胆红素脑病仔鼠血清S-100蛋白水平及其脑组织蛋白表达的动态变化

目的探讨胆红素脑病血清S-100蛋白(S-100)水平的变化及其意义。方法7日龄Wistar大鼠腹腔注射胆红素200 mg/kg,制备胆红素脑病动物模型。应用酶联免疫法动态观察胆红素脑病仔鼠血清S-100水平及免疫组织化学的方法动态观察胆红素脑病仔鼠不同时间点脑组织S-100蛋白水平。结果与对照组比较,造模后12 h仔鼠血清S-100水平升高(P<0.001),24 h达峰值,至72 h仍高于对照组,96 h降至正常组水平;造模后仔鼠不同时间点脑组织S-100蛋白的表达阳性面积的变化随时间变化逐渐增加。结论S-100可反映胆红素脑病仔鼠神经胶质的损伤程度,是判定胆红素脑病的可靠指标。     

碘标记神经生长因子在缺氧新生鼠脑内的吸收

目的观察碘标记神经生长因子(125I-NGF)在缺氧新生鼠脑内的吸收情况。方法选取32只7日龄健康新生鼠随机分成实验组(125I-NGF组和125I组)及正常组(125I-NGF组和125I组),实验组制成缺氧缺血性脑损伤(HIBD)模型。分别予125I-NGF和单纯125I腹腔注射后30 min处死取脑,按如下解剖分出基底前脑、额皮质、海马、丘脑下区、小脑、嗅球、垂体,对标本进行放射性测量。结果两125I NGF组于基底前脑、小脑、额皮质、海马、嗅球均有显著吸收,且NGF在缺氧鼠额皮质、海马、小脑吸收显著高于NGF在正常新生鼠以上部位。结论外源性NGF可透过新生鼠血-脑脊液屏障,早期应用治疗HIE是可行的。     

前臂内侧神经血管复合体岛状筋膜皮瓣的应用解剖

目的为前臂内侧神经血管复合体岛状筋膜皮瓣的应用提供解剖学基础。方法上肢标本18侧,显微剥离表皮组织,观察前臂内侧皮神经、贵要静脉及各自营养血管的起始、走行、分支、分布及与其它血管的吻合情况;新鲜整尸标本5具,动脉灌注显影剂,剥离体被组织于X光下摄影,分析皮动脉的分布及其与毗邻血管的关系。结果前臂内侧皮神经前支与贵要静脉伴行,两者周围分布着外径大于0.5 mm的营养动脉,平均3.4支,它们分别来自尺侧下副动脉、尺侧返动脉和尺动脉,营养动脉彼此吻合,形成动脉血管链。其中第一支位于肘横纹上21.25±6.33 mm,血管外径1.03±0.24 mm。结论可以在前臂内侧部切取神经血管复合体岛状筋膜皮瓣,供临床使用。     

胰头后面神经分布的应用解剖学研究

目的：观察胰头后面的神经分布，探讨胰头癌沿神经浸润转移的解剖学基础，为临床上清除由于胰头癌神经浸润转移所致的残留癌以及胰源性疼痛止痛术等提供相关的应用解剖学资料。方法：运用大体解剖学方法观测了30具成人尸体胰头后面神经分支的来源和分布特征。结果：（1）胰头后面的神经分支主要来源于右腹腔神经节（27例）、腹腔丛右侧半（20例）和肝丛（16例），少数发自肠系膜上丛（14例）。（2）胰头后面神经分布形式以成丛型．即“胰头丛”占多数（24例），仅有6例为不成丛型。（3）“胰共丛”的位置较恒定，肾贴于胰头后面，邻接下腔静脉和左肾静脉的末段。胰头后面神经分支进入胰头后面腺体的部位以右上、下象限为主（分别有21例和26例），其次为左下象限（14例），而左上象限最少（3例）。结论：胰头后面的神经分布丰富，其来源和分布具有一定的规律性和特点，为胰头癌神经浸润转移和术后局部肿瘤复发提供了可能，也是导致中、晚期胰腺癌剧烈疼痛的形态学基础。     

全直肠系膜切除术治疗中下段直肠癌

目的:探讨全直肠系膜切除术治疗中下段直肠癌的临床疗效。方法:回顾性分析采用保留植物神经的全直肠系膜切除术治疗86例中下段直肠癌的临床资料。结果:全组无手术死亡,平均手术时间为126±42min,术中失血平均235.30±189.50ml,发生吻合口瘘2例(2.33%)。术后拔尿管时间3~14d,平均6.23d。术后4周随访,保肛组67例中51例(76.1%)控便能力良好,术后勃起功能障碍发生率24.1%(14/58),射精功能障碍发生率为27.6%(16/58)。随访时间6个月~9年,平均46个月。发生局部复发2例(2.33%)。术后3、5年生存率分别为81.4%和63.2%。结论:全直肠系膜切除术是预防中低位直肠癌的局部复发,提高生活质量的有效措施。直肠癌根治性手术中采用TME手术方法是完全必要的。     

Characteristics of facial nerve palsy during childhood in Japan: frequency of varicella–zoster virus association

BACKGROUND: The aim of this study was to clarify the clinical characteristics of facial nerve palsy and the frequency of varicella-zoster virus association in Japanese children, retrospectively. METHODS: The subjects were 30 facial nerve palsy patients less than 15 years old, treated in the Department of Pediatrics, Kawasaki Medical School Hospital, Okayama, Japan, during the last 10 years. RESULTS: The male/female and right/left ratios were 16/14 and 16/13, respectively. The patients included 21 cases (70%) of Bell's palsy, four cases (13%) due to otitis media, three cases (10%) of Ramsay Hunt syndrome and two cases (7%) due to birth trauma. There were six cases of zoster sine herpete among the Bell's palsy cases. CONCLUSION: Varicella-zoster virus-associated facial palsy was found in nine (36%) of the 25 patients examined. Zoster sine herpete was more frequently encountered in children than adults. Ramsay Hunt syndrome was found in school-age children and zoster sine herpete was often found in preschool children. The period of recovery was fast for facial nerve palsy due to acute otitis media, which occurred within 23 months of age, after myringotomy and administration of antibiotics.     

