CT导引经皮穿刺注射无水乙醇治疗溶骨性骨转移瘤

目的探讨CT导引下经皮穿刺注射无水乙醇（CT～PEI）治疗溶骨性骨转移瘤的价值及安全性。方法对17例骨转移瘤患者（25个病灶）采用CT—PEI治疗，使用无水乙醇和超化碘油10：1的混合剂，用CT精确定位、准确穿刺瘤灶并密切监控无水乙醇弥散情况及用量，以减少并发症。对接近椎管及椎间孔的病灶，采用利多卡因实验性治疗以避免严重并发症。术前及术后定期CT检查，3例病人行同位素骨扫描检查，与治疗前检查进行对照研究。对患者随访3～30个月观察其临床疗效。结果所有患者经1次CT—PEI治疗后，疼痛即明显减轻，经2～3次CT-PEI治疗后疼痛完全缓解（CR）16例（24处病灶），疼痛部分缓解（PR）1例。术后随访3个月时，23处病灶内肿瘤组织均发生坏死，被高密度碘油混合液均匀浸润。其中，9处病灶体积缩小。随访3～30个月，除1例因周边出现新的肿瘤浸润灶而再次出现疼痛，其余病例转移瘤处止痛效果无反复。所有病例无严重并发症。结论CT—PEI是一种治疗骨转移瘤有效、微创、安全、简便的方法，使骨转移瘤内肿瘤组织坏死，最大限度的杀灭肿瘤细胞，从而达到满意的止痛效果，明显改善恶性肿瘤溶骨性转移病人的生活质量。     

小角度弯曲针法介入治疗腰5-骶1椎间盘突出症

目的探讨小角度弯曲针穿刺法进行腰5-骶1椎间盘或低位腰4~5椎间盘介入治疗的方法和应用效果。方法对50例明显低于髂嵴的腰4-5或腰5-骶1椎间盘突出症患者采取小角度弯曲针法穿刺椎间盘进行介入治疗。透视下旋转血管机的C型臂,使射线方向与椎间隙平行,将皮肤穿刺点位于距离脊柱中线6~8cm处,常规消毒麻醉;将穿刺针的前端2~3cm向一侧弯曲20°后向椎间盘穿刺,侧位观察接近椎间盘后缘时,将穿刺针弯曲端偏向内侧、上方进入椎间盘后外侧部,然后进行椎间盘内臭氧注射或等离子消融治疗。结果椎间盘穿刺顺利,一次穿刺成功者45例,占90%,穿刺针进入椎间隙后多数与椎间隙平行,利于盘内介入操作(40/50,占80%),仅20%穿刺后针尖位置欠理想,但尚可完成臭氧注射溶核。经穿刺针向盘内注射臭氧分布良好,等离子刀头活动范围适合消融需要,手术后近期有效率96%,无明显穿刺并发症。结论小角度弯曲针法可以避免高位髂嵴对低位椎间盘穿刺的限制,提高穿刺针在椎间盘内的位置精度,有利于顺利施行介入处理,减少穿刺损伤,缩短手术时间。     

NeuroformⅡ支架联合MatrixⅡ弹簧圈治疗颅内宽颈动脉瘤的初步经验

目的探讨NeuroformⅡ支架植入联合MatrixⅡ弹簧圈栓塞治疗颅内宽颈动脉瘤的疗效、技术要点、安全性及并发症防治。方法诊断为颅内宽颈动脉瘤的病人11例,其中大脑前动脉瘤2例,后交通动脉瘤4例,眼动脉瘤1例,大脑中动脉瘤2例,椎基底动脉瘤2例。7例先行NeuroformⅡ支架瘤颈成形,将微导管通过支架网眼置入动脉瘤内,填塞弹簧圈;4例先置入微导管于动脉瘤内,再释放支架后栓塞,术后3~6个月随访。结果所有病例栓塞操作均顺利完成,无手术并发症;其中致密填塞8例,部分致密填塞3例,术后病人均恢复良好,4例短期随访无再出血及血栓栓塞症状发生。结论NeuroformⅡ支架联合MatrixⅡ弹簧圈治疗颅内宽颈动脉瘤安全、有效。     

