脊柱结核MRI诊断及鉴别诊断

目的探讨脊柱结核的MR表现。方法回顾性分析经临床或病理证实的27例脊柱结核病人资料。结果8例表现为椎体内斑片状／条片状长T1长,12信号,其中7例脊柱后凸畸形,其中6例增强扫描病变明显强化,13例椎体边缘及邻近椎间盘长T1长T2信号,其中9例椎体部分或完全融合,椎间盘破坏显示不清,11例椎旁脓肿形成,5例脓肿内可见点片状钙化灶,9例合并腰大肌受累增强扫描脓肿坏形强化。2例未见明显异常信号,仅表现为背疝,1例表现为韧带下条片状长T1长,12信号,增强扫描病变强化,2例附件型表现为椎弓根骨质破坏,并椎旁脓肿形成增强扫描椎弓根旁软组织病变及脓肿均强化,1例脊膜型MRI可见脊膜不规则增厚,增强扫描明显强化。脊柱结核MRI表现为椎体／附件骨质破、椎间盘异常信号、椎旁脓肿形成、椎管受累、韧带下脊膜播散等。结论MRI是脊柱结核的诊断和鉴别诊断很好的补充,显示脊柱早期改变及韧带下播散,硬膜及脊髓侵犯等方面具有绝对优势。     

脑脊膜膨出66例手术治疗的体会

本文报道脑脊膜膨出 6 6例手术治疗 ,对辨别脊髓、合并脂肪瘤、早期手术以及术后尿潴留等问题谈谈自己的体会。1　临床资料本组 6 6例 ,男 35例 ,女 31例 ;年龄 37天至 4 0岁 ,平均 4 8岁。其中脑部 6例中 ,脑膜膨出 3例 ,脑膜脑膨出 3例 ;颈段 6例中 ,脊膜膨出 5例 ,脊髓脊膜膨出 1例 ;胸段 6例中 ,脊膜膨出 5例 ,脊髓脊膜膨出 1例 ;胸腰段 3例中 ,脊膜膨出 1例 ,脊髓脊膜膨出 2例 (此 2例合并局部脂肪瘤 ) ;腰段 6例中 ,脊膜膨出 5例 (有 3例合并脂肪瘤 ) ,脊髓脊膜膨出1例 (且合并脂肪瘤 ) ;腰骶段 19例中 ,脊膜膨出 9例 (有 2例合并脂…     

4例髓外硬脊膜内肿瘤误诊误治的经验教训

例1，女，61岁。因右腰腿痛3年伴右下肢麻木，于．1992年3月9日入院。CT示LZ～SI椎间盘膨隆，碘油椎管造影见TI。～T12受压，LZ＿3、I－3＿4椎间盘突出。3月19日行椎管探查术，予Tll全椎板减压，见脊髓受压搏动消失，咬除T；。、T；2部分椎板，搏动恢复，诊断椎管狭窄。术后出现两下肢瘫痪，小便失禁，MRI提示；T；；椎管内肿瘤，于4月29日由神经外科再次手术，术中见Till2脊髓膨出，左腹侧面有一紫红色肿瘤，约4CmX4cmXZcm，有包膜，质脆，予以切除。病理诊断：脊膜瘤。术后症状改善，5月22日出院。例2，男，38岁。腰痛4个月，两…     

小儿脊髓栓系综合征的显微手术治疗

一、临床资料男 7例 ,女 2例 ,年龄 3— 13岁。表现 :膀胱功能障碍 8例 ,进行性下肢无力 5例 ,双下肢感觉异常 3例 ,会阴部浅感觉减退 1例 ,骶部皮肤包块 1例。合并腰骶部隐性脊柱裂 3例 ,硬膜外脂肪瘤 2例 ,脊膜膨出 1例。全部患者均行ＭＲＩ检查 ,表现为 :低位脊髓圆锥 ,终丝增粗 ,并可发现其合并病变。二、手术方法和结果在全麻下行脊髓栓系松解术 ,取侧俯位 ,骶部抬高 ,棘上纵行直切口或梭形切口 ,包括病变上下各1— 2个正常椎板。沿棘突和锥板剥开两侧椎旁肌 ,显露棘突和椎板的缺损处。术前诊断合并脊膜膨出者 ,自膨出囊四周逐步游离出…     

婴幼儿脊髓脂肪瘤合并脊髓栓系的围手术期护理及用药

脊髓栓系综合征(tethered cord syndrome,TCS)是指由于先天性及后天性因素如脊髓脂肪瘤、皮样囊肿、脊膜膨出、变短增粗的终丝等导致脊髓末端受压或(和)回缩不良,产生一系列神经功能障碍和畸形的症候群.     

