大剂量丙种球蛋白治疗小儿急性感染性多发神经根炎的疗效观察

目的评价静脉注射大剂量人血丙种球蛋白（IVIG）治疗小儿急性感染性多发神经根炎的临床疗效。方法将94例小儿急性感染性多发神经根炎患者按入院先后顺序随机分为对照组和观察组各47例。在以复合维生素、加兰他敏、能量合剂等综合治疗的基础上,对照组采用地塞米松0．5～1．0mg／kg·d,连用5～8天,继以泼尼松龙维持;而观察组采用IVIG 400mg／kg·d,静脉注射,连用5天。比较分析两组治疗后的疗效指标。结果观察组48h内总有效率86．7％,对照组21．4％;治疗组肌力、行走恢复正常所需时间平均18．6天,对照组30．3天,组间差异有显著性（P〈0．05）。结论IVIG治疗小儿急性感染性多发神经根炎的疗效显著,副作用低,优于地塞米松治疗,可在临床推广。     

家兔腰椎间盘脱出自身免疫模型中神经根组织形态学研究

目的　探讨腰椎间盘突出症(LDH)自身免疫因素及神经根炎病理变化。方法36只家兔,随机分为免疫组(A)、强化组(B)和空白组(C),手术取出前两组髓核,一部分置于相应节段硬膜囊外,不接触神经根,另一部分3周后注射于B组局部皮下,C组仅暴露硬膜囊和脊神经根。4W处死动物,取脊神经根及注射区皮肤,观察并测定组织形态学、淋巴细胞、浆细胞、巨噬细胞计数及神经纤维束间最大距离。结果　较C组,A、B组神经根水肿,淋巴细胞大量浸润,浆细胞生成,毛细血管充血,其它类型炎性细胞散在;B组皮下巨噬细胞出现,统计学C组呈显著性差异(P<0.01)。较A组,B组淋巴细胞、浆细胞及水肿情况严重(P<0.05)。结论　自身免疫反应是LDH的一个重要原因。     

合并移行椎腰椎间盘突出症患者腰骶神经根支配区的变化

背景:腰骶移行椎是一种常见的先天脊柱畸形,国内外学者均有报道移行椎患者的腰骶神经根支配I区可能会发生改变,但并未系统阐述其支配区的变化以及该种改变对腰椎间盘突出症患者手术的指导意义。目的:探讨当存在腰骶移行椎时,腰骶神经根的运动和感觉支配区发生改变的可能性。方法:研究方案的实施符合滨州医学院附属医院对研究的相关伦理要求,参与试验的患病个体及其家属对试验过程完全知情同意。回顾分析321例单一节段腰椎间盘突出症行手术治疗患者的病历资料。其中38例(11.8%)存在腰骶移行椎,包括骶椎腰化26例、腰椎骶化12例。26例骶椎腰化患者中,23例为L5/S1(L6)椎间盘突出,压迫S1(L6)神经根。12例腰椎骶化患者中,8例为L3/4椎间盘突出,压迫L4神经根。在283例正常结构的患者中,138例患者L5/S1椎间盘突出压迫S1神经根,95例患者L4/L5椎间盘突出压迫L5神经根,47例患者L3/L4椎间盘突出压迫L4神经根。比较术前骶椎腰化患者S1神经根受压的症状、腰椎骶化患者L4神经根受压的症状与正常腰骶椎患者L4、L5或S1神经根受压的症状。结果与结论:(1)S1神经根受压所致运动功能减退的分布在骶椎腰化患者组和正常组之间差异有显著性意义(P<0.05);(2)L4神经根受压所致运动功能减退的分布在腰椎骶化患者组和正常组之间差异有显著性意义(P<0.05);(3)骶椎腰化患者S1神经根受压所致的运动功能减退与正常状态下L5神经根受压所致的运动功能减退相似;而腰椎骶化患者L4神经根受压所致的运动功能减退与正常状态下L5神经根受压所致的运动功能减退相似;皮肤感觉异常的分析也显示了相似的结果;(4)结果说明,腰骶神经根的功能在移行椎患者中发生改变,使得骶椎腰化患者的S1神经根起到L5神经根的通常功能(神经根功能上移),腰椎骶化患者的L4神经根起到L5神经根的通常功能(神经根功能下移)。     

