三叉神经痛采用阿霉素神经毁损治疗的临床疗效

目的探讨三叉神经痛采用三种不同浓度阿霉素进行神经毁损治疗的临床疗效。方法回顾性分析我院2013-04—2014-04收治的67例三叉神经痛患者的临床资料,均给予阿霉素神经毁损治疗,按阿霉素使用浓度分为A组(0.33%,22例)和B组(0.50%,22例)、C组(1.00%,23例)。观察3组治疗后2周、6个月、12个月的疼痛评分情况和治疗效果,并进行比较。结果 (1)治疗后2周、6个月、12个月,3组疼痛评分较治疗前均出现显著下降(均P0.05);B组和C组治疗后2周、6个月、12个月的疼痛评分均显著低于A组(均P0.05);治疗后2周、6个月B组和C组之间的疼痛评分比较差异无统计学意义(P0.05),治疗后12个月,B组疼痛评分显著高于C组(P0.05)。(2)治疗后2周、6个月、12个月,B组和C组的治疗优良率均显著高于A组(均P0.05);治疗后2周、6个月B组和C组之间治疗优良率比较差异无统计学意义(P0.05),治疗后12个月,B组治疗优良率显著低于C组(P0.05)。结论利用不同浓度阿霉素对三叉神经痛患者进行神经毁损治疗均可获得一定的效果,其中0.50%和1.00%浓度阿霉素的治疗效果优于0.33%浓度,且1.00%浓度阿霉素的远期疗效优于0.50%浓度。     

神经妥乐平治疗老年原发性三叉神经痛的疗效观察

目的 观察神经妥乐平治疗老年原发性三叉神经痛的疗效.方法 将58例老年患者随机分为神经妥乐平组和卡马西平组,应用视觉模糊评分法(VAS)评价2组治疗后疼痛的改善情况并观察药物不良反应.结果 治疗第1周、2周、3周、4周后神经妥乐平组VAS较治疗前明显下降(均P＜0.01),总有效率为83.3 %,明显优于卡马西平组(60.7%).结论 神经妥乐平治疗老年原发性三叉神经痛的疗效优于卡马西平.     

拉莫三嗪在治疗三叉神经痛中的临床作用评价

目的探讨拉莫三嗪治疗三叉神经痛的临床疗效。方法按照随机数字表法将80例原发性三叉神经痛(Trigeminal neuralgia,TN)患者均分为实验组和对照组,实验组给予拉莫三嗪片治疗,对照组给予卡马西平片治疗,比较2组治疗前及治疗后1、2个月疼痛VAS评分变化情况及不良反应发生情况。结果 2组治疗后1、2个月疼痛VAS评分均明显下降,与治疗前比较,差异具有统计学意义(P0.05);组间疼痛VAS评分和不良反应发生率比较,差异无统计学意义(P0.05);实验组治疗后1个月和2个月完全缓解率均明显高于对照组,差异具有统计学意义(P0.05)。结论拉莫三嗪能够显著改善三叉神经痛患者临床症状,安全性高,具有较高临床应用价值。     

庆大霉素神经阻滞术治疗三叉神经痛早期疼痛的疗效观察

目的研究庆大霉素神经阻滞术治疗三叉神经痛早期疼痛的临床疗效。方法选取我院收治的三叉神经痛患者82例为研究对象,采用随机数表法分为观察组和对照组各41例,对照组采用卡马西平及无水乙醇神经阻滞剂治疗,观察组在此基础上给予庆大霉素,2组均治疗2个月,采用疼痛视觉模拟评分法(VAS)、卡氏功能状态评分表(KPS)评价其疼痛度与生活质量,并应用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)比较2组治疗前后焦虑与抑郁程度,同时观察不良反应。结果治疗后观察组VAS评分(2.32±1.17)分低于对照组(P0.05),观察组KPS评分(82.16±1.31)分高于对照组,差异有统计学意义(P0.05);与对照组比较,观察组治疗后HAMD评分(10.45±1.23)分、HAMA评分(13.27±1.35)分明显降低,差异有统计学意义(P0.05);观察组不良反应发生率12.20%,与对照组的9.76%比较无显著差异(P0.05)。结论庆大霉素神经阻滞治疗三叉神经痛早期疼痛效果较好,可明显改善预后,且不良反应轻,值得临床推广应用。     

A型肉毒毒素治疗难治性三叉神经痛临床观察

目的：评价A型肉毒毒素（BTX-A）治疗难治性三叉神经痛的疗效。方法：选取难治性三叉神经痛患者6例,其中原发性5例,继发性1例。采用视觉模拟评分（VAS）于局部多点注射BTX-A,予治疗前及治疗后2周、2个月和6个月时进行疼痛测评。结果：VAS评分：BTX-A治疗前为（8.86±0.75）分;BTX-A注射后2周和2个月分别降至（1.00±1.26）分和（2.00±2.45）分,与治疗前比,差异均有统计学意义（P〈0.05）;6个月时为（5.33±2.16）分,与治疗前比,差异仍有统计学意义（P〈0.05）。6例患者均无明显并发症出现。结论：BTX-A注射治疗难治性三叉神经痛是一种安全有效的新疗法。     

