骶管内黑色素性神经鞘瘤1例

1病例资料患者,女,43岁,因"骶部、右侧臀部及右下肢酸痛、麻木不适3年余,加重半个月"于2010年8月13日入院。患者于2008年无明显诱因出现腰骶部、右侧臀部及右下肢酸痛、麻木不适,行走及活     

椎管内脊膜瘤合并椎管内外哑铃形神经鞘瘤一例

患者 ,女性 ,2 3岁 ,以双下肢麻木 2年 ,不能活动并腰骶部疼痛 3个月主诉入院。查体 :双下肢肌肉萎缩明显 ,左下肢肌力Ⅱ级 ,右下肢肌力Ⅰ级 ,肌张力低。双膝腱、跟腱反射消失 ,肛门反射弱 ,脐以下各种深、浅感觉均减弱 ,双侧Ｂａｂｉｎｓｋｉ征阳性。腰椎ＣＴ检查示Ｌ3、4椎管内外哑铃形肿瘤 ,其椎管外部分位于Ｌ3、4椎体的右侧。因ＣＴ检查结果与查体感觉平面不相符 ,遂行椎管造影 ,发现Ｔ7、8髓外硬脊膜下肿瘤。于 1996年 10月 18日在基础加局麻下行Ｔ7、8髓外硬脊膜下肿瘤及Ｌ3、4椎管内外哑铃形肿瘤切除术 ,术中见Ｔ7、8硬脊膜下、脊髓…     

脊髓多发性神经鞘瘤1例报告

患 者男 ,38 岁 。2004 年 5 月 6 日 入院 。1 年 前患 者 无明显 诱 因出 现左 11￣12 肋部 疼 痛 ,曾 在 当 地 医院 按 肋 间 神经痛 治 疗,一直 未缓 解 。1 个 月前 出现 双 下肢 无力 ,门 诊 行M RI检 查 ,见 T12￣L1 髓 外 硬 膜内 占 位 病 变 (图 1),遂 收 入院 。入 院 后 查 体:T6、L1 叩 痛,双 肋 弓 以 下 皮 肤 感 觉 减 退 ,双 下 肢 肌 力 3 级 ,腹 壁 反 射 、提 睾 反 射 未 引 出 ,膝 、跟 腱 反射 略 亢 进 ,踝 阵 挛 ( ),双 下 肢 Babinski征 阳 性 ,直 腿 抬 高试验 …     

C3椎管内髓外硬膜内哑铃形神经鞘瘤并不全瘫一例

患者 ,女 ,49岁 ,农民 ,因右半身麻木、疼痛 10个月 ,加重 2个月为主诉入院。患者于 10个月前无明显诱因出现右上肢麻木 ,右手及右足发冷 ,继而出现右下肢麻木无力 ,走路蹒跚。曾在当地医院就诊 ,诊为“脑血栓” ,予静脉输入活血化瘀药治疗 2个月无效 ,症状逐渐加重 ,并伴有胸部束带感 ,来我院 ,患者既往健康。体检 :一般状况好 ,颈部生理弯曲消失 ,Ｃ2 ,3棘突上压痛 ( )。颈后侧、右肩部及右半身皮肤感觉减弱 ,右手握力减弱 ,右上肢、右下肢肌肉肌力Ⅳ级 ,右侧肱二头肌腱、肱三头肌腱、膝腱反射亢进 ,右侧巴彬氏征阳性 ,霍夫曼征阴性。Ｘ…     

坐骨神经恶性神经鞘膜瘤复发一例北大核心CSCD

1病例介绍患者男,41岁。因＂左足外侧疼痛、麻木1年,发现左大腿肿物1个月＂于2016年8月入院。查体：左大腿后方中段可触及鹌鹑蛋大小质韧肿物,横向活动度可、纵向活动度差,压之轻度疼痛伴放射痛,Tinel征（＋）;左足外侧及足背皮肤刺痛觉减退;膝、踝及足部各关节屈伸正常。左下肢各肌肌力未见明显异常。MRI显示左大腿中下份后部肌间隙间见结节状长T1长T2信号影,大小2.     

