Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

股骨远端疲劳骨折误诊教训

目的 提高对疲劳骨折的认识和诊断水平,避免误诊误治。方法 报告和总结５例股骨远端疲劳骨折的诊治经验和误诊教训。结果 ５例患者均为男性,年龄１８￣２３岁,病程３￣６周,均有高强度运动史。经Ｘ线片检查及病理活检,初步诊断为骨肉瘤;后经仔细询问并分析病史,结合系列Ｘ线片观察,诊断为股骨远端疲劳骨折。经患肢适当制动和对症治疗,患者症状逐渐减轻或消失,均痊愈出院。随访７￣１８个月,患者无异常。结论 仔细询问     

Evaluation of the effectiveness of drainage of the abdominal cavity

In order to generalize the indications for drainage of the abdominal cavity the authors have systematized and subdivided them into one-type groups depending on the aims, (medical, prophylactic) and tasks, which on their opinion can allow the surgeons to better realize the reasons of using this method of treatment and to critically assess it. An analysis of clinical material was made in order to find out the frequency and localization of intraabdominal abscesses and to assess the measures taken for their prevention. It was found that in spite of the abdominal cavity drainage after 1568 operations on emergency indications, abscesses developed in 43 patients. An analysis of the investigation has shown that the causes, frequency and localization of postoperative abscesses are not predictable, prophylactic measures have low efficiency due to using passive glove-tube drainage and to too frequent using this not safe method without special need.     

自体骨膜游离移植的实验研究--不同龄动物大块关节软骨缺损修复的比较

目的研究比较自体骨膜移植软骨再生修复不同龄动物大块关节软骨缺损。方法用52只不同龄家兔自体骨膜游离移植修复大块关节软骨缺损,比较移植骨膜生发层朝向关节腔与松质骨时再生软骨的差别。结果经不同时期肉眼和组织学检查证实,幼年兔和成年兔的骨膜移植都能生成软骨,修复大块关节软骨缺损。在成年兔骨膜再生的软骨与成年兔本身周围正常软骨的厚度、组织结构一样。移植骨膜生发层朝向关节腔与松质骨二者间再生软骨结果无明显差别。结论骨膜具有再生软骨的能力,可用来移植修复关节软骨的缺损。骨膜移植生发层不同朝向对软骨再生无明显影响。成年后骨膜移植修复关节软骨缺损能够生成与自身相适应的软骨。     

Predictors of severity of attacks of acute pancreatitis

In an attempt to reduce the current morbidity and mortality from acute pancreatitis, a prospective randomized multicentre trial was begun in August 1982. Part of this study involved an attempt to develop a set of prognostic indices which would identify patients with severe pancreatitis on the day of admission to hospital. An analysis of a predetermined set of 10 indices (age, blood pressure, white cell count, blood urea, serum calcium, aspartate aminotransferase, lactate dehydrogenase, blood glucose, arterial blood pH and PO2) on admission to hospital, in 100 patients, is presented. The positive predictive value of these indices (excluding age) is 90%. These indices are readily available in most hospitals, and allow the early identification of the high risk patient with an accuracy equal to or better than that previously reported.     

Analysis of the mechanism of fracture of silicone metacarpophalangeal prostheses

Eleven fractured Sutter metacarpophalangeal prostheses were obtained from the hands of three patients. All of the implants had fractured at the junction of the distal stem and the hinge. After visual examination, the fracture faces were prepared and viewed using a scanning electron microscope. These images indicated that fracture was initiated by abrasion on the dorsal aspect of the distal stem of the prostheses, close to the hinge. Crack propagation was shown to be due to a fatigue process. Once a crack started, its direction of travel could be followed, using topographical features common to engineering fracture analyses. Propagation was from radial to ulnar and from dorsal to palmar.     

Survey of methods of treatment of haemorrhoids and complications of injection sclerotherapy.

