Sonographically guided percutaneous muscle biopsy in diagnosis of neuromuscular disease: a useful alternative to open surgical biopsy.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of sonographically guided percutaneous muscle biopsy in the investigation of neuromuscular disorders. METHODS: Sonographically guided percutaneous needle biopsy of skeletal muscle was performed with a 14-gauge core biopsy system in 40 patients over a 24-month period. Patients were referred from the Department of Neurology under investigation for neuromuscular disorders. Sonography was used to find suitable tissue and to avoid major vascular structures. A local anesthetic was applied below skin only. A 3- to 4-mm incision was made. Three 14-gauge samples were obtained from each patient. All samples were placed on saline-dampened gauze and sent for neuropathologic analysis. As a control, we retrospectively assessed results of the 40 most recent muscle samples acquired via open surgical biopsy. RESULTS: With the use of sonography, 32 (80%) of 40 patients had a histologic diagnosis made via percutaneous needle biopsy. This included 26 (93%) of 28 patients with acute muscular disease and 6 (50%) of 12 patients with chronic disease. In the surgical group (all acute disease), 38 (95%) of 40 patients had diagnostic tissue attained. CONCLUSIONS: Sonographically guided percutaneous 14-gauge core skeletal muscle biopsy is a useful procedure, facilitating diagnosis in acute muscular disease. It provides results comparable with those of open surgical biopsy in acute muscular disease. It may also be used in chronic muscular disease but repeated or open biopsy may be needed.     

眼科患者医院感染危险因素分析与护理对策

目的:探讨眼科患者感染危险因素及护理对策。方法:选择本院眼科2008年7月～2010年10月收治的眼科患者362例为研究组,选取同期收治的341例眼科患者为对照组,分别行不同护理干预方法,并进行效果对比。结果:对照组患者共有9例发生感染,而经针对性护理干预的研究组患者则未发生院内感染,两组间感染发生率分别为2.64%与0,两组比较具有统计学差异(P<0.05)。结论:对眼科住院患者采取术前、术中、术后的分阶段针对性护理工作,能够有效控制眼科医院感染的发生,从而减少患者的痛苦,提高患者的预后恢复效果。     

Ophthalmic artery aneurysms: An investigation by duplex scan

With the objective of analyzing the postaneurysmal peak systolic velocity (PSV) in ophthalmic arteries, duplex scanning was analyzed in 28 carotid-ophthalmic artery segments after exclusion of ipsilateral carotid stenosis. For comparison, the angiographic study of the extracranial and intracranial carotid system was utilized as the “gold standard”. A subgroup of 7 subjects with 8 ophthalmic arteries with aneurysms identified where the artery leaves the internal carotid artery presented with PSVs significantly reduced (mean PSVs 17.95 ± 7.99 cm/s) compared to the mean PSVs in the healthy group (27.95 ± 5.54 cm/s) (p = 0.006). A PSV of less than 19 cm/s offered a sensitivity of 80% and a specificity of 100% in diagnosing ophthalmic artery aneurysms. We conclude that duplex scan is diagnostically useful in the identification of patients with ophthalmic artery aneurysms when severe ipsilateral carotid stenosis is excluded.     

Logistic regression: a useful tool in rehabilitation research

Regression analysis is a frequently used tool to examine associations between a dependent (outcome) variable and one or more independent variables. The resulting model enables prediction of an unobserved outcome based on the observed independent variables. In rehabilitation research the dependent variable is quite often dichotomous, i. e. having just two parameter values (e. g. capable of work: yes/no). For such an outcome variable, the logistic regression model can be applied, having specific advantages in interpreting the model parameters with respect to risk factor analysis. In this paper the basics of the logistic regression model, interpretation of the model parameters and special aspects of modelling are presented. Subsequently the logistic regression model is applied to an example dataset for estimating the risk of early retirement after inpatient rehabilitation.     

Limit setting: a useful strategy in rehabilitation.

Limit setting is a concept familiar to most mental health clinicians, but much less familiar to staff not specifically trained in mental health care. This paper presents guidelines developed for rehabilitation staff on the strategy of limit setting. The aim of these guidelines was to provide a starting point for ongoing education on limit setting and behavioural management for staff working in a non-psychiatric rehabilitation environment. Limit setting is presented, not only as a response to challenging behaviour, but also as fundamental to all patient care within the rehabilitation context. The guidelines draw on the concepts of limit setting, acting out, therapeutic relationships and therapeutic milieu as described in the psychiatric literature. A humanistic framework for helping people underpins the guidelines. Principles for selecting and enforcing limits are described. Finally, a list of clarification prompts is provided for clinicians to use when faced with challenging patient behaviour.