Cauda equina syndrome: a review of clinical progress

Objective To review the literature on the clinical progress in cauda equina syndrome （CES）, including the epidemic history, pathogenesis, diagnosis, treatment policy and prognosis.
Data sources All reports on CES in the literature were searched in PubMed, Ovid, Springer, Elsevier, and the Chinese Biomedical Literature Disk using the key terms ＂cauda equina syndrome＂, ＂diagnosis＂, ＂treatment＂, ＂prognosis＂ and ＂evidence-based medicine＂.
Study selection Original milestone articles and critical reviews written by major pioneer investigators about the cauda equina syndrome were selected.
Results CES is rare, both atraumatically and traumatically. CES is variable, depending on the etiology of the syndrome. Males and females are equally affected. The incidence of The most common cause of CES is herniation of a lumbar intervertebral disc. CES symptoms may have sudden onset and evolve rapidly or sometimes chronic ally. Each type of CES has different typical signs and symptoms. Low back pain may be the most significant symptoms, accompanied by sciatica, lower extremities weakness, saddle or perianal hypoesthesia, sexual impotence, and sphincter dysfunction. MRI is usually the preferred investigation approach. Patients who have had CES are difficult to return to a normal status.
Conclusions The diagnosis of CES is primarily based on a careful history inquiry and clinical examination, assisted by elective radiologic investigations. Early diagnosis and early surgical decompression are crucial for a favorable outcome in most CES cases.     

Cauda equina syndrome secondary to disseminated zygomycosis

We describe a case of cauda equina syndrome secondary to disseminated zygomycosis. A 52-year-old man had myelodysplastic syndrome, progressive weakness of the lower extremities, and incontinence. Neuroradiological findings were consistent with lumbar stenosis and probable disk herniation. A lung lesion was also discovered on the chest roentgenogram. The patient's condition rapidly deteriorated after surgical decompression. Attempts at determining other etiologies were unsuccessful. At autopsy, disseminated zygomycosis was found affecting the lung and the vasculature of the cauda equina and lumbosacral nerve roots, with resultant focal demyelination of these structures. Ribbon-like hyphal elements were also present in the caudal roots. This opportunistic pathogen is discussed along with the diagnostic challenge presented by its unusual clinical presentation.     

Thyroid disorders in female patients with ankylosing spondylitis

The association between rheumatological and thyroid disorders has long been known, the most common being the association of rheumatoid arthritis and autoimmune thyroiditis. Little is known as to possible thyroid involvement in ankylosing spondylitis (AS). In 22 female patients with AS and 22 healthy age-matched control subjects parameters of thyroid gland function, rheumatic activity, as well as a subtle drug anamnesis of the rheumatic medication, and an ultrasonographic examination of the thyroid gland were determined. Thyroid function was tested by intravenous injection of 400 microg thyrotropin-releasing hormone (TRH). In parallel basal levels of reverse-T3 (rT3), calcium and anti-thyroid antibodies were estimated. In the AS-group an enlarged thyroid volume was seen in 10 cases, basal FT4, FT3 and TT3 were significantly lower, TSH and TT4 were found to be in the normal range and rT3 was significantly increased. The prevalence of anti-thyroid antibodies was significantly higher in the AS-group. The AS-patients responded as well as the controls with thyroid hormone secretion to TRH, within an observation period of 2 hours. No differences were observed in TSH response. Free serum calcium showed in both groups no significant difference. To summarize our results, female patients with AS showed a     

女性与男性强直性脊柱炎对比研究

目的：了解不同性别的强直性脊柱炎的临床特点。方法：对比性地分析57例女性AS（FAS）患者和114例病程相同的男性AS（MAS）患者（1：2配对）的临床表现及实验室检查结果。结果：平均发病年龄,首发症状,腰椎的X线受累和病情活动指标在两组无差异（P＞0．05）;贫血,外周关节炎和颈椎的受累在女性明显多于男性（P＜0．05）,而全身症状,虹膜睫状体炎,严重的骶髂关节及髂关节的X线受累和HLA－B27的阳性率在女性明显少于男性（P＜0．05）。结论：FAS患者病情发展较慢,预后较好,这与B27阳性率低有一定的关系。     

女性与男性强直性脊柱炎对比研究

目的　了解不同性别的强直性脊柱炎的临床特点。方法　对比性地分析57例女性AS(FAS)患者和114例病程相同的男性AS(MAS)患者(1∶2配对)的临床表现及实验室检查结果。结果　平均发病年龄、首发症状、腰椎的X线受累和病情活动指标在两组无差异(P>0.05)；贫血、外周关节炎和颈椎的受累在女性明显多于男性(P<0.05)；而全身症状、虹膜睫状体炎、严重的骶髂关节及髋关节的X线受累和HLA-B27的阳性率在女性明显少于男性(P<0.05)。结论　FAS患者病情发展较慢，预后较好。这与B27阳性率低有一定的关系。     

