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1.
Dropped head syndrome (DHS) is characterized by severe weakness of neck extension that occurs in isolation or association with a generalized neuromuscular disorder. Multietiologies may be responsible for DHS, including radiotherapy, which may cause a delayed form of DHS. However, DHS acutely triggered by neck surgery after chemoradiotherapy is rare. The author reports a case of acute onset of isolated DHS following selective neck dissection surgery after concomitant chemoradiotherapy for laryngeal cancer.  相似文献   

2.
BackgroundDropped head syndrome (DHS) occurring with parkinsonism is often suggested to be a clue to multiple system atrophy (MSA), but it may occur in other parkinsonian conditions. The substrate for DHS is controversial, with some concluding that the cause is myopathic and others, exclusively dystonic. We report our clinical series of DHS arising in the setting of parkinsonism.MethodsPatients with DHS were initially identified by a retrospective computer search of the Mayo Clinic (Rochester, MN) medical record database from January 1997 to July 2010. Subsequent record review confirmed DHS and documented those with parkinsonism.ResultsWe identified 21 patients with DHS and parkinsonism, 12 male, 9, female. The median age of DHS onset was 69 years (interquartile range: 63.6–77.5 years). This included 10 patients with Parkinson‘s disease (PD), 10 with MSA, and 1 with drug-induced parkinsonism. The DHS component of their disorder segregated into three different subgroups: dystonia-alone (12 patients); myopathy-alone (4 patients; focal cervical myopathy in 3 and generalized myopathy in one); coexisting dystonia and myopathy (5 patients; 3 generalized, 2 focal cervical myopathy).ConclusionsDHS may be seen in either MSA or PD. It may be due to myopathy, dystonia or both. In some cases, the myopathy was focal, confined to the neck musculature. Whether dystonic antecollis predisposes to local muscle pathology is open to speculation.  相似文献   

3.
This study examined the psychometric overlap between the Dispositional Hope Scale (DHS; Snyder et al., 1991) and the Verinis, Lichtenberg & Henrich version of the D-A-P-R (Oster & Gould Crone, 2004) as an objective and projective measure of hope among a high-stress population of medical students. Results indicated that the DHS and D-A-P-R were correlated. Students with higher hope scores on the D-A-P-R also had significantly higher DHS scores in agency related beliefs. In addition to theoretical convergence, first year medical students obtained significantly lower scores on the D-A-P-R than second year students, suggesting lower hope on the projective measure. No significant differences were found by student year and the DHS. Future studies would compare the D-A-P-R and a state measure of the DHS.  相似文献   

4.
背景:治疗股骨转子间骨折的内固定有动力髋螺钉、Gamma钉、股骨近端交锁髓内钉等,究竟使用何种内固定目前仍存在争议。 目的:比较传统动力髋螺钉与锁定加压接骨板治疗老年股骨转子间骨折临床疗效的差异。 方法:2007-06/2010-03收治老年股骨转子间骨折96例,分别采用动力髋螺钉与锁定加压接骨板治疗各48例,两组患者性别、年龄、骨折类型、致伤原因等情况匹配。股骨近端锁定加压接骨板采用00Cr18Ni14Mo3不锈钢、Ti6Al4V钛合金或纯钛,部分钛合金或纯钛产品表面经阳极化处理,非灭菌包装。动力髋螺钉内固定弹性模量接近人体骨,耐体液电解,耐腐蚀强,性质稳定。比较两组患者手术时间、术中出血量、伤口引流量、骨折愈合时间及内固定后髋关节功能恢复情况。 结果与结论:与动力髋螺钉组相比,锁定加压接骨板组的手术时间及骨折愈合时间均明显缩短,术中出血量明显减少(P < 0.01)。锁定加压接骨板组髋关节功能恢复优良率显著高于动力髋螺钉组(94.6%,87.9%,P < 0.01)。提示与传统动力髋螺钉相比,锁定加压接骨板内固定治疗高龄股骨转子间骨折生物力学更合理,操作简便、微创、固定稳固、骨折易愈合,尤其适用于骨质疏松或老年患者。  相似文献   

5.
背景:如何选择最适合的内固定方法治疗复杂的股骨转子间骨折,是骨科医生经常面临的问题。 目的:比较动力髋螺钉、股骨近端防旋髓内钉、Gamma3三种内固定器械的生物力学性能和临床疗效。 方法:制作18具成人股骨标本制成转子间骨折模型,以动力髋螺钉、Gamma3、股骨近端防旋髓内钉固定,用实验应力分析方法,比较其生物力学性能。另外回顾分析392例股骨转子间骨折患者采用以上3种内固定方法的临床效果。 结果与结论 应力分析结果证明,Gamma3和股骨近端防旋髓内钉的力学性能优于动力髋螺钉(P < 0.05),Gamma3与股骨近端防旋髓内钉无明显差别。临床试验结果显示,动力髋螺钉组患者术中平均失血量最多、内固定后并发症发生率最高(P < 0.05)。内固定后髋关节早期Harris评分股骨近端防旋髓内钉组和Gamma3组优于动力髋螺钉组(P < 0.05),远期评分3组差异无显著性意义(P >0.05)。提示A2型骨折不推荐使用动力髋螺钉;A2型伴随明显骨质疏松和A3型应采用股骨近端防旋髓内钉或Gamma3。股骨近端防旋髓内钉、Gamma3内固定器械生物力学性能优良,临床证实是目前比较理想的方法。  相似文献   