Electrophysiological evaluation in 4 patients with diabetic pseudotabes

BACKGROUND: Researches on diabetic nervous system lesion are mainly focus on peripheral nerve and vegetative nerve, so there are few investigations on diabetic pseudotabes. OBJECTIVE: To investigate the electrophysiological examinations on the diagnosis of diabetic pseudotabes. DESIGN: Case study. SETTING: Department of Electrophysiology and Department of Neurology, Zhongshan Hospital Affiliated to Xiamen University. PARTICIPANTS: A total of 4 patients with type 2 diabetes mellitus, including 3 males and 1 female aged from 50 to 72 years, were selected from Department of Neurology, Zhongshan Hospital Affiliated to Xiamen University from March 2002 to February 2005. All accepted subjects met the modified diagnostic criteria of diabetes mellitus, which was set by American Diabetes Mellitus Association (ADA) in 1997. Otherwise, the subjects had typical symptoms and physical signs of spinal posterior funiculus damage. However, patients with spinal cord lesion which was caused by other factors were excluded. All accepted subjects provided the confirmed consent. METHODS: Nicolet NT electromyography (EMG)/evoked potential meter (made in the USA) was used to detect spinal cord conduction velocity (SCCV), somatosensory evoked potential (SEP) of lower limbs, motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of extremities. Determining criteria: Measurements were performed based on the laboratory standards. SCCV, which was less than lower limit of normal value (T2–12: 40–55 m/s, T12–L4: 20–41 m/s, T2–L4: 36–45 m/s), was regarded as abnormal. SEP value of lower limbs: P40, P60 and PF, which were more than standard deviation of normal value (x(—)+2.5), were regarded as the abnormality. Normal value of P40, P60 and PF latencies (x(—)±s) in this study: P40, P60 and PF in males were (37.6±1.9) ms, (59.8±3.9) ms and (7.6±0.9) ms, respectively; meanwhile, those in females were (35.5±1.7) ms, (55.2±2.7) ms and (6.3±0.7) ms, respectively. MNCV and SNCV, which were less than 50 m/s in upper limbs and 40 m/s in lower limbs, were regarded as the abnormality. MAIN OUTCOME MEASURES: Electrophysiological examinations. RESULTS: All 4 patients with type 2 diabetes mellitus were involved in the final analysis. ① SCCV: Among 4 patients, SCCV of three patients was decreased in T2–12, T12–L4 and T2–L4, and that of the other one was decreased in T2–12 and T2–L4; however, SCCV in T12–L4 was normal. There was significant difference as compared with normal value (P < 0.01). ② SEP of lower limbs: SEP values of lower limbs were abnormal in all 4 patients. Among them, P40, P60 and PF latencies of two patients were delayed; P40 of one patient was delayed and PF was not drained out; P40 and P60 of the last one were delayed and PF was normal. ③ MNCV and SNCV: The MNCV and SNCV were normal in one patient and abnormal in three patients. The results demonstrated that MNCV and SNCV of extremities decreased; especially, sensory nerve action potential (SNAP) of both lower extremities of one patient were not drained out. CONCLUSION: Detections of SCCV, SEP of lower limbs, MNCV and SNCV of extremities are helpful to investigate whether peripheral nerve and deep sensory passage are damaged or not and determine whether deep sensory damage is caused by peripheral nerve and spinal posterior funiculus.     

全血黏度的参考值与年龄关系的研究

本项研究根据年龄、性别的不同,分析和描述血液流变学检测值的分布范围,为临床应用提供理论依据。 1.对象与方法:1999～2003年我院排除有高血压、糖尿病、心脏病、肥胖和其他器质性病变的健康体检者,男性1578名,年龄22～88岁;女性547名,年龄20～87岁。血液流变学检测所用仪器是北京中勤世帝公司生产的R80血液黏度仪。取空腹静脉血,肝素抗凝,恒温37℃下分别测量全血黏度。用方差分析方法检验年龄因素对切变率的显著性;采用Kolmogorov Smirnov D统计量检验各变量的正态性;并各个年龄组利用正态分布给出各切变率95％的可信区间(CI)。     

The health-related quality of life of male and female heavy smokers

Objectives: Heavy smokers are a segment of the smoking population who are at increased risk of smoking-related morbidity and least likely to achieve cessation. This study identifies the impact of heavy smoking on quality of life by gender and describes the subpopulation for improved targeting.Methods: South Australian representative population data (n = 3010) was used to compare the health-related quality of life status of male and female heavy smokers as assessed by the SF-36.     

急性脑梗死88例临床分析

[背景 ]比较分析 88例不同年龄组急性脑梗死患者的病因、症状、体征及头部CT所见 .[病例报告 ]将 88例急性脑梗死患者分为老年组和非老年组 ,对发病因素、症状、体征和头部CT特点进行对比分析 ,发病因素中有高血压者占 6 4 % ,心脏病者占 2 3% ,糖尿病者占 2 5 % ,有短暂性脑缺血发作病史者占 30 % ,高脂血症者占 4 5 % ,吸烟者占 5 2 % ,有家族史者占 33% .非老年组中初发者多见 ,有头痛、头晕及偏身感觉障碍等症状者比老年组多见 ,而偏瘫、四肢瘫、构音障碍及意识障碍者则老年组多见 .头部CT示单梗塞灶者在非老年组多见 ,多梗塞灶、脑白质脱髓鞘及脑萎缩者在老年组多见 .[讨论 ]脑梗死病人因年龄不同 ,其发病因素、临床表现及头部CT所见有所不同