脊髓栓系综合征的磁共振成像诊断价值

目的探讨脊髓栓系综合征(TCS)磁共振的成像特点及诊断价值。方法对经手术证实的26例TCS患者的资料进行回顾分析。结果 26例患者中,椎管内脂肪瘤5例,畸胎瘤3例,脊髓膨出5例,皮毛窦3例,脊髓纵裂4例,隐性脊柱裂6例。结论 MRI对TCS患者确诊具有重要价值,能明显显示脊髓圆柱的位置形态及伴发的畸形,可以为手术治疗提供可靠的依据,所以应作为脊髓栓系和脊柱闭合不全术前常规检查。     

脊髓硬脊膜动静脉瘘的手术治疗

<正>硬脊膜动静脉瘘(SDAVF)是供应脊膜或神经根的细小动脉在椎间孔附近与脊髓表面的引流静脉直接交通,是脊髓血管畸形的一种,约占脊髓血管畸形的30%。本研究总结2007—2009年收治SDAVF患者64例资料,术前常规行磁共振成像(MRI)及全脊髓血管造影确诊,均采用手术半椎板切     

平山病的MRI检查及诊断

目的分析平山病MRI检查方法和诊断要点,提高对该病的发病机制、临床表现的认识。方法回顾性分析4例经临床证实的平山病患者的MRI资料。结合相关文献报道,归纳、总结MRI的检查方法和诊断要点。结果平山病MRI检查方法包括:自然位和屈颈位颈椎矢状位T1WI及T2WI扫描及低位颈髓横轴位T2WI扫描,屈颈位颈椎矢状位及横轴位增强扫描。诊断要点包括下颈段脊髓萎缩、变扁,硬脊膜后壁前移,硬膜外间隙增宽,增强扫描后可见硬脊膜外间隙内明显强化。结论 MRI检查软组织分辨率高,可多方位扫描,对平山病诊断十分有利,是诊断平山病的重要的、不可或缺的检查手段。颈椎过屈位MRI扫描能显示平山病的所有影像学特征,可提高该病的诊断率。     

硬脊膜动静脉瘘23例临床特征分析

目的：探讨硬脊膜动静脉瘘的诊治方式及临床特点。方法选取本院接收的23例硬脊膜动静脉瘘患者作为本次的研究对象,并对其临床资料进行回顾性分析。结果本组23例患者均为单发,其中其中5例患者为颈段,8例患者为腰段,10例患者为胸段;23例患者中仅4例患者瘘口为多支动脉供血,其余19例患者为均为单支动脉供血。术后随访1年,所有患者均未复发。结论 MRI是现阶段临床上诊断硬脊膜动静脉瘘的常用方式,而经全脊髓血管造影则可对瘘口位置进行明确,并可排除其他脊髓血管畸形;因而临床上通常将磁共振成像(MRI)联合血管造影作为硬脊膜动静脉瘘诊断的金标准。微创半椎板切除显微镜手术则是治疗该病的有效方式。     

腰骶部脊髓脊膜膨出患儿的护理

脊髓脊膜膨出是由于神经轴中胚叶发育缺陷,神经管闭合不全形成脊柱裂,导致脊膜、脊髓或神经根成分膨出所致畸形[1],表现为腰骶部脊髓疝入膨出的脊膜内形成囊肿,并存在尿失禁、便秘、大便失禁等障碍,尽早手术是有效的治疗预防途径,而术后精心护理,预防并发症的发生对手术成功至关重要.2004年10月至2006年10月我科收住小儿腰骶部脊髓脊膜膨出患儿39例,均手术成功,报道如下.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

---

Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.