脊髓源性间歇性跛行21例报告

目的：神经源性间歇性跛行中，由腰椎管狭窄所致的马尾源性间歇性跛行最常见，且为大家所熟知，而由脊髓压迫所致的脊髓源性间歇性跛行却较少见。对颈、胸椎退变压迫脊髓所致的脊髓源性间歇性跛行进行临床研究。方法：对２１例颈、胸椎退变性疾病压迫脊髓所致的脊髓源性间歇性跛行，就其临床特点、影像学、手术所见及随访结果进行了研究。结果：２１例颈或胸脊髓压迫者均有间歇性跛行的临床症状，步行负荷试验均阳性，脊髓减压术后间歇性跛行症状均消失，随访平均４．３年，均未再发。结论：颈、胸椎退变性疾病所致的脊髓压迫，可产生脊髓源性间歇性跛行，临床特征为步行负荷试验阳性，脊髓减压术后间歇性跛行症状消失。     

间歇性跛行的鉴别诊断

间歇性跛行是脊柱外科中常见的临床症状，可分为神经源性及血管源性间歇性跛行两大类。其症状有许多类似之处，但病因却完全不同，尤其是神经源性的马尾性与脊髓性间歇性跛行在临床上极易导致误诊，使治疗走入歧途。通过了解其发病机制、病理基础及详细的临床检查，结合一定的辅助检查，并结合了数年来行之有效的临床经验，可以有效地做出鉴别诊断，使治疗得以及时、正确。     

踝肱指数对血管源性及神经源性间歇性跛行的诊断价值

目的 探讨踝肱指数（ABI）对血管源性及神经源性间歇性跛行的诊断价值。方法 收集2021年10月至2022年3月于首都医科大学附属北京朝阳医院就诊的160例间歇性跛行患者的临床资料,根据病理类型的不同将其分为血管源性组（n=104）和神经源性组（n=56）,收集两组患者的性别、年龄、体重指数（BMI）、病程、间歇性跛行严重程度、吸烟史、饮酒史、基础疾病情况、血肌酐（Scr）、尿素氮（BUN）、C反应蛋白（CRP）、血小板计数（PLT）、脂蛋白A(Lp A)、同型半胱氨酸（Hcy）、趾肱指数（TBI）、ABI,分析发生血管源性间歇性跛行的影响因素。结果 血管源性组患者CRP、Lp A、Hcy水平均高于神经源性组患者,TBI、ABI均低于神经源性组患者,差异均有统计学意义（P﹤0.05）。多因素分析结果显示,CRP、Lp A、Hcy、TBI、ABI均是发生血管源性间歇性跛行的影响因素（P﹤0.05）。不同严重程度间歇性跛行患者TBI、ABI比较,差异均有统计学意义（P﹤0.05）;重度间歇性跛行患者TBI、ABI均低于轻度、中度患者,中度间歇性跛行患者TBI、ABI均低于轻度患者,差异均有...     

间歇性跛行的发生机理

临床上间歇性跛行症状十分常见 ,病人主要分布在骨科、神经科、血管外科及内科等领域。其发生机理多种多样 ,表现形式也较复杂 ,有时容易误诊误治。为了便于对此类疾病的掌握 ,本文较为全面的描述了神经源性、脊髓源性、血管源性间歇跛行的发生机理以及临床特点。目的是能够提供较为系统的理论依据 ,从而及时正确的掌握病因诊断和恰当有效的治疗。     

脊髓栓系伴神经源性膀胱16例诊治

目的：探讨脊髓栓系伴神经源性膀胱的诊治方法。方法：对26例脊髓栓系伴神经源性膀胱患者的临床资料进行回顾性分析,治疗前所有患者均行尿动力学及腰骶MRI检查,均行解栓术,术后排尿症状均有不同程度改善,再依尿动力学结果采取针对性的治疗方法,A型肉毒素膀胱逼尿肌注射术5例,间歇性清洁导尿2例,膀胱扩大术2例。所有患者治疗后均行尿动力学随访。结果：26例获3个月至3年的随访,其中24例膀胱、尿道功能明显改善,2例需一直行间歇性清洁导尿,但无上尿路恶化。结论：对脊髓栓系伴神经源性膀胱的治疗,无论早晚解栓术都是十分必要的,再根据术后排尿症状采取相应的个性化治疗。     

一、神经性跛行

自从Charcot报导间歇性跛行100多年以来,这个术语应用于描述小腿疼痛性缺血性肌痉挛。最近,又插入跛行的另一种形式,即神经性而不是肌肉性跛行,认为是脊髓和马尾神经根病变引起。于此,神经性跛行这个术语被专用于腰椎关节病和椎管狭窄引起的马尾神经根病变。 临床资料 神经性跛行的主要症状表现是感觉方面。不舒服的感觉往往被形容为麻木、发凉,有时为烧灼样。极少数病人把这种感觉描述为痉挛性疼痛。这是鉴别该病和真性间歇性跛行的一个重要特征。虽然一些病人否认有疼痛,但另一些人认为这种感觉很难受、很不舒服。但亦有少数病人以疼痛作为他们的主要主诉。无论感觉障碍的特征和原因如何,但总是在某种活动通程中或步行后出现。     

腰椎管狭窄的自然过程

本文研究了32例未经治疗的椎管狭窄病人的自然过程。该组病人平均年龄60岁,平均观察期49个月,大约75%的病人有椎体源性间歇性跛行。在以后的调查中,相同数量的病人有间歇性跛行,但症状减轻。同样依靠     

神经源性间歇性跛行病理生理机制的研究进展

自１９５４年Ｖｅｒｂｉｅｓｔ首次系统地提出腰椎椎管狭窄症的概念以来，人们对其临床表现已经有了很深的认识。腰椎椎管狭窄症主要发生在５０岁以后，典型表现为神经源性间歇性跛行。通常在站立、腰伸直以及行走时出现，休息或腰屈曲时缓解。目前有关神经源性间歇性跛行...     

应重视血管性与神经性间歇性跛行的鉴别

下肢血管疾病和脊髓受压性疾病均可引起间歇性跛行的症状。下肢动脉闭塞及腰椎椎管狭窄性疾病是引起间歇性跛行的常见原因之一,同时合并有椎管狭窄和动脉硬化性闭塞症时,若仅注意腰椎病变而忽略下肢动脉病变,可能会带来严重后果,因此应引起重视。     

双侧开窗减压术治疗中央型腰椎间盘突出症

<正> 1990年至2001年6月,本院对16例中央型腰椎间盘突出症病人行双侧开窗减压术,疗效满意,报告如下。 1 临床资料 1.1 一般资料:本组16例,男12例,女4例,年龄20岁至50岁,平均35岁。病程最短7个月,最长8年,平均3.2年。均有典型腰痛和交替性两下肢放射痛,直腿抬高试验阳性。加强试验阳性等表现,无大、小便困难,2例有(足母)趾背伸力减弱,4例有间歇性跛行。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.