老年性颈椎病的MRI诊断及表现

目的了解老年性颈椎病的MRI表现在诊断方面的意义,并初步探讨一般病理过程。方法100例老年性颈椎病均经用飞利蒲公司生产的0．5TMRI扫描系统,使用颈椎表面线圈行自旋回波及梯度回波序扫描。结果在100例老年性颈椎病中,生理曲度发生改变占78％;椎体骨质增生占椎体总数的68％;间盘变性及间盘突出或膨出分别占间盘总数的53％及47％;后纵韧带骨化或肥厚占病例总数的15％;椎体滑脱占病例总数的4％;而硬膜囊及脊髓受压占病例总数的100％。结论MRI能清楚显示颈椎病各部位的病变程度及病理变化。因此MRI是诊断老年性颈椎病最理想的检查手段,对临床治疗及预后的判断具有重大意义。     

老年性颈椎病的MRI诊断及表现

目的了解老年性颈椎病的ＭＲＩ表现在诊断方面的意义,并初步探讨一般病理过程。方法１００例老年性颈椎病均经用飞利蒲公司生产的０．５ＴＭＲＩ扫描系统,使用颈椎表面线圈行自旋回波及梯度回波序扫描。结果在１００例老年性颈椎病中,生理曲度发生改变占７８％;椎体骨质增生占椎体总数的６８％;间盘变性及间盘突出或膨出分别占间盘总数的５３％及４７％;后纵韧带骨化或肥厚占病例总数的１５％;椎体滑脱占病例总数的４％;而硬膜囊及脊髓受压占病例总数的１００％。结论ＭＲＩ能清楚显示颈椎病各部位的病变程度及病理变化。因此ＭＲＩ是诊断老年性颈椎病最理想的检查手段,对临床治疗及预后的判断具有重大意义。     

Cervical Spondylosis and Hypertension: A Clinical Study of 2 Cases

Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms.Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis.     

黄芪川芎嗪治疗老年椎动脉型颈椎病的临床观察

目的观察黄芪注射液联合川芎嗪注射液对老年椎动脉型颈椎病的疗效.方法选择80例住院病例,采用单盲法随机分为治疗组和对照组.治疗组给予黄芪注射液与川芎嗪氯化钠注射液联用,对照组给予维脑路通注射液静脉输注.两组均治疗两个疗程后评价疗效.结果治疗后症状积分治疗组有明显下降(P<0.01);旋颈试验阳性率治疗前(80.0%)、治疗后(12.5%)有明显改变;压顶试验阳性率治疗前(77.5%)、治疗后(20.0%)比较亦有明显改变,治疗组血脂、血流变、血管活性物质;基底动脉SV、DV治疗后较治疗前均有明显改善(P<0.01);治疗组愈显率、有效率(75.0%、92.5%)优于对照组(52.5%、87.5%).结论益气活血中药可增加颈总动脉、椎-基底动脉血流量,降低血管阻力,改善脑血流量,纠正缺血的作用.     

Tetraplegia After Thyroidectomy in a Patient with Cervical Spondylosis: A Case Report and Literature Review

Cervical spondylosis is degeneration of the cervical spine that occurs during the normal course of aging, and may progress into compression of the spinal cord, or cervical spondylotic myelopathy (CSM), which can cause neurologic dysfunction. Cervical spondylosis can be identified in the majority of people older than 50 years. Many people with cervical spondylosis or CSM are asymptomatic. However, patients with CSM are at higher risk of spinal cord injury (SCI) following minor injury.A 60-year-old woman with asymptomatic cervical spondylosis underwent an elective subtotal thyroidectomy for thyroid nodules. After the surgery, she developed tetraplegia. MRI revealed spinal cord compression and injury. Main diagnoses, therapeutics interventions, and outcomes: Acute cervical SCI was diagnosed. After an emergency anterior cervical corpectomy and fusion surgery, she almost completely recovered.Iatrogenic cervical SCI after nonspinal surgeries that requires neck hyperextension is rarely reported, probably due to underdiagnosis and underreport. Among the 14 cases (including ours) published in the literature, most patients had cervical spondylosis and were senior men. Five patients had diabetes. Four patients had long-term hemodialysis. Seven patients had undergone coronary artery bypass surgery that requires prolonged operative time. Only 3 patients had almost complete recovery. Most patients were disabled. Two patients required tracheostomy for long-term ventilator support. Two patients died. These cases reiterate the potential risk of iatrogenic SCI in people with predisposing conditions such as cervical spondylosis, especially considering the rising prevalence and severity of cervical spondylosis caused by the aging of the population and modern sedentary lifestyle. Surgeries requiring prolonged neck hyperextension put patients with cervical spondylosis at risk for SCI. Failure to recognize the potential occurrence of iatrogenic SCI might endanger patients’ lives.     

