎旁软组…     

严重慢性机械压迫性脊髓损伤的手术疗效分析

目的:评价严重慢性机械压迫性脊髓损伤的手术疗效。方法:回顾性分析手术治疗的28例严重慢性脊髓损伤患者的临床资料,根据术前及术后随访24月时JOA评分的变化进行疗效评价。结果:脊髓型颈椎病7例,颈椎后纵韧带钙化6例,寰枢椎脱位1例,胸椎黄韧带钙化7例,胸椎黄韧带钙化并后纵韧带钙化4例,胸腰椎创伤后后凸畸形3例;均根据损伤类型进行相应手术治疗;随访结果显示术后24月时患者的JOA评分较术前均增加(P0.05),疗效评价"差"2例,"一般"5例,"好"21例。结论:对于大部分严重慢性机械压迫性脊髓损伤患者手术治疗可取得良好疗效,手术方式是影响部分患者疗效的重要因素。     

T_(3～12)胸椎松质骨冲击力学特性:青年与老年的差异比较

背景:骨质疏松、骨重建、骨再造、胸椎骨折固定器选择等都需要了解青年和老年尸体胸椎松质骨的冲击力学特性.以往的研究多以单独青年尸体或单独老年尸体胸椎松质骨为观察对象,而有关青年和老年尸体胸椎松质骨冲击力学特性的研究报道极少.目的:对正常国人青年和老年新鲜尸体胸椎松骨进行冲击实验,分析胸椎松质骨的冲击力学性质,确定老年尸体松质骨和青年尸体胸椎松质骨是否具有不同的冲击力学性质.方法:实验标本取自4具正常国人男性新鲜尸体,年龄分别为20,25,70,75岁,由白求恩医科大学解剖教研室提供.人死亡后1 h之内解剖取出死者胸椎T_(3～12)标本,将标本沿纵向切成长40 mm,宽6 mm,高6 mm的试样,每组各20个.以能量释放的方法对2组试样进行冲击实验,在室温28℃的温度场下进行实验.实验结束后,试验机测量度盘自动显示试样的冲击功,根据材料力学公式计算出每个试样的冲击韧性,观察各试样的宏观断口形貌.结果与结论:青年组胸椎松质骨冲击功、冲击韧性均显著大于老年组(P＜0.05).胸椎松质骨冲击实验断口多数为粉碎性断口,少数为横断口或斜断口.宏观观察青年组腰椎松质骨骨小梁排列细密,老年组腰椎松质骨骨小梁排列稀疏,孔隙较大,呈现出老年骨质疏松的表现形式.提示青年组脊柱胸椎松质骨和老年组脊柱胸椎松质骨具有不同的冲击力学特性,老年组试样由于骨质疏松导致冲击力学特性发生改变.     

手法整复胸椎小关节紊乱治疗慢性胆囊炎9例

20 0 0 -2 0 0 2年我科收治的慢性胆囊炎伴有胸椎小关节紊乱患者 9例 ,男 2例 ,女 7例 ;年龄 3 6～ 55岁 ;病程 1～ 6年 ;患者均有不同程度的肩背胀痛 ,沉重感、痛及前胸、腹胀或厌食油脂 ,劳累后加重等症状 ;胸椎触诊 ,棘突向右偏歪 5例 ,向左 1例 ,向后凸 3例 ,偏歪及后凸棘突压痛均为阳性 ;X线正位片示胸椎棘上韧带钙化 3例 ;超声诊断为胆囊缩小、胆囊壁增厚 9例 ,其中结石 5例均长期服用消炎利胆药物而疗效不佳。治疗采用按压胸椎复位法 :患者俯卧位 ,上肢放于体侧 ,医者立于患者棘突凸向一侧 ,右掌根按住凸起棘突 ,左手叠加在右手背上…     

