免疫性血小板减少性紫癜辨证分型与血小板表面相关抗体及T淋巴细胞亚群的关系

为探讨免疫性血小板减少性紫癜（ITP）中医辨证分型与免疫机理的关系,将ITP患者中医辨证分型结合血小板相关抗体（PAIg）及T淋巴细胞亚群进行分析。发现作为本病主要抗体的PAIgG脾肾阴亏型明显高于脾虚失统型（P<0.01）;OKT₈⁺值亦显著高于脾虚失统型（P<0.05）,OKT₄⁺/OKT₈⁺比值则明显低于脾虚失统型（P<0.05）。提示脾肾阴亏型的免疫损伤程度较脾虚失统型严重。     

Prevalence study of primary dystonia in Iceland.

In Iceland, the crude prevalence for all types of primary dystonia was 37.1/10(5) (confidence interval, 30.4-44.9). Focal dystonia had the highest prevalence (31.2/10(5)), followed by segmental (3.1/10(5)), multifocal (2.4/10(5)) and generalized dystonia (0.3/10(5)). Cervical dystonia was the most common focal dystonia (11.5/10(5)), followed by limb dystonia (8.0/10(5)), laryngeal dystonia (5.9/10(5)), blepharospasm (3.1/10(5)), and oromandibular dystonia (2.8/10(5)). The male:female ratio for all patients was 1:1.9 (P=0.0007), and females outnumbered males in all subtypes except oromandibular dystonia. Mean age of onset for all patients was 42.7 years (range, 3-82 years). This prevalence of primary dystonia is higher than in most reported studies, possibly because of more complete ascertainment but the relative frequencies of dystonia subtypes is similar.     

La douleur peut-elle être perçue et cherchée plus « vivement » dans une culture postmoderne en perte de sens ?

The perception of the pain, and the “work of pain” which ensues from it, bound to the notion of trauma-hurt to subjects presenting a thought operating and a depression main part, sign a physical fixation for an object psychically not representable. These subjects have a real incapacity to perceive and symbolize the affect of psychic suffering as well borderline teenagers (self-harm). Having reminded the Freudian and psychoanalytical conceptions on the pain, the operating functioning and the self-harm behaviour, the authors will refer to certain sociological works describing certain characteristics of our post-modern social, cultural and linguistic organization to underline the impact of these in the increase of the behaviour of search for the pain to borderline patients or with the perception of the pain as only sign of a mental suffering impossible to symbolize. So, we notice that the loss of symbolic structuring of our post-modern civilization, the ascent in power of the thought operating, the social and domestic disorganizations, have a real cost on our contemporaries psychic and somatic health, particularly on the most numerous among them as teenagers.     

低角度青少年特发性脊柱侧凸女性患者的骨密度分析

目的分析低角度青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)女性患者的骨密度(BMD)和骨矿含量(BMC),探讨其与年龄、生长发育、人体测量学和侧凸角度等的相关性。方法研究对象为218例Cobb角15～40°的女性AIS患者。运用双能X线骨密度吸收仪测定非优势侧股骨颈和腰椎的BMC/BMD。探讨这两个部位的BMC/BMD与患者的年龄、生长发育、人体测量学和侧凸角度等的相关性。结果所有患者的年龄平均为(13.4±1.4)岁,Cobb角平均为(28.3±6.2)°。股骨颈BMD平均为(0.827±0.103)g/cm2,腰椎BMD平均为(0.887±0.124)g/cm2,显著低于同龄健康女性儿童;股骨颈BMC平均为(3.49±0.56)g,腰椎BMC平均为(29.78±7.37)g。患者的BMC/BMD与Cobb角无显著相关,而与体重、身高、Risser征、月经状况、BMI和年龄显著相关。逐步回归分析显示,体重和年龄是影响患者BMD的主要因素。结论低角度女性AIS患者存在全身性的骨量减低,且与Cobb角无显著相关,而与生长发育和人体测量学相关指标显著相关。这提示AIS患者的骨量减低与生长发育和低体重有关。     

