开胸术后肋间神经冷冻镇痛与自控静脉泵镇痛效果对比观察

目的:观察比较开胸术后肋间神经冷冻镇痛与自控静脉泵镇痛效果。方法:选择胸外科手术60例,随机分为肋间神经冷冻镇痛组(观察组)和自控静脉泵镇痛组(对照组)各30例。观察组于关胸前在胸部切口的上下各3个肋间解剖出肋间神经,应用氩氦超冷刀2mm探头在-70～-90℃冷冻肋间神经80～90s。对照组应用自控静脉镇痛泵镇痛。以视觉模拟评分法评价疼痛程度,并比较两组不良反应发生率。结果:两组术后镇痛效果比较无显著差异(P>0.05),但镇痛不良反应发生率差异显著(P<0.05)。结论:两组术后镇痛效果确实,但肋间神经冷冻镇痛简便实用,不良反应发生率低。     

乌藤镇痛胶囊对佐剂性关节炎大鼠NO及炎性细胞因子的影响

目的探讨乌藤镇痛胶囊对佐剂性关节炎（AA）大鼠细胞致炎因子的影响。方法采用弗氏完全佐剂AA大鼠模型,以雷公藤多苷为阳性对照药物,观察WTZT对RA大鼠血清TNF-α、IL-1β和NO的影响。结果与模型组比较,WTZT和雷公藤多苷均能显著降低AA大鼠血清TNF—α、IL-1β和NO的含量（P〈0．01）。结论WTZT可通过下调炎症介质和细胞因子合成发挥抗炎和抗风湿作用。     

冷冻止痛法用于胸外科术后镇痛

我院自1986年12月～1987年1月进行30例胸外科手术中，20例病人冷冻肋间神经，术后镇痛作用显著，未发生并发症。     

光动力疗法对大鼠类风湿性关节炎治疗作用的观察

目的　观察以血啉甲醚 (HMME)为光敏剂的光动力效应对类风湿性关节炎动物模型的治疗作用。方法　LEW大鼠 30只 ,随机分为正常对照组 5只、关节炎组 10只、治疗组 15只。关节炎组和治疗组用Ⅱ型胶原蛋白诱发关节炎 (CIA)。治疗组在大鼠出现踝关节红肿后 1周 ,炎症达到高峰时进行光动力治疗 (PDT)。随机治疗大鼠一侧的踝关节 ,对侧作为单纯HMME对照。治疗方法是大鼠麻醉后尾静脉注入HMME 10mg kg ,2 0min后踝关节照光 ,激光波长 6 2 7 8nm ,功率密度 10 0mW cm2 ,照射时间 10 0 0s,能量密度 10 0J cm2 。治疗后 2周取关节进行病理评分。结果　关节炎组滑膜细胞增生 ,血管翳形成 ,并侵蚀和破坏软骨和骨 ;治疗组滑膜细胞增生不明显 ,软骨和骨完整。病理评分治疗组滑膜增生、血管翳形成及软骨破坏、骨破坏和总分较关节炎组和HMME组低 ,统计学检验差异有显著意义 (P <0 0 1)。结论　在HMME 10mg kg,激光功率密度 10 0mW cm2 、能量密度 10 0J cm2 的条件下 ,光动力疗法能够有效地减轻CIA的滑膜细胞增生 ,减轻血管翳的形成及对软骨和骨的破坏 ,起到保护软骨和骨的作用。     

大鼠急性痛风性关节炎模型的建立及特点

目的:建立急性痛风性关节炎动物模型,探索尿酸钠(monosod ium urate,MSU)晶体的最佳诱导条件及炎症反应特点。方法:以改进方法制备MSU晶体,通过W istar大鼠单侧踝关节注入50μl不同浓度的MSU晶体诱导急性单关节炎,研究关节炎性变化与注入MSU剂量的关系;观测诱导关节炎后不同时间点的炎症指数、肿胀指数和功能障碍指数变化。结果:改进制备的MSU晶体呈骨针形,大小一致。5 mg/m l的MSU可导致明显的关节红肿。5~20 mg/m l范围内,关节红肿和功能障碍严重程度呈剂量依赖性增加,超过20 mg/m l后关节炎的严重程度不再随MSU注射用量的增加而加重,但可延长关节炎病程,并见关节腔内MSU晶体被大量蛋白样物质和炎性细胞包裹。将20 mg/m l的MSU注入大鼠踝关节可见迅速出现关节红肿和功能障碍,发生率100%;诱导后2 h出现,4 h表现明显,8~12 h达高峰期,24 h后自发减轻,5~6 d自行缓解;关节炎高峰期见三足步态,组织严重水肿,关节腔明显积液;关节液、关节滑膜及其周围组织见大量炎性细胞浸润,较好地模拟了人急性痛风性关节炎的病变特点。结论:改进方法制备的晶体提高了实验可重复性,并可成功诱导典型的大鼠急性关节炎。MSU剂量以每个踝关节20 mg/m l×50μl为最佳。该模型适合于痛风的相关实验研究。     

