2017年 · 第97卷第35期

Ankle osteoarthritis can cause pain, dysfunction, and even disability, resulting in socioeconomic losses and increased medical expenses. As our country enters an aging society, the number of patients with ankle osteoarthritis is increasing year by year. The incidence of ankle osteoarthritis accounts for 13% of systemic osteoarthritis^[1]In Asians, the vast majority of ankle osteoarthritis is varus due to tibial plateau varus and lifestyle habits.

subtalar instability (STI) is caused by abnormal bone structure and/or ligament injury around the joint, with pain in the tarsal sinus area as the main manifestation. Simple STI is rare and often occurs at the same time as ankle instability. About 1/4 of patients with chronic ankle instability are complicated by STI, so STI is often misdiagnosed as chronic ankle instability. At the same time, because there are many controversies about the pathogenesis of STI, the diagnosis and treatment of STI are challenging and deserve high attention.

Hallux valgus is one of the most common lesions of forefoot, and its incidence is increasing in recent years. The treatment of hallux valgus is extremely challenging^[1,2,3,4]。 There are nearly 200 kinds of surgical methods for treating hallux valgus at home and abroad, and each method has its own advantages^{[5,6,7,8,9,10,11,12,13,14]}Most have been eliminated at present. One question before us is how to choose an individualized surgical protocol that is suitable for the patient^[15,16]To avoid the occurrence of complications and obtain satisfactory curative effect.

Chronic migraine (CM) is a complex, severely disabling neurological disorder with monthly headache episodes ≥15 days and lasting more than 3 months. The execution criteria are at least 5 migraines without aura per month and headache ≥8 days per month. The typical progression pattern of chronic migraine is that the incidence frequency increases with time, the incidence rate of the population is 1% ~3%, the cure rate of clinical treatment is low, and there is a high hospitalization rate and migraine-related disability, which causes a great burden to the patient's family and society. Studies have confirmed that botulinum toxin has some efficacy in chronic migraine that is ineffective in traditional treatment. Aydinlar et al.The Journal of Headache and PainA published article [J Headache Pain, 2017, 18 (1): 23] aimed to evaluate the therapeutic effect, negative emotions, and sleep quality after botulinum toxin injection in the treatment of chronic migraine. The study included 190 patients [mean age (39.3±10.2) years, 87.9% female] at the initial visit (baseline level, first visit) and 4 subsequent follow-up visits at 12 weeks (second follow-up), 24 weeks (third follow-up), 36 weeks (fourth follow-up), and 48 weeks (fifth follow-up) after botulinum toxin injection. PAQI (Pittsburgh Sleep Quality Index), headache frequency and severity, number of analgesics used, migraine disability rating scale (MIDAS), depression, anxiety, stress scale (DASS-21) were evaluated at each visit, and the four follow-up visits were compared with baseline levels. The results showed that from the baseline level to the 5th follow-up, all indicators decreased, and the mean headache frequency decreased from 19.5 to 8.4 (P=0.002), headache severity decreased from 8.1 to 6.1 (P=0.017), the analgesic drug use dose decreased from 26.9 to 10.4 (P=0.023) and the MIDAS score decreased from 67.3 to 18.5 (P<0.001)。 There were no significant changes in PSOI and DASS-21 scores throughout the study. It was concluded that the outcome of migraine was significantly improved after botulinum toxin injection, which was manifested in the frequency and severity of migraine, the number of analgesics used, and the MIDAS score. While there was no significant improvement in overall sleep quality and in prevalent negative mood states, patients without negative mood at baseline levels showed improved sleep quality throughout the study.

Skull base tumor is located in the deep intracranial layer, closely related to brainstem and intracranial nerves, and it is difficult to treat, with more and more serious postoperative complications^[1,2,3]。 Patients with skull base tumors tend to have a higher risk of lower extremity venous thrombosis after operation due to long operation time and many postoperative complications, and lower extremity venous thrombosis can be disabled if not treated in time. In severe cases, pulmonary embolism and other serious consequences can be caused by thrombus detachment^[4]It is one of the main causes of perioperative death, so the prevention of lower extremity venous thrombosis is very important^[1]。 The anti-thrombotic pressure pump improves the venous blood circulation of the lower limb by assisting circulation, and provides dynamic continuous pressure gradient for the lower limb veins of patients, thereby preventing the occurrence of venous thrombosis of the lower limb^[5]。 From March 2016 to March 2017, the Department of Neurosurgery of Beijing Tiantan Hospital used antithrombotic pressure pump to prevent venous thrombosis of lower limbs in patients with skull base tumors, with satisfactory results, which are reported as follows.