Association Between Cardiac Rehabilitation and Frailty

BackgroundCardiac rehabilitation is a mainstay treatment for patients experiencing an adverse cardiovascular event. Heart disease is important in frailty, but the impact of cardiac rehabilitation on frailty is unclear.MethodsPatients were referred to a 12-week group-based exercise and education cardiac rehabilitation program performed twice weekly. Frailty was measured with the use of a 25-item accumulation of deficits frailty index (range 0-1; higher values indicate greater frailty) at cardiac rehabilitation admission and completion. Patients were categorized by the degree of frailty in 0.1 increments.ResultsOf the 4004 patients who enrolled, 2322 (58.0%) completed cardiac rehabilitation with complete data at admission and completion. There were 414 (17.8%), 642 (27.6%), 690 (29.7%), 401 (17.3%), and 175 (7.5%) patients with admission frailty levels of < 0.20, 0.20-0.30, 0.30-0.40, 0.40-0.50, and > 0.50, respectively. Frailty levels improved from cardiac rehabilitation admission (mean 0.34 [95% CI 0.32-0.35]) to completion (0.26 [0.25-0.28]) for those who completed the program (P < 0.001). After adjusting for age, sex, and number of exercise sessions attended, frailty improved in all frailty groups by mean differences of 0.03 (0.02-0.03), 0.05 (0.05-0.06), 0.08 (0.08-0.09), 0.10 (0.09-0.11), and 0.11 (0.10-0.13) in the < 0.20, 0.20-0.30, 0.30-0.40, 0.40-0.50, and > 0.50 frailty groups, respectively. The minimal improvement in frailty scores (≥ 0.03 reduction) was achieved by 48%, 65%, 72%, 76%, and 79% of patients in the the 5 frailty groups, respectively.ConclusionsAlthough higher frailty levels were associated with cardiac rehabilitation drop-out, finishing the program was related to improving frailty levels, especially in patients who were the frailest.     

Association Between Gout and Aortic Stenosis

Background

An independent association between gout and coronary artery disease is well established. The relationship between gout and valvular heart disease, however, is unclear. The aim of this study was to assess the association between gout and aortic stenosis.

胱抑素C与心血管疾病的关系

既往研究已证实胱抑素C是评价肾功能损伤的一项敏感指标,然而近年的研究提示胱抑素C与动脉粥样硬化、冠心病、高血压、心力衰竭等的发生、发展和预后密切相关,这种相关性反映了胱抑素C在心血管疾病的发生和发展中有肾性和非肾性的作用,其非肾性方面可能通过参与炎症过程而发挥作用。     

Association Between Vitamin D Status and COPD Phenotypes

Background

It has been suggested that identifying phenotypes in chronic obstructive pulmonary disease (COPD) might improve treatment outcome and the accuracy of prediction of prognosis. In observational studies vitamin D deficiency has been associated with decreased pulmonary function, presence of emphysema and osteoporosis, upper respiratory tract infections, and systemic inflammation. This could indicate a relationship between vitamin D status and COPD phenotypes. The aim of this study was to assess the association between vitamin D levels and COPD phenotypes. In addition, seasonality of vitamin D levels was examined.

Methods

A total of 91 patients from a Danish subpopulation of the “Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points” cohort took part in a biomarker substudy. Vitamin D concentration was measured from blood samples taken at two visits, approximately 6 months apart. The participants were 40–75-year-old patients with COPD and had a smoking history of >10 pack-years.

