Intraoperative somatosensory evoked potential monitoring during anterior cervical discectomy and fusion in nonmyelopathic patients--a review of 1,039 cases.

BACKGROUND CONTEXT: Intraoperative somatosensory evoked potential (SSEP) monitoring has been shown to reduce the incidence of new postoperative neurological deficits in scoliosis surgery. However, its usefulness during cervical spine surgery remains a subject of debate. PURPOSE: To determine the utility of intraoperative SSEP monitoring in a specific patient population (those with cervical radiculopathy in the absence of myelopathy) who underwent anterior cervical discectomy and fusion (ACDF) surgery. STUDY DESIGN: Retrospective review. PATIENT SAMPLE: A total of 1,039 nonmyelopathic patients who underwent single or multilevel ACDF surgery. The control group (462 patients) did not have intraoperative SSEP monitoring, whereas the monitored group (577 patients) had continuous intraoperative SSEP monitoring performed. OUTCOME MEASURE: A new postoperative neurological deficit. METHODS: SSEP tracings were reviewed for all 577 patients in the monitored group and all significant signal changes were noted. Medical records were reviewed for all 1,039 patients to determine if any new neurological deficits developed in the immediate postoperative period. RESULTS: None of the patients in the control group had any new postoperative neurological deficits. In the monitored group there were six instances of transient SSEP changes (1 due to suspected carotid artery compression; 5 thought to be due to transient hypotension) which resolved with the appropriate intraoperative intervention (repositioning of retractors; raising the arterial blood pressure). Upon waking up from anesthesia, one patient in the monitored group had a new neurological deficit (partial central cord syndrome) despite normal intraoperative SSEP signals. CONCLUSIONS: ACDF appears to be a safe surgical procedure with a low incidence of iatrogenic neurological injury. Transient SSEP signal changes, which improved with intraoperative interventions, were not associated with new postoperative neurological deficits. An intraoperative neurological deficit is possible despite normal SSEP signals.     

Serpentine aneurysm of the posterior circulation: report of two cases

Giant serpentine aneurysms form a subgroup of giant intracranial aneurysms with specific radiological and surgical features. Previous reports have stressed the predilection of these lesions for the carotid circulation, particularly the middle cerebral artery. Two cases of serpentine aneurysm affecting the posterior circulation are reported and the problems of diagnosis and treatment of this lesion are discussed.     

Validity of the 'Ten Questions' for screening serious childhood disability: results from urban Bangladesh

A survey of 2576 children aged two to nine years was carried out in Dhaka, Bangladesh, as part of a collaborative study to test the validity of a questionnaire (the Ten Questions) for screening severe childhood disabilities in community settings. Approximately 7% of the children were positive on the screen and this rate was slightly higher in boys than girls. The sensitivity, specificity and negative predictive value of the Ten Questions were perfect or nearly perfect for severe and moderate (serious) disabilities. The positive predictive value was only 22% for serious disabilities, but 70% of children classified as false positives were found to have mild disabilities or other conditions (such as ear infections) for which early detection and treatment could be beneficial. No major age or gender differences in the validity of the questionnaire were apparent, but this finding needs additional study and confirmation with studies based on larger samples. In general, the results indicate that the Ten Questions is a valid tool for screening serious disabilities in children and can potentially improve the efficiency of health services by reducing the number of children requiring attention from professionals. Future studies using the Ten Questions should foster greater attention to the dimensions of childhood disability as a public health problem in the less developed world.     

Advanced colonic carcinoma in children.

We report two cases of colorectal carcinoma in children with a delay in diagnosis due to the low index of suspicion of this pathology as the cause of presenting symptoms. We conclude that any child presenting with unexplained rectal bleeding and abdominal pain should be investigated with endoscopy and barium enema.     

