Neurally Augmented Sexual Function in Human Females: A Preliminary Investigation

Objective. Neurally augmented sexual function (NASF) is the production of pleasurable genital stimulation and subsequent orgasm through the application of electrical energy to provide stimulation of the spinal cord or peripheral nerves. The purpose of this paper is to demonstrate the reproducibility of this phenomenon. Materials and Methods. Eleven otherwise healthy women, ages 32–60 years, were selected for this study. Through standard techniques, quadripolar (octopolar in the final patient) leads were placed in the epidural space percutaneuously. The lead was maneuvered initially to an L1–L2 position and then repositioned based on feedback from the patient. The patients were allowed to utilize the device ad libitum for up to 9 days. Results. Successful stimulation was achieved in 91% (10/11) of patients. These women described a greater frequency in sexual activity, increased lubrication, and overall satisfaction. A smaller subset had substantial improvement in sexual function as measured by orgasmic capacity. This subset consisted of women with secondary anorgasmia. A return of orgasmic capacity was found in 80% (4/5) of patients having secondary anorgasmia with an average intensity of ≥ 3/5 while using the device. Once the device was removed, the patients returned to their previous anorgasmic status. Conclusions. Pleasurable genital stimulation of the spinal cord is a consistently reproducible phenomenon. In a subset of the population studied, improvement in orgasmic function was noted. This was noted in the group with secondary orgasmic dysfunction.     

胫骨前肌疲劳时比目鱼肌诱发肌电图H波的变化及其机制探讨

为了解主动肌疲劳时拮抗肌脊髓运动神经元兴奋性变化的规律 ,本研究采用踝关节背屈运动形式 ,对胫骨前肌 (主动肌 )疲劳状态下的比目鱼肌 (拮抗肌 )诱发肌电图H波成分进行了观察。并以压迫阻断胫骨前肌Ⅰa类神经纤维传导的方法 ,对比目鱼肌H波变化机制进行了分析探讨。结果发现 :(1)胫骨前肌疲劳后 ,比目鱼肌H波明显受到抑制 ,与安静时比较呈非常显著性差异 ;(2 )胫骨前肌Ⅰa类神经纤维传导被阻断后 ,比目鱼肌H波的抑制现象没有解除。表明 ,胫骨前肌疲劳时比目鱼肌H波被抑制的原因 ,可能是由于主动肌内的代谢产物激活了Ⅲ·Ⅳ类神经纤维的感受器 ,Ⅲ·Ⅳ类神经纤维的传入冲动增加 ,使Ⅰa抑制性中间神经元被激活 ,导致拮抗肌脊髓运动神经元的兴奋性受到了抑制     

A New and Alternative Leads Positioning for Complex Regional Pain Syndrome Treatment: Paraforaminal Stimulation

We present a case of a female patient suffering from type I complex regional pain syndrome (CRPS) who developed “mirror imaging” of her CRPS and was successfully treated with dual spinal cord stimulation (SCS) in the paraforaminal epidural space. This patient initially had unilateral pain that was unsuccessfully treated with midline SCS and single‐lead lateral epidural lead placement “paraforaminally.” One year later, because we believed that paraforaminal stimulation would preferentially stimulate primary sensitized afferents innervating the painful area, we reperformed SCS with two leads positioned laterally and paraforaminally close to the roots within the epidural space. After repositioning and after 1 year of paraforaminal stimulation, there was significant improvement in the patient's symptoms, resolving all unilateral and “mirrored” symptoms. We conclude that paraforaminal stimulation may be a valid therapeutic option for the treatment of CRPS.     

脊柱放线菌感染并发脊髓压迫症(附3例报告)

目的探讨脊柱放线菌感染并发脊髓压迫症的临床和影像学特点及治疗方法。方法回顾性分析3例经病理检查证实的本病患者的临床资料。结果3例患者均有颈、胸脊椎及软组织感染和脊髓压迫症状;MRI示病变椎体骨质破坏,颈、胸硬膜外软组织肿块,脊髓受压。病理学检查组织病理学检查证实3例均为放线菌感染,2例表现为炎性肉芽组织伴微脓肿形成,另1例表现为硬膜外脓肿。均予以脓肿清除、脊髓减压术,并给予4~8周大剂量青霉素G静脉滴注,后改口服维持4~6个月,术后及随访3例患者均取得显著的疗效。结论脊柱放线菌感染并发脊髓压迫症临床和影像学表现无特征性,其确诊依赖于病理学和微生物学检查。脓肿引流、椎管内减压术和大剂量抗生素治疗有效。     

