胚胎脊髓组织移植促进成年宿主损伤脊髓功能恢复的研究

目的 探讨胚胎脊髓组织移植促进成年宿主损伤脊髓功能恢复的作用。方法 采用成年大鼠脊髓半切洞损伤模型，移植胚胎大鼠脊髓组织，术后进行联合行为计分（CBS)、体感诱发电位(SEP）、运动诱发电位(MEP）和性行为及生育机能检查。结果 移植组CBS与对照组比较相差显著（P＜0.05)，移植术后4周以内两者相差非常显著(P＜0.01）；移植组SEP、MEP早期反应的峰潜伏时恢复优于对照组(P＜0.05)；术后4～12周75%的雌鼠阴道涂片检出精子并能正常生育。结论 胚胎脊髓移植能促进成年宿主损伤脊髓的功能恢复。     

新生鼠和成年鼠脊髓损伤后胚胎脊髓移植对大鼠损伤脊髓功能恢复的影响

目的研究新生鼠和成年鼠脊髓损伤后胚胎脊髓移植对大鼠损伤脊髓功能恢复的影响。方法将新生鼠和成年鼠腰段脊髓半切洞损伤,取E14胚胎脊髓组织移植到损伤区,手术后4、8、12周,进行组织学检查,联合行为评分,感觉诱发电位,运动诱发电位检查。结果组织学检查发现移植的胚胎脊髓在宿主脊髓中存活。联合行为评分,感觉诱发电位,运动诱发电位潜峰时的恢复,新生鼠移植组均优于成鼠移植组(P<0.05)。结论通过各种功能检查(CBS,SEP,MEP)表明胚胎脊髓移植能够促进脊髓损伤后新生鼠和成鼠运动功能的恢复。     

胚胎脊髓组织移植联合应用神经生长因子对损伤脊髓再生修…

选择胎龄为１４－１５天的大鼠胚胎脊髓植入成年大鼠半横断的脊髓损伤腔，同时局部应用神经生长因子。术后２－８个月，用组织学、免疫细胞化学、辣根过氧化酶示踪及超微结构的检查方法证实，移植组织在宿主脊髓内的存活率为９０％，并且分化成熟，具有正常的神经组织结构特征，大多数移植物充满损伤腔，与宿主脊髓形成良好的融合，移植组织与宿主组织出现新的纤维联系，使脊髓损伤的两端恢复了解剖的连续性。     

大鼠胚胎脊髓移植物对成体损伤脊髓运动功能修复的影响

为了探讨胚胎脊髓移植物对成体损伤脊髓运动功能修复的效应，取妊娠１４天胚胎大鼠脊髓组织，移植到成年大鼠脊髓半切洞损伤模型，术后进行联合行为记分（ＣＢＳ）和运动诱发电位（ＭＥＰ）检查。结果发现，移植组ＣＢＳ与对照组比较相差显著（Ｐ＜０．０５），移植术后４周以内两者相差非常显著（Ｐ＜０．０１）。移植组ＭＥＰ早期反应（Ｐ１，Ｎ１）的峰潜伏时恢复优于对照组（Ｐ＜０．０５）。结果提示，胚胎脊髓移植对成年宿主损伤脊髓的功能修复具有促进作用。这可能与胚胎脊髓组织能分泌多种神经营养因子、神经生长因子、神经递质，或激素的调节作用有关。     

大鼠胚胎脊髓移植物对成体损伤脊髓运用能修复的影响

为了探讨胚胎脊髓移植物对成体损伤脊髓运动功能修复的效应，取妊娠１４天胚胎大鼠脊髓组织，移植到成年大鼠脊髓半切洞损伤模型，术后进行联合行为记分（ＣＢＳ）和运动诱发电位（ＭＥＰ）检查。结果发现，移植组ＣＢＳ与对照组比较相差显著（Ｐ〈０．０５），移植术后４周以内两者相差非常显著（Ｐ〈０．０１）。移植组ＭＥＰ早期反应（Ｐ１，Ｎ１）的峰潜代恢复优于对照组（Ｐ〈０．０５）。结果提示，胚胎脊髓移植对成年宿主损伤     

