Endoscopic-assisted microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: A case report

Introduction and importanceTrigeminal neuralgia (TN) secondary to vertebrobasilar dolichoectasia (VBD) was a rare condition. This paper reported a successful endoscopic-assisted microvascular decompression (MVD) for TN secondary to VBD.Case presentationA 53-year-old male with a history of myocardial infarction and heart failure complained of left refractory facial pain three years prior to admission. His pain was intermittent, electrical-like, severe, sharp, and radiated along the maxillary and mandibular branches. He used carbamazepine 600 mg daily. Brain magnetic resonance imaging revealed a neurovascular conflict between VBD and the left trigeminal nerve. The endoscopic-assisted MVD was indicated. The shredded neurosurgical sponges were interposed between VBD and trigeminal nerve. The 0° and 30° rigid rod-lens endoscope was used to explore and confirm the complete decompression. Postoperatively, TN was disappeared entirely. At a three-month postoperative, no facial pain and paraesthesia were found. The patient discontinued carbamazepine permanently.Clinical discussionMVD was still the most effective treatment. An inspection of root entry zone (REZ) and complete MVD with a solely operating microscope were challenging due to the massive diameter of VBD and multiple offending arteries behind the VBD. However, the wide viewing field and high-quality resolution of endoscopes allowed better visualization of REZ and neurovascular conflicts behind neural structures and least cerebellar retraction. This is essential in case of less potential space created by VBD.ConclusionEndoscope-assisted MVD allowed better visualization of REZ and neurovascular conflicts behind neural structures and least cerebellar retraction in management of trigeminal neuralgia secondary to VBD.     

脑卒中患者肠道菌群与血脂水平的相关性分析

目的研究急性缺血性脑卒中(AIS)患者肠道菌群与血清中甘油三酯和胆固醇的相关性。方法选取2015年5月-2018年1月在天津市环湖医院就诊的30例AIS患者纳入AIS组,另选取同期体检健康志愿者30例纳入HC组。检测两组肠道菌群、血清甘油三酯和胆固醇水平,并分析其相关性。结果 AIS组双歧杆菌属的相对丰度明显高于HC组,霍尔德曼菌属的相对丰度明显低于HC组,差异均有统计学意义(P<0.05);AIS组巨单胞菌属和大肠杆菌-志贺菌与HC组比较,差异均无统计学意义(P>0.05)。AIS组血清中甘油三酯水平明显高于HC组,差异有统计学意义(P<0.05);AIS组血清中胆固醇水平与HC组比较,差异无统计学意义(P>0.05)。巨单胞菌属与胆固醇具有相关性,巨单胞菌属/大肠杆菌-志贺菌与NIHSS和mRS有明显的相关性,双歧杆菌属/大肠杆菌-志贺杆菌与NIHSS均有明显的相关性(均|r|>0.3,均P<0.05)。结论 AIS的患者存在肠道菌群紊乱的情况,其菌属的变化与NIHSS、mRS、血清甘油三酯和胆固醇水平相关。     

肠梗阻导管对结直肠癌合并肠梗阻患者术后感染的影响

目的探究肠梗阻导管对结直肠癌合并肠梗阻患者术后感染并发症发生率的影响。方法选择2015年2月-2019年10月上饶市立医院收治的235例结直肠癌合并肠梗阻患者作为研究对象,根据是否应用肠梗阻导管将患者分为两组,对照组102例患者行急诊结直肠癌肿瘤切除术,研究组133例患者行肠梗阻导管置入术后择期行根治术。收集患者围手术期指标及并发症发生情况,对术后感染患者进行病原菌分析。结果研究组患者全部行择期一期吻合术,且24 h症状缓解率96.99%显著高于对照组的11.76%(P<0.05);研究组患者术后排气时间(3.22±1.01)h、住院时间(11.23±2.13)d均较对照组缩短(P<0.05);研究组切口感染4.51%(6/133)、总感染率7.52%(10/133)和低钠低钾蛋白血症发生率30.08%(40/133)均低于对照组(P<0.05);29例感染患者共分离出46株病原菌,其中革兰阴性菌28株,占60.87%,革兰阳性菌17株,占36.96%,真菌1例,占2.17%。结论梗阻性导管置入后择期手术术后恢复较快,可降低结直肠癌合并肠梗阻患者术后感染并发症发生率,有较高的临床应用价值。     

