RELATION OF VARICELLA TO HERPES ZOSTER : II. CLINICAL AND EXPERIMENTAL OBSERVATIONS.

Experiments and clinical observations dealing with the identity of the viruses of varicella and herpes zoster were presented. The results indicate that the etiological agents concerned with these two diseases are in the majority of instances not identical.     

THE RELATION OF STREPTOCOCCI TO HERPES VIRUS ENCEPHALITIS

Cultures of microorganisms similar to those described by Evans have been obtained in media inoculated with suspensions of herpes virus-infected brains prepared by grinding. But they have also been isolated from saline suspensions of uninoculated meat particles ground in a sterile mortar, and from dextrose broth treated in the same way. It is believed that these organisms are contaminants introduced during the process of grinding. Since they enter the material in no great number, one may suppose them to be suppressed by animals inoculated with the ground substance. In artificial media, on the other hand, they find favorable conditions for multiplication. In our experience, no growth of microorganisms is obtained in routine cultures of virus-infected brains, when fragments, instead of ground material, are used—a fact which may be taken to support the explanation just given. The tests of the part played by streptococci in experimental virus encephalitis failed to disclose that the microorganisms have any etiological relationship to the affection. The intracerebral injection of rabbits with the cultures procured in the course of the experiments produces a purulent type of meningoencephalitis which does not resemble virus encephalitis either in its symptom-complex or in its pathology. The same type of meningitis follows the injection of streptococci derived from ground meat particles, from "ground" broth, from normal brains, and those infected with herpes virus. Some rabbits manifested resistance to the streptococci, whereas all that have been inoculated intracerebrally with the three strains of herpes virus used in this study have proved susceptible thereto. Certain of the rabbits just mentioned which had proved resistant to streptococci inoculated into the brain or cornea were injected with herpes virus and reacted typically. Comparative tests have revealed that the streptococci are more sensitive to the destructive effect of 50 per cent glycerol than is herpes virus. From all this, it can be concluded that streptococci are not the visible form of herpes virus, nor do they produce in rabbits effects like those induced in the brain and cornea by the herpes virus.     

