无水酒精阻滞大鼠腹腔神经丛后脊髓、孤束核C-FOS和NOS-1的表达

目的:通过免疫组化的方法研究无水酒精阻滞大鼠腹腔神经丛后脊髓和延髓孤束核内CFOS和NOS1的表达。材料和方法:对70只Wistar大鼠实施手术,建立实验动物模型。分5组于术后不同时间取得脊髓和延髓样本,并用标准方法对其进行CFOS和NOS1免疫组化染色,观察脊髓和延髓孤束核CFOS和NOS1的表达。结果:无水酒精阻滞后脊髓后角、延髓孤束核神经元细胞内均有CFOS和NOS1表达。结论:无水酒精阻滞腹腔神经丛后,短时间内脊髓后角和延髓孤束核内CFOS和NOS1表达阳性,表明FOS和NOS1与内脏信息在脊髓水平的传导有关。CFOS和NOS1参与了内脏信息在孤束核内的传导。     

Idiopathic Spinal Cord Herniation as a Treatable Cause of Progressive Brown-Sequard Syndrome

Idiopathic spinal cord herniation is a rare spinal cord disorder caused by spinal cord prolapse through a adural defect. It is a curable disease, so early detection is of particular importance. We report a 38-year-old woman with Brown-Sequard syndrome which was caused by the thoracic spinal cord herniation. Her weakness was almost completely resolved after surgical management, which emphasizes the importance of early diagnosis and surgical management in this rare disease entity.     

Effect of the free radical scavenger MCI-186 on spinal cord reperfusion after transient ischemia in the rabbit

Objective: Paraplegia remains a serious complication of aortic operations. The production of free radicals during reperfusion after transient ischemia is believed to induce secondary spinal neuronal injury, resulting in paraplegia. The aim of the present study was to clarify the protective effect and method of administration of antioxidants on the neurological and histological outcome in the animal model for reperfusion injury after transient spinal cord ischemia. Methods: New Zealand white rabbits underwent surgical exposure of the abdominal aorta that was clamped for 15 minutes to achieve spinal cord ischemia. Group A animals received two 10 mg/kg doses of 3-methyl-l-phenyl-2-pyrazolin-5-one (MCI-186) at the time of release of the aortic clamp and 30 minutes later. In group B, MCI-186, 5 mg/kg, was given three times, at the time of aorta clamp release, 30 minutes and 12 hours later. In group C (control group), one dose of vehicle was administered. Neurological status was assessed using modified Tarlov’s score until 168 hours after operation. Spinal cord sections were examined microscopically to determine the extent of ischemic neuronal damage. Results: Groups A and B animals had better neurological function than group C (p(0.001). In contrast, group C animals exhibited paraplegia or paraparesis with marked neuronal necrosis. The number of surviving neurons within examined sections of the spinal cord was significantly greater in group B than in group C (p(0.001). Conclusion: In a 15-minute ischemia-reperfusion model using rabbits, systemic repetitious administration of MCI-186, a free radical scavenger, was found to have a protective effect on the spinal cord neurons both neurologically and histologically. We postulate that the drug minimizes the delayed neuronal cell death for reperfusion injury after transient ischemia by reducing the free radical molecules. Moreover, it was thought that we could protect delayed neuronal cell death more effectively by administering MCI-18612 hours later.     

Prenatal diagnosis of Werdnig Hoffmann disease in China

Objective To establish a means for prenatal prediction of spinal muscular atrophy (SMA) through survival motor neuron (SMN) gene deletion analysis and genetic counseling in families with a child affected with SMA.
Methods Genetic analysis for prenatal prediction of Werdnig-Hoffmann disease was performed in a at risk Chinese family by polymerase chain reaction (PCR)-single-strand conformation polymorphism (SSCP) in SMN gene exons 7 and 8.
Results The pregnancy was positive for the homozygous deletion of the SMN gene, thus the fetus was diagnosed as being affected and the pregnancy was terminated.
Conclusion This approach is fast and reliable for DNA-based prenatal diagnosis of Werdnig-Hoffmann disease.     

腰麻硬膜外联合麻醉在全产程中的镇痛效果及对母婴的影响

①目的　探讨腰麻硬膜外联合麻醉在全产程中的镇痛效果以及对母婴的影响。②方法　选择ASAⅠ～Ⅱ级、无禁忌证的单胎头位临产初产妇 30 0例 ,随机分为腰硬组 (腰麻硬膜外联合麻醉 )、硬外组 (硬膜外麻醉 )和对照组 (未用任何麻醉方法 )各 10 0例。行L2～ 3 椎间隙一点穿刺并一次成功。分别观察镇痛效果、起效时间、用药量、副作用、产程、分娩方式及母婴情况。③结果　腰硬组镇痛效果、起效时间以及用药量明显优于硬外组(uc=5 .34,t=16 .92～ 2 9.6 9,P <0 .0 1) ;与对照组比较 ,宫颈扩张加速 ,第一产程明显缩短 ,而第二产程延长 (t =3.34～ 4 8.4 9,P <0 .0 1) ,剖宫产率明显下降 ,而阴道助产率增高 ,胎儿宫内窘迫的发生率下降 (χ2 =6 .82～ 2 0 .35 ,P <0 .0 1)。④结论　腰麻硬膜外联合麻醉用于分娩镇痛优于硬膜外麻醉 ,是一种安全有效、更适合全产程镇痛的麻醉方法。     

