颗粒复位法治疗20例后半规管良性发作性位置性眩晕

目的：探讨颗粒复位法对后半规管耳石引起的良性发作性位置性眩晕的治疗效果。方法：对20例急诊确诊为后半规管性良性发作性位置性眩晕的患者行颗粒复位法治疗。结果：经1次颗粒复位法治疗后，16例患者症状消失，首次治疗有效率为80％，2例经2次，1例经3次该手法治疗有效，总有效率为95％。经随访，1例复发，复发者再行颗粒复位法治疗仍有效。结论：颗粒复位法治疗后半规管良性发作性位置性眩晕简单、安全、经济、有效。     

Dizziness is associated with decreased vasoreactivity in right cerebral hemisphere for head-down manoeuvre--near-infrared spectroscopy study

To investigate the vasoreactivity of cerebral hemisphere in patients with dizziness and syncope, we compared changes in total haemoglobin (THbl) and regional oxygen saturation (rSO2) of the right and left frontal lobes in response to head-down manoeuvre. Ninety-six right-handed subjects (aged 59 +/- 19 years) were asked to perform a head-down or a standing manoeuvre. Head-down manoeuvre produced a greater increase in right side THbl in subjects under 70 years of age (8.5 +/- 3.1) when compared with subjects older than 70 years (0.40 +/- 0.08). In contrast, the head-down manoeuvre had no effects on left side THbl, irrespective of patient age. Similarly, the head-down manoeuvre resulted in a greater decrease of right side rSO2 in subjects under 70 years of age (-5.2 +/- 2.1%) when compared with subjects older than 70 years (0.31 +/- 0.9%). In contrast, the head-down manoeuvre had no effects on left side rSO2, irrespective of patient age. The head-down manoeuvre produced a smaller increase in right side THbl in subjects with dizziness (0.38 +/- 0.19) than in those without dizziness (9.4 +/- 3.5). A standing manoeuvre produced a smaller increase in right side THbl in subjects with syncope (-0.057 +/- 0.047) than in those without syncope (0.063 +/- 0.028). The head-down manoeuvre produced a decrease in right side rSO2 in subjects without dizziness (-6.4 +/- 2.4%) and a slight increase in right side rSO2 in subjects with dizziness (1.1 +/- 0.4%). Subjects with dizziness (67 +/- 2.1 years) were significantly older than those without dizziness (53 +/- 2.7 years) or those with syncope (44 +/- 4.2 years). These data indicate that reduced vasoreactivity to right hemispheric pressure changes is associated with dizziness in older subjects. Further, decreases in right hemispheric THbl during a standing manoeuvre are associated with syncope in relatively younger subjects.     

Hematoma endocapsular: complicación inusual tras facoemulsificación y esclerectomía profunda no perforante

Case reportA 68-year-old male with a cataract and uncontrolled primary open angle glaucoma with maximal tolerated medication underwent non-penetrating deep sclerectomy combined with phacoemulsification surgery in right eye. There were no complications during the procedure, but shortly after the surgery, he lost visual acuity after a Valsalva manoeuvre due to an endocapsular haematoma. Neodymium:YAG laser posterior capsulotomy was performed for the treatment of an unresolving endocapsular haemorrhage at the third month of the follow-up, with immediate visual improvement and optimal control of intraocular pressure.DiscussionTo the best of our knowledge, this is the first reported case of endocapsular haematoma as a complication of non-penetrating glaucoma surgery that has been successfully solved by a YAG capsulotomy.     

Comparison of blood pressure response to isokinetic and weight-lifting exercise

Summary Brachial arterial pressure, oesophageal pressure, and knee joint angle were monitored in eight untrained young men as they performed bilateral leg-press actions (simultaneous hip and knee extension and ankle plantarflexion) against resistance. Single maximal leg-press actions on an isokinetic device evoked mean peak arterial (systolic/diastolic) pressures of 35.4/26.2 and 34.0/23.4 kPa at lever arm velocities of 0.262 and 1.31 rad·s^–1, respectively. The corresponding oesophageal pressures were 13.2 and 10.4 kPa, respectively. Although the peak force was 30% greater, and duration of the action 3–4 times longer at 0.262 than 1.31 rad·s^–1, the arterial and oesophageal pressure responses did not differ. On a weight-lifting machine, a set of repetitions [mean (SEM): 11 (3)] to failure at 80–90% one repetition maximum evoked peak arterial pressures of 45.5/32.8 kPa; the corresponding oesophageal pressure was 15.7 kPa. The peak systolic and diastolic pressures observed during weight-lifting were significantly (P < 0.05) higher than during isokinetic actions at both velocities, whereas oesophageal pressure was more elevated only in relation to isokinetic actions at the higher velocity. These data indicate that resisted leg-press actions cause extreme elevations in arterial blood pressure. The degree of voluntary effort is the major determinant of the blood pressure response, rather than the resistance mode or the type (concentric, eccentric, isometric) of muscle action. Repetitive resistance exercise (e.g. a set of repetitions to failure in weight-lifting) tends to produce greater pressure elevations than isolated, single maximal effort actions.     

