Comparative study of awake endotracheal intubation with Glidescope video laryngoscope versus flexible fiber optic bronchoscope in patients with traumatic cervical spine injury

BackgroundThe Gldiescope video laryngoscope (GVL) as a recent intubating device has gained much popularity in difficult intubation over the last decade. It can be used as a substitute to flexible fiber optic bronchoscope (FOB) in intubating challenges. The object of this study is to compare the utility of GVL and FOB for intubating time, attempts, effects on hemodynamics, adverse effects, patient satisfaction and post intubation neurological outcome during awake intubation in traumatic cervical spine injury.MethodsFifty patients undergoing post traumatic cervical spine fixation under general anesthesia were randomly allocated to two groups in a prospective, controlled non-blinded study. All patients were premedicated with glycopyrrolate 0.2 mg iv and midazolam 1 mg iv that be repeated up to 0.05 mg/kg followed with a bolus dose of remifentanil 1.5 μg/kg then a continuous remifentanil infusion of 0.15 μg/kg/min for 3 min before procedure. Each patient underwent a wake endotracheal intubation with either GVL (G group) or FOB (F group) with manual in line stabilization (MILS). Intubating time, intubating attempts, hear rate (HR), mean arterial pressure (MAP), oxygen desaturation (SO₂ < 90%), sore throat, patient satisfaction and postintubation neurological outcome were recorded.ResultsIntubating time was significantly lower in G group compared with F group (26 ± 5 versus 72 ± 11 respectively), while the percentage of the first successful intubating attempt was insignificantly higher in G group (88%) than in F group (72%). Both HR and MAP were significantly increased only in F group during intubation in comparison with the basal line values. Both devices were safe for post neurological outcome. No significant differences of adverse effects or patient satisfaction were recorded between groups.ConclusionThe GVL is a safe surrogate for FOB during awake intubation for post traumatic cervical spine fixation.     

Leber遗传性视神经病相关的三种原发性线粒体突变的无创检测方法建立

目的：建立1种Leber遗传性视神经病（LHON）相关的3种原发性线粒体突变11778G＞A、14484T＞C和3460G＞A的无创检测方法。方法：研究对象为在温州医科大学附属眼视光医院就诊的3例（WZ1481、WZ1478、WZ1435）基因检测确定为m.11778G＞A、m.14484T＞C和m.3460G＞A突变的LHON患者。采集3例LHON患者和2例野生型健康对照的静脉血样及口腔黏膜细胞样本,然后分别用手工法和试剂盒法提取全基因组DNA,分析比较2种样本、2种方法提取的DNA的纯度及浓度有无差别。最后以携带m.11778G＞A、m.14484T＞C和m.3460G＞A突变的LHON患者和野生型的口腔黏膜细胞和外周血提取的全基因组DNA作为模板,通过PCR扩增分别包含以上3种突变的DNA片段,然后进行焦磷酸测序、斑点杂交和Southern blot分析PCR产物。结果：口腔黏膜细胞和血液提取的DNA浓度的差异无统计学意义（P＞0.05）。手工法提取的口腔黏膜细胞DNA纯度低于试剂盒法提取的口腔黏膜细胞和血液DNA的纯度,差异有统计学意义（P＜0.05）。口腔黏膜细胞提取的DNA产量与血液相似。DNA测序结果显示血液样本和口腔黏膜细胞样本具有很好的一致性,对照组均检测不到突变,而突变组可以检测到相应的突变。斑点杂交和Southern blot的结果也一致,对照组均为阳性而突变组均为阴性。结论：口腔黏膜细胞DNA可用于筛查和鉴定LHON的3个主要线粒体突变。本研究建立了一种方便、无创的方法来检测LHON相关的m.11778G＞A、m.14484T＞C和m.3460G＞A突变。     

