Isolated lesion of the lateral cutaneous nerve of the forearm

Because of its location in the antecubital fossa, the lateral cutaneous nerve of the forearm is at risk of injury when a person is carrying objects with the forearm flexed or during venipuncture. Injury to this nerve, however, is rarely reported. A case report of traumatic injury to the lateral cutaneous nerve, the use of appropriate nerve conduction studies for diagnosis, and a discussion of the available literature is presented.     

能谱CT在手足软组织疾病中的初步应用

目的 初步探讨能谱CT成像（双能量模式）质量以及在手足软组织病变中的应用价值.方法 回顾性分析来我院就诊的45例手足软组织疾病患者,行能谱CT和MRI检查,选择适宜单能量值（keV）,将常规CT混合能量图像转换为单能量图像.采用双盲法阅片,两位影像科专家对能谱CT图像质量和手足软组织病变的能谱CT和MRI图像做出初步分析和对照.结果 能谱CT单能量图像噪声指数较常规CT混合能量图像显著减少（P=0.005）,能谱CT能清楚显示肌腱的断裂、缺失、受压、黏连,与MRI相比,无统计学差异.但能谱CT在显示腱鞘疾病方面与MRI相比,缺乏敏感性,有统计学差异（P＜0.05）.结论 能谱CT能够改善图像质量,提供了一种显示手足软组织病变的新的成像方式,为临床提供有力的影像学支持.     

Weight Loss,Diarrhea and Edema

Radical vulvectomy with bilateral en bloc lymph node dissection results in an absolute cure rate of more than 50 percent among patients with vulval carcinoma. Although opinions differ as to the necessary extent of the operative procedure, the less extensive approach gives a satisfactory cure rate and a lower incidence of severe postoperative morbidity or mortality.     

Edema and the tropics

People visiting or living in tropical or subtropical regions are exposed to various factors, which can lead to edema. Tourists staying for only a short time in the tropics are exposed to different risks, with other disease patterns, than people living in the tropics or immigrants from tropical regions. The differential diagnosis of edema and swelling is extensive and it can sometimes be difficult to distinguish classical edema with fluid retention in the extravascular interstitial space, from lymphedema or swelling due to other aetiologies. The patients often connect the edema to their stay in the tropics although it may have been pre-existing with no obvious relation to their travels. Already the long trip in the plane can lead to an "economy class syndrome" due to deep venous thrombosis. Contacts with animal or plant toxins, parasites or parasitic larvae can produce peripheral edema. The diagnosis can often only be made by taking a meticulous history, checking for eosinophilia and with the help of serological investigations. Chronic lymphedema or elephantiasis of the limbs is often due to blocked lymph vessels by filarial worms. It has to be distinguished from other forms as e.g. podoconiosis due to blockage by mineral particles in barefoot walking people. The trend to book adventure and trekking holidays at high altitude leads to high altitude peripheral edema or non-freezing cold injuries such as frostbites and trench foot. Edema can be an unwanted side effect of a range of drugs e.g. nifedipine, which is used to prevent and treat high altitude pulmonary edema. Protein malnutrition, (Kwashiorkor), and vitamin B6 deficiency, (Beri-Beri) are very rarely observed in immigrants and almost never in tourists. A very painful swelling of fingers and hands in children and young adults of African origin can be observed during a sickle cell crisis. Many protein loosing nephropathies connected with plant and animal toxins but also bacterial, viral or parasitic agents, can lead to edema. But very often edema in tourists or immigrants from the tropics is not related to their stay abroad. To take an accurate history of the itinerary, eating habits and exposure to water etc. is very important. Knowledge of the precise epidemiology and geographic distribution of diseases are essential.     

Development of a set of activities to evaluate the arm and hand function in children with obstetric brachial plexus lesion

OBJECTIVE: To develop an observational instrument that can be used to evaluate the quality of arm and hand skills in daily functional activities in children with obstetric brachial plexus lesion (OBPL). A set of functional activities was constructed and standardized, and the intra-observer reliability of the assessment of this set of activities was studied. SETTING: Department of Occupational Therapy and Department of Rehabilitation Medicine, VU University Medical Centre. SUBJECTS: Twenty-six children with OBPL in the age range of 4 -6 years. INTERVENTIONS: The children were asked to perform 47 bimanual activities, which were recorded on videotape. MAIN MEASURES: The videotapes were scored twice by the same occupational therapist. RESULTS: The percentage of agreement in scoring 'hand-use', 'speed' and 'assistance' was over 80% for a substantial number of activities, indicating a strong agreement. However, in scoring 'deviations in movements and body posture' the percentage of agreement was insufficient in most activities. CONCLUSIONS: This set of activities has good potential for assessment of the performance of functional activities in children with OBPL. This study, however, showed a number of difficulties in observing and scoring the activities that have to be considered when developing a standardized video observation.     