THE PROBLEM OF THE ETIOLOGY OF HERPES ZOSTER

Attempts were made to produce lesions in. animals by the injection of material obtained from the vesicles and involved skin of nine cases of herpes zoster. All the cases, with the exception of one (Case II), were characteristic cases of idiopathic herpes zoster and the question of their being cases of so called zosteriform herpes or symptomatic herpes zoster can hardly be raised. As regards Case II, if this case occurred alone, there might be some doubt as to its nature on account of the mildness of the symptoms and the small area of skin involvement. Taken in connection with Cases III and IV, however, which occurred in the same ward and in patients who were quite closely in contact with Patient II, it seems fairly reasonable to assume that they were all of the same character. Cases of herpes zoster have been extremely rare in this hospital and the occurrence of three cases in the same ward within a very short period of time suggests very strongly a transference of infection from one case to the other. That Case II was not one of herpes simplex also seems fairly certain from the negative results obtained by inoculation of rabbits'' eyes with vesicle material. In making the animal experiments we employed various methods which were suggested largely by the technique used by previous observers, especially by those who have reported results which were considered positive. In making inoculations into the corneas the technique recommended by Lipschütz was employed as far as possible. Young rabbits were used and the material was obtained from fresh vesicles early in the disease and inoculated with as little delay as possible. The material injected into rabbits'' eyes was obtained from seven cases and twenty-four rabbits were used. In judging of the results obtained in this kind of experimentation great caution must be observed. Our experience convinces us that slight opacities occurring along the lines of scarification and mild conjunctivitis cannot be held to indicate the effect of a specific virus. As regards the interpretation of the microscopic changes found, we were quite familiar with the appearance of intranuclear inclusion bodies as seen in the lesions of experimental herpes simplex and the filterable virus (Virus III) indigenous to rabbits described by Rivers and Tillett (5). We also had no difficulty in imding intranuclear inclusions in the sections of skin removed from patients. It is not likely, therefore, that these structures were overlooked in our study of the sections. Briefly stated, although the material studied was satisfactory and in spite of the fact that a considerable number of animals were used for each case, we have been unable to confirm the observations of Lipschütz regarding the experimental production of specific lesions in the corneas of rabbits. We realize that this is only negative evidence and therefore not of conclusive importance in view of Lipschütz''s observations. It indicates, however, that the production of specific lesions in rabbits'' eyes with material from herpes zoster vesicles is extremely difficult and that successful results may be a matter of chance, depending, possibly, on peculiar susceptibility on the part of the rabbits. In view of the fact, however, that a careful analysis of the positive results reported by other observers shows that the conclusions were based on insufficient evidence, we believe that further work is necessary before the successful inoculation of the rabbits'' corneas with herpes zoster virus can be accepted as fully demonstrated. To make the evidence convincing specific lesions should be obtained with a fair degree of regularity and the virus should be successfully transmitted through at least two generations. Apparently the latter was not attempted by Lipschütz. Intracerebral inoculations into three rabbits with material from two cases (Nos. I and IV) were made. Two rabbits were also inoculated intraspinally with material from one case (No. IV). None of these animals showed any reaction. In the case of one of the animals inoculated into the brain (Case I) although this rabbit showed no symptoms, we thought it conceivable that the susceptibility of the species for the virus might be so slight that no obvious lesion had been produced. Nevertheless it was thought that the virus might possibly remain alive at the seat of inoculation and by repeated transfers become adapted to the rabbit. This phenomenon has been observed by Noguchi with vaccine virus, and by Rivers and Tillett with the rabbit virus isolated by these workers. This possibility was tested by us by making serial corneal and brain inoculations. Corneal transfers were carried through fourteen animals in series, and brain transfers through ten. No specific lesions developed in any of the animals. The work of Teague and Goodpasture suggested that the skin might be rendered more susceptible to infection by previous treatment with tar. Material from two cases (Nos. I and VIII) was inoculated into the tarred skin of guinea pigs and rabbits. The material was injected intracutaneously and also rubbed into the scarified skin. No reaction was obtained in any of the animals. Finally, the transmission of herpes zoster to monkeys was attempted. Blanc and Caminopetros, and Bastai and Busacca, as discussed in the review of the literature, inoculated monkeys (Macacus) in various ways, without success. It was thought possible that although monkeys of the genus Macacus might be refractory, monkeys of another genus might prove susceptible. Consequently, besides the inoculation of two Macacus monkeys, attempts were made to infect five vervets. Moreover, in view of the fact that the virus of vaccinia and the rabbit virus of Rivers and Tillett could be successfully cultivated in the testicle, intratesticular inoculations were employed. The testicles were removed at varying periods following inoculation. Numerous sections of these testicles were made and examined, but in no instance were any lesions found which could be interpreted as specific. No cells containing intranuclear inclusion bodies were found. These experiments, therefore, have also led to purely negative results. This report of our work is made at the present time because a considerable amount of literature has been published which gives the impression that herpes zoster has been successfully transmitted to animals. Although the observations of Lipschütz are suggestive, it is important that they be confirmed by further investigations. Until herpes zoster can be regularly transmitted to animals and cross-immunity tests be carried out, the relation of the virus of herpes zoster to that of herpes simplex remains a matter of speculation. In view of the fact that herpes simplex can be easily and regularly transmitted to rabbits, whereas in the hands of a large number of investigators similar experiments with herpes zoster are completely negative, it does not seem likely that the etiological agent concerned in these two diseases can be absolutely identical. The question of the identity or non-identity of herpes zoster and varicella is even more difficult to answer, because at present neither of these infections is readily transmissible to animals. The work of Kundratitz is extremely interesting. His observations, aside from indicating a close immunological relationship between herpes zoster and varicella, are important in that they seem to show the presence of a transmissible virus in the vesicles of herpes zoster. The only question that arises is whether the cases of herpes zoster from which Kundratitz was able to make successful transfers were true cases of idiopathic herpes zoster.     

STUDIES ON VARICELLA : THE SUSCEPTIBILITY OF RABBITS TO THE VIRUS OF VARICELLA.

1. The localization of the virus of varicella in the human skin is influenced by irritation. This is indirect evidence that the virus is in the blood. 2. Rabbits are susceptible to a virus recovered from the blood of varicella patients. 3. Testicular emulsions containing the virus are free from ordinary aerobic and anaerobic bacteria, and produce lesions in the cornea, skin, and testicles of rabbits. 4. The virus can be transmitted indefinitely from rabbit to rabbit by means of testicular inoculation, and can be preserved 29 days in 50 per cent glycerol at a low temperature.     

