Video-assisted thoracoscopic treatment of spontaneous pneumothorax: technique and results of one hundred cases

OBJECTIVE: This article describes the technique and results for an initial series of 100 pneumothoraces treated by video-assisted thoracoscopy. METHODS: From May 1991 to November 1994, 97 patients (78 male and 19 female patients) aged 37.2 +/- 17 years (range 14 to 92 years) underwent video-assisted thoracoscopy for treatment of spontaneous pneumothorax (primary in 75 patients, secondary in 22 patients). RESULTS: The procedure was unilateral in 94 patients and bilateral in three patients (total 100 cases). Pleural bullae were resected with an endoscopic linear stapler; a lung biopsy was performed in the absence of any identifiable lesion. Pleurodesis was achieved by electrocoagulation of the pleura (n = 3), "patch" pleurectomy (n = 3), subtotal pleurectomy (n = 20), or pleural abrasion (n = 74), including conversion to standard thoracotomy in five. One of these five patients had primary pneumothorax and four had secondary pneumothorax. There were no postoperative deaths. A complication developed in 10 patients: five patients with a primary pneumothorax (6.6%) and five with a secondary pneumothorax (27.7%). The mean postoperative hospital stay was 8.25 +/- 3.2 days. Mean follow-up is 30 months (range 7 to 49 months). Pneumothorax recurred in 3% of patients, all of whom were operated on at the start of our experience. Three percent of the patients had chronic postoperative chest pain. CONCLUSIONS: Video-assisted thoracoscopy is a valid alternative to open thoracotomy for the treatment of spontaneous primary pneumothorax. Its role for the management of secondary pneumothorax remains to be defined. In the long term, the efficacy of video-assisted thoracoscopic pleurodesis and surgeon experience should yield the same results as standard operative therapy.     

Transforming growth factor-beta isoforms expressions in pulmonary adenocarcinomas as prognostic markers: an immunohistological study of one hundred and twenty patients

Congenital eye malformations were studied in a small geographical area in 212,479 consecutive births. For each of the 145 new cases studied during the period 1979 to 1994, more than 50 factors were compared in probands and in controls. The prevalence rate of congenital eye malformations was 6.8 per 10,000 for microphthalmia 1.7, anophthalmia 0.23, cataract 2.7 and coloboma 1.4 respectively. Sex ratio was 0.82. Prenatal diagnosis was performed in 18 cases and 7 cases were induced abortions. The more common types of associated malformations in the 81 affected cases (53.8%) with at least one anomaly other than an eye malformation were clubfeet, microcephaly, hydrocephaly, cleft lip/palate and facial dysmorphia. At birth infants with eye malformations and other malformations were smaller, weighted less and their head circumference was lower than in controls. Placental weight was also lower than in controls. Pregnancies with eye malformations were more often complicated by threatened abortion, oligoamnios and polyhydramnios. Mothers of children with congenital eye malformations took more often drugs during pregnancy than mothers of controls. Fathers of children with congenital eye malformations were more often exposed to occupational hazards than fathers of controls. There was a significant association between eye malformations and consanguinity of parents. The recurrence risk for first degree relatives of probands was 8.9%. First degree relatives of probands had more than three times the prevalence of non-eye malformations than controls. These results are of relevance to genetic counseling.     

Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients

One hundred elderly patients who had an intertrochanteric femoral fracture were randomized to treatment with a compression hip-screw with a plate (fifty patients) or a new intramedullary device, the intramedullary hip-screw (fifty patients). All patients were followed prospectively for one year or until death. A detailed assessment of the functional status and the plain radiographs of the hip was performed one, three, six, and twelve months postoperatively. The two treatment groups were strictly comparable. The operative time needed to insert the intramedullary hip-screw was significantly greater than that needed to insert the compression hip-screw with the plate (p = 0.02), but use of the intramedullary hip-screw was associated with less estimated intraoperative blood loss (p = 0.011). The prevalence of perioperative complications, such as bronchopneumonia, cardiac failure, and urinary tract infection, was comparable in the two treatment groups. There were one intraoperative fracture of the femoral shaft and two intraoperative fractures of the greater trochanter in the group managed with the intramedullary hip-screw. One patient had pulling-out of the compression hip-screw on the seventh postoperative day. Four patients had a trochanteric wound hematoma, without infection, after insertion of an intramedullary hip-screw. All but one of the fractures healed. The one non-union, which was in a patient who had a compression hip-screw, was treated with a hemiarthroplasty. The mortality rate was similar in the two treatment groups. The patients who had an intramedullary hip-screw had, on the average, significantly better mobility at one (p < 0.0001) and three months (p = 0.0013) postoperatively. This difference was no longer seen at six and twelve months, although the patients who had an intramedullary hip-screw still had significantly better walking ability outside the home at those time-periods (p = 0.05). The compression hip-screw was removed from two patients because of pain in the mid-portion of the thigh, which had begun after consolidation of the fracture. Fourteen patients who had an intramedullary hip-screw had cortical hypertrophy at the level of the tip of the nail at twelve months postoperatively. Cortical hypertrophy was significantly related to the use of two interlocking screws (p = 0.02). Six of these patients also had pain in the mid-portion of the thigh, and the nail had been locked with two screws in five of them. Three of the six patients had the hardware removed because of the pain, and the symptoms resolved. A seventh patient had pain without cortical hypertrophy. The intramedullary hip-screw device was associated with significantly less sliding of the lag-screw and subsequent shortening of the limb in the region of the thigh (p = 0.012 and 0.019, respectively); these differences were more pronounced when the unstable fractures in the two treatment groups were compared (p < 0.001).     

Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients

We evaluated the results of the Robinson method of anterior cervical discectomy and arthrodesis with use of autogenous iliac-crest bone graft, at one to four levels, in 122 patients who had cervical radiculopathy. A one-level procedure was done in sixty-two of the 122 patients; a two-level procedure, in forty-eight; a three-level procedure, in eleven; and a four-level procedure, in one. The average duration of clinical and roentgenographic follow-up was six years (range, two to fifteen years). The average age was fifty years (range, twenty-five to seventy-eight years). Preoperatively, 118 patients had pain in the arm, fifty-five had weakness of one or more motor roots, and seventy-seven had sensory loss. At the time of follow-up, eighty-one patients had no pain in the neck, twenty-six had mild pain in the neck, nine had moderate pain in the neck, four had mild radicular pain, and two had a combination of mild radicular pain and moderate pain in the neck. One hundred and eight patients had no functional impairment, and fourteen had a slight limitation of function during the activities of daily living. Nine of eleven patients who had symptoms related to a change at one level cephalad or caudad to the site of a previous arthrodesis had another operative procedure. Lateral roentgenograms of the cervical spine, made in flexion and extension, showed a pseudarthrosis at twenty-four of 195 operatively treated segments. Sixteen of the patients who had a pseudarthrosis were symptomatic, but only four had sufficient pain to warrant revision. The risk of pseudarthrosis was significantly greater after a multiple-level arthrodesis than after a single-level arthrodesis (p < 0.01). At the time of the most recent follow-up, fifty-three of the fifty-five patients who had had a motor deficit had had a complete recovery, and the two remaining patients had had a partial recovery. Seventy-one of the seventy-seven patients who had had a sensory loss had regained sensation. None of the patients had an increased neurological deficit postoperatively. Our results suggest that the Robinson anterior cervical discectomy and arthrodesis with an autogenous iliac-crest bone graft for cervical radiculopathy is a safe procedure that can relieve pain and lead to resolution of neurological deficits in a high percentage of patients.     

