Delayed presentation of thoracic esophageal perforation after blunt trauma

Thoracic esophageal perforation after blunt trauma is a rare injury with high mortality. Prompt recognition and aggressive treatment are paramount to survival. We report a case of delayed presentation that emphasizes the diagnostic difficulties in this traumatic injury. A review of the prevalence, diagnosis, and management is also discussed.     

Unilateral diaphragmatic paralysis and segmental motor paresis following herpes zoster

We report the case of a 73-year-old woman who complained of acute onset of pain and weakness of her left shoulder and proximal arm muscles 3 weeks after a diagnosis of herpes zoster. Electromyography revealed involvement of the C5-6 myotomes and the upper trunk of the brachial plexus. Chest X-ray and electromyographic studies documented paralysis of the left diaphragm. One year after onset, muscle strength returned to normal, but radiographic and electrophysiologic findings of diaphragm paralysis were unchanged.     

Assessment of corticodiaphragmatic pathway and pulmonary function in acute ischemic stroke patients.

This study investigates the effect of stroke on the corticodiaphragmatic pathway and attempts to clarify the relationship between neurophysiological data and degree of motor disability, site of infarction in computerized tomography (CT) scan, diaphragmatic excursion, blood gases and pulmonary function in stroke patients. Using magnetic stimulation of the scalp sites and cervical roots, an assessment of corticodiaphragmatic pathway was made. The study included 34 sequentially selected patients from a total of 250 patients with acute ischemic stroke. Twenty-five (age- and sex-matched) volunteers served as controls. Sixteen patients had cortical infarction, 13 had subcortical infarction and five had both cortical and subcortical infarction. The mean according to the Scandinavian Stroke Scale was 32.2. Decreased diaphragmatic excursion was observed in 41% of the patients. Twenty-four patients (70.5%) had abnormal magnetic evoked potentials (MEPs) in the affected hemisphere. In five patients MEPs could not be elicited from the affected hemisphere; the remaining 19 patients had abnormal values of both cortical latency and central conduction time (CCT). Cortical latency, CCT, amplitude of compound muscle action potentials (CMAPs) and excitability threshold of the affected hemisphere were significantly altered compared with both the unaffected hemisphere and the control group. Those patients with hemiplegia had a greater degree of hypoxia, hypocapnia and decreased serum bicarbonate level compared with the control group. Also, hemiplegic patients had different degree of respiratory dysfunction. A statistically significant association was found between neurophysiological data and disability score, diaphragmatic excursion, site of infarction in CT scan and degree of respiratory dysfunction. Central diaphragmatic impairment may occur in acute stroke and could contribute to the occurrence of hypoxia in those patients.     

Isolation of a neuromuscular junctional blocking agent from Cleistanthus collinus plant leaf extract

A potent neuromuscular junctional blocking agent was isolated from chloroform extracts of poisonous Cleistanthus collinus leaf by a combined chromatographic—cholinesterase inhibition technique. An amorphous yellowish green extract was eluted from paper or micro thin layer chromatographic plates. This compound caused a 93% fade on nerve evoked muscle tension and a 95% decrement in nerve evoked muscle action potentials and least change in muscle evoked muscle action potentials and tension in a rat phrenic nerve—diaphragm preparation, suggesting the presence of a potent pharmacologically active ingredient causing neuromuscular blockade which is irreversible.     

