Mistakes in the diagnosis and treatment of the complete dislocation and fractures of the acromial end of the clavicle

The analysis of the mistakes in the operative treatment of the sick with such a trauma was conducted. Two typical examples were given. The mistakes were stipulated non-diagnosis of the simultaneous break of the coracoclavicular ligament and not taking measures for its recovery. The radiodiagnosis based on N. Z. Shmidt's method is considered to be inevitable for this category of the sick. After the confirmation of the diagnosis the operation of choice can be the operation of Yotkins-Leochuk for the sick with the complete dislocation of the acromial end of the clavicle, and the operation of Yotkins for the sick with fractures of the acromial end of the clavicle with the break of the coracoclavicular ligament. By means of these methods 43 sick men with the dislocation and 7 sick men with fractures of the acromial end of the clavicle have been operated since 1973. No cases had complications, relapses or unsatisfactory results.     

Functional anatomy of the dorsal hood or the hand: correlation of ultrasound and MR findings with cadaveric dissection

The main aim of this study was to provide an overview of the anatomy of the dorsal hood (DH) based on the dissection of sixteen cadaver hands, correlated with magnetic resonance (MR) and ultrasound findings. A secondary aim was to assess the function of components of the DH. Sixteen embalmed hands were evaluated by MRI and ultrasound before being dissected. Each hand was photographed during each stage of dissection. Secondly we evaluated the role of the different structures of the DH in the stability of the extensor tendon by transection of the different components alternatively at the ulnar and radial sides. MR, ultrasound, and dissection showed that the extensor tendon (ET) is stabilized by the sagittal band (SB) at the level of the metacarpophalangeal (MCP) joint and more distally by the transverse and the oblique bands, respectively. Transection of the radial SB of the second finger leads systematically to ulnar dislocation of the ET. The transection of the ulnar DH does not lead to instability of the ET. The SB is the most important structure of the DH in the stability of the ET at the MCP level. Rupture of the radial SB of the second finger leads systematically to ulnar dislocation of the ET.     

Fractures of the neural arch and odontoid process of the axis: A study of their causation

Summary The anatomical findings in 43 cases with fractures of the neural arch or odontoid process of the axis have been correlated to the reconstructions of the course of events in the accidents. Bilateral fractures of the neural arch anterior to the inferior apophyseal joints were the result of a violent anteroflexion of the head. Simultaneous traction or compression of the cervical spine were possibly of contributing importance. Considerable non symmetrical fractures of the neural arch were due to oblique anteroflexion of the head combined with traction of the cervical spine. Trauma against the posterior part of the neck resulted in fractures of the neural arch posterior to the inferior apophyseal joints. The fractures of the odontoid process were the result of a violent anteroflexion or retroflexion of the head. Simultaneous compression of the cervical spine and rotation of the head were possibly of contributing importance in some cases.     

Joint mobility and the oscillation characteristics of muscle

The aim of this study was to investigate which muscle characteristics of oscillation of the lower extremities have influence on trunk forward flexion and knee extension. The frequency and the decrement of damped oscillation of the muscles m. rectus femoris, m. biceps femoris, m. semitendinosus and t. semimembranosus in relaxed, contracted or stretched states were recorded by the myometer among the 22 first-year male students of the department of physical education. The subjects were divided twice into two groups according to: 1) the values of the trunk forward flexion, and 2) the values of the knee extension range of motion. The oscillation frequency of m. rectus femoris of the groups with high trunk forward flexion and high knee extension range of motion was lower than in groups with less range of motion. The similarity was followed in the decrement of m. semitendinosus. The difference between the decrements of the relaxed and stretched state of m. semitendinosus and the decrement of the relaxed state of the same muscle tendon correlated with the knee extension range of motion (r=0.46 and r=0.48, P<0.05). The relationship between the decrement of the relaxed state of m. biceps femons and the range of motion was r=-0.51 (P<0.01). The results of this study showed that the characteristics of the damped oscillation as indirect parameters of viscoelastic properties of the muscles were related to the joint mobility.     

