Compartment syndrome and rhabdomyolysis as a positioning complication following retrosigmoid craniotomy

The goal of surgical positioning is to provide optimal surgical access and visualization while maintaining the patient's safety, with the least physiological compromise. Here, we report a 30-year-old man with an unremarkable past medical history who developed superior vena cava syndrome after a 15-hour retrosigmoid craniotomy for removal of a right cerebellopontine (CP) angle tumor. Compartment syndrome from the head to neck and rhabdomyolysis were recognized, with extensive swelling of his head and neck, markedly swollen soft tissues and necrosis of multiple muscles revealed by computed tomography, and very high concentrations of creatine kinase (CK) and aspartate transaminase. Immediate intensive care and rehabilitation therapy were provided and aimed at maintaining adequate perfusion/oxygenation and decreasing tissue pressure. He was successfully weaned from ventilation on postoperative day (POD) 25, transferred to a general ward on POD 29, and discharged with mild muscular and neurological sequelae on POD 51. Careful adjustment of surgical positioning is crucial for patient safety, especially when positioned at an extreme position in association with prolonged surgery.     

Suggestive evidence of genetic association of −572G > C polymorphism with primary open angle glaucoma in a North Indian Punjabi population

BackgroundIL6 is an important candidate gene implicated in the pathogenesis of glaucoma. The present study assessed the genetic association of −174G > C and −572G > C polymorphisms in the IL6 promoter region with primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in a north Indian Punjabi cohort.Methods910 subjects (313 POAG, 148 PACG cases and 449 controls) were recruited. Genotyping was done by TaqMan assays. Genetic association was tested under different genetic models using Plink. Diplotype and linkage disequilibrium (LD) analysis was done through Haploview. Association of clinical parameters with the genotypes was assessed by one-way ANOVA. Adjustment for potential confounding variables was done by binary logistic regression. IL6 levels were measured in POAG patients and controls.Results572G > C variant showed marginal difference in genotype frequency between pooled cases and POAG subgroup with respect to controls (p = 0.042; OR = 1.33; and p = 0.041; OR = 1.37). The GC genotype conferred 1.37-fold protection under codominant model in POAG cases (p = 0.034, OR = 1.37, 95% CI = 1.02–1.85; p_corr = 0.025, OR = 1.45, 95% CI = 1.04–2.02). The mean value for IOP was elevated among cases having ‘CC’ genotype at the −572G > C locus (p = 0.037).Lower levels of IL6 were detected in POAG patients in plasma samples (p = 0.0001).ConclusionThe study reports suggestive evidence for −572G > C variant in IL6 in affecting genetic susceptibility to POAG in the targeted North Indian Punjabi cohort. A correlation of IL6 levels in aqueous humor (AH) and systemic circulation in POAG was observed, the functional and diagnostic relevance of which may be further investigated.     

减小后牙▉平面倾斜度对安氏Ⅱ类高角畸形髁突位置影响的研究

目的: 研究在安氏Ⅱ类高角畸形正畸治疗中,减小后牙平面倾斜度对髁突位置的影响。方法: 15例安氏Ⅱ类高角畸形患者,年龄15~30岁。治疗前ANB>5°,下颌平面角FH-MP>32°,磨牙关系为双侧远中关系。常规排齐整平及适当扩弓后,利用多曲唇弓导下颌向前,并使后牙平面平坦化。利用锥形束CT（cone-beam CT,CBCT）测量治疗前、后颞下颌关节前、上、后间隙及后牙平面的改变情况。采用SPSS19软件包对变化量进行t检验;并利用相关性分析,进一步探讨髁突位置改变量与后牙平面倾斜度减小量之间的相关性。结果: 所有患者磨牙尖牙关系均调整到中性,侧貌改善明显,髁突后间隙平均增加(0.88±0.17)mm,变化有统计学意义(P<0.001);髁突上间隙平均增加(0.45±0.20)mm,变化也具有统计学意义(P<0.05)。后牙平面变平坦,POP-SN及POP-FH平均减小3.59°±2.31°及2.31°±3.62°,变化具有统计学意义(P<0.001)。髁突前间隙变化量无统计学意义,髁突位置改变量与后牙平面倾角的变化量之间无显著相关性。结论: 在安氏Ⅱ类高角畸形患者的正畸治疗中,通过正畸减小后牙平面倾斜度,可使髁突的位置发生适当的前下改变,有利于关节症状的改善。     

Glossopharyngeal Neuralgia Caused by Arachnoid Cyst in the Cerebellopontine Angle

Glossopharyngeal neuralgia is a relatively rare condition characterized by severe, paroxysmal episodes of lancinating pain in the tongue, throat, ear, and tonsil. This disorder is assumed to be due to compression of the glossopharyngeal nerve by vascular structures. A 47-year-old woman complaining of sharp and lancinating pain in the right periauricular and submandibular areas visited our hospital. Swallowing, chewing, and lying on her right side triggered the pain. Her neurologic examination revealed no specific abnormalities. The results of routine hematologic and blood chemistry studies were all within normal limits. Carbamazepine and gabapentin were given, but her symptoms persisted. Her pain was temporarily relieved only by narcotic pain medication. MRI showed an arachnoid cyst located in the right cerebellomedullary cistern extending to the cerebellopontine cistern. Cyst removal was performed via a right retrosigmoid approach. Lateral suboccipital craniotomy was performed using the right park-bench position. After opening the dura and cerebellopontine angle, the arachnoid cyst was exposed. The arachnoid cyst was compressing the flattened lower cranial nerves at the right jugular fossa. Her symptoms resolved postoperatively. Two months after the operation, she was completely free from her previous symptoms.     

