针灸调理髓海、疏通经络方法治疗脑膜瘤术后并发眩晕、一侧肢体不利1例

方法：利用针灸调理髓海、疏通经脉方法治疗脑膜瘤术后并发眩晕、一侧肢体不利1例患者，经治疗6周后，观察疗效。结果：患者并发症状基本消除。结论：该疗法是治疗脑膜瘤术后并发眩晕、一侧肢体不利的有效方法。     

Unusual Clinic Presentation of Polyarteritis Nodosa: Involvement of Axillary and Brachial Artery

Polyarteritis nodosa (PAN) is a necrotizing inflammatory vasculitis of small- and medium-sized muscular arteries. Multiple organs, especially the kidney, skin, peripheric nerves, striated muscles, and intestine, are affected. In this case report, a patient with renal and hepatic involvement and axillary and brachial artery aneurysm resulting in shoulder hematoma and pain due to underlying PAN is presented.     

A comparison of function after limb salvage with non-invasive expandable or modular prostheses in children

BackgroundModular and non-invasive expandable prostheses have been developed to provide a functional knee joint that allows future expansion as growth occurs in the contralateral extremity in children with bone sarcomas that require removal of the growth plate. This study aimed to evaluate the functional outcomes of paediatric patients who received either a non-invasive expandable or modular prosthesis for bone sarcomas arising around the knee.MethodsWe evaluated clinician-reported, patient-reported and measured function in 42 paediatric patients at least one year (median age at assessment 19.1 years) after limb salvage surgery, and compared patients who received modular system prostheses (N = 29, median age 15.5), who did not require lengthening procedures to those who received non-invasive expandable prostheses (N = 13, median age 11.1) requiring lengthening procedures (median 5).ResultsThe number of revisions and time to first revision did not differ between the two groups. There were no differences between the two groups in total scores on the Enneking Musculoskeletal Tumor Society Scale, the Toronto Extremity Salvage Scale, and the Functional Mobility Assessment. Children with non-invasive expandable prostheses climbed stairs (11.93 ± 4.83 versus 16.73 ± 7.24 s, p = 0.02) in less time than those with modular prostheses.ConclusionOur results suggest that the non-invasive expandable prosthesis produces similar functional results to the more traditional modular prosthesis.     

Impact of intermittent pneumatic foot pumps on delay to surgery following ankle fracture

BackgroundAnkle fractures requiring open reduction and internal fixation (ORIF) are common and place considerable burden on inpatient beds. ORIF cannot be performed once the associated swelling is too excessive to permit tension-free wound closure. Where ORIF cannot be performed before the onset of swelling in the first 24–48 h, patients typically require up to 7 days of inpatient bed-rest and elevation to reduce swelling to an acceptable level for ORIF.The primary aim of this study was to determine whether delay to ORIF could be reduced with the pre-operative application of an intermittent pneumatic foot pump (IPF). These devices were designed as anti-embolic adjuncts, but have also been shown to be effective in the reduction of swelling.We compared 12 patients managed with an IPF to 12 matched historical controls who were not.No previous studies have addressed this question in unselected patients requiring ankle ORIF.MethodsWe performed a retrospective, controlled, before and after study of 24 patients who underwent ankle ORIF at our orthopaedic unit. Foot pumps were applied in the Accident and Emergency Department to ankle fracture patients requiring admission, and kept in place until ORIF.Data was collected from patient case notes for all patients.Patients were matched for age, gender, American Society of Anaesthesiologists (ASA) Grade, and pre-injury mobility. The primary outcome measure was time to surgery. We also recorded total hospital stay, and calculated cost savings.ResultsPatients managed with IPFs had a statistically significant 50% reduction in time from presentation to surgery compared to those managed without (p = 0.024), and had a reduced hospital stay (p = 0.116). This resulted in a net saving of £10,480 (£953 per patient).ConclusionsWe conclude that foot pumps reduce the time to surgery and total hospital stay of patients requiring ankle ORIF, and are cost effective.     

The Upper Limb Tension Test: Inter-tester Reliability for Assessing the Onset of Passive Resistance R 1

Abstract

The aim of this trial was to assess the inter-tester reliability of the Upper Limb Tension Test (ULTT). The onset of passive resistance (R1) of the left elbow was determined by four experienced manual therapists in a group of asymptomatic subjects. A recording of the degrees of elbow extension was obtained using a goniometer, having first positioned the upper extremity in a bracket maintaining 110 degrees of shoulder abduction and 10 degrees of shoulder extension. Each rater then moved the subjects' left shoulder into full external rotation and the forearm into full supination with the wrist and fingers in a neutral position. Data was collected four consecutive days. The data was analyzed by a two-way analysis of variance. The means of the readings among the four raters was found to be significantly different. It was concluded that the ULTT has a low inter-tester reliability when R1 is compared. Several suggestions are made for future research projects in this area.     

