BUERGER'S DISEASE IN HONG KONG: A REVIEW OF 89 CASES

Background : A retrospective analysis of 103 case records from 1978 to 1996 with a provisional diagnosis of Buerger's disease was undertaken at the Department of Surgery, University of Hong Kong, Queen Mary Hospital. The aim of the study was to elucidate the clinical course and evaluate the results of surgical intervention of Buerger's disease in Hong Kong Chinese people. Methods : Fourteen patients were subsequently excluded from the study because of inability to fulfil our diagnostic criteria. Data on clinical presentation, investigations, indications and results of surgical intervention were reviewed. Sympathectomies and arterial reconstructions were performed on 42 and four patients, respectively, for critical ischaemia or rest pain. Outcome was analysed with respect to the rate of ulcer healing, pattern of recurrence and limb loss. Results : The patients were all young male heavy smokers with a mean age of 36.5 years. The majority of patients (80%) presented with ischaemic ulceration or gangrene. Vascular reconstruction was undertaken in four patients and satisfactory long-term results were obtained in three patients. Sympathectomy was able to relieve symptoms in 87% of operated patients and ischaemic ulceration healed in 2.6 (mean) ± 1.7 (SD) months after the operation. If the patient continued to smoke, surgical intervention did not exempt the patient from a relapse or amputation. Conclusion : Sympathectomy provides short-term pain relief and promotes ulcer healing in patients with Buerger's disease but carries no long-term benefit. Complete abstinence from smoking is the only means of arresting the progression of the disease.     

Monkey hippocampal neuron responses to complex sensory stimulation during object discrimination.

The purpose of this study was to investigate, during the performance of an object discrimination task, responses of neurons in the monkey hippocampal formation to the sight of several objects that have biological meaning, and compare these responses with those of amygdalar neurons studied previously using the same task. Neuronal activity in the hippocampal formation of conscious monkeys was recorded during performance of a task that led to presentation of familiar rewarding, familiar aversive, or unfamiliar objects. Of 864 neurons recorded in the hippocampal formation and adjacent cortices, 160 (18.5%) responded to the sight of a certain object(s). Responses to the sight of different kinds of objects were analyzed in detail. Nondifferential neurons (n = 73) responded to different objects with no significant difference in response magnitudes, and differential neurons (n = 87) responded to different objects with different response magnitudes. Of the differential neurons, 23 responded more strongly to rewarding objects than to other objects (rewarding-object-dominant neurons), but the magnitude of responses to objects did not necessarily correlates with the order of preferences to the objects as determined from observation of animal behavior. Aversive-object-dominant neurons (n = 13) responded more to aversive objects than to other objects. Unfamiliar-object-dominant neurons (n = 7) responded more to unfamiliar objects than to familiar objects. Selective neurons (n = 10) responded selectively to only one object or one category of objects. Fourteen of the rewarding- or averse-object-dominant neurons were tested in extinction or reversal trials. In 12 of 14 neurons, responses to a rewarding or aversive object did not change, or slightly weakened, in extinction or reversal trials. The results suggest the following. (1) Responses of rewarding- or aversive-object-dominant neurons may be involved in object-reward or object-aversion association. However, responses of many of these neurons might reflect past inputs to reinforcement rather than extant emotional processing. (2) Responses of unfamiliar-object-dominant neurons may be involved in recognition of objects based on their familiar or unfamiliar aspects. These results are further discussed and compared with responsiveness of amygdalar neurons.     

Linear relationship between the maintenance of hippocampal long-term potentiation and retention of an associative memory.

The hypothesis that the maintenance or decay of an associative memory trace after an extended retention interval is a function of the residual strength of the synapses originally strengthened during learning was examined in a classical conditioning paradigm in which high-frequency stimulation of a hippocampal input--the medial perforant path--served as a conditioned stimulus. Rats received perforant path stimulus-foot shock pairings while engaged in a previously acquired food-motivated lever-pressing task. Conditioned suppression of lever pressing was the behavioral measure of learning and retention of the association. Stimulus trains to the perforant path at an intensity above the threshold for eliciting a population spike induced long-term potentiation of synaptic transmission in the dentate gyrus. Synaptic potentials recorded extracellularly in the dentate gyrus were subsequently monitored for 31 days to examine quantitatively the decay of synaptic potentiation, a period after which retention of the learned association was assessed. All rats learned the association to a similar extent and displayed equivalent amounts of long-term potentiation by the end of conditioning. A slowly decaying function of synaptic potentiation was observed in remembering rats, i.e., rats with high retention performance after the 31-day learning-to-retention interval, while forgetting was associated with a rapid decay of long-term potentiation. Behavioral performance at the long-term memory test was linearly correlated with the amplitude of long-term potentiation maintained just prior to the retention test. The results favor the hypothesis that long-term associative memory depends, at least in part, on the maintenance of elevated synaptic strengths in the pathway activated during learning and suggest a role for the lasting component of long-term potentiation in the maintenance of memory.     