开胸术后肋间神经冷冻与静脉镇痛的疗效比较

目的比较肋间神经冷冻与静脉自控镇痛治疗开胸术后疼痛的效果及副作用。方法选择80例接受开胸手术的病人,随机分为静脉镇痛组(I组)和神经冷冻组(II组),静脉镇痛组行术后病人自控静脉镇痛(PCIA),后者采用北京库蓝公司JT-1型冷冻治疗仪在关胸前对切口所在肋间及上、下各一肋间和放置胸引瓶所在肋间的肋间神经进行冷冻,以VAS评分判断两组术后胸部切口疼痛情况,并记录不良反应。结果冷冻组术后72h内VAS评分(P<0.001)、不良反应发生率(P<0.05)与对照组比较差异显著,有统计学意义。结论肋间神经冷冻减轻开胸术后切口疼痛的效果明显优于PCIA,且并发症更少。     

鲨鱼软骨提取物对大鼠佐剂性关节炎的防治作用

目的　探讨鲨鱼软骨提取物 (SCE)灌胃对大鼠佐剂性关节炎 (AIA )的预防和治疗作用。方法　用 Freund完全佐剂注入实验大鼠右后足造成佐剂诱导性大鼠关节炎模型 ,观察鲨鱼软骨提取物对佐剂性关节炎的影响。结果　在致炎后 7d SCE灌胃 ,连续 7d,在 SCE剂量为 2 .5 ,10 .0 ,4 0 .0 mg/kg时 ,第 2 2天 AIA计分分别为 (6 .12± 0 .6 4 )、(5 .38± 0 .74 )、(4.5 0± 1.2 0 )分 ,体重分别为 (2 74± 15 )、(2 76± 16 )、(2 88± 9) g,与 AIA对照组 [计分为 (6 .38± 0 .74 )分 ,体重为 (2 6 3± 16 ) g]比较 ,差异均有显著性 (P<0 .0 5或 0 .0 1) ,提示 SCE可明显抑制 AIA症状。在致炎后 19d SCE灌胃 ,连续 7d,在剂量为2 .5 ,10 .0 ,4 0 .0 mg/kg时 ,第 38天其 AIA计分分别为 (6 .75± 0 .4 6 )、(5 .2 5± 0 .4 6 )、(4.88± 0 .35 )分 ,与 AIA对照组 [计分 (7.38± 0 .74 )分 ]比较 ,抑制率分别为 8.5 4 % ,2 8.86 % ,33.87% ,差异均有显著性(P<0 .0 5或 0 .0 1) ,明显抑制 AIA症状。结论　鲨鱼软骨提取物灌胃对大鼠佐剂性关节炎模型的继发性病变具有显著的预防和治疗作用。     

综合疗法治疗类风湿性关节炎217例

类风湿性关节炎是以慢性对称性多关节炎为主要表现的一种全身性疾病,严重影响病人的日常活动。迄今对本病的治疗效果尚不十分理想。1998年以来。我们以手法、理疗配加中药散剂治疗本病217例,疗效满意。     

金铁锁水煎浸膏对实验性类风湿关节痛镇痛作用的研究

 目的深入探讨金铁锁水煎浸膏对实验关节痛的镇痛作用,并阐述其作用机制.方法以福氏完全佐剂(Fre-und's complete adjuvant,FCA)作为实验性类风湿性关节炎(Rheumatoid arthritis,RA)疼痛模型为基础,采用金铁锁水煎浸膏(大、中、小剂量组),并设立空白对照组、模型组、中药阳性对照组和西药阳性对照组治疗,检测其痛阈、皮肤肿胀度和疼痛级别等的变化.结果金铁锁水煎浸膏对实验性RA关节痛具有显著的镇痛效应,金铁锁水煎浸膏明显提高痛阈、减轻皮肤的肿胀度,降低疼痛级别等.结论金铁锁具有明显的镇痛作用.     