胸椎骨折合并胸外伤的外科治疗

目的　总结 17例胸椎骨折患者的特点与诊疗情况 ,为提高此类合并胸外伤患者的疗效提供有效的治疗方案。方法　分析了 17例胸椎骨折患者的临床特点、诊疗经过、近远期随访结果。结果　 14例 (82 .4 % )合并肋骨骨折 ,11例 (6 4 .7% )合并血气胸 ,10例 (5 8.8% )合并严重脊髓伤 ,3例 (30 % )远期脊髓伤为有用恢复。结论　胸椎骨折常合并肋骨骨折、血气胸、严重脊髓损伤 ,预后较差 ,为此应重视合并胸外伤的胸椎骨折的围手术期处理     

羊水细胞培养进行脊肌萎缩症的产前诊断

目的 应用错配聚合酶链反应-限制性片断长度多态性（PCR-RFLP）方法进行脊肌萎缩症（spinal muscular atrophy,SMA)的产前诊断。方法 基于运动神经元生存基因（SMN）的两个同源拷贝碱基的差异，通过羊水细胞培养，应用错配PCR-RFLP法对2例有SMA阳性家族史的胎儿进行产前基因诊断。结果 2例均无SMN基因外显子缺失。结论 SMN基因缺失检测技术是高效、快速的SMA产前诊断的方法。     

家兔阴茎皮肤感觉脊神经来源的电生理研究

目的:探讨家兔阴茎感觉神经来源。方法:健康成年雄性新西兰白兔12只,随机均分为两组:每组6只,A组在左侧脊神经上记录,B组在右侧脊神经上记录。对家兔阴茎施加不同大小的机械刺激,用神经单纤维记录技术,在同侧S1~S4脊神经上记录单纤维放电。结果:通过对家兔阴茎施加各种不同机械刺激,在同侧S2~S3脊神经上能记录到放电,S1、S4脊神经上未能记录到放电。左侧脊神经放电纤维数量分别为:S2:39.67±3.14,S3:21.00±2.19;右侧脊神经放电纤维数量分别为:S2:40.00±3.16,S3:19.67±2.58,左右侧差异无显著性(P>0.05)。结论:家兔阴茎皮肤感觉来源于S2~S3脊神经。     

常压及控制性降压下脊髓急性牵拉损伤比较研究

目的 评价控制性降压是否增加脊髓对牵拉损伤的易感性。材料与方法健康成年杂种犬6只，随机分为常压和控制性降压脊髓牵拉损伤组。观察常压及控制性降压水平下相同程度牵拉损伤后脊髓血流(SCBF)、体感诱发电位(SEP)、神经源性运动诱发电位(NMEP)改变的差异。结果 外周血有创动脉压(MABP)平均下降幅度为40．5％。经SSPS统计软件独立样本t检验，不同牵拉水平下，常压组及低压组的SCBF(％)、SEP波幅(Asep)(％)及NMEP波幅(％)无显著差异。结论 尼卡地平控制性降压不增加脊髓对牵拉损伤的易感性。     

脊柱后路减压治疗胸腰段骨折脱位合并脊髓损伤术式选择

目的研究两种不同脊柱后路减压方法治疗胸腰段骨折脱位合并脊髓损伤的手术治疗效果。方法回顾分析本院1996年3月～2002年6月收治的胸腰段骨折脱位并脊髓损伤患者76例，按不同减压方法将其分为两组：切除一侧或两侧椎板、椎弓根或部分关节突行侧前方环状减压AF内固定者40例，为直接减压组；体位复位结合AF器械矫正复位36例，为间接减压组。统计学分析，两组资料具有可比性。对术后神经功能恢复情况，按ASIA神经功能评定标准进行评定。中晚期并发症，根据是否有腰背痛，下肢根性痛、麻木无力，两便功能障碍进行评定。生活能力按FIM评定。结果两组病例获6个月～5年随访，结果表明，术前脊髓完全性损伤，术后均无恢复；术前脊髓不完全性损伤，术后两组间比较差异无显著性。中晚期并发症发生，直接减压组高于间接减压组；术后生活自理能力，间接减压组好于直接减压组。结论间接减压手术方法治疗胸腰段骨折脱位合并脊髓损伤不失为一种早期治疗的首选方法。