Self-inflicted tourniquet paralysis mimicking acute demyelinating polyneuropathy.

Tourniquet paralysis is an uncommon complication of surgery, and self-inflicted tourniquet paralysis has never been documented to our knowledge. We report a patient with bilateral self-induced tourniquet paralysis of the lower extremities, whose symptoms were initially attributed to an acute demyelinating sensorimotor polyneuropathy based on clinical presentation and electrodiagnostic study. After investigations failed to reveal a cause, he was found to have placed tourniquets on his legs because of a rare obsession with limb amputation known as apotemnophilia. Significant spontaneous partial resolution of clinical symptoms was noted after 6 weeks. Electrophysiologic evidence of segmental demyelination of multiple motor nerves localized to the same region may help to distinguish this condition from other forms of acute demyelinating polyneuropathy.     

Rest thallium-201 myocardial perfusion imaging in a patient with leukaemic infiltration of the heart

Despite the high incidence of leukaemic infiltration of the heart, only 8 cases of atrioventricular block due to leukaemia have been reported in the literature. Improvement in the heart block associated with disappearance of the leukaemic infiltrate has not been reported. A rest thallium-201 study was used in a 65-year-old man to demonstrate leukaemic infiltration of the heart which was associated with complete heart block. After chemotherapy, when the tumour burden was reduced and the leukaemia in remission, his heart block resolved, and a follow-up thallium scan was normal. Offprint requests to: A.C. Civelek     

126例心房颤动合并长R-R间期患者的动态心电图分析

Objective To analyze the relationship between atrial fibrillation complicating long R-R interval, escape beat and escape heart rhythm and pathological atrioventricular block by dynamic electrocardiography (DCG). Methods 126 patients with atrial fibrillation were divided into group A (being related to sleep) and group B (being not related to sleep) according to the factor whether long R-R interval, escape beat and escape heart rhythm relevant to sleep. All were detected by DCG for 24 hours. Results The cases with1.5～2.0 s long R-R interval, more than 2.0s long R-R interval, escape beat and escape heart rhythm were (26.02±6.03), (7.39±1.05 ) and (6.90±1.28)in group A and (203.05±41.01), (35.48±7.52), (28.10±6.25) in group B respectively. The cases of group B were markedly more than those in group A. Conclusion Those atrial fibrillation complicating long R-R interval, escape bbeat and escape heart rhythm were related to sleep could not be deemed as pathological atrioventricular block, while those were not related to sleep could be considered pathological atrioventricular block.     

Effects of complete heart block on myocardial function, morphology, and energy metabolism in the rat.

AIMS: Severe sustained bradycardia may cause acute and possibly chronic congestive heart failure (CHF). The aim of this study was to investigate acute and chronic effects of complete heart block (CHB) on cardiac function, morphology, and creatine (Cr) metabolism. METHODS AND RESULTS: CHB was induced in male Sprague-Dawley rats (approximately 250 g, n = 11) by means of electrocautery applied to the region of AV node and were compared with controls (n = 15). The rats were investigated at 1, 3, and 12 weeks after CHB induction with transthoracic echocardiography. Invasive haemodynamic assessment of left and right ventricular pressures was performed at 12 weeks. After the sacrifice, the hearts were freeze-clamped for analysis of myocardial Cr, and high energy phosphometabolites. The efficacy of operative procedure was 54%. The peri-operative mortality rate was 20%. Heart rate (HR) decreased by approximately 50% (P < 0.01) while stroke volume (SV) increased 2.5 times (P < 0.01) in the CHB rats. Cardiac index remained unchanged. The rats with CHB grew normally and were in no apparent distress. Filling pressures in left and right ventricles were normal. The CHB rats developed marked cardiomegaly with biventricular dilatation and eccentric left ventricular hypertrophy (P < 0.01). There was no change in the myocardial content of Cr and high energy phosphometabolites. CONCLUSION: Rats with CHB are compensating for reduction in HR with increased SV without haemodynamic and biochemical characteristics of CHF. This model may be useful to study the effects of CHB and bradycardia on myocardial structure, function, electrophysiology, and metabolism as well as for studies of cell therapy for reparation of AV conductance.     

交感神经节与椎旁阻滞联合运用于改善脑中风预后的研究

目的 评价交感神经节与椎旁阻滞联合运用在脑中风康复治疗中的效果。方法 150例中风患者随机分为交感神经节与椎旁阻滞联合运用组（SGB组）和康复训练组（H组）。分别在治疗前、治疗后及随访期间，记录患者的体征、实验室检查及特殊检测结果。使用临床神经功能缺损程度评分标准及修订的巴氏指数（modified Barthel index，MBI）评测。采用t检验和卡方检验分析组间差异。结果 治疗1、3、6个月后，SGB组与H组总疗效均有改善，分别为H组：50％、60％、70％；SGB组：90％、95％、100％，SGB组疗效优于H组。两组比较，自觉症状、神经功能缺损改善程度有明显差异，生活活动能力改善程度差别不大。治疗前、后相比，SGB组收缩压、舒张压、局部皮温、血高切黏度、血低切黏度、PGA有改善，H组改变不明显；两组患者血浆黏度无明显改善。TCD显示，SGB组脑血流改善占85．3％，H组占14．3％。SGB组住院时间短于H组，住院费用不增加。结论 在脑中风康复治疗中，联合运用交感神经节与椎旁阻滞，疗效明显优于常规康复训练。     

