手术治疗周围神经缺血再灌注损伤的电生理研究

目的：探讨周围神经缺血再灌注损伤后不同时限外膜切开手术后电生理的变化。方法：对２４只兔随机分成对照组，即刻行神经外膜切开减压组、１周后神经松解和４周后神经松解组的电生理学观察。结果：神经传导的潜伏期，传导速度和肌肉动作电位波幅，各实验组均好于对照组（Ｐ＜０．０５），其中即刻行外膜切开减压组与对照组及４周后松解组比较差异有非常显著性（Ｐ＜０．０１）。结论：周围神经缺血与再灌注损伤后如能尽快或急诊行神经外膜切开减压，可取得较好疗效。     

Migration of the true pacemaker within the sinoatrial cell aggregate in man

The functional anatomy of the sinoatrial node (SAN) in man is first reviewed, together with its possible anatomical substructure. The true group pacemaker (PM) shift under autonomic drive is then related to a continuous competition between the intrinsic auto-firing period hierarchy and the autonomic topological susceptibility hierarchy. Accordingly, the PM ‘skip’ to both lower and higher periods following an abrupt and consistent acetylcholine (ACh) release at the SAN periphery, and the PM ‘slip’ towards a relocation of the next period, as a possible response to a slower and smaller ACh release, are considered. The PM ‘skip’ and ‘slip’ as boundaries of the true PM excursion within the SAN during the respiratory cycle, and their statistical properties, are then examined. Under current heart rate control menus in normals, the PM skip appears to follow central influence, whereas the conservative or slipping PMs suggest peripheral control. Finally, interpretation of the PM skip as a salutary sign of functional reserve is proposed, and a method of alleviating the PM skip which confounds electrophysiological testing of the SAN function in patients is devised.     

Chronic inflammatory demyelinating polyneuropathy in childhood: clinical and electrophysiological features

Five children with chronic progressive polyneuropathy but no familial history of it showed electrophysiological evidence of demyelination with partial conduction block, temporal dispersion, and focal slowing of nerve conduction velocities in multiple nerves. These findings are indicative of an acquired demyelinating polyneuropathy that is chronic and inflammatory and differentiate this condition from most of the inherited neuropathies. It is very important to recognize this entity because of the avaibility of various treatments.     

Tongue adaptation temperature influences lingual nerve responses to thermal and menthol stimulation

Menthol, a tangible substance present in many orally administered products, can produce a powerful influence on the perceived intensity of subsequent thermal stimulation in humans as well as the response magnitudes of thermally sensitive neurons in rats. However, there are no prior studies examining the influence of adaptation temperature on perceived intensity and/or response magnitudes of thermally sensitive neurons to subsequent menthol stimulation. We identified 32 thermally sensitive neurons that increased their discharge rate to a gradual temperature decrement beginning from 35°C and dropping to 10°C at 1°C. Based on their response threshold, time-to-peak, and range of sensitivity, these thermally sensitive lingual neurons were found to be divisible into two distinct groups. Group 1 neurons (n = 21) responded best to the upper cool range (34–15°C) of the temperature decrement, whereas Group 2 neurons (n = 11) responded to the lower cold range (32–10°C) of the temperature decrement. Our Group 1 and Group 2 neurons may be analogous to low threshold and high threshold cold receptors identified previously in primates. We also examined the responses of lingual neurons to 0%, 25%, 50% and 75% dilution's of a stock menthol concentration (1.28 mM) at 25 and 35°C adaptation temperatures. Menthol responses across all concentrations were far larger after adaptation to 35°C compared to 25°C. Furthermore, only during 35°C adaptation did responses to menthol stimulation persist during the ensuing 20 s after menthol off-set and water on-set. Although an effective coolant, the degree of perceived cooling due to menthol applied to lingual mucosa depends on the temperature of the vehicle and the surface to which it is applied.     

Surgical management for sciatic nerve injury

Objective:To summarize surgical treatments and their corresponding curative effects on sciatic nerve injuries.Methods:Surgical treatments on sciatic nerve injury were performed in 28 patients from January 1990 to July 2000.The treatments included neurolysis, neurolysis plus partial nerve anastomosis,nerve anastomosis and nerve transplantation.The curative effect was evaluated according to Sunderland criteria.Results:Of 28 cases, 22 patients were followed up with a follow-up period of 13 months to 5 years (average 30 months).Of 22 nerves, 7 were excellent ,5 good,7 fair and 3 poor ,with an excellence rate of 54.5%.Conclusions:The fair results of sciatic nerve injury are related to its structural character.Surgical exploration should be performed if nerve function does not recover 3 months after primary operation and if Tinel‘s sign and electromyogram show no signs of nerve regeneration.Electrophysiological monitoring in the operation is useful in electing surgical methods and predicting the results of nerve anastomosls .     

