Objective To investigate the effects of the site for access to internal jugular vein (lateral versus anterior),lying position of patients (supine versus Trendelenburg),and head rotation (0°,20°,and maximum) during central venous catheterization on the location depth and cross-sectional area (CSA) of the right internal jugular vein (IJV).Methods Fifteen healthy volunteers were recruited in this prospective observational study from September 2008 to October 2008.Healthy volunteers were placed in flat supine position and 15°.Trendelenburg position separately.In each position,IJV were measured ultrasonographically from lateral site and anterior site with the head oriented at 0°,20°,and maximum rotation separately.Data of measured CSA and location depth of internal jugular vein in different positions were compared.Results The largest CSA (2.16 ±0.89) cm2 and location depth [(1.38 ± 0.43)cm] were occurred at the lateral approach in Trendelenburg position with head oriented at maximum rotation.The CSA in Trendelenburg position was larger than that in flat supine position.Only at the maximum head rotation,lateral approach got statistically larger CSA.The effects of head rotation varied with different degrees of rotation.Conclusions Site of approach,lying position and head rotation had noticeable effects on internal jugular vein cross-sectional area.Trendelenburg position increased the CSA of IJV.

Objective To systematically review the existing evidence about the effect of medial and lateral (crossed) entry pins versus only lateral entry pin fixation on the supracondylar fractures of the humerus in children.Methods Eligible studies were identified in Cochrane library,the Cochrane Bone,Joint and Muscle Trauma Group (till March 2011 ),Medline (from 1966 to March 2011 ),EMbase (from 1966 to 2011 ),CBM (from January 1979 to March 2011 ),PubMed,Wanfang Data (from 2000 to March 2011 ) and CNKI and the references of the included studies and several Chinese orthopedic journals were manually searched.Then,the randomized controlled trials (RCTs) and quasi-randomized controlled trials (CCTs) about two entries (crossed and only lateral pinning) for supracondylar fractures of humerus in children were collected.After evaluation of methodology with the enrolled studies,available data was extracted and systematic review was conducted via the method recommended by the Cochrane Collaboration.Results In total,five RCTs involving 311 patients were involved.Compared with the preoperative data,the meta-analysis results showed no significant difference in reduction stability in terms of change in Baumann angle and Carrying angle between the two groups.For the postoperative function outcome including complete reduction,Flynn grade and full return to function,no significant difference was found between the two groups.For the postoperative complications,there was no difference in the infection of pin tract,though lateral entry resulted in a significant lower incidence of the iatrogenic nerve injury compared with the medial and lateral entry.Conclusions With the Kirschner wire fixation for supracondylar fractures of humerus in children,current existing evidences indicate that the lateral entry of pinning has similar results in reduction stability,function outcome and incidence of pin tract infection compared with medial and lateral entry.Nevertheless,lateral entry,as a safe pinning technique,may effectively decrease the risk of iatrogenic nerve injury

Adult ; Diagnosis, Differential ; Female ; Humans ; Nevus, Sebaceous of Jadassohn ; diagnosis ; pathology ; Psoriasis ; diagnosis ; pathology

OBJECTIVETo investigate the clinical experiment of cortical screw in the treatment of tibiofibular syndesmosis separation together with ankle fractures.

METHODSFrom March 2008 to May 2012,42 patients with tibiofibular syndesmosis separation were treated with cortical screw, including 20 cases in the left and 24 cases in the right. All the patients had closed injury. According to Lauge-Hansen classification, there were 18 cases of supination-external rotation, in which 4 patients with injuries belong to type II, 8 patients with injuries belong to type III, 6 patients with injuries belong to type IV; 14 cases of pronation-external rotation, in which 6 patients with injuries belong to type III, 8 patients with injuries belong to type IV; and 12 cases of pronation-abduction, in which 4 patients with injuries belong to type II, 8 patients with injuries belong to type III. According to injury of ankle, 4 patients had injuries in one ankle, 28 patients had injuries in 2 ankles, and 12 patients had injuries in 3 ankles. All the patients were diagnosised definitely in sight of medical history, checking-up, iconography. The clinical effects were evaluated based on Baird-Jackson score and activity degree of ankle.

