MEDIAN NERVE INJURY AND THE TRANSVERSE WRIST CREASE INCISION IN OPEN CARPAL TUNNEL RELEASE

The author has recently had referred to him three patients with median nerve injuries who have had open carpal tunnel decompression via a small transverse wrist incision. Despite previous adverse reports, some surgeons persist with this technique.     

Sodium channels accumulate at the tips of injured axons

The axolemmal distribution of voltage-gated sodium channels largely determines the regions of axonal electrical excitability. Using a wellcharacterized anti–sodium channel antibody, we examined peripheral nerve fibers focally injured by exposure to the neurotoxic agent, potassium tellurite (K₂TeO₃). Immunocytochemical and radioimmunoassay data showed a focal accumulation of sodium channels within the tips of injured axons. The major increase in sodium channel concentration occurred between 7 and 11 days after toxin exposure; however, immunocytochemically, excess sodium channels persisted in several axonal endings for a much longer time. The accumulation of sodium channels at injured axonal tips may be responsible, in part, for ectopic axonal excitability and the resulting abnormal sensory phenomena (especially pain and paresthesias) which frequently complicate peripheral nerve injury in humans. © 1994 John Wiley & Sons, Inc.     

A ring electrode to record extraocular muscle activities during skull base surgery

Summary A ring-shaped electrode was developed and used in 20 patients to record evoked electromyographic responses directly from the extraocular muscles during skull base surgery. Intra-operative monitoring with this electrode helps the surgeon to localize the nerves that innervate the extraocular muscles precisely and to refrain from disturbing important neural structures during operations. Such monitoring also provides some insight into the pathophysiology of the dysfunction of these nerves resulting from skull base lesions.     

THE EFFECT OF ACUPUNCTURE ON PREVENTION AND TREATMENT OF ISCHEMIC ARRHYTHMIA AND THE RELATION BETWEEN EFFECT OF ACUPUNCTURE AND CHOLINERGIC MUSCARINE-LIKE RECEPTORS

For investigating the effect of acupuncture on ischemic arrhythmia and its mech-anism, adult albino rats with ligated anterior descending branch of coronary artery as experimentalmodel were treated with or without acupuncture, and others with imitative operation but without bothcoronary artery ligation and acupuncture treatment were used as control. It was found in acupuncturegroup that the fibrillation-liability of ischemic myocardium was efficiently decreased, the affinity ofAch-M receptors on membranes of ischemic myocardium was markedly increased, and the tolerance ofischemic myocardium to atropine was elevated in the experiment of atropine inducing fibrillation.These results indicate that acupuncture may play a therapeutic role on ischemic arrhythmia throughactivating the activity of muscarine-like receptors of cholinergic nervous system.     

保留肋间臂神经在乳腺癌改良根治手术中的应用

目的探讨乳腺癌改良根治手术中保留肋间臂神经的可行性和方法。方法乳腺癌患者78例，其中49例在改良根治术中保留肋间臂神经．29例未保留肋间臂神经。结果49例保留肋间臂神经的患者中，46例术后腋窝及上臂感觉良好．3例出现感觉障碍，但在短时间内恢复。未保留肋间臂神经的29例患者均出现不同程度的腋窝及上臂感觉障碍。经随访无1例出现局部复发。结论乳腺癌改良根治术中保留肋间臂神经可以预防术后腋窝及上臂感觉障碍的发生，不增加局部复发的风险，应成为乳腺癌改良根治手术的标准组成部分。     

NGF对小脑皮质细胞凋亡影响的实验研究

目的　探讨神经生长因子 (NGF)对小脑皮质神经细胞凋亡的影响 ,为临床治疗小脑变性疾病提供新的措施。方法　以原代培养的新生SD乳鼠小脑皮质细胞建立谷氨酸诱导的神经细胞凋亡模型。为观察NGF对受损细胞的保护作用 ,应用MTT法测定细胞的存活率和细胞代谢情况 ;利用光学显微镜技术观察细胞凋亡的形态学改变。结果　Glu (5 0 0 μmol/L)作用 5min可诱导小脑神经细胞凋亡。MTT法计数结果显示 ,NGF高剂量治疗组细胞存活率显著高于模型组 (P <0 0 1) ,光学显微镜观察发现受损细胞的形态学变化也得到明显改善。结论　外源性NGF能够减轻大鼠小脑皮质神经细胞凋亡。     

Fatal encephalitis in a patient with refractory celiac disease presenting with myorhythmia and carpal spasm.

