老年骨质疏松性腰背痛误诊调查

作者通过对84例老年性骨质疏松性腰背痛误诊病例的调查分析发现：（1）该清首诊误诊率为47.17％（84/176）；（2）县以下医院误诊占91．3％（314/344）；（3）骨科医师误诊占40．1％（138／344）；（4）误诊的主要原因是对本病认识不足。     

Evaluation of complications of three different types of proximal extra-articular femur fractures

The comparability of studies of extra-articular proximal femur fractures is compromised by the lack of a widely accepted, simple classification system with clinical and prognostic relevance. The aim of the study is to define the complication profile as well as differences relating to age, gender and survival rate of simple trochanteric fractures, intertrochanteric comminuted and subtrochanteric fractures. Records of 335 consecutive patients were analysed. Patients had a median follow-up of 10 (1-56) months, and were treated operatively with three intramedullary nailing systems. Simple trochanteric fractures (n=67) show wound healing problems (1.5%). Median age is m/f 77(45-98) years/ 85(39-101), and two-year survival rate is m/f 50.3%/ 84.9%. Intertrochanteric comminuted fractures (n=204) show the highest complications (25%), 9.7% femoralhead perforations, 3.5% hardware related problems and 11.8% wound healing problems. Median age is m/f 75(41-94) years/ 85(54-100), survival rate is m/f 92.7%/ 66.5%. Complication rate is 17.0% in subtrochanteric fractures (n=64), no femoralhead perforation but 9.1% other hardware problems and 7.8% wound healing problems. Median age is m/f 72(24-91) years/ 83(38-99), survival rate is m/f 92.3%/ 67.9%. Females show higher complication rates compared to males (19% versus 10%). The three types of fractures show different patterns of complications, survival rates, age, and sex distribution.     

Survey of urological centres and review of current practice in the pre-operative assessment of prostatism.

A survey of 24 urological centres has shown a wide variation in the routine pre-operative assessment of patients being considered for prostatectomy. Imaging of the urinary tract by intravenous urography (IVU) or ultrasound (US) is performed in 21/24 centres (79%) and plain films in 16/24 (67%). Post-micturition residual volume (PMRV) is estimated quantitatively in 10/24 centers (42%). Although there is little agreement on what constitutes a significant PMRV, a large PMRV leads to increased likelihood of operation, and earlier operation. Peak urine flow rate (Q max) is measured in 19/24 centres (79%). The significance of these findings is discussed.     

Handling of cysteine S-conjugates of methylmercury in MDCK cells expressing human OAT1

BACKGROUND: The activity of the organic anion transporter 1 (OAT1) has been implicated recently in the basolateral uptake of thiol conjugates of inorganic mercury in renal proximal tubular cells. However, very little is known about the role of OAT1 in the renal epithelial transport of organic forms of mercury, such as methylmercury (CH(3)Hg(+)), especially when it is in the form of the cysteine (Cys) S-conjugate of methylmercury (CH(3)Hg-Cys), which is believed to be a biologically relevant form of mercury. METHODS: Accordingly, the present study, was designed to characterize the transport of CH(3)Hg-Cys in Madin-Darby canine kidney (MDCK) cells transfected stably with the human isoform of OAT1 (hOAT1) and in proximal tubular-derived NRK-52E cells. RESULTS: Data on saturation kinetics, time dependency, substrate specificity, and temperature dependency demonstrate that CH(3)Hg-Cys is transported by hOAT1. Substrate-specificity data from the control cells also show that CH(3)Hg-Cys is a substrate of one or more transporter(s) that is/are not hOAT1. Additional findings indicate that at least one amino acid transport system is involved in the uptake of CH(3)Hg-Cys in MDCK cells. Furthermore, in the presence of cytotoxic concentrations of CH(3)Hg-Cys, rates of survival were lower in hOAT1-transfected cells than in wild-type control cells. CONCLUSION: The present data demonstrate clearly that CH(3)Hg-Cys is indeed a transportable substrate of OAT1. Moreover, the collective findings from the MDCK cells and NRK-52E cells infer that CH(3)Hg-Cys is a likely transportable mercuric species in proximal tubular epithelial cells that is taken up in vivo by both OAT1 and amino acid transporters.     

