显微血管减压术后面肌痉挛症状的演变特点

目的分析面肌痉挛行显微血管减压手术后症状的演变特点,探讨其可能机制。方法回顾性分析90例面肌痉挛病人的临床资料,均采用显微血管减压手术治疗。根据Cohen分级对病人术后1年内不同时间段的面肌痉挛程度进行评分,得到症状评分-时间曲线,分析面肌痉挛症状改善的演变特点。结果显微血管减压术后,将病人分为术后顷刻和出院时症状均消失组(A组)、术后顷刻症状消失而出院时又再现组(B组)、术后顷刻和出院时症状均减轻组(C组),3组病人长期随访症状消失比例分别为90.1%、83.3%、66.7%。术后症状评分-时间曲线表明:总体演变趋势先急剧下降,后低幅波动,并逐渐下降,术后9个月趋于稳定。结论显微血管减压术后,面肌痉挛症状有逐渐缓解趋势。根据术后即刻至出院前的症状恢复情况将病人分组,有助于预测显微血管减压手术的长期疗效。     

Meige syndrome and pallidal deep brain stimulation.

The cause of primary Meige syndrome is unknown, and although gender and age predilections are different from idiopathic torsion dystonia, most investigators consider Meige syndrome a variant of that disorder. Interest in the use of stereotactic brain surgery for refractory forms of dystonia is thus increasing. There is little experience with the use of deep brain stimulation (DBS) in focal dystonias, and reports of its use in Meige syndrome are very rare. We report on a case of Meige syndrome successfully treated with bilateral pallidal DBS.     

睑肌及面肌痉挛病人心理健康状态研究

目的 探讨睑肌及面肌痉挛病人有无异常心理健康状态。方法 对156例睑肌及面肌痉挛病人在评定痉挛程度的同时进行汉密顿焦虑量表（HAMA）和汉密顿抑郁量表（HAMD）测量。结果 100例睑肌及面肌痉挛病人伴有焦虑，检出率为64.1%。随痉挛程度的增加焦虑更加明显，49例睑肌及面肌痉挛病人伴有抑郁，检出率为31.3%，痉挛程度与抑郁严重程度之间统计学差异不大。结论 睑肌及面肌痉挛病人许多伴有焦虑和抑郁，其中焦虑非常明显，与痉挛程度相关，应当加强睑肌及面肌痉挛病人心理健康状态的评价和处理。     

Facial dystonia: clinical features, prognosis and pharmacology in 31 patients

The natural history and response to different treatments were assessed in 31 consecutive patients with blepharospasm (BS) and/or oromandibular dystonia (OMD). The mean age at onset was 52.4 years and there was a female preponderance of 2.5 to 1. Ocular symptoms preceded the onset of blepharospasm in more than 50% of the affected patients, whereas psychiatric and dental problems prior to the onset of focal dystonia were found in 10% and 13% of the cases respectively. Dystonia elsewhere, mainly in the craniocervical area, was found in 23% of patients and appeared to follow a somatotopic progression. The first 2–3 years of history were crucial for the spread of dystonia to other face and body parts. When OMD was the first symptom, a lower tendency of dystonia to progress elsewhere was observed. A putative cause was found in 14% of patients who showed clinical and radiographic evidence of basal ganglia or rostral brainstemdiencephalon lesions. The response to different drugs was inconsistent although transient improvement was induced by haloperidol in 6 patients, by L-Dopa plus deprenyl in 3 patients, by trihexyphenidyl in 2 patients and by clonazepam in 2 patients. One, apparently spontaneous, remission was observed. Botulinum A toxin was iniected in the orbicularis oculi of 8 patients affected by BS: moderate to marked improvement lasting 5 to 30 weeks (mean 14.5 weeks) was achieved in all cases; transient ptosis, lasting 1 to 3 weeks, occurred in 3 cases.

