Biological correlates of mental stress related to anticipated caesarean section

The relationships between self-reported assessments of acute anxiety and several biochemical and physiological indicators of stress reaction were investigated in pregnant women at term in connection with spinal analgesia for caesarean section. Fear and apprehension were statistically significantly associated only with blood pressure and with an increase in heart rate from the previous day. The subjective estimate of the quality of the preoperative night's sleep was negatively associated with biochemical plasma and cerebrospinal fluid (CSF) measures of sympatho-adrenal activity. The previously reported negative correlation between body height and 5-hydroxyindoleacetic acid (5-HIAA, an indicator of serotonin metabolism) in lumbar CSF was confirmed. The concentration of 5-HIAA in CSF was positively correlated with the levels of other acidic monoamine metabolites and cortisol in CSF. It is concluded that hormone and monoamine metabolite measurements in CSF and plasma have only limited usefulness as quantitative indicators of the intensity of preoperative fear and anxiety.     

Effects of oral clonidine premedication on concentrations of Cortisol and monoamine neurotransmitters and their metabolites in cerebrospinal fluid and plasma

Forty-two healthy male patients (aged 19-40 years), undergoing orthopaedic surgery under spinal anaesthesia (3 ml isobaric 0.5% bupivacaine), were given clonidine 4.5 micrograms kg-1 orally either 2 (Group I, n = 10) or 4 (Group II, n = 10) hours before the operation, diazepam 0.15 mg kg-1 orally (Group III, n = 10) or a placebo tablet (Group IV, n = 12) 2 h before the operation. Plasma concentrations of cortisol, noradrenaline (NA), adrenaline (A), 3,4-dihydroxyphenylglycol (DHPG) and dihydroxyphenylacetic acid (DOPAC) were assayed from venous blood samples just before premedication and just before the spinal block. Cerebrospinal fluid (CSF) concentrations of cortisol, tryptophan, 5-hydroxyindoleacetic acid and catecholamine metabolites were assayed from a sample taken before the spinal block. The plasma NA concentrations of the patients in the groups receiving clonidine decreased clearly compared with the other groups (P less than 0.05). The NA metabolite DHPG was also lower in Groups I and II than in Group III (P less than 0.05) after premedication. Plasma A concentrations were lower in Groups I and III than in Group IV (P less than 0.05). The CSF concentrations of the different substances were similar in all groups. In Group I the sensory blockade lasted significantly longer than in Group III (P less than 0.05) and the mean duration of motor blockade was longer in Group I than in Groups III and IV (P less than 0.05). Two patients in both clonidine groups developed bradycardia (heart rate less than 45 min-1) requiring atropine treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

腰椎内镜髓核摘除术硬脊膜损伤或脑脊液漏的原因分析及防治

目的探讨显微内镜下髓核除手术(microendoscopic discectomy，MED)并发硬脊膜损伤或脑脊液漏的原因及防治。方法回顾分析1999年12月～2003年12月我院452例MED手术15例发生硬脊膜损伤或脑脊液漏的临床资料。结果术中发现硬脊膜损伤13例，9例术后出现脑脊液漏；2例术中未发现硬脊膜损伤术后发生脑脊液漏。11例脑脊液漏经正规保守治疗后3～7d治愈，无1例发生脑脊髓膜炎，无继发深部感染。结论MED因其自身的特点，易发生硬脊膜损伤；术前仔细分析病例，术中具备一定的手术技巧，可以减少硬脊膜损伤的发生；术中对损伤硬脊膜及时堵塞或修补，术后采取正规保守治疗措施，脑脊液漏均可治愈。     