CT引导下阿霉素治疗原发性三叉神经痛定量感觉分析

目的评价原发性三叉神经痛患者阿霉素治疗后疼痛程度和感觉功能变化,并探讨二者的相关性。方法于CT引导下阿霉素治疗23例原发性三叉神经痛患者,分别于治疗前以及治疗后1 d、7 d、1个月、3个月、6个月、12个月采用视觉模拟评分(VAS)评价疼痛程度,定量感觉检测(QST)测定患侧下颏冷觉、温觉、冷痛觉、热痛觉阈值。结果与治疗前相比,治疗后1 d、7 d、1个月、3个月、6个月和12个月VAS评分降低(均P=0.000);治疗后1、3、6和12个月患侧下颏冷觉(P=0.003,0.000,0.000,0.000)和冷痛觉(P=0.022,0.000,0.000,0.013)阈值降低,温觉(P=0.004,0.002,0.000,0.000)和热痛觉(P=0.004,0.002,0.000,0.000)阈值升高。Pearson相关分析显示,阿霉素治疗后VAS评分与患侧下颏冷觉(r=0.703,P=0.000)和冷痛觉(r=0.679,P=0.002)阈值呈正相关,与温觉(r=-0.782,P=0.000)和热痛觉(r=-0.726,P=0.001)阈值呈负相关。结论 QST检测是一种无创性、简便的感觉功能评价方法,可以定量测定感觉神经损害,成为评价三叉神经毁损术治疗效果的有价值指标。     

神经导航联合电生理监测辅助下半月神经节射频热凝术治疗原发性三叉神经痛

目的 探讨神经导航联合电生理监测辅助下半月神经节射频热凝术（PRT）治疗三叉神经痛的疗效。方法 回顾性分析2016年3月至2018年6月在神经导航联合电生理监测辅助下采用PRT治疗的38例原发性三叉神经痛的临床资料。术前及术后1年采用视觉模拟量表（VAS）评分评价疼痛程度。术后1年,采用巴罗神经病学研究所疼痛预后分级（BNI）评分评估疼痛预后,Ⅰ~Ⅲ级为有效,Ⅳ~Ⅴ级为无效。结果 38例卵圆孔首次穿刺成功35例,成功率为92.1%。术后1年VAS评分[（1.5±1.2）分]较术前[（8.5±1.0）分]明显降低（P<0.05）。术后1年,BNI评分Ⅰ级29例,Ⅱ级4例,Ⅲa级2例,Ⅲb级l例,Ⅳ级1例,Ⅴ级1例;有效率为94.7%（36/38）。术中23例（60.5%）出现血压明显上升,5例（13.2%）发生心动过缓。术后出现面部麻木34例（89.5%）、穿刺部位皮下血肿4例（10.5%）、口唇带状疱疹2例（5.3%）、咬肌无力1例（2.6%）,经对症治疗3个月后均逐渐恢复。术后随访1年,没有发生颅内出血、脑脊液漏及颅内感染等严重并发症。结论 神经导航联合电生理监测技术可精确定位半月神经节靶点,提高手术的安全性及临床疗效。     

注射用A型肉毒毒素缓解脊髓损伤患者神经病理性疼痛的可行性

目的评价注射用 A型肉毒毒素缓解脊髓损伤（SCI）患者神经病理性疼痛（NP）的可行性。方法选择 2013年 4月 ~2016年 1月在荆州市第二人民医院就诊的SCI伴 NP患者 47例，随机分为试验组 24例和对照组 23例，分别给予注射用 A型肉毒毒素 200 U和生理盐水皮下注射，疗程 8周，评价治疗前和治疗 4周、8周后疼痛视觉模拟评分（VAS）、疼痛性质和生存质量。结果所有患者均顺利完成治疗。混合效应模型分析显示，试验组和对照组治疗前后不同时点 VAS评分、 VAS评分下降百分比、疼痛感觉、疼痛情感和总分差异均有统计学意义（P＜ 0.05）。重复测量效应分析显示，两组治疗前后各指标差异仍有统计学意义（P＜ 0.05）。分组与测量时点交互效应分析显示，两组各指标随时间变化趋势不同（P＜ 0.05）。以治疗前 WHO生存质量评估量表（WHOQOL）评分为协变量，治疗后第 8周试验组的生理领域、心理领域、环境领域评分高于对照组，差异有统计学意义（P＜ 0.05）社会关系领域组间比较差异无统计学意义（P＞ 0.05）。结论 A型肉毒毒素皮下注射能有效缓解 SCI患NP症状，镇痛效果优于安慰剂。     

鼻内镜翼腭窝上颌神经切除治疗三叉神经痛临床分析

目的：探讨鼻内镜翼腭窝上颌神经切除治疗三叉神经痛的临床效果,以期提高临床诊治水平。方法选取2010‐02—2014‐0270例三叉神经痛患者为研究对象,随机分成2组各35例,对照组予常规西医治疗,观察组行鼻内镜翼腭窝上颌神经切除治疗,观察临床效果。结果2组治疗前后视觉疼痛模拟评分、满意度评分比较差异均无统计学意义（P＞0.05）,治疗后和治疗前比较差异均有统计学意义（P＜0.05）;对照组并发症总发生率20％,观察组为5.72％,2组比较差异有统计学意义（P＜0.05）。结论鼻内镜翼腭窝上颌神经切除能改善三叉神经痛临床症状,可降低术后并发症发生率。     

加巴喷丁治疗原发性三叉神经痛临床观察

目的观察加巴喷丁治疗原发性三叉神经痛的临床疗效。方法30例原发性三叉神经痛患者采用加巴喷丁（GBP）治疗及自身对照观察,用视觉模拟评分（VAS）和睡眠质量评分（Qs）评价治疗后第l、2、4周的治疗效果,同时观察患者的不良反应。结果加巴喷丁治疗前与治疗后第1、2、4周VAS评分及Qs评分相比显著降低（P〈0．01）,治疗后疼痛严重程度及睡眠质量方面均有明显改善,治疗4周后显效26例（86．7％）,好转4例（13．3％）,总有效率100％。且加巴喷丁组不良反应作用较少且轻微。结论加巴喷丁能有效改善原发性三叉神经痛疼痛程度和睡眠质量,疗效确切且安全。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -