中小型颅内动脉瘤自发性闭塞(四例报告并文献复习)

目的 探讨蛛网膜下腔出血血管造影阴性病例动脉瘤自闭假说的起初真实性，以及导致动脉瘤自闭发生的相关因素。方法 回顾性分析临床上出现的经全脑血管造影证实的４例明确的动脉瘤症例动脉瘤自闭现象，对动脉瘤自闭发生的因素进行了分析。结论 在蛛网膜下腔出血全脑血管造影阴性时，要考虑到动脉瘤自闭的可能，不论是否巨大动脉瘤，均有发生自闭的可能。与动脉瘤自闭有关的因素有：血流速度的改变、动脉瘤的大小、形态、部位及动脉     

Asymmetry in D-2 binding in female rat striata

An asymmetry in D-2 receptor densities (Bmax) measured by [3H]N-methyl spiperone binding was found in striata from female Sprague-Dawley rats. The D-2 Bmax on the right side was on average 40% greater than the D-2 Bmax on the left side. This asymmetry is greater in magnitude and opposite in direction to that reported for males and is independent of directional preference exhibited during nocturnal circling.     

Effect of deprivation of the paradoxical phase of sleep on rotational and stereotyped behavior induced by selective agonists of dopamine receptors

Research Institute of Pharmacology, Academy of Medical Sciences of the USSR, Moscow. Institute of Pharmacology, Polish Academy of Sciences, Krakow. Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 110, No. 11, pp. 495–497, November, 1990.     

64排螺旋CT冠状动脉造影的护理

目的评价在6 4排螺旋CT冠状动脉造影检查中相关护理的重要性。方法对8 5 0例行6 4排螺旋CT冠状动脉造影检查患者进行严格的护理操作和指导,并对相关图像资料进行回顾性分析。结果8 5 0例6 4排CT冠脉检查患者无一例渗漏,成功率(图像优良)达到9 5.6 3%。结论严格的护理操作和心理、生理干预是6 4排螺旋CT冠脉造影检查成功的重要保证。     

Extrinsic Factors as Component Positions to Bone and Intrinsic Factors Affecting Postoperative Rotational Limb Alignment in Total Knee Arthroplasty

Background

This study aimed to identify the factors affecting postoperative rotational limb alignment of the tibia relative to the femur. We hypothesized that not only component positions but also several intrinsic factors were associated with postoperative rotational limb alignment.

Reliability,Surgeon Preferences,and Eye-Tracking Assessment of the Stress Examination of the Ankle Syndesmosis

The diagnosis and stabilization of ankle syndesmotic injuries after acute injury remains an area of controversy in the foot and ankle surgical literature, seemingly without universal consensus. The primary objective of this investigation was to determine the frequency of agreement and reliability of the stress examination of the ankle syndesmosis. Secondary objectives were to determine surgeon preferences and protocols with respect to the ankle syndesmosis and to use gaze recognition software to perform an eye-tracking assessment during performance of stress examinations. Twelve foot and ankle surgeons, 12 residents, and 12 students were shown 5 intraoperative fluoroscopic still images and videos of the stress examination of the ankle syndesmosis. They were asked to evaluate the result as being “positive” or “negative” for syndesmotic stability. The overall reliability of the interpretation of the stress examination of the ankle syndesmosis was a kappa of 0.123 (surgeons 0.087; residents 0.019; students 0.237), indicating “slight” agreement. Survey results indicated wide variability in the perioperative preferences and protocols of surgeons dealing with the evaluation and treatment of the ankle syndesmosis. Eye-tracking results also demonstrated variability in the anatomic structures of interest focused on during performance of this testing. The results of this investigation provide evidence of reliability well below what would be expected of a gold standard test during stress examination of the ankle syndesmosis. These results indicate that future scientific endeavors are required to standardize the performance and interpretation of this testing.     

Pleural effusion in patients with pulmonary embolism

Background and objective: It has been suggested that pulmonary embolism (PE) is an under‐recognized cause of pleural effusion. This study aimed to (i) establish the incidence and clinical relevance of pleural effusion in patients with pulmonary emboli; and (ii) determine if there is a relationship between development of pleural effusions and the location of emboli and number of pulmonary arteries involved. Methods: A retrospective analysis of all CT pulmonary angiograms (CTPA) performed over 12 months on adult patients with clinically suspected PE in a hospital which used CTPA as first‐line imaging investigation for PE. Results: Of 285 CTPA, 60 patients (21%) had evidence of pulmonary emboli (38 had both central and peripheral clots and 22 peripheral emboli only). Emboli were bilateral in 39 cases and unilateral in 21 cases. Pleural effusion was present in almost one half (n = 29, 48%) of the patients with pulmonary emboli. Patients with pulmonary emboli were more likely to have a pleural effusion (OR 2.2 (95% CI: 1.1–4.7), P < 0.05) than patients without PE; however, the effusions were generally very small. Most (86%) of the effusions were present on the same side as the emboli. The location of emboli and number of arteries involved did not predict the presence of pleural effusions. Conclusions: Pleural effusion is common in patients with pulmonary emboli demonstrated on CTPA. These effusions are small and seldom alter clinical management. Clinicians should therefore have a high threshold of suspicion in attributing large or contralateral pleural effusions to embolic diseases without excluding alternative diagnoses.     

开展医师医务管理轮训的实践与思考

为提升医师对医疗工作的整体认识水平,促进其熟悉医务管理工作和提高病历书写质量,加强医患沟通和管理部门与临床科室的交流,以及完善对医师医务管理知识的再教育工作,阜外心血管病医院针对高年资主治医师建立了医务管理轮训制度。经过近2年的实践和效果评价显示,适时地开展医务管理知识培训和实践十分重要而且必要,并对管理部门和临床医师双方而言都大有裨益。     

Laryngeal mask airway insertion in children: comparison between rotational, lateral and standard technique

Background:  The purpose of the study was to compare the success and ease of insertion of three techniques of laryngeal mask airway (LMA) insertion; the standard Brain technique, a lateral technique with cuff partially inflated and a rotational technique with cuff partially inflated.
Methods:  One hundred and sixty-eight ASA I and II children aged 6 months to 6 years undergoing short elective surgical procedures lasting 40–60 min were included in the study. A standard anesthesia protocol was followed for all patients. Patients were randomly allocated into one of the three groups i.e. standard (S), rotational (R) and lateral (L). The primary outcome measure of the study was success rate at the first attempt using three techniques of LMA insertion. Secondary outcomes measures studied were overall success rate, time before successful LMA insertion, complications and maneuvers used to relieve airway obstruction.
Results:  Successful insertion at the first attempt was significantly higher in group R (96%) compared with group L (84%) and group S (80%) ( P  =   0.03). Overall success rate (i.e. successful insertion with two attempts) was 100% for group R, 93% for group L and 87% for group S ( P  =   0.03). Time for successful insertion was significantly lower in group R compared with group L and S ( P  <   0.001). The incidence of complications was lower in group R.
Conclusions:  A rotational technique with partially inflated cuff is associated with the highest success rate of insertion and lowest incidence of complications and could be the technique of first choice for LMA insertion in pediatric patients.