肱骨近端移位骨折的手术治疗

目的：总结肱骨近端移位骨折的手术治疗方法和疗效。方法：分析手术治疗肱骨近端骨折28例资料。患者平均年龄24．4岁，平均随访2年6个月；手术均采用三角肌胸大肌间隙入路，钢板固定15例，交叉克氏针固定11例，单纯螺丝钉固定15例；采用Neer分类及评分方法评价手术结果。结果：两部分外科颈骨折优良率为64．7％，无头坏死及不愈合，三部分骨折和四部分骨折切开复位的满意率较低。结论：两部分骨折和三部分骨折可采用切开复位内固定，但尽量避免使用钢板；对四部分骨折，内固定满意率较低且肱骨头坏死率较高。     

旋转复位配合矫形鞋治疗退变性腰椎侧弯

退变性腰椎侧弯(degenerative lumbar scoliosis,DLS)是继发于腰椎间盘及腰椎骨关节退变的成人脊柱侧弯,较一般典型的腰椎骨性关节炎症状重,同时伴有明显旋转侧弯畸形,常规治疗方法疗效差。2003年9月-2005年9月采用脊柱(定点)旋转复位手法结合矫形鞋治疗77例DLS患者,近期效果满意,总结报告如下。1临床资料本组77例中,男29例,女48例;平均年龄56.5岁(45~76岁)。病程平均6个月(2个月~10年)。所有患者均有腰痛及下肢疼痛,同时伴有明显的腰脊柱侧弯,站立、行走疼痛明显,其中48例(82.3%)需要药物控制疼痛,间歇性跛行者26例(33.8%),直腿抬高试验…     

Generalized Convulsive Status Epilepticus in the Adult

Summary: Status epilepticus (SE) is denned as recurrent epileptic seizures without full recovery of consciousness before the next seizure begins, or more-or-less continuous clinical and/or electrical seizure activity lasting for more than 30 min whether or not consciousness is impaired. Three presentations of SE are now recognized: recurrent generalized tonic and/or clonic seizures without full recovery of consciousness between attacks, nonconvulsive status where the patient appears to be in a prolonged "epileptic twilight state," and continuous/repetitive focal seizure activity without alteration of consciousness. Generalized convulsive status epilepticus (GCSE) encompasses a broad spectrum of clinical presentations from repeated overt generalized tonic-clonic seizures to subtle convulsive movements in a profoundly comatose patient. Thus, GCSE is a dynamic state that is characterized by paroxysmal or continuous tonic and/or clonic motor activity, which may be symmetrical or asymmetrical and overt or subtle but which is associated with a marked impairment of consciousness and with bilateral (although frequently asymmetrical) ictal discharges on the EEG. Just as there is a progression from overt to increasingly subtle clinical manifestations of GCSE, there is also a predictable sequence of progressive EEG changes during untreated GCSE. A sequence of five patterns of ictal discharges has been observed: discrete electrographic seizures, waxing and waning, continuous, continuous with flat periods, and periodic epileptiform discharges on a relatively flat background. A patient actively having seizures or comatose who exhibits any of these patterns on EEG should be considered to be in GCSE and should be treated aggressively to stop all clinical and electrical seizure activity to prevent further neurological morbidity and mortality.     

Mammaplasty: Shape,volume, and scar size

Recently many mammaplasty techniques have been presented with special attention paid to the resulting scar's size and its position. The surgeon should try to hid the scar, and if the inverted T incision is used, its horizontal branch should be as short as possible and kept in the breast area. Neverthelss, excessive concern about the final scar size should not interfere with the final results of the mammaplasty as far as shape, volume and lasting results are concerned. The author presents his experience in mammaplasty with respect to the volume, the shape, and the scar size interrelationships.     

Genetics: Genetic analysis prior to selective fetal reduction in multiple pregnancy: technical aspects and clinical outcome

Multiple pregnancies resulting from ovarian stimulation areat a higher risk of carrying at least one fetus affected byMendelian or chromosomal anomalies, the incidence of which isdirectly related to the order of multiples. Genetic analysisbefore fetal reduction was offered to both high-and low-riskpregnant women carrying two or more fetuses after ovulationinduction. Chorionic villus sampling (CVS) and fetal reductionwere achieved by transabdominal needling. The use of short-termculture, the polymerase chain reaction and fresh tissue enzymaticanalyses have made it possible for genetic diagnosis to be availablein a few days. A total of 100 patients had multifetal pregnancyreduction performed by a single operator; all of them completedpregnancy and none was lost at follow-up. The total fetal lossbefore 24 weeks was 7% and no statistically significant relationshipwas found with the final number of fetuses and CVS. Perinatallosses (3.9%) were only present in the series with a final numberof two fetuses. Pregnancy duration and birthweight were significantlyhigher in singletons than in twins, but were not related toCVS. The rate of chromosomal disorders was higher (7.2%) inthe study series than in singleton pregnancies not undergoingfetal reduction. Diagnostic error due to incorrect samplingwas reported in 1.5% of cases. These data support fetal reductionas a valuable strategy to improve the outcome of multiple pregnancy.The outcome of pregnancies reduced to singletons was significantlybetter than of those reduced to twins, and was not related toCVS. Therefore, prenatal genetic diagnosis should become anintegral part of counselling on multiple pregnancy, and is stronglyrecommended when reduction to singleton pregnancy is requested.     

Thickness effects of a carbon-supported platinum catalyst layer on the electrochemical reduction of oxygen in sulfuric acid solution

The influence of the thickness of a carbon-supported platinum catalyst layer on the oxygen reduction reaction (orr) has been studied in sulfuric acid solution by means of a thin-film rotating disk electrode. Pronounced changes in the Pt utilization, electrode activity and the orr kinetics have been observed upon varying the catalyst layer thickness. The thicker film electrode exhibits a higher Pt utilization efficiency and higher activity, and promotes the orr kinetics at potentials relevant to fuel cell operations. The participation of Pt surfaces not in contact with the electrolyte solution in electrochemical reactions via the spillover of adsorbed hydrogen and oxygen species, is proposed to be responsible for the changes. The thicker catalyst layer is likely to modify the Pt particle–particle distance by providing shared Pt sites between adjacent carbon supports, to improve the surface density of active catalyst particles per single carbon support by sharing adjacent catalyst sites, and to increase the ratio of the particle surfaces free of blocking anions to the catalyst|electrolyte interface surfaces. The carbon-supported platinum catalyst layer becomes active at 0.90 V vs RHE only when the catalyst layer is thicker than 1 μm. To provide reasonable activity, the minimum catalyst layer thickness should be around 2–4 μm. These results should be considered in the design of the cathode catalyst layer of polymer electrolyte membrane fuel cells.     

开放复位可塑形钛板内固定治疗跟骨骨折33例

目的 评价开放复位可塑形钛板内固定治疗跟骨骨折的疗效。方法 对33例(37足)以后关节突移位为主的跟骨骨折,行跟骨外侧入路、开放性复位可塑形钛板螺钉内固定,必要时行植骨术(18例)。结果 平均随访11.5个月,参照Mary—land food score评分,对患足是否疼痛、步态、距下关节及踝关节活动度、是否支架辅助、术后X线摄片等加以评估,19足疗效为优,17足为良,1足可。其中钛板断裂1例,手术切口皮缘坏死1例,换药后自愈。结论 跟骨外侧入路开放复位可塑形钛板螺钉内固定,必要时植骨术是治疗跟骨骨折的有效方法。