Diaphragmatic hernia in a female newborn with focal dermal hypoplasia and marked asymmetric malformations (Goltz-Gorlin Syndrome)

We report a female newborn with focal dermal hypoplasia (Goltz-Gorlin Syndrome) and marked asymmetric malformations on the right side of the body. Diaphragmatic hernia on the same side, which has not been reported in this syndrome, led to perinatal complications.     

先天性婴幼儿膈膨出的诊断和治疗

目的 探讨先天性婴幼儿膈膨出的病因、临床特点、诊断及治疗方法。方法 对近１０年来收治的１２例先天性婴幼儿膈膨出进行回顾性分析。结果 本组１２例中，行膈肌折叠手术治疗８例，３例为右侧因膨出程度及症状较轻而未手术，１例因合并多发畸形放弃治疗，术后死亡１例，其余效果良好。结论 先天性婴幼儿膈膨出病因不明确，可能与遗传、胎儿宫内感染以及药物有关，低体重和反复呼吸道感染是该症的主要临床特征。早期诊断和手术治     

Activity pattern of swallowing-related muscles, food properties and body position in normal humans

Summary  Activity patterns of the swallowing-related muscles were examined in normal subjects at different four body positions during swallowing of foods with different textural properties. Surface electromyograms were recorded from two muscle groups, the anterior tongue and suprahyoid muscles. The T _P technique we developed was applied to the electromyograms for quantitative analysis of the activity patterns. Three test foods were prepared by dissolving 2·0% (low), 5·7% (middle) and 9·1% (high concentration) of a thickening agent into distilled water. Each subject was delivered randomly, one of the test foods to swallow at one of the four body positions i.e. horizontal supine, 30° inclined, 60° inclined and upright. In this study, T ₅₀ values were calculated in activity data of the two muscle groups, and the T ₅₀ values were statistically examined analysis of variance with a linear model including four fixed effects of 'concentrations', 'body positions', 'subjects' and 'sessions'. Three major findings obtained were that (i) the activity pattern of the anterior tongue was altered from a decrementing discharge pattern to an incrementing discharge pattern by shifting from the upright to the horizontal supine position, (ii) the activity pattern of the suprahyoid muscles was altered from a decrementing discharge pattern to an incrementing discharge pattern by shifting from the low concentration food to the higher ones and (iii) two subgroups were detected in subjects with the significant effects of 'concentrations' and 'body positions'. These findings lead a conclusion that activity patterns of the swallowing-related muscles are affected by food properties and body positions.     

Zum Faserverlauf im Centrum tendineum

Zusammenfassung Bei einem Polytrauma besteht immer die Möglichkeit einer Zwerchfellruptur. Vorwiegend erfolgt die Ruptur im Centrum tendineum. Ein Grunt für die bizarre Form der Rupturen sind die in individueller Abstufung auftretenden Lücken zwischen den Sehnenbündeln; these Bündel lassen sich in 3 Gruppen einteilen. Bei Rupturen ist meist der linke Seitenteil betroffen. Neben der schültzenden Wirkung der Leber ist ein weiterer Grund für das relativ geringe Auftreten rechtsseitiger Rupturen die größere Stabilität des rechten Seitenteils durch eine stärkere Verflechtung der Sehnenfasern. Die Zwerchfellruptur bei Polytraumatisierten wird häufig übersehen, ihre Zahl könnte jedoch bei gezielter Diagnostik deutlich gesenkt werden. Eine operative Versorgung der Zwerchfellruptur macht im allgemeinen keine Schwierigkeiten, ein abdominales Vorgehen ist zu favorisieren. Die Gesamtprognose hängt von Art und Schwere der Begleitverletzungen ab.

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The course of fibres in the central tendon

Summary In each polytrauma a diaphragmatic rupture is possible. Usually the rupture is located in the central tendon. A cause of the bizarre form of ruptures is the individual arrangement of gaps between the fibres of the central tendon. These fibres are classified in three groups. A rupture is generally on the left side of the central tendon. A further cause of the relative rare rupture on the right side is beside protection by the liver the greater stability on the right side of the central tendon, because fibres are more interlocked. The diaphragmatic rupture of a polytrauma is often overlooked, this number could be reduced by specific diagnostics. The repair of a diaphragmatic rupture is not a problem, an abdominal approach should be preferred. The prognosis depends on extension of concomitant lesions.

     

鞍区硬膜结构相关的临床解剖研究

目的 研究鞍区硬膜结构的显微解剖及其手术意义。方法 观测尸颅鞍区硬膜结构的显微解剖特征。结果 床突间皱襞将海绵窦顶分为两个三角，少数鞍隔向内下倾斜成盆状，动眼神经硬膜孔大致位于后床突水平。隔孔区的垂体腺由二层组织覆盖，上层是蛛网膜，下是更薄的膜样结构，少数蛛网膜层以脂肪垫形式填塞于鞍隔与垂体腺之间，仅见一例垂体池。结论 隔孔大者垂体容易下陷，蛛网膜坠入鞍隔下方与隔孔较大有关，垂体池是形成空蝶鞍的潜在因素。国人鞍隔屏障性能差，经蝶手术后容易脑脊液漏。     

Transition from slow to ballistic movement: development of triphasic electromyogram patterns