Laparoscopic Dissection and Anatomy of Sacral Nerve Roots and Pelvic Splanchnic Nerves

Study ObjectiveTo demonstrate the technique of laparoscopic dissection for identification of sacral nerve roots and pelvic splanchnic nerves.DesignCase report (Canadian Task Force classification III).SettingPrivate practice hospital in São Paulo, Brazil.PatientA 31-year-old woman with suspected iatrogenic and/or compression of sacral nerve roots. She reported debilitating pelvic, gluteal, and perineal unilateral left-sided pain (score 8 on a pain scale of 0–10), and had primary infertility with 1 previous failed attempt at in vitro fertilization. Surgical history included laparoscopic excision of endometriosis 10 months before the procedure and left oophoroplasty during adolescence because of a benign neoplasm.InterventionsStandard 4-puncture laparoscopy was performed. The peritoneum of the left pelvic sidewall was resected to preclude eventual residual endometriosis. This also enabled identification of uterine vessels including the deep uterine vein, which is the limit between the pars vascularis superiorly and the pars nervosa inferiorly in the uterine broad ligament. Surgery was using the laparoscopic neuro-navigation (LANN) technique, previously described by one of us (M. P.). For identification of the sacral roots, dissection was begun medial to the ureter and lateral to the uterosacral ligament. The Okabayashi pararectal space was entered as deep as possible via blunt dissection in avascular spaces. Hemostasis was performed using 5-mm bipolar forceps, and harmonic energy was not used. The hypogastric fascia was entered from medial to lateral, and the piriformis muscle was identified. The sacral nerve root S1 was identified lying over it. Dissection then proceeded caudally, and sacral roots S2 and S3 were sequentially identified. Small and delicate fibers forming the pelvic splanchnic nerves were isolated emerging from sacral roots S2 and S3. Other nerve fibers were identified caudally, probably representing pelvic splanchnic nerves emerging from S4.Measurements and Main ResultsThe surgical operative time was 70 minutes, and bleeding was minimal. No suspected compression or iatrogenic injury was identified. The patient was discharged on the day after the procedure. At 8-month follow-up, she had partial resolution of pain (score 5, pain scale 0–10), and another failed attempt at in vitro fertilization was attributed to unsatisfactory quality of the embryos. There were no symptoms or dysfunctions attributable to manipulation of the nerves.ConclusionLaparoscopy is a useful tool for identification of sacral roots and pelvic splanchnic nerves in suspected diseases. Its application in the field of neuropelveology can be expanded with proper knowledge and training.     

上颌第一前磨牙根管峡部的解剖形态研究

目的 观察上颌第一前磨牙的根管分布、峡部形态和纵向走行变化,为根管治疗和根尖手术提供根管解剖形态的指导.方法 收集北京大学口腔医学院·口腔医院口腔颌面外科门诊拔除的上颌第一前磨牙118颗,进行横切片,体视显微镜下观察牙根全长的根管数目、峡部形态及Hsu和Kim分型.结果 72.0％(85/118)的牙根含双根管,有峡部者占69％(59/85);牙根在根冠1/3段的双根管占99％(84/85),独立双根管和含峡部者均占49％ (42/85),含峡部双根管在向根尖走行的过程中逐渐融合为单根管;全根长中根管峡部的横断面形态主要为Ⅳ和V型.结论 上颌第一前磨牙双根管间峡部主要存在于根中1/3,横断面形态与根管通联,根冠向根尖走行过程中渐融合为单根管;提示临床根管治疗中应以渗透性强的冲洗剂充分浸泡,加强对峡部的清理,提高疗效.     

白及须根和块茎总酚含量的测定

目的:测定白及块茎和须根中总酚的含量.方法:以没食子酸为对照品,采用folin-酚比色法测定白及块茎和须根中的总酚含量.采用TLC对白及须根和块茎进行定性比较.结果:采用folin-酚比色法测定白及中总酚含量,准确度好,精密度高.没食子酸对照品在5～25μg的范围内线性良好,标准曲线方程为Y=0.033 2X +0.000 1.白及须根中的总酚含量为0.895％,块茎中的总酚含量为0.394％.TLC结果表明,白及须根的斑点比块茎多.结论:白及须根中总酚含量高于块茎.     

