微血管减压术治疗老年面肌痉挛患者的疗效

目的探讨微血管减压术(MVD)治疗老年面肌痉挛(HFS)患者的疗效与临床评价。方法选取老年HFS患者47例,非老年HFS患者256例,均进行MVD治疗,观察两组患者疗效、住院时间、术后并发症以及随访2年复发患者。结果老年组患者MVD总有效率(45例,95.74%)、住院时间〔(10.24±3.18)d〕和并发症发生率(6例,12.77%)与非老年组总有效率(248例,96.88%)、住院时间〔(9.64±2.57)d〕和并发症发生率(28例,10.94%)的差异无统计学意义(P>0.05);老年组患者2年复发率(复发8例,17.78%)与非老年组(复发49例,20.08%)的差异无统计学意义(P>0.05)。结论 MVD对老年HFS患者的疗效及并发症与年轻人并没有差异,可作为老年HFS的首选治疗方式。     

微血管减压术治疗面肌痉挛疗效及并发症分析

目的探讨微血管减压术治疗面肌痉挛的疗效及并发症。方法回顾性分析采用微血管减压术治疗的378例原发性面肌痉挛患者资料,探讨术前、术中及术后各种潜在因素对手术效果及并发症的影响。结果微血管减压术治疗面肌痉挛术后3个月优秀率96%,听力减退可能为永久性后遗症,其中重度听力减退发生率为3.2%,应用耳脑胶后手术有效率及听力障碍发生率高于未用耳脑胶患者（P〈0.05）。结论微血管减压手术治疗面肌痉挛疗效确切,听力障碍可能为永久性并发症,应慎重应用医用耳脑胶。     

显微镜联合神经内镜辅助下显微血管减压术治疗面肌痉挛的疗效探讨

目的探讨采用显微镜联合神经内镜行显微血管减压术治疗面肌痉挛的疗效。方法选取2014年1月~2016年5月在我科住院治疗的面肌痉挛患者50例,随机分为观察组30例与对照组25例。观察组给予显微镜联合神经内镜血管减压术。对照组给予常规显微镜下血管减压术,对比分析两组患者的疗效及并发症等情况。结果观察组治愈率为93.3%,显著高于对照组的68.0%(P0.05);观察组并发症为20.0%,低于对照组的60.0%(P0.05)。结论显微镜联合神经内镜辅助下显微血管减压术治疗面肌痉挛临床效果显著,并发症发生率低,值得推广。     

微血管减压术治疗面肌痉挛230例临床分析

目的：探讨面肌痉挛微血管减压治疗术中注意事项和术后情况的发生因素。方法回顾性分析我院230例面肌痉挛经微血管减压治疗的病例资料。结果230例术中均发现存在责任血管。术后161例抽搐立刻消失,57例抽搐明显减轻,12例无效,其中10例观察3个月至1年内,证实为延迟治愈。结论微血管减压术是有效治疗面肌痉挛的方法,且治愈率高。术中的“零牵拉”技术、不用电凝双极、术中的精细操作、抬起小脑绒球时避免过分和反复,可有效减少术后的并发症。     

面肌痉挛显微血管减压术中责任血管的解剖分析对手术疗效的影响

目的分析面肌痉挛（hemifacial spasm，HFS）患者颅内责任血管与面神经之间的解剖关系，为HFS显微血管减压术（microsurgical neumvascular decompression，MVD）提供解剖学依据。方法回顾性分析106例经显微血管减压术治疗的面肌痉挛患者的临床资料。术前均行三维时间飞越法磁共振血管造影（3D-TOF-MRA）检查，了解面神经受压迫是否存在责任血管及其来源与走向。采用枕下乙状窦后小脑下外侧入路显露面神经脑干段，仔细观察责任血管及其来源后将其推移，在责任血管与脑干之间放置Teflon减压垫棉。结果3D-TOF-MRA检查显示面神经被微小血管压迫的阳性率达92％。术中发现全部病例均有明确的责任血管，其中小脑前下动脉占66％（70／106）。34例患者中发现面神经根区（root exit zone，REZ）存在明显的压迫切迹。术后104例抽搐症状立即完全消失；2例抽搐症状明显好转，3个月内延迟治愈，总有效率为100％。结论血管压迫可能是面肌痉挛的主要病因。术中REZ的显露、准确判断责任血管、面神经REZ的充分减压，以及垫棉的大小和放置的位置等，是影响手术疗效的重要因素。     

