Stereoroentgenometry a method for mensuration by means of the roentgen ray

Stereoroentgenometry as applied to pelvimetry offers a practical roentgenologic method for accurate calculation of all the internal diameters of the maternal pelvis as well as the essential diameters of the fetal head. The examination also offers incidental information as to the position and presentation of the fetus as well as positive information as to the presence of a fetal monster or a multiple pregnancy.     

头面部致伤部位与颈髓过伸伤的相关分析

目的探讨头面部不同撞击位置对颈髓过伸损伤严重程度的影响,并分析其治疗方法和疗效。方法回顾性分析1999年1月～2004年1月收治的41例无骨折脱位颈髓损伤患者的病历资料,所有患者外伤位置主要在前额、颊部或下颌部。用ASIA法对患者在入院初期及出院后6个月时脊髓的神经功能进行评估。结果前额受伤20例,住院初期神经功能：B级4例,C级11例,D级5例；6个月后：C级1例,D级11例,E级8例。烦部伤12例,住院初期神经功能：B级1例,C级4例,D级7例；6个月后：C级1例,D级2例,E级9例。下颌部伤9例,住院初期神经功能：B级5例,C级3例,D级1例；6个月后：B级2例,C级5例,E级2例。经过治疗后6个月复查,神经功能在C级以下者9例,其中7例是下颌区受伤；2例脊髓功能为B级经治疗后没有改善者均为下颌致伤。结论外力作用于下颌部致颈髓过伸伤较作用于额部或颊部更严重。对无骨折脱位颈髓过伸伤者合理选择非手术或手术治疗均可得到满意的治疗效果。     

Proposed novel unified nomenclature for range of joint motion: method for measuring and recording for the ankles, feet, and toes

The Ad Hoc Committee of Terminology of the Japanese Society for Surgery of the Foot (JSSF) proposes novel terminology for motion of the ankle, foot, and toe because there are some ambiguities in the current terminology. Articles were identified by searching the electronic databases of PubMed that compared definitions of American Orthopaedic Foot and Ankle Society (AOFAS), International Society of Biomechanics (ISB), and in the textbook of Kapandji as well as the American Academy of Orthopaedic Surgeons (AAOS). A total of 11 articles described the transverse (horizontal) plane motion in the hindfoot as external rotation/internal rotation and 10 as abduction/adduction. In all, 2 articles described the transverse (horizontal) plane motion in midfoot as external rotation/internal rotation and 10 as abduction/adduction. Another 4 articles described the transverse (horizontal) plane motion in the forefoot as external rotation/internal rotation and 8 as abduction/adduction. Altogether, 109 articles described the sagittal plane motion of the foot/ankle as dorsiflexion/plantarflexion and 20 as extension/flexion. In all, 99 articles described the frontal (coronal) plane motion of the foot/ankle as inversion/eversion and 4 as supination/pronation. Furthermore, 12 articles described the sagittal plane motion of toes as dorsiflexion/plantarflexion and 15 as extension/flexion. Another 16 articles described the frontal (coronal) plane motion of toes as supination/pronation and 1 as inversion/eversion. The transverse (horizontal) plane motion of the foot/ankle was defined as abduction/adduction in the hindfoot, midfoot, and forefoot; the sagittal plane motion of the foot/ankle was defined as dorsiflexion/plantarflexion; and the frontal (coronal) plane motion of the foot/ankle as inversion/eversion. The transverse (horizontal) plane motion of toes was defined as abduction/adduction; the sagittal plane motion of toes was defined as extension/flexion; and the frontal (coronal) plane motion of toes was defined as supination/pronation.     

Der Stellenwert der Lymphknotenchirurgie beim Peniskarzinom

Inguinal lymphadenectomy is performed according to the clinical features as well as the risk factors of the primary tumor. In cases involving more than two positive lymph nodes or extranodal growth as well as positive imaging, pelvic lymphadenectomy is indicated. Large or fixed inguinal nodes as well as iliac lymph nodes seen on computed tomography scanning are a good indication for neoadjuvant rather than adjuvant chemotherapy.     

Anterior cervical discectomy and fusion for cervical radiculopathy and myelopathy

Anterior cervical discectomy and fusion is indicated for the operative treatment of either cervical radiculopathy orcervical myelopathy. This article discusses the indications for the procedure, as well as the advantages of this approach, compared with foraminotomy, laminectomy, as well as laminoplasty. The operative technique is described in detail, as well as the results and complications.     