93例女性强直性脊柱炎的诊断特点

目的探讨女性强直性脊柱炎的诊断特点。方法回顾性分析我院1999年1月-2009年1月诊治的93例女性强直性脊柱炎和191例男性强直性脊柱炎患者并进行临床特点比较。结果93例患者平均年龄35.05岁,平均病程7.48年,有生育史者68例（73.12%）,HLA-B27阳性者59例（63.40%）,主要临床特征以臀部、耻骨部、足跟部疼痛为主;影像学检查,单侧Ⅰ级39例,双侧Ⅰ级25例,单侧Ⅱ级15例,双侧Ⅱ级8例、Ⅲ级7例。结论女性强直性脊柱炎临床特点是病程长、症状轻,以外周关节疼痛为主,缺乏典型的影像学表现,致残率低,生育后病情可能加重。     

女性强直性脊柱炎骶髂关节病变的早期诊断

目的:研究女性强直性脊柱炎的骶髂关节病变的早期X线平片、CT影像表现,探讨影像学对强直性脊柱炎的骶髂关节病变诊断价值.方法:对临床确诊的22例强直性脊柱炎的双侧骶髂关节(SIJ)摄X线平片,同时作CT扫描.总结其影像表现及病变分级,作平行对照研究,并进行分析.结果: 强直性脊柱炎的骶髂关节病变的患者主诉以髋部疼痛、腰痛、弯腰受限、颈椎受限出现的百分率依次为40.91%、36.36%、18.18%、4.55%.X线骶髂关节影像表现正常、关节变毛糙、模糊、硬化、关节融合分别为13.64%、59.10%、22.73%、4.55%;CT分别为0%、50.0%、45.55%、4.55%.X线与CT诊断的符合率从0级～Ⅳ级分别为0%、66.6 %、85.71%、100%.结论:女性强直性脊柱炎的骶髂关节病变的早期诊断受女性自身解剖结构复杂等因素影响,X线平片的早期诊断困难,对临床怀疑而平片难以确诊的早期病变,CT检查有较高价值.平片表现为早期病变(0～Ⅱ级)的患者CT对其分级更为准确,可提高1～2个级别.     

强直性脊柱炎伴发葡萄膜炎的临床治疗与分析

目的 探讨强直性脊柱炎(ankylosing spondylitis,AS)伴发葡萄膜炎的临床特征、诊断,分析其治疗及预后.方法 回顾性分析19例葡萄膜炎患者临床资料,对AS伴发葡萄膜炎的患者进行临床观察及分析.结果 AS发病年龄11 ～42岁,平均(27± 11)岁,葡萄膜炎发病年龄13～46岁,平均(29±12)岁.12例患者先行确诊为AS后就诊于眼科,7例患者以眼部葡萄膜炎为首诊病历后确诊为AS.葡萄膜炎病史:4天～5年,病程:14 ～ 37天,平均(27±7)天.13例患者有明确葡萄膜炎复发病史.X线影像学检查显示均为骶髂关节炎,HLA-B27阳性:15例(78.9％)、红细胞沉降率升高:12例(63.2％)、CRP＞ 10 mg/L:7例(36.8％).经过糖皮质激素和睫状肌麻痹剂眼液系统治疗后19例患者前部葡萄膜炎均治愈.结论 AS伴发葡萄膜炎多累及中青年男性,多单眼发病,易复发,具有典型的临床特征及明确的确诊依据.给予及时有效的治疗均能取得良好效果.     

强直性脊柱炎伴发葡萄膜炎82例临床分析

目的探讨强直性脊柱炎（As）伴发葡萄膜炎的临床特点及药物治疗疗效。方法回顾性分析82例AS伴葡萄膜炎患者的临床资料。结果82例AS伴葡萄膜炎患者平均年龄（34．994±8．28）岁,其中男性占85．37％,HLA-B27阳性率为87．80％,葡萄膜炎评分（5．56±2．04）分。经非甾体类抗炎药、改善病情药物及眼科局部用药后,患者葡萄膜炎症状缓解,视力提高,眼部炎症消失,腰痛改善,血沉、C反应蛋白（CRP）、强直性脊柱炎疾病活动性指数（BASDAI）和强直性脊柱炎功能指数（BASFI）与治疗前比较差异均有统计学意义（P〈0．05）。结论AS伴发葡萄膜炎多见于青壮年男性,单侧受累为主,大部分患者HLA-B27阳性,及时有效治疗疗效确切,一般预后良好。     

Management of pregnancy with ankylosing spondylitis

To discuss the interaction between pregnancy and ankylosing spondylitis,and the management of pregnancy with ankylosing spondylitis.Methods Twelve cases of pregnancy with ankylosing spondylitis in Pek...     