Fatal head injury in homicidal victims

Homicide represents one of the leading causes of death, and the head is the target in the majority of cases. The objective of the present study was to analyze the pattern of head injury among homicidal death victims. Information was obtained by interviewing the accompanying persons, post-mortem examination and perusal of hospital records. Most of the victims were predominantly male and belonged in the age group 21-30 years. Blunt weapons caused the majority of the injuries. Defence wounds were present in 48% of the victims. The street was the place of crime in the majority of cases (46.7%) and in most of the cases there was more than one offender. Multiple assaults were seen on the body in 70% of cases. The skull was fractured in more than 80% of victims and intracranial haemorrhages were seen in 47 victims. Out of 77 cases, 55 victims showed intracranial lesions along with injuries to the skull and scalp. Associated fatal injuries were most commonly present on the neck and chest. The majority of the victims died instantly or within 24 hours. Blunt force is commonly used when the head is the target. Defence wounds, when present, are indicative of the homicidal nature of the attack, and multiple strokes present over the body indicate determination on the part of the accused to end the life of the victim.     

A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings

BACKGROUND AND PURPOSE: The sphenoid sinus is rarely implicated as a site of spontaneous CSF fistula. We undertook this study to evaluate the potential etiopathogenesis of spontaneous CSF fistula involving the sphenoid sinus and to review the imaging findings. METHODS: We retrospectively reviewed the imaging findings of 145 cases of CSF fistula from our departmental archives (August 1995 through August 1998). Fifteen (10%) patients had CSF fistulas involving the sphenoid sinus. Eleven (7%) patients had spontaneous CSF fistulas, whereas in four patients, the CSF fistulas in the sphenoid sinus were related to trauma. Of the 11 patients, nine underwent only plain high-resolution CT and MR cisternography. One patient additionally underwent contrast-enhanced CT cisternography, and one other patient underwent MR cisternography only. For each patient, the CSF fistula site was surgically confirmed. The MR imaging technique included T1-weighted and fast spin-echo T2-weighted 3-mm-thick coronal sequences obtained with the patient in the supine position. The plain high-resolution CT study included 3-mm-thick, and sometimes 1- to 1.5-mm-thick, coronal sections obtained with the patient in the prone position. Similar sections were obtained after injecting nonionic contrast material intrathecally via lumbar puncture for the CT cisternographic study. We evaluated each of the 11 patients for the exact site of CSF leak in the sphenoid sinus. We also determined the presence of pneumatization of lateral recess of the sphenoid sinus, orientation of the lateral wall of the sphenoid sinus, presence of arachnoid pits, presence of brain tissue herniation, and presence of empty sella in each of these patients. RESULTS: The exact sites of the CSF fistulas were documented for all 11 patients by using plain high-resolution CT, MR cisternography, or CT cisternography. In nine (82%) patients, the sites of the CSF fistulas were at the junction of the anterior portion of the lateral wall of the sphenoid sinus and the floor of the middle cranial fossa. In the remaining two (18%) patients, the sites of the CSF fistulas were along the midportion of the lateral wall of the sphenoid sinus. Of these 11 patients, one had bilateral sites of the CSF fistula at the junction of the anterior portion of the lateral wall of the sphenoid sinus with the floor of the middle cranial fossa. In nine (82%) patients, the presence of brain tissue herniation was revealed, and this finding was best shown by MR cisternography. Ten (91%) patients had extensive pneumatization of the lateral recess of the sphenoid sinus, with an equal number having outward concave orientation of the inferior portion of the lateral wall of the sphenoid sinus. In seven (63%) patients, the presence of arachnoid pits, predominantly along the anteromedial aspect of the middle cranial fossa, was shown. In seven (63%) patients, empty sella was shown. For comparison, we reviewed the CT studies of the paranasal sinuses in 100 age-matched control subjects from a normal population. Twenty-three had extensive lateral pneumatization of the sphenoid sinus along with outward concavity of the inferior portion of the lateral wall. None of these 23 patients had arachnoid pits. CONCLUSION: The sphenoid sinus, when implicated as a site of spontaneous CSF leak, yields a multitude of imaging findings. These are extensive pneumatization of the lateral recess of the sphenoid sinus, outward concave orientation of the inferior portion of the lateral wall of the sphenoid sinus, arachnoid pits, and empty sella. Considering the normative data, we speculate that this constellation of findings could play a role in the etiopathogenesis of spontaneous sphenoid sinus fistulas. Our findings also show the efficacy of noninvasive imaging techniques, such as plain high-resolution CT and MR cisternography, in the evaluation of sphenoid sinus CSF leak. Our data also suggest that spontaneous sphenoid sinus CSF leak is not an uncommon occurrenc     

