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IntroductionBenign paroxysmal positional vertigo is a common vestibular disorder that accounts for one fifth of hospital admissions due to vertigo, although it is commonly undiagnosed.ObjectiveTo evaluate the effects of betahistine add-on therapy in the treatment of subjects with posterior benign paroxysmal positional vertigo.MethodsThis randomized controlled study was conducted in a population of 100 subjects with posterior benign paroxysmal positional vertigo. Subjects were divided into the Epley maneuver + betahistine group (group A) and Epley maneuver only (group B) group. Subjects were evaluated before and 1-week after the maneuver using a visual analog scale and dizziness handicap inventoryResultsOne hundred subjects completed the study protocol. The Epley maneuver had an overall success rate of 95% (96% in group A; 94% in group B, p = 0.024). Groups A and B had similar baseline visual analog scale scores (6.98 ± 2.133 and 6.27 ± 2.148, respectively, p = 0.100). After treatment, the visual analog scale score was significantly lower in both groups, and was significantly lower in group A than group B (0.74 ± 0.853 vs. 1.92 ± 1.288, respectively, p = 0.000). The change in visual analog scale score after treatment compared to baseline was also significantly greater in group A than group B (6.24 ± 2.01 vs. 4.34 ± 2.32, respectively, p = 0.000). The baseline dizziness handicap inventory values were also similar in groups A and B (55.60 ± 22.732 vs. 45.59 ± 17.049, respectively, p = 0.028). After treatment, they were significantly lower in both groups. The change in score after treatment compared to baseline was also significantly greater in group A than group B (52.44 ± 21.42 vs. 35.71 ± 13.51, respectively, p = 0.000).ConclusionThe Epley maneuver is effective for treatment of benign paroxysmal positional vertigo. Betahistine add-on treatment in posterior benign paroxysmal positional vertigo resulted in improvements in both visual analog scale score and dizziness handicap inventory.  相似文献   
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CA是指脑血流在动脉血压和脑灌注压发生改变时保持相对稳定的一个复杂的多因素过 程。脑血流自动调节与多种神经系统疾病如脑血管病、帕金森病、头痛、自主神经功能障碍等疾病的 发生、发展及临床预后相关。对脑血流自动调节功能有很多种评估测量方法,监测瓦氏动作所诱导 的血压变化更具有操作性及标准化,适用于各种人群,其安全、简单、准确的特点使其在脑血流自动 调节中运用十分广泛。本文重点对瓦氏动作在脑血流自动调节功能中的应用做一个综述介绍。  相似文献   
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目的:探讨前半规管良性阵发性位置性眩晕(anterior canal benign paroxysmal positional vertigo,AC-BPPV)患者的眼震和管型受累特征。方法:回顾性收集AC-BPPV患者20例的临床资料,在眼震视图下行Dix-Hallpike试验,根据其眼震特征对其诊断,并采用Yacovino法对其进行手法复位治疗。结果:①本组20例患者中,左侧前半规管受累10例(50.0%),右侧前半规管受累5例(25.0%),侧别不能明确判定者5例(25.0%)。②眼震特征:Dix-Hallpike试验:单侧下跳性眼震11例(55.0%),单侧下跳伴扭转性眼震1例(5.0%),双侧下跳性眼震5例(25.0%),一侧下跳、另一侧下跳伴扭转性眼震2例(10.0%),双侧扭转伴下跳性眼震1例(5.0%)。坐起时出现眼震逆转5例(25.0%)。③Yacovino手法复位:首次手法复位治愈12例(60.0%),有效7例(35.0%),无效1例(5.0%)。1周后复查痊愈15例(75.0%),有效4例(20.0%),无效1例(5.0%)。结论:AC-BPPV患者在Dix-Hallpike试验中诱发出的眼震多样,单侧多见。多数为下跳眼震不伴有扭转成分,部分患者双侧Dix-Hallpike试验均能诱发出眼震;Yacovino法手法复位治疗常常效果较好。  相似文献   
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BackgroundDetecting a neoplasm in pediatric patients with acute abdominal pain is difficult, especially when there is no palpable mass. Ihara's maneuver, which allows the physician to apply manual pressure directly on the pancreatic body, is a useful palpation method of diagnosing acute pancreatitis in children. We report a case of solid pseudopapillary neoplasm of the pancreas (SPNP) detected by Ihara's maneuver.Case ReportAn otherwise healthy, 15-year-old male visited our emergency department with acute abdominal pain and