腹茧症16例诊治体会

目的 探讨腹茧症的诊断及治疗方法。方法 回顾性分析l6例腹茧症的临床资料及随访结果。结果 16例腹茧症均经手术治疗并确诊。术前11例误诊为机械性肠梗阻2～l0年，4例为误诊慢性阑尾炎，l例误诊为腹部肿块。术后并发症2例，全部患者均临床治愈。并获随访1～l0年，2例分别因反复发作肠梗阻于1年和5年死亡，2例反复发作不完全性肠梗阻合并营养不良，12例情况良好。结论 腹茧症术前诊断困难，上消化道造影和B超及CT对诊断可能有帮助；包膜切除，肠粘连松解是治疗本病的有效方法。     

Creation and Critique of Studies of Diagnostic Accuracy: Use of the STARD and QUADAS Methodological Quality Assessment Tools

Abstract

Clinical special tests are a mainstay of orthopaedic diagnosis. Within the context of the evidence-based practice paradigm, data on the diagnostic accuracy of these special tests are frequently used in the decision-making process when determining the diagnosis, prognosis, and selection of appropriate intervention strategies. However, the reported diagnostic utility of these tests is significantly affected by study methodology of diagnostic accuracy studies. Methodological shortcomings can influence the outcome of such studies, and this in turn will affect the clinician's interpretation of diagnostic findings. The methodological issues associated with studies investigating the diagnostic utility of clinical tests have mandated the development of the STARD (Standards for Reporting of Diagnostic Accuracy) and QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criterion lists. The purpose of this paper is to outline the STARD and QUADAS criterion lists and to discuss how these methodological quality assessment tools can assist the clinician in ascertaining clinically useful information from a diagnostic accuracy study.     

胰岛素瘤：附21例报告

目的探讨胰岛素瘤的术前定位方法与术中决策。方法对１９８２～１９９８年外科治疗的２１例胰岛素瘤进行回顾性分析。结果全组２１例,女１９例（９０５％）,男２例。年龄中位数为３６岁。术前均明确诊断为胰岛素瘤。但曾误诊癫痫７例,精神病２例,误诊率４２８％。Ｂ超定位准确者７５％,ＣＴ定位准确者５０％。结论胰岛素瘤定位较困难;Ｂ超、ＣＴ是术前较为实用的定位检查方法;如经各种检查仍不能定位时,可根据临床表现施行剖腹探查。手术方式首选胰岛素瘤剜除术,必要时也可行胰十二指肠切除或胰体尾切除。对无法彻底切除的恶性胰岛细胞瘤,应尽量切除原发和转移病灶。     

乳腺导管扩张症

目的　探讨乳腺导管扩张症的诊断和治疗。方法　对７６ 例乳腺导管扩张症的临床资料进行回顾性分析。结果　该病主要临床表现为乳房肿块（３１ 例,４０．７８ ％ ） ,脓肿（２４ 例,３１．５８ ％ ） ,乳头内陷（５２ 例,６８．４２ ％ ） ,乳头溢液（２１ 例,２７．６３ ％ ） ,乳瘘（２１ 例,２７．６３ ％ ） 。术前误诊率５５．２６ ％ （４２／７６） ,其中２０ 例（２６．３２ ％ ） 误诊为乳癌。本组均经手术治疗,治愈率为９２．１１ ％ （７０／７６） 。结论　乳腺导管扩张症易误诊,术中病理检查是确诊的可靠方法;彻底切除或切开病变的乳管是手术成功的关键。     

Manual Therapy in Children

Abstract

It has been proposed that patients with low back-related leg pain can be classified according to pain mechanisms into four distinct subgroups: Central Sensitization (CS), Denervation (D), Peripheral Nerve Sensitization (PNS), and Musculoskeletal (M). The purpose of this study was to determine whether there were any differences in terms of disability and psychosocial factors between these four subgroups. Forty-five subjects with low back-related leg pain completed the Oswestry Disability Index, the Hospital Anxiety and Depression Scale, and the Fear Avoidance Beliefs Questionnaire. Subsequently, an examiner blinded to the questionnaire results classified the subjects into one of the four subgroups, according to the findings of the self-administered Leeds Assessment of Neuropathic Signs and Symptoms questionnaire and a physical examination. It was found that the PNS subgroup had significantly greater disability compared to all other subgroups and significantly greater fear avoidance beliefs about physical activity compared to the CS and D subgroups. This highlights the importance of sub-classification but also the need to take into account disability and psychosocial factors in the management of low back-related leg pain.     