Surgical treatment of aneurysms of the celiac trunk. Apropos of a case]

On the basis of one personal case and 63 cases reported in the literature for patients operated from 1958 onwards, the authors assess the surgical treatment of aneurysms of the celiac trunk. These are rare (4% of all visceral aneurysms), often latent (41.3% of cases) or without any specific symptoms (36.2% of cases), and have an atheromatous (51.8% of cases) or dysplasic (38.8% of cases) origin in most cases. They mainly affect men (68.4% of cases) after 40 years of age (72.2% of cases). They are rarely identified during the clinical examination, but are detected by ultrasound and confirmed by computed tomography and/or angiography (51.8% of cases). They are often small, less than 50 mn, and their size is a criterion for the approach, which usually remains abdominal. Resection is a routine operation (84.3% of cases), but the continuity of the artery is restored in 78.3% of cases only, due to the good-quality replacement provided by the superior mesenteric artery. The operative mortality rate is 7.8%. There are 96.2% good results (2 recurrences), but the average lapse in time is only 15.75 months.     

A review of the management of 100 cases of benign stricture of the oesophagus

One hundred cases of benign stricture of the oesophagus treated over a period of 11 years from 1960 to 1971 under the care of the senior author (D.M.M.) at Frenchay Hospital Thoracic Unit are reviewed. The results indicate that the commonest site of the lesion is in the lower third of the oesophagus and that the commonest cause is peptic oesophagitis due to gastric reflux and associated hiatus hernia. As the disease is commoner in the elderly a conservative medical regimen of dilatation, antacids, and posturing is recommended as the first line of treatment. When this fails surgery is necessary. Collis (1965) managed 69 patients by gastroplasty. Belsey (1965) reported his experience with colon transplants, while Brain (1967) and Allison (1970) advised jejunal transplantation. Our experience has shown that in view of the old age and often poor physical condition of these patients resection of the stricture and oesophagogastric anastomosis is a relatively safe and simple procedure. The results obtained indicate that 25% of patients operated on will require future dilatations.     

Comparative description of approaches in surgical treatment of aneurysms of descending thoracic aorta

Surgical treatment of patients with thoracic and thoracoabdominal aortic aneurysms is one of the most difficult and topical problems of up-to-date cardio-vascular surgery. Right choice of surgical approach is important condition for effective surgery. This study is dedicated to comparative evaluation and definition of clear indication for choice of surgical approach in reconstruction of thoracic aneurysms. It is concluded that thoracotomy through 3(rd) intercost is preferable in isolated lesion of isthmus and proximal part of descending aorta. Approach through 5(th) intercost is not recommended in this localization of aneurysm. Prosthesis of all descending thoracic aorta (from arch to diaphragm) must be performed through double left-sided thoracotomy with single skin incision (left-sided double thoracotomy through 3(rd) and 6(th) intercosts from single S-type skin incision). This approach always permits to perform surgical reconstruction of distal part of aortic arch, isthmus and all descending aorta, forms optimal conditions for creation of proximal and distal anastomosis.     

Antibiotic treatment of bacterial infections of the respiratory tract

Treatment of bacterial infections of the respiratory tract should allow for factors such as the patient’s history, the treatment situation and the result of any bacteriological diagnosis. Haemophilus influenzae epiglottitis is treated with cefotaxime (a cephalosporin inhibitor of cell wall synthesis) or with chloramphenicol (an inhibitor of bacterial protein synthesis). Exacerbations of chronic bronchitis are treated with broad-spectrum penicillins (inhibitors of cell wall synthesis), tetracyclines or macrolides (both inhibitors of bacterial protein synthesis). Uncomplicated community-acquired pneumonia is treated with penicillins and/or a macrolide. Flucloxacillin (a penicillin resistant to β-lactamase) or vancomycin (a glycopeptide inhibitor of cell wall synthesis) are added if staphylococci are implicated. In severe community-acquired pneumonia of unknown aetiology, a combination of a macrolide and a cephalosporin is indicated. When Staphylococcus aureus is a suspected cause, flucloxacillin or vancomycin is added to the treatment regimen. Pneumonia possibly caused by atypical pathogens, is treated with a macrolide or a tetracycline. If Legionella pneumophila is the suspected causative organism, rifampicin (an inhibitor of bacterial DNA-dependent RNA polymerase) should be used in combination with a macrolide. Hospital-acquired pneumonia is treated with broad-spectrum cephalosporins, anti-pseudomonal penicillins (such as ticarcillin or piperacillin), the monobactam aztreonam or a fluoroquinolone such as ciprofloxacin (an inhibitor of bacterial DNA gyrase). In severe cases gentamicin (an aminoglycoside inhibitor of bacterial protein synthesis) may be used. The treatment of tuberculosis requires specialized knowledge and involves the use of combinations of rifampicin with inhibitors of tubercular mycolic acid synthesis (e.g. isoniazid or pyrazinamide) or with an inhibitor of tubercular arabinosyl transferase (e.g. ethambutol).     