神经内科危重症患者不同致病菌所致颅内感染的脑脊液生化及常规指标差异

目的分析神经内科不同致病菌所致颅内感染的脑脊液生化及常规检测指标,为治疗颅内感染提供理论依据。 方法选取2013年1月至2018年1月于重庆市开州区人民医院就诊的106例神经内科危重症患者为研究对象,其中并发颅内感染者为研究组（59例）,非颅内感染者为对照组（47例）。研究组患者根据是否出现昏迷分为未昏迷组（38例）和昏迷组（21例）,根据感染类型分为化脓性组（21例）、结核性组（20例）和病毒性组（18例）。应用生化分析仪、ELISA法和速率散射免疫比浊法检测患者脑脊液和血液上清液降钙素原（PCT）、C-反应蛋白（CRP）和神经元特异性烯醇化酶（NSE）水平。 结果化脓性组、结核性组和病毒性组患者脑脊液及血清PCT、CRP和NSE水平均显著高于对照组患者（P均< 0.05）。病毒性组患者血清和脑脊液NSE水平[（15.68 ± 6.15）μg/L、（17.06 ± 3.25）μg/L）]显著高于化脓性组患者[（11.36 ± 3.54）μg/L、（10.65 ± 3.61）μg/L]和结核性组患者[（12.63 ± 4.26）μg/L、（12.89 ± 4.33）μg/L）]（P均< 0.05）。化脓性组患者血清和脑脊液PCT[（0.86 ± 0.34）ng/ml、（0.72 ± 0.33）ng/ml]和CRP水平[（8.55 ± 2.4）ng/ml、（8.68 ± 2.57）ng/ml]均高于病毒性组和结核性组患者,差异均有统计学意义（P均< 0.05）。昏迷组患者脑脊液和血清PCT、CRP和NSE水平均高于未昏迷组患者和对照组,差异均有统计学意义（P均< 0.05）。 结论神经内科并发颅内感染者脑脊液和血清PCT、CRP和NSE水平能够反映颅内感染病情,为颅内感染的诊断和治疗提供可靠依据。     

Management of intra-operative cerebrospinal fluid leak in transnasal transsphenoidal pituitary microsurgery: use of post-operative lumbar drain and sellar reconstruction without fat packing

Summary Background. This study aims at describing primary reconstruction of sella turcica using lyophilized dura graft and fibrin glue without fat packing of the sphenoid sinus, together with postoperative lumbar drain in the management of intraoperative cerebrospinal fluid (CSF) leak. Method. Records of 127 consecutive patients undergoing 129 transnasal transsphenoidal procedures were reviewed retrospectively with respect to intra- and post-operative CSF leak and lumbar drain use. One hundred and ten patients had adenomas (60 secreting adenomas, 48 non-functioning), 10 Rathke’s cleft cysts and 9 miscellaneous lesions. Findings. Intra-operative leak was detected in 43 (33.3%) of 129 procedures: 38 (34.5%) of 110 adenoma related procedures and 5 (26.3%) of 19 non-adenomas. Among adenomas, leak occurred in 35 (41.2%) of 85 patients with suprasellar extension (SSE) and in 3 (12%) of 25 without SSE (p = 0.007). Lumbar drain was used in 61 cases (47.3%): in 34 it was inserted immediately before and in 27 at the end of procedure. In 24 of 34 patients (70.6%) with pre-operative drain (all adenomas), saline infusion was used to mobilize SSE. Only 2 patients (1.6%) developed post-operative leak, requiring an endoscopic procedure with fascia and muscle obliteration of the sphenoid sinus. Conclusions. Meticulous duroplasty and routine postoperative lumbar drain has shown satisfactory results in dealing with intra-operative CSF leaks. It compares favorably with other techniques and obviates the need for fat harvesting. In patients with SSE, where leak occurs more frequently, we recommend inserting the lumbar drain before the procedure. As an adjunctive benefit, this allows for the saline-infusion method to mobilize the SSE without producing the venous engorgement of the Valsalva maneuver.     

