不同置换液量血液透析滤过治疗尿毒症皮肤瘙痒疗效观察

目的：观察不同置换液量血液透析滤过(HDF)对尿毒症皮肤瘙痒的治疗作用。方法：将30例并发皮肤瘙痒的维持性血液透析尿毒症患随机分为三个组，分别接受高置换液量后稀释HDF(置换液20L)、低置换液量后稀释HDF(置换液10L)和高通量血液透析治疗。均使用F60透析器，隔日1次，连续3次，其余治疗条件相同。对皮肤瘙痒症状定量计分，比较三组病人治疗前后皮肤瘙痒症状积分的改变以及血磷和甲状旁腺激素(PTH)的变化。结果：高置换液量HDF组治疗后皮肤瘙痒积分明显下降，有统计学意义。其余两组无差异。以皮肤瘙痒积分下降50％为有效计算，高置换液量HDF组7例有效，有效率70％；低置换液量HDF组3例有效。有效率30％；透析组1例有效，有效率10％。三组间比较有统计学差异。三组透析后血磷均明显下降，有统计学意义；PTH亦有下降，HDF组有统计学差异，HD组无统计学差异。结论：增加置换液量可以提高HDF治疗尿毒症皮肤瘙痒的疗效；HDF治疗尿毒症皮肤瘙痒疗效优于高通量血液透析；HDF清除PTH的效果高于HD。     

A review of burn symptoms and potential novel neural targets for non-invasive brain stimulation for treatment of burn sequelae

Burn survivors experience myriad associated symptoms such as pain, pruritus, fatigue, impaired motor strength, post-traumatic stress, depression, anxiety, and sleep disturbance. Many of these symptoms are common and remain chronic, despite current standard of care. One potential novel intervention to target these post burn symptoms is transcranial direct current stimulation (tDCS). tDCS is a non-invasive brain stimulation (NIBS) technique that modulates neural excitability of a specific target or neural network. The aim of this work is to review the neural circuits of the aforementioned clinical sequelae associated with burn injuries and to provide a scientific rationale for specific NIBS targets that can potentially treat these conditions. We ran a systematic review, following the PRISMA statement, of tDCS effects on burn symptoms. Only three studies matched our criteria. One was a feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury, one looked at the effects of tDCS to reduce pain anxiety during burn wound care, and one assessed the effects of tDCS to manage pain and pruritus in burn survivors. Current literature on NIBS in burn remains limited, only a few trials have been conducted. Based on our review and results in other populations suffering from similar symptoms as patients with burn injuries, three main areas were selected: the prefrontal region, the parietal area and the motor cortex. Based on the importance of the prefrontal cortex in the emotional component of pain and its implication in various psychosocial symptoms, targeting this region may represent the most promising target. Our review of the neural circuitry involved in post burn symptoms and suggested targeted areas for stimulation provide a spring board for future study initiatives.     

Die Bedeutung des Musculus canalis ani für die Kontinenz und anorectale Erkrankungen

Zusammenfassung Es wird die funktionelle Morphologie des bisher wenig bekannten M. canalis ani beschrieben. Dieser Muskel liegt dem Sphincter ani internus auf und zieht längs durch die submuköse und subcutane Schicht des Analkanals. Es wird gezeigt, daß er ein Bestandteil des Kontinenzorgans ist und für den Verlauf anorectaler Erkrankungen bedeutsam ist.

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The importance of the musculus canalis ani for continence and anorectal diseases

Summary The functional morphology of the M. canalis ani is described. Hitherto this muscle has not been studied in detail. The M. canalis ani is located inside of the M. sphincter ani internus and reaches through the spatium submucosum et subcutaneum of the analcanal. This muscle is part of a described organ of continence. Its importance in the course of anorectal disease is shown.

     

5-HT与不同证型原发性肛门瘙痒症的相关性研究

目的：初步探讨不同证型的原发性肛门瘙痒症患者血清中5-HT的变化。方法：将60例原发性肛门瘙痒症患者按中医辨证分型分为风热挟湿证、血虚化燥证、血瘀生风讧3组,每组20例;另选择20例经体检健康者为正常对照组。4组研究对象空腹抽取静脉血,检测比较5-HT含量。结果：肛门瘙痒症患者外周血5-HT平均水平低于正常对照组,差异有统计学意义（P〈0．05）;3种不同证型患者5-HT均低于正常对照组,风热挟湿组患者5-HT高于血虚化燥组患者,差异均有统计学意义（P〈0．05）,血虚化燥和血瘀生风组组间比较差异无统计学意义（P〉0．05）。结论：不同证型原发性肛门瘙痒症患者的5-HT均低于正常,说明该疾病可能是一种神经源性疾病;且5-HT含量随其证型的不同亦有所变化,但需进一步研究证实。     

