A study exploring the role of intercostal nerve damage in chronic pain after thoracic surgery

Objective: Our aim was to investigate the prevalence of intra-operative nerve damage and its association with chronic pain. Methods: Our prospective study of 33 patients used nerve conduction studies to assess intercostal nerve function during elective thoracic surgical procedures. We used two methods to study nerve conduction: pre-operative magnetic stimulation (in 10 patients) and intra-operative nerve conduction studies (in all patients) We correlated these findings with specific intra-operative parameters, pain and psychological questionnaires pre-op and 3 month post-op and altered cutaneous sensation. Results: Magstim (magnetic stimulation) assessments were not reliable and were therefore abandoned. Intraoperative intercostal nerve studies revealed two distinct patterns of nerve injury and also that nerve injury was less in those cases where a rib was not resected. However, intercostal nerve damage detected at the time of operation is not associated with chronic pain or altered cutaneous sensation at 3 months post-op. Conclusions: The study findings suggest that either the amount of intra-operative intercostal nerve damage is not indicative of long-term nerve damage or that there is a more significant cause for chronic pain other than intercostal nerve injury.     

慢性多发性肌炎临床及病理分析

目的探讨慢性多发性肌炎的发病机制、临床和病理特征。方法回顾性分析95例慢性多发性肌炎患者临床表现、肌酶学和肌电图检查结果,总结肌肉病理学特征。结果慢性多发性肌炎以四肢近端肌无力、肌萎缩为主要表现,血清酶谱轻-中度增高,肌电图以肌源性损害为主,病理改变为灶性坏死、炎性细胞浸润与再生肌纤维共存。结论临床特点结合病理学检查有助于慢性多发性肌炎的诊断,多数患者激素治疗有效。     

Psychosis in epilepsy patients

Summary   Epileptic psychoses reflect a fundamental disruption in the fidelity of mind and occur during seizure freedom or during or after seizures. The psychotic symptoms in epilepsy share some qualities with schizophrenic psychosis, such as positive symptoms of paranoid delusions and hallucinations. Psychotic syndromes in epilepsy are most common but not exclusively associated with temporal lobe epilepsy. De Novo psychosis following epilepsy surgery is rare. Forced normalization—psychosis associated with dramatic reduction of epileptiform activity or seizures is described in small series only. Ictal and postictal psychosis can be prevented with seizure control, but postictal and chronic interictal psychoses require multidisciplinary and psychopharmacologic management.     

Medical management of chronic pancreatitis

慢性胰腺炎的临床表现包括疼痛、脂肪泻和糖尿病。在西方国家，慢性胰腺炎最常见的病因是酗酒。70％以上的病人在就诊时有疼痛的临床表现，而且，这些患者中又有75％以上会在几年之后出现疼痛减轻或完全消失。对于所有的慢性胰腺炎的病人来说，均应排除非胰源性疼痛和胆道梗阻、胰腺假性囊肿等胰腺局部并发症。应建议所有慢性胰腺炎病人戒烟、戒酒。阿片类镇痛剂仅应用于治疗疼痛严重的病人。尽管有报道认为胰酶替代治疗有助于止痛，但是，对于已经确诊的慢性胰腺炎病人来说，该疗法无效。激素类药物进行腹腔神经丛阻滞术可能有助于病人度过剧烈疼痛期。顽固性疼痛是进行胰液引流或胰腺切除的适应证。建议应用适量胰酶替代联合(或不联合)制酸剂治疗营养不良。慢性胰腺炎导致的糖尿病与原发性糖尿病的治疗原则相似。     

偏头痛和慢性紧张型头痛血浆精氨酸加压素、催产素及环核着酸含量测定

用放射免疫分析法测定了２８例偏头痛、１０例慢性紧张型头痛患者和１６例健康对照组血浆精氨酸加压素（ＡＶＰ）、催产素（ＯＴ）、环磷酸腺苷（ｃＡＭＰ）及环磷酸鸟苷（ｃＧＭＰ）含量。结果表明，偏头痛发作期ＡＶＰ含量下降、ｃＡＭＰ含量升高，偏头痛间歇期ｃＧＭＰ含量下降，血浆ＯＴ含量在发作期和间歇期均明显下降。慢性紧张型头痛患者血浆ＡＶＰ、ＯＴ、ｃＡＭＰ和ｃＧＭＰ与对照组比较均无显著性差异。结果提示，血浆ＡＶＰ和ＯＴ水平降低以及环核苷酸的代谢异常与偏头痛发病机制有关。     

Are chronic wheezing and asthma-like attacks related to FEV1 decline? The Cracow study

Analysis is presented of the relationship between decline in ventilatory function and possible symptoms of bronchial hypereactivity. Data comes from three consecutive surveys within a 13-year follow-up study of a population sample of 1747 persons (718 males and 1029 females) who completed spirometric testing and interviews. Chest symptoms recorded in the two initial surveys were used as baselines for the prognostic study on FEV₁ change. To evaluate changes in lung function the FEV₁ decline index, expressed as percentage of FEV₁ loss during the study period, was calculated. Chronic wheezing and asthma-like attacks were very strongly related to FEV₁ baseline level. Multiple linear regression analysis for each separate symptom including age and smoking habits as confounders and showed that the FEV₁ decline index was higher and more significant when wheezing and asthma-like attacks or chronic cough were present. When the combination of symptoms were introduced into the regression model, the effect of wheezing became insignificant. Only attacks of shortness of breath in both sexes and chronic cough in women were significantly associated with more rapid FEV₁ decline. However, the effect of persistent wheezing in men had a rather substantial impact on FEV₁ change. Comparing the effect of the number of cigarettes smoked with the effect of symptoms, one can see that FEV₁ decline due to attacks of shortness of breath is comparable to that seen with heavy smoking. There was no strong evidence that the symptoms under study precede the more rapid FEV₁ decline.     

Approved indications of lipo-PGE1 in Japan

For its peripheral vascular dilating effect and platelet agglutination inhibitory activity, prostaglandin E₁ is used in the treatment of diseases which are likely to cause peripheral circulatory failure or thrombus. In Japan, lipo-PGE₁, which was developed to give it a target-directed nature by modifying the conventional PGE₁, has been used and found to be useful in clinical practice. In this report, we attempt to describe the clinical benefits of lipo-PGE₁ focusing on the diseases which have been approved for its indications.     

Computed tomography features immediately after replacement of haematoma with oxygen through percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults

Summary In an effort to achieve a simple and less invasive method for the treatment of chronic subdural haematoma, replacement of the haematoma with oxygen by percutaneous subdural tapping was employed in 36 patients. This study was conducted on 23 haematomas in 20 patients, whose computed tomography (CT) scans immediately following the treatment were available for evaluation, with particular regard to distinguishing between their findings and those seen with tension pneumocephalus. The CT features werde divided into two patterns according to the location of oxygen; a convexity type (19 haematomas) and an interhemispheric type (4 haematomas). Analysis of the CT appearances revealed the oxygen was exclusively confined to the haematoma cavity, distinguishing it from the findings in tension pneumocephalus. This observation indicates the safety of replacement of the haematoma with oxygen when combined with our percutaneuous subdural tapping technique which prevents lesions of the inner haematoma membrane.     

慢性活动性肝炎中单核性细胞超微形态研究

经电镜观察,慢活肝中主要为淋巴细胞及单核巨噬细胞浸润。淋巴细胞分3型,通过4种方式与肝细胞接触,可能代表杀伤肝细胞的动态过程。与肝细胞接触的主要为起细胞毒作用的T_8~+Ⅱ型淋巴细胞及单核巨噬细胞。多数T_4~+淋巴细胞为Ⅰ型淋巴细胞,可能为T辅助细胞。在肝细胞损伤中,淋巴细胞及单核巨噬细胞均起重要作用。     

鸟氨酸-天门冬氨酸联合乳果糖治疗肝性脑病疗效观察

目的探讨鸟氨酸-天门冬氨酸(雅博司)联合乳果糖治疗肝性脑病的疗效.方法选择56例肝性脑病患者,在综合性治疗的基础上,给鸟氨酸-天门冬氨酸20g/d静脉滴注;乳果糖20ml口服或鼻饲,每日三次.另选36例患者作为对照组,给一般综合性治疗,同时给乙酰谷酰胺1.0g/d静脉滴注,分别治疗20天.结果治疗组病死率明显下降,与对照组相比,有显著性差异(x2=4.02,P＜0.05),在降低血氨及促进脑电图改善方面,两组也存在显著性差异.结论雅博司联合乳果糖治疗慢性重型肝炎合并的肝性脑病,疗效显著,值得研究和应用.