Means of purification of cephalexin with a view to therapeutic use

Cephalexin (CEX) is the generic word of chemical compound 7-(D-alpha-aminophenylacetamido)-3-methyl-3-cephem-4-carboxylic acid, which is part of first generation oral cephalosporins group. It is use as cephalexin monohydrochloride monohydrate (CEX.HCl.H2O) syrup or tablets for oral administration. For obtaining a compound with great solubility and osmotic pressure, which is ideal for pharmaceutical forms with controlled dosage, it is necessary to achieve the crystalline form of Cephalexin monohydrochloride monohydrate. The therapeutic use Cephalexin has an output over 95 %, so it is necessary to purify CEX depending on it's isoelectric pH (pKa), which is 4.2. A good purification took place at greater or less values of pH, then the isoelectric pH value of CEX. The purification of CEX at greater values of pH then isoelectric point, took place with a greater output (75-76%), and the obtaining Cephalexin is much pure (97-98%).     

Validation of ESCAP-CD as an instrument of measure for the evaluation of the quality of life in prostatic cancer. Part 2a

In order to make a measure of quality of life related to health (QLRH) useful in the investigation, it must fulfill the psychometric properties (validity, reliability and sensibility). The selection of an instrument is a job for the clinic that must choose the most effective for each proposed objective. We set out the objectives to validate the ESCAP-CDV in a multicentric study in Andalusia. We studied 88 patients who were submitted to the instrument presented to validation and two more tests recognized already: the QLQ-C30 from EORTC gold standard in Europe in the valuation of the neoplastic patients' quality of life and the KARNOFSKY the most clinic utility index in neoplastic patients, used to correlate the items. RESULTS: Questionnaire acceptance analysis: The difficulty of understanding was greater for QLQ C30 items (6.81%) than ESCAP items (1.98%). The lapse of time needed to carry out the test was shorter in the ESCAP test (9.84 min) than in the QLQ C30 (13.13), test. Structural analysis or internal validity analysis: The homogeneity index of the items is high (alfa of Cronbach = 0.93). The dimensionality proposed is not accepted, due to the existence of some modifications pund in the factorial analysis. Finally, the established dimensions: Physical and Emotional Capacity (PEC), 5 items; General Symptoms (GS), 4 items; Pain (P), 3 items; Ligh Functional Capcity (LFC), 4 items; Serious Functional Capacity (SFC), 2 items; Economic State (ES), 3 items; Social and Family State (SFE), 5 items; Capacity Sexual (CSX), 2 items; Isolated Variables (IV), 2 items; and Specific Questionnaire (P), 6 items. The ESCAP is a scale with a normal distribution. Approach or external validity analysis: The ESCAP test is well correlated with the other two scales. Reliability test retest: The interclass correlation coefficient is 0.94 in the ESCAP, not so in the KARNOFSKY that is 0.77. CONCLUSIONS: The ESCAP-CDV is a new instrument of valuation of the QLRH composed of a general questionnaire and other specific test of prostate cancer. It has turned out to be a very homogeneous scale due to its internal consistence (alfa of Cronbach of 0.93), showing that it has a normal distribution, that correlates correctly with the scales compared and it is a valid scale to measure the prostate cancer patients' quality of life. The ESCAP-CDV has shown to be a scale with a high reliability (0.94), setting up as an instrument not only useful for investigation, but to clinical use, as well.     