6.
Creatine kinase in developing skeletal and cardiac muscle of the rat   总被引:3,自引:0,他引:3  
This paper reports the changes in specific activity and isoenzyme pattern of creatine kinase in skeletal and cardiac muscle of Holtzman rats during development. There is a rapid accumulation of enzyme after day 17 of gestation and, starting at a slightly earlier time, a transition from “brain” to “heart” and then to predominantly “muscle” isoenzyme takes place. Although the changes are similar in the two types of muscle, important differences are found. The specific activity of creatine kinase is much lower in developing and mature cardiac muscle, but adult levels of the enzyme are approximated sooner in cardiac than in skeletal muscle tissue. The changes in isoenzymes are more gradual and less profound in cardiac muscle than in skeletal muscle. The factors which may relate to these striking changes in creatine kinase are discussed.  相似文献   

7.
背景:临床常用动力髋螺钉、Gamma钉、外固定架治疗老年股骨转子间骨折,但如何选择尚没有一个标准可供参考。 目的:比较动力髋螺钉、Gamma钉、外固定架3种内固定物治疗老年股骨转子间骨折的效果。 方法:对168例老年股骨转子间骨折分别采用动力髋螺钉内固定53例,Gamma钉内固定58例,外固定架57例,比较3组手术时间、出血量、骨折愈合时间和术后并发症,观察术后关节功能。 结果与结论:术后随访6~35个月。Gamma钉组平均手术时间99.11 min,长于动力髋螺钉组和外固定架组(P < 0.05),外固定架组时间最短(P < 0.05)。动力髋螺钉组出血量最多,外固定支架组最少,3组比较差异有显著性意义(P < 0.05)。外固定架组的并发症发生率明显高于动力髋螺钉组和Gamma钉组。骨折愈合时间及髋关节功能优良率3组比较差异无显著性意义(P > 0.05)。提示动力髋螺钉、Gamma钉及外固定架是治疗老年股骨转子间骨折的有效方法,各有优缺点,只要适应证掌握得当,根据病情合理选择固定物均能取得满意疗效。  相似文献   

8.
Dropped head syndrome (DHS) associated with parkinsonism is not frequent, but it markedly reduces the activities of daily living and is refractory. To elucidate the mechanism and treatment of DHS associated with parkinsonism, we assessed 28 parkinsonian patients with DHS (2 men and 26 women) by examining their clinical features and cervical-muscle-needle and surface electromyographic (EMG) recordings. We also evaluated the effects of lidocaine, muscle afferent block (MAB; 1% lidocaine mixed with ethanol), and botulinum toxin injected into the bilateral sternocleidomastoid muscles (SCMs), which were considered to be the affected muscles. In some patients, DHS occurred after the initiation or loading of dopamine agonists (less common after pergolide than cabergoline and pramipexole). Improvement was noted after a reduction in the dopamine agonist dose in some patients, and loading of l-dopa in others. Needle EMG revealed no evidence for weakness of the dorsal neck muscles. Surface EMG showed a gradual increase in SCMs activity upon passive head lifting. Lidocaine injection into SCMs markedly improved DHS, but the effect was temporary. The effect of botulinum toxin and MAB was not satisfactory. Whereas DHS could have a heterogeneous etiology, dopamine receptor sensitivity may play a role in its pathogenesis. For the treatment of DHS in parkinsonian patients, an increase in the dosage of l-dopa and a decrease in that of the dopamine agonist should be considered. Lidocaine injection (lidocaine test) could be useful for determining the most affected muscle before using botulinum toxin or MAB. Further studies are needed to examine the outcome of such treatments that include GPi-DBS.  相似文献   

9.
Referential “reporting” was defined as the transmission of information about the presence or absence of symbolically-referenced real-world objects. In Experiment 1 two bottlenosed dolphins (Tursiops truncatus), trained in earlier studies to carry out instructions conveyed by imperative sentences expressed in artificial gestural or acoustic languages, each gave spontaneous indications that an object referenced in an imperative was absent from their tank. In Experiment 2 the dolphin tutored in the gestural language was taught to make explicit reports of object absence by pressing a “No” paddle in response to imperatives referencing an absent object. Absence was reported correctly on 84% of 97 missing-object probes inserted at random intervals among 598 sentences referring to objects that were present. Reports were typically made after active search of the tank for an average of 15.0 sec. False reports, that objects present were absent, were few (7.5%). In Experiment 3, the dolphin was taught an interrogative sentence form that enabled us to ask direct questions about the presence or absence of specific objects. Responses by the dolphin on the No paddle indicated absence, while responses on a “Yes” paddle indicated presence. From one to three objects were shown the dolphin and then placed in the tank in a discrete-trial procedure. In response to the interrogative, reports of object presence or absence were better than 91% correct with a single object in the tank and either that object or some other object referenced; accuracy declined to 72–78% correct with three objects present, but was still well above chance. Several lines of evidence suggested that the dolphin was attempting to remember which objects it had been shown, rather than conducting an active environmental search as in Experiment 2. The memory strategy became less efficient as the number of objects to be remembered increased. Overall, the results evidenced the language-trained dolphin's understanding of references to present or absent objects, its ability to inventory its environment to seek information about those objects, and its ability to report its obtained knowledge to others.  相似文献   

10.
In a study of 96 randomly selected male subjects between 40 and 60 yr of age a set of sociological variables and age were studied in relation to each of the variables systolic blood pressure, cigarette smoking and serum cholesterol. Low-order correlations were found. Systolic blood pressure, however, co-varied significantly with discrepancy between social group and educational level, the “self-made man” having higher blood pressure level. Cigarette smoking co-varied with reports of conflicts with teachers during school years.  相似文献   

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