对比观察钼和硒对培养心肌细胞电生理特性的影响

钼(Mo)和硒(Se)都是人体必需微量元素,与某些心脏病、克山病病因及发病机制有关。但是,哪一个与上述疾病关系更密切说法不一。我们曾证明 Mo 和 Se 对培养心肌细胞生长发育和自发性收缩都有良好的促进作用,Se 比 Mo 更明显。为进一步验证这一结果,本实验利用细胞内微电极技术,对比观察二者对培养心肌细胞电生理特性的影响。其结果表明:Mo 和 Se对心肌细胞跨膜电位各项指标均有一定影响,其中具有统计学意义的是,动作电位时程延长;静息电位绝对值减小。这提示了,Mo 和 Se 可能与 Ca~(2+)、K~+通道的活性有关,对比之下,Se 比 Mo更明显。     

Die Myotomie im Therapiekonzept der Dickdarmdiverticulitis

Zusammenfassung In zwei getrennten Versuchsreihen wurde die Spontanaktivitdt (EMG und Tension) von frischpräparierten Längs- und Ringmuskelpräparaten Divertikelkranker untersucht und mit Muskelpräparaten von normalen entsprechenden Darmabschnitten verglichen. Anschliesßend wurden alle Muskelexplantate vergleichend histologisch aufgearbeitet. Ergebnisse: 1. Im elektromechanischen Spontanverhalten der Ringmuskulatur ergaben sich keine Unterschiede zwischen Normaldarm und Divertikelerkrankung. 2. Die Längsmuskulatur bei der Divertikulose und Diverticulitis wies erhebliche Unterschie de gegenüber normalen Taenienstreifen auf; insgesamt bot die Divertikelerkrankung das elektromanometrische Bild einer spastischen, kontrakten Taenie. 3. Die morphologischen Untersuchungen lieferten keine Erklärung für das unterschiedliche elektromanometrische Verhalten. Auffallend ist jedoch bei der Divertikelerkrankung eine konstant nachweisbare Bänderung der Längsmuskulatur —ein Befund, wie er häufig bei Uterusmyomen erhoben wird. Die Ergebnisse der Muskelfunktionsanalysen haben praktische Bedeutung für das chirurgische Therapiekonzept. Sie liegt in der Präventiv-Taenio-Myotomie im belassenen Restdarm - Colon descendens - nach erfolgter Resektion.

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On the role of myotomy in the treatment of diverticular disease

Summary Spontaneous motor action of fresly prepared circular and longitudinal muscle strips were examined in two separated trials. Bowel musculature of diverticular patients were compared with those of normal subjects. Finally all explantations were examined histologically. Results: 1. There was no difference in electrical activity and tension development regarding circular muscle strips of patients suffering from D. D. and those of normal subjects. 2. The longitudinal muscles show however significant differences in contrast to normal subjects; to sum up D. D. presents us a spastic and contracted taenia. 3. The histological investigations did not explain the different electromechanical results. There were however remarcable ribbons only in the longitudinal muscle of D. D. - known from myoma uteri. The results of the electrophysiological analysis have importance for our surgical concept in the treatment of peridiverticulitis. They justify the horizontal myotomy in the left, functionally disturbed colon descendens additional to the resection as an preventive procedure.

Mit Unterstützung der DFG Ly 6/4     

Childhood subacute inflammatory demyelinating polyneuropathy

Subacute inflammatory demyelinating polyneuropathy (SIDP) is an acquired immune-mediated peripheral polyneuropathy with clinical course between 4 weeks and 8 weeks. Rare childhood cases with SIDP had been described in the current literature. We report the first case of childhood SIDP in Taiwan with thorough clinical studies. All of the clinical presentations, laboratory data, electrophysiological studies, and image tools were compatible with childhood SIDP. Benign neurological recovery without relapse was correlated with electrophysiological evidence of demyelination predominantly.     

胆囊收缩素促大鼠坐骨神经再生的电生理检测及意义

目的:观察八肽胆囊收缩素(CCK-8)促大鼠坐骨神经损伤修复的效果。方法:24只健康SD大鼠随机分成实验组(CCK-8治疗组)和对照组(生理盐水治疗组)两组,每组12只,采用右侧坐骨神经离断后缝合外膜的损伤模型。CCK-8组大鼠腹腔注射CCK-8(8nmol/kg),每天一次,连续7d,对照组则用生理盐水代替CCK-8,在术后第12周检测大鼠坐骨神经干动作电位传导速度及肌电图。结果:实验组行为方面比对照组恢复早。术后第12周,两组大鼠坐骨神经干动作电位传导速度、肌电图潜伏期及波幅差异均有统计学意义(t分别为11.60、-8.83、4.51,P均<0.001),实验组的神经干动作电位传导速度快,肌电图潜伏期短、波幅值大,实验组恢复情况优于对照组。结论:CCK-8能有效地促进周围神经再生。     

糖尿病心肌病的电生理改变

糖尿病心肌病是特异性心肌病,其表现包括心肌肥大、左心室心功能不全、心室电生理重构、充血性心力衰竭。其中,心室电生理重构的病理生理基础是心肌代谢紊乱使氧化还原失平衡等,进而引起离子通道功能和表达异常。心肌细胞内钙稳态失调和心功能不全是糖尿病心肌病的特征,其原因是心脏多种离子通道、交换体及离子泵的功能和表达异常。