家庭多人同时烧伤的治疗与护理

目的:总结家庭多人烧伤的致伤机制、病例特点、创面治疗与护理经验,提高救治水平,加强防范措施。方法:对我科2000年1月-2004年12月收治的家庭多人(≥2人)同时烧伤病人(18起46例)的创面均采用湿润烧伤膏(MEBO)治疗,从病例特点、治疗护理经验等方面进行回顾性分析。结果:出现焦虑、烦躁等情绪病人的心理指标得到改善,浅Ⅱ度、深Ⅱ度及浅Ⅲ度创面均自行愈合,深Ⅲ度创面经MEBO治疗 4周行自体皮移植治疗,46例病人全部治愈。结论:家庭多人烧伤并不少见,病例特点与治疗方法类似于成批烧伤,创面采用湿润烧伤膏治疗效果满意,加强创面处理和注重心理治疗有助于病人康复。     

The labyrinthine portion of the facial canal in patients with Bell's palsy investigated by computed tomography

The reproducibility of the labyrinthine portion of the facial canal by computed tomography was investigated in 22 patients with Bell's palsy. The CT images were compared with those obtained in 18 temporal bone specimens. Measurements of the diameters of different parts of the facial canal were made on these images and also microscopically in plastic casts of the temporal bone specimens. No marked difference was found between the dimensions of the labyrinthine portion of the facial canal of the involved and healthy temporal bone in the patient, nor did these differ from the dimensions in the specimens. CT of the slender, curved labyrinthine portion was found to be of doubtful value for metric estimation of small differences in width. The anatomic variations of the canal rendered the evaluation more difficult. CT with a slice thickness of 2 mm was of no value for assessment of this part of the canal. Measurement of the diameters of the labyrinthine portion on CT images is an inappropriate and unreliable method for clinical purposes.     

Sectional anatomy of the peritoneal reflections of the upper abdomen in the coronal plane

PURPOSE: The purpose of this study was to provide practical anatomic data for the imaging diagnosis and surgical treatment of the diseases of the subphrenic spaces. METHODS: The sectional anatomy of the subphrenic spaces on the coronal plane was investigated on serial coronal sections of the upper abdomen of 30 Chinese adult cadavers. RESULTS: The space between the anterior margin of gastropancreatic fold and the posterior layer of hepatogastric ligament is the only direct pathway between the superior and inferior recesses of the lesser sac. That pathway can be divided into 3 types on the coronal plane. The right layer of the gastrophrenic ligament is continuous with the posterior layer of the lesser omentum, and its left layer is continuous with the right layer of the phrenosplenic ligament and the posterior layer of the gastrosplenic ligament. The gastropancreatic fold is continued to the left and right layers of the gastrophrenic ligament upwards. The bare area of the stomach is located between the left and right layers of the gastrophrenic ligament; its existing rate is 100%. The bare area of the spleen is located among the phrenosplenic ligament, gastrosplenic ligament, splenorenal ligament, and splenocolic ligament. Its greatest width exists between the two layers of the splenorenal ligament. It can be divided into the splenic hilus and splenorenal parts. CONCLUSION: The coronal section is dominant to show the anatomic relationships of the gastrophrenic ligaments and the gastropancreatic folds, and the bare area of the stomach.     

