维丁胶性钙预防关节腔内注射皮质类固醇引起骨关节的损害

目的：采用维丁胶性钙预防关节内注射皮质类固醇对骨关节的损害。方法：４５只健康新西兰白兔，随机分为三组，每组１５只。Ａ组：右膝关节内注射醋酸强的松龙７．５ｍｇ／ｋｇ。Ｂ组：用药同Ａ组，同时每周肌注维丁胶性钙三次，每次１ｍｌ。Ｃ组：右膝关节内注射生理盐水０．３７５ｍｌ／ｋｇ，作为对照。于实验的第３、５、７、９、１１周的第１天，每组取３只动物作髋关节和膝关节Ｘ光照片，并取膝关节及股骨头标本作病理组织学和超微结构检查。结果：Ａ组。用药２次后，Ｘ线照片、病理组织学检查和超微结构观察均有骨关节损害的表现，并随给药次数的增加而加重。Ｂ组。用药６次后才出现轻度病理组织学和超微结构改变。Ｃ组。各项指标均正常。从而证实维丁胶性钙有预防或减轻皮质类固醇所致骨关节损害的作用。结论：在疼痛治疗中，关节内注射皮质类固醇应尽量减少注射次数和延长间隔时间，并同时应用维丁胶性钙肌注有一定预防骨质损害作用。     

Influence of peripheral afferents on cortical and spinal motoneuron excitability.

The objective of this study was to establish to what extent muscle, cutaneous, and joint afferents alter the excitability of spinal and cortical motor neurons. This question was examined by studying the impact of electrical stimulation of the second and third digits, the median nerve at the wrist, and the recurrent thenar motor branch on the F/H and magneto-electrical cortical motor responses (MEPs) of the thenar muscles. The firing frequencies of single F/H motor unit action potentials were unaltered by the foregoing conditioning peripheral stimuli. MEPs conditioned by motor threshold stimulation of the median nerve at the wrist or the recurrent motor branch were significantly increased in size at conditioning to test intervals of 50 to 80 milliseconds. No significant change in MEP size resulted from conditioning stimulation of the digital nerves. We conclude that muscle afferents were primarily responsible for the increase in MEP size. Conditioning stimuli may allow examiners to assess central motor conduction where it would otherwise be impossible.     

Changes in somatosensory evoked responses by repetition of the median nerve stimulation

OBJECTIVE: We investigate the synaptic factor for the recovery function of evoked responses using a repetitive stimulation technique. METHODS: Somatosensory evoked cortical magnetic field (SEF) was recorded following stimulation of the median nerve using single to 6-train stimulation in 8 healthy subjects. The SEF responses after each stimulus in the train stimulation were extracted by subtraction of the waveforms. RESULTS: An attenuation of the SEF components was recognized after the second of the stimuli, but there was no significant attenuation with the third or later stimulations. The root mean square (RMS) of the 1M (peak latency at 20 ms after stimulation) and 4M (70 ms) components were smaller than that of the single stimulation during the train stimulation, while the 2M (30 ms) and 3M (45 ms) components were not attenuated, but the 3M was facilitated at the fourth to sixth stimulation. CONCLUSION: The synaptic factor was not responsible for the attenuation of the SEF components during repetitive stimulation in healthy subjects. The SEF change disclosed a functional difference among the SEF components during the train stimulation, especially among the later components.     

Adenoma malignum (minimal deviation adenocarcinoma) of the cervix responsive to hormonal treatment

Adenoma malignum (AM) is a rare variant of cervical adenocarcinoma with an unfavorable prognosis despite radiation therapy, surgery, or chemotherapy either alone or in combination. Hitherto, however, the effectiveness of hormonal therapy for this condition has not been evaluated. We report on a patient with cervical AM treated with progesterone before surgery. The progesterone therapy resulted in a complete clinical response and partial surgical response. Later on the treatment was changed to tamoxifen because of side effects of the progesterone treatment. The patient is still without evidence of disease 42 months after the start of the hormonal therapy. The progesterone receptor analysis on the biopsy was clearly positive. This is, to our knowledge, the first case of an AM responsive to hormonal treatment. Furthermore, this is the first case of an AM with bone metastases at the time of primary diagnosis.     

先天性肾上腺皮质增生伴睾丸间质细胞腺瘤性增生一例报告并文献复习

目的提高对先灭性肾上腺皮质增生伴睾丸间质细胞腺瘤性增生的认识。方法总结1例先天性肾上隙皮质增生伴睾丸间质细胞腺瘤性增生患者资料。患者，男，25岁。以双侧睾丸结节就诊。查体见双侧睾丸、附睾结节感，右睾丸增大，表面凹凸不平，质地硬。实验审检查睾酮（T）18．7nmol／L、17α-羟化酶（17α-（OH）P）〉20．0ng／ml、快速ACTH兴奋试验阳性、中剂量地塞米松抑制试验阳性。B超提示双睾丸弥漫性病变合并部分占位，示双侧肾上腺皮质增生。睾丸活枪结果为间质细胞增生结节，免疫组化α-inhibin（＋）。结果结合病史、实验室、影像学及病理学检查诊断为先大性肾上腺皮质增生伴睾丸间质细胞腺瘤性增生。口服氢化可的松替代治疗，40mg／d，2周后30mg／d维持治疗，8个月后超声检查双侧睾丸结节消退。随访2年，肿物无复发。结论双侧睾丸肿块应结合病史和内分泌检查除外先天性肾上腺皮质增生伴睾凡间质细胞腺瘤性增生，经口服皮质激素替代治疗，激素敏感型睾丸间质细胞腺瘤性增生可以消退。     

