Localization of NADPH-diaphorase containing neurons in the spinal dorsal horn and spinal sensory ganglia of the turtle Chrysemys d’orbigny

 NADPH-diaphorase positive (NDP) neurons and nerve fibers were found in the spinal dorsal horn (DH) and sensory ganglia of the turtle Chrysemys d’orbigny. Three well-defined types of NDP neurons were found in the DH: (a) elongated nerve cells with two radially arranged dendritic branches, (b) neurons with rostro-caudal dendritic branches, (c) bitufted neurons with two, practically symmetric branches that project to the ipsilateral and contralateral dorsal horns. A combination of the techniques that reveal NADPH-diaphorase activity with the horseradish peroxidase transganglionic labeling of the dorsal root collaterals, suggested that NDP neurons of the DH are second-order cells of the spinal sensory pathway. NDP neurons were also found in the spinal sensory ganglia at all metameric levels. Our findings indicate that the DH of turtles, like that of mammals, contains both the enzymatic machinery and the neural connections required to postulate the participation of nitric oxide in ”plastic phenomena” such as hyperalgesia and central sensitization. Two other alternatives or complementary hypotheses are discussed: (a) NDP neurons in the DH and sensory ganglia may represent specific cell populations involved in the processing of sensory visceral information; (b) NADPH-diaphorase reactivity may indicate sustained levels of neuronal activity. Received: 12 February 1996 / Accepted: 2 August 1996     

Spinal cholinergic and monoamine receptors mediate the antinociceptive effect of morphine microinjected in the periaqueductal gray on the rat tail, but not the feet

The antinociceptive effects of morphine (5 μg) microinjected into the ventrolateral periaqueductal gray were determined using both the tail flick and the foot withdrawal responses to noxious radiant heating in lightly anesthetized rats. Intrathecal injection of appropriate antagonists was used to determine whether the antinociceptive effects of morphine were mediated byα₂-noradrenergic, serotonergic, opioid, or cholinergic muscarinic receptors. The increase in the foot withdrawal response latency produced by microinjection of morphine in the ventrolateral periaqueductal gray was reversed by intrathecal injection of the cholinergic muscarinic receptor antagonist atropine, but was not affected by the a2-adrenoceptor antagonist yohimbine, the serotonergic receptor antagonist methysergide, or the opioid receptor antagonist naloxone. In contrast, the increase in the tail flick response latency produced by morphine was reduced by either yohimbine, methysergide or atropine. These results indicate that microinjection of morphine in the ventrolateral periaqueductal gray inhibits nociceptive responses to noxious heating of the tail by activating descending neuronal systems that are different from those that inhibit the nociceptive responses to noxious heating of the feet. More specifically, serotonergic, muscarinic cholinergic andα₂-noradrenergic receptors appear to mediate the antinociception produced by morphine using the tail flick test. In contrast, muscarinic cholinergic, but not monoamine receptors appear to mediate the antinociceptive effects of morphine using the foot withdrawal response.     

颈椎后路切除高位颈椎管内肿瘤1例

高位颈椎管内肿瘤的切除手术危险程度高,手术复杂难处理.我们对1例C3,4部位的巨大神经鞘膜瘤患者经后路进行肿瘤切除,患者得到了良好的恢复. 　　……     

大鼠脊髓慢性压迫及减压后神经细胞凋亡及其相关基因的表达

目的：观察慢性压迫性脊髓损伤后及减压后神经细胞凋亡和Bcl-2mRNA，P53mRNA,CASPASE-3神经功能恢复的影响。方法：将55只同龄Wistar大鼠，置入后路渐进式压迫装置，制作成慢性压迫性脊髓损伤模型。随机分为假手术对照组（A组5只），慢性脊髓压迫组（B组25只），减压组（C组25只）。应用原原位末端脱氧核糖核苷酸转移酶介导dUTP标记（TUNEL）技术及原位杂交检测方法，观察各组细胞凋亡率及细胞凋亡相关基因Bcl-2mRNA、P53mRNA、CASPASE－3在慢性压迫性脊髓损伤后及减压后的表达，分别于损伤后及减压后1、3、7、14、28d对慢性脊髓损伤区进行细胞凋亡及原位杂交检测。结果：A、B、C三组均发现神经细胞凋亡及细胞凋亡相关基因Bcl-2mRNA、P53mRNA，CASPASE－3的表达，A、B、C三组细胞凋亡率及阳性细胞灰度值比较，差异有显著性意义（P＜0．05）。阳性细胞表达程度与细胞凋亡的减少及神经功能的恢复相一致。结论：慢性压迫性脊髓损伤可导致大量的神经细胞凋亡，同时激活内源性保护机制，使脊髓发生适应性改变，减压可能通过激活此机制而减轻神经细胞凋亡，起到保护作用。     

Symptomatic cystic dilatation of V ventricle: Case report and review of the literature

We report a case of V ventricular cystic dilatation, presenting with specific neurological symptoms including low back pain, bilateral sciatica, weakness of dorsiflexion, and urinary retention. MRI showed a large cystic dilatation of the ventriculus terminalis. Surgical fenestration of the cyst allowed complete relief from symptoms and remission of the neurological deficit.     

