Arm function after axillary dissection for breast cancer: a pilot study to provide parameter estimates.

Sixty-three women participated in a study in Calgary, Alberta to assess the rate of arm recovery and factors affecting it up to one year after axillary node dissection for breast cancer. Outcomes included objective measures of swelling, mobility, and strength, and subjective assessments of pain (at rest and with movement) and stiffness. Approximately 42% of women had residual impairment of at least one type one year after surgery, the most common problems being pain (16%) and reduced grip strength (16%). Except for lymphedema, measurements one year after surgery showed little change from measurements at 6 months, suggesting that the shorter follow-up may be appropriate for assessing the long term effects of axillary dissection. Lymphedema was the only sequela which increased over time. The results provide parameter estimates for designing studies to evaluate the role of physiotherapy after axillary dissection.     

伴上肢局部水肿的颈椎病与颈椎减压术的关系

[目的]探讨伴有上肢局部水肿的颈椎病患者的发病机理和与手术颈椎减压的关系。[方法]总结分析4a来收治的10例伴有上肢局部水肿的颈椎病人，其中脊髓型颈椎病7例，神经根型颈椎病2例，后纵韧带骨化型1例，7例行前路椎体次全切减压植骨内固定，1例行前路椎体次全切＋单间隙间盘摘除植骨内固定，2例行后路减压植骨内固定，术后观察患者水肿消退情况。[结果]10例病人上肢局部水肿不同程度消退，前路手术者较后路手术者消退快。[结论]颈椎病患者上肢水肿的发生与颈交感神经受激惹有关，通过前路或后路颈椎管减压，去除颈椎不稳、椎间盘突出、骨赘等交感神经受激惹因素，水肿可逐步消退。     

A new hypothesis for the bone marrow edema pathogenesis during transient osteoporosis

Transient osteoporosis is an infrequent condition of uncertain etiology with pain, limited range of motion and radiographic evidence of osteoporosis affecting one or more joints. It is self-limited, reversible and can involve only the hip (transient osteoporosis of the hip, TOH) or, less frequently, one or more joints contemporaneously or at different times (regional migratory osteoporosis, RMO). We studied four men with transient osteoporosis, including two with TOH and two with RMO. All patients underwent a standard radiographic work-up of the affected joints, arteriovenous Doppler US, computed tomography, magnetic resonance imaging (MRI) and three-phase bone scanning. In all patients, symptoms were related to bone marrow edema demonstrated at MRI and to a transitory regional arterial hyperflow observed at the early scintigraphic analysis. On the basis of our observations, we hypothesize that regional arterial hyperflow may be the cause of the bone marrow edema and therefore of the transient osteoporosis.     

中枢去甲肾上腺素能神经元在脑水肿发生过程中的作用实验研究

为探讨中枢去甲肾上腺素（ＮＥ）能神经元兴奋对脑水肿的影响，作者观察了刺激或损毁大鼠右侧蓝斑后，同侧大脑半球脑水含量的变化．结果，ＮＥ能神经元兴奋时，同侧半球脑皮质神经元也处于兴奋状态，脑内ＮＥ，肾上腺素（Ｅ）含量分别达正常组的３０７．４６％和２９９．４１％，脑水含量（７９．２１±０．２８％）也较正常组（７８．４６±０．４２％）明显增高（Ｐ＜０．０１）．损毁蓝斑后，同侧半球脑内ＮＥ，Ｅ含量仅为正常组的１２．８０％和３２．３１％，脑水含量稍有下降，无统计学意义．提示中枢ＮＥ能神经元兴奋可能是脑水肿发生过程中的重要环节之一．     

L-精氨酸对高原肺水肿患者血液流变学的作用

目的：探讨雾化吸入左旋精氨酸（L-Arg）对高原肺水肿患者血液流变学的影响。方法：在海拔3700m高原，采用氧气驱动雾化吸入L-Arg，治疗高原肺水肿（HAPE）患者9例（L-Arg组），将吸入低浓度一氧化氮（NO）混合气治疗的另外8例高原肺水肿患者（NO组）作对照，分别测定患者的红细胞压积（HCT）、血液粘度（ηb）、血浆粘度（ηp）、还原粘度（ηr）、红细胞刚性指数（IR）、红细胞变形系数（TK）、红细胞聚集系数（VAI）和血栓形成系数（TFL）等血液流变学指标。结果：NO组和L-Arg组治疗后较治愈前ηb、ηp、ηr、VAI、TFL均降低显著（P〈0．05～0．01），而HCT、TK、IR无统计学差异（P〉0．05）；NO组与L-Arg组比较，各指标均无统计学差异（P〉0．01）。结论：L-Arg治疗HAPE有效，通过提高NO水平而改善血液循环，且经济简便，易于推广应用。     

