Etiología y tratamiento de la parálisis laríngea: estudio retrospectivo de 108 pacientes

ObjectivesTo review the aetiology and treatment of laryngeal paralysis diagnosed at our hospital and to describe the available therapeutic options.MethodsRetrospective review of medical records of 108 patients diagnosed with unilateral and bilateral vocal fold paralysis between 2000 and 2012, identifying the cause of paralysis and its treatment.ResultsOf the 108 cases analysed, 70% had unilateral vocal fold immobility and 30% bilateral immobility. The most frequent aetiology in both cases was trauma (represented mainly by surgical injury), followed by tumours in unilateral paralysis and medical causes in bilateral paralysis. Half of the patients with unilateral paralysis (38) were treated surgically, with medialization thyroplasty. In bilateral vocal fold immobility, the treatment consisted of tracheostomy in patients with threatened airway (40%). We planned to widen the air passage in 9 patients (27%), performing cordectomy in most of them.ConclusionsThe aetiology observed in our patients is similar to that described in the literature. In cases of unilateral vocal fold paralysis, we believe thyroplasty is the procedure of choice. In bilateral paralysis, it is possible to perform cordectomy in selected patients once the airway has been secured.     

Reversible electrophysiological abnormalities in hypokalemic paralysis: Case report of two cases

Compound muscle action potential (CMAP) amplitude declines during a paralytic attack in patients with hypokalemic periodic paralysis (HPP). However, serial motor nerve conduction studies in hypokalemic paralysis have not been commonly reported. We report two cases with hypokalemic paralysis, who had severely reduced CMAPs in all motor nerves at presentation during the episode of quadriparesis. However, the amplitude of CMAPs increased and reached normal levels, as the serum potassium concentration and motor power returned to normal state.     

Sporadic hypokalemic paralysis caused by osmotic diuresis in diabetes mellitus

A wide variety of neurological manifestations are known in patients with diabetes mellitus. We describe a 40-year-old man who presented with hypokalemic paralysis. On evaluation, we found that the cause of the hypokalemia was osmotic diuresis induced by marked hyperglycemia due to undiagnosed diabetes mellitus. The patient had an uneventful recovery with potassium replacement, followed by glycemic control with insulin. Barring a few instances of symptomatic hypokalemia in the setting of diabetic emergencies, to our knowledge uncomplicated hyperglycemia has not been reported to result in hypokalemic paralysis.     

甲亢性周期性瘫痪心电图、心肌酶变化及临床特点分析

目的分析甲亢性周期性瘫痪患者心电图、心肌酶变化及临床特点。方法回顾性分析1997年1月~2009年5月间甲亢合并周期性瘫痪（TPP）患者31例,分析其临床发病特点及心电图、心肌酶在发病前后的变化特点。结果 TPP心电图异常18例,其中窦性心动过缓占35.2%,表现为T波低平,ST段下降,P-R间期延长,可见U波。窦性心动过速占12.9%,2例出现传导阻滞。发病时血清钾均低于正常。7例出现心肌酶升高。结论及时发现心电图变化,及早补钾纠正心律失常,早期积极治疗甲亢是治疗TPP的关键。     

热敏灸辅助配合渐进式康复训练在卒中后上肢痉挛中的应用效果

目的 评价热敏灸辅助配合渐进式康复训练在卒中后上肢痉挛中的应用效果。方法 选择2017年2月～2019年5月我院康复科收治的80例卒中后上肢痉挛患者为研究对象,根据患者在院病床尾号单双号不同原则将其分为对照组与观察组两组,每组40例。对照组(单号)开展渐进式康复训练,观察组(双号)在对照组基础上辅助热敏灸治疗,比较两组患者改良Ashworth评分(MAS)、简化Fugl-Meyer运动功能(FMA)评分、改良Barthel指数(MBI)及临床治疗效果。结果 治疗前两组患者MAS评级情况差异无统计学意义(P0.05),治疗后两组患者评级比较差异有统计学意义(P0.05),观察组优于对照组;治疗前两组患者FMA、MBI评分比较,差异无统计学意义(P0.05),治疗后两组患者评分与治疗前比较,差异有统计学意义(P0.05);治疗后观察组评分明显高于对照组,差异有统计学意义(P0.05);观察组治疗总有效率92.50%,明显高于对照组的75.00%,差异有统计学意义(P0.05)。结论 热敏灸配合渐进式康复训练在卒中后上肢痉挛患者中应用,可有效改善患者上肢痉挛程度,提升上肢运动功能与日常生活能力,值得应用与推广。     