大鼠心肌缺血再灌注时心肌细胞凋亡caspase-3活性变化规律及药物对其影响

目的　探讨大鼠心肌缺血再灌注 (Ischemiareperfusion ,IR)不同时相的心肌细胞凋亡、caspase 3活性变化规律及caspase 3抑制剂Ac DEVD CHO的影响。方法　Wistar大鼠 12 2只 ,设立IR组 ,IR +Ac DEVD CHO组和假手术对照组并分设缺血 3 0min后再灌注 1、3、6、12、2 4h 5个时相点 ;以缺口末端标记法 (TUNEL)标记凋亡细胞 ,用荧光分析法检测caspase 3活性 ,行TTC染色测定心肌梗死范围。结果　心肌细胞凋亡与caspase 3活性随心肌再灌注不同时相而变化 ,心肌细胞凋亡指数 (Apoptosisindex ,AI)与caspase 3活性于再灌注 12h最高 [AI :( 3 4 83± 9 3 5 ) % ;caspase 3活性 :( 1 3 4±0 2 ) ] ,其后基本维持在平台状态 ;心肌梗死范围随IR时间逐渐增加 ,至 2 4h仍未见下降趋势 ,三者间呈显著正相关 (P <0 0 5 )。IR +Ac DEVD CHO组上述指标虽也明显增高 ,但比IR组明显减小 (P <0 0 5 )。结论　Caspase 3激活及心肌细胞凋亡参与了心肌缺血再灌注损伤过程 ,Ac DEVD CHO减轻心肌缺血再灌注损伤可能部分与其抑制心肌细胞凋亡有关。     

An innocuous finger injury resulting in a very rare complication

We report a case of acromio-clavicular joint septic arthritis, a very rare complication of an innocuous finger injury.     

A Management of Early CRPS I Caused by Ankle Sprain: A Case Report

Abstract:   We present a case of a 13-year-old boy who developed signs and symptoms of neuropathic pain/early Complex Regional Pain Syndrome (CRPS) Type I, formerly known as Reflex Sympathetic Dystrophy (RSD), after spraining his ankle while wrestling. Aggressive pain control, using medications and sympatholytic blocks, with physical therapy and rehabilitation, led to the resolution of his painful condition. This prevented the disease from possibly progressing to a full-blown case of CRPS I (RSD) that is very challenging to treat.     

止咳枇杷冲剂中枇杷叶和桔梗的薄层色谱鉴别研究

研究止咳枇杷冲剂中枇杷叶和桔梗的薄层色谱鉴别方法。分别取枇杷叶和桔梗药材，制剂及阴性制剂的醋酸乙酯提取液，在硅胶板上前者以ψ（氯仿：甲醇：水）=2：2.25:1.5展开，后者以ψ（正已烷：氯仿：甲醇）=5：4：0.3展开，磷钼酸乙醇溶液显色，在两者供试吕色谱中与各自对照药材色谱相应位置上，分别有相同的蓝绿色特征斑点；阴性制剂色谱图中无此斑点，因此该方法可作为这两味中药的鉴别方法。     

Willard Parker's 1841 orbital operation

There are few records detailing the techniques and tribulations of early American surgeons who dared venture into the treacherous recess of the human orbit. The authors present a recently discovered letter written by a young woman who in 1841 underwent an orbital operation performed by the prominent New York City surgeon, Willard Parker. The letter details the patient's experiences in an era without anesthesia or antibiotics, and her subsequent development of conjunctival adhesions.     

Characteristics of placebo response during long-term treatment of panic disorder

Mixed-panic disorder patients (16/60, 27%) randomly assigned to receive blind placebo during a 40-week treatment study were defined as placebo responders based on combined criteria of Hamilton Anxiety Scale score percentage decreases below the median point (-42%), moderate to marked improvement on both clinician and patient Clinical Global Impressions scores, and panic-free at final treatment visit. These criteria applied separately also resulted in a similar clinical grouping and pattern of response. Differential patterns of response between responders and nonresponders occurred across most clinical measures of panic/anxiety. Responders experienced early improvement within the first week of double-blind treatment. This response progressed during treatment and tended to persist during taper and at followup 1 month later. Post-hoc analysis of demographic and clinical features at entrance into the study failed to characterize this stringently defined group of placebo responders.