探讨双重排粪造影对结肠功能性便秘的诊断价值

目的研究双重排粪造影方式应用在结肠功能性便秘诊断当中的效果。方法文章所选择的调查对象来自2017年10月-2018年12月,均为在此期间本院收治的60例经临床病理诊断确诊为结肠功能性便秘患者,分析双重排粪造影方式和排粪造影的符合性。结果采用双重排粪造影方式诊断结肠功能性便秘59例得到确诊,占98.33%,和排粪造影相比,差异有统计学意义(P<0.05)。结论通过双重排粪造影方式进行结肠功能性便秘诊断,可以有效的提升诊断的效率,对于具体症型的确认也具有重要意义。     

Síndromes de compresión vascular. Valor de la ecografía Doppler

Vascular compression syndromes arise when a vessel in a tight anatomic space is entrapped by another structure, resulting in diverse symptoms for which different imaging tests are used to diagnose. Radiologists need to be familiar with vascular compression syndromes and to be able to identify their most representative findings. This paper aims to review the principal symptoms of vascular compression, describing and illustrating the key findings on Doppler ultrasonography that enable accurate diagnosis and guide further workup, avoiding unnecessary invasive tests and pointing to the appropriate treatment.     

四君子汤合四磨汤加减治疗出口梗阻型便秘吻合器经肛门直肠切除术后的临床疗效

目的:观察四君子汤合四磨汤加减治疗出口梗阻型便秘(OOC)吻合器经肛门直肠切除术后(STARR)的临床疗效。方法:124例患者随机按数字表法分为对照组和观察组各62例。对照组术后给予芪蓉润肠口服液,20 mL/次/,3次/d;观察组术后给予四君子汤合四磨汤加减内服,1剂/d。两组疗程均连续治疗4周,并进行8周随访。分别于手术前、治疗后2周,4周、随访8周进行便秘主要症状评分和Longo ODS评分;于手术前和治疗后4周,进行超氧化物歧化酶(SOD),丙二醛(MDA)和便秘患者生存质量自评量表(PAC-QOL)评价,并进行肛门直肠测压,记录肛管静息压(ARP),肛管最大收缩压(MSP),直肠排便压力(RSP),初始感觉阈值(FSV),排便感觉阈值(CRS)和最大耐受容量(MTV)等指标;随访记录并发症发生率、复发率和排便正常率;术后4周进行满意度评价和安全性评价。结果:治疗后4周,观察组患者临床疗效优于对照组(Z=2.096,P0.05);治疗后2周,4周和随访8周,观察组便秘主要症状积分和Longo ODS评分均低于对照组(P0.01);观察组患者ARP,FSV,FSV,CRS均低于对照组(P0.01),MSP和RSP均高于对照组(P0.01);观察组并发症发生率、复发率分别为20.97%(13/62)和4.84%(3/62),分别低于对照组的39.71%(24/62)和16.13%(10/62)(P0.05);观察组排便正常率为91.94%(57/62),高于对照组的80.65%(50/62),组间差异无统计学意义;观察组PAC-QOL总分和各因子评分均低于对照组(P0.01);观察组SOD水平高于对照组,MDA水平低于对照组(P0.01);未发现干预中药相关不良反应。结论:四君子汤合四磨汤加减用于出口梗阻型便秘STARR术后患者,可进一步减轻便秘症状和病情程度,提高生活质量,降低术后并发症发生率和复发率,并可改善肛门直肠动力学指标和氧化应激指标,提高临床疗效。     

Reoperation rates and risk factors for revision 4 years after dynamic stabilization of the lumbar spine

Background Context

The concept of dynamic stabilization (DS) of the lumbar spine for treatment of degenerative instability has been introduced almost two decades ago. Dynamic stabilization follows the principle of controlling movement in the coronal plane by providing load transfer of the spinal segment without fusion and, at the same time, reducing side effects such as adjacent segment disease (ASD). So far, only little is known about revision rates after DS due to ASD and screw loosening (SL).

