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101.
The Gulf War syndrome represents neurological and neuropsychological disorders in veterans of the Persian Gulf war. Until today, the various symptoms observed could not be attributed to any defined disease. As a possible cause, exposure to neurotoxic agents such as the organophosphates used during the war has been suggested by many authors. We report on a 29-year-old man who suffered from dysmnesia, disturbance of orientation, cognitive impairment, and double vision. His history revealed several front-line operations in 1990 and 1991 during the Gulf War. Physical examinations showed a complex eye-movement disturbance and a horizontal nystagmus, which was neuro-ophthalmologically confirmed. The early auditory potentials referred to a brainstem dysfunction and the cognitive disturbances correlated to changes in the late-appearing component of event-related potentials (P 300). Brain imaging with CCT, MRI, SPECT, PET, and EEG and CSF showed no pathologies. Neuropsychological tests disclosed severe cognitive impairment especially concerning memory. Three-month follow-up studies in a department of psychosomatic medicine excluded a dissociative disorder as a feature of a post-traumatic stress or a conversion disorder. This is the first case of Gulf War syndrome in Germany. We focus on an unfamiliar complication after the war. The recent literature is reviewed. 相似文献
102.
103.
Loss of tumor-promoting activity of unleaded gasoline in N- nitrosodiethylamine-initiated ovariectomized B6C3F1 mouse liver 总被引:1,自引:0,他引:1
Unleaded gasoline (UG) vapor (2056 ppm) increased the incidence of liver
tumors in a chronic bioassay and exhibited tumor-promoting activity in
N-nitrosodiethylamine (DEN)-initiated female mouse liver. Estrogen
inhibited mouse liver tumor development and the hepatocarcinogenic and
tumor-promoting dose of UG produced uterine changes suggestive of estrogen
antagonism. To directly test the hypothesis that UG-induced tumor-promoting
ability is secondary to its interaction with the mouse liver tumor
inhibitor, estrogen, we compared the tumor-promoting ability of UG in
ovariectomized (Ovex) mice with the hepatic tumor-promoting ability of UG
in intact mice. Ovaries were surgically removed at 4 weeks of age. Exposure
to wholly vaporized UG (2018 ppm) under bioassay and tumor-promoting
conditions began at 8 weeks of age. After 4 months of exposure, UG
increased relative liver weight and hepatic microsomal cytochrome P450
pentoxyresourfin-O- dealkylase and ethoxyresorufin-O-deethylase activity to
a similar extent in intact and Ovex mice. Non-focal hepatocyte
proliferation, as measured by the incorporation of bromo-deoxyuridine, was
not changed by UG exposure and was similar in all treatment groups. After 4
months of exposure to DEN-initiated mice, UG significantly increased the
volume fraction of liver occupied by foci (three-fold) as compared to
control intact mice. As expected, volume of foci was elevated in
DEN/Ovex/control mice as compared to DEN/intact/control mice. In DEN/Ovex
mice UG did not significantly increase the focal volume fraction. Thus, the
tumor promoting activity of UG, as demonstrated by increased volume
fraction of liver occupied by hepatic foci in intact mice, is greatly
attenuated in Ovex mice. The volume fraction data in Ovex mice support the
hypothesis that the tumor promoting activity of UG is dependent upon the
interaction of UG with ovarian hormones. These data also indicate that
hepatic microsomal cytochrome P450 PROD and EROD induction, hepatomegaly
and non-focal hepatic LI are not specific markers of hepatic tumor
promoting activity of UG.
相似文献
104.
Perkins SN; Hursting SD; Haines DC; James SJ; Miller BJ; Phang JM 《Carcinogenesis》1997,18(5):989-994
Transgenic mice with both alleles of the p53 tumor suppressor gene product
'knocked out' by gene targeting are susceptible to early development of
tumors, chiefly lymphomas and sarcomas. Compared with the control group,
administration of dehydroepiandrosterone (DHEA) at 0.3% of the diet to male
p53-deficient mice extended their lifespan by delaying death due to
neoplasms (from 105 to 166 days on study, P = 0.002), primarily by
suppressing lymphoblastic lymphoma (from 45 to 6% of neoplastic deaths, P =
0.010). Treatment with a synthetic DHEA analog,
16alpha-fluoro-5-androsten-17-one (compound 8354), at 0.15% of the diet
also increased lifespan, to 140 days for mice that developed tumors (P =
0.037). The effects of these steroids on lifespan and tumor development did
not appear to be strongly related to inhibition of food consumption and
weight gain, in that a group pair-fed with control diet to the reduced food
consumption of the DHEA-treated group developed and died of the same types
of neoplasms at the same rate as the controls fed ad libitum. The
chemopreventive effect of these steroids has been proposed to be due to
suppression of DNA synthesis by inhibition of glucose 6-phosphate
dehydrogenase, the rate-limiting enzyme of the pentose phosphate pathway.