Toward a code for the interactions of zinc fingers with DNA: selection of randomized fingers displayed on phage

We have used two selection techniques to study sequence-specific DNA recognition by the zinc finger, a small, modular DNA-binding minidomain. We have chosen zinc fingers because they bind as independent modules and so can be linked together in a peptide designed to bind a predetermined DNA site. In this paper, we describe how a library of zinc fingers displayed on the surface of bacteriophage enables selection of fingers capable of binding to given DNA triplets. The amino acid sequences of selected fingers which bind the same triplet are compared to examine how sequence-specific DNA recognition occurs. Our results can be rationalized in terms of coded interactions between zinc fingers and DNA, involving base contacts from a few alpha-helical positions. In the paper following this one, we describe a complementary technique which confirms the identity of amino acids capable of DNA sequence discrimination from these positions.     

The development of hospital dentistry in America--the first one hundred years (1850-1950)

The development of hospital dentistry in America began in the middle of the nineteenth century with the pioneering endeavors of Dr. Simon Hullihen and Dr. James Garretson who is credited with the development of the specialty of oral surgery. While starting small, the prodigious work of these and other dentists laid the foundation on which modern hospital dentistry would be built. Throughout its establishment, however, hospital dentistry would have to fight for a place in the hospital, not only with the medical community but also from within the dental community. In time though, hospital dentistry would come to have the support of the American Dental Association and the respect of the medical community.     

Learning a motor task involving obstacles by a multi-joint, redundant limb: two synergies within one movement

We investigated survival of patients with out-of-hospital cardiac arrest in Ljubljana according to the 'Utstein' style. Ljubljana consists of urban, suburban and semi-rural communities which encompass an area of 1615 km2 with 397306 residents. The area is served by a single response emergency medical system and local family practitioners. Between January 1, 1995 and December 31, 1997 cardiac arrest was confirmed in 966 patients. Cardiopulmonary resuscitation was attempted in 454 patients (47%). Collapse of presumed cardiac etiology (337 patients) was either bystander-witnessed (89%), un-witnessed (9%) or EMS personnel-witnessed (2%). Asystole was documented in 55%, ventricular fibrillation or tachycardia in 36% and other non-perfusing rhythms in 9% of these patients. Lay-bystander basic life support was performed in 19%. Nineteen patients (5.6%) survived to hospital discharge and 12 of them were independent in daily life. The survival of subgroups with bystanders-witnessed collapse and bystanders-witnessed ventricular fibrillation was 6.4 and 13%, respectively. Collapse of non-cardiac etiology (117 patients) was preceded by either respiratory failure (41), politrauma (22), circulatory shock (19), cerebrovascular incident (ten), intoxication (nine), strangulation (seven), electrocution (five) or drowning (four patients). Only five patients (4.2%) survived to hospital discharge. Hospital treatment of patients after successful initial cardiopulmonary resuscitation was associated with high mortality and required considerable resources.     

基于关联数据融合的地表移动传感器节点

开发了具有多个相关联传感器的地表移动传感器节点;提出一种基于专家系统进行关联数据处理的几何方格面积数据融合方法,即主要采用软硬件结合的方式,利用专家系统预设的节点环境阈值与传感器实际感测的数据相结合进行关联数据处理,将数据关系转化为几何方格面积,从而实现分类分层次的数据融合.结果表明:该方法能够对多个不同类型传感器提供的相同特征数据、互补特征数据、并行特征数据、条件关联数据进行融合;与传统传感器节点相比,地表移动传感器节点感测信息的准确率更高,能量消耗更低.     

