Predicting spontaneous early neurological recovery after acute ischemic stroke

We assessed predictors of spontaneous early neurological recovery after acute ischemic stroke by means of multivariate analysis in a cohort of 1,473 consecutive patients treated at one academic center. At hospital discharge, spontaneous neurological improvement or good outcome was defined as grades 0-2 of the Rankin scale, and poor outcome (no improvement or in-hospital death) as grades 3-5. Spontaneous recovery of neurological deficit at the time of discharge from the hospital was observed in 16% of patients with cerebral infarction (n = 238). Dysarthria-clumsy hand syndrome improved in 44% of patients and was the only variable significantly associated with in-hospital functional recovery in three logistic regression models that in addition to lacunar syndromes, included demographic variables, cardiovascular risk factors, and clinical variables [odds ratio (OR) 2.56], neuroimaging findings (OR 2.48), and outcome data (OR 2.39), respectively. Clinical factors related to severity of infarction available at stroke onset have a predominant influence upon in-hospital outcome and may help clinicians to assess prognosis more accurately. Our work gives a contribution into prognostic factors after acute ischemic stroke. With regard to patterns of stroke, dysarthria-clumsy hand syndrome was a significant predictor of spontaneous in-hospital recovery in ischemic stroke patients.     

Early parental adjustment to visible congenital disfigurement

Summary When a baby is born with a visible disfigurement, then parents need to adjust to the loss of the anticipated 'perfect' child and thus accept their baby. The impact of the birth on the parents is described in the context of a measure which identifies areas of potential difficulty. The two groups studied were parents of children with cleft palates and parents of children with congenital hand deficit. A wide range of adjustment was found. There was no significant difference between the two groups in terms of their overall adjustment, but there were individual differences in adjustment which did not relate to the severity or type of anomaly. The only significant variable found to relate to parental adjustment was perceived family support.     

Clinical diagnosis of trauma from occlusion and its relation with severity of periodontitis

The purpose of the present study was to determine the reliability of several selected signs of trauma from occlusion and their relations with severity of periodontitis. 32 moderate to advanced chronic periodontitis patients participated in the study. All teeth present were evaluated for various abnormal occlusal contacts, signs of trauma from occlusion, and the severity of periodontitis. Standardized periapical radiographs were also taken for each tooth. The results demonstrated that: (1) no significant difference occurred in probing pocket depth (PD), clinical attachment loss (AL), or percentage of alveolar bone height (BH) between teeth with and without various abnormal occlusal contacts, i.e., premature contacts in centric relation occlusion, non-working contacts in lateral excursions, premature contacts of anterior teeth or posterior protrusive tooth contacts; (2) teeth with either significant mobility, functional mobility, or radiographically widened periodontal ligament space (PDLS) had deeper PD, more AL and lower BH than teeth without these signs, while teeth with pronounced wear or radiographically thickened lamina dura had less AL than teeth without these findings; (3) 2 combined indices, i.e., the trauma from occlusion index (TOI) and the adaptability index (AI), were proposed for the identification of occlusal trauma and the response of periodontium to excessive biting forces in heavy function, respectively; TOI-positive teeth exhibit deeper PD, more AL and less osseous support than TOI-negative teeth; however, AI-positive teeth had less AL and more osseous support than AI-negative teeth; (4) with identical attachment level, TOI-positive teeth had less osseous support than TOI-negative teeth while the magnitude of difference became greater with an increase of attachment loss.     

前臂逆行骨间背侧皮瓣的临床应用

目的总结前臂逆行骨间背侧皮瓣的临床疗效。方法回顾性分析42例前臂逆行骨间背侧皮瓣，并结合文献阐明其变异程度及变异的处理。结果骨间背侧血管在前臂中1／3缺如1例．皮瓣边缘坏死；皮瓣向近端延伸超过4cm者4例，远端坏死，延迟愈合；其余均一期愈合：结论虽然前臂骨间背侧血管有变异，但前臂逆行骨间背侧皮瓣仍是修复手背中等大小创面较为理想的方法，以近点皮肤穿支向近端延伸皮瓣不要超过4cm。     