显微血管减压术治疗面肌痉挛48例疗效观察

面肌痉挛（HFS）是神经科常见病,目前该病治疗首选显微血管减压术（MVD）。2004年6月～2007年6月,我科采用MVD手术治疗48例HFS患者,疗效满意。现报告如下。     

罂粟碱溶液灌洗预防微血管减压术后并发症的疗效

目的 探讨罂粟碱溶液灌洗在三叉神经痛、面肌痉挛行显微血管减压术术后并发症的预防作用.方法 将80例三叉神经痛、面肌痉挛病人随机分为治疗组和对照组各40例,对照组常规给予乙状窦后入路颅神经微血管减压术(MVD),治疗组在常规MVD基础上,给予术区罂粟碱溶液灌洗.监测手术区动脉血管血液流速变化,观察术后病人的症状变化.结果 MVD可导致脑血管痉挛,手术前后比较差异显著(P<0.01).罂粟碱溶液灌注可缓解脑血管痉挛,灌注前后比较差异显著(P<0.01).治疗组术后头晕、耳鸣等并发症明显低于对照组(P<0.01).听力障碍并发症略优于对照组.治疗组头晕5例、耳鸣2例、听力障碍2例;对照组头晕18例、耳鸣13例、听力障碍4例.结论 罂粟碱溶液灌洗可作为颅神经显微血管减压术中的常规治疗手段.通过缓解血管痉挛,对预防术后并发症有积极意义.     

显微血管减压术治疗颅神经血管压迫综合征

系统回顾采用显微血管减压术(MVD)治疗的神经血管压迫综合征132例患者的临床资料,其中三叉神经痛103例,面肌痉挛27例,舌咽神经痛2例.治疗总有效率为94.7%,无死亡病例,三叉神经痛术后发生面部麻木和唇嘴角处疱疹5例,听力减退和(或)面瘫2例,面肌痉挛术后听力下降和轻面瘫3例.术后复发3例.提示提高MVD的治愈率、减少并发症有多方面因素值得考虑.     

显微血管减压术治疗三叉神经痛及面肌痉挛的临床体会

目的探讨显微血管减压术治疗三叉神经痛(TN)和面肌痉挛(HFS)的手术治疗经验和效果。方法采用显微血管减压术对我院2012年—2015年99例三叉神经痛和面肌痉挛病人进行手术治疗。术后随访至少1年,根据临床症状评定临床疗效。结果 93例病人术后症状即刻消失,有效率93.9%。面肌痉挛病人中1例术后3d有轻度抽搐,随诊末症状消失;术后出现耳鸣、听力障碍1例,随诊末症状明显好转;1例轻度面瘫,随诊末好转。三叉神经痛病人中4例病人术后症状时有发作,其中3例随诊末症状消失,1例配合口服卡马西平可满意控制。全部病人均无脑脊液漏、颅内感染发生、死亡和致残病例。结论显微血管减压术是三叉神经痛和面肌痉挛最有效的治疗方法,治愈率高,创伤小,远期并发症少。     

改良微血管减压术治疗三叉神经痛疗效观察

目的观察改良微血管减压术治疗三叉神经痛的疗效。方法将42例原发性三叉神经痛患者随机分为2组。改良组（11例）采用改良微血管减压术治疗,即术中应用患者自身桥小脑脚硬膜或人工可缝合硬膜将单纯压迫在三叉神经上方或外侧方的血管包裹“悬吊”,从而达到减压目的;对照组（31例）采用传统微血管减压术治疗。结果对照组术后疼痛完全缓解27例,明显缓解2例,轻微缓解1例,未缓解1例;并发面部麻木感5例,外耳道异物感3例,听力下降1例;术后随访复发I例。该良组术后疼痛均完全缓解,无面部麻木等并发症,随访无复发。结论改良微血管减压术治疗三叉神经痛安全有效,且可减少术后复发。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.