An extremely unusual presentation of varicella zoster viral infection of cranial nerves mimicking Garcin syndrome

We report a patient with the varicella zoster viral (VZV) infection of multiple cranial nerves mimicking Garcin syndrome, who initially presented with Ramsay Hunt syndrome (herpes zoster oticus). A 78-year-old man showed left facial palsy with zosteric eruptions in his left auricle and dysphagia, followed by left total ophthalmoplegia. His serum anti-VZV antibody titer was elevated. Cerebrospinal fluid examination revealed pleocytosis with a slightly elevated protein level. He was treated with intravenous acyclovir and corticosteroids. His tongue weakness resolved, and then ocular movement improved. The improvement of facial palsy and swallowing difficulty was delayed. VZV infection should be considered even in patients who show unilateral multiple cranial neuropathy mimicking Garcin syndrome because it is treatable.     

Clinical studies of the movement-related cortical potential (MP) and the relationship between the dentatorubrothalamic pathway and readiness potential (RP)

Summary In order to investigate the influence of basal ganglia and cerebellar involvement on the preparatory state of the cerebral cortex for voluntary movement, the cortical potential preceding finger movement was studied in 20 patients with Parkinson's disease and 20 patients with cerebellar ataxia. Readiness potential (RP) was abnormal in 90% of the Parkinson group and in 55% of the cerebellar ataxia group. The most frequent abnormality was a depressed amplitude and earlier onset of RP in both groups. The most remarkable finding in the present study was the complete absence of RP with dyssynergia cerebellaris myoclonica (presumed Ramsay Hunt syndrome) whereas normal RP was obtained with cerebellar cortical degeneration. In addition, RP was absent or severely depressed in patients with a unilateral vascular lesion of the midbrain (Benedikt's syndrome) and in patients with Parkinson's disease who underwent unilateral intermedioventral (Vim) thalamotomy. These facts suggest a possible important role of the dentatorubro-thalamic or dentatothalamic pathway in the physiogenesis of RP.A part of this paper was presented at the 11th World Congress of Neurology on September 14, 1977 in Amsterdam     

右美托咪啶用于清醒气管插管时镇静比较

目的：评价右美托咪啶和芬太尼用于患者清醒气管插管时的镇静效果。方法：本研究选取60例择期骨科手术的老年患者,随机分成两组：研究组患者给予1 μg/kg右美托咪啶,对照组患者给予1 μg/kg芬太尼。气管插管前对气管黏膜和喉部实施局部麻醉。以呛咳程度评分和插管后耐受程度评分来评价插管条件,记录并比较两组患者的血流动力学、Ramsay镇静评分（RSS）、呼吸频率、低氧例数等情况。术后24 h随访对声音嘶哑和咽喉疼痛等进行评估。结果：与对照组相比,研究组患者的呛咳程度评分显著降低,Ramsay镇静评分明显增加,平均动脉压明显降低,发生低氧的患者例数明显减少（P＜0.05）。两组患者术后声音嘶哑和咽喉疼痛差异无统计学意义。结论：与芬太尼相比,右美托咪啶能在稳定血流动力学的情况下,为老年患者的清醒气管插管提供足够的镇静效果。     

脑电双频指数反馈控制下的异丙酚闭环靶控输注在ICU镇静中的应用价值

目的探讨脑电双频指数（BIS）反馈控制下的闭环靶控镇静（CLTC）I技术应用于ICU机械通气患者镇静治疗的可行性和应用价值.方法接受机械通气治疗的30例患者,随机分为3组,Ⅰ组使用微量泵连续输注异丙酚进行镇静,Ⅱ组使用靶控输注（TC）I异丙酚进行镇静;Ⅲ组使用闭环靶控输注异丙酚进行镇静,闭环靶控的目标BIS值设定为80～70,记录平均动脉压（MAP）、心率（HR）、BIS值、Ramsay评分情况和三组24h异丙酚平均使用量.结果镇静治疗开始后,三组平均动脉压与基础值比较均有下降（P〈0.05）,三组MAP下降幅度无明显差异（P〉0.05）,三组患者心率与基础值比较变化不明显（P〉0.05）;各组BIS值和Ramsay评分具有较好的相关性;Ⅲ组维持理想镇静时间百分比与其它组比较有明显差异（P〈0.05）;Ⅲ组达到60～80范围BIS值时间百分比与其它组比较有明显差异（P〈0.05）;Ⅲ组24 h异丙酚平均用量明显少于其它组（P〈0.05）.结论CLTCI与TCI和恒速输注方法比较,是更为理想的镇静方法,CLTCI能够在提供较为理想的镇静效果同时保持患者血液动力学的相对稳定,有效减少镇静不足或过度镇静的发生,并减少镇静药物的使用量.     

