颈内动脉接近完全闭塞时的处理

目的由于卒中风险随着狭窄严重程度的增加而升高，因此认为颈内动脉（ICA）接近闭塞患者的卒中风险很高。在现有的随机试验中，还没有专门针对这种情况进行探讨，因此其处理尚存在争汶。方法：对相关文献进行系统评价。结果：对ICA接近闭塞患者的处理还存在争议：一些学者支持进行干预，而另一些学者则认为存在风险或没有益处而反对进行干预。在ICA接近闭塞的有症状患者中进行一项比较外科治疗与最佳内科治疗的多中心前瞻性随机试验似乎非常困难，因为这类研究需要大量的患者。尽管如此，基于目前的证据，似乎很难拒绝手术治疗。结论：由于目前对ICA接近闭塞患者的最佳处理方案仍存在着争议，因此需要前瞻性观察性研究以证实其在有症状和无症状人群中的患病率以及相关的卒中风险。基于目前的证据，大多数医疗中心选择手术治疗，但它相对干内科治疗的特粱尚右待证章．     

Case report 720

A man presented with a mass in the left first metacarpal bone. Later, his chest radiograph showed extensive, bilateral, rounded opacities in both lungs with enlarged hilar lymph nodes, and he developed expanding lesions in the left radius, ulna, and metacarpal bones. The pulmonary lesions were treated with radiotherapy and cytotoxic agents, and the tumor mass in the first metacarpal was debulked. All biopsies showed similar features of a mixed tumor (pleomorphic adenoma) with metastatic or embolic pulmonary involvement; ultrastructural and immunocytochemical investigations supported this unique diagnosis. The patient remains well 15 years after the initial diagnosis. It is possible that the myoepithelial elements in this case had been displaced intraosseously during development. We are not aware of a similar case in the literature.     

Cardiac microcirculatory effects of beta-adrenergic blockade during sympathetic stimulation.

The effects of beta-adrenergic blockade on cardiac transcapillary exchange were examined at rest and during sympathetic stimulation. Multiple indicator dilution experiments were carried out in closed-chest anesthetized dogs at rest and during carotid occlusion, either under basal conditions or after beta-adrenergic blockade with alprenolol. beta-Adrenergic blockade at rest had no effect on coronary flow or transcapillary exchange in comparison with the control situation, but it abolished the increase in coronary flow and in the permeability/surface area product for labeled sucrose produced by carotid occlusion. High coronary resistance values in beta-blocked animals with carotid occlusion were associated with a high degree of heterogeneity in capillary transit times, but the overall relation between coronary flow and the capillary permeability/surface area product was unchanged. The findings indicate that beta-blockade increases coronary resistance during sympathetic stimulation and, simultaneously, decreases the coronary blood flow and capillary permeability/surface area product while increasing the heterogeneity of capillary transit times.     

Invasive ventilation in the emergency department: Part 2: Implications for patient safety

The use of mechanical ventilation in the Emergency Department requires adequate resources in order to maintain patient safety and avoid potential risks. Moreover, developments in technology require increased knowledge of mechanical ventilation techniques to address the complexity of decision-making involved. Organisational issues and system factors have the potential to negatively impact on the ability of the emergency service to provide optimum care to patients receiving mechanical ventilation. These issues include staffing and skill-mix, demand on emergency services, role-delineation, scope of practice, and current mechanisms for monitoring of quality and safety. Furthermore, in response to advances in ventilator technology, current education programs for both nursing and medical staff require review to ensure that they provide comprehensive information about the types of ventilation techniques now available and the relative risks and benefits associated with their application.This article is the second in a two-part series and explores the educational and organisational factors that impact upon safety and quality of care delivered to patients receiving mechanical ventilation in the emergency department. Recommendations for future policy development, curriculum review and reporting mechanisms to support further research in the application of mechanical ventilation in the emergency department are made.     

Urinary output of endogenous monoamine oxidase inhibitor and isatin during acute migraine attacks

Summary Urinary output of endogenous monoamine oxidase (MAO) inhibitory activity, was significantly raised in serial samples collected across a migraine attack compared with collections during attack-free periods and in healthy controls, which did not differ from each other. There was a highly significant correlation in output between isatin, a major fraction of the MAO inhibitory activity, and output of the MAO inhibitory activity itself. However, although there was a tendency towards increased isatin excretion during migraine attacks, it failed to reach statistical significance.     

Magnetic resonance in the diagnosis of aneurysmal bone cyst]

A patient of 12 suffering from aneurysmal cyst of the ischium was studied with traditional radiology, computed tomography (CT) and magnetic resonance imaging (MRI). The advantages of MRI in the study of this pathology compared to traditional radiography and CT are assessed. It was shown that the CT and MRI techniques are superior to standard X-ray examinations in anatomic definition and in evaluating the lesions's relationships with neighbouring structures and, in particular, that MRI is superior to CT in extension.     

Popliteus tendon rupture. Case report and review of the literature

A 23-year-old man sustained an isolated popliteus tendon rupture while pushing a car. The diagnosis was established with the use of arthroscopy, electromyography, and Cybex testing. After the patient failed to respond to conservative therapy, the tendon rupture was surgically repaired. The patient had an uneventful recovery and returned to his preinjury level of athletic activity. Although popliteus tendon tenosynovitis as well as injury to the popliteus in association with other ligamentous knee injuries has been described, neither an isolated popliteus tendon rupture nor an arthroscopic evaluation of a popliteus tendon rupture has been reported.