自体骨髓、骨联合移植在脊柱融合中的应用

目的 探讨自体骨髓、骨联合移植在脊柱融合中的运用。方法 84例中2例半椎体畸形、8例胸椎及胸腰椎结核、10例椎体滑脱、4例下颈椎骨折、51例胸腰段骨折、6例腰椎骨折及3例退变节段不稳患者在处理原发病的同时行植骨融合术，二期再在X线监视下行经皮注射自体骨髓移植，其中74例合并应用内固定器。结果 78例获得随访，平均随访期30．06个月。75例融合成功。3例失败，其中2例二次取内固定术中才被发现，第3例术后8个月X线片有假关节形成表现，再次术中也证实有假关节形成。无神经系统症状加重的病例出现。结论 骨髓、骨联合移植在脊柱融合中运用失败率低(3．85％)，成骨性强、生物安全性好。     

胸腰椎骨折伴脊髓损伤前后路手术适应证的选择

目的 通过107例胸腰椎骨折伴脊髓损伤病例的治疗,探讨前、后路手术适应证的选择。方法 31例经前路减压植骨,采用Z-Plate等内固定。76例经后路采用短节段椎弓根钉内固定。结果 两组均获得了满意的疗效。结论 选择前或后路手术,应综合考虑脊髓损伤程度、手术时机与技巧、骨折的部位、骨折类型和影像结果等,才能确实做到减压、恢复脊柱序列和坚强固定的目的。     

硬脊膜动静脉瘘(附1例临床分析)

目的探讨硬脊膜动静脉瘘(SDAVF)的病因、发病机制、临床表现、诊断及治疗。方法回顾性分析了1例患者的相关临床资料。结果本例患者以双下肢渐进性麻木、无力1年余,加重伴大小便障碍9个月为主要临床表现,脊髓MRI显示T9~L1髓内以长T2长T1为主之异常信号,超选择DSA造影可见位于入LT12椎管处一硬脊膜动静脉之瘘口,成功地进行了经单侧椎板开窗夹闭瘘口术。结论SDAVF为一具有直接的动静脉交通性病变,常伴有小型畸形团,多发生于中年男性,误诊率高,主要表现为渐进性的肢体麻木、无力及大小便障碍,MRI有助于诊断,但仍须DSA确诊。阻断连接瘘口与冠状静脉丛的引流静脉是治疗SDAVF的有效方法,显微外科手术效果可靠、复发率低,尽早地确诊和治疗是取得良好疗效的根本前提。     

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

A biomechanical study comparing simulated lytic vertebral metastases treated with laser-induced thermotherapy (LITT) and vertebroplasty versus vertebroplasty alone. To investigate the effect of tumor ablation using LITT prior to vertebroplasty on biomechanical stability and cement fill patterns in a standardized model of spinal metastatic disease. Vertebroplasty in the metastatic spine is aimed at reducing pain, but is associated with risk of cement extravasation in up to 10%. Six pairs of fresh-frozen cadaveric thoracolumbar spinal motion segments were tested in axial compression intact, with simulated metastases and following percutaneous vertebroplasty with or without LITT. Canal narrowing under load, pattern of cement fill, load to failure, and LITT temperature and pressure generation were collected. In all LITT specimens, cement filled the defect without extravasation. The canal extravasation rate was 33% in specimens treated without LITT. LITT and vertebroplasty yielded a trend toward improved posterior wall stability (P = 0.095) as compared to vertebroplasty alone. Moderate rises in temperature and minimal pressure generation was seen during LITT. In this model, elimination of tumor by LITT, facilitates cement fill, enhances biomechanical stability and reduces the risk of cement extravasation.     

椎管内修复臂丛神经损伤的解剖及临床应用研究

目的观察通过打开椎管找到残存的臂丛神经根并进行神经修复的可行性。方法甲醛溶液固定的成人尸体标本15具30侧，测量C5-T1，神经前根椎间孔段的直径、长度和有髓神经纤维计数。选择5例臂丛神经损伤患者，2例为椎孔处刀刺伤，3例为闭合性创伤。自受伤到椎管内探查的时间为3-6个月，平均4个月。CTM显示部分已损伤的神经根其椎管内神经前后根仍存在，而锁骨上臂丛神经探查在椎间孔外找不到相应的具有正常结构的神经根近端，通过打开椎管将椎管内残存的神经根用腓肠神经桥接进行神经修复。结果C5-T1，神经前根的有髓神经纤维数目为4000-6000根，椎间孔段的长度为11～14mm，外径为1．2～1．5mm。5例患者的椎管内均找到了具有正常结构的神经根近端，其中C5神经根3例，C5、C6神经根1例，C7神经根1例。C5修复肩胛上神经和C5神经远端各1例，C5修复正中神经内侧头1例，C7修复内侧束1例，C5、C6分别修复上干后股、肌皮神经1例。术后随访38--46个月，平均42个月。5例患者其修复神经所支配肌肉的肌力分别达3-4级。结论对于神经根在椎间孔处断裂的臂丛神经损伤，可通过打开椎管找到损伤神经根的近端，为臂丛神经根性损伤的修复提供理想的动力神经源，有利于臂丛神经治疗效果的提高。