全麻复合硬膜外阻滞与单纯全麻的比较

比较全麻复合硬膜外阻滞和单纯全麻在围术期对机体应激、炎性、免疫等方面的影响。使用全麻加硬膜外麻醉能有效地抑制手术引起的应激反应，稳定循环状态，减少并发症，使病人在术中更为安全平稳，麻醉效果更为可靠，术毕清醒快，术后镇痛有利于术后病人咳嗽咯痰，并且能减轻围手术期对T细胞亚群的影响。     

Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl.

A 4-year-old girl with post-surgical complete atrioventricular block received an epicardial dual chamber pacemaker system. During further growth intermittent exit block occurred, first misinterpreted as neurological seizures. The epicardial lead was replaced using a transvenous approach, and a pacemaker with an integrated home monitoring facility was implanted. After her discharge, a rise in the pacing threshold automatically initiated an event message. On the basis of this information, the patient was called in and imminent dislodgement of the ventricular lead was diagnosed by x-ray. The lead was repositioned and was found stable over 1-year follow-up.     

Peripheral Foot Blockade Versus Popliteal Fossa Nerve Block: A Prospective Randomized Trial in 51 Patients

The majority of foot and ankle operations are performed on an outpatient basis and often under some form of regional anesthesia. In this prospective, randomized study of 51 patients undergoing elective unilateral forefoot procedures, we compared 2 different anesthetic techniques: the peripheral foot blockade and the popliteal sciatic nerve block. Variables assessed included the quality of surgical anesthesia, postoperative analgesia, and the incidence of postoperative complications. The anesthesia was classified as effective if it was the sole anesthetic technique for the forefoot surgery. We found successful results in both groups: 92% in the foot block group and 96% in the popliteal block group. Analysis of time required to perform the anesthetic procedure showed a significant difference between the 2 groups, with foot block being considerably faster (14.3 minutes vs 19.2 minutes for popliteal block) (P = .0078). Foot block patients demonstrated 10.96 hours of analgesia, whereas popliteal block patients exhibited 14.32 hours (P = .132). With a mean follow-up of 5.7 months, we did not find anesthesia-related complications in any of the patients. Both techniques showed a high level of safety and efficacy, with no significant difference detected between them. Our patients showed a high rate of satisfaction with both procedures (96% for foot block patients and 96.1% for popliteal block patients) and reported a good discharge disposition. These data show that both procedures are safe and effective anesthetic techniques and well suited to forefoot ambulatory surgery.     

穿刺针导引技术在超声引导下臂丛神经阻滞中的应用

目的设计超声引导下臂丛神经阻滞时的穿刺针导引器,并在体外和临床上验证其效果。方法自制一个穿刺针导引器,其主要部分是一个双层的扇形不锈钢薄片。选择80例在臂丛神经阻滞下行上肢手术的患者,随机分为自由手组和导引组,每组40人。由四位麻醉医师实施在超声引导下臂丛神经阻滞(锁骨上入路),每位医师完成20例,10例用自由手技术,10例用穿刺针导引器引导技术。记录穿刺针的主观可视性、阻滞完成时间、临床效果以及麻醉医师和患者对臂丛神经阻滞的满意度。结果导引组的针的主观可视性显著优于自由手组(P<0.05);导引组的阻滞完成时间明显短于自由手组(P<0.01);麻醉医师使用导引技术的满意度高于使用自由手技术(P<0.05)。结论使用穿刺针引导技术更容易完成超声引导下臂丛神经阻滞。     

成人肌间沟臂丛神经阻滞运动反应终点的研究

目的研究胸大肌、三角肌运动反应作为外周神经刺激器(PNS)定位下成人经肌间沟臂丛神经阻滞终点的可行性。方法择期成人上肢手术240例,PNS定位下行经肌间沟臂丛神经阻滞,随机均分为四组:胸大肌运动反应终点组(A组)、三角肌运动反应终点组(B组)、肱二头肌运动反应终点组(C组)和胸大肌、三角肌或肱二头肌运动反应终点组(D组)。比较组间刺激域电流、获得终点时间、运动阻滞起效时间、各神经分支感觉阻滞起效时间、运动阻滞效果、各神经分支感觉阻滞效果及神经阻滞综合效果。结果D组获得终点时间短于A、B、C组(P<0.05),组间刺激域电流、运动阻滞起效时间、各神经分支感觉阻滞起效时间、运动阻滞效果、各神经分支感觉阻滞效果及神经阻滞综合效果差异无统计学意义。神经阻滞综合优良率90.8%。结论胸大肌、三角肌运动反应终点可作为PNS定位下成人经肌间沟臂丛神经阻滞穿刺针正确定位的满意、安全标志。