同种胚胎脊髓移植对成年大鼠损伤脊髓组织形态与功能的修复作用

探讨大鼠胎脊髓组织移植对成年大鼠损伤脊髓组织形太民与功能的修复作用。在半切洞损伤的成年大鼠脊髓内，植入大鼠胚胎脊髓组织，术后行联合行为记分、诱发电位及组织学检查。结果“移植物能在宿主脊髓损伤部位存活，并能生长、分化、修复宿主脊髓的组织损伤，诱导宿主神经纤维系的建建，改善宿主损伤脊髓的神经传导，促进功能恢复。     

大鼠胚胎脊髓移植对损伤脊髓GAP-43 mRNA表达的影响

目的观察大鼠胚胎脊髓移植对损伤脊髓 GAP－ 43 mRNA表达和大鼠后肢功能恢复的影响。方法成年 Wistar大鼠 66只,随机被分为脊髓半切洞损伤应用胚胎脊髓移植组 (脊髓移植组, 30只 )、单纯脊髓半切洞损伤明胶海绵填充组 (单纯损伤组, 30只 )、正常对照组 (6只 )。术后第 1、 3、 7、 14、 28 d,对大鼠进行 Tarlov评分和斜板试验检查后肢功能。应用原位杂交的方法观察 GAP－ 43 mRNA的表达,记录阳性细胞数,采用计算机图像分析技术,进行定量分析。结果脊髓损伤后第 1 d,在脊髓移植组和单纯损伤组的损伤脊髓灰质中都可见到 GAP－ 43 mRNA的表达。于损伤后迅速增加,第 7 d时达到高峰。脊髓移植组 GAP－ 43 mRNA蛋白表达为 39.24± 6.83,约是单纯损伤组 (21.48± 7.83)的 2倍 (P< 0.05)。胚胎脊髓移植后可使损伤的脊髓中 GAP－ 43 mRNA持续高表达至术后第 28 d,而单纯损伤组仅持续到术后第 14 d。增加的 GAP－ 43 mRNA阳性细胞数与神经功能的改善平行。结论胚胎脊髓移植后可使损伤大鼠脊髓高表达 GAP－ 43 mRNA,并促进大鼠功能的恢复。     

胚胎脊髓组织移植联合应用神经生长因子对损伤脊髓再生修复的形态学影响

选择胎龄为１４～１５天的大鼠胚胎脊髓植入成年大鼠半横断的脊髓损伤腔，同时局部应用神经生长因子。术后２～８个月，用组织学、免疫细胞化学、辣根过氧化酶示踪及超微结构的检查方法证实，移植组织在宿主脊髓内的存活率为９０％，并且分化成熟，具有正常的神经组织结构特征，大多数移植物充满损伤腔，与宿主脊髓形成良好的融合，移植组织与宿主组织出现新的纤维联系，使脊髓损伤的两端恢复了解剖的连续性。     

不同方法移植胚胎脊髓促进成鼠损伤脊髓功能恢复的研究

目的：研究提供血运的胚胎脊髓移植对成鼠损伤脊髓功能恢复的作用。方法：将成年Ｗｉｓｔａｒ大鼠作为脊髓半切洞损伤模型,应用单纯胚髓组织、胚胎脊髓＋大网组织、胚社以半切洞损伤的脊髓中,手术后１、２、４、１２周进行联合行为发,感觉诱闰（ＳＥＰ）和运动诱发电位（ＭＥＰ）检查,并与一言堂３组为单纯损伤线比较。结果：联合行为评分,单纯移植级和胚胎脊髓＋大网膜组织移植组优于单纯损伤组,ＳＥＰ和ＭＥＰ潜峰时的恢复,     

同种胚胎脊髓移植物对成年大鼠损伤脊髓组织形态与功能的修复作用

探讨大鼠胚胎脊髓组织移植物对成年大鼠损伤脊髓组织形态与功能的修复作用。在半切洞损伤的成年大鼠脊髓内，植入大鼠胚胎脊髓组织，术后行联合行为记分、诱发电位及组织学检查。结果：移植物能在宿主脊髓损伤部位存活，并能生长、分化、修复宿主脊髓的组织损伤，诱导宿生神经纤维联系的重建，改善宿主损伤脊髓的神经传导，促进功能恢复。以上结果提示：胚胎脊髓移植物对成年大鼠损伤脊髓组织形态与功能均具有修复作用。     

Histologic studies of the spinal cord following spinal anesthesia

Spinal anesthesia induced in autumn frogs produces histologic changes in the large multipolar cells particularly in the dorsal region of the spinal cord. These changes consist of hydropic swelling, loss of distinct outline, bluish staining of the reticulum, dissolution of the Nissl granules, and disappearance of nuclear structure.These changes are transitory, beginning to regress in six hours after the induction of the anesthesia and disappearing entirely within twenty-four hours. No histologic deviation from the normal is observed twenty-four or more hours after the induction of spinal anesthesia in the autumn frog.Human cords examined twenty-two, thirty-six, ninety-six, 144, 192, and 816 hours after spinal anesthesia show no histologic change from the normal.     

