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.     

Quantitative evaluation of the echo intensity of the median nerve and flexor muscles of the forearm in the young and the elderly

Objectives

Musculoskeletal structures often appear brighter on imaging in the elderly, which makes it difficult to accurately delineate a peripheral nerve during ultrasound-guided regional anaesthetic procedures. The echo intensity of skeletal muscles is significantly increased in the elderly. However, there are no data comparing the echo intensity of peripheral nerves in the young and the elderly, which this study was designed to evaluate.

Methods

13 healthy, young volunteers (aged <30 years) and 11 elderly patients (aged >60 years) who were scheduled to undergo orthopaedic lower limb surgery were recruited. The settings of the ultrasound system were standardised and a high-frequency linear array transducer was used for the scan. A transverse scan of the median nerve (MN) and the flexor muscles (FMs) at the left mid-forearm was performed and three video loops of the ultrasound scan were recorded for each subject. Still images were captured from the video loops and normalised. Computer-assisted greyscale analysis was then performed on these images to determine the echo intensity of the MN and the FMs of the forearm.

Results

The echo intensity of the MN and FMs of the mid-forearm was significantly increased in the elderly (p<0.005). There was also a reduction in contrast between the MN and the adjoining FM in the elderly (p=0.04).

Conclusion

Under the conditions of this study, the MN and the FMs in the forearm appeared significantly brighter than those in the young, and there was a loss of contrast between these structures in sonograms of the elderly.Recently, there has been an increase in interest in the use of ultrasound to guide peripheral nerve blocks [1-3]. We have observed during such procedures that musculoskeletal structures often appear significantly brighter and that there is loss of contrast between the nerve and its adjoining muscles in the elderly, which often makes it difficult to accurately delineate a peripheral nerve using ultrasound in this age group. There are published data showing that the echo intensity (EI) of skeletal muscles is significantly increased in the elderly [4]. However, there are no data comparing the EI of a peripheral nerve in the young and the elderly, which this study was designed to evaluate.     

Aspects of the venous drainage of the pons and the mesencephalon

Summary After a brief resumé of the morphology of the pontomesencephalic veins, the authors demonstrate the drainage dynamics of these veins in normal and pathlogical vertebral angio-seriograms. The repercussions of drainage impairment are illustrated.

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Untersuchungen über die Venen-Drainage von Pons und Mesencephalon

Zusammenfassung Nach kurzer Beschreibung der Morphologie der pontomesencephalen Venen wird die Drainagedynamik dieser Venen anhand normaler und pathologischer Vertebralisangiogramme demonstriert. Die unterschiedlichen Mechanismen einer Drainagebehinderung werden erläutert.

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A propos du drainage veineux du pont et du mésencéphale

Résumé Après un bref résumé de la morphologie des veines ponto-mésencéphalques, les auteurs décrivent les modalités de drainage de ces veines en sérioangiographie vertébrale normale et pathologique. Ils illustrent les répercussions de drainage défectueux.

     

Sonography of the wrist and the hand

Sonographic examination of the hand requires high-frequency linear transducers. As the relevant structures are located very close to the surface, water stand-off pads are mandatory. Owing to the high sensitivity of sonography in the detection of fluid, exudative synovitis, tenosynovitis and ganglia can be easily diagnosed. Sonographic information on muscle atrophy and alterations of the shape and echogenicity of the median nerve in patients with carpal tunnel syndrome may be useful in evaluating the extent of disease. Further indications for the sonographic examination of the hand include suspected tumors, foreign bodies and synovial proliferation. Osseous destruction can be visualized in patients with rheumatoid disease, but the precise extent is hard to determine.     

高原彝汉成年人血红蛋白、红细胞值调查分析

目的了解高原地区彝汉成年人血红蛋白、红细胞及相关指标的基础水平，探讨其与国家参考值指标是否存在差异。方法选择健康成人规范采集静脉血，用美国COULTERAC·Tdiff2血球分析仪检测，对数据进行统计学处理。结果川西南高原彝汉成人的血红蛋白、红细胞水平及相关指标与国家参考值比较差异有非常显著的意义，P〈0．001；当地彝汉民族比较差异无显著意义，P〉0．05。结论有必要制定高原地区成人血红蛋白、红细胞及相关指标的正常参考值，为临床提供更科学实际的参考依据。     

MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm

Magnetic resonance (MR) imaging provides useful information in the evaluation of peripheral nerves. Recent advances in MR imaging allow for detailed depiction of the soft tissue structures of the elbow joint. Three major nerves are present about the elbow. Six cadaveric elbows were imaged to depict the normal anatomy of these nerves and to determine the best plane and position of the elbow for optimal visualization of each nerve. Axial images of the elbow in full extension with the forearm in supination allow identification of all major nerves. Axial images with the elbow in full flexion allow accurate assessment of the cubital tunnel and the ulner nerve. Axial images of the elbow in full extension with the forearm in pronation are helpful for assessment of the median and radial nerves in the forearm.     

Study on the stability of the calibration and normalization in PET and the influence of drifts on the accuracy of quantification

With regard to the quality control of quantification in positron emission tomography some characteristics were examined, to develop a simple method for frequent monitoring. The stability and uniformity of the detector count rate was checked by plotting the RMS deviation of the non normalized count rate and the standard deviation of the normalized count rate, each normalized to its value after the calibration or normalization respectively. Switching off a single detector did not impair the image quality, but the normalized image pixel counts were reduced by 2%-3% when a detector block was switched off. Thus in case of need, a weak detector can still be used to perform a scan. A reduced count rate capability at specific activities above 5 x 10(4) Bq/ml (approximately 1.5 x 10(5) corrected true system counts/s or approximately 1.5 x 10(4)/s for a plane) was found compared to the maximum usable activity of 8 x 10(4) Bq/ml obtained 1 year earlier, indicating a drift in the count loss corrections. A variation of the room temperature changes the temperature distribution inside the gantry by 5% per degree C and the drift of the sensitivity (normalized image pixel counts) is 2% per degree C.     