INTRODUCTION: This study was conducted to survey current practices in the treatment of haemorrhoids (Hs), prevalence of complications associated with injection sclerotherapy (IS) and attitudes to its use to treat anterior Hs. METHODS: Postal questionnaires were sent to 92 consultant surgeons in the South East Thames Region. They were returned anonymously. RESULTS: Seventy questionnaires were returned (76% response rate) and 61 questionnaires were used in the data analysis; 18 from coloproctologists and 43 from non-coloproctologists who treated Hs. First degree Hs were mostly treated with IS alone (76%). Second degree Hs were treated with rubber band ligation (RBL) alone (36%) or a combination of IS and RBL (36%). Third degree Hs were mostly treated with haemorrhoidectomy (76%). Nineteen surgeons (31%) reported complications using IS; 82% of these were urological. Nine surgeons (15%) did not use IS to treat anterior Hs and 10 (16%) advised their trainees not to inject anteriorly. CONCLUSIONS: IS is a common treatment of Hs. Nearly one-third of consultants reported complications, the majority of which were urological and likely to be secondary to IS of anterior Hs. It may be safer to avoid IS of anterior haemorrhoids.     

Impact of laparoscopy on frequency of surgery for treatment of gallstones

Although the indications for laparoscopic cholecystectomy are generally the same as those for open cholecystectomy, there has been a suspicion that indications for cholecystectomy have broadened and the spectrum of patients undergoing this procedure has changed. This study was designed to determine whether surgeons and patients have lowered the threshold for proceeding to cholecystectomy with use of laparoscopic cholecystectomy. Discharge data were collected for all patients who underwent an elective operation in general surgery clinics in Ankara Numune Teaching and Research Hospital between 1990 to 2001. The rate of total cholecystectomy to all elective operations and rate of laparoscopic technique to all cholecystectomies were analyzed. Total number of operations and rate of cholecystectomy were relatively stable over 6 years prior to laparoscopy. With the introduction of laparoscopic cholecystectomy, although total number of elective operations seems stable, the proportion of cholecystectomy to all operations showed an increase. Our study could not explain the increase of total number of cholecystectomies since the widespread introduction of laparoscopy. First, it may be due to changing selection criteria for surgical treatment of gallstones. Second, surgery may have been done for asymptomatic gallstones. And third, patients with moderate symptoms who refused the (open) operation in the past may now be more willing to undergo a laparoscopic cholecystectomy.     

肘关节后脱位并尺骨冠状突骨折9例临床疗效分析

目的 探讨肘关节后脱位并尺骨冠状突骨折的治疗方法。方法 总结2000年3月～2003年5月9例肘关节后脱位合并尺骨冠状突骨折患者的治疗经验，根据骨折类型分别采用内外侧入路对8例患者进行手术治疗，术后配合早期功能锻炼。结果 所有患者随访8～24个月，根据HSS评分标准，优5例（55.6%)，良2例（22.2%)，一般2例（22.2%)，优良率77.8%，无严重肘关节并发症发生。结论 选择恰当的手术入路和早期功能锻炼是提高该类骨折效果的关键。     

Alterations of nuclear maturity in spermatozoids of males with antecedents of cryptorchidism

The association between infertility and cryptorchidism is an accepted fact, usually attributed to the oligozoosperm, asthenozoosperm or teratozoosperm presented in ejaculation products of males with this antecedent. The nuclear maturity in a sample of men with antecedents of cryptorchidism have been studied and these results have been compared to those of a control group. The results of this work show the deficient transformation of nuclear proteins to protamines in males with antecedents of cryptorchidism compared to the control group, due to the remaining of immature histones. Alterations of nuclear maturity able to contribute to the subfertility of these men were found in spermatozoids of adult males with antecedents of cryptorchidism.     