FURTHER OBSERVATIONS ON THE PHENOMENA ENCOUNTERED IN ATTEMPTING TO TRANSMIT VARICELLA TO RABBITS

1. The intradermal method of inoculating Virus III, a hitherto unknown filterable virus producing lesions in rabbits, gives more reliable results than those obtained by smearing the virus on the scarified skin. 2. Virus III, heated 10 minutes at 55°C., will not produce visible reactions in the skin of rabbits. 3. Virus III passes through Berkefeld N and V filters. 4. The data obtained so far indicate that the best method of preserving Virus III in an active state is to filter the testicular emulsions containing the virus, add glycerol to the filtrate up to 40 per cent of the total volume, seal with vaseline, and store on ice. 5. Viable Virus III produces a definite immunity in rabbits which persists for at least 6 months. The immunity follows intradermal, intratesticular, intravenous, intracerebral, or intranasal inoculations of the virus. 6. A single intradermal injection of Virus III, which has been killed by heat, will not produce a demonstrable immunity in rabbits. 7. No passive immunity to Virus III could be demonstrated in rabbits which had received intravenous injections of 5 to 10 cc. of immune rabbit serum 24 hours previously. 8. Immune rabbit serum neutralizes Virus III either in vitro, or locally in a rabbit''s skin when the immune serum and the virus are injected into the same part of the skin at or about the same time. 9. Three strains of the virus under investigation are immunologically identical. 10. Virus III and vaccine virus are immunologically distinct. 11. Virus III and the virus of symptomatic herpes are immunologically distinct. 12. No passive immunity to Virus III could be demonstrated in rabbits which had received intravenous injections of 5 to 10 cc. of serum or whole blood from patients convalescent from varicella. 13. Sera from two normal adults and from fourteen patients convalescent from varicella did not neutralize Virus III in vitro. 14. Rabbits could not be actively immunized against Virus III by injections of whole blood, vesicle fluid, or nasal washings from patients with varicella. 15. Four of twenty sera collected from stock rabbits of different ages, 20 per cent, neutralized Virus III in vitro. The animals whose sera neutralized Virus III failed to show a reaction at the site of intradermal inoculations with the same virus. About 15 per cent of 200 young stock rabbits (1,800 gm.) used in routine transfers were found to be refractory to Virus III, as evidenced by a failure to react to intradermal inoculations of the virus. 16. No susceptibility to Virus III was observed in guinea pigs, mice, or monkeys. 17. A volunteer who had never suffered from varicella experienced no general reaction and only a mild local one following an intradermal inoculation of Virus III. A volunteer who had had chicken-pox in childhood experienced a moderate general action, viz., fever, headache, backache, and general malaise, and also a moderate local reaction, viz., redness, swelling, tenderness, and pain, following an intradermal inoculation of Virus III. 18. The study of the immunological reactions has failed to bring any evidence that the virus under investigation bears an etiologic relationship to varicella.     

OBSERVATIONS ON THE IMMUNOLOGICAL RELATION OF POLIOMYELITIS TO LOUPING ILL

The results of the work presented in the present paper show that louping ill and poliomyelitis immunologically are not closely related. Although relatively few experiments were performed, the data obtained were sufficiently decisive for our purposes. Certainly nothing was found to indicate that one might be able to immunize human beings against poliomyelitis by the use of louping ill virus. In addition to the negative findings, a certain amount of useful information was also secured, namely, (1) monkeys can be solidly immunized against louping ill by intraperitoneal injections of virus and partially protected by intramuscular administrations of the active agent, (2) during the process of immunization no signs of involvement of the central nervous system are manifested, and (3) sera from monkeys immunized in the manner described contain antibodies capable of neutralizing the virus.     

