环枕畸形神经源性吞咽困难的临床研究

本文报道我院１９７５～１９９２年间收治的８４例环枕畸形病例，其中２８例表现有神经源性吞咽困难。这些病人在出现吞咽困难症状前均有正常吞咽功能。病人的吞咽困难呈进行性发展，严重者合并咽喉区功能障碍、鼻咽部反流和气管内吸入。除１例外，均行颅后窝减压以及环椎后弓和Ｃ２，３椎板切除术。术后２例因中枢性呼吸衰竭和吸入性肺炎死亡。２１例行追踪观察（随防期６个月～１１年，平均３．２年），１６例（７６．２％）症状消失或改善。作者讨论了本病的病机与诊治方法，并指出早期认识本征象并采取手术治疗，对促进神经功能恢复具有重要意义。     

The influence of posture upon cardiovascular dynamics throughout pregnancy

Systemic blood pressure (measured with a zero-randomized sphyngmomanometer), stroke volume and heart-rate (measured with a Minnesota Impedance Cardiograph), hematocrit and their derivatives — cardiac output, pulse pressure, mean arterial blood pressure and peripheral vascular resistance, were assessed in 19 nonpregnant women of child-bearing age and in 27 patients who were examined at regular intervals on 12 to 15 occasions from 8 to 11 wk of pregnancy until 6-wk postpartum. Readings were made with the subjects in each of six positions: supine, reclining, left and right lateral, left and right tilt. The purpose of this paper is to compare the results of these different postures.Systolic and diastolic blood pressure readings were lowest in the left lateral and second lowest in the left tilt. We suggest that this reflects a hydrostatic pressure difference. Stroke volume and cardiac output were lowest in the right lateral and second lowest in the right tilt. Thus, the derived values of peripheral resistance were lowest when subjects were turned towards the left and highest when turned towards the right.The rank orders of values were maintained with impressive consistency between subjects (pregnant and nonpregnant) and throughout pregnancy, reaching levels of statistical significance in almost all instances. No evidence was found that aortocaval compression led to a change in the measured attributes of central cardiovascular dynamics. For the ‘normal unembarrassed parturient’ it is suggested that aortocaval compression is rapidly succeeded by a restabilization of these attributes to their previous levels, reflecting the prompt establishment of a suitably diminished circulating blood volume within a reduced vascular capacity. It is nevertheless likely that aortocaval compression will interfere markedly with uteroplacental vascular dynamics and hence pose a hazard to the fetus.     

Effects of body posture on local sweating and sudomotor outflow as estimated using sweat expulsion

To estimate the effects of changes in body posture on sudomotor function, sweat rates on the forearm, chest and thigh, tympanic temperature (Tty), and skin temperatures were recorded in an upright sitting and a supine position under a hot environment of 40 degrees C Ta and 40% relative humidity for 60 min. Sweat expulsions were identified on sweat rate curves and their rates (Fsw) were calculated. Tty was higher, and its initial fall was greater, in the supine position than in the sitting position. On the forearm and the chest, the regression line relating sweat rate to mean body temperature (Tmb) had a gentler slope in the supine position, whereas on the thigh, it showed a steeper slope. The regression line relating Fsw to Tmb had a steeper slope in the supine position than in the sitting position, suggesting that the gain in the mechanisms for central integration and rhythm-generation was enhanced in the supine position. The parameter of sweat rate divided by Fsw was lower on the forearm and the chest, whereas it was higher on the thigh in the supine position than in the sitting position, suggesting that sudomotor outflow was modified at the spinal cord in association with skin pressure. It was concluded that body posture affects sudomotor functions through both brain and spinal mechanisms.     

Maintenance of equilibrium during tracing eye movements

Horizontal tracing movements of eyes modify the type of vertical posture maintenance decreasing the role of the lower segment in the regulation of the position of the pressure center. The relationship between fluctuations of the pressure center in the frontal and sagittal planes increases. Periodicity of eye movements corresponds to fluctuations of the pressure center and these signals were phase shifted relatively to each other. Translated fromByulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 138, No. 8, pp. 152–158, August, 2004 The study was supported by the Russian Foundation for Basic Research (grant No. 01-04-49489).     

Maintenance of Equilibrium during Tracing Eye Movements

Horizontal tracing movements of eyes modify the type of vertical posture maintenance decreasing the role of the lower segment in the regulation of the position of the pressure center. The relationship between fluctuations of the pressure center in the frontal and sagittal planes increases. Periodicity of eye movements corresponds to fluctuations of the pressure center and these signals were phase shifted relatively to each other.     