针刺益气养阴活血法治疗糖尿病周围神经病变机制的实验研究

目的:探讨针刺对糖尿病大鼠周围神经病变的治疗作用和机制。方法:对链脲佐菌素(STZ)诱导的糖尿病大鼠取穴脾俞、肾俞、三阴交、足三里,隔日针刺1次,每次30 min,针刺治疗8周后测定大鼠感觉神经传导速度(SNCV)、热痛域,坐骨神经能够内山梨醇、一氧化氮(NO)和Na -K -ATPase活性。结果:糖尿病大鼠SNCV明显减慢,热痛域值明显升高;坐骨神经内山梨醇升高、NO降低,Na -K -ATPase活性降低,与正常组比较差异显著(P<0.05或0.01)。针刺治疗可使上述改变减轻,与糖尿病模型组比较差异显著(P<0.05或0.01)。结论:针刺治疗通过降低实验性糖尿病大鼠坐骨神经内山梨醇含量,防止NO降低和Na -K -ATPase活性下降,可有效恢复其神经传导速度、热痛域等神经障碍,为治疗DPN的有效方法。     

电针、直流点送、运动疗法综合治疗对周围神经损伤后功能恢复的影响

目的探讨电针、直流点送、运动疗法综合治疗对周围神经损伤后功能障碍恢复的影响，以选择最佳治疗方案。方法将52例周围神经损伤的病例。随机分为电针、直流点送、运动疗法综合综合组（治疗组）和单纯运动疗法组（对照组）。结果治疗后1个月进行疗效评定。经过治疗，治疗组明显优于对照组，两组差异有显著性（P〈0．01）。结论采用电针、直流点送、运动疗法综合治疗周围神经损伤后功能障碍可以明显提高疗效，缩短病程，促进运动和感觉功能的恢复。     

经皮穴位电刺激对粘连期肩关节周围炎的治疗作用

目的观察经皮穴位电刺激对粘连期肩周炎的治疗作用及与电针治疗的效应异同。方法采用规范化、标准化的诊断和疗效评价标准,明确和固定各治疗参数,以肩部疼痛和肩关节活动为观察指标,194例粘连期肩关节周围炎患者分别进行经皮穴位电刺激和电针治疗。结果经皮穴位电刺激对粘连期肩周炎的总有效率达到96·9%,电针刺激对粘连期肩周炎的总有效率达到97·9%,2组比较无明显差异;经皮穴位电刺激疗法不仅能有效止痛,对粘连期的肩关节活动障碍也有明显的改善作用。结论经皮穴位电刺激为治疗肩周炎有效、简便的疗法。     

Stretch of mammalian nerve in vitro: effect on compound action potentials

Stretch of nerve has been reported to decrease the amplitude of the compound action potential (CAP) with a complete block appearing in approximately 30 minutes. But for the most part, those experiments were carried out in vivo, and it is generally accepted that the failure of responses was due to a closure of vessels supplying the nerve with a resulting ischemia and anoxia. These studies were undertaken to determine if stretch of nerve has effects that are independent of interference with its vascular supply. In the studies, lengths of rat sciatic and dog peroneal nerves were removed and placed in a chamber supplied with oxygen in which their CAPs were continuously elicited and recorded. This in vitro preparation obviated interference with the nerve's metabolism on stretching. We have previously shown that the form change termed 'beading,' appearing within 10 seconds and reversing as quickly on relaxation, can be elicited with tensions of only several grams. We wished to determine if stretch adequate to produce beading could alter CAPs with the same rapidity. Tensions below 2 g had little effect. On applying tensions of 10-100 g, levels well above those needed to bead the fibers, both increases and decreases of CAP amplitude were seen. The changes occurred within 10 seconds of stretch application, the time at which beading arises with stretch. Although the decreases of CAP amplitudes could be accounted for by beading, the degree of CAP change did not correspond to the amount of tension applied. We hypothesize that the constrictions in the beaded fibers increase axial resistivity and diminish local currents so as to block conduction. The lack of an increasing degree of decreased CAP amplitude with increases in tension is ascribed to the inhibition of elongation offered by the collagen fibrils present in nerve. Collagenase applied to nerves allowed a further increase in length, producing a 'hyperbeading,' showing much longer lengths of beading constrictions on stretch. This would further increase axial resistance and is taken to account for the greater decreases of CAP amplitudes seen following collagenase treatment. To account for those cases where increases of CAP amplitude were seen on stretch, we hypothesize that stretch can also cause an increase in the excitability of the nodes. The outcome of stretch in any given nerve would be the resultant of two opposing actions; beading of the internodes causes a decrease of local currents leading to block of CAPs, while an increased excitability of the nodes acts to augment the responses.