激光点灼治疗带状疱疹的效果

目的探讨激光点灼治疗带状疱疹的效果。方法急性带状疱疹病人62例，随机分为2组。A组32例，给予激光点灼＋阿昔洛韦治疗；B组30例，给予阿昔洛韦＋可由软膏治疗。比较两组疼痛减轻时间、皮疹结痂时间、痊愈时间及有无遗留带状疱疹后神经痛。结果A组疼痛减轻时间、结痂时间及痊愈时间较B组明显缩短（t＇=284．0、265．2、165．4．P〈0．01）．无遗留神经痛。结论激光点灼治疗带状疱疹安全，操作简单，无副作用，可明显缩短疗程。     

草乌甲素治疗带状疱疹性疼痛疗效观察

目的:评价草乌甲素(bulleyaconitine A,BLA)治疗带状疱疹性疼痛的疗效。方法:带状疱疹性疼痛病人30例,随机分为对照组和试验组,两组均在入院后给予相同的基础综合治疗,试验组在综合治疗的同时加用草乌甲素片,观察记录:两组病人分别在治疗前、治疗后第1天、第3天、第5天、第7天、第30天的以下指标:疼痛数字评分(numerical rating scale,NRS);睡眠评分(athens insomnia scale,AIS);抑郁自评量表(self-rating depression scale,SDS);病人的不良反应;带状疱疹后神经痛的发生率。结果:1与治疗前比较,两组病人各时点NRS、AIS及SDS评分均明显降低,差异有统计学意义(P<0.05);两组相比较,试验组NRS评分、AIS评分及SDS评分下降程度均明显高于对照组,组间差异均有统计学意义(P<0.05)。2两组均未见不良反应。3对照组有2例病人发生后神经痛,试验组无病人发生后神经痛。结论:1基础综合治疗能有效缓解带状疱疹性疼痛、改善病人睡眠质量及减轻病人抑郁状态。2联合草乌甲素疗效更为显著,且未见明显不良反应。     

STUDIES ON THE RELATIONSHIP OF STREPTOCOCCUS HEMOLYTICUS TO THE RHEUMATIC PROCESS : I. OBSERVATIONS ON THE ECOLOGY OF HEMOLYTIC STREPTOCOCCUS IN RELATION TO THE EPIDEMIOLOGY OF RHEUMATIC FEVER

Certain factors of climate are favorable to streptococcus respiratory diseases. In those tropical environments where hemolytic streptococcus is unusual in the throat flora, scarlet fever is unknown and rheumatic fever rare. In New York City, however, following epidemic waves of pharyngitis with hemolytic streptococcus the incidence of rheumatic fever rises precipitously. The correlation between the geographical distribution of hemolytic streptococcus and rheumatic fever is a definite one. Furthermore, in New York City during the seasons of the year in which hemolytic streptococcus is seldom recovered from the pharynx, acute attacks of rheumatism are unusual. Corresponding to the seasonal rise in hemolytic streptococcus infections, the curve of incidence of acute rheumatism shows a similar form. Among the children of wealthy patients, enjoying great protection, hemolytic streptococcus has been recovered infrequently from the throat, and rheumatism has not been encountered during this study. Among the poor under observation in New York City, however, the organism is found frequently in the pharyngeal flora, and rheumatic fever is common. The findings suggest that poverty and unhygienic living conditions favor both the activity of hemolytic streptococcus in the throat and the incidence of rheumatic fever. Moreover, localized outbreaks of rheumatism have been observed frequently following epidemics of "sore throat". Bacteriological studies of these upper respiratory infections demonstrate a close relationship between the advent of hemolytic streptococcus in the throat flora and the outbreak of rheumatic fever in susceptible individuals. In addition to these studies of streptococcus infections and their relationship to the development of rheumatic fever, observations of the rheumatic patient add further emphasis to this association. First, among a group of rheumatic children in an isolated environment, reactivation of the rheumatic process has been recognized only following the advent of hemolytic streptococcus in the throat flora. Also, an investigation of families in which several members have rheumatic heart disease has led to the same conclusion. Recrudescences of the disease have been observed under a variety of conditions among these individuals. However, the one constant factor in the outbreaks of recrudescences in rheumatic homes is their association with family epidemics of hemolytic streptococcus infection. Moreover, by studying rheumatic patients before, during and after transplantation to a tropical environment, it has been possible to demonstrate a close relationship between activity of the disease process and infection with hemolytic streptococcus. While the rheumatic patients remained in the tropics this organism was not recovered from the pharyngeal flora, and the disease process seemed quiescent. On return to New York City, those individuals who have escaped respiratory infection have remained symptom-free. However, of those who have contracted hemolytic streptococcus pharyngitis, each has developed a rheumatic attack within 3 weeks after infection. Finally, extensive bacteriological studies made in ambulatory rheumatic subjects over a period of 4 years have demonstrated that the individuals who escape respiratory disease remain free of rheumatic manifestations. On the other hand, the majority of rheumatic patients who contract hemolytic streptococcus pharyngitis experience shortly afterward a definite recrudescence of their disease. In conclusion, there is a close relationship between respiratory infection with hemolytic streptococcus and activity of the rheumatic process in susceptible individuals.     

