Effect of botulinum neurotoxin treatment in the lateral spread monitoring of microvascular decompression for hemifacial spasm

Introduction: Botulinum neurotoxin (BtNtx) treatment for hemifacial spasm (HFS) prior to microvascular decompression (MVD) is hypothesized to be a factor in the variability of intraoperative neurophysiological monitoring (IONM) during this procedure. Methods: We analyzed 282 MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000 and December 31, 2007. We retrospectively compared the lateral spread response (LSR) in the mentalis muscle when stimulus‐triggered electromyography (EMG) was elicited from the facial nerve. Previous BtNtx treatment was the grouping factor. Results: Baseline LSR amplitudes during MVD (prior BtNtx: mean = 341.47 μV; no BtNtx: mean = 241.81 μV) were significantly different between groups (df = 1,281; t = ?2.463; P = 0.014). Comparisons of latency and current threshold at baseline, as well as HFS disappearance or LSR persistence after the procedure, did not achieve statistical significance. Conclusions: HFS patients treated with BtNtx prior to MVD demonstrated higher LSR baseline amplitudes during IONM. This could be related to muscle poly‐reinnervation after recovery from repeated BtNtx use. Muscle Nerve, 2011     

Review and update of involuntary facial movement disorders presenting in the ophthalmological setting

We review the existing literature on the involuntary facial movement disorders—benign essential blepharospasm, apraxia of eyelid opening, hemifacial spasm, and aberrant facial nerve regeneration. The etiology of idiopathic blepharospasm, a disorder of the central nervous system, and hemifacial spasm, a condition involving the facial nerve of the peripheral nervous system, is markedly different. We discuss established methods of managing patients and highlight new approaches.     

电针头皮针配合面部埋针法治疗面肌痉挛38例

目的:观察电针头皮针配合面部埋针法治疗面肌痉挛的临床疗效。方法:采用电针头皮针配合面部埋针法治疗面部痉挛38例,并与常规针刺法治疗的32例作对照。结果:电针头皮针配合埋针组治疗面肌痉挛痊愈率28.95%,总有效率89.47%,常规针刺组痊愈率12.50%,总有效率71.88%,两组总有效率差异有统计学意义(P<0.05)。结论:电针头皮针配合埋针组治疗面肌痉挛具有良好的效果,而且操作简单,值得临床推广。     

医用臭氧治疗腰背部术后疼痛综合征的临床疗效观察

目的: 探讨经皮穿刺医用臭氧注射治疗腰背部术后疼痛综合征(FBSS)的疗效。方法: 24例FBSS患者在数字减影血管造影交易额透视下,采用经皮穿刺椎间盘内及椎旁间隙注射医用臭氧(45 μg/ml)20 ml,观察临床症状缓解情况。结果: 24例术后随访2~57个月,临床总有效率62.5%,其中显效8例,有效7例,无效9例。除1例出现咳嗽及胸闷症状外,其他患者无任何并发症发生。结论: 经皮穿刺医用臭氧注射治疗FBSS效果满意。     

进行性半侧颜面萎缩的病因与发病机制研究进展

进行性半侧颜面萎缩是一类以半侧面部萎缩为主要表现的疾病,由于病因及发病机制尚不明确,临床工作中缺乏有效的治疗指导。近年来,众多学者对其发病机制进行了大量研究,取得了一些进展。本文从神经系统、免疫系统以及感染等方面,就进行性半侧颜面萎缩的病因及发病机制作一综述。     

克纳综合征Ⅰ型1 例报告

目的探讨克纳综合征的病因、诊断、治疗。方法回顾性分析1例克纳综合征患儿的临床资料。结果患儿,男,3个月,因黄疸入院,患儿血清总胆红素波动于450.1~479.3μmol/L之间,以非结合胆红素为主,光疗效果欠佳,临床高度怀疑克纳综合征Ⅰ型;经尿苷二磷酸葡萄糖醛酸基转移酶(uridine diphosphoglucuronyl transferase,UGT)1A1基因检测Exon1位点插入突变,确诊克纳综合征Ⅰ型。患儿于肝脏移植过程中死亡。结论克纳综合征由UGT1A1基因突变使其酶活性完全或部分丧失而导致的遗传性胆红素代谢障碍性疾病,诊断主要是根据临床表现、实验室检查及UGT1A1基因检测,肝移植手术可根治此病,基因治疗则是最终治愈的理想方法。     

Mandibular distraction osteogenesis in hemifacial microsomia: Long-term follow-up

AIM: Prospective, longitudinal, clinical long-term follow-up study of a homogeneous sample of children affected by hemifacial microsomia and treated by mandibular distraction osteogenesis. MATERIAL: Eight patients affected by types I and II hemifacial microsomia were operated on at an average age of 5.6 years with an average follow-up of 5.8 years. METHODS: Vertical changes were measured on postero-anterior cephalometric and panoramic radiographs taken sequentially. RESULTS: Angular changes of the infraorbital and nasal floor planes were not significant, showing that distraction osteogenesis starting after 5 years of age did not influence the maxillary skeletal base. Occlusal (plane) cant was reduced by 7 degrees on average following distraction osteogenesis, showing good dentoalveolar plasticity. Mandibular vertical changes showed a gradual return of the asymmetry, with growth in all patients (the ratio between affected and non-affected rami returned by 77% of the correction obtained by means of distraction 5 years postoperatively). CONCLUSION: Although aesthetic and psychological advantages of distraction osteogenesis are well accepted it should only be applied after careful patient selection and honest explanation of the long-term recurrence by genetically determined craniofacial growth patterns.     