尺神经结核瘤的诊断与治疗

周围神经系统结核罕见 ,尺神经结核病更少见。到目前为止 ,国内外文献都仅个案报道。本文报道 1例 ,现结合文献探讨其发病机制 ,诊断及临床治疗。临床资料患者 ,男 ,14岁。患者 1年前曾不慎摔伤左上肢致酸痛 ,治疗后症状消失。约 8个月前于左上臂内下侧可触及一约小指头大小肿物 ,肿物质韧 ,能移动 ,无明显触痛 ,触摸时有放射状触电感疼痛 ,未行治疗。随后肿物渐大 ,4个月前开始觉手部肌肉萎缩 ,环指、小指感觉麻木 ,活动受限 ,呈爪状畸形。诊断尺神经肿瘤入院治疗。既往史无咳嗽、无午后低热、无盗汗、无咯血等病史。体格检查 :一般情况好 …     

腰椎间盘突出症合并受累神经根神经鞘膜瘤1例报告

患者女，55岁。于2007年5月23日入院。患者4个月前出现劳累后右下肢放射性疼痛，伴麻木、无力。休息后可完全缓解，无腰痛，大小便正常，未系统诊治。4d前患者从事重体力劳动后上述症状明显加重且左下肢也出现相应症状。双下肢症状交替出现，以右下肢为重，症状持续不缓解．以致影响到睡眠及活动，在当地医院行腰椎CT检查示腰椎间盘突出及椎管内占位．建议手术治疗。     

颈髓髓内神经鞘瘤1例报告

患者男性 ,2 7岁。自觉右手小指有冰凉感 1年半 ,3个月后出现麻木、小指及环指僵硬 ,7个月后跑步时右腿活动不便 ,1年后右手手指不能屈伸 ,右腿抬腿困难。无大、小便功能障碍。查体 :右上肢屈肌肌力Ⅲ级 ,伸肌肌力Ⅱ级 ,右手屈伸障碍。左上肢屈肌肌力Ⅴ级 ,伸肌肌力Ⅲ级 ,手指活动灵活。双下肢肌力Ⅳ级 ,右下肢肌张力增高 ,踝阵挛阳性。腹壁反射、提睾反射未引出 ,肛门反射存在。双Ｈｏｆｆｍａｎ′ｓ征及双Ｂａｂｉｎｓｋｉ′ｓ征阳性。右上肢尺侧痛觉减退。躯干、四肢两点辨别觉减退 ,位置觉存在。颈部ＭＲＩ检查 :颈髓 4～ 6节段脊髓增粗…     

尺神经神经束膜瘤二例

目的 总结2例尺神经神经束膜瘤患者的诊治过程,并对该病进行相关的文献复习.方法 例1为女性患者,发现右上臂肿块3年,术前患肢感觉正常,手部运动功能略减退.术中见肘上尺神经呈梭形增粗膨大约4cm×2cm,将肿瘤切除1周后行腓肠神经移植修复.例2为男性患者,发现右肘部肿块3个月,术前右小指刺痛觉减退,手内在肌肌力下降.术中见尺神经于肘部呈梭形增粗膨大约9 cm×4 cm,切取部分尺神经组织送病理检查.结果 术后2例病理报告均为尺神经神经束膜瘤.例1术后随访3个月,未见肿瘤复发,尺神经支配区手功能无恢复.例2术后随访9个月,肿瘤无增大,手功能与术前相同.结论 神经内神经束膜瘤是一种少见的良性病变过程,对于病理诊断明确的患者,可手术切除并行神经修复,也可取神经活组织检查,定期随访肿瘤的进展情况.     

原发性肾上腺节细胞神经瘤1例

患者,男,38岁。因右腰腹部隐痛不适2个月入院。既往无头痛、头晕及高血压等病史。体检:无异常发现,血电解质、肝肾功能无异常,醛固酮、皮质醇等检查均正常。B超及CT检查均显示右肾上腺区有实性占位性病变,B超表现为低回声图像,边界清晰,回声均匀;CT表现为均匀低密度灶,呈类圆形     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Intrathecal administration of sameridine to patients subjected to arthroscopic knee joint surgery

Background: Sameridine, a new substance with both local anesthetic and opioid effects, was administered intrathecally for the first time to humans, i. e. in patients subjected to arthroscopic knee joint surgery.
Method: A dose-escalating (10, 15, 20 and 25 mg), open study was performed in 33 patients. Only two patients were included in the 25 mg group.
Results: Sameridine provided good quality of surgical anesthesia in all patients except those receiving 10 mg. The maximum level of sensory block, Th5–Th7, was reached within 30 min with a median duration of 3.6–3.9 h. The motor block was more profound with increasing dose, but never lasted longer than the sensory block. The influence on heart rate and blood pressure was minor and atropine and ephedrine were needed in four patients. No clinically significant ECG-changes were detected and no arrhythmias were recorded. Oxygen saturation and respiratory rate did not decrease in a clinically significant way and were not affected by concomitant morphine given i. v. postoperatively. There were few side-effects, the most frequent being mild pruritus (10/33).
Conclusion: Sameridine provided clinically adequate anesthesia for the patients receiving the doses of 15, 20 and 25 mg. Further studies are needed to evaluate the substance and it is of great interest to clinically investigate the opioid component with respect to postoperative analgesia.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.