Anulus fibrosus in bulging intervertebral disks

In this investigation the association of radial tears of the anulus fibrosus and bulging of the intervertebral disk was studied. An index of disk bulging was measured in sagittal anatomic sections in 149 lumbar disks from 31 cadavers. The indexes of disk bulging were correlated with stages of disk development and the presence of an annular tear. The largest disk-bulging indexes were always associated with radial tears of the anulus. Eighty-four percent of the disks with radial tears had disk-bulging indexes greater than 2.5 mm. Most normal adult disks had an index of less than 2.5 mm. The results challenge the concept that the anulus fibrosus is intact in bulging disks, although ruptured in herniated disks.     

痛

黑暗!黑暗!!黑暗!!!这样的世界看不到半点光明。孤独的舞者终究还是孤独地倒下,然后又孤独地消失。黑暗呀,为什么老是缠绕着我?一声“妈妈”划破了天际,却也突不出黑暗的包围。谁来应我一声呀,妈妈,你在哪里呀?我的心在不停地挣扎,告诉自己:“不怕,不怕。”可这是在黑暗里呀,周     

Evaluation of restoration of extensor pollicis function by transfer of the extensor indicis

The aim of this study was to assess long-term results of extensor indicis (EI) to extensor pollicis longus (EPL) transfers and to assess donor site morbidity. A specific EI-EPL evaluation method (SEEM) was used to measure EPL function after transfer. The outcomes in 17 patients are presented. Results were assessed by the Geldmacher score, the SEEM, mobility and strength of thumb and index finger, pinch and grip strength, and a questionnaire, comparing the operated and non-operated hands. Based on the SEEM, the results were excellent to good in 11 of 17 patients. There was no marked loss of independent extension of the index finger and only a 38% loss of extension strength.     

Early stage nasopharyngeal carcinoma: radiotherapy dose and time factors in tumor control

OBJECTIVE: To evaluate radiotherapy dose and length of treatment in the control of early stage nasopharyngeal carcinoma (NPC) treated with a combination of external radiotherapy and brachytherapy, MATERIALS & METHODS: We reviewed the records of 133 patients with early stage nasopharyngeal carcinoma (stage I or II, AJC/UICC staging system) who received definitive radiotherapy in Chang Gung Memorial Hospital from 1979 to 1991. The median follow-up time was 7.1 years with a minimum of 2 years. All patients were treated with megavoltage external radiotherapy to the nasopharynx area (63-72 Gy) followed by high dose rate intracavitary brachytherapy (5-16.5 Gy in one to three fractions, spaced 1-2 weeks apart). The median total dose and time of irradiation was 75 Gy (69.8-81.4 Gy) and 11.6 weeks (7.8-20 weeks) respectively. Survival analysis was used to examine the effect of several variables on prognosis. RESULTS: The 5-year rates were 86.4% for local control, 84.7% for disease free survival, 88.5% for actuarial survival and 84.2% for overall survival. The treatment group (combination of time and dose of irradiation) was the most important prognostic factor according to Cox's proportional hazard model. Patients receiving radiation at a total dose of < or = 75 Gy completed in < 12 weeks showed the best prognosis. CONCLUSION: Treatment time and total treatment dose are both important factors in treating early stage NPC. Decreasing the total radiation time to < 12 weeks and not exceeding a radiation dose of 75 Gy gave the best results.      

Individuelle Therapieziele bei diabetischer Retinopathie und Makulopathie

Prospective randomized studies show that the prevalence and incidence of diabetic retinal complications can be reduced by consistent and suitable adjustment of blood glucose and blood pressure. However, if diabetic retinopathy or maculopathy develop they must be recognized as early as possible and treated according to the stage enabling inclusion of intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors or corticoids in the therapy concept. After operations for age and/or diabetes-related cataracts, diabetic retinal damage, in particular previously existing damage can deteriorate. Therefore, it is important to perform a timely examination and if necessary to treat as soon as possible. In cases of visual impairment or blindness due to diabetic retinopathy or maculopathy despite all therapeutic efforts, visual rehabilitation using magnifying visual aids or by orientation and mobility training can enhance patient independence and quality of life.     

Are chlorhexidine-containing dressings safe for use with ventricular drainages?

The purpose of this report was to assess the safety and application of chlorhexidine (CHG)-containing dressings—shown to reduce central line infection rates markedly—for external ventricular drainages (EVDs) and lumbar drainages (LDs). Cerebrospinal fluid samples of patients receiving standard dressings and CHG-containing dressing (ten each) were analyzed by high-performance liquid chromatography for the presence of CHG. The application was evaluated. CHG was not detectable in all samples. The dressings’ application for EVDs and LDs worked without problems. Thus, the use of CHG-containing dressings for EVDs and LDs seems to be safe. Further studies addressing their infection reduction potential are warranted.