左腋动脉和臂丛神经走行变异1例

笔者在标本解剖操作观察腋窝结构时发现1例左侧腋动脉与臂丛神经位置及走行出现变异,既往文献报道的变异多为腋动脉发出的分支与臂丛神经之间的位置与走行之间变异^[1-3],本次解剖观察发现腋动脉与臂丛神经的内侧束、外侧束和后束之间的位置关系出现变异,与既往报道有所不同,现报告如下。     

Acquired immune hemolytic anemia associated with IgA erythrocyte coating: investigation of hemolytic mechanisms

We have investigated the hemolytic mechanisms in a patient with acquired immune hemolytic anemia whose red cells appeared to be coated with IgA alone. The clinical course was similar to that of patients with hemolytic anemia mediated by warm-reacting IgG antibody. Splenic sequestration of red cells was demonstrated, and marked reduction of hemolysis occurred after corticosteroid therapy. Antibody was eluted from the patient's red cells and used to sensitize normal red cells in vitro. These sensitized red cells were not lysed by fresh autologous serum, nor did they fix detectable amounts of C3. However, red cells sensitized by eluted antibody were lysed by normal human peripheral blood monocytes in a system designed to demonstrate antibody-dependent cell-mediated cytotoxicity. Monocyte-mediated hemolysis of sensitized red cells was inhibited by the addition of low concentrations of normal serum IgA to the system, but not by IgG. The ability of the eluate to induce monocyte-mediated hemolysis was abolished by its adsorption on Sepharose-bound anti-IgA, but not by preincubation with Sepharose-bound anti-IgG. In addition, normal human monocytes were demonstrated to ingest eluate-sensitized red cells. These data demonstrate an in vitro interaction of IgA-sensitized red cells with leukocytes and suggest a possible mechanism for the patient's hemolysis.     

经皮肤活体组织检查确诊的Lafora病五例

目的 探讨Lafora病的临床、病理特点及诊断方法.方法 总结分析5例经腋窝皮肤活体组织检查确诊的Lafora病患者的临床和组织病理学特点.5例患者都进行了腋窝皮肤活体组织检查,常规行HE、糖原(PAS)和阿辛蓝-糖原(AB-PAS)染色.结果 5例患者中4例青少年发病,1例成年起病.所有患者均表现为进行性加重的强直阵挛发作、肌阵挛和智能损害,可早期出现性格改变,构音障碍和行走不稳.腋窝皮肤活体组织检查发现Lafora包涵体存在于大、小汗腺的肌上皮细胞和导管细胞内.结论 经皮肤活体组织检查发现PAS阳性圆形或卵圆形包涵体,结合Lafora病典型的临床表现可以确诊该病;皮肤活体组织检查的部位可选择腋窝或腋窝以外的部位.     

The kidneys in paroxysmal nocturnal hemoglobinuria

Long-term study of 21 PNH patients revealed an unexpectedly high incidence of functional and anatomic renal abnormalities. Most patients demonstrated varying degrees of hematuria and proteinuria distinct from hemoglobinuria. Evaluation of renal function revealed hyposthenuria, abnormal tubular function, and declining creatinine clearance. Radiologically these patients had enlarged kidneys, cortical infarcts, cortical thinning, and papillary necrosis which were confirmed by autopsy studies. Hypertension developed in eight patients. Urinary tract infection was uncommon. The renal findings bear striking similarity to those of sickle cell anemia. Contrary to the usual opinion, out studies clearly showed evidence of widespread renal pathology in PNH most likely due to repeated microvascular thrombosis similar to the venous thrombosis involving other organs in this disorder.     

脊髓延髓肌萎缩症临床及电生理特点分析

目的分析5例脊髓延髓肌萎缩症患者的临床特征,以便临床医生对该病的认识。方法收集基因确诊的5例脊髓延髓肌萎缩症患者的临床资料,分析其临床特点及血清性激素、各生化指标水平、脑脊液及肌电图特点。结果脊髓延髓肌萎缩症患者青年发病,病情进展缓慢。神经系统表现为以肢体近端和延髓部受累为主的瘫痪。舌肌受累较早,运动功能损害较轻。血清睾酮(969.3±234.9ng/dl)、雌二醇(57.1±5.3pg/ml)水平增高,男性乳腺发育出现在病史较长的患者。三核苷酸(CAG)重复序列数目43～51(平均47.2±3.6pg/ml)。患者的肌酸激酶(CK,481.8±264.8 IU/L)均增高,脑脊液检查均正常。肌电图为广泛神经源性损害。结论脊髓延髓肌萎缩症患者的早期症状不典型,易误诊,临床特征为青年起病,缓慢加重,以肢体近端无力为主的瘫痪。     

Effects of Ballates,Step Aerobics,and Walking on Balance in Women Aged 50–75 Years

This study examined the effectiveness of Ballates training (strengthening of the central core musculature by the inception of balance techniques) compared to more traditional exercise programs, such as step aerobics and walking, on balance in women aged 50- 75 years. Participants were randomly assigned to one of three supervised training groups (1 hour/day, 3 days/week, 13 weeks), Ballates (n = 12), step aerobics (n = 17), or walking (n =15). Balance was measured by four different methods (modified Clinical Test for the Sensory Interaction on Balance - mCTSIB; Unilateral Stance with Eyes Open - US-EO or Eyes Closed - US-EC; Tandem Walk - TW; Step Quick Turn - SQT) using the NeuroCom Balance Master. A 2-way (Group and Trial) repeated measures ANOVA and post-hoc Bonferroni Pair-wise Comparisons were used to evaluate changes in the dependent variables used to describe stability and balance (sway velocity, turn sway, speed, and turn time). Measures of static postural stability and dynamic balance were similar for the three groups prior to training. Following the different exercise interventions, sway velocity on firm and foam surfaces (mCTSIB) with eyes closed (p < 0.05) increased for the Ballates group while the other two exercise groups either maintained or decreased their sway velocity following the training, therefore suggesting that these two groups either maintained or improved their balance. There were significant improvements in speed during the TW test (p < 0.01), and turn time (p < 0.01) and sway (p < 0.05) during the SQT test for each of the three groups. In general, all three training programs improved dynamic balance, however, step aerobics and walking programs resulted in be better improvements in postural stability or static balance when compared to the Ballates program.

Key Points

• Exercise training can improve balance
• Need to consider both static and dynamic aspects of balance individually
• Improved balance can reduce the risk of fall

Key words: Exercise intervention, static balance, dynamic balance, aging