Inclusion body myositis with abundant ring fibers

Summary A 37-year-old male presenting with a 7-year history of leg weakness was found to have moderate weakness confined to the quadriceps and myopathic changes on electromyography. Serum creatine phosphokinase was 2130 units/liter. Biopsy of the quadriceps muscle revealed an inflammatory myopathy with cytoplasmic and nuclear filamentous inclusions characteristic of inclusion body myositis. An unusual finding was the large proportion of ring fibers along with severe atrophy and fibrosis. The pathogenesis of the ring fibers in this setting is discussed.     

光谱核型分析联合微阵列比较基因组杂交诊断15号环状染色体综合征

目的 探讨联合应用光谱核型分析技术(spectral karyotyping,SKY)和微阵列比较基因组杂交技术(microarray-based comparative genomic hybridization,array-CGH)在诊断复杂疑难的环状染色体畸变中的价值.方法 对1例常规G显带染色体核型分析疑诊为46,XY,r(15)?的8岁男性生长发育迟缓患儿依次应用SKY及array-CGH技术常规进行制片杂交,并通过相应的显微摄像系统和计算机软件分析结果.结果 SKY技术明确了该患儿环状染色体来源于15号染色体,array-CGH技术明确患儿15q26.3末端存在约594 kb的缺失,染色体基因位点编码范围为99689349-100282878.结论 联合应用现代分子细胞遗传学技术可以从细胞到分子水平精确诊断复杂疑难的环状染色体病例,是常规染色体核型分析的有益补充,也有利于细胞遗传学向分子水平深入.     

Women's experiences with vaginal pessary use

Title.  Women's experiences with vaginal pessary use.
Aim.  This paper is a report of a study of the lived experiences of women using vaginal pessaries for the treatment of urinary incontinence (UI) and/or pelvic organ prolapse.
Background.  The use of a vaginal pessary offers a non-surgical treatment option to provide physical support to the bladder and internal organs. As the literature asserts, a woman's choice to use a pessary is very individual and involves not only physical, but also psychological and emotional considerations.
Method.  Narrative inquiry was used to conduct face-to-face semi-structured interviews in 2007 with 11 postmenopausal women who accessed services from a Urogynecology Clinic in Eastern Canada.
Findings.  The women's stories revealed that living with a pessary is a life-changing experience and an ongoing learning process. The women's comfort level and confidence in caring for the device figured prominently in their experiences. Psychosocial support provided by the clinic nurses also played a primary role in the women's experiences.
Conclusion.  Women and healthcare professionals need to be aware of the personal isolation and embarrassment, and social and cultural implications that urinary incontinence may cause as well as the subjective experiences of using a pessary. With appropriate support, vaginal pessaries can provide women with the freedom to lead active, engaged and social lives.     

纤维支气管镜序贯取材法对肺癌的诊断价值

目的观察经纤维支气管镜针吸术对肺癌的诊断价值。方法对180例肺癌患者在纤支镜检查的过程中，采用针吸术，结合钳夹、刷检等序贯取材法收集病理标本，分析各种方法诊断肺癌的阳性率。结果针吸活检、钳夹活检、刷检阳性率分别是70％、80％、67％，针吸活检结合钳夹、刷检阳性率91％；3种单独的取材方法，其阳性率差异并无统计学意义（P〉0．05）；但采用序贯取材法后，诊断肺癌的阳性率明显高于各种单独的取材方法，差异有统计学意义（P〈0．01）。结论纤支镜检查对肺癌的诊断有重要价值，对于疑似肺癌患者应尽可能联合使用多种取材方法，以提高纤支镜检查对肺癌的诊断率。     

Pitfalls in using the ring finger test alone for the diagnosis of carpal tunnel syndrome

Latency differences (>0.5 ms) of median and ulnar sensory action potentials (mSAP and uSAP) at the wrist evoked by ring finger stimulation are considered a sensitive and specific test for diagnosis of carpal tunnel syndrome (CTS). In this study, we aimed to assess the practical usefulness of the ring finger test (RFT) in routine electromyography (EMG) examinations. We investigated 2 series of patients: in the first prospective series we considered 300 hands affected by only mild CTS; in the second series we examined retrospectively the EMG charts of 961 hands affected only by CTS but not selected for severity or duration of symptoms. In the first series we found pathological RFT scores in 87% of cases, and pathological RFT or mSAP latency results in 92%. In the second series, pathological RFT scores were found only in 55% of cases, while in 20% where mSAP failed, a volume conducted uSAP had been erroneously interpreted as arising from the median nerve. RFT sensitivity tested in routine EMG examinations of unselected hands affected by CTS drops considerably. Fingers innervated by one only nerve, such as the index and the little fingers, must also be investigated to increase the diagnostic value of RFT.