Cryotherapy of breast cancer under ultrasound guidance: initial results and limitations

The aim of this study was to investigate the potential and feasibility of ultrasound-guided cryotherapy in breast cancer. Fifteen female patients with 16 breast cancers (mean tumour diameter 21±7.8 mm) were treated. A 3-mm cryo probe was placed in the tumour under ultrasound guidance. Two freeze/thaw cycles with durations of 7–10 min and 5 min, respectively, were performed. The size of the iceballs was measured sonographically in 1-min intervals. The patients underwent surgery within 5 days and the specimens were evaluated histologically. The mean diameter of the iceball was 28±2.7 mm after the second freezing cycle. No severe side effects were observed. Five tumours with a diameter below 16 mm did not show any remaining invasive cancer after treatment. Two of these had ductal carcinoma in situ (DCIS) in the surrounding tissue. In 11 patients cryotherapy of tumours reaching diameters of 23 mm or more resulted in incomplete necrosis. This study shows that the invasive components of small tumours can be treated using cryotherapy. Remnant DCIS components which may not be detected preinterventionally represent a challenging problem for complete ablation. In tumours larger than 15 mm two or more cryo probes should be used to achieve larger iceballs. Electronic Publication     

氩氦刀冷冻术配合肝动脉化疗栓塞术治疗原发性肝癌

目的探讨氩氦刀冷冻术配合肝动脉化疗栓塞术治疗原发性肝癌的疗效。方法124例原发性肝癌患者随机分成两组,对照组64例,行肝动脉化疗栓塞治疗;联合治疗组60例,行肝动脉化疗栓塞治疗加氩氦刀冷冻术。肝动脉化疗栓塞一般每月进行1次,3次为一疗程;冷冻治疗一般每一疗程进行1～3次。结果对照组总有效率(CR PR)45．3％,联合治疗组为68．3％,两组间差异有显著性。对照组半年、1年、1年半的生存率,分别为81．3％、62．5％、43．8％,联合治疗组分别为93．3％、83．3％、63．3％,1年和1年半的生存率有显著差异。结论氩氦刀冷冻术配合肝动脉化疗栓塞术治疗原发性肝癌是一种有效的方法,可以延长患者的生存期。     

Visualisation of subchondral erosion in rat monoarticular arthritis by magnetic resonance imaging

High-resolution magnetic resonance imaging (MRI) was used to investigate antigen-induced monoarticular arthritis (AIMA) in the rat. In sagittal, spin-echo images of the knee, characteristic parallel bands, in the order dark-light-dark, were consistently observed 5–8 days after arthritis induction; the bands ran concentric with, and just beneath, the femoral and tibial articular surfaces. Concurrent radiology, histology and MRI (chemical shift-selective imaging and contrast enhancement with magnetisation transfer and gadolinium) established that the phenomenon reflected subchondral erosion, not artefact. The outer hypointense band corresponded to calcified cartilage underlying the articular surface. The central hyperintense band reflected inflammatory matrix displacing normal haematopoietic tissue immediately subchondrally; here, trabecular bone had mostly disappeared, but adjacent articular cartilage, although under attack and lacking proteoglycan, appeared structurally normal. The inner hypointense band reflected deeper, truncated trabeculae within inflammatory matrix, layered with pallisading osteoblast-like cells. This study exemplifies the power of MRI for revealing localised joint pathology non-invasively, and shows that rat AIMA shares many pathological features with arthritis in human beings.     

Assessment of unspecific near-infrared dyes in laser-induced fluorescence imaging of experimental arthritis

OBJECTIVE: The aim of the study is to evaluate in vivo fluorescence imaging of experimental inflammatory joint disease by applying two different near-infrared (NIR) dyes in a model of Borrelia-induced Lyme arthritis. MATERIALS AND METHODS: Forty mice, 20 with Lyme arthritis and 20 controls, were examined. Two nonspecific NIR carbocyanine dyes, indocyanine green (ICG) and a hydrophilic carbocyanine derivative (1,1'-bis-[4-sulfobutyl] indotricarbocyanine-5,5'-dicarboxylic acid diglucamide monosodium salt [SIDAG]), were administered intravenously at two doses. Fluorescence images were acquired before and during 120 seconds after injection of cyanine dyes. For both dyes, the area under the curve (AUC) was determined for the interval between 40 and 80 seconds after injection. In addition, the slope of the signal decrease was compared among animal groups. Results were compared with histological findings. RESULTS: The general temporal fluorescence intensity course for ICG was characterized by a rapid increase, with a peak at 40-50 seconds followed by a decrease; conversely for SIDAG, by a slow increase. AUC analysis for both dyes showed that the fluorescence signal differed significantly between controls and arthritic animals (P < .05). Within these groups, there were significant differences between the two doses investigated. ICG differed significantly between control and arthritic animals in the slope of the signal decrease for both doses investigated (P < .05). Histological examination showed early stages of inflammation in arthritic animals. CONCLUSIONS: NIR fluorescence imaging based on the pharmacokinetic behavior of ICG or SIDAG is a promising approach to detect inflammatory joint changes of experimental arthritis. Moreover, SIDAG is suited to differentiate inflammatory and noninflammatory joints 24 hours after dye application.     