Although DHEA and its analog are strong non- competitive inhibitors of this
enzyme in vitro, treatment with DHEA did not deplete cellular nucleotide
pools in the liver, as would have been predicted. The chemopreventive
effect of DHEA in this model may be due to steroid-induced thymic atrophy
and suppression of T cell lymphoma, permitting these mice to survive long
enough to develop tumors with longer latency.
相似文献
105.
Wu DC; Liu JM; Chen YM; Yang S; Liu SM; Chen LT; Whang-Peng J 《Japanese journal of clinical oncology》1997,27(2):115-118
Hemolytic uremic syndrome spontaneously arises in a few patients with
advanced cancer, but it is more commonly related to the use of certain
chemotherapeutic agents. Mitomycin-C is, etiologically, the most common
causative agent inducing hemolytic uremic syndrome, in a dose dependent
manner. We report this syndrome, attributable to mitomycin-C at a
cumulative dose of 40 mg/m2, in a gastric cancer patient. A 42-year-old
female with stage III gastric cancer underwent radical gastrectomy and was
given mitomycin-C at 10 mg/m2 intravenously every four weeks as adjuvant
therapy. Hemolytic uremic syndrome was diagnosed three months after the
last dose of mitomycin-C administration. The most prominent symptoms
included pallor, hypertension and anasarca, with laboratory evidence of
microangiopathic hemolytic anemia, azotemia and hyperkalemia. Her disease
was progressive, but fortunately stabilized after staphylococcus column A
dialysis. Her disease remained in remission for 24 months from the time of
diagnosis, and then relapsed in the form of peritoneal carcinomatosis with
partial intestinal obstruction.
相似文献
106.
Lateral mass screw–rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up 总被引:6,自引:0,他引:6
H. Gordon Deen MD Barry D. Birch MD Robert E. Wharen MD Ronald Reimer MD 《The spine journal》2003,3(6):489-495
BACKGROUND CONTEXT: Lateral mass plating has become the technique of choice for posterior cervical fixation. Although these systems are safe and reliable, they can be difficult to use in patients with abnormal cervical anatomy; screw placement can be compromised by the fixed hole spacing of the plate; screw back-out and other forms of implant failure can occur; and extension across the cervicothoracic junction can be problematic. PURPOSE: To report a series of patients undergoing posterior cervical stabilization with a polyaxial screw-rod construct and to investigate whether this new system offers any advantages over existing methods of fixation. STUDY DESIGN: A prospective study evaluating clinical and radiographic parameters in a consecutive series of patients treated with this technique. PATIENT SAMPLE: There were 21 patients in the study group. The surgical indication was cervical spondylosis in 14, trauma in 2, postsurgical kyphosis in 2 and 1 case each of congenital cervicothoracic stenosis, C7-T1 pseudarthrosis and basilar invagination with brainstem compression. OUTCOME MEASURES: Clinical indicators included age, gender, neurologic status, surgical indication and number of levels stabilized. Note was made of whether laminectomy and concomitant anterior reconstructive surgery were performed. Radiographic indicators included early postoperative computed tomography (CT) scan to check for screw placement and plain radiographs at subsequent visits. METHODS: The participants in this study underwent posterior cervical stabilization using lateral mass screw-rod fixation. Clinical and radiographic assessment was carried out immediately after surgery, and 3, 6 and 12 months after surgery. One-year follow-up was obtained in all cases. RESULTS: A total of 212 screws were implanted in 21 patients. Fixation was carried out over an average of 5.5 spinal segments (range, 2 to 11). The system was successfully implanted in all patients despite the presence of coronal and sagittal plane deformities and/or lateral mass abnormalities in the majority of cases. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-C7 lateral masses and upper thoracic pedicles. Early postoperative CT scanning confirmed satisfactory screw placement in all cases. Three patients experienced transient single-level radiculopathy, for an incidence of 1.4% per screw placed. Two patients developed wound seromas requiring evacuation. There were no infections or other wound healing problems. There were no examples of cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, loss of alignment or implant failure. When compared with plating techniques, screw-rod fixation appeared to offer several advantages. First, unlike plates, rods proved to be amenable to multiplanar contouring, which is often needed for deformities associated with cervical spondylosis. Second, lateral mass screw placement was more precise because it was not constrained by the hole spacing of the plate. Third, screw back-out and other types of implant failure were not seen. Fourth, the screw-rod system was more easily extended to the occiput and across the cervicothoracic junction. Fifth, the screw-rod system permitted the application of compression, distraction and reduction forces within the construct, to a greater extent than plate systems. The incidence of postoperative radiculopathy was similar to that seen with plate systems. CONCLUSIONS: These data indicate that posterior cervical stabilization with polyaxial screw-rod fixation is a safe, straightforward technique that appears to offer some advantages over existing methods of fixation. Results appear to be durable at 1-year follow-up. Benefits are more significant with longer constructs, especially those extending to the occiput or crossing the cervicothoracic junction. 相似文献
107.