掌侧T形钢板治疗桡骨远端不稳定骨折

目的评价掌侧T形钢板治疗桡骨远端不稳定骨折的疗效。方法采用掌侧T形钢板治疗桡骨远端不稳定骨折患者80例,AO分型A3型20例,B1型2例,B2型1例,B3型1例,C1型21例,C2型22例,C3型13例。结果本组80例患者全部获得随访,随访6～38个月(平均25.3个月),骨折全部愈合。采用Dienst腕关节功能标准评价疗效:优67例,良9例,可4例。结论掌侧T形钢板治疗桡骨骨远端不稳定骨折,内固定牢靠,可早期进行功能锻炼,疗效满意。     

激光加臭氧联合治疗椎间盘源性下腰痛初步研究

目的：评价联合应用经皮穿刺激光加臭氧对椎间盘源性下腰痛的治疗效果。方法：椎间盘源性下腰痛患者48例,男32例,女16例;年龄21～66岁,平均43.5岁;病程6个月以上。所有病例均在X线电视导向下联合应用经皮穿刺激光髓核消融加臭氧治疗。结果：术后随访无严重并发症发生。根据Macnab腰腿痛手术评价标准,术后1周时优8例,良28例,可8例,差4例,优良率75%;3个月时优17例,良23例,可6例,差2例,优良率83.3%;6个月时优20例,良22例,可4例,差2例,优良率87.5%;12个月时优21例,良22例,可4例,差1例,优良率89.6%。结论：联合应用经皮穿刺激光加臭氧治疗椎间盘源性下腰痛的疗效确切。     

SANGUINATE (PEGylated Carboxyhemoglobin Bovine): Mechanism of Action and Clinical Update

Historically, blood substitutes were under development that would provide oxygen carrying capacity as well as fluid replacement for both trauma and surgical indications. Their development was halted by the inability of the products to deliver therapeutic amounts of oxygen targeted to hypoxic tissue as well as from the inherent toxicity of the molecules. This led to the concept of an oxygen therapeutic that would be targeted for indications caused by anemia/ischemia/hypoxia but would not exhibit the toxicity that plagued earlier products. The complex pathophysiology of diseases such as sickle cell and hemorrhagic stroke not only has hypoxia as a pivotal event but also includes inflammation and vasoconstriction that perpetuate the oxygen deprivation. There is a need for an effective therapeutic that addresses the multiple events of inflammation and oxygen deprivation. SANGUINATE acts as a dual mode carbon monoxide (CO) and oxygen delivery therapeutic. SANGUINATE is designed not only to treat hypoxia but also to act on concurrent pathologies such as inflammation and reperfusion injury. This expands the potential therapeutic utility of SANGUINATE beyond anemia into indications such as early brain injury and delayed kidney graft function, where inflammation plays a pivotal pathological role as well as in indications such as sickle cell disease where the inflammation and hypoxia contribute to the development of comorbidities such as vaso‐occlusive crisis. Clinical trials in multiple indications are underway.     

Editorial Commentary: Meniscal Repair,When Possible,Is Better for Patients Than Meniscectomy

Patients do not do as well after meniscectomy as after repair. Although saving the meniscus is not always easy and the success rate of repair is not 100%, repair—when possible—remains the best option for patients in the long run. Meniscal repair rates are on the rise, especially in younger patients, but are not high enough. Recent research has shown that more than 95% of meniscal procedures are partial meniscectomies. Improved surgical techniques and instrumentation, as well as a continued increase in understanding the importance of repair, are leading to an increase in meniscal repair rates. Preserve as much meniscus as possible and as often as possible.     

Partial nephrectomy for tumour

Thirty-three cases of malignant renal tumour removed by partial nephrectomy are discussed. The indications of this conservative therapy as well as the surgical technique, the results obtained, especially survivals beyond 10 years, as well as the period of time after which the neoplasic disease can be considered as cured are presented.     

A clinical assay for prostatic acid phosphatase using choline phosphate as a substrate: Comparison with thymolphthalein phosphate

We describe an assay method using choline O-phosphate as a substrate for the measurement of serum prostatic acid phosphatase as an aid in the diagnosis of prostatic cancer. Choline phosphate is hydrolyzed by homogeneous prostatic acid phosphatase, and it is also hydrolyzed by an acid phosphatase present in the serum of prostatic carcinoma patients. In contrast, serum samples from apparently healthy persons do not exhibit any significant choline O-phosphate phosphatase activity. There is a correlation of 98% (n = 46) between choline O-phosphate phosphatase activity and typical measurement for prostatic acid phosphatase activity carried out using thymolphthalein monophosphate as the substrate. The new method appears to be as accurate as colorimetric methods based on thymolphthalein phosphate as a substrate. Although not as sensitive as immunologically based methods, the present technique for measuring prostatic acid phosphatase activity using choline phosphate as a substrate is economical and relatively simple.     