某含银多金属矿石工艺矿物学研究

对某含银多金属矿石的工艺性质进行了重点研究,包括矿物组成、嵌存状态、粒度分布等。同时,对超出显微镜分辨能力的次显微银采用扫描电镜进行系统研究。测定结果表明:矿石中银矿物主要为含银黝铜矿、辉铜银矿、硫锑铜银矿、银黝铜矿、辉银矿、碲银矿、角银矿、自然银等;银矿物与黝铜矿嵌存关系密切,而黝铜矿主要嵌存在方铅矿中,黝铜矿、方铅矿为银矿物的主要载体矿物。矿石的工艺矿物学研究为选矿工艺流程和条件试验的确定提供可靠数据,使选矿试验获得理想的回收指标。     

某银铅锌矿石浮选试验研究

某银铅锌矿石主要有价元素为银、铅、锌。通过原矿工艺矿物学研究及小型试验研究,确定了适合该矿石性质的全优先浮选工艺流程及最佳的工艺条件。优先浮选银铅再浮选锌的小型闭路试验获得了铅精矿铅品位51.38%、铅回收率92.32%,银品位2 078.0 g/t、银回收率74.36%,锌精矿锌品位48.64%、锌回收率80.81%的良好指标。     

Replantation of the hand and fingers

Using microsurgical techniques to replant an amputated hand or digit is one of the most important progress in the field of hand surgery during the last three decades. The result of a replantation depends on: the mechanism and the level of amputation, the length and the type of ischaemia of the amputated segment, the surgical techniques, the postoperative care, the rehabilitation and so on. Although the success of a replantation is first judged on the survival of the replanted segment, it nevertheless should be assessed on the function achieved. Thanks to the 30-year clinical experience, the final functional result of a replantation can now be anticipated at initial examination; thus indications can be better established by patient selection criteria. The replantation of the hand and the digits is henceforth reasonable only if there is a possibility of a useful functional result.     

Motor subcircuits mediating the control of movement velocity: a PET study

The influence of changes in the mean velocity of movement on regional cerebral blood flow (rCBF) was studied using positron emission tomography (PET) in nine healthy right-handed adults while they performed a smooth pursuit visuomanual tracking task. Images of relative rCBF were obtained while subjects moved a hand-held joystick to track the movement of a target at three different rates of a sinusoidal displacement (0.1, 0.4, and 0.7 Hz). Significant changes in rCBF between task conditions were detected using analysis of variance and weighted linear contrasts. The kinematics of arm and eye movements indicated that subjects performed tasks in a similar manner, particularly during the faster two tracking conditions. Significant increases in rCBF during arm movement (relative to an eye tracking only control condition) were detected in a widespread network of areas known for their involvement in motor control. The activated areas included primary sensorimotor (M1S1), dorsal and mesial premotor, and dorsal parietal cortices in the left hemisphere and to a lesser extent the sensorimotor and superior parietal cortices in the right hemisphere. Subcortically, activations were found in the left putamen, globus pallidus (GP), and thalamus, in the right basal ganglia, and in the right anterior cerebellum. Within the cerebral volume activated with movement, three areas had changes in rCBF that correlated positively with the rate of movement: left M1S1, left GP, and right anterior cerebellum. No movement-related sites had rCBF that correlated negatively with the rate of movement. Regressions of mean percent change (MPC) in rCBF onto mean hand velocity yielded two nonoverlapping subpopulations of movement-related loci, the three sites with significant rate effects and regression slopes steeper than 0.17 MPC.cm-1.s-1 and all other sites with nonsignificant rate effects and regression slopes below 0.1 MPC.cm-1. s-1. Moreover, the effects of movement per se and of movement velocity varied in magnitude independently. These results confirm previous reports that movement-related activations of M1S1 and cerebellum are sensitive to movement frequency or some covarying parameter of movement. The activation of GP with increasing movement velocity, not described in previous functional-imaging studies, supports the hypothesis that the basal ganglia motor circuit may be involved preferentially in controlling or monitoring the scale and/or dynamics of arm movements. The remaining areas that were activated equally for all movement rates may be involved in controlling higher level aspects of motor control that are independent of movement dynamics.     

Patterns of movement in the first 6 months of life: New directions.