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??Objective??To measure and compare the discrepancy of Collum angle of incisors among different types of Angle malocclusion using CBCT??and to provide guidance for the prevention of alveolar bone fenestration and dehiscence in anterior region. Methods??The cases of malocclusion were chosen in the Xi'an Jiao Tong University Hospital of Stomatology from 2014 to 2016??and four types of malocclusion were obtained class ??30 cases????class ??1 ??29 cases????class ??2??27 cases????class ??30 cases????according to the clinical occlusion. Sagittal sections of right upper and lower incisors were obtained by three-dimensional CBCT images using Invivo 5 software?? and Auto CAD 2007 software was used to measure the angle formed by the long axis of crown and root??Collum angle????and then analyzing the differences among groups were analyzed by single factor variance and compared by Scheffe method. Results??There were significant differences in the size of Collum angle among different types of malocclusion??P??0.05??. The Collum angle of upper incisor in class ??2 was ??7.02 ± 1.83??°??which was significantly larger than that of other groups. The Collum angle of lower incisor in Class ??1 was??-2.25 ± 4.76??°??which meaned that the crown could be lip side compared to the root??and there was significant difference compared with the other groups. The Collum angle of the lower incisor in class ?? was??8.15 ± 2.50??°??which was also significantly larger than other groups. Conclusion??There are significant differences in the Collum angle of the upper and lower incisors among different types of malocclusion. The crown of upper incisor in Class ?? 2 and lower incisor in Class ?? can be lingual side to the root??and the crown of lower incisor in Class II1 can be lip side compared to the root??which should be taken into consideration when the incisor is pulled backward or inclined to lip to avoid the root cutting through bone cortex.     

目测法评估床头抬高角度测量误差的分析

目的针对目前医院病床基本无配备床头抬高角度测量工具的现状,调查护士目测法评估床头抬高角度的测量误差,探讨使用精确测量工具的必要性。方法随机选择我院各护理单元主管护师、护师和护士各2名,共96名。采用目测法评估床头抬高15°、30°、45°三种角度,与角度尺精确测量法比较床头抬高角度的差异。结果目测评估床头抬高15°、30°、45°所产生的实际角度分别为（10.56±3.67）°、（19.54±6.58）°、（38.18±9.69）°,测量误差发生率96.2%,其中实际测量角度小于目标角度,占93.8%,实际测量角度大于目标角度,占2.4%,与角度尺测量方法比较,差异有统计学意义（P〈0.01）。结论目测法评估会影响有特殊卧位要求患者的治疗效果,并发症发生几率增加,应使用精确的测量工具。     

Scaphoid fracture geometrics: an assessment of location and orientation

The location and angle of scaphoid fractures are important attributes which guide management. We used a 3 dimensional scaphoid model, generated from CT scans, to map scaphoid fracture planes. The point at which the fracture plane crossed the central axis of the scaphoid was noted. The angle of the fracture planes with regard to the central axis was also noted. This allowed calculation of the location of the fracture and the angle of the 379 fractures. The mean point of intersection for fractures with the scaphoid axis was 50% along the scaphoid. Sixty percent of all fractures were found around the central 20% of the scaphoid. The mean angle between the scaphoid axis and the fracture plane was 63 degrees). On comparing angle with location, as fractures move away from the scaphoid waist, they become less perpendicular to the scaphoid axis (p?p?p?p?=?.018). There was no link between fracture plane angles and age, sex and union status. Most fractures occur at the centre of the scaphoid. There is a link between the location and angle of scaphoid fractures. It also identifies older patients and males are more likely to have more proximal scaphoid fractures.     

Oseltamivir (Tamiflu)-induced bilateral acute angle closure glaucoma and transient myopia

A 27-year-old woman developed bilateral acute angle closure glaucoma (AACG) and transient myopia after taking oseltamivir for four days. On the fourth day, she received systemic and topical intraocular pressure (IOP)-lowering agents, and IOP decreased in both eyes. However, her visual acuity was unchanged. A myopic shift of -5.25 D OD and -5.0 D OS was estimated to have occurred in the acute phase. A-scan ultrasonography and Pentacam showed markedly shallow anterior chambers and increased lens thickness. Ultrasound biomicroscopy revealed an annular ciliochoroidal effusion with forward displacement of the lens-iris diaphragm. Ciliochoroidal effusion and transient myopia were resolved after discontinuation of oseltamivir.