Scribner shunt conversion to arteriovenous fistula.

Scribner shunts were converted to arteriovenous fistulas in twenty-six patients, with long-term success in twenty patients. Infection with loss of the fistula was a problem in two patients. The fistulas were used for home as well as center dialysis and as a primary blood access site as well as a backup site.     

慢性前列腺炎诊治中值得关注的几点问题

慢性前列腺炎是泌尿外科最常见的疾病之一,患病率高．治愈率低,易于复发。世界各地报道患病率不同,患暂症状多变。目前,该病病因不明,发病机制不清．缺乏大家公认的诊断标准,治疗方案与疗效判断也存在争议。正确对待慢性前列腺炎．不仅是患者的事情．而且对泌尿外科医生也至关重要。     

Importance of lymph node involvement in breast carcinoma for the oncologist

Axillary node status is the most important prognostic information regarding treatment and prognosis for breast cancer patients. Localisation and number of involved lymph nodes add further information and are of prognostic relevance as well. The problem of the involvement of different axilla levels as well as skip metastases are discussed. Sentinel lymph node dissection is still considered investigational as well as axilla downstaging by preoperative chemotherapy. New prognostic markers are helpful in individual situations but are not yet considered as standard procedures. Conclusions of practical relevance are summarised.     

The elderly surgical patient. Experiences with patients over 85

Hospitalised treatment was applied to 326 patients aged between 85 and 101 years, between 1982 and 1987. Operations were performed on 215 of them. The surgical lethality amounted to 16.3 per cent, though lethality in conjunction with emergency operations was as high as 23.9 per cent or as low as 11.8 per cent in the context of elective operations. X-ray findings recorded from heart and lung as well as ECG provided reliable criteria for assessment of the surgical risk.     

Anästhesiologisches Management bei mikrochirurgischen Rekonstruktionen

Microsurgical procedures for construction of anastomoses present new challenges for anesthetists in the perioperative setting. Despite their increasing importance, so far no perioperative management guidelines for these patients existed. Anesthetists can influence the success of surgery (e.?g. successful perfusion of a flap) via an optimal preoperative, intraoperative and postoperative approach. Patients should be carefully evaluated preoperatively for increased risks to avoid poor postoperative outcomes. Perioperatively, the choice of anesthetic procedure as well as the management of fluid infusion, blood glucose, temperature and blood transfusion are of great importance. Adequate analgesia as well as strict control should be performed as soon as possible postoperatively, preferably in a surveillance unit to detect and treat any complications as early as possible.     

Postburn contracture treatment: a healthcare project in Bangladesh

Over the last 6 years, a health care program aimed at the surgical correction of postburn contractures has taken place in Faridpur, Bangladesh. People in this rural region are very poor and often cannot afford medical treatment. Often secondary flexion contractures of the face and chin as well as the upper and lower extremity impede daily functioning and have an enormous psycho-social impact. The application of basic plastic surgical principles such as local transposition of skin flaps as well as skin grafts restores function dramatically and results in stable skin cover. It is quite challenging - both for the surgeon and the anaesthesiologist - to perform these operations within a rather limited infrastructure. In Bangladesh, there is a monumental need for correction of postburn contractures for the social needs of the patient as well as for functional purposes. Future actions should be directed to the training of surgeons and the development of specialized hospitals to demonstrate social as well as political commitment to health care programs.     

Arthroskopische Eingriffe am Schultergelenk

The number of outpatient operations increases; this is also true for shoulder arthroscopy. With its large range of indications shoulder arthroscopy is well established in trauma surgery and sports medicine. However, not all shoulder arthroscopies can be performed as an outpatient procedure. Each case needs to be decided individually on the basis of complexity of the procedure, the patient’s general health and social environment, as well as the surgeon’s experience. In general, non-reconstructive operations such as acromioplasty, subacromial decompression and excision of calcium for calcifying tendinitis can be carried out as outpatient procedures. Reconstructions of the rotator cuff or stabilisation after shoulder dislocation should be dealt with as inpatient procedures due to invasiveness of these operations as well as the pre-, peri- and postoperative management.