Conducted 3 studies using movement counters to record developmental changes in frequency and synchrony of movements on all 4 limbs of 74 infants between the ages of 1 to 5.5 mo. Infant activity increased dramatically between 1 and 2 mo, but there was evidence of a decline between 2.5 and 4 mo before a final increase between 4 and 5 mo. Synchrony scores for pairs of limbs showed significant increases from 1 to 5 mo. In all 3 experiments, the presentation of an attractive toy resulted in suppression of activity. (French abstract). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

End-point accuracy of kinesthetically and visually based corrections to a mechanically perturbed aiming movement.

12 right-handed females performed a multi-degrees of freedom manual aiming movement which could be unexpectedly perturbed. Ss performed the task in either a full vision (FV) situation or while only the target to be reached was visible (TO). Neither the absolute constant error (ICEI) nor the variable error (VE) of aiming could differentiate the perturbed and unperturbed trials for the Ss submitted to the FV condition. However, significantly larger ICEI and VE were observed for the perturbed trials in the TO condition. This is taken to indicate that the sensorimotor representation of the movement developed through learning is more precise when learning occurs in the presence of more afferent sources. Further, the larger spatial error found in the TO condition for the perturbed trials suggests that, when a learned movement is forced out of its usual trajectory, the kinesthetic feedback available, and/or the corrective motor commands, are less accurate than those available when the movement follows its usual trajectory. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing a unit based quality improvement program: one hospital's experience

The continuous enhancement of the quality of patient care is the prime directive of a Nursing Quality Improvement Program. A decentralized approach, using a Unit Based Quality Improvement model, was used in one hospital. In this paper, the author examines the process from conceptualization to implementation and evaluation of the decentralized approach.     

Comparison of functional performance after McKee-Farrar, Charnley, and Muller total hip replacement. A six-month follow-up of one hundred sixty-five cases

Measurements of functional performance were compared before and at 6 months after 58 McKee-Farrar, 50 Charnley, and 57 Muller total hip replacements in 143 patients. The measurment included: range of motion of the hip, hip abductor and adductor-muscle torque, weight-bearing activity during standing, forces applied to canes or crutches, and multiple components of walking performance. Each group of patients improved significantly after surgery in all of the components measured. Early postoperative differences among the 3 groups were found with respect to pain ratings, impressions of hip status, hip motions, muscle torque, the number of patients using assistive devices, and certain components of walking performance. There is nothing to suggest that the performance of any 1 group is distinctly better or worse than that of any other group 6 months after surgery. On the basis of average values, each group improved in every component of function and it is gratifying that, except for a few patients who developed postoperative infection, each patient could be considered to have successful reconstruction.     

基于粒子系统的爆破烟尘运动的模拟研究

在对爆破烟尘源及其特征分析的基础上,通过质量通量、动量通量、浮力通量分析,加之闭合假设,建立了描述爆破烟尘运动的数学模型,基于粒子系统对爆破烟尘的冲击运动、蘑菇云运动和扩散运动的烟尘云形状进行模拟研究,编制出BSMS模拟软件,实现了对爆破烟尘运动实时模拟.     

Spatiotemporal study of event-related desynchronization during self-paced movement

The desynchronization of Alpha band components during a self-paced movement of the thumb was studied in 7 subjects. The EEG was recorded from 23 electrodes located on the frontocentral, central, and parietocentral regions, referred to the right masto?de, 4 s before and 2 s after movement onset. The data were then transformed to obtain 11 source derivations. The temporal evolution of the power of the signal within the Alpha band, every 250 ms, associated to the non parametric statistic test of Wilcoxon, authentifies the event-related desynchronization (ERD). The spatiotemporal analysis of ERD underlines on the central regions, two principal locations of ERD: one controlateral to the movement, starting more than 1 s before the movement; the other, ipsilateral, shorter, during the movement. However, no significance desynchronization was underlined on the vertex. The ANOVA used to analyse these results confirms the principal location of ERD on the central region, and seems to indicate a right lateralisation during the right or the left movement.