肌萎缩型颈椎病1例报告

正Sobue等~([1])于1975年提出"节段性脊髓病变"理论,首次将以上肢肌肉萎缩为特征的颈椎病命名为肌萎缩型颈椎病(CSA)。CSA又称为"Keegan型颈椎病",以颈椎退变为基础,主要表现为节段性、非对称性、稳定性上肢肌肉萎缩,伴/不伴轻度的感觉异常及脊髓病变(表现为下肢症状及步态异常),使患者的生活质量严重降低~([2])。CSA发生率较低,易发生漏诊、误诊,应引起临床医生足够的重     

手术治疗远端型肌萎缩型颈椎病10例疗效分析

目的探讨肌萎缩型颈椎病的诊疗方案。方法分析自2021年3月至2023年2月于郑州大学第一附属医院骨科就诊并被诊断为远端型肌萎缩型颈椎病(CSA)的患者10例。根据手术方式将患者分为两组:前路手术组, 共5例;后路手术组, 共5例。比较两组患者的基线资料、术后临床指标。手术前后采用徒手肌力试验方法(MMT)对患者肌力进行评估, 组间对比采用独立样本t检验。结果术后随访时10例患者肌力较术前有不同程度的改善, 改善效果优1例, 良5例, 中4例, 未出现术后肌力较术前下降情况, 疗效满意率为60%(6/10)。前路组满意度为40%, 后路组满意度为80%, 前路组满意度小于后路组差异无统计学意义(P>0.05)。结论远端型CSA术后肌萎缩恢复相对较差, 患者满意度低, 手术治疗应与患者充分沟通、慎重选择。     

平山病、肌萎缩性侧索硬化及远侧型肌萎缩型颈椎病的神经电生理特点

目的 探讨平山病、肌萎缩性侧索硬化及远侧型肌萎缩型颈椎病的上肢神经电生理特点.方法 回顾性分析87例平山病患者、83例肌萎缩性侧索硬化患者和28例远侧型肌萎缩型颈椎病患者的上肢神经电生理检测资料.其中87例平山病患者中,72例单侧上肢、15例双侧上肢出现肌肉萎缩;83例肌萎缩性侧索硬化患者中,30例单侧上肢、53例双侧上肢出现肌肉萎缩;28例远侧型肌萎缩型颈椎病患者中,20例单侧上肢、8例双侧上肢出现肌肉萎缩.结果 平山病患者患肢尺神经刺激的复合肌肉动作电位(compound muscle action potential,CMAP)波幅明显低于正中神经刺激的CMAP波幅,肌萎缩性侧索硬化患者患肢正中神经CMAP波幅明显低于尺神经CMAP波幅,远侧型肌萎缩型颈椎病患者正中神经和尺神经CMAP波幅降低程度相同.平山病患者的平均尺神经/正中神经(U/M)CMAP比为0.58±0.40,肌萎缩性侧索硬化为2.28±1.25,远侧型肌萎缩型颈椎病为1.31 ±0.63,三者比较差异有统计学意义.在U/M CMAP比值＜0.6的患肢中,平山病有62例,肌萎缩性侧索硬化和远侧型肌萎缩型颈椎病分别只有3例和1例;在U/M CMAP比值＞1.7的患肢中,肌萎缩性侧索硬化有57例,平山病有12例,远侧型肌萎缩型颈椎病有4例.所有患者双侧的运动神经和感觉神经传导速度、感觉神经动作电位波幅均正常,健肢的CMAP波幅均正常.结论 平山病患者小鱼际肌肉萎缩程度重于大鱼际肌,肌萎缩性侧索硬化患者与之相反,而远侧型肌萎缩型颈椎病患者大、小鱼际肌肉萎缩程度相似.     

椎动脉型颈椎病对记忆力影响的临床观察

椎动脉型颈椎病(CSA)是骨科常见病,近年来随着科技发展,发现椎动脉型颈椎病伴有记忆力减退者日渐增多[1].     

中药治疗椎动脉型颈椎病的国内研究进展

椎动脉型颈椎病(CSA)是颈椎病中常见的一种类型,其发病仅次于神经根型颈椎病,直接危害人类的健康。近年来,国内学者在中药治疗椎动脉型颈椎病的研究上取得了一些进展,本文综述了中药治疗CSA的各家辨证分型,治疗用药,发病机制及中药药理的各家研究。     

椎动脉型颈椎病诊治研究进展

椎动脉型颈椎病(cervical spondylotic vertebral arteriopathy,CSA)属多发常见病,轻者影响生活质量及工作效率,重者危及生命.Ebraheim等[1]报道人类颈椎在钩椎关节退变非常严重时才会导致横突孔狭窄,致椎动脉受压扭曲,血液流变学改变.韩伟等[2]将CSA称为椎动脉缺血型颈椎病.     

肌萎缩型颈椎病的研究现状与进展

肌萎缩型颈椎病是近年来越来越受到关注的一类特殊性颈椎病,本文参考大量的文献报道,综述了肌萎缩型颈椎病相关理论的研究进展,从疾病的基本定义,致病因素,临床表现,诊断标准及预后角度,给予了本病准确的概括,为临床诊断及治疗肌萎缩型颈椎病提供了理论基础.     

肌萎缩型颈椎病的诊断与治疗

肌萎缩型颈椎病是一种特殊型颈椎病 ,它没有明显的感觉障碍 ,也不伴疼痛 ,主要症状是双侧或单侧上肢、近侧肌或远侧肌无力及萎缩。此型颈椎病由Ａｌｌｅｎ和Ｂｒａｉｎ于 195 2年首先报告 ,由Ｋｅｅｇａｎ[1] 于 1965年根据解剖所见 ,提出发病机制。由于该型颈椎病是一种少见的非典型颈椎病 ,对其发病及诊断报告的较少。我们根据 2 0 0 0年 2月～ 2 0 0 0年 8月临床所见的 4例典型病例及有关文献资料对该型颈椎病的诊断及治疗加以探讨。1　临床资料1.1　一般资料　本组 4例 ,均为女性 ,年龄 73、66、5 6、5 7岁 ,病程 1个月～ 2年。1.2　临…     

中西医结合治疗椎动脉型颈椎病86例

椎动脉型颈椎病(clinical investigation on cervical spaine ailment,CSA)是颈椎病常见的临床类型之一,约占1/4,表现为当颈部不正当的姿势或外力作用时出现眩晕、头痛、耳鸣、视物不清、恶心、呕吐等症状.我们2003年10月-2005年10月采用针药并用治疗86例,报道如下.……     

旋转手法对椎动脉型颈椎病去甲肾上腺素及内皮素含量的影响

我们选择符合椎动脉型颈椎病(CSA)诊断标准病人60例,对其治疗前后去甲肾上腺素(NA)及内皮素(ET)观察,旨在探讨旋转手法对椎动脉型颈椎病NA、ET含量影响。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.