成人肾上腺皮质癌的诊断和治疗(附16例报告)

目的：探讨成人肾上腺皮质癌的临床特点和治疗方法。方法：回顾性分析16例成人肾上腺皮质癌患者的临床资料，全部患者术前行B超、CT等影像学检查，10例接受内分泌激素检测，均首先行手术治疗，完整切除肿瘤13例，未能完整切除者3例。结果：术前13例明确诊断，3例末确诊。术后病理检查I期肿瘤3例，Ⅱ期9例，Ⅲ期4例。随访N一62个月，平均生存48个月；有5例至今生存，其中3例因术后转移而进展为Ⅳ期，行联合化疗(PDD加ADM加VN16)3—5周期，均末达到肿瘤缓解，术后平均生存17个月。3例末完全切除者术后放疗均末控，均因肿瘤扩散死亡，术后平均生存期为11个月。结论：成人肾上腺皮质癌恶性程度高，影像学检查是确诊的关键；早期发现并行根治性切除手术是目前提高其生存率的唯一有效方法。     

Enlarged adenomectomy for enclosed prolactinomas: A preliminary study of 26 cases

Summary Preliminary results obtained from 26 cases of prolactinomas less than 20 mm in diameter after treatment by enlarged adenomectomy are described.The operation consisted in removal of the adenoma, a layer of normal pituitary at the outer edge of the tumour and the pituitary capsule in contact with the sellar meninges. 24 women and 2 men were involved whose prolactin levels (PRL) were less than 200 ng/ ml. All presented abnormal PRL responses to Thyrotropin releasing hormone (TRH) and Metoclopramide (MCP) tests and an absence of a nocturnal rise in the sleep cycle study. Postoperatively, three patients developed transitory diabetes insipidus and five transitory adrenal insufficiency. Gonadotropin reserve was always found normal. All 24 women resumed normal menstrual cycles and two became pregnant within one year. From a serological viewpoint, after surgery 100% of patients were found to be normal for levels of prolactin but only 85% turned to normal dynamic tests. The results of this small series of enlarged adenomectomies seem better than those obtained using selective adenomectomy, but must be confirmed with time.     

大型垂体生长激素腺瘤合并重型糖尿病的临床治疗

目的 探讨垂体生长激素腺瘤并发重型糖尿病的临床治疗方法和效果。方法 收治6例大型垂体生长激素腺瘤合并重型糖尿病病人，首先给予大剂量胰岛素控制血糖，待血糖降至10mmol/L左右时手术行肿瘤次全切除，术后常规放疗，DT：50Gy。结果 本组6例病人术后胰岛素所需剂量即明显下降。其中5例获随访0．6～6年，平均随访时间4．5年，均已恢复正常工作，停用任何降糖药物。血糖尿糖复查正常。结论 对大型生长激素腺瘤合并重型糖尿病的病人，积极手术切除肿瘤并辅以放疗是一种迅速有效的治疗选择。     

无框架MRI导航下的内镜经蝶鞍区肿瘤切除术

目的探讨无框架MRI导航系统在内镜经蝶垂体腺瘤和颅咽管瘤切除术中的作用.方法对8例垂体腺瘤和2例颅咽管瘤病人在无框架MRI影像导航引导内镜下经蝶入路切除肿瘤.结果机器定位误差平均1.5mm,重要结构和病变定位满意,导航注册时间平均5 min,手术时间平均50min,术后病人症状均减轻.结论在内镜经蝶鞍区手术治疗中,无框架影像导航使重要结构及病变定位准确,可在手术中发挥重要作用.     

Follow up of growth and steroids in premature adrenarche

In a follow up study of 34 patients with premature adrenarche we examined serum adrenal androgen levels and growth. The majority (28/34) showed an upward bend in the growth curve which, at the mean age of 2.3 years, preceded other signs of adrenarche on average by 3.8 years. Pubertal growth spurt was missing or reduced in 50% of the patients (8/16), however, final height did not differ from that expected from parental heights. Adrenal androgens did not remain elevated at adolescence. The mean age at menarche for all the girls was 0.5 years younger than in the general population.Conclusion Our findings imply that premature adrenarche may start earlier than previously recognized. Compared to ordinary growth these children seen to use a greater part of their potential for adult height already at that early age.