肌腹内腱鞘囊肿2例

腱鞘囊肿一般指发生在手部和足部关节或腱鞘内的结缔组织黏液退行性变所形成的囊肿,一般认为病因不清,可能与外伤、慢性劳损有关,多见于女性和青少年。我们收治了2例,其中1例发生在某些肌肉肌腹内的患者为3岁男孩,这里提供临床病例,以资探讨。     

Human pelvic extramural ganglion cells: a semiquantitative and immunohistochemical study

In pelvic surgery, much attention is paid to nerve bundles but not to ganglion cells. Using serial section histology of 14 postmortem-treated hemipelvis (eight males, six females; mean, 79 years old), we examined the population number, distribution, and tyrosine hydroxylase-immunoreactivity (TH-IR; suggesting sympathetic neurons) of extramural pelvic ganglion cells. All pelvic ganglion cells were uniformly sized (25–30 μm) contrasting with small intramural rectal neurons. Abundant ganglion cells (30,000–140,000 unilaterally) existed not only along the pelvic viscera except for the rectum, but also along the hypogastric nerve, pelvic splanchnic nerve, pelvic plexus, and associated branches excluding those within the mesorectum. The intrapelvic ganglion cells outside the sympathetic trunk did not form macroscopically identifiable ganglia, but made small clusters (0.1–2.0 mm of maximum diameter) or were diffusely scattered within nerve bundles. More than half of these cells appeared TH-IR positive, although the positive/negative proportion differed between nerves and specimens. Greater numbers of ganglion cells were found in dorsosuperior sites (e.g., around the seminal vesicle) rather than in ventroinferior sites (e.g., along the urethra) in males, and vice versa in females. However, in total cell numbers, interindividual variations were evident rather than intergender difference. Due to significant interindividual variations in cell number, differences are likely to exist between patients in “resistance” to surgical stresses. We hypothesized that pelvic ganglion cells are liable to be damaged due to drying along the surgical margin, hypoxia in venous bleeding, pressure from surgical retractors, extension stress with taping and excess traction and/or direct injury with electrical scalpels.     

Nerve cell bodies and small ganglia in the connective tissue stroma of human submandibular glands

The objective of the study was to investigate the presence and distribution of nerve cell bodies and small ganglia in the stroma of human submandibular gland. A retrospective immunohistochemical study in 13 human submandibular glands, fixed in neutral buffered formalin and embedded in paraffin wax, was undertaken. Six glands were excised in the course of radical neck dissection for oral squamous cell carcinoma and were disease-free, six showed sialadenitis, and one was involved by tuberculosis. Primary antibodies applied were neuron specific enolase, synaptophysin, and glial fibrilliary acidic protein. Neuron specific enolase and synaptophysin positive nerve cell bodies and small ganglia were found in 8/13 and 13/13 glands, respectively. They were found in the interlobular connective tissue stroma of human SMG, in close association to salivary parenchymal cells and blood vessels, and some of them were incorporated in GFAP positive peripheral nerves. To our knowledge, nerve cell bodies and small ganglia have been described only in the connective tissue stroma of autotransplanted human SMG and their functional importance is not clear.     

Localization of Nitric Oxide Synthase Isoforms in the Human Cochlea

The location of nitric oxide (NO) in the structures of the cochlea is a topical issue. Nitric oxide synthase (NOS) has been detected previously in mammalian cochleae, but information on its presence in the human cochlea is still sparse. The location of NOS isoforms I, II and III in substructures of the human cochlea was studied by immunohistochemistry (fluorescein isothiocyanate technique) using monoclonal antibodies to NOS I, II and III. NOS I was the predominant isoform and staining could be observed in cells of the spiral ganglion (SG), in nerve fibres and in the outer hair cells (OHC). Furthermore, the supporting cells of the organ of Corti and the stria vascularis showed a fluorescent reaction to NOS I. Staining for NOS III was less intense and was located in the OHC, supporting cells and SG cells, while the stria vascularis remained unstained. By contrast, NOS II showed weak staining in a few neuron fibres only. The results imply that NO in the human cochlea could act as a neurotransmitter/neuromodulator at the level of neural cells and may be involved in the physiology of the supporting cells and stria vascularis. Moreover, because NO is both a mediator of excitotoxicity and a non-specifically toxic radical, it may also play a role in neurotoxicity of the human cochlea.     