50岁以上健康人膈肌活动度与肺功能的关系

X线下测定40例50岁以上健康人的膈肌运动范围(简称膈肌活动度DM),并分析了DM与肺功能的相关性。DM实际测量的范围是5.5cm～13cm,均值是7.5±1.4cm。DM与IC、VC和MVV呈显著正相关。     

有机溶剂对氧化乐果抑制离体大鼠膈肌的影响

使用４０％市售氧化乐果和６７％氧化乐果抑制离体大鼠膈神经膈肌标本进行毒理实验。结果发现，４０％的市售氧化乐果中所含有机溶剂与氧化乐果之间存在着增强性交互作用，这种交互作用可对标本产生不可逆性细胞毒性作用。提示临床工作者在救治有机磷中毒的同时勿记有机溶剂中毒的救治     

Cu2+对神经肌肉接头传递的作用

Cu²⁺对间接刺激诱发大鼠隔肌的收缩及诱发小鸡颈二腹肌的收缩均产生浓度依赖性抑制作用。但Cu²⁺不影响膈神经的兴奋和传导,对直接刺激诱发膈肌收缩的抑制作用弱于间接刺激诱发膈肌收缩的抑制。Cu²⁺不影响小鸡颈二腹肌对Ach的敏感性。说明Cu²⁺主要作用于突触前膜阻滞神经肌接头的传递。Ca²⁺,L-半胱氨酸可拮抗Cu²⁺的阻滞提示Cu²⁺可能与突触前膜的SH基结合,影响Ca²⁺的跨膜内流,减少Ach的释放,阻滞神经肌接头的传递。     

糖皮质激素对大鼠膈肌形态及功能作用的实验观察

３０只ＳＤ大鼠随机分为实验组［醋酸可的松５０ｍｇ／（ｋｇ·ｄ），肌注共１４ｄ］、饮食配对组及正常对照组，观察营养指标、离体隔肌最大张力以及张力－频率曲线和形态改变。结果显示实验组平均每日进食量下降，并出现体重、隔肌重量、白蛋白和总蛋白下降，膈肌出现高频疲劳，光镜下隔肌纤维变性、坏死、增生，部分纤维萎缩变细，而饮食配对组和正常对照组则无上述变化。讨论了皮质类固醇肌病的发病机理及与营养不良的关系。     

Application of Electrical Impedance Principle in the Diagnosis of Diaphragm Fatigue

ＡｐｐｌｉｃａｔｉｏｎｏｆＥｌｅｃｔｒｉｃａｌＩｍｐｅｄａｎｃｅＰｒｉｎｃｉｐｌｅｉｎｔｈｅＤｉａｇｎｏｓｉｓｏｆＤｉａｐｈｒａｇｍ　ＦａｔｉｇｕｅＮＩＵＲｕ－ｊｉ（牛汝楫）（ＩｎｓｔｉｔｕｔｅｏｆＲｅｓｐｉｒａｒｏｒｙＤｉｓｅａｓｅｓ，Ｔｏｎｇｊｉ...     

Potential foramen to allow communication between the pleural cavity and retroperitoneal space during laparoscopic surgery: a cadaver study of Bochdalek’s triangle

The indications for laparoscopic retroperitoneal surgery have recently been greatly extended and the technique has become popular, but concomitant pleural injury or pneumothorax has been reported from numerous hospitals in Japan. Which anatomical information is useful to avoid surgical injury of the suggested weak portion of the diaphragm? We identified a diaphragm-free triangular area or Bochdalek’s triangle in 90.1% of elderly Japanese cadavers (100/111 cadavers), comprising about 622.8 mm² in area (height 47.9 mm, base 25.0 mm). In most cases (80.1%; 129/161), the entire triangle was restricted to the superior side of the 12th rib in addition to the medial side of the distal end of the rib. A “potential foramen” (PF) was defined as the diaphragm-free triangle >100 mm² in area on the parietal pleura. Most triangles (77.6%, 125/161) met this criterion. The PF was often covered by the kidney (93.3%), and had a mean area of 318.9 mm². The PF was located 42.3 mm from the distal end of the 12th rib, while the inferior pleural margin was 27.8 mm superior to the rib end. When the triangle was large, the PF was also large, with the PF often occupying >50% of the triangle area (62/125; 49.6%). To avoid the distal end of the 12th rib, in laparoscopic retroperitoneal surgery, we recommend making a transverse skin incision at the midpoint between the end of the 12th rib and the iliac crest.