双媒介间接电解氧化法合成醋酸可的松

在相转移试剂（Ｂｕ_４Ｎ~＋）存在下，以Ａｇ~＋／Ａｇ~（２＋）－Ｃｒ~（３＋）／Ｃｒ_２Ｏ_７~（２－）为双媒介，间接电解氧化表氢可的松醋酸酯生成醋酸可的松，化学收率为９４．３％，电流效率为７６．５％，同时阳极电解液可重复使用。     

Reduction of peristaltic artifacts on magnetic resonance imaging of the abdomen: a comparative evaluation of three drugs

Background: Peristaltic motion is an omnipresent source of degradation in abdominal magnetic resonance (MR) imaging by blurring images and producing ghost artifacts that can mask or mimic lesions. The objective of this study was to select an effective and easy-to-administer drug to provide consistent reduction of peristaltic motion artifacts on MR images. Methods: One hundred forty-eight adult patients with MR examinations of the abdomen were enrolled in a prospective, single-blind comparative study. Four groups were defined: (a) no-drug control group (n = 35), (b) 1 mg of intravenous (IV) glucagon (n = 19), (c) 20 mg of IV butylscopolamine (n = 28), and (d) 20 mg of oral dicyclomine (n = 66). All patients received high-density barium sulphate as a negative oral contrast medium. Quantitative image analysis was performed with operator-defined region-of-interest measurements of signal intensity. Gastrointestinal noise was measured outside the patient at the posterior part of the left hemiabdomen along the phase-encoding direction on a short inversion time inversion recovery (STIR) sequence. Results: Treatment groups showed reduced gastrointestinal noise (p < 0.01). When compared with the control group, IV butylscopolamine (p < 0.05) and oral dicyclomine (p < 0.05) significantly reduced gastrointestinal noise, whereas glucagon did not. Conclusion: Anticholinergic drugs significantly reduced the intensity of ghost artifacts on MR imaging of the abdomen. Twenty milligrams of oral dicyclomine is an effective and safe alternative to more expensive and parenterally administered drugs such as glucagon and butylscopolamine. Received: 22 November 1994/Accepted after revision: 14 March 1995     

Histochemical evaluation of the coagulation depth after argon laser impact on a port-wine stain.

A two-step excisional treatment of a port-wine stain (PWS) on the back of a 43-yr-old female patient was performed. Immediately before the first surgical treatment, two corresponding series of argon laser impacts were performed, each on one PWS half. Different laser parameters with irradiances ranging from 95 to 382 W/cm2 and energy fluences ranging from 19 to 114,6 J/cm2 were used. Laser spots on the first part ot be excised were biopsied 10 min after laser treatment and prepared for histochemical analysis by staining with nitro blue tetrazolium chloride (NBTC). Reduction of this redox dye by nicotinamide adenine dinucleotide diaphorase (NADH-diaphorase) leads on frozen tissue sections to an intense blue precipitate. The activity of NADH-diaphorase subsides immediately upon cell damage. All vital epidermal and dermal cells presented a dense blue granular pigment in their cytoplasm, sparing the nuclei. Laser induced arc-shaped epidermal and dermal necrosis did not stain, showing a clear demarcation from surrounding vital tissue. The depth of the thermal injury ranged from 0.28 to 0.45 mm; it did not correlate with the chosen fluences. With these penetration depths, the vast majority of PWS vessels was affected. Assessment of the remaining part of the PWS 8 months later yielded blanching of all laser-treated areas. With the NBTC method, an accurate definition of laser-induced tissue damage is feasible. It could be shown that the exposure time is the most relevant parameter influencing the penetration depth.     

Another option to treat Kümmell’s disease with cord compression

The efficiency of short-segment fixation with transpedicle body augmenter (a titanium spacer with bone-ingrowth porous surface, TpBA) to treat Kümmell's disease with cord compression (stage III) was retrospectively evaluated. No laminectomy or instrumentation reduction was done. Inclusion criteria included Frankel CDE, single-level within T10-L2. FU rate was 88%, i.e. 21 cases were included. Frankel function classification was 6E9D6C. Mean age was 72+/-8 years. F:M was 16:5. FU period was 48 M (range, 30-76 M). The hospitalization was 4.5+/-2.2 days; operation time, 70.4+/-17.2 min; blood loss, 150+/-72 cc. Final Frankel class was 20E1D. Complications included two superficial infection and one pneumonia. Body height and kyphosis were all corrected significantly and well preserved at the final visit. No TpBA dislodgement or implant failure was noted; however, three cases developed new compression fractures. The clinical outcome showed 81% with P1 or P2 by Denis pain scale. This method can decompress spinal canal, maintain kyphosis correction and vertebral restoration, prevent implant failure, and attain good clinical results.     

