Nerve injuries in anterior shoulder dislocations

A retrospective study was conducted to determine the incidence of nerve injuries in anterior dislocations of the shoulder and to determine if a neurological examination is routinely performed in such cases. One hundred and fifteen shoulder dislocations in 100 patients (74 males, 26 females; mean age 35+/-18 years) were reviewed. Eighty-seven patients were examined for neurological injuries prior to reduction and 8 of these patients (9.2%) were found to have sustained neurological injuries. Following reduction, neurological examination was performed in 85 patients. Three patients who were not examined initially prior to reduction were subsequently found to have nerve injuries after reduction. Seven patients (7%) were not examined for neurological injury both before and after reduction of the dislocation. Eleven patients were found to have sustained nerve injuries in the final analysis. Axillary nerve injuries were the most common, occurring in 8 patients. In conclusion, nerve injuries are common in shoulder dislocations. The importance of performing and documenting the findings of neurological examination anterior shoulder dislocations needs to be reiterated.     

应用神经传导治疗软组织伤病的研究

本文报道主要应用增强神经传导治疗颈椎病为代表的软组织伤病５２４例研究。采用手法点压，弹拨颈丛皮支，锁骨上臂丛神经及其分支。该手法具有简便、易行、无创伤、疗程短、见效快等优点，为软组织伤病治疗提供一种新途径。     

Nerve grafting for peripheral nerve injuries with extended defect sizes

Wiener Medizinische Wochenschrift - Artificial and non-artificial nerve grafts are the gold standard in peripheral nerve reconstruction in cases with extensive loss of nerve tissue, particularly...     

Hyperekplexia in neonates

Hyperekplexia (startle disease) is a rare non-epileptic disorder characterised by an exaggerated persistent startle reaction to unexpected auditory, somatosensory and visual stimuli, generalised muscular rigidity, and nocturnal myoclonus. The genetic basis is a mutation usually of the arginine residue 271 leading to neuronal hyperexcitability by impairing glycinergic inhibition. Hyperekplexia is usually familial, most often autosomal dominant with complete penetrance and variable expression. It can present in fetal life as abnormal intrauterine movements, or later at any time from the neonatal period to adulthood. Early manifestations include abnormal responses to unexpected auditory, visual, and somatosensory stimuli such as sustained tonic spasm, exaggerated startle response, and fetal posture with clenched fists and anxious stare. The tonic spasms may mimic generalised tonic seizures, leading to apnoea and death. Consistent generalised flexor spasm in response to tapping of the nasal bridge (without habituation) is the clinical hallmark of hyperekplexia. Electroencephalography may show fast spikes initially during the tonic spasms, followed by slowing of background activity with eventual flattening corresponding to the phase of apnoea bradycardia and cyanosis. Electromyography shows a characteristic almost permanent muscular activity with periods of electrical quietness. Nerve conduction velocity is normal. No specific computed tomography findings have been reported yet. Clonazepam, a gamma aminobutyric acid (GABA) receptor agonist, is the treatment of choice for hypertonia and apnoeic episodes. It, however, may not influence the degree of stiffness significantly. A simple manoeuvre like forced flexion of the head and legs towards the trunk is known to be life saving when prolonged stiffness impedes respiration.     

早产儿与足月儿新生儿期血清甲状腺激素水平比较

目的：了解早产儿和足月儿新生儿期血清甲状腺激素水平。方法用化学发光免疫分析法测定新生儿血清T3、T4、FT3、FT4和TSH水平,按胎龄分早产儿组和足月儿组,并进行组间比较,作胎龄与甲状腺激素水平间的相关性分析。结果早产儿组T3、T4和FT3水平分别为（1.34±0.40）、（141.50±39.62）nmol/L和（4.11±1.10）pmol/L,明显低于足月儿组的（1.70±0.50）、（160.88±37.59）nmol/L和（4.87±1.42）pmol/L,（均P＜0.01）。胎龄与血清T3水平（r=0.36,P＜0.01）、T4水平（r=0.30,P＜0.01）和FT3水平（r=0.27,P＜0.01）明显相关。结论新生儿出生时T3、T4、FT3水平与胎龄有关,早产儿甲状腺激素水平明显低于足月儿。     