基层医院腹腔镜腹股沟疝修补术36例报告

目的:探讨基层医院腹腔镜治疗腹股沟疝的手术方法及要点。方法:回顾分析2007年12月至2009年4月我院行腹膜前腹腔镜疝修补术36例患者的临床资料。结果:均顺利完成手术,手术时间40～80min,术后患者疼痛轻,无感染、血肿及其他并发症发生,术后3～5d出院。随访1～16个月未见复发。结论:腹膜前腹腔镜疝修补术具有并发症少,效果好,美观等优点,值得临床推广。     

Sacral Tarlov cysts: Neurophysiology abnormalities and correlation with pelvic sensory and visceral symptoms

Background and purpose

Recent studies suggest a possible association between Tarlov cysts (TCs), usually considered as incidental radiological findings, and neurological symptoms such as pain, numbness and urogenital complaints. The aim was to explore the relationship between TCs and sacral nerve root functions using pelvic neurophysiology tests, and to correlate changes with clinical symptoms and magnetic resonance imaging (MRI) findings.

Methods

Consecutive patients with sacral TCs, referred for pelvic neurophysiology testing and presenting with at least one symptom related to the pelvic area, participated in a cross-sectional review of symptoms using validated questionnaires. Findings of pelvic neurophysiology (pudendal sensory evoked potentials, sacral dermatomal sensory evoked potentials, external anal sphincter electromyography) and urodynamics testing were collected retrospectively. The relationship between neurophysiology, MRI findings and patients' symptoms was assessed using Fisher and ANOVA tests.

Results

Sixty-five females were included (mean age 51.2 ± 12.1 years). The commonest symptom was pain (92%). Urinary (91%), bowel (71%) and sexual (80%) symptoms were also frequently reported. Thirty-seven patients (57%) had abnormal neurophysiology findings reflecting sacral root dysfunction. No association was seen between MRI findings (size, location of the cysts, severity of compression) and neurophysiology. A negative association was observed between neurophysiology abnormalities and occurrence of urgency urinary incontinence (p = 0.03), detrusor overactivity (p < 0.01) and stress urinary incontinence (p = 0.04); however, there was no association with voiding difficulties.

Conclusions

Contrary to current understanding, TCs are associated with injury to the sacral somatic innervation in the majority of patients with presumed symptomatic cysts. However, urinary incontinence is unlikely to be related to TC-induced nerve damage.     

先天性牙根发育不良致病相关基因的筛选

目的:筛选先天性牙根发育不良的致病相关基因.方法:采用改良消减杂交技术,以先天性牙根发育不良患儿及其正常兄弟为研究对象,制备血液基因表达cDNA文库,构建两者的差异表达文库,采用反向点杂交技术剔除假性克隆,挑取部分克隆进行定性测序.结果:构建的差异表达基因文库浓度为4.0×102,反向点杂交检测发现基因文库质量较好:获得了11个与先天性牙根发育不良疾病相关的基因克隆.结论:成功构建了先天性牙根发育不良致病相关基因的消减cDNA文库,推测筛选出的ADAM28和MCPR1可能是牙根发育不良的致病相关基因.     

分根术治疗磨牙根分叉病变对咀嚼效率的影响

目的探讨分根术后单冠或联冠修复下颌磨牙根分叉病变对咀嚼效率的影响。方法将21颗Ⅲ、Ⅳ度根分叉病变的下颌磨牙经完善的根管治疗、牙周基础治疗后,把近、远中根分离,然后行单冠或固定桥修复。并在分根术前后进行咀嚼效率测定。结果经1~2年随访,21颗修复牙咬合、咀嚼功能良好。结论分根术后固定修复是治疗下颌磨牙Ⅲ、Ⅳ度根分叉病变的有效方法之一,有利于提高咀嚼效率。