交感神经节与椎旁阻滞联合运用于改善脑中风预后的研究

目的 评价交感神经节与椎旁阻滞联合运用在脑中风康复治疗中的效果。方法 150例中风患者随机分为交感神经节与椎旁阻滞联合运用组（SGB组）和康复训练组（H组）。分别在治疗前、治疗后及随访期间，记录患者的体征、实验室检查及特殊检测结果。使用临床神经功能缺损程度评分标准及修订的巴氏指数（modified Barthel index，MBI）评测。采用t检验和卡方检验分析组间差异。结果 治疗1、3、6个月后，SGB组与H组总疗效均有改善，分别为H组：50％、60％、70％；SGB组：90％、95％、100％，SGB组疗效优于H组。两组比较，自觉症状、神经功能缺损改善程度有明显差异，生活活动能力改善程度差别不大。治疗前、后相比，SGB组收缩压、舒张压、局部皮温、血高切黏度、血低切黏度、PGA有改善，H组改变不明显；两组患者血浆黏度无明显改善。TCD显示，SGB组脑血流改善占85．3％，H组占14．3％。SGB组住院时间短于H组，住院费用不增加。结论 在脑中风康复治疗中，联合运用交感神经节与椎旁阻滞，疗效明显优于常规康复训练。     

全麻复合硬膜外阻滞与单纯全麻的比较

比较全麻复合硬膜外阻滞和单纯全麻在围术期对机体应激、炎性、免疫等方面的影响。使用全麻加硬膜外麻醉能有效地抑制手术引起的应激反应，稳定循环状态，减少并发症，使病人在术中更为安全平稳，麻醉效果更为可靠，术毕清醒快，术后镇痛有利于术后病人咳嗽咯痰，并且能减轻围手术期对T细胞亚群的影响。     

Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl.

A 4-year-old girl with post-surgical complete atrioventricular block received an epicardial dual chamber pacemaker system. During further growth intermittent exit block occurred, first misinterpreted as neurological seizures. The epicardial lead was replaced using a transvenous approach, and a pacemaker with an integrated home monitoring facility was implanted. After her discharge, a rise in the pacing threshold automatically initiated an event message. On the basis of this information, the patient was called in and imminent dislodgement of the ventricular lead was diagnosed by x-ray. The lead was repositioned and was found stable over 1-year follow-up.     

Peripheral Foot Blockade Versus Popliteal Fossa Nerve Block: A Prospective Randomized Trial in 51 Patients

The majority of foot and ankle operations are performed on an outpatient basis and often under some form of regional anesthesia. In this prospective, randomized study of 51 patients undergoing elective unilateral forefoot procedures, we compared 2 different anesthetic techniques: the peripheral foot blockade and the popliteal sciatic nerve block. Variables assessed included the quality of surgical anesthesia, postoperative analgesia, and the incidence of postoperative complications. The anesthesia was classified as effective if it was the sole anesthetic technique for the forefoot surgery. We found successful results in both groups: 92% in the foot block group and 96% in the popliteal block group. Analysis of time required to perform the anesthetic procedure showed a significant difference between the 2 groups, with foot block being considerably faster (14.3 minutes vs 19.2 minutes for popliteal block) (P = .0078). Foot block patients demonstrated 10.96 hours of analgesia, whereas popliteal block patients exhibited 14.32 hours (P = .132). With a mean follow-up of 5.7 months, we did not find anesthesia-related complications in any of the patients. Both techniques showed a high level of safety and efficacy, with no significant difference detected between them. Our patients showed a high rate of satisfaction with both procedures (96% for foot block patients and 96.1% for popliteal block patients) and reported a good discharge disposition. These data show that both procedures are safe and effective anesthetic techniques and well suited to forefoot ambulatory surgery.     