神经刺激仪对臂丛神经运动与感觉阻滞的临床分析

目的比较传统异感法与神经刺激仪辅助定位法在臂丛神经阻滞中对运动与感觉阻滞的临床效果。方法选取行上肢手术的80例患者,随机分为对照组和观察组各40例,对照组采用传统异感法进行肌间沟臂丛阻滞,观察组在神经刺激仪引导下行肌间沟臂丛阻滞。比较两组患者麻醉后不同时间感觉和运动阻滞的情况。结果①观察组对于尺神经、桡神经、正中神经及肌皮神经组织效果均较好,两组患者在尺神经和正中神经阻滞效果上差异不明显,但观察组对桡神经和肌皮神经的阻滞效果明显优于对照组(P<0.05)。②两组患者麻醉后0.5 h、1 h、2 h、24 h疼痛评分差异不明显,6 h时观察组高于对照组(P<0.05);不同时间运动功能的恢复比较,观察组麻醉后1 h、2 h期间肌力超过2级的患者人数显著高于对照组(P<0.05)。结论神经刺激仪辅助定位法局麻效果更为肯定,可降低局麻药量,有利于术后恢复。     

选择性脊神经后根切除术中神经电生理监测的应用

目的 讨论神经电生理监测在选择性脊神经后根切除术中的应用.方法 应用肌电图/诱发电位仪对脑瘫患者的选择性脊神经后根切除术进行全程监测.结果 经3～18个月随访,本组11例在神经电生理监测下行SPR的痉挛性脑瘫患者,双下肢肌痉挛的解除率100%,功能改善率80%,膝、踝反射正常率80%,髌、踝阵挛消失率90%,剪刀步均消失,肌力均在3级以上.结论 在神经电生理监测下进行的SPR,患者双下肢肌痉挛的解除率、功能改善率、反射正常率、肌力等均明显优于其他学者报道的肉眼下进行SPR的结果.     

Subaponeurotic haemorrhage in Malaysian neonates

In a 30-month prospective study, between January 1987 and June 1989, 101 of 64,424 Malaysian neonates (1.6 per 1000 livebirths) born in the Maternity Hospital, Kuala Lumpur were found to have subaponeurotic haemorrhage shortly after delivery. The incidence was highest in neonates weighting 4000 gm or more. There was no significant difference in incidence of this condition in neonates of different ethnic origins. Hypoprothrombinemia was present in only 5/101 (5.0%) of the affected neonates. Sixty seven (66.3%) of the neonates with subaponeurotic haemorrhage had history of trial of vacuum extraction. The incidence of subaponeurotic haemorrhage was significantly higher in neonates delivered by vacuum extraction than by other modes of delivery in this hospital (41.4 per 1000 livebirths in neonates delivered by vacuum extraction versus 1.0 per 1000 livebirths in neonates delivered by other modes). Those neonates who developed subaponeurotic haemorrhage without trial of vacuum extraction had a history of either prolonged labour or difficult delivery. Thirty-three (32.7%) of the neonates with subaponeurotic haemorrhage developed anaemia which required blood transfusion and 3/33 (9.1%) were in shock. Fifty seven (56.4%) of the neonates with subaponeurotic haemorrhage developed hyperbilirubinemia due to the haemorrhage. Four (7.0%) of them had severe unconjugated hyperbilirubinemia which required exchange transfusion. The results of this study suggest that subaponeurotic haemorrhage in Malaysian neonates was commonly associated with vacuum extraction and was not a benign condition.     

Hyperbilirubinemia in Inuit neonates.

A prospective study was undertaken to determine if Inuit and Caucasian neonates have different patterns of physiologic jaundice. Daily blood samples obtained by heel pricks of Inuit and Caucasian neonates born at the Churchill (Man.) Health Centre were assayed for the total serum bilirubin concentration. The mean peak bilirubin level in the Inuit group was significantly higher than that in the Caucasian group (8.76 v. 6.04 mg/dl [150 v. 103 mumol/l]) and occurred later (on day 3 rather than day 2). Of the Caucasian neonates, those who were breast-fed in hospital had a significantly higher (P less than 0.05) mean peak bilirubin level than those who were not, and among all the neonates who were not breast-fed in hospital the Inuit had a significantly higher mean peak bilirubin level than the Caucasians (7.98 v. 3.64 mg/dl [136 v. 62 mumol/l]). These findings indicate that factors other than breastfeeding, some of which may be genetic, are responsible for the higher and later peak in the serum bilirubin concentration in Inuit neonates.     

Treating defective neonates in Hungary

How to decide which very small or handicapped newborn babies to treat is as much a problem in the former communist countries as in the West. Hungarian attitudes to the problem are discussed here.