Current classification of gliomas

The histologic classification of gliomas, which is based on oligodendroglial- or astrocytic-like morphology distinguishes gliomas in astrocytic tumors (grade 1- pilocytic astrocytoma to grade 4- glioblastoma), oligodendroglial and mixed tumors (grade 2 and 3) according to cell differenciation, cellularity, nuclear atypia, mitotic activity, necrosis and microvascular proliferation. Prognosis is correlated to grade. Based on interobserver variability, the histological diagnosis is often highly subjective and should be interpreted within the context of clinical and radiological data. Newly identified good prognostic markers (1p and 19q loss in oligodendrogliomas) and new molecular techniques such as microarray may further refine the existing classification.     

Patterns of neuroaxis dissemination of gliomas: suggestion of a classification based on magnetic resonance imaging findings

BACKGROUND: Local invasion is the hallmark of malignant glioma dissemination. Leptomeningeal dissemination, a serious complication of malignant gliomas, has been increasingly observed. To correlate the physiopathologic mechanisms and the magnetic resonance imaging patterns of neuroaxis dissemination, a classification of malignant glioma dissemination is proposed (Instituto de Neurologia de Curitiba Classification). METHODS: This classification includes the following patterns of dissemination: leptomeningeal (type I), nodular (type Ia), diffuse (type Ib); subependymal (type II); satellite (type IIIa, IIIb); and mixed (type IV), combination of 2 or more previous types. Of 138 patients with histologically confirmed gliomas treated between 2000 and 2004, 10 presented neuroaxis dissemination and were evaluated. RESULTS: The distribution of dissemination patterns was as follows: subependymal, 4 of 10; diffuse leptomeningeal, 1 of 10; nodular leptomeningeal, 1 of 10; and satellite, 4 of 10. Mean interval between primary tumor and dissemination was 4 months. The most frequent glioma dissemination risk factor was entering the ventricular system during surgery. CONCLUSIONS: Improvements in our diagnostic imaging capabilities have contributed to a better understanding of the patterns of malignant glioma dissemination. Using this information, we present a useful classification scheme, applicable to patients with neuroaxis dissemination, which will help standardize future discussions aimed at understanding these patterns of tumor spread.     

Zygomatic fracture. I. A simplified classification for practical use

A review of classifications of zygomatic fractures demonstrates an increasing complexity in the choice of proper treatment. To facilitate the choice of treatment a proposal is made of a simplified classification with prediction of post-reductive fracture stability. The author's material, comprising 137 patients, has been accordingly divided and the proposed classification justified by the peroperative findings and by the follow-up results.     

Syringomyelia: a practical,clinical concept for classification

Background

The term syringomyelia describes many pathogenetically different disorders, and a variety of attempts to group these based on different criteria have been proposed in the literature. As a consequence a lack of consensus regarding classification and terminology exists. This inconsistency extends to the ICD-10 classification of diseases in regards to syringomyelia (G95.0) and hydromyelia (Q06.4). We propose a new unifying concept for classification that also incorporates diagnostics and treatment.

Methods

The PubMed online database was used to gain a general overview of the existing pathogenetic theories in relation to syringomyelia. Illustrative cases at our department were included and similar cases of the literature were found using the PubMed database. All material was reviewed with main focus on the classification and terminology used.

Results

Despite syringomyelia (G95.0) and hydromyelia (Q06.4) existing as independent ICD-10 entities, we have shown that the use of classifying terminology for fluid-filled cavities in the spinal cord is indiscriminate and inconsistent. Even though a general agreement on the believed pathogenetic mechanism exists, and the general treatment methods are used in accordance with this mechanism, the terminology fails to function as a simple and universal link between theory and treatment.

Conclusions

We propose a new causal concept for an ICD classification with syringomyelia (G95.0) as the only describing terminology, thus abandoning the use of hydromyelia (Q06.4). Syringomyelia is divided into five subgroups according to the associated pathologies. The classification is based on applied diagnostics and serves as a clinical guidance for treatment.     

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休克是临床上常见的一种急危重综合征.其病因各异、病理生理变化复杂、病情表现不一, 来势往往迅猛, 故需及时识别, 立即采取果断措施, 大力纠治, 否则病人的预后将极为险恶.     

A classification of shock based on hemodynamic profiles

Shock is a syndrome of numerous etiologies. The treatment of shock syndrome depends on the etiology and circulatory pathophysiology. From the viewpoint of circulatory physiology, the mechanism of circulatory failure can be attributed to three factors: blood volume; cardiac contractility; and vascular resistance. Balloon-tipped pulmonary artery (Swan-Ganz) catheters can distinguish between these factors in the clinical setting and allows physicians to treat shock patients most appropriately and logically. The author proposes a treatment-oriented classification of shock based on Swan-Ganz catheter findings and divides shock into three types: hypovolemic; cardiogenic; and low-resistant shock. All clinicians who treat shock must have qualified knowledge of and experience in handling this beneficial but invasive monitoring device.     

