人工肩关节置换术后假体松动的预防

目前人工肩关节越来越广泛地应用于临床,其远期结果不仅取决于手术操作是否成功,而且更应强调术后并发症的预防及康复.本文将目前国内外人工肩关节置换术后假体松动的预防作一综述.     

Pancreatic cancer: Preliminary experience with sodium iodide fluorodeoxyglucose positron emission tomography in Australia

Previous studies of fluorodeoxyglucose positron emission tomography (FDG‐PET) in pancreatic cancer have used Bismuth Germinate detector systems. This preliminary Australian study aims to confirm the accuracy of FDG‐PET in pancreatic cancer using a dedicated sodium iodide (NaI) PET system. Fifteen consecutive patients underwent FDG‐PET using a GE QUEST dedicated NaI PET scanner. The indications were the characterization of a pancreatic mass seen on CT or ultrasonographic imaging (nine cases), diagnosis or exclusion of recurrent disease following surgery and adjuvant therapy (four cases) and presurgical staging of primary pancreatic cancer (two cases). The final diagnosis was determined from histology or, when no histology was available, by radiological and clinical follow up. The FDG‐PET accurately characterized eight out of nine pancreatic masses (seven were true negative, one was true positive and one was false positive). Of the four cases performed to determine recurrent disease, three were accurately diagnosed (two true negatives and one true positive). In the fourth case, PET accurately detected a liver metastasis but did not detect the local recurrence. Results in the two cases where PET was performed for preoperative staging comprised one true positive and one false negative. Sodium iodide FDG‐PET is useful in the diagnosis of pancreatic cancer, particularly in the presence of a previously detected mass.     

中医药治疗痛风的研究进展

痛风是单钠尿酸盐沉积在关节所致的晶体相关性关节病,与嘌呤代谢紊乱和（或）尿酸排泄障碍所致的高尿酸血症直接相关,除关节损害,还可伴发肾脏病变及其他代谢综合征的表现,临床常见的代谢性风湿病。近年来关于中医药治疗痛风的研究越来越多,包括中药单体、单味药、中药复方和中医外治法,其具有疗效显著且无明显不良反应的优势。通过对痛风的病因病机、中医药治疗的基础研究和临床研究等方面进行全面综述,为临床治疗提供理论依据。     

外伤性腕部正中神经损伤治疗进展

正中神经损伤在腕部切割伤中非常常见,其治疗方法多种多样。如需消除张力,应采用端端吻合修复;自体神经移植仍然是临床治疗长距离损伤的重要手段;当不能采用自体神经移植时,可以应用同种异体神经移植或自体组织移植;可降解生物、人工合成的神经导管在实验中表现出广阔的应用前景。本文就外伤性腕部正中神经损伤的治疗策略及有关进展作一综述。     

"Ethnic" variation in childhood lung function may relate to preventable nutritional deficiency

This study aimed to define the differences in lung function between British Caucasian and rural eastern Indian children, and to test the hypothesis that nutrition could account for such "ethnic" variation. To exclude confounders, a rural Indian setting was identified and children were screened for respiratory illness before lung function and nutritional characteristics were measured. Regression equations for this population have already been published. In this study, the lung function differences between rural eastern Indian ( n = 391) and mean predicted lung function for Caucasian children were characterized, matched for height and sex. In addition, stepwise multiple regression models were fitted to investigate the relative associations of lung function differences with body mass index (BMI), occipitofrontal circumference and age. Although the largest differences in the forced expiratory volume in 1 s (FEV 1 ) [girls 28.7 (27.3-30.1), boys 23.4 (22.2-24.6)] and forced vital capacity [girls 27.9 (26.4-29.4), boys 30.7 (29.6-31.9)] [values as mean difference in % predicted (95% confidence intervals)] ever reported between two populations were observed, differences in peak expiratory flow rate (PEFR) were small. BMI was strongly associated with inter-racial differences for FEV 1 for both sexes (boys β= -0.227, girls β= -0.353, p ≤0.001) and PEFR for girls ( β= -0.200, p ≤0.05) ( β= standardized coefficient).

Conclusion: Preventable nutritional factors may play a causal role in determining the FEV 1 differences between rural Indian and Caucasian children. As peak FEV 1 in youth influences respiratory morbidity in later life, it is important to define specific nutrient 1 deficiencies that may relate to poor FEV growth in these children.     

A visual pitfall: Persistent Mullerian duct syndrome (PMDS)

Persistent Müllerian Duct Syndrome (PMDS) is a rare disorder of the anti-mullerian hormone (AMH) synthesis or receptor, which due to the visual contrast of normal masculine external genitalia and female internal genitalia can raise confusion, sometimes during surgery for cryptorchidism or hernia inguinalis. For an acute and accurate analysis of such a situation a thorough knowledge of gonadal embryology is mandatory. The diagnosis is made on finding Müllerian structures in an individual with complete virilization without signs of hypocortisolism or exposition to maternal androgens during foetal life. Karyotyping and gonadal biopsy provide additional information to confirm the diagnosis. As the risk of malignant transformation is not clear, orchidopexy is advised in patients with cryptorchidism, with lifelong palpatory follow-up. In case of urologic symptoms, surgical removal of the Müllerian remnants can be considered, with careful attention for the vulnerable ductus deferens. Despite optimal treatment the prognosis regarding fertility remain uncertain.     

Dilated biliary tract: evaluation with MR cholangiography with a T2- weighted contrast-enhanced fast sequence

A heavily T2-weighted gradient-echo sequence was used for magnetic resonance (MR) imaging of the biliary system in five healthy volunteers and 13 patients with obstructive jaundice. Images were obtained in the sagittal and coronal planes during sequential breath-hold intervals and were post-processed by using a maximum-intensity projection algorithm. The extrahepatic and intrahepatic bile ducts were well visualized in 11 patients. The level of obstruction and the grade of dilatation were depicted with MR cholangiography. However, the cause of obstruction could be determined with MR cholangiography in only eight cases. The part of the biliary system below the obstruction could not be visualized with MR cholangiography. In the volunteers, MR cholangiography could demonstrate the anatomy of the biliary tract in only two subjects. Possible causes for this phenomenon are the limited spatial resolution of MR imaging, partial volume effects, or flow within the bile ducts. MR cholangiography may be a useful adjunctive tool for noninvasive evaluation of patients with obstructive jaundice. However, further technical advances are necessary to improve image quality.