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Sommario La differenza (>0.5 ms) tra le latenze distali dei potenziali sensitivi di mediano e ulnare (mSAP e uSAP) registrati al polso ed evocati per stimolazione al quarto dito (ring finger test, RTF) viene considerato un test sensibile e specifico per la diagnosi di sindrome del tunnel carpale (CTS). Sono state studiate 2 serie di pazienti: nella prima serie prospettica abbiamo esaminato 300 mani affette da CTS lieve, in cui mSAP e uSAP dopo stimolazione al quarto dito potevano essere chiaramente differenziati. Il RFT era patologico nell'87%. Considerando insieme il risultato del RFT e il valore assoluto della latenza distale del mSAP dal quarto dito, almeno uno dei test era patologico nel 92% dei casi. Nella seconda serie sono stati esaminati retrospettivamente i referti EMG di 961 mani non selezionate affette esclusivamente da CTS. Attraverso il solo RFT solo il 55% delle diagnosi sarebbero state classificate correttamente, perchè in 20% un uSAP volume condotto era stato erroneamente interpretato come proveniente dal mediano. Dita innervate da un solo nervo come il secondo dito ed it quinto dito devono essere esaminate per aumentare il valore diagnostico del RFT in esami di routine.

     

Experiences with total Hip Replacement Arthroplasty Ad Modum Ring

The results of total replacement of the hip joint ad modum King are presented. The review includes 63 hips (from among the total number of cases operated by the various methods) followed up for periods ranging from 6 months to 5 years. The assessment has shown excellent results in 33.3 per cent, good results in 50.8 per cent, fair in 9.5 per cent and poor results in 6.4 per cent. Advantages and disadvantages of the method are discussed.     

Gonadal dysgenesis and somatic stigmata in patients with 45,X/46,Xr(X) ring chromosome

Two cases of gonadal dysgenesis and stigmata of Turner's syndrome with ring chromosome X are described. Their features support the idea that ring chromosome X should be considered as a deletion in the genetic sense, affecting both the gonadal and statural determinants. Without knowing the cytogenetic findings, these patients are usually labeled as having Turner's syndrome. Furthermore, endocrine data and histologic examination of the gonads are indistinguishable from those of individuals with 45,X or 46XX gonadal dysgenesis.     

Short-term brain atrophy changes in relapsing-remitting multiple sclerosis

The objective of this study was to establish whether the time interval of 3 months is sufficient to detect whole-brain atrophy changes in patients with relapsing-remitting (RR) multiple sclerosis (MS). Another aim was to assess the value of monthly gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) and of different Gd-enhancement patterns as predictors of brain atrophy. Thirty patients with RRMS (mean disease duration 4.9 years, mean age 34.4 years and mean Expanded Disability Status Scale [EDSS] 1.4) were assessed at baseline and monthly for a period of 3 months with clinical and MRI examinations. Calculations of baseline and monthly absolute and percent changes of MRI measures have been obtained using two semiautomated (Buffalo and Trieste) and one automated (SPM99) segmentation method. Changes of brain parenchymal fraction (BPF) were investigated according to Gd-enhancement patterns. Mean absolute and percent changes of BPF did not significantly differ at any time point in the study for any of the three methods. There was slight but not significant decrease of BPF from baseline to month 3: -0.0004 (0.05%), p=0.093 for Trieste; -0.0006 (0.07%), p=0.078 for Buffalo; and -0.0006 (0.08%), p=0.081 for SPM99 method. In ring-enhancement positive patients, there was a significant difference between baseline and month 3 changes of BPF, EDSS, and number of relapses. Over the study period, we did not demonstrate differences between changes of BPF according to the presence of Gd enhancement. Longitudinally, multiple regression analysis demonstrated that the only clinical or MRI parameter that predicted BPF decrease was the mean absolute change of ring-enhancing lesion load (R=0.62, p=0.003). The noteworthy findings of this study are (1) the observation that a significant brain atrophy progression cannot be detected over a 3-month period in RRMS; (2) the demonstration that the ring-enhancement pattern may contribute to more severe brain tissue loss in the short term; and (3) the lack of relationship between the presence and duration of Gd-enhancement activity and brain volume changes in the short term.     

分体式髌骨爪与髌骨环固定治疗髌骨骨折的疗效比较

目的：探讨髌骨环固定术治疗髌骨骨折的疗效和指导临床治疗。方法选取该院66例髌骨骨折患者,对照组30例采取分体式髌骨爪手术方法,治疗组36例采用髌骨环固定手术方法,观察两组患者术后一般情况、膝关节功能恢复情况及并发症发生情况。结果对照组采取分体式髌骨爪手术方法治疗后,膝关节功能活动完全恢复患者10例,基本恢复患者8例,大部分恢复患者4例,预后不良患者8例,患者恢复优良率为73.3%明显低于治疗组的16例、7例、10例、3例以及91.7%。治疗组患者膝关节功能活动恢复情况更佳。结论采用髌骨环内固定术治疗髌骨骨折并不会增加患者痛苦,疗效较为肯定,安全性高,可以显著提高临床疗效,改善术后康复质量,值得临床加深研究及推广应用。     

直肠黏膜硬化注射内固定术治疗56例环状混合痔疗效观察

目的探讨直肠黏膜硬化注射内固定术加外剥内夹硬注术治疗环状混合痔的临床疗效。方法采用直肠黏膜硬化注射内固定术和外剥内夹硬注术的方法,对56例环状混合痔患者进行手术治疗。结果本组56例,其中52例达到临床治愈,治愈率为92.86%,4例达到好转。手术时间为45～110min,平均62min;术中出血量为20～50mL,无继发大出血。结论采用直肠黏膜硬化注射内固定术加外剥内夹硬注术治疗环状混合痔,对肛垫有悬吊、固定作用,使下移的肛垫得以复位,进一步加强了手术疗效,具有安全、有效、方法简便、恢复快等优点,故该术式符合痔的现代病理和生理概念,值得推广。