全程围套式与常规微血管减压术治疗面肌痉挛的对比研究

目的探讨全程围套式与常规微血管减压术治疗面肌痉挛的疗效和显微操作技术。方法回顾性分析两种微血管减压方式治疗65例面肌痉挛患者的术中情况、显微操作技术及结果。按手术方式不同分a组30例,b组35例。按起病时年龄分为C组〈40岁27例,d组〉40岁38例。结果术中a、b两组均发现面神经受压迫有4种模式：单纯接触型,压迫型,黏连包绕型,无明确责任血管型;责任血管包括动脉、静脉、混合性,血管袢;C组术中多见蛛网膜增厚,d组多见血管的构筑改变而致血管解剖移位;a组总有效率80％,复发率13-3％。b组总有效率97．1％,复发率2．9％;并发症随访1年以上未恢复者a组：耳鸣、听力下降10％,共济失调6．7％,面瘫10％;b组：耳鸣、听力下降2．9％,面瘫2．9％。结论全程围套式减压术治疗面肌痉挛更安全、有效;全程解剖分离面神经自进出脑干区域（rootentry／exitzone,REZ）至内听道口。识别责任血管和可疑被压迫部位,置入Teflon棉对面神脑池段全程围套式包裹,避免损伤颅神经和细小穿支血管是影响疗效和减少复发的关键。     

Botulinum toxin in ophthalmology

Since its introduction into clinical medicine in 1980, botulinum toxin has become a major therapeutic drug with applications valuable to many medical sub-specialties. Its use was spearheaded in ophthalmology where its potential applications have expanded to cover a broad range of visually related disorders. These include dystonic movement disorders, strabismus, nystagmus, headache syndromes such as migraine, lacrimal hypersecretion syndromes, eyelid retraction, spastic entropion, compressive optic neuropathy, and, more recently, periorbital aesthetic uses. Botulinum toxin is a potent neurotoxin that blocks the release of acetylcholine at the neuromuscular junction of cholinergic nerves. When used appropriately it will weaken the force of muscular contraction, or inhibit glandular secretion. Recovery occurs over 3 to 4 months from nerve terminal sprouting and regeneration of inactivated proteins necessary for degranualtion of acetylcholine vesicles. Complications are related to chemodenervation of adjacent muscle groups, injection technique, and immunological mechanisms.     

Botulinum toxin for blepharospasm and hemifacial spasm: stability of duration of effect and dosage over time.

BACKGROUND: Patients often ask whether the relief they experience with botulinum A toxin will diminish with time, resulting in the need for an increased dosage and more frequent administration. We performed a retrospective study to examine these questions. METHODS: We reviewed the charts of 28 patients (17 with benign essential blepharospasm and 11 with hemifacial spasm) seen between 1989 and 1994 by one ophthalmologist at the botulinum clinic at a university-affiliated hospital in Edmonton. All patients had had at least 6 botulinum A toxin treatments; 17 had had 12 or more treatments, and 7 had had 20 or more treatments. A follow-up data collection form was used to record duration of effect, dosage and side effects. We analysed the data on duration of effect and dosage versus treatment number for individual patients and for the overall group using linear regression analysis. RESULTS: There was no clinically or statistically significant change in duration of effect over time (mean slope 0.024 [95% confidence interval (CI) -0.218 to 0.266]). A positive mean slope of 0.677 (95% CI 0.252 to 1.102) was observed for the change in dosage over time. This trend was most likely related to the practitioner's habit of using half the normal maintenance dosage for the initial injection. When we eliminated the data for the first injection and recalculated the dosage requirement over time, the mean slope for the change in dosage was 0.321 (95% CI -0.084 to 0.726), confirming stable dosage requirements over time. INTERPRETATION: The results suggest that patients can be reassured that duration of benefit and dosage requirements will likely remain stable over time for at least their first 20 treatments.     

谷氨酰胺对急性肺损伤转归的影响

目的 探讨谷氨酰胺对急性肺损伤肺部转归的影响.方法 将70例急性肺损伤患者根据数字表格法随机分为对照组和谷氨酰胺治疗组(Gln组),每组35例.两组均给予常规治疗和肠外营养支持,Gln组同时给予谷氨酰胺治疗.治疗7d,比较两组患者机械通气时间、重症监护室停留时间和治疗前后的APACHE Ⅱ评分、Murray肺损伤评分.结果 两组治疗后APACHE Ⅱ评分和Murray肺损伤评分较治疗前均明显改善(均P ＜0.05),其中Gln组治疗后APACHE Ⅱ评分和Murray肺损伤评分分别为(6.54±2.31)分和(0.53 ±0.42)分,均低于对照组治疗后的(10.43 ±2.15)分和(1.53±0.62)分(t=3.15、2.17,均P＜0.05).Gln组机械通气时间和重症监护室停留时间分别为(6.17 ±4.53)d、(13.41 ±8.74)d,均少于对照组的(11.57±5.25)d、(21.34±10.27)d(t=2.78、4.62,均P＜0.05).结论 谷氨酰胺有利于改善急性肺损伤患者的转归,是危重患者肠外营养的有效药物.     