Allan Hoffman: A 70th Birthday Celebration

Water sorption which is not classically Fickian has been observed in a variety of polymers. Deviation from Fickian kinetics is widely assumed to be caused by rate-limiting polymer relaxation, despite minimal proof of this. To the contrary, the evidence accumulated in this work indicates that water transport in initially glassy poly(2-hydroxyethyl methacrylate) (PHEMA), an important water-swellable biomedical polymer, is controlled by Fickian diffusion. First of all, the fractional water uptake is initially linear and independent of sample thickness when plotted against the square root of time over initial thickness, as expected for a Fickian process. Furthermore, the moving solvent front also advanced with the square root of time. Temperature, polymer thermal history and initial solvent concentration all affected the sorption kinetics of PHEMA in manners consistent with a Fickian process. The invariably Fickian sorption mechanism is believed to be the consequence of the water molecule's small size and affinity for hydrophilic, swellable polymers.     

伤科接骨片联合双氯芬酸钠治疗闭合性足踝部骨折早期肿胀的疗效观察

目的探讨伤科接骨片联合双氯芬酸钠注射液治疗闭合性足踝部骨折早期肿胀的临床疗效。方法选取2016年12月—2017年12月天全县中医医院收治的100例闭合性足踝部骨折患者,按随机数字法分为对照组和治疗组,每组各50例。对照组患者肌肉注射双氯芬酸钠注射液,50 mg/次,2～3次/d。治疗组在对照组治疗的基础上以温开水或温黄酒送服伤科接骨片,4片/次,3次/d。两组患者均连续治疗4d。观察两组的临床疗效,比较两组的临床症状改善情况和视觉模拟评分法(VAS)评分。结果治疗后,对照组和治疗组的总有效率分别为82.00%、90.00%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组踝关节背伸、踝关节屈曲均明显大于对照组,消肿止痛时间、住院时间均明显短于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者VAS评分均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组患者VAS评分均明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论伤科接骨片联合双氯芬酸钠注射液治疗闭合性足踝部骨折早期肿胀具有较好的临床疗效,可改善临床症状,缓解疼痛,具有一定的临床推广应用价值。     

Cerebellar swelling after surgery for medulloblastoma with leptomeningeal dissemination in children. A case based-update

ObjectDespite the improvement in the overall management of medulloblastomas in recent years, certain phenomena and in particular postoperative cerebellar swelling remain an enigma. This rare complication, little described in the literature, is nonetheless life threatening for the patients.Case reportsWe report our experience about two children who developed severe cerebellar swelling with hydrocephalus and upward herniation soon after a gross total resection of a fourth ventricle medulloblastoma by a telo-velar approach. Despite rapid management of ventricular dilation and optimal medical intensive treatment of intracranial hypertension, both children died quickly after the surgery. Pathological examination analyses were in favour of anaplastic/large cell medulloblastoma.DiscussionDiffuse cerebellar swelling with upward herniation may occur postoperatively in young children with anaplastic/large cell medulloblastoma with leptomeningeal spread. In the literature, only 4 cases have been so far described with delayed onset of symptoms. Two children survived with an aggressive management (decompressive surgery and early radio-chemotherapy).ConclusionCerebellar swelling is an unrecognised and sudden complication of posterior fossa surgery for metastatic anaplastic medulloblastoma with leptomeningeal dissemination in young children. An initial less invasive surgical approach could be considered in such cases, in order to prevent this complication with potentially tragic issue, and which cannot be managed with a CSF shunt alone.     

Hybrid Assistive Limb® for sporadic inclusion body myositis: A case series

We evaluated the efficacy of rehabilitation therapy with Hybrid Assistive Limb® (HAL; hereafter HAL therapy) in three patients diagnosed with sporadic inclusion body myositis (sIBM) who were hospitalized to undergo HAL therapy. Among them, one patient participated in eight courses and the other two in two courses of HAL therapy between 2017 and 2020. We determined the mean rate of improvement in two-minute walking distance and 6 m walking speed at the time of hospital discharge. After HAL therapy, we confirmed the patients’ desire to continue the use of HAL. In one patient, we observed improvements of 146.0% and 120.0% in two-minute walk and 6 m walking speed, respectively, after the first course of HAL therapy; these values are 133.7% and 130% after the eighth course of HAL therapy. These values exceeded 90% in the other two patients after the second course of HAL therapy. HAL therapy maintained both quantity and quality of ambulation and showed positive psychological effects on patient conditions because it reduces exercise load and facilitates safety. While HAL therapy might be effective in maintaining and improving ambulation in patients with sIBM, we should consider to discontinue HAL therapy as it increased risk of falling.