周期性麻痹发生房室阻滞14例分析

目的探讨周期性麻痹导致房室阻滞的临床和心电图特点。方法回顾性分析我院2002～2005年收治的14例周期性麻痹引起房室阻滞病人的临床资料。结果血清钾均低予正常，平均2．05±0．45mmoL／L，发生二度房室阻滞5例，一度房室阻滞9例，合并其它心律失常者4例。结论周期性麻痹导致房室阻滞与低钾的程度无明显关系，补钾治疗后，心电图恢复正常。     

Effect of ventilation by high-frequency oscillation on lung and chest wall mechanics in the dog

High-frequency oscillation (HFO) has been shown to be effective in maintaining gas exchange, but the effects of high-frequency, small-volume ventilation on the mechanical properties of the respiratory system are unknown. A volume displacement plethysmograph was used to study lung volumes and static pressure-volume (PV) curves during HFO in pentobarbital-anesthetized dogs. During long-term studies, adequate gas exchange was maintained with a stroke volume of 2.5 ml/kg and frequencies between 15 and 30 Hz. The effect of 5–7 hours of HFO on lung and chest wall mechanics was studied in 8 dogs. In another 8 dogs the relationship of volume history and respiratory muscle tone to occlusion airway pressure and lung volume during short-term HFO was investigated. With prolonged HFO, a small but significant decrease in total lung capacity occurred by 5 hours and the static respiratory system PV curve shifted slightly to the right. These changes were reversed by muscle paralysis and may be explained by a change in respiratory muscle tone. Static lung compliance and the hysteresis ratio (an index of tissue properties) remained unchanged. The relationship of occlusion airway pressure and lung volume during short-term HFO was dependent on the lung volume history and was influenced by respiratory muscle tone only at low airway pressures. These findings suggest that during prolonged HFO a small increase in chest wall stiffness may result. However, occlusion airway pressure and lung volume at the onset of HFO are mainly dependent on the volume history of the lung. Presented in part at the Fall Meeting of the American Physiological Society, Toronto, Canada, October 12–17, 1980     

北京市1995-2011年急性弛缓性麻痹病例肠道病毒监测分析

目的分析北京市1995-2011年急性弛缓性麻痹（Acute Flaccid Paralysis,AFP）病例肠道病毒（Enterovirus,EV）监测情况。方法对北京市1995-2011年AFP病例分离到的脊髓灰质炎（脊灰）病毒（Poliovirus,PV）和非脊灰（Non-polio）EV（NPEV）进行描述性分析。结果共检测478例AFP病例的967份粪便标本,在90例AFP病例的133份粪便标本中检出EV,分离率为13.75%;其中20例AFP病例的41份粪便标本检出PV（30.83%）,70例AFP病例的92份粪便标本检出NPEV（69.17%）。在41份PV阳性标本中,检出PVⅡ型（Type 2）（PVⅡ）11份,PVⅢ型（Type 3）（PVⅢ）10份,分别占单型PV检出总数的40.74%和37.04%。在14例疫苗相关麻痹型脊灰（Vaccineassociated Paralytic Poliomyelitis,VAPP）病例中,PVⅡ和PVⅠ型（Type 1）（PVⅠ）＋PVⅡ＋PVⅢVAPP病例发病60天后随访均有不同程度的残留麻痹。2007-2008年,在NPEV阳性标本中检出7例14份粪便标本EV71型阳性,1例2份粪便标本柯萨奇病毒A组16型阳性。结论北京市1995~2011年AFP病例中,EV分布主要为NPEV,其次为PV;PVⅡ和PVⅠ＋PVⅡ＋PVⅢ是引起残留麻痹的主要PV型别;应深入研究EV不同血清型分布及流行规律。     

正常血钾型周期性麻痹一家系28例分析

目的：报道一正常血钾型周期性麻痹（normoKPP）家系,以提高对该病的认识。方法：调查一normoKPP家系,分析其家系中28例normo KPP患者的临床表现、辅助检查以及治疗结果,并复习相关文献。结果：患者均于儿童期起病,周期性发作四肢迟缓性瘫痪,发作期血钾正常,葡萄糖酸钙治疗有效。结论：normoKPP 是少见的常染色体显性遗传的骨骼肌病,依据其家族史、临床表现及相关辅助检查可诊断,基因分析可确诊。     

中西医结合治疗周围性面瘫

目的：观察中西药结合治疗周围性面瘫临床疗效。方法对1992~2013年收治的42例周围性面瘫病人分析总结。结果42例中治愈32例（占76.2%）,显效6例（14.2%）,有效2例（4.8%）,无效2例（占4.8%）。总有效率95.2%。结论中西药治疗周围性面瘫疗效显著。值得临床推广应用的。