Time course of muscle atrophy and recovery following a phenol-induced nerve block

Clinically, phenol is used often as a neurolytic agent to treat pain and spasticity. The purpose of this study was to examine the time course of denervation and recovery in several hindlimb muscles following application of a 5% aqueous solution of phenol to the sciatic nerve. Phenol was applied to the sciatic nerve of adult female rats either by intraneural or perineural injection. Axonal degeneration was evident within the sciatic nerve 2 days following phenol application, although variable amounts of damage were observed. By 2 weeks, the soleus and tibialis anterior had atrophied to 63% and 51% of control. Reinnervation of hindlimb muscles occurred between 2 and 4 weeks following the nerve block. Following denervation, the soleus became slower in that all of the fibers expressed the slow myosin heavy chain (MHC). At 5 months, maximum tension of the soleus was 74% of control and the muscle consisted of more fast fibers on average, some of which expressed IIx MHC. These data suggest that 5% phenol causes an injury to the nerve that is more severe than a crush injury, and that reinnervation of denervated muscles may be by motoneurons other than those that originally innervated the muscles. © 1996 John Wiley & Sons, Inc.     

First clinical experiences with an implantable bone conduction hearing aid at the University of Amsterdam

Summary A transcutaneous bone-conduction hearing aid was implanted in 11 patients who were not suitable for transcranial sound amplification. Audiological and surgical selection criteria were followed strictly. One device had to be explanted and minor revision surgery was needed in two cases for skin irritation and scarring. In general the aids were well tolerated but the amplification power of the external device proved to be insufficient in some patients, in whom bone conduction levels were on the borderline of the selection limits. Correspondence to: W.A. Dreschler     

Effects of chronic treatment with a nitric oxide donor on nerve conduction abnormalities and endoneurial blood flow in streptozotocin-diabetic rats

Abstract. This study examined the ability of nitrova-sodilator treatment with isosorbide dinitrate to prevent the development of reduced nerve conduction velocity and nutritive blood flow in streptozotocin-induced diabetes mellitus in rats. Two month untreated diabetes caused approximately 23% and 13% reductions in sciatic motor and saphenous nerve sensory conduction velocity ( P < 0.001). Isosorbide dinitrate treatment provided 64.6 and 67.6% protection for motor and sensory nerves, respectively ( P < 0.01). Sciatic endoneurial nutritive blood flow was measured by microelectrode polarography and a hydrogen clearance technique. After 1 month untreated diabetes, flow was reduced by 41.9% ( P < 0.001). Isosorbide dinitrate treatment for 1 month in non-diabetic and diabetic rats significantly increased blood flow ( P < 0.01). When between-group variations in blood pressure were taken into account, vascular conductance increased by 29% and 31% in non-diabetic and diabetic rats, respectively ( P < 0.01). Thus, nitrovasodilator treatment improves nerve perfusion and function in experimental diabetes, probably by compensating for reduced endothelium-derived nitric oxide release or action.     

Clinical Recurrences After Successful Accessory Pathway Ablation:

Dormant Accessory Pathways. Introduction : Recurrence of clinical symptoms after radiofrequency catheter ablation of an accessory atrioventricular pathway (AP) may be due to the late manifestation of an additional AP that was not detected during the initial ablation session. It was the purpose of this study to elucidate the phenomenon of these "dormant" APs.
Methods and Results : Of 1280 consecutive patients who underwent radiofrequency catheter ablation of an AP, 54 patients (4.2 %) developed clinical symptoms postablation, necessitating a repeat ablation session. Recurrence of conduction over the AP targeted al the initial ablation session was found in 45 patients, whereas in the other 9 patients (0.7%) the manifestation of a previously unnoticed AP had caused symptom recurrence. Retrospective analysis of the data from these patients' ablation sessions revealed that the late manifesting AP was ablated at a site clearly different from that of the initially targeted AP, and that the manifestation of conduction over a previously "dormant" AP occurred significantly later than the recovery of a presumably ablated AP. Seven (78%) of the 9 "dormant" APs were concealed, and none exhibited decremental conduction properties.
Conclusion : The incidence of clinical recurrences mediated by the late manifestation of conduction over a previously "dormant" AP is low. The lack of an anatomic vicinity of these predominantly concealed APs with the initially targeted AP and the lack of evidence for their presence during the initial ablation session suggest intermittent conduction as the most likely explanation for their late manifestation.