Ferritin: another pregnancy-specific protein in human seminal plasma and amniotic fluid, as estimated by six methods: Ferritin: ein weiteres schwangerschaftsspezifisches Eiweiß in menschlichem Seminalplasma und Fruchtwasser

Large quantities of ferritin were found in both seminal plasma and amniotic fluid, but there was a wide spread of results for each of six new non-radioactive monoclonal assays designed to give the same results for ferritin in blood serum. Correlation of values between the various assays was also poor, but after the exclusion of outliers it was possible to calculate approximate ratios for the concentrations. For seminal plasma, the Amersham 'Amerlite' luminescence immunoassay gave the lowest concentrations at 81 +/- 56 ng ml-1 WHO 80/602 (mean +/- SD, n = 43). Relative to this value as 100%, the other assays gave:Flow 'Monoscan' colorimetric IEMA = 161%; Pharmacia-LKB 'DELFIA' fluoroimmunoassay = 174%, Walker 'Synelisa' colorimetric ELISA = 182%; Abbott 'IMx' MEIA = 207%, while the results from the Ramco colorimetric ELISA were much higher and not parallel to the other assays. For amniotic fluid, the Amersham 'Amerlite' LIA gave 127 +/- 95 ng ml-1 (n = 38), taken as 100%, and the ratios for the other assays were:Abbott also approximately 100% but with a wide spread; Walker 43%, Pharmacia-LKB 22% and Ramco 148%. The Flow assay produced 15 zero values from 38 samples, and values were also very low in another 17 samples, so that no comparison with the other assays was possible. An attempt was made to determine the proportion of the different types of isoferritins being estimated. The Pharmacia-LKB assay estimated 90% of the theoretical concentration for pure liver ferritin, 42% of that from the placenta, 26% of that from the heart and 13% of that from the spleen. The other assays gave different proportions.     

Chronic changes in cerebrospinal fluid pathways produced by subarachnoid kaolin injection and experimental spinal cord trauma in the rabbit: their relationship with the development of spinal deformity

Post-traumatic cystic changes in cerebrospinal fluid (CSF) pathways such as ventriculomegaly and/or hydrosyringomyelia are not uncommon, but their characteristics have not yet been fully clarified. This study was designed to investigate the alterations affecting the CSF pathways in rabbits at a late stage, and to clarify the relationship between these changes and the development of spinal deformity. In this study, a total of 60 New Zealand white rabbits were used and they were segregated into four different groups of 15 animals each: sham-operation group, kaolin group, and kaolin plus mild trauma group and kaolin plus severe trauma group. The animals were subjected to radiological investigation using direct X-ray study and magnetic resonance imaging (MRI) after 4 months. The thoracic spinal cords of the animals were dissected after intracardiac perfusion–fixation with 10% formalin for light microscopy and 2.5% glutaraldehyde for transmission electron microscopic study. Following the sectioning and staining procedures, the histological characteristics of the spinal cords were evaluated with light microscopy and transmission electron microscopy. A spinal deformity developed in 90% in rabbits in both kaolin injection group and spinal trauma groups. MRI revealed generalized dilatation of the ventricular system and the central canal of the spinal cord after the kaolin injection with/without trauma in this study. Gross morphologic examination showed some enlargement of entire CSF pathways in these groups. All animals with central canal dilatation had mild or severe scoliotic and kyphotic deformities. In a light microscopic study, a denuded ependymal line and multicyst formations in periependymal areas were found in both kaolin injection and spinal trauma groups. Ultrastructurally, an apical flattening of the ependyma, microcysts in the ependymal cells, axonal degeneration, demyelination, and loss of ependymal cells adjacent mild spongy were found in the spinal cords of animals in these groups. To the best of our knowledge, this is the first study to investigate the chronic effects of spinal cord injury (SCI) on the CSF pathways and their relationship with the development of spinal deformity in an experimental model of kaolin injection and trauma, using MRI as well as light and transmission electron microscopy. In the light of this study, the severity of spinal cord injury on the development of some degenerative findings in the spinal cord was clear, but further clinical and experimental studies using dynamic imaging techniques will be valuable.