手术治疗病毒性尺神经炎11例

2005年3月～2008年12月,我院收治病毒性尺神经炎患者11例,经手术治疗,疗效满意。1材料与方法1.1病例资料本组11例,男6例,女5例,年龄16～34岁。4例有明确的感冒病史,1周内出现局部疼痛,手部尺侧麻木。来院就诊时间距发病后3周～4个月。11例均为前臂尺神经段。     

正常成人眶内段视神经的MRI测量研究

目的 :评价正常成人视神经、视神经蛛网膜下腔的 MRI表现 ;通过测量视神经直径和蛛网膜下腔外径 ,建立正常标准。方法 :正常成人志愿受试者 42例 ,按性别和年龄 (18～ 40岁 ,41～ 6 0岁 ,6 0岁以上 )分组 ;采用 1.0 T MRI成像仪 ,环形激化圆形头颅线圈作眶内段视神经 MRI检查 ,应用 fs TSE- T2 加权序列 ,以斜矢状位为基准 ,垂直于视神经作斜冠状位扫描 ,扫描点位于球后 4mm、8mm和眶尖部。结果 :眶内段视神经不等粗 ,由前至后逐渐变细 ,前、后段直径分别为 2 .94± 0 .2 2 mm至 2 .2 4± 0 .2 4mm ,蛛网膜下腔外径不等宽 ,由前至后逐渐变窄 ,前、后段外径分别为 5 .2 5± 0 .2 4mm和 3.5 6± 0 .32 mm,蛛网膜下腔面积也逐渐变小 ,两径线比率则逐渐变大 ;性别和年龄组间无显著差异 (P>0 .0 5 )。结论 :MRI能准确显示视神经和蛛网膜下腔 ,测量结果与解剖学研究有良好的相关性 ,为视神经及蛛网膜下腔的评价提供了客观的定量指标 ,是视神经及相关病变较好的影像学检查方法     

视神经炎的MRI表现及与视觉诱发电位的相关性研究

目的 探讨诊断视神经炎的有效MR检查序列、MRI表现及其与视觉诱发电位(VEP)的相关性.方法 对98例(154只眼)诊断为视神经炎、视神经乳头炎、多发性硬化、视神经脊髓炎的视力下降患者MRI资料进行分析,并与VEP结果及临床视力表现做x2检验、秩和检验和一致性分析.结果154只患眼中56条视神经增粗,76条形态不变,22条变细.MR短时间反转恢复(STIR)序列显示132条视神经呈异常高信号.异常信号累及范围包括视神经球壁段7条,眶内段135条,管内段109条,颅内段97条,视交叉受累56例,视束受累23条.54例行钆喷替酸葡甲胺(Gd-DTPA)增强枪查者,87只患眼中74条视神经强化.98例患者共196只眼中,视力下降同时视神经MRI信号异常者132只眼,视力正常、视神经MRI信号正常者26眼,MRI与视力表现之间的一致率为80.61%(Kappa=0.453,P＜0.01).住获得VEP结果的175只眼中,视力下降同时VEP异常者129只眼,视力正常、VEP正常者30只眼,VEP与视力表现之间的一致率为90.86%(Kappa=0.731,P＜0.01);视神经MRI信号异常及VEP异常者117只眼,MRI信号正常、VEP正常者24只眼,MRI表现与VEP之间的一致率为80.57%(Kappa=0.460,P＜0.01).结论MR STIR序列和Gd-DTPA增强扫描联合脂肪抑制技术有助于视神经炎定位和定性诊断,VEP有助于视神经炎的诊断和亚临床病灶发现,MRI结合VEP能提高视神经炎诊断的准确率.     