压力性尿失禁患者肛提肌形态的MRI研究

目的探讨盆底肌群的解剖及功能改变与尿失禁(stress urinary incontinence,SUI组)的相关性。方法收集2005年初至2006年初收住入院的病例43例,年龄40~82岁,SUI组20例,对照组23例。所有病例均行MRI扫描,扫描范围是横断位上缘至髂嵴水平、下缘扫描至肛门口;矢状位向两侧扫描至髋臼外侧缘。完成平静扫描后,嘱患者进行缩肛并坚持,重复FSE序列矢状位、横断位T2WI扫描。利用医学影像分析系统软件分析处理MRI原始图像。结果运用方差分析,分别对平静、缩肛状态下及缩肛前后组间的左右两侧肛提肌厚度进行组间比较,差异无显著性,在平静及缩肛状态下,将两组人群的左右肛提肌厚度进行自体比较,对照组和尿失禁组均有显著性差异;对缩肛前后同侧肛提肌厚度进行比较,对照组两侧肛提肌厚度均有显著性差异,尿失禁组两侧肛提肌厚度均无差异。结论肛提肌存在不对称现象;尿失禁患者肛提肌的收缩功能可能下降。     

抗敏止痒乳膏治疗瘙痒性皮肤病的疗效观察

目的：观察抗敏止痒乳膏治疗瘙瘁性皮肤病的临床疗效。方法：治疗组用抗敏止痒乳膏外涂,并与空白基质自身对照观察;对照组用哈西奈德乳膏外涂,并采用统一的疗效评定标准进行疗效评价。结果：抗敏止痒乳膏疗效与空白基质比较有统计学差异（P〈0．01）,抗敏止痒乳膏治疗局限性瘙痒症疗效显著高于激素制剂（P〈0．05）,治疗神经性皮炎和慢性湿疹疗效与激素制剂无统计学差异（P〉0．05）,其不良反应发生率比激素制剂明显为低。结论：抗敏止痒乳膏治疗瘙痒性皮肤病安全、有效。     

不同溶媒预冲管路改善血液透析患者皮肤瘙痒的临床观察

目的 观察两种常用的溶媒预冲体外血液循环管路(包括一次性透析器)对改善血液透析患者皮肤瘙痒的临床治疗效果.方法 对22例患者,分为治疗组(11例),采用5%葡萄糖预冲血液透析管路,后进行维持性血液透析;对照组(11例),常规采用0.9%生理盐水预冲血液透析管路,后进行维持性血液透析;每位患者连续观察15次,治疗过程使用的药物包括促红素、透析参数如血流量、透析器及透析机的型号均相同,对两组患者进行瘙痒程度、糖化血红蛋白、血脂、空腹血糖、血补体C3及嗜酸粒细胞计数的比较.结果 5%葡萄糖预冲(治疗组),其透析器显示出较好的相容性,表现在瘙痒程度方面有明显减轻.与0.9%生理盐水预冲(对照组)有显著性差异(P<0.05);但在反应过敏的指标血C3及嗜酸粒细胞计数、糖化血红蛋白、血脂、空腹血糖等方面无显著差异(P>0.05).结论 5%葡萄糖预冲血液透析管路和透析器,能明显减轻血液透析过程中因为使用一次性透析器,导致皮肤瘙痒增高的机率,在短期内对人体血糖和脂代谢影响不明显,相对安全、有效.     

Ultrasonographic and doppler velocimetric evaluation of the levator ani muscle according to the hormonal status

Objective

We aimed to study the cross-sectional area of levator ani muscle and the doppler velocimetric parameters of vessels its in premenopausal and postmenopausal women.

Study design

Sixty-four patients, divided into 3 groups, were assessed: group I (20 women—average age 28 years) premenopausal and nulliparous (control); group II (24 women—average age 38 years, vaginal delivery 1–4) premenopausal with vaginal deliveries; group III (20 women—average age 55 years, parity 0–4) postmenopausal without hormonal therapy. Doppler velocimetry of levator ani muscle vessels through resistance and pulsatility indices was used and the means of the groups compared by adjusting the weighed variance model with multiple comparisons, according to Tukey's method. Similarly, we measured the cross-sectional area of the muscle using ultrasonography.

Results

There was a significant increase in resistance and pulsatility indices in postmenopausal patients as compared to the other two groups. We also observed a significant decrease in the cross-sectional area of the muscle of postmenopausal patients when compared to those in premenopausal.

Conclusion

The obtained results allow us to conclude that levator ani muscle vascularization significantly decreases after menopause (age and/or hipoestrogenism) and that it can be assumed that vaginal delivery does not promote long-term alterations in levator ani muscle vascularization. We also observed a significant decrease in the cross-sectional area of the muscle in postmenopausal women when compared to those in premenopausal.