内固定治疗复杂髋臼骨折

目的提高复杂髋臼骨折复位和内固定治疗水平.方法对65例复杂髋臼骨折、臼顶部骨折14例,臼前壁或前柱骨折,或前壁前柱均骨折18例,臼后壁或后柱骨折,或后壁后柱均骨折20例,臼中央骨折、股骨头半脱位或中央脱位6例,臼内有游离骨块,来源于股骨头或髋臼2例.臼骨折合并股骨头、颈或骨盆骨折5例.用后方入路41髋、前方入路17髋、延长髂股切口2髋和前后联合入路5髋.进行骨折切开复位,重建钢板或拉力螺钉长轴固定.结果术后按Matta 标准评定:解剖复位51髋,满意12髋,不满意2髋.按关节功能(Aubigen 6分法)评定,获随访41例,平均时间14.2个月,优30髋,良6髋,可3髋,差2髋,优良率87.8%.结论争取早期手术,选择适合的手术入路,直视下行解剖复位和骨盆重建钢板内固定术,是提高复杂髋臼骨折疗效重要措施.     

内固定治疗复杂髋臼骨折

目的 提高复杂髋臼骨折复位和内固定治疗水平．方法 对65例复杂髋臼骨折、臼顶部骨折14例，臼前壁或前柱骨折，或前壁前柱均骨折18例，臼后壁或后柱骨折，或后壁后柱均骨折20例，臼中央骨折、股骨头半脱位或中央脱位6例，臼内有游离骨块，来源于股骨头或髋臼2例．臼骨折合并股骨头、颈或骨盆骨折5例．用后方入路41髋、前方入路17髋、延长髂股切口2髋和前后联合入路5髋．进行骨折切开复位，重建钢板或拉力螺钉长轴固定．结果 术后按Matta标准评定：解剖复位51髋，满意12髋，不满意2髋．按关节功能(Aubigen6分法)评定，获随访41例，平均时间14．2个月，优30髋，良6髋，可3髋，差2髋，优良率87．8％．结论 争取早期手术，选择适合的手术入路，直视下行解剖复位和骨盆重建钢板内固定术，是提高复杂髋臼骨折疗效重要措施．     

髋臼骨折的Letournel-Judet分型诊断及手术治疗

目的 探讨髋臼骨折的Letournel-Judet分型诊断及手术治疗方法.方法 45例髋臼骨折,术前经X线片及髋臼CT明确诊断,采用Letournel-Judet分型后,分别用Kocher-Langenbeck入路30例,髂腹股沟入路11例,前后联合入路4例,应用骨盆重建钢板和螺丝钉内固定.结果 全部病例获得随访,平均随访时间28.4个月.骨折复位按Matta标准,解剖复位35例,满意复位8例,不满意复位2例.根据改良merled'Aubigne和Postel的髋臼骨折临床结果评分标准,优14例,良20例,一般7例,差4例,优良率为75.5％.结论 术前完善影像学检查,正确分型,合理的手术入路,术中尽可能解剖复位及坚强内固定是提高髋臼骨折手术疗效的关键.     

髋臼骨折的Stoppa手术入路与手术策略

目的探讨经改良Stoppa手术入路治疗不同类型髋臼骨折与手术策略。方法对我院2000年~2012年经改良Stoppa手术入路治疗的20例髋臼骨折病例在手术创伤和术后功能恢复方面进行回顾综合分析。结果骨折复位程度按Matta标准评价:解剖复位15例,满意复位5例。随访6~36个月,疗效评价按照骨科临床疗效评价标准:优11例,良6例,可2例,差1例,优良率85%。结论选择改良Stoppa手术入路简便、高效、创伤小,是提高髋臼骨折疗效、恢复骨盆功能的较好手术途径。     

复杂性髋臼骨折手术治疗中长期疗效分析

目的:探讨复杂性髋臼骨折手术治疗的临床疗效.方法:自2001年5月至2008年11月对63例复杂性髋臼骨折采用开放复位、重建钢板和拉力螺钉内固定手术治疗.按照Letournel分类,前柱加前壁骨折28例,后柱加后壁骨折8例,双柱骨折23例,横形加后壁骨折4例.髂腹股沟入路38例,Kocher-Langenbeck(K-L)入路12例,髂腹股沟入路联合K-L入路13例.伤后至手术时间1周内10例,1～2周27例,2～3周19例,3周以上7例.术后早期功能锻炼.结果:术后随访1～8 a,平均5.5 a,按matta评定标准,临床优良率为78%,可为14%,差8%.术后X线片示解剖复位46例(73%),满意复位14例(22%),不满意复位3例(5%,均为陈旧性骨折).术中坐骨神经牵拉伤1例(另有3例术前损伤)、股神经牵拉伤1例,术后3个月均完全恢复.异位骨化伴股骨头再脱位1例(为K-L入路),股骨头坏死1例,髋骨性关节炎5例,术后发生深静脉血栓1例,无切口感染病例.结论:复杂性髋臼骨折积极手术复位及内固定,中长期疗效好、能有效地防治其并发症.     