L161982对大鼠实验性自身免疫性神经炎中巨噬细胞亚型变化的影响

目的 探讨前列腺素E₂-EP4受体拮抗剂L161982对大鼠实验性自身免疫性神经炎(EAN)中巨噬细胞亚型的影响。方法 EAN模型建立后将21只EAN大鼠随机分为A、B、C 3组。A组每日腹腔注射L161982溶媒,B组自免疫前1天至免疫第8天(免疫阶段)、C组自免疫第5~16天(发病期)均每日腹腔注射L161982(5 mg/kg)。免疫第16天处死大鼠收集腹腔灌洗细胞,用CD68与CD86或CD163不同荧光抗体组合标记M1、M2亚型巨噬细胞,流式细胞术检测各组巨噬细胞亚群比例;ELISA法检测各组大鼠脾单核细胞培养上清中IL-12、IL-10含量。结果 B、C组与A组相比,L161982降低CD86+细胞占总细胞的比例(P<0.05)及CD86+细胞占CD68+细胞比例(P<0.05),升高CD163+细胞占CD68+细胞比例(P<0.05);降低IL-12含量(P<0.05),升高IL-10含量(P<0.05)。B组高峰期临床评分较A、C组降低(P<0.05)。结论 L161982通过降低EAN中M1型巨噬细胞比例,升高M2型巨噬细胞比例减轻EAN病情,免疫阶段作用更明显。     

高树中针药并用辨治疑难病案三则

高树中重视中医经典理论与临床应用的有机结合,倡导针药并用,内外合治。以高老师将《黄帝内经》与临床相结合为例,摘选其针药并用,结合脏腑经络辨证、面部全息理论等方法,辨治痉挛性斜颈、视神经损伤及顽固性心悸三则验案,介绍高老师临床诊疗思路及遣方用穴特色。     

富血小板血浆与骨再生

急性臂丛神经炎是一种少见病,但人们往往认识不足,在早期,易被误诊为神经根型颈椎病或胸廓出口综合征。为了提高对本病的认识,降低误诊和漏诊率,本文就急性臂丛神经炎的诊断、鉴别诊断与治疗进行综述。1诊断名词与病因急性臂丛神经炎,病因尚未明了,但却有典型的临床特征。最初由Parsonage等[1]和Turner等[2]报道为肩胛带综合征和麻痹性臂丛神经炎,后被称之为:Parsonage-Turner综合征。其他诊断名词有:急性臂丛神经炎,神经源性肌萎缩,术后原发性臂丛神经炎等[3,4]。     

Cavernous haemangiomas of the anterior visual pathways. Short review on occasion of an exceptional case

Summary The anterior optic pathways are rarely affected by vascular malformations. In a meticulous literature review, 42 published cases of patients with vascular malformations within optic nerves, chiasma and/or optic tract were found, 30 of them being diagnosed as cavernous haemangiomas. All of them suffered from visual disturbances; in 38.1% previous symptoms had occurred. Surgical treatment resulted in major improvement in most patients. We include a further patient with a cavernous haemangioma of the optic chiasma and left optic tract who presented with an acute defect of the right visual field and severe retro-orbital pain. We succeeded in total excision of the malformation via a neuronavigationally guided approach. In the postoperative course, vision of our patient improved immediately and was found to be completely normal three months after the surgical intervention. Considering our patient and the published cases in the literature, we are of the opinion that microsurgical excision is a safe and efficient treatment for these rare pathologies.     

脑外伤合并视神经损伤的诊断方法和手术治疗的临床价值研究

目的：研究分析脑外伤合并视神经损伤的诊断方法和手术治疗的临床价值。方法：选取该院自2013年3月至2014年3月的脑外伤以及脑出血手术约200例患者作为研究对象,其中脑肿瘤手术的患者约20例,脑动脉瘤手术的患者约15例,对其临床诊断方法以及手术价值进行总结分析。结果：200例脑外伤合并视神经损伤患者经手术治疗之后显效120（60．0％）,有效70例（35．0％）,总有效率为95．0％。结论：采用眶部 CT 检查诊断脑外伤合并视神经损伤具有重要临床意义,采用视神经减压术治疗脑损伤合并视神经损伤的疗效非常显著,值得临床广泛使用和推广。