Costovertebral joint dysfunction: another misdiagnosed cause of atypical chest pain.

The diagnostic work-up of atypical chest pain frequently leads to invasive procedures. However, this painful symptomatology can sometimes be of benign origin and respond to simple therapeutic manoeuvres. A number of musculoskeletal conditions such as costovertebral joint dysfunctions should be carefully considered. We report five cases in which patient discomfort and high costs could have been avoided if awareness of these conditions had led to a correct diagnosis upon initial physical examination.     

Ultrastructure of the perineurial cell of the sciatic nerve in rats--a transmission and scanning electron microscopic study.

The perineurial cells of the sciatic nerve of mature albino rats were investigated by using light microscope (LM), transmission electron microscope (TEM) and scanning electron microscope (SEM). The perineurium of the sciatic nerve was composed of several lamellae of thin perineurial cells which were held together by the zonula occludens and also by the zonula adherens. The TEM view of the perineurium revealed that the plasmalemma of the perineurial cells presented numerous caveolae similar to those described in the endothelial cells of blood capillaries. By SEM, the perineurial cells were very thin, flattened out with various shapes from rectangular to hexagonal, and arranged closely to each other in the fashion of a stone pavement around the nerve fascicles. It was possible to isolate the perineurium from the nerve and to demonstrate the cellular border of the perineurial cells by silver impregnation method. The SEM observation of the perineurial cells ascertained the figure of the cells which were seen in the silver-impregnated specimen under LM. The present authors have interest in the fact that shape and arrangement of the perineurial cells of spinal nerves resemble closely those of the myoid cells in the limiting lamina of the seminiferous tubules of the mammalian testes. The meaning and significance of the similarity between these two types of cells was discussed.     

骶神经电刺激治疗功能性肛门直肠痛疗效观察

目的探讨骶神经电刺激(SNS)治疗功能性肛门直肠痛(FAP)的临床效果及其对患者生活质量的影响。方法选取2013年6月至2015年6月驻马店市中心医院收治的FAP患者125例,按照治疗方式分为药物治疗组(n=42)和SNS组(n=83),药物治疗组患者给予氟哌噻吨美利曲辛治疗,SNS组患者给予SNS治疗,均连续治疗3个月;分别于治疗前后对2组患者进行疼痛视觉模拟评分法(VAS)评分,采用健康调查简表评价患者生活质量;治疗后评定2组患者的临床治疗效果。结果药物治疗组和SNS组患者治疗总有效率分别为83.3%(35/42)和97.6%(81/83),SNS组患者治疗总有效率显著高于药物治疗组(χ~2=6.48,P<0.05)。治疗前2组患者直肠感觉功能比较差异无统计学意义(P>0.05),治疗后2组患者直肠感觉功能显著优于治疗前(P<0.05);治疗后SNS组患者直肠感觉功能显著优于药物治疗组(P<0.05)。治疗前2组患者生活质量评分比较差异无统计学意义(P>0.05),治疗后2组患者生活质量评分显著高于治疗前(P<0.05);治疗后,SNS组患者生理功能、躯体疼痛、总体健康、社会功能、情感职能、精神健康及活力评分均显著高于药物治疗组(P<0.05),但2组患者生理职能评分比较差异无统计学意义(P>0.05)。结论 SNS可以显著改善FAP患者直肠感觉功能和生活质量。     

慢性下腰痛与骶骨倾斜角和腰椎前凸角的相关性研究

目的探讨骶骨倾斜角和腰椎前凸角与慢性下腰痛的相互关系。方法选择1997～2005年以反复腰痛为主诉的门诊患者539例。对照组476例。对每一个研究对象分别采用Ferguson法和Cobb法测量骶骨倾斜角、腰椎前凸角并调查Oswestry功能障碍指数（ODI）后对腰椎前凸角和骶骨倾斜角进行相关性研究。结果与对照组比较，慢性下腰痛组ODI较高。骶骨倾斜角、腰椎前凸角较大，（P〈0．01）．对照组中腰椎前凸角和骶骨倾斜角存在着相关性。结论腰椎前凸角、骶骨倾斜角与较高的慢性下腰痛的发生率有关。正常人群中合适的腰椎前凸角与骶骨倾斜角的比值是0．7～0．9。     

Neuroleptic malignant syndrome: another medical cause of acute abdomen

We present a patient with neuroleptic malignant syndrome and intestinal pseudo-obstruction misdiagnosed as being secondary to septicaemia. The management of the patient is discussed with emphasis on the role of creatine kinase and liver function tests.     

Lingual haematoma: yet another unusual cause of upper airway obstruction

An episode of acute upper airway obstruction was caused by a lingual haematoma, when a patient with end stage renal failure suffered a hypocalcaemic fit and bit his tongue. The large haematoma and profuse bleeding caused the patient to obstruct and become hypoxic, and rendered laryngoscopy and intubation impossible, requiring an urgent tracheostomy to secure the airway.     

骶神经根对直肠肛门功能选择性支配的实验研究

研究骶神经根对直肠和肛门功能的选择性支配,为临床从骶神经根角度重建脊髓损伤后的排便功能障碍提供依据。方法：对７只ＳＣＩ犬进行硬膜外Ｌ７－Ｓ３神经根电刺激,用二导程测压仪同时记录直肠和肛门的压力变化。结果：犬直肠的神经支配以Ｓ２为主,Ｓ１,Ｓ３次之;肛门的神经支配以Ｓ３为主,Ｓ１,Ｓ２次之。     

骶管阻滞和联合神经干阻滞治疗腰椎间盘突出症的比较

目的 比较和评价骶管阻滞和骶管阻滞与坐骨神经干阻滞治疗腰椎间盘突出症的临床疗效.方法 腰椎间蕊突出症患者80例随机分成A、B二组,每组40例,分别行骶管阻滞和骶管阻滞联合坐骨神经干阻滞治疗,两组均以曲安奈得、利多卡因、维生素B12、维生素B1与生理盐水混合液行神经阻滞治疗,每周1次,4次为1疗程.结果 经过1个疗程治疗后A、B组的优良率分别为40.0%（16/40例）和82.5%（23/40例）,两组的总有效率分别为65.0%（26/40例）和92.5%（37/40例）,B组疗效明显高于A组（P〈0.01）.A、B二组出现下肢乏力的发生率分别为12.5%（5/40例）和2.5%（1/40例）（P〈0.01）,两组治疗前、后血压均无明显变化（P〉0.05）.结论 骶管阻滞和骶管阻滞联合坐骨神经干阻滞均为治疗腰椎间盘突出症的有效方法,但后者比前者疗效更优,下肢乏力现象更少.