A classification of the herniated cervical disc based on metrizamide CT

In 202 surgical cases of anterior fusion of cervical spine, there were 150 cases in which disc herniation was the responsible lesion. According to metrizamide CT (met. CT) findings of these 150 cases, we proposed to classify the herniated cervical disc into 7 types. In the 150 cases there were 103 men and 47 women. Seventy-seven had single disc lesion, 57 had the two and 6 had three disc lesions. The most frequent involvement was of C 5/6 in 107 cases (51.2%). The next was of C 6/7 in 50 cases (23.9%) and the third was of C 4/5 in 36 (17.2%). Primarily herniated discs were classified into soft or hard disc. The soft discs were classified into medial, mediolateral and lateral type according to the direction of the protrusion of the disc. Each of the three types indicates that herniated disc compresses the median portion of the cord, lateral part of the cord and root simultaneously and root alone, respectively. The hard discs were classified into central, bilateral and unilateral types. The central type means the case in which the cord was compressed by the centromedian part of the posterior aspect of the vertebral body. The unilateral and bilateral type indicate that lateral portion of the cord and root were simultaneously compressed by the disc unilaterally or bilaterally. The other one was combined type. The combined type is that which belongs neither of the types noted above. In the soft disc group there were 37 cases (17.7%) of medial type, 28 (12.4%) of mediolateral and 8 (3.8%) of lateral type.(ABSTRACT TRUNCATED AT 250 WORDS)     

A simplified concept for controlling oxygen mixtures in the anaesthetic machine — better,cheaper and more user-friendly?

Modern anaesthetic machines are equipped with several safety components to prevent delivery of hypoxic mixtures. However, such a technical development has increased the complexity of the equipment. We report a reconstructed anaesthetic machine in which a paramagnetic oxygen analyzer has provided the means to simplify the apparatus. The new machine is devoid of several components conventionally included to prevent hypoxic mixtures: oxygen failure protection device, reservoir O₂ alarm, N₂O/air selector, and proportioning system for oxygen/nitrous oxide delivery. These devices have been replaced by a simple safety system using a paramagnetic oxygen analyzer at the common gas outlet, which in a feed-back system cuts off the supply of nitrous oxide whenever the oxygen concentration falls below 25%. The simplified construction of the anaesthetic machine has important consequences for safety, cost and user-friendliness. Reducing the complexity of the construction also simplifies the pre-use checkout procedure, and an efficient 5-point check list is presented for the new machine.     

A new concept and classification of corona mortis and its clinical significance

Purpose: The obturator artery and its accessory (aberrant) arising from different origins and crossing the pubic rami are vascular variations. The internal iliac artery usually provides the obturator artery which may communicates with the external iliac artery through either the accessory obturator or inferior epigastric artery. A collateral circulation between the external and internal iliac system is known as corona mortis. The aim of current study is to provide sufficient data of vascular variability crossing the pubic rami for clinical field. Methods: Present study includes 208 hemipelvises dissected in the Institution of Anatomy, Medical University of Graz. During dissection, the obturator artery and its accessory crossing the superior rami of pubic bone were found to have different origins. Results: The obturator artery arising from the external iliac artery and from the femoral artery accounts for 9.8% and 1.1% respectively. Therefore, it passes over the superior pubic rami in 10.9%. Further, the accessory (aberrant) artery arises only from the femoral artery in 1.1%. In present study, the vascular variation crossing the superior pubic rami with or without collateral circulation between external and internal iliac system referred as corona mortis is addressed. This study includes new classification of obturator and accessory obturator arteries as well as the corona mortis. It includes a comparison of corona mortis incidence in Austria population and other populations. The corona mortis found to be in 12% of Austrian population. Conclusion: A great attention of clinicians, radiologists, surgeons, orthopedic surgeons, obstetricians and gynecologists has to be considered before pubic surgical procedures such as internal fixation of pubic fracture, an inguinal hernia repair. Further, traumatic pubic rami fracture may lead to massive hemorrhage due to laceration of the obturator artery.     

桡骨远端骨折分型新论

桡骨远端骨折的分型国内外学者早有论述。1814年英国人克雷氏曾系统报道桡骨远端伸直型骨折,间接暴力引起,骨折远端向背侧桡侧移位,向掌侧成角。以后史密斯又报道桡骨远端屈曲型骨折。再后又报道背侧缘劈裂型骨折,又称巴尔通骨折和掌侧缘劈裂骨折,又称反巴尔通骨折。笔者在临床     

Metacarpophalangeal joint arthroplast based on the osseointegration concept

The osseointegration concept has been used for fixation of 68 MP joint endoprostheses in 31 patients operated on at the Department of Hand Surgery, Malmö General Hospital during the period 1988–1992. The indications were rheumatoid arthritis (50 joints), primary osteoarthrosis (three joints), post-traumatic osteoarthrosis (three joints), post-traumatic osteoarthrosis (five joints), post-infectious osteoarthrosis (seven joints) and joint deformities secondary to spastic conditions (three joints). The average follow-up time was 2.5 years (6–54 months). The surgical procedure included resection of the joint followed by introduction of screw-shaped titanium fixtures into the bone marrow cavities of the metacarpal and the phalangeal base. Rheumatoid cases usually required grafting of cancellous bone and marrow from the iliac crest. At the same time a flexible constrained silicone spacer was connected to the titanium fixtures in such a way as to allow later replacement of the spacer if accessory. The average active range of motion (ROM) was 57° in the rheumatoid cases and 50° in all cases. Radiological and clinical osseointegration occurred in every case, and there were no clinical signs of loosening. In four cases (6%) there was a fracture of the joint mechanism. Patient satisfaction was high, with pain relief, increased range of motion, improved hand function and good cosmetic appearance.