The skin: its structure and response to ionizing radiation

The response of the skin to ionizing radiation has important implications both for the treatment of malignant disease by radiation and for radiological protection. The structural organization of human skin is described and compared with that of the pig, with which it shows many similarities, in order that the response of the skin to ionizing radiation may be more fully understood. Acute radiation damage to the skin is primarily a consequence of changes in the epidermis; the timing of the peak of the reaction is related to the kinetic organization of this layer. The rate of development of damage is independent of the radiation dose, since this is related to the natural rate of loss of cells from the basal layer of the epidermis. Recovery of the epidermis occurs as a result of the proliferation of surviving clonogenic basal cells from within the irradiated area. The presence of clonogenic cells in the canal of the hair follicle is important, particularly after non-uniform irradiation from intermediate energy beta-emitters. The migration of viable cells from the edges of the irradiated site is also significant when small areas of skin are irradiated. Late damage to the skin is primarily a function of radiation effects on the vasculature; this produces a wave of dermal atrophy after 16-26 weeks. Dermal necrosis develops at this time after high doses. A second phase of dermal thinning is seen to develop after greater than 52 weeks, and this later phase of damage is associated with the appearance of telangiectasia. Highly localized irradiation of the skin, either to a specific layer (as may result from exposure to very low energy beta-emitters) or after exposure to small highly radioactive particles, 'hot particles', produces gross effects that become visibly manifest within 2 weeks of exposure. These changes result from the direct killing of the cells of the skin in interphase after doses greater than 100 Gy. Dose-effect curves have been established for the majority of these deterministic endpoints in the skin from the results of both experimental and clinical studies. These are of value in the establishment of safe radiation dose limits for the skin.     

Percutaneous angioscopy in the diagnosis of arteriopathies of the lower limbs

Because of the poor specificity of the arteriography, the authors have performed a percutaneous angioscopy before every angioplasty of the arteries of lower limbs for nearly 3 years. They define the angioscopy and describe materials and technique. The percutaneous route without surgery and without anesthesia underlines the originality of the technique. The great difficulty is to counter-pulse the arterial inflow. The rate of saline irrigation and all the means of arterial blockade are described. In the second part, the "elementary images" are classified. The authors insist on the specificity of the angioscopy in the interpretation of arterial obstructions. Because of this specificity, the right treatment can be applied to any type of lesion. Angioscopy permits to foresee endoluminal surgery technique.     

合理调控自动洗片机运行参数--提高照片质量的重要环节

目的初步研究自动洗片机运行参数的调控方法.方法在显影液的一个使用周期中,用标准感光的"样片”,每3d测试一次自动洗片机不同显影温度时输出胶片的密度.选择适当的显影温度,制成调控参数表.结果胶片密度随显影液新旧变化,幅度为0.82.根据调控参数表调整洗片机运行参数后输出胶片的密度变化幅度为0.17,是调整前的20%.胶片的密度变化明显减少.结论根据调控参数表,适时调整洗片机运行参数,可以有效控制洗片机输出胶片的密度.     