RESULTSAll the patient were followed up, and the duration ranged from 11 to 23 months, with an average of 15.7 months. No postoperative wound infection, nonunion, and tibiofibular syndesmosis separation again and other complications occurred. Postoperative Baird-Jackson score exhibited 91.56 ± 6.26 (75 to 99), and 26 patients got an excellent result, 10 good, 6 poor and 2 bad. One patient had nail broken after operation,and got good function after removing broken nail without external fixation. Other 1 patient had osteoarthritis to 1 degree, and got better result with the treatment of physical therapy and intra-articular injection.

CONCLUSIONCortex screw is the effective treatment for tibiofibular syndesmosis separation. Clear diagnosis, delicate operation and postoperative reasonable functional exercise are primary factor of prognosis.

Adult ; Ankle Fractures ; surgery ; Ankle Joint ; surgery ; Bone Screws ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Treatment Outcome

Objective To determine the association between homocysteine and severity of large cerebral artery atherosclerosis.Methods Total 152 ischemic stroke patients were evaluated using transcranial Doppler(TCD),magnetic resonance angiography(MRA) or digital substraction angiography(DSA).Severity of cerebral artery atherosclerosis was scaled by number of stenosed or occluded artery.Results There were 83 patients in low level homocysteine group with mean Hcy level(15.31?3.08)?mol/L,while 69 patients in high level homocysteine group with mean Hcy(34.47?21.38)?mol/L.Number of abnormal intra-and extra-artery was 1.86?1.51 and 1.52?1.46 respectively.No significant difference was demonstrated in the number of abnormal artery between two groups.No correlation was noted between Hcy and number of abnormal artery.Conclusion There is no relationship between high homocysteine and severity of large cerebral artery atherosclerosis in ischemic stroke patients.Homocysteine might be the marker of the disease.

Objective To investigate the diagnostic value of 1H magnetic resonance spectroscopy (1H-MRS) in mammary tumors and to discuss the technique factors which influence the detection rate.Methods The 1H-MRS features of 47 mammary tumors, of which 24 malignant tumors and 23 benign tumors confirmed by pathology were analyzed. All of the tumors were detected before Gd-DTPA enhancement. Results Eleven of 24 malignant tumors showed increased choline resonance peak at 3.24 ppm while 4 of 23 benign ones at 3.24 ppm .The positive value were 45.8% and 17.4% respectively. The sensitivity and specificity were 45.8% and 82.6% respectively by using 1H-MRS to discriminate benign from malignant tumors. The main factors influencing the detection rate were low suppressed lipid, low suppressed water and low single-noise rate.Conclusion Choline is not special features of malignant tumors. Choline can be obtained despite the nature of tumor if they grow rapidly. The low sensitivity of choline to be detected mainly dues to technique factors.

OBJECTIVE To summarize the use of intraoperative neuromonitoring system for monitoring and protection of recurrent laryngeal nerve during thyroid surgery. METHODS There were 21 cases in this study, included 5 cases with thyroid cancer, 9 cases with thyroid benign tumor and 7cases with hyperthyroidism. Intraoperative neuromonitoring system includes the host monitor, stimulus detection pin of recurrent laryngeal nerve, special EMG endotracheal intubation tube which contacts vocal cord, grounding conductive circuit electrode, and anti-jamming probe. Operation method: a "three-step method" was adopted. First we revealed the cervical vagus nerve trunk and tested our instruments, and then dissected and protected the recurrent laryngeal nerve, followed by removal of thyroid tissue. RESULTS In all 21 patients, operative side recurrent laryngeal nerve were exposed from lower thyroid blood vessels to the larynx. All patients were phonated as well as before operation, and without drinking cough. CONCLUSION The intraoperative neuromonitoring system can avoid damage of the recurrent laryngeal nerves when we exposed the recurrent laryngeal nerve before resection of the thyroid tissue and tumor.