Clinical history as a screening test for ankylosing spondylitis.

A controlled study of 138 subjects demonstrated that the clinical history may be sensitive (95%) and specific (85%) in the differential diagnosis of ankylosing spondylitis when reliance of five specific historic features is made. Back pain that is insidious in onset, in a patient younger than 40 years, persisting for at least three months, associated with morning stiffness and improving with exercise is characteristic of inflammatory spinal disease.     

强直性脊柱炎患者的细胞免疫功能研究

对12例强直性脊柱炎(AS)患者进行外周血淋巴细胞(PBL)亚群、体外培养产生IL-2的能力以及自然杀伤(NK)细胞活性测定。结果表明,AS患者PBLT_4、T_8阳性细胞百分率及T_4/T_8比值与正常人相比无显著差异;PBL体外培养产生的IL-2明显增多,但细胞膜IL-2受体表达无明显增多;NK细胞活性明显降低,且对IL-2刺激无反应。本结果提示,AS患者存在明显的细胞免疫功能紊乱,并在导致体液免疫异常中起重要作用。     

194例强直性脊柱炎中医证候分布特点分析

目的:分析强直性脊柱类(AS)常见证候的构成比,探讨其证候分布特点,以期为强直性脊柱炎的临床实践提供帮助。方法:设计AS中医证候分布临床调查表,并采用横断面调查研究的方法,对194例AS患者进行调查。结果:强直性脊柱炎证候出现频率依次为瘀血痹阻(75.8%),肾阳亏虚(45.9%)和湿热痹阻(38.7%)。其中湿热痹阻与肾阳亏虚主要以主证形式存在,瘀血痹阻以兼证形式存在。临床证型的存在绝大多数为复合证型,占78.9%,其中湿热痹阻+瘀血痹阻、肾阳亏虚+瘀血痹阻为主要形式,分别占22.7%和30.4%。结论:AS的常见证候分别为湿热痹阻证、肾阳亏虚证、瘀血痹阻证,临床常见复合证候主要为肾虚血瘀证和湿热瘀血证,在治疗上,应根据不同的证候给以清热利湿、活血通络或补肾强腰、活血通络之法。     

强直性脊柱炎患者HLA-B27的检测

目的　探讨强直性脊柱炎 (AS)患者HLA B2 7检测方法的特点。方法　采用补体依赖性微量淋巴细胞毒法、聚合酶链反应 -序列特异性引物法、流式细胞仪法 ,对 4 3例AS患者与 4 5例健康体检者的HLA B2 7抗原进行检测。结果　三种方法AS组的HLA B2 7阳性率均高 ,且均极显著高于对照组 (P <0 .0 1) ,三种方法之间的阳性率无显著性差异 (P >0 .0 5 )。结论　AS与HLA B2 7存在相关性 ;三种方法均可用于检测HLA B 2 7,但各有其特点。     

强直性脊柱炎患者细胞毒性T淋巴细胞变化

目的 探讨细胞毒性T淋巴细胞(T-lymphocytes,Tc)在强直性脊柱炎(ankylosing spondylitis,AS)患者中的表达变化.方法 筛选42例AS患者作为研究对象(病例组),20例同时期健康查体者作为对照(对照组).检测2组血小板计数、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-neactveprotein,CRP)水平并记录强直性脊柱炎病情活动指数调查表(bath ankylosing spondylitis disease activity index,BASDAI)评分.应用流式细胞仪检测外周血中淋巴细胞表型(CD3+CD8+)、胞浆内细胞因子γ干扰素、白细胞介素4的表达.采用t检验分析两组间外周血中Tc、Tc1、Tc2、Tc1/Tc2比值的差异;相关分析采用Pearson检验.结果 病例组与对照组外周血中Tc分别为(21.22±4.27)％ vs (14.23±4.15)％ (t=6.177,P＜0.01),Tc1分别为(0.35±0.08)％vs(1.45±0.27)％(t=24.640,P＜0.01),Tc2分别为(0.53±0.12)％vs(0.41±0.12)％(t=3.608,P＜0.01),Tc1/Tc2比值分别为0.72±0.29vs3.93±1.63(t=6.431,P＜0.01).相关分析显示AS患者外周血中Tc、Tc1、Tc2、Tc1/Tc2比值与血小板计数、ESR、CRP、BASDAI均无相关性.结论 AS患者外周血中Tc1细胞减少,Tc2细胞增多,的确存在Tc1/Tc2细胞的失衡,而且是Tc2细胞占优势.