BIS监测联合Ramsay镇静评分在预防ICU患者非计划性气管拔管中的应用

目的 探讨脑电双频指数(BIS)监测联合Ramsay镇静评分在预防ICU患者非计划性气管拔管中的应用价值.方法 选择93例神志清醒的气管插管患者作为研究对象,采用随机数字法将患者分为实验组47例与对照组46例,实验组采用BIS监测联合Ramsay镇静评分进行镇静管理,对照组采用Ramsay镇静评分进行镇静管理,对2组患者气管插管期间非计划性拔管发生率进行比较.结果 实验组非计划性拔管发生率显著低于对照组.结论 BIS监测联合Ramsay镇静评分比单纯Ramsay镇静评分法更适合于气管插管患者的镇静管理.     

星状神经节阻滞联合枝川注射法治疗拉姆齐·亨特综合征的效果

目的 观察星状神经节阻滞联合枝川注射法治疗拉姆齐＆#183;亨特综合征（Ramsay Hunt syndrome,RHS）的疗效.方法拉姆齐＆#183;亨特综合征患者12例,以星状神经节阻滞和枝川注射法治疗,辅以抗病毒药、营养神经药和对症治疗.观察患者治疗前,治疗后7d、15 d、1个月时VAS评分及治疗后1、3个月时面瘫和听力恢复情况.结果 所有患者治疗后各测量时点VAS均下降（P＜0.05）;与治疗前比较,治疗后各评估时点面肌、听力恢复情况均明显改善（P＜0.05）.结论 星状神经节阻滞联合枝川注射治疗拉姆齐＆#183;亨特综合征是一种有效的方法.     

七氟烷吸入麻醉在小儿心脏彩色多普勒超声检查中最佳浓度研究

目的 探讨七氟烷吸入麻醉应用于小儿心脏彩色多普勒超声检查时的最佳维持浓度.方法 35天～3岁患儿120例,排除严重紫绀型先天性心脏病及严重肺炎患儿,按美国医师学会（ASA）分级Ⅰ～Ⅱ级,所有患儿均在七氟烷吸入麻醉下行心脏彩色多普勒超声检查.按照七氟烷吸入浓度分为1.0％、1.5％、2.0％、2.5％4个浓度组,每组30例.记录各组诱导时间、检查时间、苏醒时间,监测患儿血压、心率、呼吸和脉搏氧饱和度的变化.同时记录各组患儿麻醉镇静过程中Ramsay评分情况以及无法完成检查的例数.结果 1.0％七氟烷吸入浓度维持麻醉时,患儿Ramsay评分较低,与其他各组比较P＜0.05,检查过程中有8例患儿无法配合.当七氟烷吸入浓度增加时,Ramsay评分也增加.当七氟烷吸入浓度达到1.5％时,患儿能安静入睡,检查过程中无躁动现象,血压平稳.七氟烷吸入浓度增加至2.5％时,患儿Ramsay评分没有继续增加,但苏醒时间明显延长（P＜0.05）.各组患儿血压、心率呼吸和脉搏氧饱和度无明显异常变化.结论 在保证安全及有效的情况下,七氟烷吸入麻醉用于35天～3岁小儿心脏彩色多普勒超声检查时的最佳浓度为1.5％～2.0％.     

Patient-oriented optimal depth of conscious sedation using midazolam during flexible bronchoscopy: A prospective open-labeled single-arm trial

Background

The British Thoracic Society guidelines for diagnostic flexible bronchoscopy (FB) in adults recommend that intravenous sedation should be offered to patients undergoing bronchoscopy. However, it is difficult to determine the adequate depth of sedation for each patient because of inter-individual variability.