肝功能衰竭大鼠脑水通道蛋白-4表达与MR扩散加权成像的相关性研究

目的研究水通道蛋白-4（AQP-4）在急、慢性肝功能衰竭时脑组织中的表达规律，应用MR扩散加权成像（DWI）探讨脑水肿的分子生物学机制。方法雄性SD大鼠65只采用数字表法随机分为急性组（25只）、慢性组（25只）和对照组（15只），分别诱发急、慢性肝功能衰竭。行DWI观察异常信号分布情况，测量顶部皮质区、外侧部皮质区和邻近侧脑室区的DWI信号强度。处死后进行血氨检测，取与DWI检查对应的大脑层面切片行病理观察、免疫组织化学及逆转录．聚合酶链式反应（RT—PCR）检测，检测AQP-4蛋白表达水平，并进行统计学分析。结果急性组肝细胞坏死及脑水肿明显，慢性组呈肝硬化改变，脑水肿不明显。血氨浓度急性组、慢性组和对照组分别为（516±46）、（158±26）和（148±32）μmol／L，差异有统计学意义（F=188．325，P〈0．01）。顶部皮质区、外侧部皮质区和邻近侧脑室区的DWI信号强度对照组分别为516±160、727±183和656±181；急性组分别为1766±438、1223±503和1216±446；慢性组分别为700±213、820±263和713±243，差异均有统计学意义（F值分别为44．612、3．422和5．581，P值均〈0．05）。相应区域AQP-4蛋白表达水平（用平均灰度值表示）对照组分别为7379±1617、8104±2093和4851±2178；急性组分别为9580±2616、11057±2334和2949±1735；慢性组分别为12137±2332、11135±3102和7688±2925，3组间差异均有统计学意义（F值分别为11．414、4．602和7．002，P值均〈0．05）。急性组AQP-4蛋白表达水平与DWI信号强度有相关性（r=0．756，P〈0．05），慢性组AQP-4蛋白表达水平与DWI信号强度无相关关系（r=0．236，P〉0．05）。结论在急、慢性肝功能衰竭中血氨增高是导致脑内能量代谢异常、星形胶质细胞内AQP-4mRNA和蛋白表达增加的主要因素；DWI技术发现的信号异常可很好的反映脑水肿、AQP-4蛋白表达异常的范围、程度。     

Effect of AVP on brain edema following traumatic brain injury

Objective: To evaluate plasma arginine vasopressin (AVP) level in patients with traumatic brain injury and investigate the role of AVP in the process of brain edema. Methods: A total of 30 patients with traumatic brain injury were involved in our study. They were divided into two groups by Glasgow Coma Scale: severe traumatic brain injury group (STBI, GCS≤8) and moderate traumatic brain injury group ( MTBI, GCS >8). Samples of venous blood were collected in the morning at rest from 15 healthy volunteers (control group) and within 24 h after traumatic brain injury from these patients for AVP determinations by radioimmunoassay. The severity and duration of the brain edema were estimated by head CT scan. Results: plasma AVP levels (ng/L) were (mean±SD): control, 3. 06±1. 49; MTBI, 38. 12±7. 25; and STBI, 66. 61±17. 10. The plasma level of AVP was significantly increased within 24 h after traumatic brain injury and followed by the reduction of GCS, suggesting the deterioration of cerebral injury (P<0. 01). And the AVP level was correlated with the severity (STBI r =0.919, P < 0.01; MTBI r = 0.724, P < 0.01) and the duration of brain edema (STBI r = 0. 790, P < 0. 01; MTBI r = 0. 712, P<0.01). Conclusions: The plasma AVP level is closely associated with the severity of traumatic brain injury. AVP may play an important role in pathogenesis of brain edema after traumatic brain injury.     

甲基强的松龙和地塞米松治疗放射性脑水肿的差异

目的研究甲基强的松龙及地塞米松治疗放射性脑水肿的差异。方法建立大鼠脑胶质瘤模型。实验分组：A组（大剂量甲基强的松龙组）、B组（小剂量甲基强的松龙组）、C组（地塞米松组）、D组（对照组）、E组（空白组）。各组均颅内种植肿瘤，于种植15天后A、B、C、D各组给予C060照射，A、B、C组大鼠照射前后分别给予甲基强的松龙和地塞米松治疗。测量大鼠脑水肿情况。结果治疗后，与其他各组比较，D组大鼠脑组织含水率最高，E组最低（P〈0．05）；C组大鼠脑组织含水率明显高于A、B两组（P〈0．05）；但A、B两组间无显著性差异（P〉O．05）。结论甲基强的松龙和地塞米松都可以有效防治放射性脑水肿，且甲基强的松龙比地塞米松疗效更好。     

The peri‐microvascular edema in hippocampal CA1 area in a rat model of sepsis

Encephalopathy is a common complication of sepsis. However, little is known about the morphological changes that occur in the brain during sepsis. In this study, fecal peritonitis was induced in Wistar rats, which had been monitored for 4 h before their brains were removed and samples from the CA1 area taken. In addition to higher blood pressure with a decreasing pattern and a significant drop in rectal temperature, an increased heart rate and marked respiratory failure were observed. The tissue was investigated and compared with corresponding hippocampal samples taken from sham‐operated and not operated control groups. Significantly more peri‐microvascular edema was found in the hippocampal CA1 area in the septic group. The percentages of the peri‐microvascular edema were 158.57 ± 3.6%, 122.84 ± 1.5% and 120.24 ± 1.9% in the fecal peritonitis group, sham‐operated and not operated control groups, respectively. The results may suggest that the edema observed around the microvessels may participate in the pathogenesis of the septic encephalopathy probably by causing in the microvascular permeability characteristics.