排尿困难为首发症状的急性脊髓炎患者1例诊疗分析

1 病例资料 某男,19岁,因排尿困难1月诊断为膀胱炎于我院泌尿外科住院治疗.住院1周后出现发热,患者偶诉颈痛,双下肢无力,已给予抗感染治疗1周,效果差,在1天内病情加重,出现四肢无力、持续低热、意识模糊等症状.会诊后查体可见颈抵抗,双侧霍夫曼征阳性,双侧腹壁反射消失,建议行颈椎MRI检查,检查结果示T2加权像颈4/5脊髓信号斑片状改变.给予腰椎穿刺术检查,测压力为200mmH2O,脑脊液检查结果示微量蛋1183mg/L,有核细胞数70×106/L(淋巴细胞为主),查血常规、血沉、尿常规、C反应蛋白正常.给予大剂量甲强龙冲击、抗氧化、抗病毒、降颅压治疗.20天后患者症状明显减轻,已无四肢无力、低热,颈痛较前明显减轻,排尿困难较前稍改善,复查脑脊液测压力为160mmH2O,脑脊液检查示微量蛋白789mg/L,有核细胞数130×106/L,遂给予免疫球蛋白治疗,继续治疗10天后,患者症状基本消失,查体已无阳性体征,复查腰穿,脑脊液压力120mmH2O,脑脊液检查结果均示正常,复查颈椎MRI信号正常.院外随访8个月无复发.     

推拿按摩致波动性四肢瘫综合征2例

例1,男,62岁,因摔跌引起发作性眩晕伴恶心、呕吐及右上肢阵发性麻木1周,行颈椎CT检查发现C3/4、C4/5、C5/6椎间盘后突并椎管狭窄,遂行颈部推拿按摩治疗。第5次治疗过程中(手法有剧烈过伸活动),患者出现剧烈眩晕、恶心、呕吐,10min后四肢完全瘫痪,小便潴留,2h后眩晕症状减轻,7h后瘫痪缓解。但转颈时又出现上述症状,于发病后12h来诊。查体示:BP21/12kPa,水平眼球震颤,双上肢肌力级,双下肢肌力～级,双肱二、三头反射(),双膝反射,踝反射(),双Babinski征( ),右Chaddock征( ),C4以下痛觉减退,深感觉正常,颈椎MRI无异常发现。经静滴尼莫通、…     

肺尖癌误诊为颈椎病1例

患者男性,57岁,主诉右上肢放射痛伴无力2年余.查体:颈椎段无压痛,活动无受限,右面部、右肩胛骨下区、右胸外侧及右侧上臂内侧感放射痛,右手感觉减退,握力较左侧降低,环小指并指分指肌力降低.右侧hoffman征阴性,压颈试验阴性,右侧肱二头肌、肱三头肌腱反射及桡骨骨膜反射降低.左侧上肢及双下肢无异常.颈椎MR示:C4/5C5/6C6/7椎间盘突出.确诊为"颈椎间盘突出"并行后路切开椎板减压手术治疗.术后患者右上肢症状无缓解.追问病史,患者自诉除上述症状外还伴有右侧面部无汗症状,再次查体发现患者右侧眼裂较左侧缩小,瞳孔较左侧也明显缩小,提举双上肢后右侧桡动脉搏动较左侧减弱.仔细阅颈椎X线光片及颈椎MR后发现右侧肺尖部有阴影,做胸部CT检查,请胸外科会诊后考虑肺尖癌.随后患者转上级医院治疗.     

弥漫性特发性骨肥厚1例

患者,男,54岁,因反复腰部疼痛6年余,加重伴颈部疼痛9个月前来就诊.患者缘于6年前无明显诱因出现腰部疼痛,为钝痛感,以步行及卧床等体位改变时明显,无晨僵,无下肢放射痛及麻木感,无其他关节肿痛,于外院就诊查腰椎X线片示:腰椎退行性变.给予推拿、针灸等理疗,疼痛未见明显缓解.9个月前出现颈部疼痛,无头晕、头痛,无黑蒙、无视物模糊,无恶心、呕吐,在外院就诊查颈椎X线片示:各颈椎椎体骨质疏松,C2～7椎体前后缘上下角增生、变尖、边缘硬化;各颈椎椎间隙未见变窄,项韧带钙化.颈椎MRI示:C3～7椎间盘突出,颈椎退行性变.予对症治疗后颈痛症状明显改善.2009年12月腰部疼痛加重,至外院就诊查胸、腰椎X线片示:前纵韧带及侧方韧带广泛的骨化和钙化及韧带附着部椎体边缘的骨质增生,脊柱呈竹节样变.     