原发性支气管肺癌的钙化多为偏心性分布吗？

目的分析原发性支气管肺癌钙化的分布及其鉴别诊断意义.方法收集经病理证实的并含肉眼可见钙化的原发性支气管肺癌32例,回顾性分析CT像上钙化的分布特征及与原发肿瘤病理类型的关系,用非配对t检验行统计学分析.结果病灶平均最大直径5.4±2.3cm(2.0～13.0cm),其中直径5cm以下者3例.偏心性钙化16例,其中9例为腺癌,鳞癌7例.中心性者14例,包括腺癌5例,鳞癌5例,小细胞癌2例,低度恶性肿瘤1例,未能分型1例.钙化数目5枚、4枚、3枚各1例,2枚者3例,均属偏心分布;1例含4枚钙化者,既有中心又有偏心性钙化;另1例为弥漫性钙化,其余25例均只含1枚.中心性组和偏心性组间数目、及与病理组织类型间均无显著性差异(P＞0.05).结论原发性肺癌的钙化既可以是中心性也可以偏心性分布,钙化的分布不能作为定性诊断的依据.     

颈椎病并发胸椎小关节紊乱症相关因素分析及护理对策

[目的]分析颈椎病并发胸椎小关节紊乱症的相关因素,探讨相应的护理对策.[方法]回顾性分析39例颈椎病并发胸椎小关节紊乱症病人的临床资料.[结果]颈椎病并发胸椎小关节紊乱症以31岁～44岁年龄段为主(占44.68%);女性病人发生率较高(占44.78%);在临床各类型颈椎病中分布无明显差异;在长期从事低头或伏案工作的颈椎病病人中发病率较高(占51.16%);发病几率随病程逐渐增高,其中病程＞1年合并胸椎小关节紊乱症达58.62%.[结论]颈椎病并发胸椎小关节紊乱与年龄、性别、病程、职业特点有一定的相关性.应针对其发病的相关因素采取相应的护理措施.     

胸椎结核误诊6例分析

现将胸椎结核误诊6例分析如下. 1 临床资料 本组男3例,女3例,年龄16～53（平均35.2）岁.病变部位：单纯胸椎结核1例,胸椎结核伴椎旁脓肿3例,胸椎结核伴椎旁脓肿、肺结核1例,胸腰椎结核伴腰大肌脓肿1例.临床表现：均以疼痛为主要表现,呈阵发性剧痛或放散痛,胸痛2例,腹痛2例,下肢痛1例,腰痛1例.发病到最后确诊时间最短3个月,最长2 a,平均7个月.平均就诊次数4次,最多7次.     

有肋骨支架胸椎急性损伤的MRI诊断与评价

脊柱损伤是临床上的常见病、多发病,好发于脊柱的胸腰段.转移性肿瘤以胸椎为多发[1].胸椎的第2～10椎体有肋骨支架[2],称之为有肋骨支架胸椎,其受外力作用所致的损伤有其特殊性.回顾性分析有肋骨支架胸椎损伤39例MRI诊断,旨在提高对该病的认识以及鉴别诊断水平.     

胸椎结核经胸腔手术的围手术期护理

脊椎结核占全身骨结核的首位,近年来发病率有上升趋势[1],其中胸椎、腰椎结核占大多数.由于胸椎结核易引起脊髓或神经根损伤,甚至截瘫,护理难度较大,特别是经胸腔行胸椎结核病灶清除术风险大,因此对围手术期护理工作提出了更高的要求.为此,笔者对2003年2月至2005年1月本院12例胸椎结核经胸腔手术病例做一回顾总结,现报告如下.     

乳腺癌的X线表现和分型

目的分析139例乳腺癌影像表现和分型,旨在提高对本病诊断的准确性.方法回顾性观察139例经全数字化平板乳腺摄影(FFDM)检查、手术及病理证实的乳腺癌的X线表现和分型.结果 139例乳腺癌中肿块结节型88例,单纯钙化型39例,局部结构紊乱型11例,导管阻塞型1例.肿块结节型中检测到小于1 cm的微小癌和小癌16例.除导管阻塞型乳腺癌外其他各类型中均有钙化出现, 钙化总显示率为80.57%,单纯钙化型乳腺癌的钙化分布、数目、密度和形态有别于其他类型.临床扪及包块的乳腺癌见于肿块结节型和局部结构紊乱型,未扪及包块乳腺癌仅见单纯钙化型和导管阻塞型.结论乳腺癌不同类型有其特有X线表现,FFDM对乳腺癌的影像表现显示清晰,对小病灶探测率高,显示小于0.1 mm的微小钙化等有利于乳腺癌的诊断和分型.     

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.     

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.     

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.