Achieve Closed Reduction of Irreducible,Unilateral Vertically Displaced Pelvic Ring Disruption with an Unlocking Closed Reduction Technique

ObjectiveTo be able to treat irreducible unilateral vertically displaced pelvic ring disruption (UVDPRD) using closed reduction, we introduced a technique named Unlocking Closed Reduction Technique (UCRT) and evaluated its effectiveness with improved pelvic closed reduction system (PCRS).MethodsA retrospective study was performed in our department. Between January 2014 and December 2017, 43 patients whose UVDPRD were not successfully reduced using transcondylar traction. Subsequently, they were treated with UCRT using improved PCRS. The study included 19 male and 24 female patients, with a mean age at the time of the operation of 46.2 years. During surgery, operation time and blood loss were recorded. Post‐surgical reduction quality was evaluated using Matta scoring criteria and patient lower‐extremity functional outcome was evaluated using Majeed functional scoring criteria.ResultsWhen used with improved PCRS, UCRT achieved pelvic reduction in all 43 cases of irreducible UVDPRD with postoperative pelvic reduction quality rated excellent and good for 42/43 (97.6%) patients according to the Matta scoring criteria (Matta Score < 10 mm). While no post‐surgical complications emerged as the direct result of UCRT in this cohort of patients, 8/37 patients who were treated with subcutaneous supra‐acetabular pedicle screw internal fixation (INFIX) for anterior ring fixation developed lateral femoral cutaneous nerve injury but recovered 6 months postoperatively. No revision surgery was performed on any of the recruited patients. All patients'' lower‐extremity functionality was rated excellent with an average Majeed function score of 94.3 during the last follow‐up at an average of 41.6 months postoperatively.ConclusionWith excellent surgical and functional outcomes in patients with irreducible UVDPRD, improved PCRS‐assisted UCRT proved to be a safe and effective method for the treatment of irreducible UVDPRD.     

Morel-Lavallée lesion diagnosed 25 years after blunt trauma

IntroductionMorel-Lavallée lesions are closed degloving injuries in which the skin and subcutaneous tissues separate from the underlying fascia secondary to a shearing force. These injuries are uncommon and can be misdiagnosed in acute settings. If treated incorrectly, they can recur, causing complications requiring multiple surgical interventions. Therefore, it is important to discuss the clinical presentation and imaging characteristics in order to improve their diagnosis and management.Presentation of caseThis is the case of a 44-year-old male patient with a Morel-Lavallée lesion of the left thigh that presented 25 years after trauma. He was successfully treated with open surgical excision. The patient underwent multiple surgical interventions before the lesion was accurately diagnosed and treated.DiscussionMorel-Lavallée injuries can lead to chronic symptoms, such as pain and swelling, affecting the patient’s quality of life. Treatment options include minimally invasive procedures, such as compression bandages or percutaneous drainage. However, if diagnosed late, a fibrotic capsule can form, which may require surgical excision. Our patient was diagnosed more than 20 years after the trauma. Earlier noninvasive treatment options were unsuccessful.ConclusionThe patient was treated with open surgical excision of the chronic lesion. There was no report of any recurrence up to 10 months after surgery. Such lesion treatments should be guided based on the chronicity of the injury and the patient’s symptoms. To the best of our knowledge, this is the first case with such delayed presentation.     

通脉络胶囊抗心肌缺血和耐常压缺氧作用的研究

目的：研究通脉络胶囊对实验动物的抗心肌缺血和耐常压缺氧作用,为临床用药提供依据。方法：给兔耳静脉注射脑垂体后叶素,造成急性心肌缺血状态,以心电图ＳＴ段及Ｔ波产生的变化为指标,来研究通脉络胶囊对抗垂体后叶素引起的兔心肌缺血作用;将小鼠放在密闭的容器中造成缺氧环境,以小鼠在常压缺氧条件下呼吸停止的时间为指标,来研究小鼠的耐常压缺氧作用。各实验均设四组动物：通脉络胶囊高、低剂量组、复方丹参片组、水对照组。结果：通脉络胶囊高剂量组与对照组比较有极显著性差异（Ｐ＜０．０１）;低剂量组有显著性差异（Ｐ＜０．０５）。与复方丹参片组比较,抗心肌缺血作用无显著性差异（Ｐ＞０．０５）;耐常压缺氧作用的高剂量组有极显著性差异（Ｐ＜０．０１）。结论：通脉络胶囊有显著的抗心肌缺血作用和耐常压缺氧作用,它的疗效与剂量有依赖关系;抗心肌缺血作用与复方丹参片近似,耐常压缺氧作用远较复方丹参片强。     

Maternal and perinatal outcome in rheumatic heart disease.