Severe paroxysmal hypertension induced by a subconscious Valsalva-like manoeuvres

We describe the case history of a 32 year old male with severe paroxysmal hypertensive spikes when there was an increase in diastolic blood pressure to 150–200 mmHg. These spikes occurred during rest and especially during modest exercise. They were associated with headache and dyspnoea and were resistant to antihypertensive medication. After 5 years of observations and investigations he underwent further 24-h intra-arterial blood pressure monitoring and physiological testing. The 24-h blood pressure profile was near normal at rest. The observed hypertensive spikes seemed to be induced by involuntary Valsalva-like manoeuvres. This had not been detected previously by the investigators and the patient was unaware of inducing these manoeuvres.     

Tonography, Valsalva manoeuvre and central visual fields. A study of 429 patients

Four hundred and twenty nine patients (846 eyes) referred to the glaucoma clinic at Concord Hospital between 1979 and 1989, were included in a prospective study. This study investigated the circulatory status of each eye during tonography, by using a modified Valsalva manoeuvre to induce changes in intraocular pressure (IOP) and amplitude of tonography pulse pressure (TPP). Of the large falls in IOP, 85% of the eyes had a Po/C > 150. The average IOP without medication, on the morning of the test, was 20 mmHg (2.67 kPa). Central visual field defects were found in 495 eyes, and these were far more prevalent in the Po/C> 150 category. An unexpected finding was the ratio of 67:33 right to left eyes in the Po/C < 100 category. The commonest reasons for referral were intermittent rises of IOP, suspicious optic disc cupping, and the need to confirm a previously made diagnosis.     

Cricoid pressure: assessment of performance and effect of training in emergency department staff

Objectives: (i) To evaluate the theoretical knowledge and practical skills of ED staff regarding the technique of cricoid pressure; (ii) to assess the efficacy of two methods of cricoid pressure training. Methods: Theoretical knowledge of participants was assessed by a pretraining questionnaire, and practical ability was assessed using a Flinders Meditech cricoid pressure trainer. Participants then received a brief period of theoretical instruction, and were allocated to two training groups. Group A received further training with the pressure trainer. Group B was provided with reading material. Practical ability was assessed again immediately and then 4–6 weeks later. Results: Seventy subjects were recruited. A total of 53% could identify the position of the cricoid cartilage, and 16% could identify the pressure required. The percentage achieving a correct position at baseline, immediately after training and after 4–6 weeks was 47%, 97% and 70% respectively in group A, compared with 61%, 86% and 74% respectively in group B, a non‐significant difference between groups. The percentage achieving correct pressure at baseline, immediately after training and 4–6 weeks later was 38%, 88% and 67% respectively in group A, compared with 30%, 33% and 51% respectively in group B. The between‐group difference was significant only immediately following training (P < 0.0001). Conclusion: Theoretical knowledge and technique regarding cricoid pressure was poor among our ED staff. Both methods of training appeared to improve performance. The biofeedback group was more likely to apply correct pressure immediately after training. The effects of training diminished rapidly with time.     

军医大学机动卫勤分队“联训联演”教学训练

某军医大学充分发挥卫勤学术研究和卫勤保障方面的先导优势,广泛开展与部队训演合作,改革军医大学卫勤综合演练模式,探索机动卫勤分队能力建设的新路;本文从运行机制、保障平台和考评体系三个方面,简要总结机动卫勤分队保障能力建设过程中的经验和做法,提出改进建议,旨在为推进院校机动卫勤分队训练模式转型和提升卫勤保障力提供借鉴。     

Cartwheel retinopathy

A case of Valsalva retinopathy is presented, with a discussion of treatment options.