Difenoxin and loperamide: studies on possible mechanisms of intestinal antisecretory action

Summary Experiments have been performed to determine whether the antisecretory (antidiarrhoeal) actions of difenoxin and loperamide are mediated by enteric neurones. An iso-osmotic perfusion solution was circulated around the lumen of the jejunum of anaesthetised rats. Vasoactive intestinal peptide was infused intra-arterially to induce net fluid secretion which was inhibited by difenoxin (ED₅₀, 0.23 mg/kg) and loperamide (ED₅₀, 0.5 mg/kg). However, neither were able to restore the fluid transport rate to the control level of absorption.The antisecretory effects of difenoxin (0.77 mg/kg) and loperamide (0.6 mg/kg) were blocked by the opiate receptor antagonist naloxone (2 mg/kg). Their effects were also abolished by pretreatment with the 5-HT synthesis inhibitor p-chlorophenylalanine (PCPA; 200 mg/kg; with desmethylimipramine given beforehand to protect noradrenergic nerves and enhance 5-HT depletion). The effect of difenoxin was blocked with methiothepin (1 mg/kg) and methysergide (30 g/kg) but not ketanserin (30 g/kg), ritanserin (30 mg/kg), ondansetron (10 g/kg) or ICS 205-930 (3 mg/kg). None of the above 5-HT receptor antagonists modified the antisecretory effect of loperamide. The antisecretory effect of difenoxin but not loperamide was prevented by phentolamine (2 mg/kg) and by pretreatment with 6-hydroxydopamine (150 mg/kg) total.It is concluded that both difenoxin and loperamide inhibit net fluid secretion by indirect mechanisms. It is proposed that the initial action is on enteric -opiate receptors and that this results in the release of 5-HT. In the case of difenoxin, the 5-HT may act on 5-HT₁-like receptors to release noradrenaline. However, the major difference in the mechanism of action of loperamide compared to difenoxin is that it does not utilize noradrenaline as the final mediator of its antisecretory action.Correspondence to A. De Luca at the above address     

Septischer Schock und multiples Organversagen in der chirurgischen Intensivmedizin

Zusammenfassung Beschrieben wird ein tierexperimentelles Sepsismodell, das der Problematik chirurgischer Intensivpatienten entspricht. Nach rezidivierender Applikation von E.-coli-Endotoxin W0111:134 unter standardisierten Bedingungen konnten spezifische hämodynamische, biochemische (TNF, TXA₂, PG I₂, IL-6, PAF) und morphologische Veränderungen (pulmonales Endothel) nachgewiesen werden. Die sepsisinduzierten ARDS-Veränderungen werden mit einer Hochfrequenzdruck-und-flowmessung mit 385 Meßpunkten fiber einem Atemzyklus analysiert. Die Rolle des Darms in der Sepsis wurde mit ionenselektivem Kaliummonitoring vergleichend auf der Mukosa and Serosa untersucht. Jede Endotoxingabe wurde vom Dünndarm mit selektiven Anstiegen der Kaliumaktivität als Ausdruck einer Endotoxin-induzierten relativen Ischämie beantwortet. Das Profil der Oberflächenkaliumwerte korreliert sowohl mit dem cardiaco output als auch mit den Prostazyklinspiegeln. Die während der Versuchsdauer kontinuierlich abnehmende Mukosa-Serosa-Kaliumdifferenz kann als Nachweis einer die Sepsis katalysierenden intestinalen Permeabilitätsstörung interpretiert werden.