Komplexverletzungen des Fußes

Complex injuries of the foot are often overlooked, especially in the multiple injured patient, and they then lead to major loss of function. When the mechanism of injury suggests involvement of the foot, a clinical examination of the lower extremities should be included in the primary diagnostic procedures implemented in the multiply injured patient, followed by radiological examination once the patient's condition is stable. The condition of the soft tissues is of decisive importance in the prognosis of complex foot injuries, regardless of whether the damage to the foot is one component of a polytrauma or an isolated injury, which can also be life threatening. The diagnostic examinations selected should be adapted to the severity of the injuries in the particular multiply injured patient. Successful therapy involves stable internal fixation of injuries to bones and joints, though the external fixation options should be considered in the first instance, and carefully selected methods of temporary and definitive soft tissue reconstruction. The aim of treatment is the best possible reconstruction of the foot as a functional weight-bearing unit with intact soft tissue cover and a natural form. Good results can be achieved when there is close interdisciplinary cooperation between trauma (orthopedic) and plastic surgeons. Patient with severe injuries of this kind should be transferred to a trauma center as the first step toward this end.     

Dislocation of an upper third molar into the maxillary sinus after a severe trauma: a case report

Abstract – Dental injuries are common following facial trauma. This article presents a rare injury: the dislocation of a third molar into the maxillary sinus after complex mandibular and maxillary tuberosity fractures. The possible mechanism and clinical treatment are discussed.     

Early Intervention for Trauma: Current Status and Future Directions

Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.     

Variability in hand surface representations in areas 3b and 1 in adult owl and squirrel monkeys

Detailed microelectrode maps of the hand representation were derived in cortical areas 3b and 1 from a series of normal adult owl and squirrel monkeys. While overlap relationships were maintained, and all maps were internally topographic, many map features varied significantly when examined in detail. Variable features of the hand representations among different monkeys included a) the overall shapes and sizes of hand surface representations; b) the actual and proportional areas of representations of different skin surfaces and the cortical magnifications of representations of specific skin surfaces, which commonly varied severalfold in area 3b and manyfold in area 1; c) the topographic relationships among skin surface representations, with skin surfaces that were represented adjacently in some monkeys represented in locations many hundreds of microns apart in others; d) the internal orderliness of representations; e) the completeness of representations of the dorsal hand surfaces; and f) the skin surfaces represented along the borders of the hand representation. Owl monkey maps were, in general, internally more strictly topographic than squirrel monkey maps. In both species, area 3b was more strictly topographic and less variable than was area 1. The degree of individual variability revealed in these experiments is difficult to reconcile with the hypothesis that details of cortical maps are ontogenetically specified during a period in early life. Instead, we propose that differences in the details of cortical map structure are the consequence of individual differences in lifelong use of the hands. This conclusion is consistent with earlier studies of the consequences of peripheral nerve transection and digital amputation, which revealed that cortical maps are dynamically maintained and are alterable as a function of use or nerve injury in these monkeys (Merzenich et al., '83a,b, '84a; Merzenich, '86; Jenkins et al., '84; Jenkins and Merzenich, '87).     

高压氧结合针灸治疗脑外伤患者的效果观察与分析

目的:观察高压氧结合针灸治疗脑外伤患者的疗效。方法:对96例脑外伤患者采用高压氧、针灸配合药物进行综合治疗。同时,对83例对照组患者根据病情给予降颅压、抗感染、改善脑供血、保护脑细胞等治疗,有手术指征者行清除血肿、减压和清创术。结果:出院时两组患者功能比较,治疗组明显优于对照组,有显著性差异(P<0.O1),疗效治疗组也明显好于对照组。结论:高压氧结合针灸治疗能够明显提高脑损伤患者疗效,对肢体功能有明显提高。     

Successful treatment of blunt trauma involving complete laceration of the pancreas and duodenum in a 7-year-old child: Report of a case

The acute onset of peritoneal signs and shock in a 7year-old boy who had been hit in the epigastrium by a log-seesaw mandated surgical treatment. Enhanced computed tomography (CT) demonstrated complete laceration of the pancreas as well as duodenal injury, and a duodenoduodenostomy with distal pancreaticogastrostomy was subsequently performed. Temporary external drainage of the stomach and distal pancreas led to an uneventful recovery in the early postoperative period. Although the patient's postoperative development was appropriate for his age, the orifice of the distal pancreas spontaneously closed 2.5 years following surgery. We present this report to stress the fact that every effort should be made to preserve the pancreas following abdominal injury in children.