下肢穴位按摩改善终末期肾病患者睡眠质量42例临床研究

目的研究下肢穴位按摩对终末期肾病患者睡眠质量的影响。方法将82例伴有睡眠紊乱的终末期肾病住院患者随机分为观察组42例及对照组40例。观察组采用下肢穴位按摩，每日1次，每次按摩20～30分钟；对照组每晚睡前半小时口服舒乐安定片1mg，总疗程均为4周。同时采用睡眠状况自评量表（SRSS）测评两组治疗前后睡眠状况，并记录治疗前后不良主诉发生率。结果两组在SRSS的睡眠不足、主观睡眠质量、入睡困难、噩梦夜惊、失眠后反应等因子评分，SRSS总评分及不良主诉发生率方面差异有显著性意义（P＜0．05），观察组睡眠质量和不良主诉改善情况明显优于对照组。结论下肢穴位按摩能有效改善终末期肾病患者睡眠质量。     

Clinical Observation of Tuina Therapy in Treating 47 Cases of Vertigo

为观察推拿治疗眩晕的临床疗效，以推拿头部三焦经及胆经为主，治疗眩晕患者47例，结果痊愈36例，好转11例，总有效率100％。     

第一跖趾关节Swanson人工假体置换术及其疗效评价

目的 评价Swanson双柄硅胶人工铰链式假体第一跖趾关节置换术的疗效。方法 使用Swanson双柄硅胶人工铰链式假体实施第一跖趾关节置换术10例13个关节,其中老年骨关节炎拇外翻8例10足,类风湿关节炎1例2足,创伤性关节炎1例1足。结果 全部病例获得随访,随访时间12个月一38个月,平均25个月。8例患者获得了完全满意的效果,1例病人部分满意。不满意的1例患者是因为关节置换术后3年跖趾关节截骨面出现了较严重的骨质增生而引起疼痛的症状。有2例出现硅胶假体周围明显的骨溶解,但无症状,未作特殊处理。结论 Swanson双柄硅胶假体第一跖趾关节置换术能够保留关节活动度及躅趾长度,从而维持前足正常的行走功能,达到消除跖趾关节疼痛、改善功能、矫正畸形等理想的效果,是重建跖趾关节的有效方法。     

关节镜下膝关节骨性关节炎伴半月板损伤分析

目的探讨膝关节骨性关节炎（OA）伴发半月板损伤的发生率及其在诊断治疗中的意义。方法对因第一诊断为膝关节OA而行关节镜下关节清理术共120例125个膝关节,分析半月板损伤的发生率、损伤类型及其与OA严重程度的相关性,并对选择性关节腔清理结合半月板修切术的疗效进行评价。结果症状以膝关节疼痛为主,无游离体而有绞锁现象者32膝（25．6％）,术前诊断OA合并半月板损伤22膝（17．6％）,LYSHOLM评分平均52分。术中发现内侧半月板损伤41膝（32．8％）,外侧半月板损伤21膝（16．8％）,其中内外侧均损伤7膝（5．6％）。镜下损伤类型主要为磨损（29．0％）、边缘毛刷样破损（12．9％）、各种破裂（51．6％）以及桶柄样撕裂（1．61％）,损伤程度与关节软骨破坏程度明显呈正相关,手术前后诊断符合率为40．0％（22／55）。术后3、6、12个月复诊,总体满意率分别为89．6％（107／120）、86．4％（104／120）、83．2％（100／120）,有半月板损伤者满意率分别为94．5％（59／62）、91．0％（56／62）、87．3％（54／62）,平均LYSHOLM评分分别为77、74、71分和85、82、79分。结论膝关节OA往往伴有半月板损伤,两者可有相互加重的作用。部分OA患者保守治疗难以缓解膝关节症状或延缓OA的病程,关节镜下清理术有一定的诊断和治疗价值。     

Widening of foot processes in normoalbuminuric adolescents with type 1 diabetes

We compared renal morphology in normoalbuminuric adolescents with type 1 diabetes with age-and sex-matched controls. Renal morphological measurements in 46 unselected adolescents with diabetes for approx. 10 years were compared with those in 20 healthy kidney donors. Renal volume estimated by ultra-sound, renal function determined by clearances of inulin and para-aminohippurate, and long-term mean HbA_1c were measured in the patient group. Basement membrane thickness (BMT), mesangial matrix and capillary volume fractions per glomerulus [V_V(matrix/glom), V_V(cap/glom)] were significantly greater in patients than in controls (505 nm, 10.5%, 46.7% vs. 320 nm, 7.9% and 39.3%). The foot processes were wider in patients than in living donors (414 nm vs. 372 nm). There was no difference in mean kidney volume of patients with diabetes and healthy subjects. Glomerular filtration rate, body weight, and slit pore length density explained 60% of the variance in renal volume. After about 10 years duration of type 1 diabetes, BMT, V_V(matrix/glom), V_V(cap/glom), and foot process width were greater in normoalbuminuric adolescents than in healthy controls. This increase in foot processes of normoalbuminuric patients has not been reported before.     