Results

Fifty-six patients had 25-hydroxyvitamin D measured from blood samples from both visits. In the final model of the multivariate analyses, the factors that were associated with vitamin D deficiency at the first visit were age (OR: 0.89, p = 0.02) and summer season (OR: 3.3, p = 0.03). Factors associated with vitamin D level also at the first visit were age (B: 0.9, p = 0.02) and 6 min walking distance (B: 0.05, p = 0.01).

Conclusion

Vitamin D was not associated with COPD phenotypes and season did not seem to be a determinant of vitamin D levels in patients with moderate to severe COPD.     

Association Between Patient-Reported Medication Adherence and Anticoagulation Control

Background

The prevention of thromboembolism events remains challenging in cases of poor medication adherence. Unfortunately, clinical prediction of future adherence has been suboptimal. The objective of this study was to examine the correlation between 2 measures of real-time, self-reported adherence and anticoagulation control.

Association Between Fecal Hydrogen Sulfide Production and Pouchitis

PURPOSE The beneficial effect of antibiotics in pouchitis suggests that an unidentified fecal bacterial product causes this condition. A candidate compound is hydrogen sulfide, a highly toxic gas produced by certain fecal bacteria, which causes tissue injury in experimental models. We investigated hydrogen sulfide release and sulfate-reducing bac-terial counts in pouch contents to determine whether hy-drogen sulfide production correlates with pouchitis.METHODS During incubation at 37°C, the production of hydrogen sulfide, methylmercaptan, carbon dioxide, and hydrogen were studied using fresh fecal specimens obtained from 50 patients with ileoanal pouches constructed after total proctocolectomy for ulcerative colitis (n = 45) or for familial adenomatous polyposis (n = 5). Patients with ulcerative colitis were divided into five groups: a) no history of pouchitis (pouch for at least 2 years; n = 8); b) past episode(s) of pouchitis but no active disease for the previous year (n = 9); c) pouchitis in the past year but presently inactive (n = 9); d) ongoing antibiotic treatment (metronidazole or ciprofloxacin) for pouchitis (n = 11); e) currently suffering from pouchitis (n = 8).RESULTS Release of hydrogen sulfide when pouchitis was active (6.06 ± 1.03 mol g^–1 4 h^–1) or had occurred in the past year (4.71 ± 0.41 mol g^–1 4 h^–1) was significantly higher (P < 0.05) than when pouchitis had never occurred (1.71 ± 0.43 mol g^–1 4 h^–1) or had been inactive in the past year (2.62 ± 0.49 mol g^–1 4 h^–1). Antibiotic therapy was associated with very low hydrogen sulfide release (0.68 ± 0.29 mol g^–1 4 h^–1). Pouch contents from familial adenomatous polyposis patients produced significantly less hydrogen sulfide (0.75 ± 0.09 mol g^–1 4 h^–1) than did any group of nonantibiotic-treated ulcerative colitis patients. Sulfate-reducing bacterial counts in active pouchitis (9.5 ± 0.5 log₁₀/g) were significantly higher than in those who never experienced pouchitis (7.38 ± 0.32 log₁₀/g), and these counts fell dramatically with antibiotic treatment. No statistically significant differences in carbon dioxide and hydrogen were observed among the groups not receiving antibiotics.CONCLUSIONS Pouch contents of patients with ongoing pouchitis or an episode within the previous year released significantly more hydrogen sulfide than did the contents of patients who never had an attack of pouchitis and those with longstanding inactive disease. The response to therapy with metronidazole or ciprofloxacin was associated with marked reductions in hydrogen sulfide release and sulfate-reducing bacteria. These results provide a rationale for additional studies to determine whether the high sulfide production is a cause or effect of pouchitis. The lower hydrogen sulfide production by pouch contents of familial adenomatous polyposis vs. patients with ulcerative colitis suggests a fundamental difference in gut sulfide metabolism that could have implications for the etiology of ulcerative colitis as well as the pouchitis of patients with ulcerative colitis.Supported by The International Research Scholarship of the Research Foundation, The American Society of Colon and Rectal Surgeons, and Minnesota Colon and Rectal Foundation.Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004.