Treatment of fecal incontinence by temporary sacral nerve stimulation

Summary BACKGROUND: Sacral nerve stimulation (SNS) is an option for the treatment of fecal incontinence in patients with morphologically intact, but weak external anal sphincter. METHODS: In ten patients a percutaneous test-SNS was performed. Two patients suffered from fecal incontinence after surgery, one patient after incomplete leg palsy after traumatic spine injury and seven patients from idiopathic incontinence. Incontinence score, anorectal manometry and patient diary were performed before and after test-SNS. RESULTS: Intraoperative response (Bellows action) could be achieved in 90% of patients. Test-SNS was successful in 50% of patients. In these patients, resting pressure was increased by 100.1% and squeeze pressure by 84.5%. CONCLUSIONS: SNS is an effective therapy in a subset of patients with fecal incontinence. Fifty percent of patients tested are eligible for implantation of a permanent stimulation device.      

蛋白聚糖与移植静脉粥样化关系的实验研究

目的 观察移植静脉粥样化过程,探讨蛋白聚糖(PG)对粥样化改变的影响。 方法 建立兔移植静脉粥样化模型,阴离子蛋白层析柱分离移植静脉蛋白聚糖,定量分析硫酸乙酰肝素蛋白聚糖(HSPG)和硫酸软骨素-硫酸皮肤素蛋白聚糖(CSPG-DSPG)。 结果 普食组术后8周CSPG-DSPG含量较正常静脉明显增加(P<0.05),术后12～20周含量接近正常,术后20周电镜下见泡沫细胞;高脂组术后8～20周CSPG-DSPG含量较正常静脉明显增加(P<0.05),术后4周见泡沫细胞形成,术后20周血管壁出现无组织结构区域。各组HSPG含量无明显差异(P>0.05),但占总PG比例下降。 结论 HSPG对移植静脉粥样化有一定的保护作用,CSPG-DSPG则具有促进作用。     

小脑延髓池的显微外科解剖研究

目的研究小脑延髓池的显微外科解剖特征,探讨其临床意义.方法选择经10%福尔马林固定成人头颈标本15例,显微镜下(5～25倍)模拟枕下极外侧入路、颈-乳突入路和耳前颞下窝入路的手术操作,分别自后、侧和前方显露小脑延髓池内结构,详细观测其神经血管结构的形态特征.结果小脑延髓池位于延髓外侧,上至桥延沟,下达枕骨大孔,侧方沿枕骨形成蛛网膜袖套进入颈静脉孔和舌下神经管.舌咽神经、迷走神经和副神经的根丝自上而下起自橄榄体背侧、延髓和脊髓的后外侧沟,根丝逐级汇合后分别进入舌咽神经道和迷走神经道.椎动脉于小脑延髓池的下端入颅后经该池行向前上内进入延髓前池.小脑下后动脉(PICA)可分为延髓前段、延髓侧段、扁桃体延髓段、脉络膜扁桃体段和皮质段.主要的静脉有小脑延髓裂内静脉、延髓静脉、小脑岩面下组静脉和岩下桥静脉.结论小脑绒球和Luschka孔脉络丛复合体及颈静脉孔硬膜返折可作为辨认舌咽神经脑池段的解剖标志,深刻认识小脑延髓池的蛛网膜界限对手术处理累及小脑延髓池的不同性质病变,保护重要神经功能意义重大.     

颈前部皮神经构筑研究

目的　为研究皮肤疾病和损伤提供皮神经构筑资料。方法　用S 10 0蛋白免疫组化染色法研究正常成人颈前部胸锁乳突肌前、后缘皮肤各层内皮神经的数量、分布及构筑特点。结果　 ( 1)皮肤乳头层内皮神经的小分支多分布在皮突下和乳头内血管丛附近。 ( 2 )真皮网状层内神经多位于小血管附近和汗腺、皮脂腺以及毛囊周围 ,神经分支呈串珠状或波纹形。 ( 3 )皮下组织内神经干和神经网同时存在。结论　皮肤内感觉神经树的分布及构筑特点与血管树相似。     