108.
Summary A 79-year-old female patient was hospitalized because of polyneuritis and polyradiculitis. In this case it could be made likely that polyneuritis and polyradiculitis were due to the paraproteinemia accompanying the plasmacytoma, a relationship only rarely described to date. 相似文献
109.
MM Harjai DC Agarwal P Dave SS Jog P Arora SM VSM 《Medical Journal Armed Forces India》2005,61(2):143-147
Background
The sudden increase in incidence and magnitude of mine blast injuries prompted us to highlight the problem and its management.Methods
The cases of mine blast injuries occurring during mining and demining in a particular geographical area were analysed. Total 27 cases of mine blast injuries occurred during mining or demining operations in a period of 13 months.Results
Various body regions were involved in the mine blast injuries but the main brunt was borne by feet and legs followed by multiple body regions due to splinters. 14 patients underwent below knee (BK) amputation while 4 patients required through knee (TK) amputations. The effect of blast was so severe that most of the cases required 2 to 5 times wound debridements. The initial aggressive debridement / open stump amputation saved the limb and life of all patients.Conclusion
A mine blast causes extensive injuries and psychological trauma. Management is needed urgently, surgery is difficult, and amputation is often inevitable. Maximum lives and limbs can be saved with aggressive debridement, repeated inspections and dressings under anaesthesia and definitive closure at optimum time.Key Words: Amputation, Antipersonnel mine, Crush syndrome, Debridements, Mine blast injury, Secondary missiles, Shrapenels 相似文献110.
Wetjen NM Link MJ Reimer R Nichols DA Giannini C 《Surgical neurology》2005,64(5):462-7; discussion 467
Intracranial dissection presenting with subarachnoid hemorrhage (SAH) most commonly involves the vertebral artery. The natural history of this lesion suggests frequent early rehemorrhage and need for urgent treatment. Isolated dissection of the posterior inferior cerebellar artery (PICA) is very rare. We present 2 cases of isolated PICA dissections presenting with SAH. Both patients were middle-aged men who presented with transient loss of consciousness, severe headache, and cranial neuropathies. Initial angiography showed dilatation and narrowing of PICA consistent with dissection and aneurysm formation. The vertebral arteries were normal and there was no other cause for the SAH. Repeat angiography 2 weeks after admission revealed significant enlargement of the aneurysmal dilation of the dissected segment of PICA in both patients. Both patients were treated operatively. One patient had clip reconstruction of the PICA with preservation of flow through the PICA. Follow-up angiography one year later showed no recurrence. The other patient underwent direct surgical trapping and resection of the dissected segment of PICA after passing balloon occlusion testing at the vertebral-PICA junction. Both patients have more than 2 years of clinical follow-up and remain well. Isolated PICA dissection seems to have a less ominous natural history compared to vertebral artery dissection. These lesions need to be followed carefully for evidence of aneurysmal enlargement. Direct surgical reconstruction of the dissected segment may be possible. Balloon occlusion testing may be very helpful in determining if the involved PICA segment can be sacrificed. 相似文献