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31.
Objective. To demonstrate the utility of magnetic resonance (MR) imaging in the diagnosis of complete and partial ligamentous injuries
in patients with suspected atlanto-occipital dissociation (AOD). Materials and methods. Five patients with suspected AOD had MR imaging performed within an average of 4 days after injury. MR scans were reviewed
with specific analysis of craniocervical ligamentous structures. Charts were reviewed to obtain clinical information regarding
presentation, treatment, hospital course, and outcome. Results. Two patients demonstrated MR evidence of complete AOD. One had disruption of all visualized major ligamentous structures
at the craniocervical junction with anterolisthesis and evidence of cord damage. The second had injuries to the tectorial
membrane, superior band of the cruciform ligament, apical ligament, and interspinous ligament at C 1–2. The remaining three
patients sustained incomplete severance of the ligamentous structures at the craniocervical junction. All patients demonstrated
subtle radiographic findings suggestive of AOD, including soft tissue swelling at the craniocervical junction without fracture.
The two patients with complete AOD died. The three patients with partial AOD were treated with stabilization. On follow-up,
these three children were asymptomatic following their craniocervical injury. Conclusion. MR imaging of acute AOD provides accurate identification of the craniocervical ligaments injured, classification of full
versus partial ligamentous disruption, and analysis of accompanying spinal cord injury. This information is important for
early appropriate neurosurgical management and preservation of neurologic function in survivors.
Received: 11 February 1998 Accepted: 20 November 1998 相似文献
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Mobile gamma cameras from three manufacturers were evaluated. Count rate capability, flood uniformity, intrinsic and extrinsic spatial resolution, and sensitivity were compared, using images made under reproducible conditions with phantoms which simulate actual clinical situations. 相似文献
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ACOG Executive Board American College of Obstetricians Gynecologists;Society of Obstetricians Gynaecologists of Canada;Central American Federation of Associations Societies of Obstetrics Gynecology;Gynaecologic Oncologists of Canada;Society of Canadian Colposcopists;Society of Gynecologic Oncologists;Royal College of Obstetricians Gynaecologists 《Obstetrics and gynecology》2004,103(3):607-609
38.
Black C Craft A;Academy of Medical Royal Colleges 《Clinical medicine (London, England)》2004,4(6):527-533
The clinical competence of doctors needs to be defined and assessed in relation to the circumstances of individual practice, in terms of knowledge and skills, both clinical and communicative, as well as attitudes and behaviour. The need to identify the role of the medical practitioner in the context of team working is important and this position requires the skills of diagnosis, synthesis of information and prioritisation of investigation and treatment. Completion of training and acquisition of the Certificate of Completion of Specialist Training (CCST) lead to inclusion in the Specialist Register thus defining the specialist; elevation of a specialist to consultant status in the NHS requires the potential to acquire with maturity, both of person and experience, the confidence to take responsibilities for handling difficult situations, to manage uncertainties in clinical encounters and to guide younger doctors in their careers. 相似文献
39.
In vitro release for topical drug products is carried out using a vertical diffusion cell system and a synthetic support membrane. The improvements in vertical diffusion cell design and automated procedures have been carefully studied and evaluated to establish their reproducibility and ruggedness of the experimental procedure. The data were analyzed using 90% confidence interval procedure developed and published by the US Food and Drug Administration in SUPAC-SS (Start Up and Post Approval Changes-Semi Solid) guidance. 相似文献
40.
Hart DN;Board of Education of The Royal College of Pathologists of Australasia 《Pathology》2001,33(4):479-492
Dendritic cells (DC) are now recognised as a unique leukocyte type, consisting of two or more subsets. The origins and functional inter-relationships of these cells are the subject of intense basic scientific investigation. They play important roles in initiating and directing immune responses, defending the host from pathogens and maintaining self tolerance. Fundamental studies are defining new molecules and mechanisms associated with DC function. The first methods for counting these rare blood cell populations are already providing interesting new clinical data. Indeed, abnormal DC function may contribute to deficiencies in the immune response against malignancies. Phase I trial data suggests that DC-based cancer vaccination protocols may contribute an important new biological approach to cancer therapy. Manipulation of DC to facilitate allogeneic transplantation and even to manage autoimmune disease are likely developments. 相似文献