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Sommario La storia naturale e la prognosi della distonia faciale sono state valutate in una serie di 31 consecutivi pazienti con blefarospasmo (BS) e/o distonia oromandibolare (OMD) (età di esordio: 19–75 anni; durata di malattia: 1–15 anni; rapporto maschi/femmine: 2.5/1). Sintomi oculari precedevano l'insorgenza del BS in oltre il 50% dei pazienti, mentre anomalie dentali e problematiche psichiatriche comparivano come prodromi nel 10% e nel 13% dei casi rispettivamente. La sintomatologia distonica diffondeva, con andamento somatotopico, oltre il distretto cranio faciale nel 23% dei casi. Evidenze cliniche o radiologiche di lesioni dei gangli della base, della parte rostrale del tronco dell'encefalo o del diencefalo erano presenti solo nel 13% dei casi. Un lieve ma transitorio miglioramento della sintomatologia distonica era indotto da aloperidolo in 6 pazienti, da 1-dopa+deprenyl in 3, da triesifenidile in 2 e da lonazepam in 2. Solo 1 paziente andava incontro a remissione apparentemente spontanea della sintomatologia distonica dopo un anno di malattia. L'iniezione di tossina botulinica di tipo A negli orbicolari delle palpebre di 8 pazienti con BS induceva un sensibile miglioramento della sintomatologia distonica che persisteva per 5–30 settimane (media 14.5 settimane) con ridotti effetti collaterali locali (transitoria ptosi in 3 casi).

     

胜红丸加减治疗胃节律紊乱综合征74例

用《竹瑞堂经验方》胜红丸加减治疗胃节律紊乱综合征74例,在20天内症状消失者57例,占病例总数的77.02％,优于国内有关吗叮啉治疗此病的报告,胃电图检查结果,则与有关吗叮啉疗效报道相近。     

浅谈小户嫁痛症的辨证论治

本文首先论述小户嫁痛证的源流及定义,明确了小户嫁痛就是阴痛。继而阐述了小户嫁痛的病因病机,认为本病有虚实之别。实证多由肝气郁结、郁而化热或寒客肝脉所致;而虚证则多由气血不足、冲任受损而成。最后论述了小户嫁痛的辨证论治。     

Retinal and optic nerve findings in Goldenhar-Gorlin syndrome

Involvement of the posterior segment of the eye in Goldenhar-Gorlin syndrome is more common than is generally appreciated. We examined seven patients with this syndrome. Abnormalities included diminished visual acuity, tilted optic disc, optic nerve hypoplasia, tortuous retinal vessels, macular hypoplasia and heterotopia, microphthalmia and anophthalmia. In one case, pathologic study showed agenesis of the optic nerve. It is proposed that retinal, optic nerve and craniofacial abnormalities in this condition may reflect an asynchrony in the migration of the neural crest cells in the early stages of embryonal development.     

妊娠高血压综合征与母婴愈后关系

我院产科14个月中,收住产妇1232例,妊娠高血压综合征96例占7.8%。妊娠高血压综合征患者的定期产前检查及药物治疗是十分重要的,但是确保母婴生命和健康的关键是终止妊娠。此征多发生在年青初产妇占97.9%,,且手术率高,头吸引和产钳13例占13.6%,剖宫产31例占32.2%。慢性高血压临产期加重者,可静脉点滴硝普钠(Sodium Nitroprussidium)应用数例,效果满意。     

Use of high‐dose botulinum A toxin in benign essential blepharospasm: is too high too much?

BACKGROUND: Botulinum toxin (Botox) is the mainstay treatment for benign essential blepharospasm. Current treatment practice appears restricted by several reports demonstrating adverse effects and resistance to high-frequency, higher-dose therapy. This study aimed to explore whether high-dose, high-frequency treatments could be used without developing secondary resistance and without significant side-effects in patients refractory to conventional Botox doses. METHODS: From a cohort of 120 patients being treated with Botox therapy for benign essential blepharospasm and idiopathic hemifacial spasm, case notes from six patients were retrospectively examined. In these patients, therapy had exceeded the recommended 50 units per side for a duration greater than 12 months and at less than 3 monthly intervals. Patterns in subjective severity grading and percentage of improvement as well as reported side-effects were analysed. RESLUTS: All patients described greater than 60% improvement and 0-2 severity grading over a 3- to 15-year period with no evidence of secondary resistance. Side-effects were minor, transient and less frequently reported at higher doses. CONCLUSION: In a select group of patients, Botox therapy can be used effectively at doses higher than recommended over long periods with minimal side-effects and little evidence of secondary resistance.     

磁共振体层成像脑血管显影术(MRTA)对颅神经疾患“血管压迫”病因的诊断

采用磁共振体层成像血管显像术(MRTA)检查11例三叉神经痛和21例面肌痉挛,其中10例行后颅窝探查.32例MRTA检查中,确认患侧有“血管压迫”28例,无血管压迫4例.10例接受探查术发现有或无压迫血管,与MRTA诊断相符9例.1例岩静脉压迫因未行增强扫描而漏诊.MRTA可作为此类疾患“血管压迫”的术前病因诊断方法.