Intrathecal migratory foreign body without neurological deficit after a gunshot wound

Background contextPenetrating bullets dissipate thermal and kinetic energy into surrounding tissues. Within the thecal sac, this is universally associated with neurological deficits.PurposeWe report a case of intrathecal penetration of a bullet without neurological deficit.Study designCase report.MethodsA 14-year-old girl was shot in the back, entering adjacent to the L3 vertebra and settling within the spinal canal adjacent to the S1 vertebra. In the absence of neurological deficits, initial management was nonoperative.ResultsOver the period of a week, the patient developed an episode of intense radicular pain, although her neurological examination remained normal. Location of the bullet was shown to vary from S1 to T12 on multiple imaging studies, and this was influenced by patient positioning. She subsequently underwent a bilateral hemilaminotomy and durotomy with excision of the intrathecal bullet.ConclusionsPatients can avoid neurological injury even with an intrathecal gunshot wound. However, intrathecal bullets may then migrate and cause variable neurological complaints, necessitating surgical removal. Patient positioning can influence bullet location which can be useful in surgical planning.     

Transluminal migration of ingested foreign body without peritonitis

The authors present 2 cases of transluminal migration of an ingested foreign body into the peritoneal cavity without causing peritonitis. Clinical and radiologic features and surgical approach are described, focusing on the absence of an acute abdomen in transluminal migration and the use of laparoscopy in achieving extraction of the foreign object.     

Vertebral body recollapse without trauma after kyphoplasty with calcium phosphate cement

Traditionally, immobilization and external bracing has been recommended for patients with type A traumatic and non-osteoporotic fractures that do not present neurological deficits or significant instability. Nevertheless, several authors have recently suggested the possibility to treat thoraco-lumbar and lumbar vertebral compression post-traumatic fractures using standalone balloon kyphoplasty with osteoconductive filler materials, such as calcium phosphate (CPC). Maestretti and Huang have demonstrated the advantages of this technique showing an almost immediate return to daily activities without the inconvenience of wearing a brace, pain reduction, minimal operative risks and maintenance of stability, therefore proposing this as a first-choice technique in young patient needing rapid spine stability. The authors present a case of vertebral body recollapse after kyphoplasty with calcium phosphate cement (CPC) in a 47-year-old man with an A1.2 post-traumatic L1 compression fracture.     

颈动脉体瘤的无术前栓塞手术切除的疗效分析：附单中心65例报告

背景与目的：颈动脉体瘤（CBT）是临床上非常罕见的疾病,目前外科手术是治疗CBT的金标准,由于该病变血供极其丰富,是否行术前栓塞目前国内外存在争议,支持术前栓塞者认为其可减少术中失血,反对者认为成本和卒中风险大于收益,本文总结我院CBT无术前栓塞的外科手术治疗经验及术后随访结果,为临床无术前栓塞切除瘤体的安全性提供数据参考。 方法：回顾性分析昆明医科大学第一附属医院血管外科自2017年1月—2020年1月间行手术治疗的65例CBT患者临床与随访资料（其中2例双侧CBT患者选择第一次手术侧的数据）。肿块大小为1.0 cm×0.5 cm×1.0 cm~8.0 cm×6.5 cm×8.5 cm。患者Shamblin分型分别为I型13例,II型33例,III型19例。 结果：65例患者均顺利完成外科手术切除,其中单纯瘤体切除51例（78.46%）,瘤体切除联合单纯颈外动脉结扎8例（12.31%）,瘤体切除联合颈内动脉、颈外动脉切除并颈内动脉重建6例（9.23%）;术中发现术野内淋巴结的患者行淋巴结摘除;术中失血量为10~1 800 mL,平均247 mL。2例双侧病变者均建议择期行对侧手术。病理检查结果,65例均为颈动脉副神经节瘤。围术期1例（1.54%）出现术后脑梗塞死亡。术后14例患者（21.54%）出现迷走神经损伤症状,表现为声音嘶哑、饮水呛咳;5例患者出现舌下神经损伤症状,表现为伸舌偏斜、吞咽困难。2例颈内动脉重建的III型患者（3.08%）术后随访过程中发现颈内动脉闭塞。 结论：CBT确诊后应首选手术治疗,无术前栓塞情况下切除肿瘤安全有效。     

Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study

HYPOTHESIS: The use of liberal whole body imaging (pan scan) in patients based on mechanism is warranted, even in evaluable patients with no obvious signs of chest or abdominal injury. DESIGN: Prospective observational study. SETTING: Academic level I trauma center. PATIENTS: All patients admitted following blunt multisystem trauma. INTERVENTION: Pan scan, including computed tomography (CT) of the head, cervical spine, chest, abdomen, and pelvis, with the following inclusion criteria: (1) no visible evidence of chest or abdominal injury, (2) hemodynamically stable, (3) normal abdominal examination results in a neurologically intact patient or unevaluable abdominal examination results secondary to a depressed level of consciousness, and (4) significant mechanisms of injury. Radiological findings and changes in treatment based on these findings were recorded. MAIN OUTCOME MEASURE: Any alteration in the normal treatment plan as a direct result of CT scan findings. These alterations include early hospital discharge, admission for observation, operative intervention, and additional diagnostic studies or interventions. RESULTS: One thousand patients underwent pan scan during the 18-month observation period, of which 592 were evaluable patients with no obvious signs of abdominal injury. Clinically significant abnormalities were found in 3.5% of head CT scans, 5.1% of cervical spine CT scans, 19.6% of chest CT scans, and 7.1% of abdominal CT scans. Overall treatment was changed in 18.9% of patients based on abnormal CT scan findings. CONCLUSIONS: The use of pan scan based on mechanism in awake, evaluable patients is warranted. Clinically significant abnormalities are not uncommon, resulting in a change in treatment in nearly 19% of patients.     

Cost-effectiveness of bone densitometry among Caucasian women and men without a prior fracture according to age and body weight

Summary

We used a microsimulation model to estimate the threshold body weights at which screening bone densitometry is cost-effective. Among women aged 55–65 years and men aged 55–75 years without a prior fracture, body weight can be used to identify those for whom bone densitometry is cost-effective.

Introduction

Bone densitometry may be more cost-effective for those with lower body weight since the prevalence of osteoporosis is higher for those with low body weight. Our purpose was to estimate weight thresholds below which bone densitometry is cost-effective for women and men without a prior clinical fracture at ages 55, 60, 65, 75, and 80 years.

Methods

We used a microsimulation model to estimate the costs and health benefits of bone densitometry and 5 years of fracture prevention therapy for those without prior fracture but with femoral neck osteoporosis (T-score?≤??2.5) and a 10-year hip fracture risk of ≥3%. Threshold pre-test probabilities of low BMD warranting drug therapy at which bone densitometry is cost-effective were calculated. Corresponding body weight thresholds were estimated using data from the Study of Osteoporotic Fractures (SOF), the Osteoporotic Fractures in Men (MrOS) study, and the National Health and Nutrition Examination Survey (NHANES) for 2005–2006.

Results

Assuming a willingness to pay of $75,000 per quality adjusted life year (QALY) and drug cost of $500/year, body weight thresholds below which bone densitometry is cost-effective for those without a prior fracture were 74, 90, and 100 kg, respectively, for women aged 55, 65, and 80 years; and were 67, 101, and 108 kg, respectively, for men aged 55, 75, and 80 years.

Conclusions

For women aged 55–65 years and men aged 55–75 years without a prior fracture, body weight can be used to select those for whom bone densitometry is cost-effective.     

不同手术入路治疗无椎体骨折的下颈椎小关节脱位

目的 探讨不同手术入路治疗无椎体骨折的下颈椎小关节脱位的临床效果.方法 回顾性分析34例无椎体骨折的下颈椎小关节脱位伴不同程度颈髓损伤患者,其中单侧小关节脱位7例,双侧小关节脱位27例.采用美国脊髓损伤协会(American Spinal Injury Association,ASIA)分级:A级5例,B级8例,C级1...     

早产儿平稳气管插管时七氟醚的最低肺泡有效浓度

目的探讨早产儿气管插管无体动反应时的七氟醚最低肺泡有效浓度(MACEI)。方法选择择期吸入全麻下行眼科手术的早产儿27例,矫正胎龄37周,ASAⅠ或Ⅱ级。吸入6%七氟醚进行全麻诱导,至患儿意识消失后,将呼气末七氟醚浓度调整至预定值,维持15min,然后行气管插管。根据序贯法进行研究,初始呼气末七氟醚浓度为3.0%,如气管插管时发生体动反应,下一例升高一个浓度梯度,如气管插管时未发生体动反应,下一例降低一个浓度梯度,相邻浓度梯度为0.2%。将无体动反应时呼气末七氟醚浓度到体动反应时呼气末七氟醚浓度的中点设为一个平衡点,计算所有平衡点七氟醚浓度的平均值即为MACEI。结果患儿气管插管无体动反应的七氟醚MACEI为2.55%±0.20%,MAC95是2.81%(95%CI 2.67%~3.58%)。结论早产儿平稳气管插管的七氟醚MACEI为2.55%,低于足月产儿的参考值。     

髋臼四方区完整经闭孔股骨头中心脱位1例

股骨头骨折合并髋关节后脱位较为常见,多为高能量损伤所致。而股骨头骨折合并髋关节前脱位同时伴盆腔移位临床上比较罕见。笔者于2018年6月25日收治1例股骨头骨折伴盆腔移位合并同侧大转子骨折、骨盆骨折患者,经治疗效果满意,报告如下。