脊髓损伤后中枢性疼痛的实验模型和机制研究进展

中枢性疼痛(central pain,CP)是脊髓损伤(spi-nal cord injury,SCI)的顽固性合并症,为患者主观上感到损伤平面以下皮肤痛觉消失区一种以自发痛为主的疼痛,发生率为11%~94%,严重者为5%~30%。近年来其发生率逐年增高,使很多患者陷于抑郁、药物成瘾、甚至自杀的悲惨境地。许多疼痛     

AF系统治疗胸腰椎骨折脱位的相关问题

目的 :探讨AF系统治疗胸腰椎骨折脱位的相关问题与效果。方法 :应用AF系统经椎弓根内固定治疗胸腰椎骨折脱位 3 6例 ,合并脊髓损伤 3 2例 ,同时行椎板减压 2 8例 ,植骨 6例。结果 :3 3例椎体高度完全恢复 ,神经功能按ASIA标准 2 5例有 1～ 3级恢复。结论 :AF系统治疗胸腰椎骨折脱位 ,椎体复位好 ,固定安全可靠 ,术中正确掌握椎弓根螺钉植入、椎管减压和复位技巧等环节 ,可进一步提高疗效。     

前路病灶清除植骨内固定治疗胸腰椎结核

目的总结前路病灶清除植骨内固定治疗脊柱结核的临床效果。方法对12例脊柱结核患者采用一期病灶清除结合植骨内固定,手术前后配合正规化疗,根据X线片观察脊柱融合时间和脊柱后凸角度变化。结果随访时间8~45个月,全部病例未出现严重并发症。植骨界面骨性融合时间4.5~8个月。后凸矫正度数为7°~18°。结论一期病灶清除植骨内固定治疗脊柱结核,骨结构重建可靠,治疗过程相对简化,效果肯定。     

Fracture of the thoracic spine with paralysis and esophageal perforation

A 17-year-old young man presented with a highly unstable fracture dislocation of the third and fourth thoracic vertebrae with neurological deficit, in which the fractured spine had perforated the thoracic esophagus. Open reduction and internal fixation of the spinal fractures in combination with aggressive treatment of the mediastinitis caused by esophageal perforation, consisting of two re-thoracotomies, was performed. Two years after the accident, the patient had recovered well. The neurological deficit had recovered, and there were no difficulties with swallowing.     

备用根大鼠脊髓后角提取液中神经营养活性组分的分离及生物活性测定

制作备用根大鼠脊髓后角提取液，取其分子量大于10kD的组分进行SDS-聚丙烯酰胺凝胶电泳分析，发现手术侧和非手术侧的电泳区带数目大致相同，但手术侧样品的第四条蛋白质区带扫描的吸收峰面积百分比大于非手术侧样品的第四条区带，两者在量上可能有差别。将手术侧样品经交联葡聚精G-75凝胶层析，得到两个洗脱峰．第一峰洗脱液有促进体外培养的背根节神经元存活及其突起生长的作用，其电泳分析显示4条主带，分子量在40～80kD之间．实验结果提示部分去传入纤维支配的脊髓后角组织含有神经营养活性物质，该物质的分子量约在40～78kD之间．     

大鼠脊髓缺血再灌流时脊髓神经元对躯体和内脏传入刺激的反应

５０只大鼠用乌拉坦麻醉，箭毒制动。通过阻断腹主动脉血流以模拟腰段脊髓的局部缺血和再灌流损伤，玻璃微电极记录Ｌ２节段脊髓单位放电（ＳＣＵＤｓ），观察缺血再灌流时脊髓神经元对腓神经刺激（ＰＮＶ），内脏大神经刺激（ＶＬＮＶ）及两者同时刺激（ＳＶ）的反应。结果在缺血前所记录的１３３个自发放电单位中，对３种刺激均产生兴奋（Ｅ）、抑制（Ｉ）及无反应（ＮＲ）３种形式的反应，表明大鼠Ｌ２节段脊髓存在躯体、内脏和躯体内脏反应性神经元，并有会聚和阻塞现象。在脊髓缺血再灌流时，神经元对ＰＮＶ、ＶＬＮＶ、ＳＶ也产生Ｅ、Ｉ、ＮＲ３种形式的反应，提示脊髓缺血再灌流时神经元对躯体和内脏传入刺激的反应形式不受影响；但缺血时ＳＣＵＤｓ对ＰＮＶ、ＶＬＮＶ产生反应的单位数减少，这表明脊髓缺血损伤时神经元对躯体和内脏传入刺激的反应性减弱，随着缺血损伤加重，脊髓神经元对躯体内脏信号的整合功能下降