高压氧在治疗脊髓损伤伴截瘫及肢体慢性溃疡中的应用

本文报告了用高压氧治疗脊髓损伤伴截瘫患者１２例，肢体慢性溃疡８例。将患者置于２个大气压的单人氧舱内，每次９０ｍｉｎ。前者疗程为１周，每日２次。后者疗程为２周，每日１次。治疗结果：脊髓损伤伴截瘫患者中８例有明显而有意义的功能恢复，占６６．６％。慢性溃疡患者中有３例愈合，４例好转，有效率为８５％。作者认为：早期使用高压氧是治疗急性截瘫，尤其是不完全性截瘫的一种安全有效的方法。高压氧治疗可加速慢性溃疡创面的愈合，但不能取代溃疡面的局部处理。     

REM sleep behavior disorder and vocal cord paralysis in Machado-Joseph disease.

We evaluated the occurrence of REM sleep behaviour disorder (RBD) and vocal cord abductor paralysis (VCAP) in a group of 9 Machado-Joseph disease (MJD) patients. RBD was diagnosed by clinical history plus audiovisual polysomnography in 4 men and 1 woman (55%). While dreaming, 4 fell out of the bed and the other injured his arms. Laryngoscopy detected bilateral VCAP in 1 patient with stridor who required emergency tracheotomy, and partial vocal cord abductor restriction in 2. RBD and VCAP are two potentially injurious conditions that should be considered part of the clinical spectrum of MJD.     

恒猴精索内注射长效局麻药后对睾丸和附睾的影响

在13只恒河猴精索内注射长效局麻药后,睾丸发生明显变化;而且给药剂量不同,睾丸曲精小管改变的程度和恢复正常的时间亦不同。睾丸间质细胞无明显变化;睾酮分泌不减少,无毒性反应。对临床男性节育应用及生殖生理研究均具有意义。     

Radiologic features compared to clinical findings in a prospective study of 153 patients with metastatic spinal cord compression treated by radiotherapy

Summary Plain radiography, myelography and post-myelographic CT-scan are described and related to clinical findings in a prospective study of 153 consecutive patients with myelographic signs of spinal cord compression. The majority of the metastatic tumours arise in the vertebral body or the pedicles. In 80% of the patients with total blockage to the contrast medium on myelography the post-myelographic-CT showed passage of the contrast medium. Ambulatory function at time of diagnosis was correlated to the degree and the localization of the epidural block. In 64 patients who underwent a second myelography, the post-treatment findings of sensory function were correlated to radiological regression.     

经椎弓根减压固定和植重组异体骨治疗脊柱脊髓损伤

目的 :探讨严重脊柱脊髓损伤经一侧椎弓根和椎体后缘复位减压 ,经椎弓根植重组异体骨和椎弓根钉固定的可行性及效果。方法 :经一侧椎弓根和椎体后缘复位或截骨减压 ,用特制环锯套管经椎弓根植重组异体骨 ,以X线片和CT片分类分型 ,评估手术前后骨折复位减压和植重组异体骨融合效果 ;按Frank分类标准评估脊髓损伤和恢复程度。结果 :除A级病人外 ,其他病人脊髓神经功能均进步 1～ 2级 ,无感染和断钉病人 ,脊柱后凸角度矫正后再丢失平均 3° ;部分病人术后早期对重组异体骨有反应 ,但几周后可消失。结论 :经一侧椎弓根椎体后缘复位或截骨减压 ,同样可达到较理想脊髓减压效果 ,经椎弓根植重组异体骨和椎弓根钉固定简单、安全、有效。     

大剂量甲基强的松龙冲击治疗急性脊髓损伤疗效分析

目的研究大剂量甲基强的松龙(MP)治疗急性脊髓损伤的临床效果.方法对87例急性脊髓损伤患者进行回顾性研究,根据伤后时间并按自愿选择用药原则分为应用MP治疗组(MP组,45例)和未应用MP治疗组(对照组,42例),以ASIA分级标准进行分级,并比较疗效和并发症.结果两组患者在治疗前后感觉及运动功能均有明显改善(P＜0.05).但MP组的感觉及运动功能恢复均优于对照组(P＜0.05).MP治疗组中24h治疗组(A组)与48h治疗组(B组)并发症发生率比较无显著性差异(P＞0.05),而MP组与对照组比较并发症的发生率明显增加,有显著性差异(P＜0.05).结论早期应用MP大剂量冲击治疗急性脊髓损伤是一项有效措施,但会显著增加患者治疗中并发症的发生率.     

脐静脉灌注提高分离人胎肝细胞纯度

应用脐静脉灌注冲洗人胎儿肝脏,胰蛋白酶消化后经光镜及扫描电镜观察,证实可获得纯度为90%以上的肝实质细胞,培养上清液可测出胎甲蛋白活性,证明胎肝细胞具有生物学活性,为应用人肝细胞培养进行生理生化及药理方面的实验研究,提供一种新的获取人肝细胞的方法.     

Esophagus atresia after cervical spine surgery: case report and literature review

We report on a case of esophageal atresia following cervical spine surgery. A swallowing examination was performed using fibre-optic endoscopy and videofluoroscopy. There was scar tissue fixation of the larynx and esophagus to the cervical spine. Operative mobilization of the larynx and esophagus and formation of a sliding layer using a platysma-fascia flap was done. The PEG and tracheal cannula were removed; oral nutrition was initiated after 3 months. Swallowing disorders following operations on the upper cervical spine should be investigated. Careful preparation that preserves the layers should be carried out. Fixation of tissues as a result of scarring should be treated with a sliding layer.     

胎儿脐带缠绕253例分析

目的　探讨胎儿脐带缠绕的临床意义及处理。方法　分析 2 5 3例有脐带缠绕的孕妇的脐带长度、剖宫产率、脐动脉血流S/D的值及对围产儿的影响 ,并与 2 6 9例无脐带缠绕者作比较。结果　 2 5 3例脐带缠绕组中脐带过长者明显高于无脐带缠绕组 (P <0 .0 1)。因脐带缠绕组中脐动脉血流S/D值≥ 3.0的百分率、胎儿宫内窘迫的发生率及新生儿窒息率明显高于对照组 (P <0 .0 1) ,故临床剖宫产率也高于对照组。结论　脐带缠绕可对围产儿造成不良影响 ,临床应提高孕期监测、产程监护 ,从而减少对围产儿的影响 ,降低不必要的剖宫产     

辣椒素对慢性脊髓损伤大鼠排尿功能的影响

目的：明确辣椒素对正常大鼠和慢性脊髓损伤(SCI)大鼠排尿功能的影响和作用的可能机制。方法：建立SCI的动物模型，实验大鼠和正常大鼠分别全身给药或膀胱内灌注辣椒素，记录膀胱内压力变化图(CMG)和尿道外括约肌肌电图(EUS-EMG)的改变。结果：正常大鼠辣椒素全身用药后出现非排尿性膀胱收缩，排尿效率下降，但排尿压不受影响。膀胱内灌注辣椒素亦会导致排尿效率降低而不影响排尿压。SCI大鼠全身用药后非排尿性膀胱收缩消失，残余尿量减少，排尿压下降，但排尿效率提高，膀胱内用药则可完全阻断排尿反射。结论：对辣椒素敏感的膀胱感觉传入神经参与正常大鼠和SCI大鼠的排尿反射。对正常大鼠起稳定膀胱逼尿肌的作用，而对SCI大鼠则是引起膀胱灌注时非排尿性收缩的原因，因此，阻滞感觉传入神经纤维是治疗SCI后膀胱高反射的有效方法。