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Septic shock and multiple organ failure during surgical intensive care. Evaluation of pulmonary and intestinal dysfunction assessment in a porcine model

The study deals with an animal model for the problems of surgical intensive care patients. Following repeated applications of E. coli endotoxin W0111:134 under standard conditions, specific hemodynamic and biochemical (TNF, TXA₂, PGI₂, IL-6, PAF) and morphological (endothelium of the lung) alterations were detected. ARDS patterns induced by the sepsis were analyzed by high-frequency measurement of pressure and flow (385 measurements per breathing cycle). The role of the intestine in sepsis was investigated by ion-selective monitoring of surface potassium activity comparing mucosa and serosa. Every injection of endotoxin was followed by a selective increase of the potassium activity revealing relative ischemia induced by the endotoxin. The profile of the potassium levels on the surface correlates both with the cardiac output and with the prostacyclin levels. The continuous narrowing of the difference between mucosa and serosa, potassium during the period of investigation can be regarded as evidence for pathologic change in permeability fostering the septic course.

     

Reflex peristalsis in the guinea pig isolated ileum is endogenously controlled by kappa opioid receptors

Summary (1) Reflex peristalsis in the circular muscle of the guinea pig ileum was elicited in vitro by sustained luminal distension of the intestinal wall according to 2 cm H₂O and evaluated in terms of the number of peristaltic waves within 15 min intervals. (2) The poorly -selective opioid antagonist naloxone at concentrations of 10^–7 and 10^–6 mol/l increased the frequency of peristaltic contractions within the first 15 min interval, and thereafter in a declining fashion, by 68 and 88%, respectively. The highly -selective opioid antagonist nor-binaltorphimine behaved similarly. It was, by one order of magnitude, more potent but a little less effective than naloxone, i.e., the maximum effect was 57% increase in peristaltic frequency at 10^–8 mol/l. Concentrations of 10^–7 and 10^–6 mol/l had the same effect as 10^–8 mol/l, and 10^–9 mol/l were ineffective. The highly -selective antagonist CTOP-NH₂ and the highly -selective antagonist ICI 174,864 were ineffective up to 10^–6 mol/l. (3) It is concluded that predominantly opioid receptors are used by endogenous opioids under the present conditions to inhibit reflex peristalsis.     

应用半椎板切除对侧潜行诫压术治疗脊髓型颈椎病

目的：观察手术治疗脊髓型颈椎病患者的术后功能改善情况。方法：对２２例脊髓型颈椎病患者采用半椎板切除对侧潜行减压术治疗,术后部效采用日本骨科学会脊髓功能１７分法评定标准,随访３－２３月。结果：该方法减压效果确实,并发症少,出血少。同时该 广,技术简捷,不影响颈椎的稳定性。结论：半椎板切除对侧潜行减压术是一种治疗颈椎病较好的手术方法。文章结果还显示了脊髓损害的性质也是影响疗效的重要因素。     

胸腺肽对肠梗阻细菌移位的影响

目的：通过对大鼠机械性肠梗阻模型细菌移位的实验研究,了解应用胸腺肽后,大鼠肠梗阻致细菌移位的改变情况,探索减少细菌移位的可能药物。方法：雄性ＳＤ大鼠３０只,随机分为假手术组,肠梗阻组和胸腺肽组。检测肝脏和肠系膜淋巴细菌移位情况、血浆内毒素水平和进行回肠病理学检查等。结果：细胞移位率和细菌移位数水平,肠梗阻组和假手术组相比,明显升高,胸朱肽组和肠阻组相一少,血浆内毒素水平,胸腺肽组与肠梗阻组相比明显     

三种药物防治胃肠肿瘤化疗所致呕吐的临床研究

目的：评价三种药物防治胃肠肿瘤化疗所致呕吐的价值。方法：９０名患者随机分成三组,灭吐灵组（Ａ组）,吗丁啉组（Ｂ组）,枢丹组（Ｃ组）。应用５－Ｆｕ＋ＬＶ方案化疗５天,观察５天内三种药物的止吐效果。结果：Ａ和Ｂ、Ｃ组比较有显著性差异（Ｐ〈０．０５）,Ｂ和Ｃ比较无显著性差异（Ｐ〉０．０５）。结论：Ｂ组副作用少,疗效高,建议临床推广使用吗丁啉。