半脱位晶状体张力环植入联合晶状体超声乳化的临床应用

目的评价半脱位晶状体超声乳化术中植入囊袋张力环(CTR)的应用价值。方法对11例(11眼)半脱位晶状体行白内障手术,术中连续环形撕囊后植入囊袋张力环,随后行白内障晶状体超声乳化术,囊袋内植入折叠式人工晶状体。结果术中所有手术都未出现张力环脱落及由于张力环张力过大而导致的晶状体囊袋撕裂现象。所有植入的人工晶状体基本位于正位。术后1周、1月、3月随访视力,观察人工晶状体位置,测量眼压,检测角膜内皮密度指标与常规超乳手术无明显差别。结论囊袋张力环是一种安全有效的辅助工具,它通过囊袋内植入,保持囊袋的位置和完整性,便于后房型人工晶状体的植入,防止术中由于晶状体核的坠落所产生的并发症及术后人工晶状体的偏位,提高了手术安全性,有利于术后视力恢复。     

中医与傣医对头痛病症的诊治比较探析

就临床常见、多发的头痛病症进行中医和傣医在诊治方法上的比较和分析,发现傣医治疗头痛病症具有众多的方药,寒性药物的使用相对偏多,且有重视头痛病症外治法的特点,既头痛医头,也头痛医脚,外治方药的运用多种多样,包括药引及增效方法的使用均是值得借鉴并进行深入研究的宝贵经验。     

Does post dural puncture headache exist in idiopathic intracranial hypertension? A pilot study

Background/ObjectiveOccurrence of post-dural puncture headache (PDPH) after diagnostic lumbar puncture (LP) for idiopathic intracranial hypertension (IIH) may seem very unlikely in clinical practice. Nevertheless, it has been suggested by several studies, mainly in sub-group analyses. We aimed to evaluate the prevalence of PDPH in an IIH population and determine any eventual predictive factors of PDPH occurrence.MethodsWe conducted a retrospective multiple-center observational study. All newly diagnosed IIH patients who met the International Classification of Headache Disorders (ICHD-3) or the Dandy modified criteria were included from three different French hospitals. They all underwent LP following the same process with the same type of needle. We recorded PDPH occurring within five days after LP, as defined by ICHD-3 criteria.ResultsSeventy-four IIH patients were recruited, of whom 23 (31%) presented with PDPH. Neither classical risk factors for PDPH such as body mass index, age or gender, nor cerebrospinal fluid opening pressure, or specific IIH features were associated with occurrence of PDPH.ConclusionPDPH can occur after LP in IIH patients. Clinicians should be aware of this possible event during the IIH diagnosis assessment and should not automatically reconsider IIH diagnosis. PDPH prevention using an atraumatic needle and dedicated PDPH treatment seem relevant in IIH patients.     

Whipple’s Disease: Neurological Relapse Presenting as Headache for Two Years

Whipple’s disease is a rare, chronic, multi-systemic infectious disorder caused by the bacterium, Tropheryma whipplei. Relapses are commonly associated with neurological symptoms. We report a case of a 55-year-old man who presented with symptoms of progressive headache, 13 years after apparent complete recovery from intestinal Whipple’s disease. Studies showed hydrocephalus with obstruction of the aqueduct and cerebrospinal fluid findings consistent with chronic meningitis. Diagnosis of central nervous system Whipple’s disease was confirmed by analysis of the cerebrospinal fluid using polymerase chain reaction. After one year of antibiotic therapy, symptoms resolved and cerebrospinal fluid pleocytosis had improved. This case illustrates that Whipple’s disease should be included in the differential diagnosis of central nervous system disorders as it is a potentially treatable cause of chronic meningitis. Failure to recognize this presentation can lead to misdiagnosis or a significant delay in diagnosis and treatment.     

Reactive oxygen species cause diabetes-induced decrease in renal oxygen tension

Aims/hypothesis Augmented formation of reactive oxygen species (ROS) induced by hyperglycaemia has been suggested to contribute to the development of diabetic nephropathy. This study was designed to evaluate the influence of streptozotocin (STZ)-induced diabetes mellitus, as well as the effects of preventing excessive ROS formation by -tocopherol treatment, on regional renal blood flow, oxygen tension and oxygen consumption in anaesthetized Wistar Furth rats.Methods Non-diabetic and STZ-diabetic rats were investigated after 4 weeks with or without dietary treatment with the radical scavenger DL--tocopherol (vitamin E, 5%). A laser-Doppler technique was used to measure regional renal blood flow, whilst oxygen tension and consumption were measured using Clark-type microelectrodes.Results Renal oxygen tension, but not renal blood flow, was lower throughout the renal parenchyma of diabetic rats when compared to non-diabetic control rats. The decrease in oxygen tension was most pronounced in the renal medulla. Renal cellular oxygen consumption was markedly increased in diabetic rats, predominantly in the medullary region. Diabetes increased lipid peroxidation and protein carbonylation in the renal medulla. Treatment with -tocopherol throughout the course of diabetes prevented diabetes-induced disturbances in oxidative stress, oxygen tension and consumption. The diabetic animals had a renal hypertrophy and a glomerular hyperfiltration, which were unaffected by -tocopherol treatment.Conclusions/interpretation We conclude that oxidative stress occurs in kidneys of diabetic rats predominantly in the medullary region and relates to augmented oxygen consumption and impaired oxygen tension in the tissue.Abbreviations ROS Reactive oxygen species - TBARS thiobarbituric acids reactive substances - NO nitric oxide - STZ streptozotocin     

Headache and Liver Disease: Is Their Relationship More Apparent Than Real?

Headache is regarded by patients as a disturbing (or unpleasant) symptom. It can be produced by either organic diseases or functional head abnormalities. Twenty-five years ago headache was supposed to be a psychosomatic angiospastic algia. Certain unusual forms were thought to be caused by triggers like anger, cough, exertion, and sexual activity. Experimental research explored the role of circulating serotonin, prostaglandin, estrogen levels, and platelet abnormalities. As computed tomography, helical computed tomography, and scanning or magnetic resonance imaging evolved, new data became available. None of the newer reports have demonstrated liver involvement as a cause of headache. This minireview intends to cover the spectrum of brain alteration in liver disease. It describes some of the pathophysiological characteristics of hepatic encephalopathy and, also, the relationship among migraine, constipation, and liver disease.