神经性肌强直的临床及肌电图表现

目的观察神经性肌强直(NMT)患者的临床特点及肌电图特异性表现。方法总结7例确诊NMT患者的临床及电生理资料,结合相关文献进行分析。结果 7例患者均为男性,发病年龄22~77岁,多在37~49岁之间。7例患者中6例有肌肉颤搐、肌肉僵硬、肌痉挛,5例有多汗的表现,3例合并肌无力,2例出现肌肉萎缩。肌电图检查均可记录到静息状态下持续的动作电位发放,呈二连、三联或多联的形式,一例行坐骨神经阻滞后,动作电位发放不减少。一例有明确家族史患者KCNA1基因检测阴性。给予卡马西平等膜稳定剂治疗后,临床症状均有一定程度的改善。结论临床症状和肌电图检查对确诊NMT非常重要。NMT为周围神经高兴奋性疾病,对膜稳定剂的治疗反应较好,肌电图的特异性改变为NMT提供重要诊断依据。获得性NMT可行VGKCs抗体检测,对治疗手段的选择有指导作用。     

卡马西平治疗原发性红斑肢痛症一例

【目的】了解原发性红斑肢痛症的临床特点、发病机制及推测该病对卡马西平有效的病理机制。【方法】对1例原发性红斑肢痛症的临床表现、实验室检查、治疗效果进行分析。【结果】19岁男性患者11岁左右时感冒后反复出现阵发性四肢末端烧灼痛，呈持续性，阵发性加重，站立、运动或受热后加重，休息、抬高肢体及浸入冷水中减轻。发作时四肢肢端皮色发红、皮温增高。母亲及外婆有类似病史。相关实验室检查及肌电图检查无异常。对阿司匹林，氯丙嗪及激素等治疗效果欠佳，卡马西平可控制症状。【结论】本例原发性红斑肢痛症对卡马西平治疗有效，国内外尚未见同类报道。     

合用苯妥英钠对卡马西平血药浓度的影响

卡马西平 (ＣＢＺ)为治疗癫痫的常用药物 ,临床上对精神运动性发作最有效 ,对大发作和混合型癫痫的疗效与苯妥英钠(ＰＨＴ)相似 ,而其副作用相对较小 ,部分患者原来长期应用ＰＨＴ治疗 ,由于效果不理想或副作用的原因 ,转而改用卡马西平或卡马西平与苯妥英钠联合应用。我们长期以来对服用ＣＢＺ、ＰＨＴ等抗癫痫药物的患者实行血药浓度监测下的用药指导 ,发现合用ＰＨＴ较单用ＣＢＺ控制癫痫发作的效果差。下面总结 82例单用ＣＢＺ或合用ＰＨＴ的ＣＢＺ血药浓度的变化。1　临床资料1.1　病例来源　本院门诊及住院的癫痫患者共 82例 ,男性 39…     

特发性肌肉颤搐的诊断与治疗

目的探讨特发性肌肉颤搐的临床特征、诊断与治疗。方法对 7例特发性肌肉颤搐诊疗过程进行回顾性分析。结果7例均有典型的波动性和虫蠕状肌肉颤搐。全部病例的肌肉颤搐均出现在双侧腓肠肌 ,5例出现在双上肢 ,2例在面部、腰背部及腹部。肌肉颤搐在活动后可加重 ,在睡眠时仍持续存在。虫蠕状波动在肌肉松弛状态时更易观察。 5例肌电图提示有肌肉颤搐放电 ,但 2例肌电图表现正常。卡马西平或苯妥英钠治疗有明显效果。结论特发性肌肉颤搐具有特殊的临床表现 ,且有较好的治疗效果。     

特发性肌肉颤搐患者的电生理及临床特征:7例分析

背景特发性肌肉颤搐在临床表现及肌电图方面均具有独特性,但临床上比较罕见,人们对其认识不足,容易误诊.目的探讨特发性肌肉颤搐的临床特征、诊断与治疗.设计以诊断为依据的回顾性研究.地点和对象2000-01/2003-12解放军总医院的门诊及住院患者7例,男3例.女4例;发病年龄26～58岁,平均年龄36岁.方法对7例特发性肌肉颤搐诊疗过程进行回顾性分析.主要观察指标临床表现、肌电图资料、实验室检查、治疗与预后结果.结果7例均有典型的波动性和虫蠕状肌肉颤搐.全部病例的肌肉颤搐均出现在双侧腓肠肌,5例还出现在双上肢,2例在面部、腰背部及腹部.肌肉颤搐活动后可加重,在睡眠时仍持续存在.虫蠕状波动在肌肉松弛状态时更易观察.5例肌电图提示有肌肉颤搐放电,但2例肌电图表现正常.卡马西平或苯妥英钠治疗有明显效果.结论特发性肌肉颤搐具有特殊的临床表现,且有较好的治疗效果.     

