Treatment of resistant distal intestinal obstruction syndrome with a modified antegrade continence enema procedure

We report a case of a patient with CF who had a long history of recurrent distal intestinal obstruction syndrome. She had been treated with conventional treatment including gastrografin, n-acetyl cysteine, Klean prep and Picolax. She underwent a modified antegrade continence enema procedure. She currently irrigates her conduit every 2-3 days. She has had no further symptoms of distal intestinal obstruction syndrome.     

非角度稳定性钢板固定治疗桡骨远端关节内背侧移位骨折的结果

Objective Intra-articular fractures of the distal radius in young adults comprise a distinet fracture pattern that is diffficuh to manage and associated with a high frequency of post-traumatic arthritis.Restoration of articular congruency and alignment should improve the outcome.Methods In this study we prospectively re- viewed the results of 21 consecutive cases of dorsally displaced intra-articular distal radius fractures which were treated with internal fixation after failing to achieve articular congruency with closed reduction.Results 3 patients were lost to follow-up.For the rest of 18 patients,follow-up time ranges from 18 to 75 weeks the fractures had healed with highly satisfactory radiographic and functional results.The final volar tilt averaged 4.9°;radial inclination 23.9°;radial length 14mm;and articular incongruity,0.1 mm.Wrist motion at final follow-up examination aver- aged flexion 62°,extension 60°,radial deviation 16°,ulnar deviation 27°,pronation 77°and supination 74°.Grip strength averaged 83% of the uninjured side.The overall outcome of 18 patients(94.4%)had a good or excellent result according to the system of Gartland and Werley and 18 patients(72.2%)had a good result according to the modified system of Green and O'Brien at the most recent evaluation.The only complication in this series was a superficial pin tract infection,which was rapidly resolved with removal of pins at 5th week of external fixation. Conclusion Thus restoration of articular congruency and alignment is possible with minimal complication using modern non-angular stable methods of internal fixation.     

肘关节脱位与肱骨远端关节内骨折

Objective To describe dislocation of the elbow with articular fracture of the distal humerus,a type of elbow fracture-dislocation about which little has been written.Methods Four patients with a dislocation of the elbow and fracture of the distal humerus were identified.Three had dislocation and complex intraarticular fracture of the capitellum,trochlea,and lateral epicondyle.Results Two patients(one treated with a second operation to address avascular necrosis of the capitellum)achieved a functional arc of elbow motion and one patient was lost after removal of the implants 3 months after fracture with documented healing.The fourth patient had a complex open fracture dislocation involving the entire articular surface.An attempt to salvage the articular surface resulted in deep infection.Extensive heterotopic bone led to arthrodesis of the elbow.Conclusions Dislocations of the elbow with articular fracture of the humerus are uncommon.Most injuries involve the capitellum,lateral trochlea,and lateral epicondyle.Open reduction and internal fixation of the distal humerus fracture can restore stability without repairing the medial collateral ligament.     

Partial resection of distal humerus and reconstruction using autogenous iliac bone graft

Summary Seven patients with eccentrically placed tumours of the distal end of the humerus treated with partial resection and autogenous iliac bone grafting are reported. The functional results are discussed.

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Résumé Présentation de sept cas de tumeurs situées à l'extrémité distale de l'humérus et traitées par résection limitée et reconstruction par autogreffe lilaque. Discussion des résultats fonctionnels.

     

Plasma concentrations of prolactin, noradrenaline, vasopressin and oxytocin during and after a prolonged epileptic seizure

The time course and extent of changes in plasma prolactin, noradrenaline, vasopressin and oxytocin levels is reported following serial observations of a prolonged epileptic seizure arising in the temporal lobe, recorded by video-EEG-telemetry, in which the epileptic activity evolved from a simple partial to complex partial to secondarily generalised attack. The prolactin levels were markedly elevated during the phase of the simple partial seizure, at a time when consciousness was preserved, when motor activity was minimal and when EEG activity was highly localised. The hormonal levels continued to rise during the subsequent seizure evolution, suggesting that the duration (or intensity) of the seizure is an important, perhaps the most important, factor determining the degree of prolactin release during limbic seizures. Indeed, the prolactin elevation in this case (26 times the baseline level) is higher than any previously recorded, reflecting the unusual duration and intensity of this seizure. We did not observe the phenomenon of "exhaustion" of prolactin release and levels peaked after 49 min, and were high for over 2 h after the onset of the seizure, and after the convulsion had ceased. The concentrations of vasopressin, oxytocin and noradrenaline remained low during the aura, but rapidly increased during the phase of generalisation. The oxytocin and noradrenaline levels peaked during the phase of generalised convulsion, but the vasopressin levels peaked well into the post ictal phase, and remained high for several hours. The differing patterns of hormone release are likely to be related to the different anatomical sites of the hypothalamic perikarya, the relative importance of excitatory and inhibitory hypophysiotrophic agents in the release of anterior pituitary hormones and the localised release of neuromodulatory agents.     

管状骨增宽牵引成骨组织形态学变化的实验研究

目的 探讨管状骨增宽牵引后新骨形成的变化。方法 在成年山羊的后肢放置2只增宽牵引器。实验组9只术后第8天牵引，对照组3只不牵引。牵引完毕后不同时期，各宰杀3只，评价管状骨增宽牵引后新骨形成的质和量。结果 实验组胫骨平均增宽7．83mm，X射线见牵引间隙逐渐变模糊，暴露侧有骨不连，非暴露侧成骨良好，牵引完毕3个月，未暴露侧新形成板层骨与原来胫骨融为一体，而暴露侧骨不连区为致密纤维组织。结论 管状骨增宽牵引成骨后，两侧牵引间隙成骨不一致，良好的血供，对新骨形成至关重要。     

应用张力带固定法治疗锁骨远端骨折

目的：评价张力带固定法治疗锁骨远端骨折的临床效果。方法：对20例锁骨远端骨折行切开复位后张力带固定法治疗。术后随诊分析。结果：所有骨折均在半年内愈合。患侧肩关节功能恢复良好。无一例出现伤口感染。结论：张力带固定治疗锁骨远端骨折是一种简单可靠的手术方法。     

Link protein shows species variation in its susceptibility to proteolysis.

Human cartilage link protein exists as three native components, while equine, bovine, and porcine cartilage link protein exist as two and Swarm rat chondrosarcoma link protein exists as only one component. These nonhuman link protein components represent intact protein structures, and there is little evidence for proteolytically modified forms in nonhuman tissues. In human cartilage, the proteolytic production of modified link proteins increases with age, whereas high amounts of such products were not seen in the nonhuman tissues. However, the small amounts of link protein fragments that were observed in the nonhuman cartilages were of a similar size to their human counterparts. On digestion of human proteoglycan aggregate with stromelysin, rapid modification of the link protein components occurred, whereas the aggregates from nonhuman cartilages showed incomplete cleavage of their link protein components. The relative resistance of nonhuman link protein to stromelysin may in part be due to a unique amino acid substitution present near the enzymic cleave site.     

内镜下切断屈肌支持带远侧纤维束治疗腕管综合征

目的探讨内镜下腕管切开减压术（endoscopic carpal tunnel release，ECTR）中切断屈肌支持带远侧纤维束（distal holdfast fibers of the flexor retinaculum，DHFFR）的必要性。方法观察组16例，臂丛神经阻滞麻醉，不使用止血带，皮肤1cm切口，内镜下应用USE系列切断腕管横韧带和DHFFR，与对照组16例单纯切断腕管横韧带进行疗效比较。结果术后6个月功能随访，按照Kelly疗效评定标准，观察组优13例，良3例；对照组优8例，良5例，可3例，2组浜田Ⅱ、Ⅲ级疗效差异有显著性（，=6．278，P=0．043）。2组均无严重并发症及术后复发。结论对浜田Ⅱ、Ⅲ级腕管综合征者术中注意腕横韧带切断不是唯一的目标，同时切断DHFFR才能彻底减压。