髂腹股沟入路在髋臼骨折手术中的应用

目的：评价髂腹股沟手术入路的方法治疗髋臼骨折的疗效。方法：采用髂腹股沟入路手术治疗髋臼骨折14例,根据不同骨折类型分别选用克氏针、加压螺钉及重建钢板固定。结果：患者均获6—18个月随访,平均12个月。髋臼骨折复位情况依据Matta评分标准,解剖复位12例,满意复位2例。依据患者的感觉、关节功能及X线片3个方面进行疗效评价,优9例、良4例、一般1例,优良率92．6％。结论：手术是治疗复杂髋臼骨折的有效方法,髂腹股沟入路对复杂髋臼骨折手术治疗是一个良好的选择。     

不稳定骨盆骨折手术治疗26例临床疗效

目的：探讨不稳定骨盆骨折手术治疗的临床效果。方法：采用切开复位、重建钛板内固定治疗不稳定骨盆骨折26例（Tile分型均为B性或c型）;前环骨折采用耻骨联合上方弧形切口或髂腹股沟入路,后环骨折选择骶髂关节前方入路或后方人路,合并髋臼骨折者采用前后联合入路。结果：26例均获随访,平均随访21月。骨折均于术后3—6个月愈合,骨盆环稳定。按Majeed标准评价疗效,优17例（65．4％）、良6例（23％）、中2例（7．7％）、差1（3．8％）,优良率88．4％（23／26）。结论：切开复位内固定是治疗不稳定骨盆骨折的有效方法,可获得满意临床疗效。     

髋臼骨折手术治疗21例临床分析

目的探讨移位髋臼骨折经手术治疗后临床疗效和并发症发生的原因及其预防措施。方法本组移位髋臼骨折21例,简单骨折选用单纯腹股沟入路3例,单纯后入路13例,复杂骨折采用前、后联合入路5例。其中3例行可吸收螺钉,4例行松质骨螺钉内固定,14例行重建钢板内固定。结果所有患者随防6-19个月,平均11．2月。按Matta标准,优14例,良5例,可1例,差1例,优良率达90．5％。坐骨神经损伤1例;异位骨化1例;可吸收螺钉断裂1例;髋关节骨性强直1例。并发症的发生率为 19．1％。结论手术治疗是移位髋臼骨折的首选方法,手术前应明确骨折类型,把握手术时机,选择正确的手术入路及合适的内固定。术中仔细操作,避免切口周围组织过度牵拉,骨折尽可能达到解剖复位或近解剖复位,并予以坚强内固定。术后持续患肢牵引两周,两周后逐渐进行患肢主动或被动功能锻炼。     

30例髋臼骨折的治疗体会

目的 探讨髋臼骨折的有效治疗方法。方法 回顾分析资料完整30例髋臼骨折病例，非手术治疗7例，采用持续骨牵引。手术治疗23例，主要采用切开复位钢板、螺钉、钢针固定。结果 随访10个月－3年（平均26月），根据Matta髋臼骨折复位标准，非手术治疗组5例满意复位，2例复位不满意；手术治疗组解剖复位10例，较满意复位10例，不满意复位3例。患髋功能：非手术组优良率为71．4％；手术组优良率为87％。结论 髋臼骨折有手术指征应早期手术治疗，根据骨折类型选择手术入路与固定材料。     

单纯后入路内固定治疗累及四边体和前柱的髋臼骨折

目的回顾分析我院治疗的累及四边体和前柱的髋臼骨折病例,探讨采用单一改良K-L入路同时治疗累及四边体和前柱的髋臼骨折方法。方法在20例髋骨标本上测量髋臼后壁的宽度,并通过测量前倾的角度探索最佳向前置钉角度。对2000年1月～2008年5月以来共15例累及四边体和前柱的髋臼骨折患者采用单一改良K-L后入路同时固定髋臼前后柱骨折,术后功能锻炼。结果髋臼后壁宽度在47～52mm之间。在髋臼后壁的外2/5区域,向前植入螺钉均进入髋臼内;在髋臼后壁的中间1/5区域,向外倾斜15°置钉,有6例部分进入髋臼内;在髋臼后壁的内2/5区域,向前倾斜10°置钉,螺钉无一进入关节内,其远端可以从前柱穿出。随访9～27月,按Matta标准评价髋臼复位质量:解剖复位11例,满意复位3例,不满意复位1例,优良率93.3%。髋关节功能参照改良的Merled,Aubigne标准:优8例,良4例,可2例,差1例,优良率80.0%。结论充分的术前计划、恰当的手术时机、充分的术野暴露以及良好的术后锻炼是治疗髋臼骨折的有效方法。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.