癫痫患者甲状腺激素水平及抗癲痫药物对其影响的研究

目的:研究癫痫患者甲状腺激素水平和抗癫痫药物对甲状腺激素水平的影响以及与抗癫痫效果之间的关系。方法:测定确诊的45例未服用过抗癫痫药物的癫痫患者的血清甲状腺激素水平并与30例健康对照组进行比较。再经卡马西平、苯妥英钠、丙戊酸钠三种抗癫痫药物分组单药治疗三月、六月、一年后对甲状腺激素水平的变化及与疗效之间的关系进行现(?)。结果:未服用抗癫痫药物的癫痫患者游离甲状腺素(FT_4)水平显著低于健康对照组,经苯妥英钠、卡(?)西平分别治疗三月、六月、一年后甲状腺激素(T_4)、FT_4、游离三碘甲状腺原氨酸(FT_3)显著低于治疗前水平。经丙戊酸治疗后的不同时间段各甲状腺激素水平与治疗前无显著性差异。甲状腺激素水平的(?)化与抗癫痫效果之间似无相关性。结论:癫痫的反复发作虽不经抗癫痫药物治疗亦存在FT_4水平的降低。苯妥英钠、卡马西平可明显造成癫痫患者的亚临床甲低(T_4、FT_4、FT_3降低)。丙戊酸钠对患者甲状腺激素水平无显著影响。甲状腺激素水平的变化与疗效之间无相关性。     

特发性肌肉颤搐患者的电生理及临床特征：7例分析

背景：特发性肌肉颤搐在临床表现及肌电图方面均具有独特性，但临床上比较罕见，人们对其认识不足，容易误诊。目的：探讨特发性肌肉颤搐的临床特征、诊断与治疗。设计：以诊断为依据的回顾性研究。地点和对象：2000-01／2003-12解放军总医院的门诊及住院患者7例，男3例。女4例；发病年龄26～58岁，平均年龄36岁。方法：对7例特发性肌肉颤搐诊疗过程进行回顾性分析。主要观察指标：临床表现、肌电图资料、实验室检查、治疗与预后结果。结果：7例均有典型的波动性和虫蠕状肌肉颤搐。全部病例的肌肉颤搐均出现在双侧腓肠肌，5例还出现在双上肢，2例在面部、腰背部及腹部。肌肉颤搐活动后可加重，在睡眠时仍持续存在。虫蠕状波动在肌肉松弛状态时更易观察。5例肌电图提示有肌肉颤搐放电，但2例肌电图表现正常。卡马西平或苯妥英钠治疗有明显效果。结论：特发性肌肉颤搐具有特殊的临床表现，且有较好的治疗效果。     

获得性癫痫性失语症临床特征及其干预效果:1例报告

目的探讨获得性癫痫性失语症的临床特点及治疗方法。方法对1例获得性癫痫性失语症患者的临床表现、治疗经过及预后进行回顾性分析。结果此例患者临床特点为全身性癫痫发作,继之出现言语功能障碍伴智能减退。病前有上呼吸道感染史。曾在院外诊断为病毒性脑炎。经糖皮质激素、卡马西平治疗及语言训练后痊愈。结论对获得性癫痫性失语症进行正确诊断、及时治疗及功能训练可使患者全面康复。     

抗癫痫药物治疗对血脂水平影响的研究

目的:探讨长期服用抗癫痫药物(卡马西平、苯妥英钠、丙戊酸钠)对血脂水平的影响。方法:测定已确诊为癫痫的48例患者(卡马西平组16例,苯妥英钠组16例,丙戊酸钠组16例)的血脂水平,并与健康对照组16例进行比较。结果:1)血脂浓度与癫痫本身无相关性;2)长期服用卡马西平和苯妥英钠后总胆固醇(TC)和甘油三酯(TG)、高密度脂蛋白(HDL-c)、载脂蛋白A(Apo-A)和脂蛋白(a)[LP(a)]明显增高(p<0.05),低密度脂蛋白(LDL-c)无变化,且LP(a)随治疗时间的延长浓度明显增高(r=0.74,p<0.05),丙戊酸钠对血脂无影响。结论:长期抗癫痫药治疗能使血脂浓度增高,因此需长期监测血脂水平,预防动脉粥样硬化。     

获得性癫痫性失语症临床特征及其干预效果：1例报告

目的探讨获得性癫痫性失语症的临床特点及治疗方法。方法对1例获得性癫痫性失语症患的临床表现、治疗经过及预后进行回顾性分析。结果此例患临床特点为全身性癫痫发作，继之出现言语功能障碍伴智能减退。病前有上呼吸道感染史。曾在院外诊断为病毒性脑炎。经糖皮质激素、卡马西平治疗及语言训练后痊愈。结论对获得性癫痫性失语症进行正确诊断、及时治疗及功能训练可使患全面康复。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.