Summary The purpose of this investigation was to determine how the triphasic electromyogram (EMG) pattern of muscle activation developed from the agonist muscle only pattern as movement time (t _mov) decreased. Six adult women produced a series of 30° elbow extension movements in the horizontal plane at speeds ranging from ballistic (< 400-ms t _mov) to very slow (> 800-ms t _mov). Surface EMG from triceps brachii (agonist) and biceps brachii (antagonist) muscles were recorded, together with elbow angle, on a microcomputer. The results showed that triphasic EMG patterns developed systematically as t _mov decreased from 1000 ms to < 200 ms. In trials with very long t _mov, many elbow extension movements were produced by a single continuous activation of the agonist triceps brachii muscle. As t _mov decreased however, agonist activation became predominantly burst-like and other components of the triphasic EMG pattern [activation of the antagonist (Ant) and second agonist activation (Ag₂)] began to appear. At the fastest movement speeds, triphasic EMG patterns (Ag₁-Ant-Ag₂, Ag₁ being first activation of agonist muscle) were always present. This data indicated that the triphasic pattern of muscle activation was not switched on when a particular t _mov was achieved. Rather, each component systematically developed until all were present, as distinctive bursts of activity, in most trials with t _mov less than 400 ms.     

创伤性膈疝的诊断与治疗

目的 总结创伤性膈疝的诊断和治疗经验。方法 分析27例创伤性膈疝患者受伤的原因，入院时的主要症状，体征，合并伤，信要检查资料及手术时机，死亡原因，钝性伤13例。锐器穿透伤14例；左膈疝25例，右膈疝2例；经腹手术14例，经腹手术13例。结果 22例（81.5%)术后痊愈，5例死亡。死亡率18.5%。结论 胸腹部创伤患者应警惕膈肌的损伤，创伤性膈疝的表现常被合并伤的表现所掩盖，要注意受伤的原因，体位及外力作用的方向。认真的胸部X线电视透视是最可靠的检查方法。创伤性膈疝一经发现，应尽快给予手术治疗。     

The pharmacological treatment of newborn diaphragmatic hernia — update 1987

Before the mid 1970s, neonates with diaphragmatic hernias (CDH) had a survival rate of 40%. Since then increased interest has been focused on the pulmonary artery and its hypertension (the persistent fetal circulation) and the pharmacologic treatment of this pathophysiology. Our initial pharmacologic experience left us with much information and even more unanswered questions. While other series were encouraging, they also showed a survival rate of about 50%. The following problems are associated with pulmonary vasodilator therapy: (1) there is no specific pulmonary vasodilator and the response is often unpredictable; (2) the pulmonary arterioles in these babies are abnormal and appear in many instances anatomically incapable of responding; (3) cardiac output may be affected secondary to inotropic or chronotropic side effects of vasodilators; and (4) the effect of a vasodilator on the pulmonary vasculature under hypoxic conditions is unknown. Moreover, we have yet to identify at birth which CDH babies require this treatment, and we must find improved pharmacologic agents that will more specifically dilate the constricted pulmonary vascular bed with minimal effect on the systemic circulation. Although some attempts at pharmacological manipulation of the pulmonary vascular bed continue in most centers, including ours, there are many other innovations in the perioperative management which require further evaluation, among them extracorporeal membrane oxygenation, high-frequency oscillation and possibly lung transplantation in the future. Offprint requests to: S. H. Ein     

Site Specificity of Pain and Tension in Tension-Type Headaches

Previous studies have not found a significant correlation between location of pain and electromyogram levels in chronic headache patients. However, these studies only examined a limited number of muscle groups and did not assess subjective tension levels. The present study evaluated a group of tension-type (n = 43) and migraine and tension-type (n = 30) headache patients. Measures were obtained at five muscle sites (frontalis, temporalis, masseter, splenius capitis, and trapezius) for patient ratings of headache pain, patient ratings of muscle tension, and electromyogram recordings cross-sectionally. Neither subjective pain nor tension ratings were found to be significantly related to electromyogram levels. The site-specificity relationship between chronic headache pain, subjective report of muscular tension, and electromyogram levels remains unclear.     

剪切波超声弹性成像技术和表面肌电图在颈肩肌筋膜疼痛综合征疗效评估中的应用

目的:探讨剪切波超声弹性成像(SWE)技术和表面肌电图(sEMG)在颈肩肌筋膜疼痛综合征(MPS)疗效评估中的应用价值。方法:回顾性分析2017年10月~2019年10月间医院收治的90例颈肩(MPS)患者的临床资料,所有患者均接受4个疗程(7d为1疗程)的针刺联合推拿治疗,根据治疗后1个月的疗效划分为A组(54例)、B组(36例)。于治疗前、后采用SWE检测两组患者的杨氏模量值、触发点厚度、组织弹性图评分,并使用sEMG检测平均振幅值、平均频率斜率值,并使用受试者工作曲线(ROC)分析以上指标对颈肩MPS患者疗效的评估价值。结果:治疗前,两组患者的组织弹性图评分、杨氏模量值、筋膜厚度、平均振幅值、平均频率斜率等比较,差异均无统计学意义(P_均>0.05)。治疗后,两组患者的组织弹性图评分、杨氏模量值、筋膜厚度等均低于治疗前(A组B组),差异均具有统计学意义(P_均<0.05)。ROC曲线显示,组织弹性图评分、杨氏模量值、筋膜厚度、平均振幅值、平均频率斜率评估颈肩MPS患者疗效的AUC分别为0.750、0.744、0.836、0.812、0.752,具有一定的价值,且联合检查的价值较高(AUC=0.957,P<0.01)。结论:剪切波超声弹性成像技术联合表面肌电图可用于颈肩肌筋膜疼痛综合征疗效评估。