An unusual cause of stridor-a case report

Slridor in children is usually acute in onset and most commonly caused by infections such as acute laryngitis, laryngotracheobronchitis, and acute epiglottitis. Stridor due to foreign body is also not uncommon. The case reported is that of a large upper thoracic pre and paravertebral abscess presenting with stridor. Although a rare cause, it presents as a life threatening entity requiring urgent treatment.     

螺旋CT在口腔正畸微种植支抗植入术诊断中的应用

目的：应用螺旋CT及其三维重建技术对口腔正畸微种植支抗植入术结果判断,探讨其辅助临床获得明确诊疗结论的应用价值．方法选择20例正畸患者,共植入48颗微种植螺钉．使用 SOMATOM Sensation40/64螺旋CT．将螺旋CT轴位平扫数据使用西门子3D后处理软件进行多平面重建（MPR）、最大密度投影（MIP）、容积再现（VR）和曲面多层面重建（CPR）．将轴位扫描图像与不同方法重建图像之间相互对照、观察和分析．结果37颗微螺钉种植效果满意,无伤及邻近牙根及周围重要组织结构的情况;11颗微螺钉植入不理想,或作观察或作再植入而获成功．螺旋CT横轴位首先观察牙根间距及牙根与微种植螺钉关系效果好;VR观察微种植螺钉与牙齿、颌骨的外表轮廓整体关系表现直观;MIP观察微种植螺钉全貌与牙齿的关系效果理想,可任意旋转,从不同角度进行观察;MPR观察微种植螺钉与牙根局部细微结构及周围组织结构关系从可选择截面上显示清晰,弥补横轴位局限的缺点,同时便于测量长轴间距及倾斜角度．结论螺旋CT及其三维重建可准确地展现颌骨内微种植螺钉的形态、位置及其与邻牙的空间关系,影像显示清晰、直观、明确,作为有力的辅助检查手段在口腔正畸微种植支抗诊疗中有着很高的应用价值.     

股骨粗隆间骨折合并同侧股骨干骨折的手术治疗

目的探讨股骨粗隆间骨折合并同侧股骨干骨折的手术治疗方法及疗效。方法回顾分析我院自1998年1月至2005年12月收治股骨粗隆间骨折合并同侧股骨干骨折患者18例，全部病例均采用手术切开复位内固定，股骨粗隆间骨折应用动力髋内固定，股骨干骨折采用记忆合金环抱器内固定。结果术后随访2～8年，平均4．2年。全部病例均获骨性愈合，疗效满意。结论股骨粗隆间骨折合并同侧股骨干骨折在下肢骨折中相对较少，但处理较为复杂和困难，治疗有一定难度，使用动力髋与记忆合金环抱器同时进行内固定，方法简单，固定牢靠，患肢可早期进行功能锻炼，这种方法是治疗单侧肢体多处骨折较好的方法之一。     

Laparoscopy-assisted hepatic lobectomy using hilar Glissonean pedicle transection

Although many reports have described laparoscopic minor liver resections, major hepatic resection, including right or left lobectomy, has not been widely developed because of technical difficulties. This article describes a new technique for performing laparoscopy-assisted right or left hepatic lobectomy using hilar Glissonean pedicle transection. Laparoscopic mobilization of the right or left hepatic lobe is performed, including dissection of the round, faliciform, triangular, and coronary ligaments. The right or left Glissonean pedicle is encircled and divided laparoscopically. A parenchymal dissection is then performed though the upper median or right subcostal incision, through which the resected liver is removed. We successfully performed this procedure in 6 patients without blood transfusion or serious complications. Laparoscopy-assisted hepatic lobectomy using hilar Glissonean pedicle transection can be feasible and safe in highly selected patients.     

Effects of clonidine on baroreceptor function in anesthetized dogs

The effects of clonidine (15–30 μg/kg i.v.) on carotid sinus and other baroreceptors were investigated in anesthetized dogs. In 14 control dogs, right carotid sinus pressure was controlled by retrograde perfusion through the common carotid artery at constant flow with femoral arterial blood. Graded reductions in heart rate and blood pressure induced by graded increases in carotid sinus pressure were prevented, whereas reflex bradycardias associated with norepinephrine pressor activity were potentiated by clonidine. Norepinephrine-induced bradycardia, although reduced, still persisted after chronic bilateral sinusectomy and these responses were also potentiated by clonidine. In contrast, clonidine did not potentiate reflex bradycardia in dogs 20 days after aortic stripping. In intact dogs, clonidine inhibited the response to bilateral carotid artery occlusion and to carotid sinus nerve stimulation. These studies suggest that clonidine can inhibit carotid sinus baroreceptor function and simultaneously potentiate other, presumably aortic, baroreceptor activity.     

Genetic analysis of ring finger protein 213 (RNF213) c.14576G>A polymorphism in patients with vertebral artery dissection: a comparative study with moyamoya disease

ABSTRACT

Background: Intracranial vertebral artery dissection (VAD) and moyamoya disease (MMD) are rare cerebrovascular diseases, both of which have an ethnic predominance in the East Asian population. Disruption of the internal elastic lamina and subsequent rupture of the medial layer result in intracranial VAD. MMD is a chronic occlusive cerebrovascular disease of unknown etiology, in which the medial layer and internal elastic lamina of the intracranial arteries are significantly compromised. Recent genetic studies found ring finger protein 213 (RNF213) to be an important susceptibility gene for MMD in East Asian patients, but the association between VAD and RNF213 has not been investigated. .

Methods: We investigated polymorphism of the RNF213 gene (c.14576G>A) in genomic DNA of 24 patients with intracranial VAD in comparison with 58 patients with definitive MMD and 48 healthy controls.

Results: Although RNF213 gene polymorphism (c.14576G>A) was evident in 69% of the MMD patients (40/58), none of the patients with intracranial VAD had this characteristic polymorphism (0/24, p < 0.001). The incidence of RNF213 c.14576G>A polymorphism was 4.2% in healthy controls (2/48). After adjustment by age and sex, the incidence of RNF213 c.14576G>A was significantly lower in intracranial VAD patients (p = 0.021) than that in MMD patients.

Conclusions: In contrast to MMD patients, the prevalence of RNF213 c.14576G>A polymorphism was significantly lower in patients with intracranial VAD. The RNF213 gene polymorphism may preferentially affect the cerebrovascular lesion in the anterior circulation, which is originated from the primitive internal carotid arteries. The genetic background underlying intracranial VAD should be elucidated in future studies.

Abbreviations: VAD: vertebral artery dissection; MMD: moyamoya disease; RNF213: ring finger protein 213; CAD: carotid artery dissection     

齐刺与常规针法治疗椎动脉型颈椎病疗效比较

目的比较齐刺与常规针法治疗椎动脉型颈椎病的临床效果。方法将49例椎动脉型颈椎病患者随机分为两组,对照组24例采用常规针法治疗,观察组25例采用齐刺针法治疗,比较两组的临床效果。结果观察组的痊愈率（76％）明显高于对照组（46％）,差异有统计学意义（Х^2=4．69,P〈0．05）。观察组的平均血流速度（Vm）改善情况优于对照组,差异有统计学意义（P〈0．05）。结论齐刺针法治疗椎动脉型颈椎病临床效果优于常规针法。     

空心螺钉治疗锁骨骨折的生物力学研究

目的检测直径6.5 mm空心螺钉固定锁骨骨折的生物力学性能,并与钢板螺钉内固定方法进行比较,为临床应用提供依据。方法采集10个成人锁骨标本,行中外1/3处锁骨横形骨折模型,随机分二组,分别采用空心螺钉和钢板螺钉内固定,测试各组的三点弯曲应变及轴向挤压效应。结果轴向挤压实验：载荷1571 N时,钢板固定组螺钉发生松动,在载荷2470.13 N时钢板固定失败,而锁骨空心螺钉固定失败载荷为3034.99 N,两者相差明显。三点弯曲实验：无论钢板组的正向（270.29-254.38 N）或负向加压负荷（425.85-443.76 N）结果均远远小于空心螺钉组（1017.16-1103.39 N）。结论直径6.5 mm空心螺钉治疗锁骨骨折从生物力学上来看,在抗轴向负荷及三点弯曲负荷上均优于目前常规使用的钢板螺钉。     

PIPELINE微创通道结合VIPER2经皮椎弓根螺钉技术治疗腰椎退变性疾病

目的：探讨采用PIPELINE可扩张微创通道管系统结合VIPER2经皮椎弓根螺钉固定技术治疗腰椎退行性疾病的疗效。方法收集2012年2月至2013年12月采用PIPELINE微创通道减压融合结合VIPER2经皮椎弓根螺钉固定治疗,并获得随访32例腰椎退变疾病患者的临床资料。均采用后路中央两旁多裂肌间隙入路,在PIPELINE可扩张通道微创系统下行椎管减压、椎间融合并联合VIPER2经皮椎弓根螺钉内固定技术。采用VAS疼痛评分和Oswestry功能障碍指数（Os-westry disabi-lity index,ODI）评分评估临床疗效,并观察术前、术后各项指标及并发症情况。结果所有患者随访时间平均为8.3个月。统计分析显示术后1周及末次随访时的腰腿痛VAS评分和ODI评分与术前相比明显改善。差异有统计学意义（P<0.05）。末次随访时生活质量改善率平均为85%。32例患者的平均手术时间为122min。平均手术切口长度为5.3cm。术中平均出血0.18L,术后平均引流量为0.085L。出现并发症3例,均为切口表皮坏死,经换药后Ⅰ期愈合。结论 PIPELINE微创通道结合VIPER2经皮椎弓根螺钉技术治疗腰椎退变性疾病具有对组织损伤轻、出血少、术后恢复快、近期疗效肯定等优点,是一种安全、有效并且可靠的微创手术方法。