Ganglionopathies: evolving concept and ideas on management

Sensory ganglionopathies have a frequent association with neoplastic disorders (paraneoplastic subacute sensory neuronopathy, or SSN) or dysimmune disorders, with drugs, such as cisplatin or pyridoxine, and with inherited disorders with degeneration of dorsal root ganglion cells. Unsteady gait and pseudoathetoid movements of the hand are the distinctive signs encountered in these disorders. The chronic disorders are characterized by non-length-dependent abnormalities of sensory nerve action potentials (SNAPs) and differ from other sensory neuropathies in showing a global, rather than distal, decrease in SNAP amplitudes. This review focuses on recent advances in defining the mechanisms involved in sensory ganglionopathies, and describes the differential diagnosis including the rarely encountered hereditary neuronopathies and the infectious causes.     

扬刺加艾条温和灸治疗腱鞘囊肿疗效观察

目的：观察扬刺加艾条温和灸治疗腱鞘囊肿疗效。方法：64例患者随机分为治疗组32例（扬刺加艾条温和灸）和对照组32例（单纯扬刺组）,治疗1个疗程,比较两组治疗前后囊肿直径缩小程度,疼痛、乏力减轻程度。结果：治疗组总有效率为93．8％。对照组为65．6％,两组疗效比较（P〈0．01）差异有显著性。结论：扬刺加艾条温和灸法治疗腱鞘囊肿疗效优于单纯扬刺治疗。     

星状神经节结合肩胛上神经阻滞治疗肩周炎

目的观察星状神经节结合肩胛上神经阻滞治疗肩周炎的临床效果。方法选择肩周炎患者61例,阻滞药物均为1％利多卡因。于患侧阻滞星状神经节,无不良反应后即于同侧行肩胛上神经阻滞。观察记录治疗前后的VAS评分,同时记录两组患者疗效及不良反应。结果与治疗前比较,第1次至第3次治疗后的VAS评分均显著降低（P〈0.05）;与第1次治疗后比较,第3次治疗后的VAS评分显著降低（P〈0.05）;第1次和第2次治疗后的VAS评分差异无统计学意义（P〉0．05）;全组治愈率83．6％（51例）,总有效率96．7％（59例）;均未见不良反应发生。结论星状神经节结合肩胛上神经阻滞治疗肩周炎可取得满意的临床疗效。     

2420例20000次星状神经节阻滞的临床总结

目的观察星状神经节治疗疼痛性与一些非疼痛性慢性病的临床效果和安全性。方法选择诊断明确的慢性病患者2 420例,全部采用气管旁入路,注入1%利多卡因7 ml,10次为1疗程,隔日1次,疗程全部结束半个月后进行疗效判定,作为最终结果。结果2 420例患者,20 000次星状神经节阻滞,出现霍纳（Horner）综合征19 878次,出现率99.4%。喉返神经阻滞11 49例,占5.7%;背痛（脊神经损伤）1 137次,占5.6%;臂丛神经阻滞344次,占1.7%;膈神经阻滞81例,占0.40%。结论SGB是治疗临床某些疼痛性与非疼痛性慢性病的一种安全有效的方法。     

超声引导介入治疗腱鞘囊肿

腱鞘囊肿是临床常见的病，多发生于腕部及足踝部，一般可以手术摘除，但是有些囊肿因解剖关系较复杂，术中常残留囊壁，造成复发。我科自2005年2月-2007年2月在超声引导下行腱鞘囊肿乙醇硬化治疗，效果显著，现报道如下。     

An intra-articular knee cyst in a 2-year-old associated with an aberrant anterior cruciate ligament

Intra-articular ganglia of the knee occur infrequently, with an overall incidence estimated to be from 0.2 to 1.9%. To date, the youngest patient reported with an intra-articular ganglion was an adolescent. In this paper, we describe a 2-year-old patient with a massive intra-articular knee cyst and an aberrant anterior cruciate ligament (ACL) origin. The cyst was successfully treated with arthroscopic debridement. Proposed pathology and treatment recommendations for intra-articular cysts are reviewed. Investigation was performed at the University of Virginia Health Science Center, Charlottesville, VA, USA