The biomechanics of vibration and low back pain

This work is a review of the mechanical factors related to low back pain production in a vibration environment. The sitting posture is an extreme orientation for the lumbar intervertebral disc that 1) increases its internal pressure, 2) increases its anteroposterior shear flexibility, while: 3) decreasing its resistance to buckling instability and 4) stressing the posterior region of the disc. Vibration is an additional mechanical stressor. Several studies suggest that the following preventive measures be taken to reduce the risk of low back pain due to driving: 1) minimize the vibration reaching the driver, 2) avoid lifting or bending immediately following driving, and 3) walk around for a few minutes following driving. © 1993 Wiley-Liss, Inc.     

Hepatobiliary scintigraphy in a patient with bilhemia

A 4-year-old child referred for acute jaundice following percutaneous needle biopsy of the liver underwent hepatobiliary scintigraphy. Although all conventional liver tests suggested preservation of hepatocyte function, the tracer uptake in the liver appeared dramatically reduced at scintigraphy and the blood pool activity did not decrease significantly until the end of the study. Visualization of the bile ducts indicated, however, that the tracer was taken up by the hepatocyte and further excreted into the biliary tree. There was no tracer pooling in the biliary tree although no bowel activity was observed, even on delayed images. The association of persistent blood pool activity, bile duct visualization without tracer pooling, and nonvisualization of the bowel was caused by a continuous recirculation of the tracer from the biliary tree into the bloodstream. The presence of a biliovenous fistula was further proven by percutaneous transhepatic cholangiography performed 24 h later. Since 1975, only 16 cases of bilhemia have been reported. To the best of our knowledge the scintigraphic pattern of this rare but lifethreatening complication has not previously been reported.     

C3 Deposition in IgA Nephropathy in Children and Adolescents

The aim of this study was to assess the significance of C3 deposition in IgA nephropathy in children and adolescents. One hundred and two patients aged 5–21 years (57 male and 45 female) were studied. The findings of C3 deposition were classified into 8 groups by immunofluorescent (IF) pattern and intensity as follows: group MC3+ (N = 12): mesangiocapillary pattern and 3+ in intensity; group MC2+ (N = 13): mesangiocapillary and 2+; group MC1 + (N = 4): mesangiocapillary and 1 +; group M3+ (N = 11): mesangial and 3+; group M2+ (N = 24): mesangial and 2+; group M1 + (N=18): mesangial 1 +; group S (N = 12): only segmentally positive; and group N (N = 8): negative. Histological changes were scored semiquantitatively as an activity index (cellular proliferation, necrosis, interstitial cell infiltration, and cellular crescents) and a chronicity index (mesangial sclerosis, segmental and global glomerular sclerosis, fibrous crescents, adhesion and tubulo-interstitial change). IF findings were scored semiquantitatively and laboratory findings were also studied. The following results were obtained: 1) The scores of total activity index in MC groups were higher than in the M, S or N groups, and the greater the degree of C3 deposition, the higher the score; 2) Such result was not evident in the chronicity index; 3) High IF scores of IgG and IgM were found in the MC3+ and MC2+ groups; 4) Hematuria was more severe in MC3+ and MC2+ than in other groups, and proteinuria was more prominent in the MC than other groups. Thus the degree of C3 deposition was parallel with histological activity and urinary findings.     

腰穿放液治疗160例外伤性蛛网膜下腔出血的体会

目的：探讨腰穿放液对外伤性蛛网膜下腔出血的作用。方法：对１６０名外伤性蛛网膜下腔出血的病人行腰穿放液，少则２次，多则７次。结果：所有病人症状均好转，从脑脊液的力学上看脑脊液恢复正常性状的时间缩短，结论：腰穿放液治疗外伤性蛛网膜下腔出血是十分有效的方法，近期内临床症状明显改善，远期并发症减少。     

37例创伤死亡病例分析

本文对住院因外伤致死者进行了一般分析，说明创伤造成死亡占总死亡人数之６３。７％，而其中６５％均为青壮年和中年，并着重对颅脑损伤的死亡情况加以分析，提出对特重型颅脑外伤当非手术疗法无效时，应行手术探查减压，另外对腹部挫伤和烧伤及开放性骨折引起死亡的病例进行了讨论。     

Motives of Childhood Firesetters: Firesetting Characteristics and Psychological Correlates

The present study evaluated curiosity and anger as motives among childhood firesetters. Parents of 133 firesetters (ages 6-13) completed the Fire Incident Analysis (FIA) to permit classification of the children as high and low on each of these two primary motives and to document details of the child's most serious incident within the past 12 months. The children were compared on measures of child dysfunction and firesetting history. An effect of Curiosity was found on measures of psychopathology, firesetting risk, and fire involvement, whereas an effect of Anger was found on measures of firesetting risk and the behavioral correlates of individual incidents. The results clarify the role of child motive in understanding firesetting involvement.     

Clinical diagnosis of trauma from occlusion and its relation with severity of periodontitis

The purpose of the present study was to determine the reliability of several selected signs of trauma from occlusion and their relations with severity of periodontitis. 32 moderate to advanced chronic periodontitis patients participated in the study. All teeth present were evaluated for various abnormal occlusal contacts, signs of trauma from occlusion, and the severity of periodontitis. Standardized periapical radiographs were also taken for each tooth. The results demonstrated that: (1) no significant difference occurred in probing pocket depth (PD), clinical attachment loss (AL), or percentage of alveolar bone height (BH) between teeth with and without various abnormal occlusal contacts, i.e., premature contacts in centric relation occlusion, non-working contacts in lateral excursions, premature contacts of anterior teeth or posterior protrusive tooth contacts; (2) teeth with either significant mobility, functional mobility, or radiographically widened periodontal ligament space (PDLS) had deeper PD, more AL and lower BH than teeth without these signs, while teeth with pronounced wear or radiographically thickened lamina dura had less AL than teeth without these findings; (3) 2 combined indices, i.e., the trauma from occlusion index (TOI) and the adaptability index (AI), were proposed for the identification of occlusal trauma and the response of periodontium to excessive biting forces in heavy function, respectively; TOI-positive teeth exhibit deeper PD, more AL and less osseous support than TOI-negative teeth; however, AI-positive teeth had less AL and more osseous support than AI-negative teeth; (4) with identical attachment level, TOI-positive teeth had less osseous support than TOI-negative teeth while the magnitude of difference became greater with an increase of attachment loss.     

Komplexverletzungen des Fußes

Complex injuries of the foot are often overlooked, especially in the multiple injured patient, and they then lead to major loss of function. When the mechanism of injury suggests involvement of the foot, a clinical examination of the lower extremities should be included in the primary diagnostic procedures implemented in the multiply injured patient, followed by radiological examination once the patient's condition is stable. The condition of the soft tissues is of decisive importance in the prognosis of complex foot injuries, regardless of whether the damage to the foot is one component of a polytrauma or an isolated injury, which can also be life threatening. The diagnostic examinations selected should be adapted to the severity of the injuries in the particular multiply injured patient. Successful therapy involves stable internal fixation of injuries to bones and joints, though the external fixation options should be considered in the first instance, and carefully selected methods of temporary and definitive soft tissue reconstruction. The aim of treatment is the best possible reconstruction of the foot as a functional weight-bearing unit with intact soft tissue cover and a natural form. Good results can be achieved when there is close interdisciplinary cooperation between trauma (orthopedic) and plastic surgeons. Patient with severe injuries of this kind should be transferred to a trauma center as the first step toward this end.