On the Importance of the Level of Glutathione and the Activity of the Pentose Phosphate Pathway in Heat Sensitivity and Thermotolerance

Summary

Heating of Ehrlich ascites tumour (EAT) cells and mouse fibroblast LM cells to 43 or 44°C respectively, results in an increased level of reduced gluthathione (GSH). The maximum elevation in GSH was to 140 per cent for LM cells and to 120 per cent for EAT cells. No increase of GSH in EAT cells was observed after heating at 44°C. LM cells were treated with diethylmaleate (DEM) and the EAT cells with buthionine-sulphoximine (BSO) at non-toxic doses to deplete the levels of GSH. No effect on thermosensitivity or on the development of thermotolerance was observed when the DEM and BSO treatments were chosen such that the lowering of GSH was just down to the level of detection (about 5 per cent of control). When higher concentrations of DEM were used, thermal sensitization was observed. The activity of the pentose phosphate pathway (PPP) was also investigated because of its importance in supplying NADPH for the regeneration of GSH from GSSG and for the endogenous production of polyols. Hyperthermia was found to enhance markedly the flux of glucose through the PPP. While the DEM treatment inhibited glucose oxidation through the PPP, BSO addition to the cells resulted in a slightly increased activity of the PPP. The PPP activity of thermotolerant cells was lower (fibroblasts) or hardly affected (EAT cells) compared to control cells. The extent of PPP activation by hyperthermia was comparable for thermotolerant and control cells. For the two cell lines studied neither a high level of GSH nor an active PPP is a prerequisite for the development of thermotolerance.     

Study on the stability of the calibration and normalization in PET and the influence of drifts on the accuracy of quantification

With regard to the quality control of quantification in positron emission tomography some characteristics were examined, to develop a simple method for frequent monitoring. The stability and uniformity of the detector count rate was checked by plotting the RMS deviation of the non normalized count rate and the standard deviation of the normalized count rate, each normalized to its value after the calibration or normalization respectively. Switching off a single detector did not impair the image quality, but the normalized image pixel counts were reduced by 2%–3% when a detector block was switched off. Thus in case of need, a weak detector can still be used to perform a scan. A reduced count rate capability at specific activities above 5x10⁴ Bq/ml (1.5x10⁵ corrected true system counts/s or 1.5x10⁴/s for a plane) was found compared to the maximum usable activity of 8x10⁴Bq/ml obtained 1 year earlier, indicating a drift in the count loss corrections. A variation of the room temperature changes the temperature distribution inside the gantry by 5% per °C and the drift of the sensitivity (normalized image pixel counts) is 2% per °C.This article was presented at the 1st EEC workshop on accuracy determination in PET, January 19–20th. 1989 Pisa, Italy (COMAC-BME Concerted Project Characterization and Standardization of PET Instrumentation)     

Diseases of the aerodigestive tract and of the soft tissues of the neck. Comparison of MRI and CT

CT and MRT are compared with each other in examinations of the aerodigestive tract in 250 patients. MRT was found to be the method of highest sensitivity and specificity after intravenous administration of the contrast medium Gd-DTPA. Magnetic resonance tomography was found to be clearly superior to computed tomography on account of the 3-dimensional imaging possibilities, improved contrasting of soft parts, and freedom from artifacts. In space-occupying growths of the nasopharynx, oropharynx and hypopharynx, the primary use of MRT must be considered mandatory in diagnostic strategy planning. CT occupies the second rank and can be used for optimised visualisation of small osseous lesions and for digital subtraction angiography (DSA). The latter plays an important role in the analysis of selective vascular supply and in diagnosis before intraarterial chemotherapy. In respect of processed in the soft tissues of the neck, pathological lesions of the lymph nodes, vessels, soft parts and cervical processes are differentiated (n = 139). For the diagnosis of the entire neck region, magnetic resonance tomography with the additional use of the contrast medium Gd-DTPA proves to be the method with the highest rate of accuracy. In processes of the soft tissues, sonography can also be employed as a primary diagnostic tool. However, in certain localisations and lesions this method can only be used with certain restrictions. According to the present state of the art, computed tomography must be considered as a secondary procedure in the diagnosis of the neck region.     

Imaging the floor of the mouth and the sublingual space

A wide range of pathologic processes may involve the floor of the mouth, the part of the oral cavity that is located beneath the tongue. They include lesions that arise uniquely in this location (eg, ranula, submandibular duct obstruction) as well as various malignancies, inflammatory processes, and vascular abnormalities that may also occur elsewhere in the head and neck. Some lesions that arise in superficial tissues such as the mucosa may be easily diagnosed at physical examination. However, computed tomography, magnetic resonance imaging, or ultrasonography may be necessary for a reliable assessment of lesion extension to deeper structures. In such cases, knowledge of the complex muscular, vascular, glandular, ductal, and neural anatomy of the region is important for accurate diagnosis and treatment planning. Familiarity with the radiologic imaging appearances of the floor of the mouth and recognition of anatomic landmarks such as the mylohyoid and hyoglossus muscles are especially useful for localizing disease within this region.