Optimization of the protrusion shape for a couette-type flow

A study is made of the longitudinal 2D viscous steady flow and heat flux between two plates. Optimal shape design problems are solved in explicit form and shown to have unique global extrema. Conformal mappings are used to bring the problems into a fixed domain and solve them as Dirichlet boundary value problems in the form of Cauchy integrals and series expansions. For the simplest problem statement the optimum is shown to coincide with the well-known concrete dam outline of constant hydraulic gradient.     

Computer-assisted 3D reconstruction of the terminal branches of the cerebral arteries

We present a three-dimensional anatomical computer model of the terminal branches of the posterior cerebral artery and circle of Willis, acquired from equidistant serial anatomical slices of three brains. The reconstructions provide a clear picture from all angles of the complicated course of the terminal branches of the cerebral arteries. This can help to identify the arteries in conventional and magnetic resonance angiography. Our rendition of the cerebral arteries can be matched with CT, MR und PET images to indicate the areas of extension of the individual branches, allowing neuromorphological and functional correlations.     

解剖型钢板固定干骺部骨折评价(附98例报告)

目的：探索MAY解剖型钢板在干骺部骨折治疗中的应用。方法：通过对98例干骺部骨折采用MAY解剖型钢板固定的评析，评价该手术的优越性。结果：MAY解剖型钢板在干骺部骨折治疗中疗效满意。结论：MAY解剖型钢板是根据骨骼的特定部位的解剖形态制作的，与干骺部骨轮廊相匹配，因而手术操作极为方便，创伤小，固定骨折稳定性好，有利于骨折愈合和功能锻炼，是干骺部骨折理想的内固定材料。     

An unusual reduction technique prior to surgical treatment for traumatic spondylolisthesis in the lower cervical spine

Traumatic spondylolisthesis in the lower cervical spine is rare and only a few cases have been reported. We present a 56-year-old man who had severe C6-C7 spondylolisthesis without major neurological complications, caused by a traffic accident. Plain CT images showed a pedicular fracture on the right side and a laminar fracture on the left side at C6, but magnetic resonance images revealed no spinal cord compression. Application of a halo brace and maintaining the neck in slight flexion without traction resulted in reduction of the spondylolisthesis to nearly normal alignment. Anterior fusion using an autogeneous bone graft and a plate was easily performed without loss of correction. We suggest that preoperative reduction using a halo brace in slight flexion without longitudinal skull traction is useful and effective for severe traumatic spondylolisthesis in the lower cervical spine.     

Patient characteristics related to intensity of weight reduction care in a university medical clinic

Objective:To identify patient characteristics related to intensity of weight reduction care provided in a primary care practice. Design:Cross-sectional study linking data from a patient survey and data from medical records. Setting:Internal medicine housestaff clinic in an urban university hospital. Participants:321 outpatients who represented a systematic sample of all outpatients who had visited the clinic over one year. Measurements and main results:The patient population was largely black (86%) and female (65%). Most patients (54%) were overweight [body-mass index (BMI)>85th percentile for the United States by gender]. Intensity of care was defined by a composite scale: points were awarded for actions documented in the medical chart or recalled by the patient. Factors independently associated with a higher intensity of care among the 161 overweight patients were: BMI [odds ratio (OR)=1.13 per kg/m ²;95% confidence interval (95% CI)=1.04, 122; p=0.002], the patient’s self-perception of being overweight (OR=5.37; 95% CI=1.99, 14.46; p=0.001), and age of 64 years or younger (OR=2.48; 95% CI=1.12, 5.48; p=0.02). Race, gender, and presence of hypertension or hypercholesterolemia were not associated with greater intensity of care. Conclusions:Patients with hypertension and hypercholes-terolemia may be receiving suboptimal weight reduction care. Heightened awareness of being overweight may enbance the provision of weight reduction care. Prospective studies are required to confirm these findings. Received from the Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Health Institutions, Baltimore, Maryland. Supported by the Pew Charitable Trusts and the Rockefeller Foundation Health of the Public Program. Computer analysis was supported by a grant from the National Center for Research Resources, National Institutes of Health, General Clinical Research Centers 5M01RR00035.     

Radial turbo spin echo imaging

Fast MR imaging methods should provide a familiar contrast behavior at a reduced scan time. The multi-spin echo approach (TSE) is one of the most promising techniques satisfying this condition. Although the data acquisition time is significantly reduced, image quality may still suffer from artifacts due to patient motion and flow. The radial turbo spin echo (rTSE) approach combines TSE methods and projection reconstruction (PR) techniques. In PR images, artifacts induced by patient motion or flow are known to have a different appearance with lower level of intensity. The contrast and artifact behavior of the rTSE approach has been investigated. The new technique has been applied to abdominal imaging with acquisition times shorter than 30 s and to heart imaging in combination with cardiac triggering.