Diaphragmatic motion in the sitting and supine positions: Healthy subject study using a vertically open magnetic resonance system

PURPOSE: To determine the postural difference of diaphragmatic motion between the sitting and supine positions. MATERIALS AND METHODS: A total of 10 healthy men were examined using a vertically open 0.5-T magnetic resonance (MR) system. A total of 40 sequential MR images were obtained in both the sitting and supine positions during two to five respiratory cycles. The diaphragmatic excursions (DEs) were measured on three diaphragmatic points of six sagittal planes for both positions. The differences in DEs between the anterior and posterior parts of the diaphragm were also determined. RESULTS: DEs in the supine position were significantly greater than those in the sitting position at 15 of the 18 points. In five of the six sagittal planes, the difference of DE between posterior and anterior points was significantly larger in the supine position than in the sitting position. CONCLUSION: Diaphragmatic movement in the supine position is greater than that in the sitting position, especially in the posterior part of the diaphragm.     

舌下神经鞘瘤的诊断和治疗

目的提高舌下神经鞘瘤的诊治水平。方法回顾性分析10例舌下神经鞘瘤患者的临床表现、影像学特征、诊断、治疗和随访情况,并对我科早期5例和近期5例舌下神经鞘瘤的治疗方案及结果进行比较。结果10例患者均有患侧舌肌萎缩表现,颅底CT薄层扫描可以显示骨性舌下神经管,但肿瘤较小时不一定能判定肿瘤的存在,MRI是最佳的诊断措施。早期5例均为哑铃型肿瘤,其中2例采用分期手术分别切除肿瘤的颅内部分和颅外部分,3例经远外侧入路切除肿瘤：1例经髁入路,2例经髁上入路;肿瘤全切除1例,次全切除4例;术后1例并发脑脊液漏,颅内感染;Kamofsky预后评分：良4例,死亡1例。近期5例,其中4例(2例哑铃型,1例颅内型和1例管内型)经改良远外侧入路切除肿瘤：经枕髁入路1例,经髁上入路3例;1例颅外型肿瘤2次经颈入路切除肿瘤：首次手术大部切除肿瘤,肿瘤残余部分行伽马刀治疗无效后在导航及内窥镜辅助下再次手术全切除肿瘤;肿瘤全切除4例,次全切除1例;术后无并发症发生;失访1例,其余4例Kamofsky预后评分：优3例,中1例。近期5例疗效优于早期5例。结论舌下神经鞘瘤罕见,手术难度大。根据肿瘤部位和大小设计手术方式,尽可能一期全切肿瘤,减少侵袭性操作对提高治疗效果非常重要。     

坐位及仰卧位人眼屈光状态的改变

目的 探讨在坐位及仰卧位人眼球镜度数及散光轴向的改变.设计 前瞻性病例系列.研究对象 拟行LASIK手术的近视患者52例(96眼),屈光度-2.50D～-10.00 D,散光-0.75D～-4.50 D.方法 对所有患者用手持自动验光仪分别测量坐位及仰卧位时的球镜度数、柱镜度数及其轴向,并对坐位及仰卧位球镜度数、柱镜度数及散光轴向的改变进行统计学分析.主要指标 球镜、柱镜度数及散光轴.结果 仰卧位球镜度数(-5.31±3.43)D与坐位球镜度数(-5.27±3.24)D相比略增高,但差异无统计学意义(P=0.25).散光度数坐位平均(-2.27±1.24)D,仰卧位平均(-2.35±1.19)D,差异无统计学意义(P=0.20).眼球散光轴向改变在-16°～ 18°之间,其中0°～2°者52.1%,6°～10°者5.2%,>10°者3.1%.散光轴向右眼在旋转方向上更倾向于逆时针旋转,而左眼更倾向于顺时针旋转.结论 患者坐位及仰卧位眼球的球镜和柱镜度数无明显变化,但眼球旋转引起的散光轴向改变,可能是影响某些患者LASIK术后效果的主要原因之一.     

Trunk Kinematics and Centre of Pressure Displacement during Lateral Lifting and Lowering

Introduction Severalstudieshaveidentifiedlateralbendingofthetrunk asahighinjuryfactorforlowerbackdisorders(Marraset al.,1993;Punnetetal.,1991Andersson,1981).Moreover,theriskoflow-backpainfurtherincreases whentrunkmovementsinotherdirectionsarecoupled withlateraltrunkloading(HaasandNyiendo,1992).Comparedtoawkwardstaticpositions,wherethetrunkis twisted,dynamicloadingofthetrunk,suchasoccurs duringlifting,isbelievedtosignificantlyincreasetherisk ofinjurytothelowerback(Bigosetal.,1986).Inapreviou…     

儿童头位正常与颅面结构的相关性研究

 目的研究正常ND03F儿童头位与颅面结构的相关性。方法选取33例正常ND03F儿童拍摄自然头位时的头颅侧位片,对其颅面结构、颈椎姿势及头位进行分析。结果正常ND03F儿童的SN-VEL、SN-OPT、SN-CVT与SNA、SNB、SND、SNPo存在显著负相关,与SN-GoGn、SN-PP、SN-OP、NSGn等变量存在显著正相关。结论正常ND03F儿童头位变量与一些颅面结构变量间存在显著的相关关系,尤其是与代表面部生长趋势和下颌骨生长方向的若干变量显著相关。