单纯后路多个全脊椎切除矫治严重脊柱侧、后凸畸形

目的评价严重脊柱侧、后凸畸形单纯后路多节段全脊椎切除,侧后凸畸形矫正技术的手术矫治效果和临床风险性。方法2003年1月~2001年1月,本院骨科收治38例严重脊柱侧、后凸畸形患者,全部病例均采用单纯后路多节段全脊椎切除的方法。全部病例手术前均行站立位X线脊柱全长片、核磁共振和三维CT重建等辅助检查,计算手术时间、出血量,观察手术前后侧后凸的矫正率、术中脊柱短缩,手术后整体平衡情况。结果本组患者均进行1.5~3个椎体的全脊椎切除,术中测量脊柱短缩42 mm(31~62 mm),手术平均用时348 m in(280~510 m in),手术中平均出血量2010 m l(1400~3200 m l)。全部病例经过1~2.5年的随访,侧凸畸形cobb角平均矫正率为56.3%(51.2%~64.2%);后凸畸形平均矫正率为75.6%(67.8%~81.4%)。所有患者躯干平衡良好,未发现失代偿现象。手术并发症包括3例出现一过性的脊髓损伤症状(1例一过性双侧下肢不全瘫、2例一过性单侧下肢不全瘫)和6例神经根性疼痛,未经特殊处理恢复正常,4例肠系膜上动脉综合症,经胃肠减压处理症愈。结论对于严重成人脊柱侧、后凸畸形患者,单纯后路顶椎附近多个椎体全脊椎切除技术三维矫正效果满意,安全有效。     

特发性脊柱侧凸PUMC分型的可重复性及可信度研究

目的:探讨特发性脊柱侧凸PUMC(协和)分型系统的一致性,并对影响分型一致性的因素进行分析.方法:随机选取南京鼓楼医院2004年～2006年治疗的80例特发性脊柱侧凸患者,其中男性15例,女性65例,平均年龄14.6岁(10～18岁),均有完整的术前站立位正侧位X线片及仰卧位左右Bending片共四张.由4名脊柱外科专科医生分别根据PUMC(协和)分型标准进行分型,2周后此4位医生分别对这些患者的X线片再次进行分型,收集分型结果分别作可信度和可重复性分析,计算Kappa值检验一致性并对影响分型一致性的因素进行统计分析,结果:80例患者均可用PUMC分型,分型可信度平均Kappa值为0.801,可重复性Kappa值为0.878.PUMC分型不一致中包括上胸弯的界定18次;胸弯明显时,代偿性与结构性腰弯的界定15次;腰弯明显时,代偿性与结构性胸弯的界定18次;单弯顶点的判断20次;测量角度的差异18次.结论:PUMC(协和)分型学习曲线相对较短,易于掌握且具有良好的可信度和可重复性.     

Local anesthesia for inguinal hernia repair in adolescents

Background Many centers use local anesthesia for adult inguinal hernia surgery in the setting of day-case surgery. There are no reports on, or guidelines for, use of anesthesia for inguinal hernia surgery in adolescents. We describe our initial experience with the use of local anesthesia and intravenous sedation for inguinal hernia surgery in adolescents in the setting of a day-surgery facility. Methods The charts of 14 consecutive adolescent patients (aged 12–17) who had inguinal hernia surgery from July 2004 to March 2005 were reviewed retrospectively. Intravenous sedation was administered 1–3 min before injection of local anesthetic. Sedation consisted of midazolam 0.085 mg kg⁻¹ and either fentanyl 0.85 μg kg⁻¹ or ketamine 0.085 mg kg⁻¹, according to the preference of the anesthesiologist. Additional sedation with half the initial dose was administered if required. Local anesthesia using a combination of lignocaine and bupivacaine was administered by the surgeon with infiltration in the skin and deep tissues. Results Fourteen adolescents aged 12–17 years (mean 14.8 ± 1.37), weighing 34–100 kg (mean 61.2 ± 16.5), had 15 inguinal hernia repairs with sedation and local anesthesia. All the patients were male. All completed the surgery with sedation and local anesthesia. None required conversion to general anesthesia. There were no immediate or subsequent complications. Mean time from the end of surgery to discharge home was under 2 h (mean 106 ± 36 min). Examination of patient charts did not reveal any complaints regarding the surgery or the postoperative course at the postoperative follow up visit. Conclusions The use of local anesthesia with intravenous sedation for inguinal hernia repair in the adolescent age group seems feasible and requires further prospective study.     