胫骨上端三维有限元模型的建立

目的 建立胫骨上端的三维有限元模型，以期为膝关节三维有限元的建立和研究，提供方法学和研究平台。方法 根据螺旋CT扫描图像，利用Ansvs有限元软件的由下向上的点、线、面、体的建模原则，对胫骨上端的三维有限元模型进行重建.结果 建立了胫骨上端的三维有限元模型。结论 本研究所建立的胫骨上端的三维有限元模型，能逼真地反应胫骨上端的真实几何结构。     

Legal aspects of withdrawal of therapy

The ability of intensive care to replace or support vital organ function has resulted in some patients surviving for long periods of time without improvement or a terminal event. In patients with no realistic chance of survival, decisions to withdraw or withhold life-sustaining therapies are commonly made. Withdrawal of life support at the patient's request is lawful at common law and, in some states of Australia, by legal statute. In the intensive care setting though, it is more common for therapy to be withdrawn because the therapy is of no perceived benefit or not in the patient's best interests. However, in Australia there is little case law and very little legislation to direct the decision of whether to withdraw life-sustaining therapy on the grounds of futility or the patient's best interests. The legislation that does exist in Australia, as well as law from other jurisdictions, largely places responsibility for the decision to withdraw therapy on the doctor in charge of the patient's care. However much weight is frequently placed on the wishes of the family. Disagreements between family and clinicians over decisions to withdraw therapy are unusual and generally resolve over time. However if disagreement persists, it may be advisable to apply to the courts for a declaratory judgement, given the tenuous legal basis of withdrawal of life-sustaining therapy in Australia and the uncertainty over the courts' view of the role of the patient's family in the decision-making process.     

Diagnosis of the stages of endogenous toxemia and differentiated use of of the methods of efferent therapy ]

The work is supposed to estimate intoxication by summary indices of the medium and low mass molecules and oligopeptides in plasma, erythrocytes and urine. The indices developed made it possible to determine the stage of endogenous intoxication and to choose differentially the optimal methods of efferent therapy or a combination of methods.     

Diagnosis and treatment of injuries of the tendons of the biceps muscle of arm]

An analysis of clinical observations (126 patients) enabled the authors to make a conclusion that early diagnostics and early operative treatment are important for better results of treatment of patients with injuries of humeral biceps tendons . Differentiated approach to treatment of such patients is thought by the authors to be necessary. The method of choice for treatment of patients with neglected injuries of the humeral biceps tendons is, to the authors' opinion, "tonicizing" autologous tendoplasty.     

Potentialities of complex treatment of prolapse of the rectum

The method of surgical correction of prolapse of the rectum should be chosen with special reference to the patient's age, severe somatic diseases, co-existing pathology of the colon (diverticulosis) and necessity of resection of part of the large intestine as well as marked previous constipations in order to use the most adequate method of surgical treatment. The biofeedback therapy should be used in some patients in the postoperative period due to concomitant insufficiency of the anal sphincter for obtaining better results of the operative treatment.     

Blockade of branches of the ophthalmic nerve in the management of acute attack of migraine

The aim of this study was the evaluation of the blockade of branches of ophthalmic nerve in the management of the acute attack of migraine headache localized to the ocular region. The study included 70 female patients 23-60 years old who presented to the pain clinic at our hospital with an acute attack of migraine headache localized to the ocular and retro-ocular region. A targeted history and a neurologic examination were performed in all patients to confirm the diagnosis and at the same time to rule out life-threatening neurological dysfunction. The method applied was the blockade of the supraorbital and supratrochlear nerves which are branches of the ophthalmic nerve. By the use of a fine short needle 27G the nerves were sought for until paraesthesia is obtained and then 1 ml of lignocaine 2% with adrenaline 1:200,000 was injected in every one of the three sites of the nerves. The migraine acute attack was relieved in 58/70 patients (82%), while in 12/70 patients (18%) the results were poor. The pain relief started 3-4 min after the injection and was completed in 10-15 min. Our results support that the blockade of the branches of the ophthalmic nerve seems to be a safe and effective technique in the management of the acute attack of migraine localized to the ocular and retro-ocular region.     