高位连续双节段颈椎间盘突出症1例

病人,女,50岁,因“四肢麻木无力、活动不灵1月,加重半月”入院。体格检查:颈椎棘突无压痛,活动无明显受限,双前臂、双小腿及足背痛觉减退,双手握力Ⅳ级,双下肢肌力Ⅴ级,双侧肱二头肌、肱三头肌腱反射正常,双侧膝腱反射活跃,踝反射正常,双HOFFMANN征阳性,BABI NSKI征阴性。颈椎X线正侧位片检查颈椎曲度变直,颈椎退变(图1)。颈椎CT及颈椎MRI检查示颈2/3及颈3/4椎间盘突出,相应节段硬膜囊受压(图2~4)。诊断为颈椎间盘突出症(颈2/3,颈3/4)。在全麻下行颈椎前路颈2/3、颈3/4椎间盘切除,颈3椎体次全切除,自体髂骨取骨植骨,行钛板内固定术。病人仰卧位,全身麻醉,取右侧颌下     

颈椎间盘退变与终板凹陷参数变化的相关研究及其临床意义

目的:研究颈椎椎间盘退变与软骨终板凹陷形态之间的变化规律及相关性并探讨其临床意义。方法:收集因颈痛等不适就诊的150例患者颈椎MRI影像学资料,在颈椎MRI正中矢状位的T2WI使用颈椎间盘退变的Miyazaki分级系统对颈5/6椎间盘退变程度进行分析,分别于MRI的T1WI正中矢状位上进行颈椎上下终板凹陷参数的测量,其中包括颈5下终板、颈6上终板凹陷角度、终板凹陷区域位置进行测量计算,将数据整理后进行统计学分析。结果:(1)颈椎终板凹陷角度在男女之间并无明显统计学差异(P>0.05);(2)随着颈椎间盘退变等级的增高,C5下终板凹陷角及C6上终板凹陷角逐渐增大(P<0.05),C6上终板凹陷角度在退变IV级与V级之间无明显统计学差异(P>0.05);(3)C5下终板凹陷区域值随椎间盘退变等级增高逐渐减小(P<0.05),在Ⅰ级与Ⅱ级、Ⅱ级与Ⅲ级之间无明显差异(P>0.05),C6上终板凹陷区域表现为没有明显变化(P>0.05)。结论:颈椎终板凹陷形态变化与颈椎间盘退变密切相关,且随椎间盘退变程度加重而出现终板的平坦化,与腰椎终板退变的结果一致,本研究结果也可为颈椎融合器端面形态的研究提供一定的初步数据。     

颈椎生理曲率与颈椎病

颈椎病属于常见病 ,是由于颈椎间盘退行性变 ,颈椎骨质增生所引起的一系列临床症状的综合征。Ｘ线主要表现为颈椎退行性变化 ,有些患者可有颈椎生理曲度改变。笔者在随机抽查 80例颈椎病患者中 ,颈椎生理曲度消失 ,椎体顺列变直有 36例占 4 5 % ,现将分析报道如下。临床资料　　 1.一般资料　 36例中男性 2 0例 ,女性 16例 ;年龄最小2 8岁 ,最大 75岁 ,≤ 4 0岁 5例 ,4 1～ 4 9岁 13例 ,≥ 5 0岁 18例。临床上主要表现为颈、肩、背部疼痛 ,酸沉及不适感 ,上肢麻木、乏力 ,颈椎压痛等症状。2 .方法　摄颈椎正侧位片 ,在侧位片上采用了Ｂｏｂ…     

先天性肩胛骨高位症1例

正1病例资料患者,女,25岁。先车祸外伤来滨州医学院烟台附属医院就诊,门诊行颈椎及双侧肋骨CT平扫加重建检查。重建及三维图片显示:颈椎序列欠规整,曲度变直,颈2、3椎体、颈4、5、6椎体呈融椎畸形,见图1-2;右肩胛骨形态欠规整,肩峰升高,肩胛骨上角达C4-5水平,肩胛骨下角达第六后肋上缘水平,肩胛骨内上方见肩椎骨桥影,尖端指向颈椎,并与右肩胛骨形成假关节,见图3-4。     

颈椎椎间盘与椎体高度比值的测量及其临床意义

颈椎间盘退变是颈椎病发生与发展的主要因素 ,而颈椎病明显的形态学改变是颈椎间盘高度的降低。鉴于下颈椎椎体的高度基本恒定不变 ,为充分显示颈椎间盘高度降低的程度 ,作者引入了颈椎椎间盘与椎体高度比值这个指标 (颈椎间盘 -椎体高度比 :高度 C2～ 3+C3～ 4+C4～ 5 +C5～ 6 +C6～ 7/高度 C3+C4+C5 +C6 +C7)。本研究试图探讨该指标在正常成人与脊髓型颈椎病患者间的差异及其临床意义。1　资料和方法1.1　一般资料　本院收治的脊髓型颈椎病 5 0例为颈椎病组 ,男性 ,年龄 5 0～ 6 0岁 ,平均 5 7.8岁。所有患者均术前摄颈椎正、侧位片 ,…     

骨盆牵引配合脱水剂综合治疗腰椎间盘突出症

近三年来 ,我科收治腰椎间盘突出症患者 5 6例 ,经骨盆牵引治疗 ,效果满意 ,报告如下。1 临床资料5 6例中男 38例 ,女 18例 ,年龄 2 1～ 6 5岁 ,病程 2周～ 3年 ,从事长久坐姿职业者居多 ,其中汽车驾驶员 32例(5 7 14% ) ,外伤等所致 2 4例 (4 2 .86 % )。临床表现　全部有腰骶部定点压痛伴有下肢后外侧放射痛 ,久坐或咳嗽、喷嚏等腹压增加时加重或诱发 ,偶有跛行 ,卧床休息后症状缓解 ;直腿抬高试验阳性 47例(83 93% ) ,加强试验阳性 5 1例 (91.0 7% )。影象学检查　Ｘ线检查示腰椎退变 13例 (2 3 .2 1% ) ,ＣＴ检查均有椎间盘膨出或突出 ;…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.