Accessory joints between basiocciput and atlas/axis in the median plane

To explore the many osseous irregularities that are found in the area between the basiocciput, the anterior arch of the atlas and the tip of the dens axis we studied 99 cadaver specimens using magnetic resonance tomography (MRT), computed tomography (CT), median saw-cut sections, and histological sections. Additionally, "dry" specimens of the skull (n = 110), atlas (n = 56), and axis (n = 33) were investigated. In the median plane, the dry and cadaver specimens exhibited osteoarthritis-related osseous outgrowths and osteophytes of the articular surfaces of the median atlanto-axial joint (n = 63), and the presence of congenitally developed free ossicles (n = 22) and of third occipital condyles (n = 3). The largest osteophytes (giant osteophytes) (n = 4) of the anterior arch of the atlas formed osseous contact zones with the basiocciput that were visible histologically as real joints and were designated accessory median atlanto-occipital joints. The third occipital condyles also formed osseous contact zones, visible histologically as real joints, with the anterior arch of the atlas or with the tip of the dens, and were designated accessory atlanto-occipital or occipito-odontoid joints. Frequent free ossicles, incorporated into the accessory joint, were found by histological examination to be covered with hyaline cartilage.     

Entry lesions in bancroftian filarial lymphoedema patients--a clinical observation

The prevalence of entry lesions in limbs was significantly higher in limbs with filarial lymphoedema (80.88%) than in normal limbs (42.86%, P = 0.000012). Among the various entry lesions in the lymphoedematous limbs, the prevalence of web space intertrigo was significantly higher in those who had acute dermatolymphangioadenitis (ADLA) than those who did not have ADLA (P = 0.04). Entry lesions were present only in 25% of those not using footwear, while 84.3% of those using footwear regularly or irregularly had these lesions (P = 0.01). None of the patients with good limb hygiene had ADLA, while 64% of those with fair to poor limb hygiene had ADLA (P = 0.02). Since the majority of the entry lesions were asymptomatic, training of patients and health care givers to specifically look for and treat these along with advice for good limb hygiene practices should form an important component of foot care programme for optimum filarial morbidity management.     

All-terrain vehicle injuries in children: injury patterns and prognostic implications

Background All-terrain vehicle (ATV) accidents are common in children. Our purpose was to identify imaging patterns associated with ATV injuries in children.Patients and methods The study group comprised 141 consecutive children admitted to a tertiary pediatric hospital following ATV accidents. Medical records were evaluated for demographics and patient outcome. All imaging studies were reviewed and abnormalities cataloged.Results Extremity fractures were the most common injuries in our study, occurring in 38% of patients. Lower extremity fractures were more common than upper extremity fractures. Partial foot amputation, an unusual injury, was present in three children. Torso injuries were present in 22% of the children. Pulmonary contusions, but not abdominal injuries, were significantly associated with long-term disability or death (p=0.01). Brain injuries occurred in 19% of the children and were significantly associated with death or long-term disability (p=<0.001). No association of brain injury and skull fracture was present.Conclusions A wide variety of injuries were identified in children with ATV accidents. Partial foot amputation, an unusual injury, was identified in three children. Brain injuries and lung contusions detected by computed tomography were associated with long-term disability and death. Radiologists need to be aware of injuries associated with ATV accidents.     

Foot and mouth disease in livestock and reduced cryptosporidiosis in humans,England and Wales

During the 2001 epidemic of foot and mouth disease (FMD) in livestock in England and Wales, we discovered a corresponding decrease in laboratory reports of cryptosporidiosis in humans. Using a regression model of laboratory reports of cryptosporidiosis, we found an estimated 35% (95% confidence interval [CI] 20% to 47%) reduction in reports during the weeks spanning the period from the first and last cases of FMD. The largest reduction occurred in northwest England, where the estimated decrease was 63% (95% CI 31% to 80%). Genotyping a subgroup of human isolates suggested that the proportion of Cryptosporidium genotype 2 strain (animal and human) was lower during the weeks of the FMD epidemic in 2001 compared with the same weeks in 2000. Our observations are consistent with livestock making a substantial contribution to Cryptosporidium infection in humans in England and Wales; our findings have implications for agriculture, visitors to rural areas, water companies, and regulators.     

A study of the distribution of load under the normal foot during walking

Summary A computerised instrumentation system which measures the distribution of vertical load under the foot has been used to measure and record the loading under 148 normal feet during walking. The correlations and variations with load, contact time, sex, age and angle of the toe out are discussed.

---

Résumé Un système informatisé, qui mesure la répartition des charges verticales au niveau des pieds, a été utilisé pour mesurer et pour enregistrer 148 pieds normaux pendant la marche. Les auteurs discutent les corrélations et les variations en fonction du poids, du temps de contact avec le sol, du sexe, de l'âge et de la désaxation des orteils.