自体表皮细胞移植治疗白癜风影响皮片成活率的因素探讨

目的　探讨自体表皮细胞移植治疗白癜风影响皮片成活率因素。方法　选择腹部皮肤为供皮区 ,予PFG Ⅰ表皮细胞分离机进行负压与温度双重分离 ,使其形成水疱 ,将供皮区的疱壁剪下备用。受皮区局麻后 ,子皮肤磨削机磨去白斑表皮 ,直至局部出现点状出血为止。将供皮区剪下的疱壁覆盖于受皮区 ,供应区及受皮区分别加压包扎 ,定期观察皮片成活情况。结果　 3 84例患者进行自体表皮细胞移植术后 ,有 3 67例皮片成活 ,成活率占治疗总数 91 .3 6%;未成活 1 7例 ( 2 4块 )占治疗总数 4.42 %。皮片未成活原因 ( 1 )创面感染化脓 3例 ( 5块 )占治疗总数 0 .78%。 ( 2 )创面术后浸水 6例( 7块 )占治疗总数 1 .5 6%。 ( 3 )正常表皮贴反了 2例 ( 2块 )占治疗总数 0 .5 2 %。 ( 4 )受皮创面太浅 2例( 3块 )占治疗总数 0 .5 2 %。 ( 5 )移植术后皮片过早脱落 4例 ( 7块 )占治疗总数 1 .0 4%。结论　自体表皮细胞移植治疗白癜风疗效确切 ,皮片成活率高 ;明确了影响皮片成活率的因素及制定相应的预防措施 ,能够进一步提高皮片的成活率。     

肾周间隙积液的CT表现及解剖学基础

目的:结合肾周间隙的解剖学基础分析肾周间隙积液的CT表现。材料和方法:观察59例肾周间隙积液的分布及CT表现。结果:肾周间隙积液CT表现:肾窦水肿,肾被膜下积液,肾周间隙内桥隔增厚,肾周间隙脂肪层内斑片状影,肾被膜及肾前、肾后筋膜增厚,部分同时有圆锥侧筋膜增厚肿胀。右侧肾周间隙积液向上可至肝裸区。结论:CT能够清楚显示肾周间隙积液和肾筋膜的分隔作用,了解这些解剖结构,可合理地解释影像学征象及了解疾病扩展途径,为泌尿外科及介入治疗提供依据。     

Pharmacology and physiology of the biliary radiographic contrast materials.

(1) Solubilization of Telepaque in the intestine is a limiting factor in the rate of intestinal absorption. Bilopaque and Oragrafin are more water-soluble and appear to be better absorbed than Telepaque. (2) Bile salts in the intestinal lumen increase the solubility of Telepaque. Therefore, a fatty meal administered with the Telepaque is desirable to evacuate bile salts from the gallbladder into the intestine. This is not required for the more water-soluble agents, Biopaque and Oragrafin. (3) The degree of protein binding of the contrast agents can be related to the degree of toxicity. Cholografin is the most highly bound and is the most toxic. (4) Hepatic receptor proteins may specifically bind the biliary contrast agents. This may be the reason that the renal contrast materials are poorly escreted in bile compared to the biliary contrast agents. (5) Telepaque is conjugated in the liver with glucuronide making the compound more soluble in bile. This prevents precipitation of Telepaque in the gallbladder and avoids reabsorpiton from the intestine. (6) The biliary excretion of Telepaque is facilitated by bile salts. Therefore, the administration of a fatty meal with Telepaque not only increases the rate of intestinal absorption of Telepaque but also the rate of biliary excretion. (7) The rate of biliary excretion of both the oral and the intravenous contrast agents appears to be limited by a hepatic transport maximum. Above a certain dose, increased amounts of the contrast agents do not result in more rapid excretion of the agents into bile. Rapid infusion of intravenous contrast agents results in high plasma concentration and greater urinary excretion, without increasing the biliary excretion. It does not appear to be indicated in clinical practice. (8) The biliary concentration of the contrast agents used for intravenous cholangiography is determined by their rate of biliary excretion, the choleretic effect of the contrast agent, and factors that determine the rate of basal bile flow. Fixed coupling of water with the biliary excretion of these contrast agents imposes an inherent limitation on the concentration of the contrast agent in bile. It appears that the biliary concentration of the intravenous contrast materials can be increased by having the patient fast prior to intravenous cholangiography. This decreases the enterohepatic circulation of bile salts and the rate of bile-salt-dependent bile flow. (9) Failure of the gallbladder to visualize after administration of Telepaque when there is adequate biliary excretion may be due to cystic duct obstruction, failure of the inflamed gallbladder mucosa to reabosrb water, or reabsorption or the contrast agent by the diseased gallbladder mucosa. (10) Maximum concentration of Telepaque occurs at 14-19 hr after ingestion. It is at this time that radiographs of the gallbladder should be made. With Bilopaque, peak concentration occurs at 10 hr so radiographs can be made earlier when Bilopaque is used.     