Use of nonsteroidal anti-inflammatory drugs in infants. A survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as perioperative analgesics. Many are currently used off label. Diclofenac is currently licensed for use in children over 1 year of age for the treatment of juvenile rheumatoid arthritis, while ibuprofen is licensed for use in children weighing over 7 kg. The dose and interval in children is currently extrapolated from adult studies, as the pharmacokinetic (PK) and pharmacodynamic (PD) data are lacking in infants. METHODS: A postal questionnaire was sent to members of the Association of Paediatric Anaesthetist of Great Britain and Ireland seeking to clarify members' prescribing patterns of NSAIDs, especially in infants. Information regarding the choice of NSAIDS, route of administration, lower age limit, dose interval, dose and practice in two specific perioperative contexts (adenotonsillectomy and open heart surgery) was sought. RESULTS: The response rate was 80%. NSAIDs are used by 86% of responders in infants. Diclofenac is most commonly used intraoperatively (78%); while ibuprofen (73%) was used more frequently postoperatively. NSAIDs are used by 21% of respondents in ICU. Commonest routes of administration were oral (81%) and rectal (80%), rarely intravenously (9%). The commonest dose for diclofena is 1 mg x kg(-1) (59%); the dosing schedule employed being 8 hourly in 53% of cases. NSAIDs are used by 57% of responders as part of their analgesic regime for adenotonsillectomies. CONCLUSION: Members of the Association of Paediatric Anaesthetists of Great Britain and Ireland commonly prescribe NSAIDs in infants. This is despite the dearth of PK and PD data in this age group.     

Evaluation of the Production and Absorption of Cerebrospinal Fluid

The traditional hypothesis of cerebrospinal fluid (CSF) hydrodynamics presumes that CSF is primarily produced in the choroid plexus (CP), then flows from the ventricles into the subarachnoid spaces, and mainly reabsorbed in the arachnoid granulations. This hypothesis is necessary to reconsider in view of recent research and clinical observations. This literature review presents numerous evidence for a new hypothesis of CSF hydrodynamics—(1) A significantly strong relationship exists between the CSF and interstitial fluid (IF), (2) CSF and IF are mainly produced and absorbed in the parenchymal capillaries of the brain and spinal cord. A considerable amount of CSF and IF are also absorbed by the lymphatic system, and (3) CSF movement is not unidirectional flow. It is only local mixing and diffusion.     

Treatment of osteochondritis dissecans of the knee joint

Osteochondritis dissecans (OD) is a lesion of the subchondral bone which can result in sequestration of the osteochondral lesion. It is categorized into 4 stages, and juvenile and adult forms depending on the distal femoral physis maturity. Prognosis and treatment depends on age and stage. Prognosis is favorable in stable lesions (stage I and II) at typical location (medial femoral condyle) in a child with open physes. Therefore non-operative treatment is indicated. If there is no response to non-operative treatment drilling to create channels for potential revascularization can be done. In unstable lesions (stage III and IV) operative treatment is necessary. Long-term results after excision of the fragment with or without drilling of the defect site are poor. Therefore refixation of an intact osteochondral fragment or biologic reconstruction should be tried.     

Assessment of the efficiency of pulmonary oxygenation. The choice of oxygenation index

Oxygen-derived indices are often used as alternatives to determination of venous admixture (Qva/Qt) when a pulmonary arterial catheter is not in use, but the question of which more accurately indicates the efficiency of oxygenation is controversial. The theoretical relationships between six measures of oxygenation (PaO2, SaO2, P(A-a)O2, PaO2/FIO2, P(A-a)O2/PaO2, PaO2/PAO2) and venous admixture were analyzed with special reference to the influence of the concentration of inspired oxygen (FIO2). In addition, the predictability of Qva/Qt was evaluated on the basis of 100 authentic sets of arterial and mixed venous blood gas data. Of the above six indices, PaO2/FIO2 was most accurate (r = 0.88), but was far from independent of the FIO2 used. However, a direct Estimate of Venous Admixture (EVA) - based on arterial blood analysis and with C(a-v)O2 assigned a value of 50 ml.l-1 - predicted Qva/Qt still better (r = 0.95). It is concluded that when mixed venous blood gas data are lacking, EVA is the preferable measure of oxygenation.     