神经肽Y及P物质在带状疱疹后神经痛中的临床意义研究

目的:探讨血清神经肽Y(neuropeptide Y,NPY)及P物质(substance P,SP)在预防带状疱疹后神经痛的意义,为治疗、预防带状疱疹后神经痛(herpes zoster neuralgia,PHN)提供依据。方法:收集带状疱疹患者50例,在入院时、出院时用视觉模拟评分法(visual analogue scale,VAS)疼痛评分及血清中NPY、SP的浓度检测,于出院1月后随访是否发生PHN。采血检测20例健康志愿者血清NPY、SP的浓度为对照。结果:50例带状疱疹患者中9例发生了PHN,发生率18%。带状疱疹患者治疗后及志愿者血清NPY、SP浓度与治疗前比显著降低;不同疼痛程度组血清NPY及SP浓度比较差异均有统计学意义;发生PHN与未发生PHN的NPY及SP浓度比较显著增高。结论:NPY及SP在带状疱疹后神经痛的发生、发展过程中有重要作用,对二者检测可能对预测PHN的发生有重要价值。     

神经根脉冲射频对带状疱疹后神经痛的干预效果观察

目的:探讨神经根脉冲射频对带状疱疹后神经痛的干预效果。方法:选择2015年8月至2016年8月之间在我院进行治疗的带状疱疹后神经痛病人74例,按照随机数字的方法分为对照组和治疗组,每组37例,对照组使用常规药物治疗方法,观察组在对照组病人治疗方案基础上使用神经根脉冲射频进行治疗,对治疗的效果进行分析和评价。结果:完成治疗后,对照组与观察组病人的疼痛情况,睡眠质量,情绪情况与每晚睡眠时间与治疗前相比,均有改善,观察组病人的改善程度高于对照组病人,数据差异均具有统计学意义(P <0.05),观察组的治疗效果显著优于对照组,数据差异具有统计学意义(z=3.685, P <0.05),在治疗过程中,两组病人的各类不良反应发生率的数据差异均不具有统计学意义(P> 0.05)。结论:使用神经根脉冲射频对带状疱疹后神经痛病人进行干预,可以显著减轻病人疼痛,改善病人睡眠质量,提高治疗效果,而不良反应发生率并未增加,是值得推广的一种治疗方法。     

芬太尼透皮贴剂治疗带状疱疹及疱疹后神经痛的疗效观察

目的 :观察芬太尼透皮贴剂 (多瑞吉 )对带状疱疹及疱疹后神经痛的疗效 ,本文选择了 31例不宜行神经阻滞的病人作为研究对象。方法 :31例病人在抗病毒治疗的同时均使用 2 5 μg/h的多瑞吉作为首次量 ,如疼痛控制不满意 ,临时追加曲马多缓释片 ,下次换贴时再增加至 5 0 μg/h ,观察其对患者疼痛的缓解程度、生活质量的改善以及出现的并发症。结果 :31例病人经多瑞吉治疗后 ,2例因副反应而终止治疗 ,其余患者疼痛明显缓解 ,VAS评分从 8.5 1± 1.12降至 2 .4 7± 1.2 3,生活质量明显提高 ,部分并发症随时间延长而减少。结论 :多瑞吉能有效地控制带状疱疹及疱疹后神经痛 ,改善病人的生活质量 ,随着病人对多瑞吉的适应 ,部分并发症逐渐减少。     