前路内固定在治疗胸腰椎结核中的作用

目的探讨胸腰椎前路内固定系统在治疗椎体结核时可行性以及对胸腰椎结核的治疗效果。方法采用胸腰椎前路病变椎体切除加自体髂骨植骨治疗27例,并同期行前路椎体内固定系统进行固定。结果经平均3年的随访,27例患者结核均治愈,植骨与受骨区全部骨性愈合,融合时间平均7~8个月,后凸矫正角度平均16°。全组病例切口均一期愈合。无手术并发症。结论该术式对胸腰椎结核病灶可彻底清除,能较好地进行椎管减压和脊柱矫形,完成脊柱稳定性重建,有利于患者早期离床活动,提高治愈率。     

Microsurgical considerations of the anterior spinal and the anterior-ventral spinal arteries

Summary Background. There are few data describing the microanatomy of the anterior-ventral spinal (AVSA) and anterior spinal arteries (ASA) and discussing their clinical and surgical implications. We describe the anatomical features of this arterial complex, and highlight their use when planning and performing surgical approaches to lesions involving the ventral aspect of the medulla and the foramen magnum. Method. The microsurgical anatomy and branching pattern of the AVSA and the ASA from fifty human cadaver brain stems is described using a surgical microscope. Results. We found one anterior-ventral spinal artery at each side in 30 of the brain stems (60%). The ASA was a direct branch emerging from the left vertebral artery (VA) in 15 (30%), from the right VA in 4 (8%), and from the basilar artery (BA) in one brain stem (2%). The previously described as “typical pattern” of the junction of the AVS arteries from both sides, was observed only in 9 brain stems (18%). The anterior communicating spinal artery (ACoSA) was observed in 15 brain stems (30%). Also multiple ACoS arteries were described in one brain stem. Both, the AVSA and the ASA were observed to send long circumferential branches that supplied irrigation to the olive in 42 (84%) brain stems. Conclusions. This anatomical study gives important information for a better understanding of the clinical picture of ischemic lesions of the brain stem, such as the medial medullary syndrome, and highlights the remarkable role of the AVSA and ASA as anatomical landmarks during the surgical approaches to lesions involving the ventral aspect of the medulla and the foramen magnum.     

Experimental analysis of the spinal cord compressed by spinal metastasis

The purpose of the present study of experimental spinal metastasis, developed in rats by inoculation of tumor cells through the spinous process, was to find the factor that causes the initial damage to the cord in this disorder. In the early stage of paralysis, the degenerated posterior funiculus originated from a small hemorrhagic area in the posterior column of the involved cord. Using the scanning electron microscope, the hemorrhage was found to be from the intrinsic vein, resulting from the disturbance of venous drainage in the compressed portion. In the early stage of compression, extravasation of horseradish peroxidase was observed in the white matter, but histologic degeneration was not. A hemorrhage existed wherever degeneration of the funiculus was observed. Therefore, the trigger to induce the initial damage on the cord in spinal metastasis was not likely to be vasogenic edema, but instead the intrinsic venous hemorrhage.     

Syringomyelia of the thoracic spinal cord associated with spinal meningiomas

Syringomyelia is known to occur secondary to compression of the spinal cord. We report the case of a female patient who underwent removal of a spinal meningioma. She re-presented 30 years later with multiple meningiomas causing cord compression. After a 4 year interval she was found to have developed a syrinx proximal to the site of compression. Comparison with previous case reports suggest that the causation of syringomyelia is multi-factorial.     

Magnetic resonance imaging of the spinal cord in spinal dysraphisms

Magnetic resonance imaging (MRI) was performed 49 times in 42 patients with spinal dysraphism. Scoliosis and a changing neurological picture were the primary indications. Spinal cord anomalies included hydromyelia, diastematomyelia, lipoma, thickened filum terminali, and spinal cord atrophy. All but one patient exhibited Arnold-Chiari malformation. Twenty-two of the 42 patients had computed tomography (CT) scans, myelograms, or operations that corroborated the 41 MRI findings. Three false-positive MRI findings of hydromyelia and no false-negative studies were observed. MRI is a noninvasive investigative technique that provides more information than myelography or CT in defining spinal cord anatomy in spinal dysraphism.     