Transfer of 45Ca and 36Cl at the blood-nerve barrier of the sciatic nerve in rats fed low or high calcium diets

Unidirectional fluxes of 45Ca, 36Cl, and of [3H]mannitol from blood into the sciatic nerve and cerebral cortex were determined from 5- and 15-min uptakes of these tracers after an intravenous (i.v.) bolus injection in awake rats. Rats were fed diets for 8 wk, that had either a low (0.01% wt/wt), normal (0.67%), or high (3%) Ca content. Plasma [Ca] was 32% less and 11% more in rats fed low (LOCA) and high Ca diets (HICA), respectively, than in rats fed a normal Ca diet (CONT). The mean permeability-surface area product (PA) of 45Ca at the blood-nerve barrier was about eightfold higher than at the blood-brain barrier in the same animals and did not differ significantly between groups (greater than 0.05). Mean PA ratios of 45Ca/36Cl for the blood-nerve and blood-brain barriers in CONT rats, 0.52 +/- 0.04 and 0.40 +/- 0.02, respectively, were not significantly different from corresponding ratios in LOCA and HICA groups, and corresponded to the aqueous limiting diffusion ratio (0.45). Our results show no evidence for concentration-dependent transport of Ca over a plasma [Ca] range of 0.8-1.4 mmol/liter at the blood-nerve barrier of the rat peripheral nerve, and suggest that Ca and Cl exchange slowly between nerve and blood via paracellular pathways.     

兔坐骨神经挤压伤的MRI与SEP对比研究

目的:探讨磁共振成像和体感诱发电位以及两者结合在坐骨神经急性挤压伤中的诊断价值。方法:24只兔按钳夹力的不同随机分为A、B两组,左后肢为损伤侧,右后肢为对照侧,建立坐骨神经急性挤压伤模型,于伤后1、2、4、8周行MR扫描,同时行双侧体感诱发电位检查。结果:损伤侧24条神经,有23条MR显示异常,诊断正确率95.8%,假阴性率4.17%(1/24);24条损伤侧坐骨神经,有22条SEP显示异常,诊断正确率91.6%,假阴性率8.3%(2/24)。MRI与SEP对神经损伤的正确诊断率无统计学差异(P>0.05)。MRI与SEP结合起来,24条损伤神经均显示异常,诊断正确率100%。结论:MR与SEP检查可无创、准确地判断神经损伤,两者结合可明显提高神经损伤的正确诊断率,重复性好,可作为神经损伤的较好诊断手段。     

BKV in Simultaneous Pancreas-Kidney Transplant Recipients: A Leading Cause of Renal Graft Loss in First 2 Years Post-Transplant

With the introduction of more potent immunosuppressive agents, rejection has decreased in simultaneous pancreas/kidney transplant (SPK) recipients. However, as a consequence, opportunistic infections have increased. The purpose of this report is to outline the course of SPK patients who developed polyomavirus-associated nephropathy (PVAN). A retrospective review of 146 consecutive SPK recipients from January 1, 1996 to December 31, 2002 was performed. Immunosuppression, rejection and development of PVAN were reviewed. Nine patients were identified. All received induction with either OKT3 or thymoglobulin. Immunosuppression included tacrolimus/cyclosporine, MMF/azathioprine and sirolimus/prednisone. Two patients were treated for kidney rejection prior to the diagnosis of PVAN. Time to diagnosis was an average of 359.3 days post-transplantation. Immunosuppression was decreased but five ultimately lost function. However, none developed pancreatic abnormalities as demonstrated by normal glucose and amylase. Two underwent renal retransplantation after PVAN diagnosis and both have normal kidney function. PVAN was the leading cause of renal loss in SPK patients in the first 2 years after transplantation and is a serious concern for SPK recipients. The pancreas, however, is spared from evidence of infection, and no pancreatic rejection occurred when immunosuppression was decreased.