皮内注射疗法治疗带状疱疹40例临床观察

目的:观察皮内注射治疗带状疱疹的临床疗效。方法:将80例带状疱疹患者随机分为皮内注射治疗组与对照组。对照组给予盐酸伐昔洛韦、甲钴胺及小剂量皮质类固醇激素口服治疗;皮内注射治疗组在对照组治疗的基础上联合皮内注射治疗,15天后观察2组患者疗效、治疗前后疼痛缓解时间及皮损情况。结果:皮内注射治疗组总有效率为95.0%,对照组总有效率仅为75.0%。结论:皮内注射治疗可明显促进带状疱疹的皮疹消退,减轻神经痛,是临床治疗带状疱疹安全有效的一种手段。     

抗病毒联合皮下及肋间神经阻滞治疗带状疱疹痛

目的：观察抗病毒治疗联合镇痛药物治疗带状疱疹痛的临床效果.方法：60例胸部带状疱疹神经痛患者随机分为三组,A组：皮内注射消炎镇痛药＋抗病毒治疗;B组：肋间神经阻滞＋抗病毒治疗;C组：单纯抗病毒治疗.以视觉模拟评分（VAS）和睡眠质量评分（QS）评定治疗效果.结果：治疗后从即刻开始至观察期（30d）结束,A、B组VAS评分较治疗前显著降低（P＜0.01）,睡眠状况也明显改善（P＜0.01）;而C组患者仅在第14天开始疼痛有所减轻,睡眠状况好转.结论：采用皮内注射或肋间神经阻滞行镇痛治疗、联合抗病毒药物治疗对带状疱疹患者的疼痛缓解和睡眠质量改善有很好的疗效.     

OBSERVATIONS ON THE RELATION OF THE EYE TO IMMUNITY IN EXPERIMENTAL SYPHILIS

Three experiments are reported in which an attempt has been made to determine the extent to which the eye participates in the general resistance which develops in rabbits during the course of syphilitic infection. Rabbits treated with arsphenamine well after the period when they would be expected to be immune to intratesticular or intracutaneous inoculations were reinoculated with the homologous strain of T. pallidum, the organisms being injected into either the cornea itself or the anterior chamber. Altogether in the three experiments 43 presumably immune animals were injected, 25 into the cornea itself and 18 into the anterior chamber. 41 normal animals were used as controls. In the immune animals 27 or 62 per cent showed lesions in the cornea. 14 of the 43 test animals were inoculated simultaneously in the cornea and in the skin of the back. In 9 of these 14, lesions developed in the cornea although no lesions developed in the skin. The lesions developing in the corneas of the "immune" animals had a longer incubation period on the average, were often of longer duration, and in some instances were more severe than the lesions developing in the control animals. In the case of some animals, also, they showed a greater tendency to recur. The immediate reactions in both the normal and the "immune" animals were entirely comparable and there was no evidence of an accelerated reaction in the test animals. It is concluded that the eye of the syphilitic rabbit does not share to the same extent as other tissues in the general resistant state which develops in that animal during the course of syphilitic infection. Possible explanations for this finding are discussed.     

神经妥乐平治疗带状疱疹后遗神经痛的临床研究

目的:研究神经妥乐平治疗带状疱疹后遗神经疼痛的疗效、方法和安全性.方法:将患者随机分为对照组和神经妥乐平不同剂量组(3.8u/日,10.8u/日),疗程14天.结果:神经妥乐平使带状疱疹后遗神经痛明显改善,并具有快速起效、长时间止痛作用.尤其神经妥乐平10.8u/日组,疗效显著.结论:神经妥乐平是治疗带状疱疹后遗神经痛有效和安全药物.     

OBSERVATIONS ON SOME CAUSES OF GALL STONE FORMATION : III. THE RELATION OF THE REACTION OF THE BILE TO EXPERIMENTAL CHOLELITHIASIS.