食管内支架置入术并发症分析及防治

目的：分析食管内钛镍记忆合金支架置入术并发症的可能原因及防治方法。方法：共52例病人，食管癌、贲门癌29例，食管胃吻合口狭窄21例，自发性食管破裂2例，共置入各种钛镍记忆合金支架54枚。随访观察3～36个月。结果：内支架置入全部成功，术后患吞咽困难症状均改善。术后出现的并发症包括支架移位3例，支架堵塞9例。吸入性肺炎3例，呕血7例，残余漏2例，疼痛和异物感24例，严重返流症状5例。经过相应的治疗，除2例大呕血患外，其余并发症均得到纠正。结论：虽然食管内钛镍记忆合金支架置入术后有不可忽视的并发症，但经过相应治疗，一般均可纠正，它是治疗食管恶性狭窄和自发性食管破裂有效的方法。     

Time course of the effects of diazepam and lorazepam on perceptual priming and explicit memory

The effects of diazepam and lorazepam on explicit memory and perceptual priming were studied 50, 130 and 300 min after drug administration. Sixty healthy volunteers were randomly assigned to one of five parallel groups (placebo, diazepam 0.2 or 0.3 mg/kg, lorazepam 0.026 or 0.038 mg/kg). The corresponding doses of benzodiazepines exerted a similar negative effect on explicit performance. Lorazepam markedly impaired priming performance, whereas the effect of diazepam was intermediate between that of placebo and that of lorazepam 0.038 mg/kg. The impairment was maximal at the theoretical peak plasma concentration. Contamination by explicit memory could account for the decrease in priming performance observed in the diazepam groups.     

镍钛记忆合金锁骨钩环抱器治疗新鲜重度肩锁关节脱位

目的 评估镍钛记忆合金锁骨钩环抱器治疗新鲜重度肩锁关节脱位的临床疗效。方法 选择16例新鲜重度肩锁关节脱位患者，其中3例合并锁骨远端骨折，应用镍钛记忆合金锁骨钩环抱器治疗并进行临床疗效观察。随访6～12个月，平均7.6个月。结果 所有患者肩关节肌肉无萎缩，外观正常，肩关节活动范围正常，x线片示无再脱位征象。采用Karlsson术后疗效分级：A级15例，B级1例。结论 镍钛记忆合金锁骨钩环抱器治疗新鲜重度肩锁关节脱位创伤小，简便易行，疗效好，对合并锁骨远端骨折病人更具有独特优点，具有临床推广应用价值。     

前额叶皮层在数字工作记忆维持中的作用:事件相关fMRI研究

目的采用事件相关功能磁共振成像(ER-fMRI)探讨前额叶皮层在工作记忆维持期的作用。方法20名正常受试者接受sternberg项目认知任务的功能磁共振成像。采用相对低负载、高负载任务。组分析方法评价维持期相对低、高负载时平均脑区激活情况;组间比较探讨高负载任务出现相关激活增加的脑区。结果维持期与双侧前额叶背外侧皮层(DLPFC)、双侧前额叶腹外侧皮层(VLPFC)、顶叶、辅助运动区(SMA)和运动前区(PMA)、视觉相关皮层激活相关,VLPFC等脑区在高负载任务中激活增加。结论工作记忆维持和操纵之间可能存在功能上的、而非神经解剖的区分。     

多巴胺受体的结构和功能

多巴胺是大脑中含量最丰富的儿茶酚胺类神经递质。多巴胺作为神经递质调控中枢神经系统的多种生理功能。多巴胺系统调节障碍涉及帕金森病，精神分裂症，Tourette综合征，注意力缺陷多动综合征和垂体肿瘤的发生等。本文综述了多巴胺受体的共同特征和各个受体的独特特征，以及它们在中枢神经系统的分布和功能，重点强调了多巴胺受体与学习记忆的关系。