The influence of lower cervical joint pain on range of motion and interpretation of the flexion–rotation test

Abstract

Objective: The purpose of this study was to investigate the impact of lower cervical facet joint pain (CFP) on the flexion–rotation test (FRT).

Methods: A single blind, comparative group design was used to investigate whether lower CFP influences FRT mobility and examiner interpretation. Twenty-four subjects were evaluated, 12 with cervicogenic headache (age 26–63 years) and 12 with lower CFP (age 44–62 years), confirmed by therapeutic cervical facet joint intervention. A single blinded examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion using a goniometer. Subjects with lower CFP were evaluated by the FRT prior to therapeutic intervention and were excluded from analysis if they did not gain complete symptomatic relief following the procedure. Only subjects with immediate complete relief were included.

Results: The average range of unilateral rotation to the limited side during the FRT was 26 and 37.5° for the cervicogenic headache and lower CFP groups respectively. The difference between groups was significant (P<0.01). Sensitivity and specificity for cervicogenic headache diagnosis was 75 and 92% respectively. A receiver operating curve revealed that an experienced examiner using the FRT was able to make the correct diagnosis 90% of the time (P<0.01), with a positive cut-off value of 32°.

Discussion: These findings provide further evidence for the clinical utility of the FRT in cervical examination and cervicogenic headache diagnosis.     

Physical Therapy Exercise Intervention Based on Classification Using the Patient Response Method: A Systematic Review of the Literature

Abstract

It has been suggested that inclusion into a study that categorizes patients in mutually exclusive, clinometric classifications should improve the outcome of an exercise based randomized clinical trial. This review examined the evidence regarding the effectiveness of physical therapist-directed therapeutic exercises when patients were classified using the patient response method. This systematic literature review restricted article inclusion to English-only articles that classified homogenous samples of low back pain patients using the patient response based method, demonstrated physical therapist-directed exercise interventions, and used specific outcome criteria for assessment of patient improvement. The PEDro scale was used to rate the methodological quality of the studies. Of 82 articles reviewed only 5 articles were accepted. All 5 met the PEDro standards for a high-quality study. Of the 5 articles, 4 demonstrated that physical therapy exercise intervention based on the patient response method of classification were significantly better than the pragmatic control comparisons; the remaining article indicated that exercise was less effective than manipulation. There appears to be a trend toward positive outcomes with physical therapy exercise intervention in trials restricted to the patient response method of classification; however, few studies have investigated this phenomenon.     

Management of Low Back Pain: A Case Series Illustrating the Pragmatic Combination of Treatment- and Mechanism-Based Classification Systems

Abstract

This case series describes the pragmatic use of a treatment-based classification system for the management of four patients with a chief complaint of low back pain. Patients were initially classified into stabilization, manipulation, or specific exercise subgroups based on history and clinical examination. Each patient was reassessed during the course of clinical care to determine whether to continue treating according to the initially assigned subgroup or to alter management and incorporate a mechanism-based classification addressing identified impairments. Patient #1 was initially classified in the manipulation category. Within three visits, he reported being "a great deal better" on the Global Rating of Change (GROC) and had a 6-point improvement in his Oswestry Disability Index (ODI). Patient #2, classified in the specific exercise/extension category, reported being "moderately better" using the GROC and had a 22-point improvement in her ODI within six visits. Patient #3, classified in the stabilization category, reported being "a very great deal better" on the GROC and had a 30-point improvement in his ODI Index within four visits. Patient #4 was categorized initially in the manipulation category and subsequently in the specific exercise category; after five visits, he noted being "quite a bit better" using the GROC and he reported a 58-point improvement on his ODI. All four patients in this study were managed using a dynamic pragmatic treatment-based classification approach that allowed for the change of subgroup classification and treatment of impairments and all achieved a clinically meaningful improvement in pain and disability.