Surgical management of symptomatic os odontoideum with posterior screw fixation performed using the magerl and harms techniques with intraoperative 3-dimensional fluoroscopy-based navigation

STUDY DESIGN.: Retrospective case series. OBJECTIVE.: To evaluate the accuracy of screw fixation using intraoperative three-dimensional fluoroscopy-based navigation (ITFN) and to assess the clinical outcomes of this treatment regimen. SUMMARY OF BACKGROUND DATA.: The surgical management of symptomatic os odontoideum poses considerable difficulties due to the highly variable anatomy of the upper cervical spine and surrounding neurovascular structures. Various methods have been described for the treatment of symptomatic os odontoideum, all of which have limitations. METHODS.: Nineteen patients with symptomatic os odontoideum were investigated. Pain scores were assessed using the visual analogue scale. Myelopathy was assessed using the Nurick scale and Odom's criteria. Radiological imaging was carried out in all patients for diagnosis and to assess the atlantodens interval, space available for cord, and presence of intramedullary hyperintensity signals on T2-weighted images at the C1-C2 level. Posterior stabilization was performed for all patients by using ITFN. RESULTS.: The mean Nurick score improved from 2.3 before surgery to 0.7 at the time of follow-up. The mean follow-up period was 34.7 months (range, 12-65 mo). According to Odom's criteria, outcomes were as follows: excellent, 47%; good, 37%; fair, 11%; and poor, 5%. All patients with preoperative neck pain had symptom relief or improvement, with all of these patients having more than 83.7% improvement in visual analogue scale scores. The mean preoperative space available for cord value of 9.3 mm improved to 17.7 mm. Solid fusion and reduction of atlantoaxial dislocation were achieved in every patient without screw failure. Sixty screws were placed in 19 patients. Two C2 polyaxial screws in 2 patients and 1 transarticular screw in 1 patient slightly penetrated the transverse foramen with no vascular injury and clinical sequelae. CONCLUSION.: ITFN is a safe, accurate, and effective tool for screw placement in patients with symptomatic os odontoideum.     

封闭式负压引流联合反植皮一期闭合开放性创伤截肢创面的临床分析

目的对比观察封闭式负压引流技术(vacuum sealing drainage,VSD)联合反取皮和直接反取皮治疗开放性创伤截肢创面的疗效。方法 2005年3月-2010年6月,应用随机单盲法对收治的60例四肢开放性骨折截肢患者分别采用一期VSD联合反取中厚皮片植皮(试验组,30例)与一期单纯反取中厚皮片植皮覆盖截肢创面(对照组,30例)治疗。两组患者性别、年龄、致伤原因、截肢部位、皮肤缺损面积、术前白蛋白指数及受伤至就诊时间等一般资料比较差异均无统计学意义(P>0.05)。试验组截肢后剪除多余残肢皮肤应用皮鼓取皮制成中厚交错筛网状皮片,植于截肢创面,表面用VSD覆盖,24 h不间断吸引持续7～10 d;对照组截肢后直接行反取中厚皮片覆盖创面,术后常规换药。结果试验组患者于术后平均8 d去除VSD装置。试验组皮片存活率(90.0%)、创面感染率(3.3%)及再截肢率(0)、换药次数[(2.0±0.5)次]、住院时间[(12.0±2.6)d],均显著优于对照组[分别为63.3%、20.0%、13.3%、(8.0±1.5)次、(18.0±3.2)d],比较差异均有统计学意义(P<0.05)。两组患者均获随访,随访时间1～3年,平均2年。末次随访时,试验组瘢痕面积、瘢痕分级及创面两点辨别觉均优于对照组,差异有统计学意义(P<0.05)。两组患者残肢均未见明显肿胀;术后试验组患肢疼痛发生率、残肢长度均优于对照组(P<0.05),而患肢残端形状比较差异无统计学意义(P>0.05)。两组残肢与健侧相比较,均存在肌肉废用性萎缩、肌力下降,各组健侧与患侧肌力比较差异均有统计学意义(P<0.05),但两组患侧间比较差异无统计学意义(P>0.05)。结论与单纯反取中厚皮片比较,VSD联合反取中厚皮片能够一期关闭截肢创面并对创面进行引流,降低感染发生,促进皮片与创面良好贴附,提高了皮片存活率,降低了截肢平面,利于假肢佩戴,是一期处理截肢创面的理想方法之一。     

Contemporary management and outcomes of infective tunnelled haemodialysis catheter-related right atrial thrombi: a case series and literature review

INTRODUCTIONInfective haemodialysis catheter-related right atrial thrombus (CRAT) is a complication of tunnelled catheter use. Management recommendations are based mainly on published case series prior to 2011. We report our institution’s recent experience in managing infective haemodialysis CRAT and correlate treatment with outcomes.METHODSWe conducted a retrospective analysis of haemodialysis CRAT cases diagnosed on transthoracic echocardiography between 1 January 2011 and 31 December 2017. Clinical outcomes, including mortality at 180 days post diagnosis and thrombus resolution, were traced from electronic medical records.RESULTSThere were 14 cases identified. The median age was 59 (range 47–88) years and 11 (78.6%) were male. Sepsis was the most common reason for hospitalisation (71.4%). Blood cultures identified Staphylococcus aureus in seven cases, of which two were methicillin-resistant. Three had coagulase-negative Staphylococcus. All cases received antibiotics with infectious disease physician input. Seven were treated with catheter removal alone, of which three died within 180 days. Both cases treated with catheter removal plus anticoagulation survived at 180 days. Of the two cases who had anticoagulation without catheter removal, one died within 180 days and the other did not have thrombus resolution. Three underwent surgical thrombus removal, of which two died postoperatively and the last required repeated operations and prolonged hospitalisation. Mortality at 180 days post diagnosis was 42.9%.CONCLUSIONCatheter removal and anticoagulation are modestly effective. Surgery is associated with poor outcomes. Despite contemporary management, infective haemodialysis CRAT still results in high mortality. Prospective studies are needed to identify the optimal management.     

探讨串道现象对饮用水中的总放射性测量结果的影响

目的：研究串道现象对饮用水中的总放射性测量结果的影响程度。方法：采用不同标准物质、不同的厚度、不同面积进行总放射性测量试验。结果：用²⁴¹Am粉测试的串道因子数随质量增加无明显变化,铀粉则随质量增加而增加。仪器测试通道不同,串道因子数也不同。总α对总β的串道影响很明显,反过来串道因子数很小,可忽略。串道因子数受样品盘面积的影响不明显。结论：做饮用水中总放射性检测使用α-β同时测量模式时,总β放射性活度受α串道影响,可以通过粉末标准物质进行修正,减小对测量结果的影响。     

放射性核素显像在小儿下消化道出血诊断中的应用

应用99mTcO及99mTc-RBC动态显像诊断消化道出血20例，结果阳性18例（美克尔憩室11例，肠重复畸形5例，克隆氏病1例，溃疡性回肠炎1例均被手术证实），阴性2例（肠息肉2例，内窥镜证实）。认为此种检查操作简单，损伤小，安全，灵敏度高，可提示出血部位及原因，对诊断及治疗有极大帮助。     

小鼠骨髓干细胞的分离培养鉴定及诱导分化的研究

目的分离培养鉴定小鼠的骨髓间充质干细胞,观察体外培养生长特性,并在特定条件下诱导分化,探讨其成脂成骨分化能力。方法采用全骨髓培养法培养小鼠骨髓间充质干细胞,观察干细胞的形态和生长特性,用流式细胞仪对其细胞表型CD29、CD90、CD34、CD44、CD31、CD45进行鉴定,成脂成骨诱导分化能力鉴定。结果原代分离的细胞培养24 h,干细胞开始贴壁,胞体呈圆形,其他血细胞悬浮。培养3 d,贴壁细胞逐渐变梭形;培养第4 d,细胞开始分裂;随着细胞数目的增加,逐渐形成漩涡状排列,细胞形态呈梭形、三角形、多边形、不规则形;培养第10 d,贴壁细胞长满瓶底的80%,按1∶2传代。选择第3代骨髓干细胞分析显示,CD29、CD44、CD90阳性表达,CD31、CD34、CD45阴性表达。细胞成脂成骨诱导后染色鉴定呈阳性。结论采用全骨髓法培养可获得生长状态良好,增殖能力强的骨髓间充质干细胞,方法简便、实用。     

226Ra 228Ra 210Pb和210Po在水生生物及食物链中转移规律的探讨

目的 为了解天然放射性核素²²⁶Ra、²²⁸Ra、²¹⁰Pb与²¹⁰Po在水生物及食物链中转移和蓄积情况。方法 定点采集养殖水产品及栖息环境中水与底质沉积物, 按不同的实验需要, 每个鲜样分别剥取肉, 骨(壳),鳞片和胃肠。烹饪样品, 洗净、称重、清炖, 熟后分离出骨(壳),余为食物。样品分别测定²²⁶Ra、²²⁸Ra、²¹⁰Pb和²¹⁰Po含量。数据按统计学要求处理, 配对数据, 作了配对显着性检验。结果 ²²⁶Ra、²²⁸Ra和²¹⁰Pb主要沉积于骨(壳)中, 浓集系数为10²～10³,肉中为10⁰～10².²¹⁰Po主要蓄积在水生物胃肠中, 浓集系数在10²～10⁴,鱼类胃肠与贝类肉中可达10⁴.水产食品烹饪加工过程²²⁶Ra、²²⁸Ra和²¹⁰Pb在食物链中转移不明显, 经配对显着性检验, 差异无显着性(P0.05);然而210Po在淡水鱼类和虾类中转移是明显的, 肉配对检验有非常显着性差别(P<0.01).结论水生物对²²⁶Ra、²²⁸Ra、²¹⁰Pb和²¹⁰Po有很强浓集能力。     

MRI在颅内血管母细胞瘤诊断中的应用价值

目的探讨MRI在颅内血管母细胞瘤诊断中的应用价值。方法18例经手术病理证实的颅内血管母细胞瘤患者，男11例，女7例，均行MRI平扫＋增强检查，分析其MRI征象。结果17例血管母细胞瘤位于后颅窝。14例表现为大囊小结节型，结节强化明显；4例表现为实质型。13例瘤内或瘤周可见血管流空信号。MRI术前诊断准确率为88．9％（16/18）。结论MRI是术前诊断血管母细胞瘤的有效检查方法。