As previous papers from our laboratory have shown, there exists a well defined tendency for calcium carbonate to come out of solution in the normal liver bile of the dog, and for it to be deposited on certain nuclei not infrequent in the secretion under pathological circumstances. Gall stones that had arisen in this fashion were a frequent occurrence in the intubated animals we studied. The present paper is concerned with the reasons for the absence of such stones from dogs with an intact biliary tract. The solubility of calcium carbonate is known to be markedly affected by the reaction of the fluid in which it is contained. The normal liver bile, out of which it tends to precipitate, is alkaline, with an average pH of 8.20 but in the gall bladder where conditions might otherwise seem especially favorable to precipitation, the secretion undergoes a change toward the acid side, becoming on long sojourn there, strongly acid to litmus (pH 5.18 to 6.00). From bile as thus altered, no carbonate precipitation takes place, even when it becomes greatly concentrated as in fasting animals or after obstruction of the common duct. Furthermore, carbonate which has precipitated out of liver bile on standing dissolves again in it when the fluid is rendered slightly acid in vitro, or, in some cases merely neutral to litmus. There are several obvious reasons for the absence of carbonate stones from the normal ducts under ordinary conditions,—notably the motility of these latter, the flushing that they undergo from an intermittently quickened bile stream, and the cleansing and possibly antagonistic action of the secretion elaborated by the duct mucosa. In the fasting animal, one at least of these influences is almost done away with, the rate of bile flow is so greatly cut down; while furthermore the calcium concentration of the secretion undergoes a considerable increase. But pari passu with these changes there occurs one in the bile reaction, a diminution in alkalinity so great that the pH often approximates that of the neutral point for litmus. That this change is not a direct consequence of the increase in calcium, may be inferred from the findings with stasis bile, the calcium content and reaction of which were observed to vary independently, if in general in the same direction. These adjustments within the organism, some of which may be thought to exhibit an element of the purposeful, when considered with the test-tube experiments, strongly suggest that the reaction of the bile plays a critical part in determining the occurrence of carbonate stones, as furthermore that their absence from the normal gall bladder is a consequence of the changes in the bile reaction there occurring. The changes come about through a functional activity of the bladder. This being the case, one might suppose that the failure to act would be followed by a formation of carbonate stones. There is sufficient evidence available in the literature to indicate that this happens, in rabbits at least. It is important to know whether changes in the bile reaction play any part in determining the cholelithiasis of man. To determine the matter will require a large material. But this much we have shown, that carbonate spheroliths not infrequently serve in human beings as centers in a formation of secondary stones of carbonate and cholesterol, as further that cholesterol precipitation out of human bladder bile can be induced or prevented by slightly altering the reaction of the fluid toward the alkaline and acid sides, respectively. The possibility that cholelithiasis may be a consequence of sins of omission on the part of the biliary channels and reservoir deserves to be considered.     

带状疱疹不同阶段局部一致性脑功能磁共振对比研究

目的:利用静息态功能磁共振技术,比较带状疱疹急性期、后遗神经痛期不同阶段大脑神经功能学差异,通过神经影像学来描述带状疱疹引发的疼痛的发生过程,阐述大脑相应激活区域与带状疱疹后神经痛发生的相关性。方法:收集带状疱疹患者12例,其中急性期组6例,后神经痛组6例。扫描前先进行视觉模拟评分法(Visual Analogue Score,VAS)以及SF-MPQ(Short-form of McGill pain questionnaire)评分。随后分组进行fMRI静息态扫描,扫描后通过SPM、REST统计软件处理分析得到局部一致性(Regional Homogeneity,ReHo)数据统计结果。然后分别对比急性期组与后神经痛组的大脑激活区域的差异。结果:对比后神经痛组与急性期组的ReHo结果,前者较后者ReHo值升高的区域有:双侧丘脑、右侧小脑、右侧海马体、右侧梭状回、右侧脑岛。结论:小脑、脑岛、丘脑可能与PHN痛觉过敏形成机制相关;海马体可能参与疼痛记忆的形成。     

急性带状疱疹三种治疗方法疗效的对比观察

６０例胸部带状疱疹患者分为三组，每组２０例，各组年龄、性别、身体质量指数等一般情况均无统计学差异性。Ⅰ组接受皮肤科住院综合治疗，Ⅱ组、Ⅲ组为门诊病人，分别接受硬膜外注药治疗和胸椎旁神经根注药治疗，每隔３￣５天注射一次，共１￣３天。使用疼痛缓解视觉模拟评分法（ＶＡＳ）评估疼痛缓解程度。结果表明，Ⅰ组接受多种药物及光疗等综合治疗，上痛优、良率仅达３０％，而Ⅱ、Ⅲ组均为１００％。Ⅰ组平均病程为１６．５天