Identification of the vitamin D receptor in various cells of the mouse kidney

The kidney is the major, if not sole, site for the production of 1α,25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3)), the biologically active form of vitamin D that can stimulate calcium reabsorption in the kidney and may provide renoprotective benefits. The biological effects of 1,25(OH)(2)D(3) are mediated through a nuclear hormone receptor, known as the vitamin D receptor (VDR). It is well accepted that the VDR is present in the distal renal convoluted tubule cells; however, whether VDR is present in other kidney cell types is uncertain. Using a highly specific and sensitive anti-VDR antibody, we determined its distribution in the mouse kidney by immunohistochemistry. Our results show that the VDR is not only present in the distal but is also found in the proximal tubules, but at 24-fold lower levels. The VDR was also found in the macula densa of the juxtaglomerular apparatus, glomerular parietal epithelial cells, and podocytes. In contrast, the VDR is either very low or absent in interstitial fibroblasts, glomerular mesangial cells, and juxtaglomerular cells. Thus, identification of VDR in the proximal tubule, macula densa, and podocytes suggests that 1,25(OH)(2)D(3) plays a direct role in these cells under normal conditions.     

针灸刀治疗腰椎间盘突出症（附675例报告）

本文介绍了应用针灸刀疗法，进行穴位疏通术，治疗腰椎间盘突出症６７５例，经１年至１３年随访，平均随访３年２个月。全愈４７６例（７０．５％）；显效１３０例（１９．３％）；好转２４例（３．６％）；无效４５例（６．７％）。无１例感染。未发现任何并发症。     

Surgical management of chylothorax: a report of 65 cases

Sixty-five cases of chylothorax treated at the Shanghai Chest Hospital over the past 30 years are reviewed. The causes of chylothorax in this series were mainly traumatic and postoperative (47/65). Two cases were associated with chylopericardium and another 2 with chylous sputum. The authors believe that untreated chylothorax is a serious, often life-threatening entity and that the following principles are applicable in its management: (1) If daily chyle loss exceeds 1000 ml in adults with no tendency of subsidence, surgery is indicated especially in the effusion may lead to disastrous nutritional and immunologic consequences; (2) Ligation of the thoracic duct is effective by a mass ligature encircling all tissues between the azygos vein and the aorta. The most favorable site for ligation is immediately above the diaphragm. Over dissection of the thoracic duct should be avoided; (3) The proper surgical approach is on the side of the effusion in unilateral chylothorax, but right side approach is preferred in case of bilateral chylothorax or when the origin of chylous fistula is unknown; (4) Pleurodesis is indicated for those cases if the duct is not obviously present or chyle comes from the pleural lymphatics. Concentrated glucose solution with or without Talc suspension is recommendable.     

Classification and evaluation of recurrent instability of the elbow

The clinical presentation, diagnosis, radiographic features, mechanism, pathologic changes, and treatment of elbow instability are understood better now. Elbow instability can be classified according to five criteria: (1) the timing (acute, chronic or recurrent); (2) the articulation(s) involved (elbow versus radial head); (3) the direction of displacement (valgus, varus, anterior, posterolateral rotatory); (4) the degree of displacement (subluxation or dislocation); and (5) the presence or absence of associated fractures. Posterolateral rotatory instability is the most common pattern of elbow instability, particularly that which is recurrent. Posterolateral rotatory instability can be considered a spectrum consisting of three stages according to the degree of soft tissue disruption. Patients typically present with a history of recurrent painful clicking, snapping, clunking, or locking of the elbow and careful examination reveals that this occurs in the extension portion of the arc of motion with the forearm in supination. There are four principle physical examination tests. The most sensitive is the lateral pivot-shift apprehension test, or posterolateral rotatory apprehension test, just as the anterior apprehension test of the shoulder is the most sensitive test for a patient with shoulder instability. Next is the lateral pivot-shift test, or posterolateral rotatory instability test. Reproducing the actual subluxation and the clunk that occurs with reduction usually can be accomplished only with the patient under general anesthesia or occasionally after injecting local anesthetic into the elbow. The third test is the posterolateral rotatory drawer test, which is a rotatory version of the drawer or Lachman test of the knee. The final test is the stand up test as reported by Regan. The patient's symptoms are reproduced as he or she attempts to stand up from the sitting position by pushing on the seat with the hand at the side and the elbow fully supinated. A lateral stress radiograph can show the rotatory subluxation.