nausea. His vital signs were appropriate for his age. A physical examination denied peritoneal signs, but Ihara's maneuver induced strong tenderness. His serum amylase and lipase were normal. A contrast-enhanced computed tomography scan revealed a well-defined, 2.2-cm, nonenhanced mass in the pancreatic tail. Laparoscopic distal pancreatectomy was performed, and the diagnosis of SPNP was confirmed. The patient was well postoperatively without any metastasis. SPNP is a rare neoplasm with low malignant potential. Although it typically occurs in young females, it has also been reported in children. The early diagnosis of SPNP is usually challenging because most patients do not have specific symptoms or laboratory findings. In the present case, the SPNP was difficult to detect by palpation because of its size, but Ihara's maneuver induced strong tenderness of the pancreas and led to a diagnosis.Why Should an Emergency Physician Be Aware of This?Ihara's maneuver has the potential to enable early diagnosis not only of pancreatitis but also of pancreatic tumors, such as SPNP.  相似文献   
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目的观察腹腔镜结直肠手术麻醉期间,肺保护性通气联合不同方法肺复张后对呼吸力学和预后的影响。方法选择腹腔镜结直肠手术患者62例,男37例,女25例,年龄46~72岁,BMI 17~27 kg/m 2,ASAⅠ—Ⅲ级。随机分为三组:序贯肺复张组(XG组,n=20)、随机肺复张组(SJ组,n=21)和无肺复张组(DZ组,n=21)。三组均进行肺保护性通气,XG组摆Trendlenburg体位后进行第1次肺复张,以后每小时用PEEP递增法肺复张1次;SJ组摆Trendlenburg体位后进行第1次肺复张,气腹停止后进行第2次肺复张;DZ组全程不进行肺复张。记录插管后、第1次肺复张后即刻,第1次肺复张后60、120 min、拔管前的气道峰压(Ppeak)、驱动压(ΔP);记录术后肺部感染、恶心呕吐发生情况和住院时间。结果与插管后比较,第1次肺复张后即刻、第1次肺复张后60、120 min三组Ppeak、ΔP明显升高(P<0.05)。与拔管前比较,第1次肺复张后即刻、第1次肺复张后60、120 min三组Ppeak、ΔP明显升高(P<0.05)。XG组和SJ组第1次肺复张后即刻、第1次肺复张后60、120 min Ppeak、ΔP明显低于DZ组(P<0.05)。XG组第1次肺复张后120 min Ppeak、ΔP明显低于SJ组(P<0.05)。术后DZ组有1例肺部感染。三组住院时间差异无统计学意义。结论对腹腔镜结、直肠手术无肺部疾病的患者进行肺复张能改善肺保护性通气的驱动压和肺效率。肺复张可作为肺保护性通气的有效补充。  相似文献   
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Objective/Background: To assess frequency domain heart rate variability (HRV) parameters at rest and in response to postural autonomic provocations in individuals with spinal cord injury (SCI) and investigate the autonomic influences on the heart of different physical activities.

Design: Cross-sectional study.

Methods: Ten subjects with complete cervical SCI and fourteen subjects with complete low thoracic SCI were prospectively recruited from the community and further divided in sedentary and physically active groups, the latter defined as regular weekly 4 hour physical activity for the preceding 3 months. Sixteen healthy individuals matched for sex and age were recruited to participate in the control group. The Low Frequency (LF), High Frequency (HF) powers and the LF/HF ratio of HRV were measured from continuous electrocardiogram (ECG) recordings at rest and after sitting using a fast Fourier transformation.

Outcome measures: The LF,HF, and the LF/HF ratio at rest and after sitting.

Results: A significant decrease in all HRV parameters in patients with SCI was found compared to controls. The change in HF, LF and LF/HF following sitting maneuver was significantly greater in controls as compared with the SCI group and greater in subjects with paraplegia as compared to subjects with tetraplegia. Better HRV values and enhanced vagal activity appears to be related to the type of physical activity in active subjects with paraplegia.

Conclusion: In this cohort of subjects spectral parameters of HRV were associated with the level of the injury. Passive standing was associated with higher HRV values in subjects with paraplegia.  相似文献   

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