皮肤增生性病变研究的最新进展:上皮间质过度增生的假上皮瘤样增生

假上皮瘤样增生(pseudoepitheliomatoushyperplasia,PEH)病变是临床上罕见的以上皮-间质过超长生为特征的良性病变,多继发于皮肤创(烧)伤、炎症刺激、慢性皮肤病和皮肤肿瘤等多种疾病。部分病例可见calretinin等神经相关蛋白异常表达和表皮生长因子受体信号通路的活化。上皮-间质细胞之间激烈的相互作用引起是上皮细胞过度增殖和异常分化,可能是PEH病变发生的重要机制,对研究肿瘤发生机制具有指导意义。就PEH的原发病、临床和病理组织学特征、组织学起源和发病机制等内容进行概述。     

Persistent cutaneous lesion in a child with tyrosinemia: Esomeprazole‐induced lichenoid drug eruptions

Lichenoid drug eruptions (LDEs) are among well‐recognized adverse reactions that different drugs including Proton‐pump inhibitors (PPIs) are associated with. LDEs are rare adverse reaction of PPIs but they should be considered as appropriate management can lead to full resolution. Herein, we report a case of Esomeprazole‐induced LDE in a child with tyrosinemia.     

Edema and the nephrotic syndrome

If proteinuria is of sufficient amount, and persists for long enough, then a series of consequences arises which is called the nephrotic syndrome. The most notable consequence of massive proteinuria is salt and water retention leading to edema formation. This edema is found in association with proteinuria usually greater than 3.5 g/day, accompanied by hypoalbuminemia, usually less than 25 g/l. The underlying disease is usually a glomerulonephritis, albeit in rare situations severe renal artery stenosis can lead to proteinuria by hyperfiltration. Two theories have been proposed. In the classical "underfill" theory edema is considered to be secondary to salt retention resulting from renal hypoperfusion. According to this theory the primary event is the decrease in plasma volume due to the diminution of plasma oncotic pressure resulting from hypoalbuminemia, causing transfer of fluid from the plasma to the interstitial space "underfilling" the blood compartment and resulting to secondary renal sodium retention. This mechanism applies mainly to the nephrotic syndrome associated with minimal change disease observed in children. By contrast, in most adults with the nephrotic syndrome due to minimal change disease or other glomerular lesions such as membranous or proliferative glomerulonephritis, an initial plasma volume expansion is observed. Therefore, the primary event responsible for the sodium retention is a renal intrinsic excretory defect, which leads to extracellular fluid expansion and edema formation. Therapy is specific for the specific glomerular disease and symptomatic for the edema (diuretics), anticoagulation therapy for prevention of venous thrombosis and embolism, antibiotics for infections, and most of all, omission of triggering factors such as specific xenobiotics.     

手背皮神经的分布对浅静脉穿刺部位选择的影响

目的为静脉穿刺时减少损伤皮神经，减轻疼痛，提供解剖学资料。方法解剖148例手标本，观察手背皮神经和浅静脉的分布及两者问的位置关系。结果（1）84．5％皮神经主干只跨过手背静脉网及其延续的静脉深面或与部分静脉伴行；（2）94．8％的掌背皮神经位于掌背静脉的桡侧，94．6％的小指尺侧指背神经伴行于同名静脉尺侧，97．2％的拇指桡侧指背神经伴行于同名静脉桡侧。结论熟悉手背皮神经和浅静脉之间的位置关系，有助于提高静脉穿刺的质量。     

Edema: a systematic approach to diagnosis and management

Edema is defined by fluid accumulation in the tissues and its onset frequently first noticed by the patients. Mild edema is common and reversible. Generalized edema requires intensive therapy. Causes of edema are numerous. Investigation of the causes is essential for appropriate therapy.     

Low rates of cutaneous adverse reactions to alcohol-based hand hygiene solution during prolonged use in a large teaching hospital

We assessed cutaneous adverse reactions (CARs) to alcohol-based hand rub (ABHR) after the introduction of a hand hygiene culture change program at our institution. CARs were infrequent among exposed health care workers (HCWs) (13/2,750; 0.47%; 1 CAR per 72 years of HCW exposure) and were not influenced by the duration or intensity of ABHR use but were associated with the presence of irritant contact dermatitis.