偏侧面肌痉挛患者的情感、睡眠和认知状态的研究

目的探讨偏侧面肌痉挛（HFS）患者的情感、睡眠和认知状态的情况。方法选取2015年1 月-2017 年2 月在昆明医科大学第一附属医院神经内科门诊就诊的偏侧面肌痉挛患者30 例,同时纳入年龄、性别和文化程度与患者相匹配的30 例为健康对照组,对两组受试者进行14 项版汉密尔顿焦虑量表（HAMA）、17 项版汉密尔顿抑郁量表（HAMD）、匹兹堡睡眠质量指数量表（PSQI）和安登布鲁克认知功能检查（ACE-Ⅲ）测评,将所获数据录入SPSS 21.0软件进行对比分析。结果①焦虑评估显示,患者焦虑的发生率较健康对照组高,差异有统计学意义（P <0.05）;焦虑的发生与痉挛程度无关,差异无统计学意义（P >0.05）;女性患者发生焦虑的比例高于男性患者,但差异无统计学意义（P <0.05）;病程≥10 年的患者发生焦虑的比例高于病程<10 年的患者,差异有统计学意义（ P<0.05）;②抑郁评估显示,患者抑郁的发生率较健康对照组高,差异有统计学意义（P <0.05）;抑郁的发生与痉挛程度无关,差异无统计学意义（P >0.05）;女性患者发生抑郁的比例高于男性,差异有统计学意义（P <0.05）;病程≥10 年的患者发生抑郁的比例高于病程<10 年的患者,差异有统计学意义（P <0.05）;③睡眠评估显示,患者组与对照组受试者的PSQI主观睡眠质量、睡眠潜伏期、睡眠持续性、白天功能紊乱和PSQI 总分比较差异有统计学意义（P <0.05）;习惯性睡眠效率、睡眠紊乱、使用睡眠药物差异无统计学意义（P >0.05）;④认知评估显示,病例组与健康对照组受试者的注意力、记忆力、语言流利性、语言、视空间和ACEⅢ总分比较差异无统计学意义（P >0.05）。结论偏侧面肌痉挛患者广泛存在焦虑、抑郁情绪和睡眠问题;应加强对面肌痉挛患者的情感、睡眠质量的关注,以提高患者的生活质量。     

偏侧面肌痉挛诊治进展

偏侧面肌痉挛(hemifacial spasm,HFS)以一侧面神经所支配的面部肌肉的不可控制的、不自主抽搐为临床特征,影响患者的生活质量.3D-TOF-MRA和3D-FIESTA等神经影像,及AMR和BAEP等神经电生理技术的应用,对HFS的诊断、术前评估及术中监测等均有很大帮助.肉毒毒素注射治疗作为首选的药物治疗手段,其长期治疗的安全性及有效性不断得到证实.神经内镜、悬吊法和架桥法对微血管减压术(MVD)的补充和改良,均使面肌痉挛的手术治疗不断得到优化.     

Short-term prognosis of depression in adults with Down's syndrome: association with thyroid status and effects on adaptive behaviour

Findings for Down's syndrome adults with depression were compared to those for non–depressed Down's syndrome controls. Mean age of onset of depression was 30.1 years, the majority of subjects were female and biological more so than psychotic symptoms were presenting features. No statistically significant association between depression and thyroid dysfunction was found. For the depressed group, scores for level of adaptive functioning were significantly lower and those for maladaptive behaviour significantly higher. At one–year follow–up, although some improvement was found, the majority of depressed subjects were still symptomatic. The short-term prognosis for depression in adults with Down's syndrome appears to be poor but possibly better the earlier the age of onset.     

78例A—V综合征手术治疗的临床观察

Ａ－Ｖ综合征７８例手术治疗，其中６６例有斜肌功能异常者行亢进斜肌减弱术，１２例无斜肌功能异常者行水平肌垂直移位法，均矫正了Ａ－Ｖ现象。故认为：对Ａ－Ｖ综合征应合理选择术式。     

Transtympanic surgery for hemifacial spasm—an electrophysiological study

Producing deliberate damage to the facial nerve in the middle ear is an established method of treating idiopathic hemifacial spasm. However, no previous electrophysiological studies have investigated the effect of this operation on facial nerve function. Eleven patients undergoing transtympanic facial nerve needling were investigated with electromyography. Following operation reduction in the abnormal discharges and synkinesis typical of hemifacial spasm was seen in the majority of patients. The success of this type of operation, although temporary in some patients, together with other neurophysiological studies conflicts with the hypothesis that this disorder is due to ephaptic transmission caused by vascular compression of the facial nerve in the cerebello-pontine angle.     

Hemifacial spasm: magnetic resonance angiography

Twenty-three consecutive patients with hemifacial spasm were studied. Magnetic resonance imaging angiography of the brain was performed in 20 patients and 15 controls. The angiograms were evaluated by two independent observers and blinded for side-location of the spasm. Contact between an artery from the vertebrobasilar circulation and the intracranial part of the facial nerve was observed ipsilaterally to the spasm in 17 patients (85%) and in two of 30 control half-brains (7%), respectively. Treatment is discussed. The study confirms that arterial relation to the facial nerve root is the most frequent cause of hemifacial spasm. Magnetic resonance imaging is recommended to exclude mass lesions in the posterior cranial fossa, and magnetic resonance angiography is recommended in preoperative evaluation and in research.