OBJECTIVES: To study the maternal and perinatal outcome of pregnancies complicated by rheumatic heart disease. METHODS: A retrospective study was carried out in the cardio-obstetric clinic of the Postgraduate Institute of Medical Education and Research, Chandigarh (India) over a period of 13 years (1987-1999) involving 486 pregnant patients with rheumatic heart disease. Maternal and perinatal outcome was reviewed. RESULTS: Three hundred and four patients (63.3%) had single valve involvement and mitral stenosis was the most predominant lesion (89.2%). One hundred and seventy one (38.6%) patients had undergone surgical correction prior to the onset of pregnancy. One hundred and thirteen patients (22.6%) were identified as NYHA class III-IV. Mitral valvotomy was performed during pregnancy in 48 patients. The incidence of preterm birth and small for gestational age newborns was 12% and 18.2%, respectively. There were 10 maternal deaths, of which eight patients were NYHA III and IV. CONCLUSIONS: Rheumatic heart disease in pregnancy is associated with significant maternal and perinatal morbidity in NYHA class III-IV patients.     

COMPARATIVE OBSERVATION ON CURATIVE EFFECT OF POSTOPERATIVE SYMPTOMS OF THE CLOSED CRANIOCEREBRAL INJURY TREATED BY ACUPUNCTURE

Theincidenceofcraniocerebralinjuryisveryhighatpresent.Trafficaccident,violenceandindustrialinjuryarethemainreasonsofthedisease.Besidesthecorrespondingsymptomsofcontusionand1acerationofbrain,subduralhematoma,extraduralhematomaandintracere-bralhematomamayoccuratthesametime.Thepatientswilldieiftheyarenotoperatedintime.However,theexacerbationofcerebralfunctioncausedbyoperativemechanicalstimulationcannotbeavoided.Therefore,therehabilitationofcraniocerebralinjuryisverycomplicatedanddif-ficult,andne…     

Generator localization by current source density (CSD): Implications of volume conduction and field closure at intracranial and scalp resolutions

The topographic ambiguity and reference-dependency that has plagued EEG/ERP research throughout its history are largely attributable to volume conduction, which may be concisely described by a vector form of Ohm’s Law. This biophysical relationship is common to popular algorithms that infer neuronal generators via inverse solutions. It may be further simplified as Poisson’s source equation, which identifies underlying current generators from estimates of the second spatial derivative of the field potential (Laplacian transformation). Intracranial current source density (CSD) studies have dissected the “cortical dipole” into intracortical sources and sinks, corresponding to physiologically-meaningful patterns of neuronal activity at a sublaminar resolution, much of which is locally cancelled (i.e., closed field). By virtue of the macroscopic scale of the scalp-recorded EEG, a surface Laplacian reflects the radial projections of these underlying currents, representing a unique, unambiguous measure of neuronal activity at scalp. Although the surface Laplacian requires minimal assumptions compared to complex, model-sensitive inverses, the resulting waveform topographies faithfully summarize and simplify essential constraints that must be placed on putative generators of a scalp potential topography, even if they arise from deep or partially-closed fields. CSD methods thereby provide a global empirical and biophysical context for generator localization, spanning scales from intracortical to scalp recordings.     

