Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia

The aim of this study was to define criteria for the selection of patients for percutaneous or open operations for the cure of drug-resistant trigeminal neuralgia (TN). Trigeminal percutaneous radiofrequency thermorhizotomy (TPRT) has an established place because of its safety in elderly patients, while microvascular decompression (MVD) has appeal in younger patients beause of its non-destructive nature and because it attacks what is believed to be the primary etiology of tic douloureux. Nevertheless, MVD is a successful operation only when true neurovascular conflict (NVC) is ascertained, rather than a simple arterial loop and neurovascular contract. Probably, many immediate failures and early relapses are the consequence of the inadequate patient selection for MVD on the presumption that this operation is in any case the ideal cure. The inadequate selection can be explained by the difficult preoperative diagnosis of NVC in the past. Indeed, angiography and computed tomography showed the neurovascular contact but not the size of compression. Fortunately, today magnetic resonance imaging is a reliable instrument to ascertain NVC. So, the diatribe between the supporters of percutaneous techniques and MVD can be concluded with the following: (1) percutaenous techniques are indicated for patients without demonstrated NVC (including patients with TN in multiple sclerosis) and in those with NVC if MVD is contraindicated by ill-health or refused by the informed patient; and (2) MVD is incated for patients with ascertained NVC who are in good health and who, informed of the surgical risk, favor this operation desiring no sensory deficit. Received: 23 June 2001 / Accepted in revised form: 24 August 2001     

The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament

The tibial attachments of the individual anteromedial (AM) and posterolateral (PL) fibre bundles and the entire attachment of the anterior cruciate ligament are described, relating them to consistent bony landmarks; 55 fresh-frozen specimens were measured. The fibre bundles were separated and excised at their attachments and their peripheries marked with a pen. High-resolution scaled digital photographs were taken of each dissected specimen and transferred onto a computer for analysis. A wide variation was found when using the posterior tibial axis, the anterior tibial surface and the medial tibial spine as reference points. The most consistent measurements used the tibial interspinous “over-the-back” ridge as a datum. The attachments of the PL and AM bundles were centred 10 ± 1 mm (mean ± SD) and 17 ± 2 mm anterior to the over-the-back ridge. They were 4 ± 1 and 5 ± 1 mm, respectively, lateral to the medial tibial spine border. The positions of 6 mm circles in the posterior-medial limits of the fibre bundles (representing tunnels in a double-tunnel reconstruction) were measured. The overall dimensions of the tibial plateaux correlated significantly with many measurements. The results from this study could be used to guide ACL reconstruction techniques.     

中西医结合治疗股骨头缺血性坏死

股骨头缺血性坏死是世界骨科难题之一。作者致力于中草药治疗本病的研究三十多年，近来又在手术治疗方面倾注心血，对该病的防治、康复创立了一整套中西医结合新方法，取得了满意效果。自１９８２年以来，共治疗各种股骨头坏死１１０１例，其中单纯中医治疗４３３例，手术配合中药治疗６６８例。按作者制定的百分评分法，总有效率９８％，优良率８４％，无一例需再作人工关节置换术。     

In vivo and in vitro effects of imidacloprid on sheep keds (Melophagus ovinus): a light and electron microscopic study

The effects of imidacloprid (Advantage) on sheep keds (Melophagus ovinus Linné 1758) were studied in vivo and in vitro by means of direct observation (monitored on video tape) and by light and electron microscopy. It was found that: 1. Imidacloprid acted rapidly on all motile stages of the sheep keds. Within 3–4 min after exposure they became immobile and their legs and the abdomen started tetanic trembling movements for 15–30 min, leading to death. 2. The compound is apparently taken up by the body, since it also acted on those sheep keds that had been exclusively exposed to imidacloprid-contaminated filter papers. 3. The compound is available and active for more than 1 month in the wool of sheep; even rainfall does not reduce its efficacy. Body contact between treated mother sheep and their lambs protects them from infestation with these ectoparasites. 4. The compound initiates an ultimately lethal destruction of the ganglia, nerve chords and related muscle fibers, as can be seen in electron micrographs. Received: 7 October 2000 / Accepted: 18 October 2000     

神经血管减压术治疗原发性高血压的理论基础

原发性高血压在人群中极为常见,以药物保守治疗为主。近年来,有学者提出动脉搏动性压迫延髓区第Ⅺ、Ⅹ脑神经根能引起高血压,并认为是原发性高血压的病因之一。神经血管减压术缓解了这种搏动性压迫,为原发性高血压尤其难治性高血压及有严重并发症的患者提供一种新的治疗方法,并已取得较好疗效。本文主要综述神经血管减压术治疗原发性高血压的理论基础,并介绍手术过程。     

高分辨率CT上非小细胞肺癌结节周围肺组织和血管改变的研究

目的 应用高分辨率CT(HRCT)对非小细胞肺癌(NSCLC)结节周围组织、血管的改变进行研究，总结NSCLC的特征性改变，提高HRCT对NSCLC上的诊断率。方法 应用HRCT观察31例NSCLC和12例肺部良性病变周围组织、血管的形态改变，由两位放射学家分别阅片，观察肺小叶血管支气管束、血管和叶间隔的改变。统计学处理应用x^2检验。结果 31例NSCLC患者中，20例(64．5％)出现肺小叶支气管血管柬增厚，15例(48．4％)上级肺小叶动脉扩张，13例(41．9％)上级肺小叶静脉扩张，16例(51．6％)叶间隔增厚，5例(16．1％)磨玻璃样变。对照组中肺小叶支气管血管柬增厚者2例(16．7％)，上级肺小叶动脉扩张1例(8．3％)，上级肺小叶静脉扩张2例(16．7％)，叶间隔增厚6例(50．0％)，5例(41．7％)磨玻璃样变。NSCLC上患者的肺小叶支气管血管束增厚和上级肺小叶动脉扩张的出现率均高于对照组(P＜0.005和0.01＜P＜0.025)。结论 肺部结节伴肺小叶支气管血管束增厚或上级肺小叶动脉扩张时可高度怀疑NSCLC。     

神经血管治疗仪联合前列地尔等治疗糖尿病足疗效观察

目的探讨神经血管治疗仪联合前列地尔等治疗糖尿病足的临床疗效。方法将70例糖尿病足患者随机分为2组,每组各35例。试验组给予神经血管治疗仪、红外线照射疼痛治疗仪联合前列地尔治疗,并给予无菌换药;对照组仅给予前列地尔针剂等药物和无菌换药治疗。观察两组的临床疗效、平均住院时间、症状体征消失时间、ABI指标水平。结果试验组的总有效率显著高于对照组(P<0.05);平均住院时间和症状体征消失时间显著短于对照组(P<0.05);ABI指标水平显著优于对照组(P<0.05)。结论神经血管治疗仪、红外线照射疼痛治疗仪联合前列地尔、无菌换药治疗糖尿病足临床疗效显著,值得临床推广应用。