Time delay of monitors of the hypnotic component of anesthesia: analysis of state entropy and index of consciousness

Monitors evaluating the hypnotic component of anesthesia by analyzing the electroencephalogram (EEG) may help to decrease the incidence of intraoperative awareness with recall. To calculate an index representing the anesthetic level, these monitors have different time delays until the correct index is displayed. In previous studies, intraoperatively recorded real and simulated EEG signals were used to determine time delays of cerebral state and Narcotrend and Bispectral indices. In the present study, we determined time delays of state entropy and index of consciousness. For this purpose, recorded real and simulated EEG sequences representing different anesthetic levels were played back to the tested monitors. Simulated and real perioperatively recorded EEG signals indicating stable states "awake," "general anesthesia," and "cortical suppression" were used to evaluate the time delays. Time delays were measured when switching from one state to another and were defined as the required time span of the monitor to reach the stable target index. Comparable results were obtained using simulated and real EEG sequences. Time delays were not constant and ranged from 18 to 152 seconds. They were also different for increasing and decreasing values. Time delays were dependent on starting and target index values. Time delays of index calculation may limit the investigated monitor's ability to prevent interoperative awareness with recall. Different time delays for increasing and decreasing transitions could be a problem if the monitors are used for pharmacodynamic studies.     

老年人胃癌穿孔32例的临床分析

目的 探讨老年人胃癌穿孔的临床特点，提高其诊断与治疗水平。方法回顾性分析收治的32例老年胃癌穿孔的临床资料。结果32例中行穿孔修补术10例，胃癌姑息性切除术16例，胃癌根治术4例，未手术2例。院内死亡率分别为40．0％、12．5％、0．0％、100．0％。并发症发生率分别为80．0％、37．5％、50．0％、100．0％，出院平均生存期分别为7个月、19个月、25个月、0个月。结论准确的疾病诊断、合理的术式选择和加强围手术期的处理对降低老年胃癌穿孔死亡率、并发症发生率，改善其预后有重要意义。     

Repair of avulsion of insertion of biceps brachii tendon

An end-result study was made of 16 cases of avulsion of the insertion of the biceps brachii tendon. The follow-up period spanned one to 25 years post-treatment (average, eight years). Fourteen of the 16 cases included in the study were acute cases with primary repair and reinsertion of the biceps tendon into the area of the radial tuberosity. One case, with the loss of function of the biceps muscle secondary to temporary paralysis of the musculocutaneous nerve, was explored. The tendon was found intact and did not require repair. The sixteenth case was included for comparison of a patient who chose to forgo surgical treatment. One surgical procedure, a modification of Bunnell's technique, was used in treating all patients from 1954 to 1977. The surgically repaired biceps showed various amounts of residual impairment, ranging from negligible to limited restriction of preinjury activities. The treatment successfully returned 14 patients to their previous occupations and activities. The one case not surgically treated of the ten work-related injuries resulted in continuing disability compensation based on no greater than 20% of the entire extremity. This end-result study substantiates the positive results of this surgical technique, presents modifications of the surgical repair procedures, and allows for a similar long-range study of other treatment techniques. The evaluation of treatment methods is easily attainable by low technological clinical methods.     

缺乏可供吻合静脉的指尖离断再植方法选择

目的:探讨缺乏可供吻合静脉的指尖离断再植方法。方法:自2004年11月至2009年11月,对86例104指指尖离断患者进行再植,其中男64例,女22例;年龄2～64岁,平均26岁。伤后至就诊时间30min～12h,断指缺血时间2.5～12h,术前各项检查均未见明显异常。采用4种再植方法:①吻合双侧指固有动脉,指根部结扎一侧指固有动脉的断指再植,37指;②动-静脉转流方式的断指再植,27指;③只吻合指动脉的断指再植,24指;④去表皮囊袋法再植,16指。结果:86例104指,成活102指,伤指成活病例中75例(92指)获得随防,时间6～24个月。按中华医学会手外科学会断指再植术后功能评定试用标准评定:优52例,良19例,差4例。结论:依据显微镜下清创所见离断指尖动脉损伤状况,选用不同的再植方式,有助于扩大指尖再植适应证,提高再植成功率。