Extent of hyperbaric spinal anesthesia influences the duration of spinal block

BACKGROUND: The influence of spread of spinal anesthesia on the duration of spinal blockade has been suggested but never investigated specifically. Because elimination of local anesthetic from subarachnoid space is probably dependent of the surface available for its diffusion and vascular absorption, the current study was designed to evaluate the hypothesis that with a same dose of hyperbaric bupivacaine, a higher anesthetic level would result in a shorter duration of spinal blockade than a lower level. METHODS: Three milliliters (15 mg) of hyperbaric bupivacaine, 0.5%, was injected intrathecally in 40 patients classified as American Society of Anesthesiologists physical status I or H scheduled for lower limb surgery during spinal anesthesia. To obtain significantly different anesthetic levels, the patients were positioned randomly either horizontally or with the torso elevated 30. Regression of sensory level and motor blockade, the appearance of pain at the operative site, and hemodynamic changes were evaluated. RESULTS: The maximum cephalad spread of sensory blockade (expressed as the median with ranges in parentheses) was significantly higher in the horizontal group than in the group with 30-degree elevation of the torso, i.e., T3.5 (T1-T9) versus T10 (T6-L1), with respectively significantly faster regression times (mean ? SD) by two segments (216 ? 46 mm vs. 253 ? 64 mm) and to segment L4 (269 ? 53 mm i s. 337 ? 58 mm), as well as shorter time to complete motor blockade recovery (173 ? 34 mm i s. 233 ? 58 mm) and faster appearance of pain at the operative site (221 ? 68 mm vs. 271 ? 56 mm). CONCLUSION: The results indicate that with the same dose of hyperbaric bupivacaine, the duration of spinal blockade is longer in patients with restricted spread.     

Classification of spinal injuries based on the essential traumatic spinal mechanisms

STUDY DESIGN: A biomechanical unitary classification of spinal injuries is proposed. OBJECTIVE: To present an evaluation of spinal injuries based on the essential traumatic spinal mechanisms: axial deformation, torsion, translation and combined mechanisms in connection with the concept of the stabilizing axial spinal pillar. SETTING: Hospital 'Sf. Treime', Iasi, Romania. METHODS: The essential mechanisms of spinal injuries are considered: (1) axial deformation with (a) compression (centric or eccentric), most often eccentric, including compression in flexion or extension; (b) spinal elongation with distraction as centric elongation, but frequently axial eccentric elongation and a flexion or extension injury; (2) torsion or axial spinal rotation, (3) segmental translation, with a shearing version for the double translation and (4) combined mechanisms - the most frequent situation. Over 300 patients with spinal injuries were analysed and the spinal instability was determined using the criteria of clinical instability. The cases of spinal instability were studied in connection with the types of lesion of the central axial spinal pillar. RESULTS: All cases with lesions of the central axial spinal pillar had traumatic spinal instability. The spinal instability was absent in cases of isolated lesions of the anterior or posterior secondary pillar. The X-ray and spinal CT analysis of the traumatic spinal lesions showed the types of lesions and specified the mechanisms of spinal injuries. The combined mechanisms were responsible for the majority of the spinal injuries. CONCLUSIONS: Spinal instability occurs because of the lesion of the central axial spinal pillar The types of lesions of the central spinal pillar and of the secondary spinal pillars are determined by the essential traumatic spinal mechanisms: axial deformation (with compression or elongation), axial rotation, translation and most frequently the above combined mechanisms.     

Effects of spinal analgesics on spinal circulation: the safety standpoint

Administration of spinal analgesics around the spinal cord requires safety assessment due to the possibility of inflicting neurotoxic damage. Thus, neurotoxicologic evaluation should be performed for effective, safer spinal antinociception. Every potential agent for spinal administration should be studied in animals for its effects on spinal blood flow or vessels before any attempt is made to administer the drug to humans. As the spinal cord normally has a marginal blood flow, excessive vasoconstriction might produce spinal cord ischemia and consequent neurologic dysfunction. This review therefore focuses on the effects on the spinal circulation induced by well-known spinal analgesics employed in the treatment of acute and chronic pain disorders.