Objective To evaluate the image deformation and measurement error of rotational DSA by model experiment. Methods Five steel balls (diameter: 20 mm) were placed in a horizontal space of 30 mm, the middle of which was as the isocenter for rotational DSA acquisition. Another 5 steel balls (diameter: 10 mm) were placed in a vertical space of 30 mm with the same alignment for rotational DSA acquisition. The screen was divided into five regions and the morphological changes of the ball image were observed at each rotation angle. The experimental images of the left anterior oblique ball images at 20°, 40°and 60° among each two groups were selected and measured by automatic isocenter calibration and sphere calibration respectively, and compared with the actual diameters of balls to calculate the image magnification. Results Except the center one, other balls were of deformation at different rotation angles due to the distance to the detector leading to enlargement and reduction. With automatic isocenter calibration, only the diameter of the center ball corresponded with the actual one, the distance away from the center or the rotation angle was inversely proportional to measurement error (maximum magnification 12.42%).With sphere calibration, the measurement results in various regions at different rotation angle were basically the same, with smaller measurement error (maximum magnification 3.41%). Conclusion Placing the organ of interest in the center area can reduce image distortion in rotational DSA imaging. Selecting reasonable measuring technology according to the lesion location is helpful to control measurement errors.

Objective To observe the relationship of awake bispectral index (BISawake) and the postoperative cognitive dysfunction (POCD). Methods 100 patients aged 60~75 years with ASA status Ⅰ~Ⅱ, underwent elective lower abdominal surgery with intravenous anesthesia (propofol, remifentanyl and rocuronium). The BIS was adjusted in 40~60 during the surgery. Their cognitive function was assessed with the neuropsychological test battery commended by International study of postoperative cognitive dysfunction (ISPOCD). Results 8 patients withdrew for unwilling or serious complications. The BISawake was more than 65 in 68 patients (group A), and less than 65 in 24 patients (group B). The difference of the verbal learning immediate and delayed of Hopkins Verbal Learning Test-Revised was more in the group B than in the group A. Conclusion Lower BISawake may be associated with the decline of postoperative cognitive function.

Objective To assess the effectiveness of iterative metal artifact reduction (IMAR) on metal artifacts reduction in thorax scan.Methods Thoracic phantom with two pedicle screws implanted in both sides of the T5 vertebrae was used,with the scan parameters of 130 kV and CARE Dose 4D,the phantom was scanned with and without the screws respectively.Images without screws were reconstructed with FBP.Images with screws were reconstructed with FBP and IMAR respectively.Three ROIs were selected on tissues including aorta,pulmonary and paravertebral soft tissue on image slice adjacent to the screws.The CT value and standard deviations (noise) of ROIs were measured,and the deviation of CT value (△HU) was calculated as the difference between CT values in images with and without screws.Twenty-six cases who received chest CT examination and with pedicle screw implant in scanning range were collected.The scanning parameters and image reconstruction methods were the same as phantom scan.The CT value (HU) of metal artifacts adjacent to vertebrae and dorsal soft tissue was measured,and the image quality of reconstructed image by two skilled radiologists independently was evaluated.Results In the phantom after implanted screws,the noise were significantly reduced by IMAR compared to FBP in all the three ROIs of aorta,pulmonary and paravertebral soft tissue (P＜0.05),and the △HU was significantly smaller in IMAR compared to that with FBP (P＜0.01).In 26 patients,there were significant differences in CT value of vertebral bone tissue and dorsal soft tissue between FBP and IMAR (P＜0.05),and the subjective evaluation scores of the two image reconstruction methods showed a statistically significant difference (P＜0.05).Conclusion IMAR can significantly reduce streak artifacts of metal implant and adjuste the CT values of artifact affected tissues to make it more close to the true value without metal implant.