Phosphorus-31 magnetic resonance spectroscopy of experimentally induced arthritis in rats

Phosphorus-31 magnetic resonance spectroscopy (MRS) of the hind paws of rats was performed at 1.5 Tesla before and during the course of an experimentally-induced inflammatory arthritis. Arthritis was induced by daily subcutaneous administration of 6-sulfanilamidoindazole, an antibacterial sulfa known to produce an acute, self-limited arthritis and periarthritis in the hind paws of rats.Phosphorus-31 spectra obtained after the development of clinical arthritis showed a significant (p<0.01) increase in the intensity of a group of resonances occurring downfiled from phosphocreatine as compared to spectra obtained before treatment. In all rats, this increase correlated well with histological evidence of inflammation as well as with the degree of inflammation judged clinically (r=0.89, p<0.001), and was present before roentgenographic evidence of bony involvement. The use of ³¹P MRS may permit evaluation of the severity of an inflammatory arthritis with greater accuracy than the bony changes definable by plain roentgenograms.This article is the award-winning Resident Paper of the International Skeletal Society for the year 1986. Support for its presentation at the annual meeting was contributed by the Department of Radiology of the University of British Columbia     

Optical imaging of experimental arthritis using allogeneic leukocytes labeled with a near-infrared fluorescent probe

Purpose The purpose of this study was to assess the feasibility of inflammation detection in an antigen-induced arthritis model using fluorescent leukocytes and optical imaging. Methods Antigen-mediated monoarthritis was induced in the right knee of 12 Sprague-Dawley rats. Six rats remained untreated and six rats were treated with cortisone. All rats received ex vivo fluorescent-labeled rat leukocytes. Optical images of both knees were acquired before and at 5 min, 1 h, 4 h, and 24 h after cell injection. Images were evaluated qualitatively and quantitatively by calculating signal intensity ratios between the right arthritic (A) and contralateral normal (N) knee. A/N ratios were tested for significant differences between baseline values and values after cell injection using a paired t test as well as between the untreated and cortisone-treated group using an unpaired t test. Synovial specimens were processed and evaluated for labeled cells with fluorescence microscopy. Results At 4 h and 24 h p.i., the A/N ratios of untreated arthritic knees showed a significant signal increase compared with baseline values (p<0.05) and a significant difference compared with A/N ratios of cortisone-treated animals (p<0.05). Fluorescent microscopy confirmed the presence of labeled cells in the arthritic synovium. Conclusion Inflammation in antigen-induced arthritis can be detected with ex vivo labeled allogenic leukocytes and optical imaging.     

US guided injections in arthritis

US guided procedures for diagnosis or treatment of different forms of arthritis are becoming more and more important. This review describes general considerations for fluid aspiration, articular or periarticular injections and biopsies by US guidance according to the recent literature. Guidelines regarding instrumentation, different techniques, pre- and postprocedural care as well as complications are outlined and in the second part a more detailed overview of different interventions in joints, tendons and other periarticular regions (nerves, bursae, etc.) is included. Furthermore, some newer, more sophisticated techniques are briefly discussed.     

Ultrasonographic imaging of the hand and wrist in rheumatoid arthritis

Objective To assess ultrasound findings in patients with rheumatoid arthritis affecting the hand and wrist compared to normal volunteers.Design Metacarpophalangeal and carpal articulations were imaged ultrasonically. Two readers reviewed static images for synovial, cartilaginous, and bony abnormalities using severity and probability scales. Ultrasound findings were correlated with disease activity.Patients Ten normal volunteers and 29 patients with known rheumatoid arthritis.Results Synovial abnormalities and erosions were most commonly identified in the rheumatoid hand and wrist (p<0.01). Criteria used for normal and abnormal cartilage did not predict normal and disease states. Significant differences in synovial abnormalities and erosions were observed between the inactive and mildly active disease groups as well as the active and mildly active disease groups (p<0.01).Conclusion Ultrasound can detect abnormalities of the hand and wrist in patients with rheumatoid arthritis compared to normal volunteers. Normal articular anatomy is well demonstrated ultrasonically.     

菖羌合剂对实验性脑缺血大鼠血液流变学影响

目的：探讨菖蒲羌活合剂对大鼠实验性脑缺血的作用。方法：用颈总动脉结扎法建立大鼠脑缺血模型。检测中药对大鼠脑缺血的血液流变学指标的影响。结果：用药组的红细胞压积和全血低切粘度明显低于盐水对照组（Ｐ〈０．０１）,凝血酶原和纤维蛋白原指标各组间无明显差别,用药组脑含水量较盐水对照组显著降低（Ｐ〈０．０５）。结论：菖蒲羌活合剂能够降低脑缺血大鼠的红细胞压积及全血低切粘度,改善缺血脑组织的血液循环,对脑缺血