We report the case of a woman with refractory celiac disease who developed abnormal spontaneous movements of the extremities and face consistent with myorhythmia. Investigation led to a diagnosis of encephalitis, confirmed by postmortem examination. The movements were likely caused by nonparaneoplastic encephalitis associated with refractory celiac disease. Etiologic and diagnostic considerations and treatment options are discussed.     

Sympathetic skin response in patients with myasthenia gravis★ A comparative analysis

BACKGROUND: The examination of sympathetic skin response is an important index for assessing the autonomic nerve function, and patients with myasthenia gravis are always accompanied by dysautonomia. Therefore, it will be important to know whether sympathetic skin response can be used as the index for the clinical evaluation of myasthenia gravis. OBJECTIVE: To investigate the diagnostic value of sympathetic skin response in the damage of autonomic nerve function of patients with myasthenia gravis. DESIGN: A case-controlled comparative observation. SETTING: Department of Neurology and Room of Nerve Electromyogram, the Affiliated Hospital of North Sichuan Medical College. PARTICIPANTS: Thirty outpatients or inpatients with myasthenia gravis were selected from the Department of Neurology, the Affiliated Hospital of North Sichuan Medical College from May 2006 to May 2007, including 9 males and 21 females, aged 8–72 years with a mean age of (28±5) years old. They were all accorded with the diagnostic standards of myasthenia gravis, accompanied by different severity of autonomic nerve symptoms, including poor skin nutrition, sweating of hands and feet, pyknocardia, persistent hypotension, abdominal pain, constipation, etc. They all had not taken any drug affecting the autonomic nerve function before the examination. Informed consents were obtained from all the patients. Meanwhile, 30 healthy physical examinees were enrolled as the normal control group, including 10 males and 20 females, aged 10–75 years with a mean age of (31±5) years old. Approval was obtained from the hospital ethic committee. METHODS: After admission, the patients were examined with sympathetic skin response using DANTEC keypoint 2.0 electromyography evoked potential apparatus (Danmark). The changes of the latency and wave amplitude of sympathetic skin response were observed. The subjects in the normal control group were examined with the same methods at physical examination. Abnormality was judged by the disappearance of wave form, latency longer than that in the normal control group by Mean±2.5SD, or wave amplitude lower than the average value in the normal control group by 50%. MAIN OUTCOME MEASURES: The results of the latency and wave amplitude of sympathetic skin response were compared between the patients with myasthenia gravis and normal controls. RESULTS: All the 30 patients with myasthenia gravis and 30 healthy physical examinees were involved in the final analysis of results. There were no significant differences between the left and right upper and lower limbs in both the myasthenia gravis group and normal control group (P > 0.05). In the myasthenia gravis group, the abnormal rate of sympathetic skin response was 37% (11/30), the latency was prolonged and the wave amplitude was decreased as compared with those in the normal control group, and there were significant differences (P < 0.01). CONCLUSION: Sympathetic skin response can be used as an electrophysiological index for judging the damages of autonomic nerve function in patients with myasthenia gravis.     

成年男性舌下神经在舌根部的定位研究

目的:探讨成年男性舌根部舌下神经解剖走行特点,指导临床舌根部射频温控减容术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)时针形电极刺入舌根部的部位及深度,以避免损伤舌下神经。方法:选择10具成年男性的舌标本,定型后在冰冻状态下作冠状切面,通过计算机图像处理与测量系统行舌下神经定位测量,并进行相关的统计学分析。结果:(1)两侧舌下神经呈对称性分布。(2)成年男性舌下神经舌内部分的主干(本实验为舌盲孔前后15mm范围内)其垂直向解剖走行基本恒定,距舌表面(22.21±2.22)mm;水平向走行中,舌盲孔后一般位于舌中内(近中线侧)(28.61±2.66)％处,舌肓孔前为(21.89±1.93)％处。结论:本实验为舌根部射频温控减容术治疗OSAHS提供了一个相对安全的范围:在不超过(22.21±2.22)mm深度且舌盲孔后避开中内(近中线侧)(28.61±2.66)％区域、舌盲孔前避开中(内近中线侧)(21.89±1.93)％区域,基本不会损伤舌下神经。     

医源性桡神经损伤46例分析

目的阐述医源性桡神经损伤的伤因、治疗和预防措施。方法分析1991年～2003年间收治的46例医源性桡神经损伤的病例。结果伤因分为上肢手术误伤，肱骨干和桡骨上端闭合性骨折复位手法不当，头静脉穿刺致桡神经浅支损伤。本组21例保守治疗，22例手术治疗，3例行肌腱转位功能重建。结论手术误伤是医源性桡神经损伤的首要原因；临床医生丰富的解剖知识和细致、轻柔的操作是预防医源性桡神经损伤的关键。