The automatization of the control over the processes determining the risk of HIV-infection spreading among servicemen

The possibilities of the control over the processes determining the HIV-infection spreading risk are considered. In the view of that the automated system which enables to evaluate risk factors predetermining the appearance of new infection cases was proposed. These factors are systematised in a multilevel database. On the basis of the statistical analysis of the risk factors situations of the spread of the HIV infection are revealed and analysed and measures for their liquidation are worked out promptly. The system is universal and can be used for the prevention of the beginning of other extreme situations caused by the spread of different infections. The examples of the comparative analysis of the risk of sexual behaviour in various groups of servicemen are given.     

Sexual harassment--abuse or flirtation

Sexual harassment is a continuum of expression of human behavior ranging from attraction and flirtation at one extreme through to violence at the other. Four main models have been proposed to account for the phenomenon. These include the biological, organizational, sociocultural and the spill-over models. In this article, the term spill-over is used to explain the appearance and characteristics of harassment in the health care environment of the hospital. With the introduction of two new laws in Israel, the Law of Equal Opportunity and the Law for Prevention of Sexual Harassment, greater awareness of the rights of victims of harassment and their remedies are now on the Statute Book. Some of the salient features of the two laws are emphasized. Changes in the attitude of the courts based on this legislation are now occurring and greater prominence given to violent behavior is a feature of the change in public awareness of sexual harassment.     

Anatomy of the posterior cruciate ligament. A review

PCL injuries are major injuries of the knee. Most of the literature on PCL injury has focused on mechanism of injury, diagnosis, and treatment. We are presenting a review of the anatomy of the PCL. Different portions of the PCL are taut at different degrees of knee flexion and extension. The PCL, thus, along with the ACL, contributes to the "screwhome mechanism" of the knee. The anatomy of the meniscofemoral ligaments (ligaments of Wrisberg and Humphrey) reveals the intimate relationship among the PCL, the popliteus muscle, and the lateral meniscus. Understanding the anatomy of the PCL is important in the diagnosis and treatment of ligamentous injuries and also in total knee arthroplasty.     

Biochemical background of ethanol-induced cold susceptibility

The process of cooling is always associated with the depletion of energetic reserves and burning the ketone bodies covers the tissues' needs. Ethanol shows antiketonaemic effects changing the cellular redox potential, inhibiting beta-oxidation of fatty acids, stimulating the release of insulin and inhibiting the release of its antagonist. The aim of the study was to determine whether the cooling process of the organism in the presence of ethanol intoxication may be related to inhibition of the physiological mechanism of ketogenesis induced by hypothermia. The study involved the 67 autopsy cases from 1996 to 2002, in which the circumstances of death indicated the effects of overcooling. This was confirmed on the basis of the data from the Prosecutor's Offices. Then, the chromatograms of autopsy blood alcohol determinations were analyzed and the acetone levels recorded. The analysis supported the hypothesis that the severity of ketosis is inversely proportional to the blood ethanol concentration. Furthermore, it demonstrated that signs of prolonged cold exposure were less frequently observed in unsober persons (frostbites, gastric hemorrhages). Increased sensitivity of intoxicated individuals to cold may be related not only to the dilation of the peripheral vessels, inhibition of shivering thermogenesis caused by muscle relaxation, central nervous system depression and behavioral factors but also to the antiketonaemic effects of ethanol.