艾司洛尔用于面神经微血管减压术中改善脑搏动的处理体会

目的 比较艾司洛尔和乌拉地尔两种药物在面神经微血管减压术中出现脑搏动时的处理效果。方法 择期行面神经微血管减压术226例,常规采用气管内全麻,术中进行血压调控,维持平均动脉压55~65 mmHg（1 mmHg=0.133 kPa）,并保持脑电双频指数（bispectral index,BIS）值在40~60之间。226例面神经微血管减压术患者术中打开硬脑膜后共出现明显脑搏动32例,运用简单随机化分组方法将32例患者分成3组,A组（11例）静脉内单次给予艾司洛尔10 mg,B组（11例）静脉内单次给予乌拉地尔5 mg,C组（10例）静脉内单次给予生理盐水2 mL。观察并记录注射前及注射后1 min、5 min、10 min、30 min时各组患者的心率（HR）、平均动脉压（MAP）及心输出量（CO）的变化,术中显微镜操作时间以及脑搏动的改善情况。结果 3组患者出现脑搏动时的HR、MAP和CO组间比较差异无统计学意义。A组11例患者静脉注射艾司洛尔后,各时间点HR和CO均明显下降,与C组比较差异有统计学意义（P<0.01）,而MAP与C组比较差异无统计学意义;C组患者给予生理盐水处理后各时间点HR、CO和MAP均无明显变化。药物干预后A组脑搏动改善率高于B组和C组（P<0.01）;A组显微镜操作时间为（18±4）min,明显短于B组[（28±6）min]和C组[（29±5）min]。结论 艾司洛尔能显著降低面神经微血管减压术中脑搏动。     

8例Richter综合征临床及生物学特征分析

为了探讨Richter综合征（RS）临床及生物学特征及其预后因素,回顾性分析8例RS患者。利用血清学检测、多参数流式细胞术（FCM）、常规细胞遗传学（CC）、间期荧光原位杂交（FISH）技术、PCR联合DNA序列测定,分别检测患者血清乳酸脱氢酶（LDH）、β2-微球蛋白（β2-MG）、胸苷激酶1（TK1）、血清铁蛋白（SF）和糖链抗原-125（CA-125）,CD38和ZAP-70,染色体核型,ATM和p53基因缺失、＋12异常,以及免疫球蛋白重链可变区（IgVH）突变。结果显示：8例RS患者中7例转化为弥漫大B细胞淋巴瘤（DLBCL）,1例转化为霍奇金淋巴瘤（HL）。7例LDH高于正常值,4例β2-MG高于正常值,7例SF高于正常值,4例CA-125高于正常值,1例TK1高于正常值。4例患者ZAP-70阳性,7例CD38阳性,5例IgVH无突变,4例有染色体复杂核型,1例有＋12,1例有p53缺失。按就诊时BinetA＋B期与BinetC期将患者分为两组,BinetA＋B组从诊断至转化的平均时间为98.5个月,BinetC组为38.3个月,两组间有显著性差异（p=0.021）。平均总生存期（OS）在BinetA＋B组及BinetC组之间分别是123.8个月及49.8个月,两组间有显著性差异（p=0.049）,转化后平均生存时间分别是34.5个月及10.3个月。结论：RS患者血清LDH、β2-MG和SF水平高,ZAP-70和CD38高表达、IgVH无突变发生率高,临床分期可能是RS转化的风险及预后因素。     

单核细胞趋化蛋白-1在颅内动脉瘤壁的表达

目的 研究内皮细胞单核细胞趋化蛋白-1（monocyte chemotactic protein 1,MCP-1）在颅内动脉瘤壁的表达及其在炎症反应过程中的作用。方法 天坛医院2006年10月至2007年9月术中随机取得9例颅内动脉瘤,以同期5例脑肿瘤患者的颞浅动脉为对照,通过苏木素-伊红（hematoxylin and eosin,HE）染色及Western-blot方法研究MCP-1在颅内动脉瘤发生中所起的作用。结果 HE染色显示,相对于正常动脉壁,动脉瘤其内层、外层网架结构均有破坏;Western-blot显示,MCP-1在动脉瘤中的蛋白表达明显增高。结论 MCP-1在囊性动脉瘤壁中的高表达与动脉瘤的发展有相关性。通过某些途径阻断炎性反应的过程可能防止囊性动脉瘤的形成。