Functional correlates of verbal memory deficits emerging during nicotine withdrawal in abstinent adolescent cannabis users.

BACKGROUND: Cannabis remains the most widely used illicit substance by adolescents and is typically consumed by this population in the context of ongoing tobacco use. Human studies have shown that both cannabis and tobacco exert effects on cognitive function; however, little is known about possible interacting effects of these drugs on brain function and cognition during adolescent development. METHODS: Verbal learning and memory were assessed in 20 adolescent users of tobacco and cannabis and 25 adolescent tobacco users with minimal history of cannabis use. Functional magnetic resonance imaging was used to examine brain function and functional connectivity while a subset of these subjects performed a verbal working memory task. RESULTS: Delayed recall of verbal stimuli deteriorated during nicotine withdrawal among cannabis users but not among comparison subjects. During high verbal working memory load, nicotine withdrawal selectively increased task-related activation of posterior cortical regions and was associated with disruption of frontoparietal connectivity in adolescent cannabis users relative to comparison subjects. CONCLUSIONS: These observations suggest that cannabis use during adolescent development may disrupt neurocircuitry supporting verbal memory formation and that deficits associated with disruption of these neurocircuits are unmasked during nicotine withdrawal.     

青少年特发性胸椎侧凸后路凸侧胸廓成形术的并发症分析

目的:探讨青少年特发性胸椎侧凸患者后路凸侧胸廓成形术的并发症发生原因及预防措施。方法:自1999年1月～2006年9月,共有410例青少年特发性胸椎侧凸患者在我科施行脊柱侧凸后路矫形内固定术,同时行同一切口下的凸侧胸廓成形术,男86例,女324例。年龄11～18岁,平均14.7岁。术前剃刀背畸形15°～48°,平均32°。统计并发症发生情况。结果:凸侧胸廓成形的肋骨切除数平均4.2根,术后剃刀背畸形0°～14°,平均6°。无手术死亡病例。24例(5.8%)术中发生壁层胸膜穿孔,6例(1.5%)术后胸腔积液,3例(0.7%)术后气胸,1例(0.2%)术后呼吸困难需间歇性吸氧,34例(8.3%)术后有局部反常呼吸,17例(4.1%)术后诉不同程度的胸壁疼痛,9例(2.2%)诉局部皮肤麻木或感觉减退,3例(0.7%)早期手术的患者术后肋骨残端突出明显,1例(0.2%)皮下血肿,1例(0.2%)皮肤压疮。经相应处理后,患者大多恢复满意。319例平均随访28个月,仅4例仍残留有胸壁皮肤感觉减退。结论:凸侧胸廓成形术是一种安全、有效的改善"剃刀背"畸形的手段。提高手术技巧,术后积极处理,可以减少甚至避免相关并发症的发生。     

青少年Pilon骨折的治疗

目的探讨青少年Pilon骨折的特点、治疗方法及其并发症。方法对1990年4月～2003年12月期间治疗的13例青少年胫骨Pilon骨折病例进行随访分析。按Merv—Letts分型：Ⅰ型5例，Ⅱ型6例，Ⅲ型2例。骨牵引治疗2例，有限内同定8例，有限内固定结合外固定支架3例。结果所有患者平均随访24个月，按Helfet踝关节功能评价：优8例，良4例，差1例，优良率92．3％。并发症：皮肤坏死2例，创伤性关节炎4例，骨骺早闭3例，畸形愈合1例，骨延迟愈合1例，外固定支架钉道感染1例，总体并发症38．5％。结论青少年Pilon骨折应根据其分型采用不同的治疗方案：疗效与创伤程度有关：Ⅲ犁骨折有较高的并发痹。