Comparison of three standard radiologic techniques for screening of patellar subluxations

The presence of many "abnormal" types of PF joints in asymptomatic cases and the frequent unilateral complaints in morphologically symmetric joints indicate that emphasis must be placed on factors that cause "abnormal" PF joints to decompensate, rendering them symptomatic. These factors include hyperlaxity, puberty, overuse, or athletic activities. It is our conviction that full understanding of PF problems needs dynamic, three-dimensional motion analysis of patellofemoral relationships. At the present time these imaging techniques do not exist, as they require more powerful computer capacities. The absence of strict and reliable relationships between radiographic anomalies and clinical symptoms brings two reflections about the treatments in symptomatic cases: It is common sense to treat PPS by conservative methods first. Our study indicates that the goal should be to turn the symptomatic patella into an asymptomatic one, rather than correcting maltracking by vastus medialis training. The high failure rates at long-term follow-up of patellar maltracking correction by surgical methods such as lateral release and tibial tubercle transfer show us that correction of part or all of the anomalies does not always make the symptoms disappear. A nice lesson in humility for the orthopedist.     

Quantification and validation of left ventricular wall thickening by a three-dimensional volume element magnetic resonance imaging approach

We have developed a method to quantify and map regional wall thickening throughout the left ventricle (LV) with magnetic resonance imaging. In contrast to methods that measure planar wall thickness and thickening, this method uses the three-dimensional (3D) geometry of the left ventricle to calculate the perpendicular thickness of the wall. We tested this method at three levels of increasing complexity using 1) phantom studies, 2) in vivo experiments in dogs with normal cardiac function, and 3) in vivo studies in dogs during acute ischemia. Experiments were conducted in 15 open-chest dogs imaged by a 0.38 T iron core magnet. Five short-axis images at end diastole and end systole were obtained with the spin echo technique by use of the QRS as a trigger for end diastole and the second heart sound, S2, to time end systole. After acquisition of preischemic images, acute ischemia was induced by either coronary artery ligation (n = 5) or intracoronary dental rubber injection (n = 5), which produced severe transmural ischemia. By use of computer-aided contouring of the endocardial and epicardial borders, each image was divided into 16 segments with radial lines originating from the midwall centroid. A 3D volume element was defined as that generated by connecting two matched planar segments in two adjacent image planes. This defined 64 volume elements comprising the entire left ventricle. Thickness and thickening before and during ischemia were then calculated by using the planar segments and the 3D volume elements. In phantom studies, the 3D method was accurate, independent of the angle of inclination of the image plane to the phantom wall, whereas the planar method showed considerable overestimation of thickness when the image plane was oblique to the phantom wall. In the dogs before induction of ischemia, the 3D method demonstrated the well-established normal taper in end-diastolic wall thickness from 1.10 +/- 0.02 cm at the base to 1.05 +/- 0.11 cm at the apex (p less than 0.01). By contrast, the planar method did not detect the decrease in thickness toward the apex (1.13 +/- 0.07 cm at the base vs. 1.16 +/- 0.14 cm at the apex, p = NS). During acute ischemia, thickening was calculated by both methods at the center of the ischemic zone defined by Monastral blue nonstaining and compared with the preischemic values.(ABSTRACT TRUNCATED AT 400 WORDS)     

食道心房调搏负荷试验QTd变化对冠心病的诊断价值研究

目的研究经食管心房调搏负荷试验 (TEAPT)中 ,QTd变化指标对冠心病的诊断价值。方法 5 0例研究对象在作冠状动脉造影术前后一周内进行TEAPT ,记录试验前及试验峰值末的常规 1 2导联心电图。测定静息及负荷峰值的QTd、QTcd(QTdr、QTcdr ,QTdp、QTcdp) ,计算QTdp与QTdr差值(QTdp r)及QTcdp与QTcdr差值 (QTcdp r) ,并比较此各项指标间及与ST段压低标准间的诊断效能。结果冠心病 (CAD)组 (n =2 7)的QTdp、QTcdp、QTdp r、QTcdp r值显著大于冠脉正常 (NCAD ,n =2 3)组(t≥ 5 38,P <0 0 0 1 ) ,此 4个QTd有关参数在NCAD组的 95 %上限值分别为 6 0ms、95ms、2 0ms、5 5ms。以它们为界限值 ,4个参数诊断冠心病的特异性均显著大于ST压低标准 (P <0 0 5 ) ,QTdp r的敏感性显著高于ST压低标准 (P <0 0 5 ) ,准确性显著高于QTcdp、QTcdp r及ST压低标准 (P <0 0 5～ 0 0 1 )。结论QTdp r是TEAPT诊断CAD的准确新指标。     

Elevated intraocular pressure and myopic shift linked to topiramate use.

PURPOSE: The purpose of this report is to describe acute myopia as an ocular adverse reaction to topiramate (Topamax, Ortho-McNeil, Raritan, NJ) and discuss the importance of recognizing this syndrome. METHODS: Retrospective case report and brief review of the literature. RESULTS: A 27-year-old female patient developed decreased vision in both eyes due to acute myopia 2 weeks of after initiating therapy with topiramate. Emergency department evaluation revealed visual acuities of 20/400 right eye and 20/200 left eye. Intraocular pressures were 33 mm Hg right eye and 26 mm Hg left eye. The anterior chambers were shallow. Retinal striae were present in the maculae. The patient stated no previous need for optical correction. However, after initiating treatment with topiramate, she refracted to approximately -5.00 D bilaterally. Ultrasound testing revealed that the patient had suprachoroidal effusions in both eyes. The symptoms and clinical findings resolved completely with discontinuation of topiramate, administration of topical atropine 1% and prednisolone acetate 1%. CONCLUSIONS: An acute myopic shift may be the presenting sign of an idiosyncratic drug reaction that can include secondary bilateral angle closure glaucoma. This condition can occur in patients who do not have a history of anterior chamber abnormalities. Recognizing this condition and discontinuing the use of the causative drug may prevent angle closure and associated vision loss.     

贵州省社区高血压危险因素的Logistic回归分析及高血压社区防治行为干预措施的思考

方法 普查贵州省黔灵镇社区15岁以上人群6361人，占社区总人口的23．9％。对调查结果作与高血压有关危险因素的逐步Logistic回归模型多因素分析。结果 本社区与高血压发病关系密切的因素有年龄、性别、饮酒、家族史、体质指数、臀腰围比，其中年龄、家族史、性别属非行为危险因素，饮酒、体质指数、臀腰围比是与行为危险因素有关的可干预因素。结论 针对本社区高血压主要的行为危险因素采取限酒、膳食平衡和运动等有效干预措施。贵州省高血压社区防治工作不可轻视。