针刀治疗膝关节骨性关节炎临床研究

目的：针刀治疗膝关节骨性关节炎的效果。方法：按照通行诊断标准和排除标准确定受试者纳入范围，按照单盲随机原则对受试者（98例）分两组治疗，一组为观察组（50例）接受针刀治疗，另一组为对照组（48例）接受封闭针治疗，连续治疗3周（每周1次），比较疗效。采用专业指数量表给两组病人在疼痛、僵硬、关节功能三方面进行量化评估。结果：观察组和对照组有效率分别达到了94.00％和72.92％，且存在统计检验上的显著差异；治疗后各指标评估分值均大幅降低，观察组低于对照组，同样存在统计检验上的显著差异。结论：针刀技术治疗膝关节骨性关节炎效果显著。     

经封闭式负压引流后应用游离股前外侧皮瓣移植修复足部皮肤缺损的临床疗效

目的探讨经封闭式负压引流后应用游离股前外侧皮瓣移植修复足部皮肤缺损的临床疗效。方法选取2017年1月至2019年1月我院收治的76例足部皮肤缺损患者,随机分为两组,对照组进行经封闭式负压引流治疗,研究组在对照组基础上进行游离股前外侧皮瓣移植修复。比较两组治疗总有效率、生活质量评分、感觉功能恢复状况、植皮成功率。结果与对照组比较,研究组治疗总有效率更高(P0.05);与对照组比较,研究组生活质量评分更高(P0.05);与对照组比较,研究组S3、S1区感觉功能恢复率更高(P0.05),但其余区感觉功能恢复没有明显差异;与对照组比较,研究组植皮成功率更高(P0.05)。结论对足部皮肤缺损患者,应用经封闭式负压引流治疗基础上联合游离股前外侧皮瓣移植修复治疗,效果理想,可提高皮瓣移植成功率,改善生活质量,恢复部分感觉功能。因此,该治疗方法值得广泛应用。     

Quantitative EEG Findings Among Men Convicted of Murder

Abstract

Quantitative EEG data were collected from 20 men convicted of murder and sentenced to death. Measures of coherence, phase, amplitude asymmetry, and relative power from 19 scalp electrode sites during an eyes closed, resting condition were compared to a normative database. Measures significantly different from normal were tallied to determine electrode site locations with greatest concentrations of abnormalities. There were more right than left hemisphere abnormalities of coherence, phase, and amplitude asymmetry, and more anterior than posterior abnormalities of phase, amplitude asymmetry, and relative power. Bilateral frontal, right temporal, and parietal sites had the greatest concentrations of multiple abnormalities. Increased coherence and longer neural conduction times characterized the majority of coherence and phase abnormalities. The concentrations of frontal and right hemisphere abnormalities are discussed as relating to impairment, in executive functions, modulation of affect, and perception of affect in others. Such impairments perhaps in conjunction with adverse environmental events, are suggested as placing one at risk for violent behaviors. Relevance of these findings for future research, forensic neuropsychological assessments, and neurofeedback treatment is mentioned.     

Closed suction drainage for deep neck infections

PurposeThere have been various incision and drainage methods for deep neck infection (DNI). Closed-suction drainage (CSD) has been used to decrease hematoma or to drain pus in other forms of medical surgery. The purpose of this investigation was to evaluate the usefulness of CSD for DNI.Patients and methodsThis study consisted of 30 patients who underwent CSD after incision and drainage for DNI between January 2006 and December 2011. The patients' demographics, systemic diseases, methods of airway control, involved spaces, incision, CSD results, duration of hospitalization, and complications were investigated.ResultsCSD was used to treat 30 DNI patients. Eleven patients (37%) had underlying systemic diseases like diabetes mellitus, hypertension, hepatitis, asthma, etc. Twenty four patients (80%) had odontogenic infections in the mandibular molar region. Tracheostomy was performed in 5 patients (17%). The involved spaces were various from parapharyngeal space to mediastinum (mean: 4.8 spaces), and CSD was applied with drainage lines (mean: 3; 2–7 drains) over the course of 4–37 days (mean 14.6 days). The total amount of drained pus was 8–1344 cc (mean: 406 cc) and the daily amount was 1–61 cc (mean: 28 cc) from each patient. The mean length of hospital stay was 26 days, with a range of 9–83 days. Wound rupture happened in 7% of 56 total incision sites and spontaneous removal of the drain tube occurred in 3% of 91 total tubes. Four patients died because of cardiac arrest, pulmonary edema, and hypoxia. A statistical significance was accepted about total and daily amount of drainage at Pearson's correlation test (p < 0.001).ConclusionAccurate diagnosis, safe airway management, and early surgical drainage were important in DNI treatment. Compared to other drainage systems, CSD is clinically useful for treating DNI due to minimal incision, convenience of post-operative management, and less postoperative complications.