The patient was a 47-year-old woman with abdominal distension for 1 year. She had a lower abdominal mass for 2 months. She occasionally had lower abdominal pain, which was tolerable. At the same time, she had a sense of anal distension and no other discomfort. She has not been treated since she became ill. Recently, abdominal distension has been worsened than before, with chest tightness, defecation and urination difficulty. B-ultrasound of Nancheng People's Hospital: anterior uterus, about 6.1 cm ×5.0 cm ×7.5 cm in size, clear outline, normal shape, uneven muscle layer echo, multiple hypoechoic nodules were detected in the basal layer, the larger one was about 1.4 cm ×1.1 cm, the endometrium was centered, IUD echoes were seen in the uterine cavity, bilateral ovaries were not detected, and heterogeneous echoic masses of about 26 cm ×22 cm ×10 cm were detected in the abdominal and pelvic cavities, located behind and above the uterus, with clear boundaries and irregular shape. The upper edge reached below the xiphoid process, and irregular anechoic areas were visible inside. Color Doppler (CDFI): a strip of blood flow signal can be seen in the right lower abdomen and a liquid dark area about 3.3 cm deep; Ultrasound showed: uterine fibroids, abdominopelvic heterogeneous echo mass, ascites. On April 8, 2016, the gynecological outpatient clinic of Shanxian Central Hospital was admitted to the hospital. Since the onset of the disease, the patient has regular menstruation, with a cycle of 25 to 26 days and 3 to 4 days of menstruation. Gynecological examination: the vulva developed normally, the vagina was unobstructed, the cervix could not be seen, a solid mass was touched in the pelvic cavity to 2 transverse fingers on the umbilicus, the mobility was poor, there was no tenderness, and the uterus and bilateral appendages could not be touched clearly; Tumor markers: AFP, CEA, CA199, CA125 and CA150 were all negative; Preliminary clinical diagnosis: (1) pelvic mass; (2) Uterine fibroids. On April 12, 2016, transabdominal exploration showed that the uterus was normal in size and there was no abnormality in the appearance of bilateral appendages. A mass about 26 cm ×20 cm ×15 cm in size was seen at the cervix behind the uterus, reaching up to the lower side of the xiphoid process, and reaching the base of the broad ligament on the left and right. It was cystic and solid with poor mobility. The peritoneum of the posterior lobe of the broad ligament and the uterorectal lacunae were opened, and the tumor capsule was incised with electrosurgical knife. The tumor ran along the pericervical vein, showing red lobules, and the lobules were different in size, the largest was about 13 cm ×13 cm ×12 cm, and the smaller was about 3 cm ×2 cm ×2 cm, all of which were connected to the uterine serosa. It was highly suspected of malignant tumor, and hysterectomy and bilateral salpingectomy were performed (Figure 1，Figure 2)。 Intraoperative rapid freezing results: lobular segmented smooth muscle tumor of uterine body with edema and mucinous degeneration, which was excluded from malignant transformation after routine extraction; Abdominal irrigation fluid exfoliation cytology was negative; Immunohistochemical marker: Ki-67 positive index<1% SMA (3+) Desmin (3+) CD10 (-), Results of routine pathological examination: Leiomyoma with edema and degeneration at the junction of cervix and body.

A 62-year-old male with low back pain was admitted to hospital for more than 1 month, and the specialist examination was negative.

Extracranial carotid atherosclerotic stenosis is one of the important causes of ischemic stroke, and more than 20% of ischemic strokes are caused by extracranial carotid atherosclerotic stenosis^[1]。 carotid endarterectomy is the best treatment for carotid stenosis. In recent years, carotid artery stenting (CAS) has attracted much attention in the treatment of extracranial carotid atherosclerotic stenosis because of its minimally invasive, safe and effective advantages. The results of multiple clinical randomized controlled trials have successively confirmed that there is no significant difference in the occurrence of long-term composite endpoint events between the two, and they have the same efficacy in long-term stroke prevention of carotid artery stenosis^[2,3,4,5]However, there were significantly more adverse events such as minor stroke in the perioperative period of CAS than CEA in subgroup analysis. Perioperative low hemodynamic changes (bradycardia, decreased blood pressure) in CAS are the most common complications^[6]It is also an important cause of perioperative cardiovascular and cerebrovascular adverse events^[7]。 This article mainly summarizes the mechanism, risk factors and prognostic risks of HD after CAS.

small fiber neuropathy (SFN) refers to peripheral neuropathy involving mainly thin-myelinated A-delta fibers and/or unmyelinated class C fibers, while large fibers are not or rarely involved^[1]。 SFN is mainly presented as sensory symptoms. Autonomic dysfunction may also occur^[1,2]。 Physical examination of the nervous system can show that the distal limb acupuncture sensation, temperature sensation decreased or hyperalgesia occurred, and the deep sensation, muscle strength and tendon reflex were generally normal.