Toward an Improved Wrist View: Qualitative and Quantitative Investigation of the 20° Axial Lateral Wrist X-Ray

AimIn standard lateral wrist radiographs, the radiocarpal joint is often obscured because of the angulation of the radial styloid process. A modified lateral projection at a 20° angle has been shown to demonstrate the distal radius in profile in postoperative patients without superimposing of the orthopedic hardware used in open reduction and internal fixation procedures over the wrist joint. We assessed whether this 20° axial-lateral view is advantageous in a wider patient group.Materials and MethodsConsenting adults receiving wrist radiographs in a tertiary hospital radiology department for any indication underwent posteroanterior, posteroanterior-oblique, 0° lateral, and 20° lateral views. A musculoskeletal radiologist and a radiology technologist, blinded to clinical data and to which view was 0°/20°, both evaluated 0°/20° images in random order for whether the radiocarpal joint was obscured by radial styloid, radiocarpal articular margins, or ulnar styloid process, and which view was preferred.ResultsIn 124 cases, the radiocarpal joint was shown clearly on more 20° than 0° views (75/124 vs. 23/124, P < .001). Orthopedic hardware obscured joint lines in fewer 20° than 0° views (12/124 vs. 28/124, P < .001). There was a trend to the ulnar styloid process obscuring part of the radiocarpal joint less in 0° view (28/124 vs. 78/124 in 20°; P = .088), primarily in 20° laterals of wrists with positive ulnar variance. The 20° view was preferred by the radiologist in 76% (95/124) and preferred by the technologist in 83% (104/124).ConclusionThe 20° lateral view was superior to the current 0° lateral view in a wide range of patients, with the radiocarpal joint obscured significantly less by hardware or adjacent anatomy, and preferred by both the blinded radiologist and technologist.     

The effects of hallux valgus and walking speed on dynamic balance in older adults

BackgroundHallux valgus (HV) contributes to deficits in static balance and increased fall risk in older adults. Very limited research has examined dynamic balance deficits in walking in this population. These individuals generally walk slowly, as balance challenge is lesser at slow speeds.Research questionHow does the dynamic balance of older adults with HV differ from healthy controls at controlled slow and fast walking speeds?MethodsNineteen older adults with HV and 13 healthy controls completed 5 continuous walking trials at 1.0 and 1.3 m·s⁻¹ as whole body marker position and ground reaction force data were captured. Dynamic balance was evaluated using whole body center of mass (COM) and center of pressure (COP) inclination angles (IA) and duration of double support.ResultsThere were no differences in measures of dynamic balance between older adults with and without HV at slow and fast speeds. At the faster speed, the peak sagittal plane COM-COP IA increased and the double support duration decreased, while the peak frontal plane COM-COP IA were not affected.SignificanceOlder adults with HV do not exhibit deficits in dynamic balance during continuous walking at comfortable speeds when compared to healthy older adults.     

Ectopia Cordis with a Double Outlet Right Ventricle,Large Ventricular Septal Defect,Malposed Great Arteries and Left Ventricular Hypoplasia

Ectopia cordis, defined as partial or complete displacement of the heart outside of the thoracic cavity, is a rare congenital malformation. If not surgically corrected during the early years of life, ectopia cordis can prove to be a fatal abnormality. However, due to the presence of multiple intracardiac and extracardiac malformations, a corrective surgery might not always be successful. The pathology of ectopia cordis with a double outlet right ventricle, large ventricular septal defect, malposed great arteries and left ventricular hypoplasia is discussed, highlighting the complexities involved in such a rare disorder.     

A pilot study of the use of fesoterodine in the management of men with refractory overactive bladder symptoms after surgery for bladder outlet obstruction

ObjectiveTo assess the efficacy of long-acting fesoterodine on persistent lower urinary tract symptoms in men who have had previous surgical treatment for bladder outlet obstruction (BOO).Materials and methodsSeventeen patients with overactive bladder (OAB) secondary to BOO, persisting for 3 months after the obstruction was surgically relieved, were treated with fesoterodine. Follow up was performed at 2 months, 3 months, and 7 months. The primary endpoint was change in the International Prostate Symptom Score (IPSS). The secondary endpoints were change in the maximum flow rate (Qmax) and postvoid residual (PVR).ResultsPatients receiving fesoterodine demonstrated trends for improvement in mean nocturia episodes (3.2–2.6, p = 0.065), IPSS irritative subscore (6.2–2.0, p = 0.066), and quality of life score (4.2–3.5, p = 0.067) over 7 months of follow up. There was also a reduction in the mean IPSS score which was not significant over time (18.8–15.1, p = 0.183). There was no significant change observed in Qmax or PVR. Six patients (33%) had significant side effects and did not complete the study.ConclusionPatients with persistent OAB symptoms after surgical treatment of BOO displayed possible reductions in the IPSS, IPSS irritative subscore, and mean number of nocturia events after 7 months of follow up, as well as trends for an increased quality of life when treated with fesoterodine. Larger trials are needed to help characterize the utility of fesoterodine in the treatment of persistent lower urinary tract symptoms after surgical treatment of benign prostatic hyperplasia.