经皮脊柱内镜下手术治疗腰5-骶1椎间盘突出症

目的 探讨经皮脊柱内镜下手术治疗腰5-骶1椎间盘突出症的方法及效果。方法 回顾性分析2013年3月至2016年1月经皮脊柱内镜下手术治疗的38例腰5-骶1腰椎间盘突出症的临床资料,采用经椎间孔入路26例,经椎板间入路12例。手术前后采用疼痛视觉模拟量表（VAS）评分、MacNab量表评分、KPS评分和日本骨科协会（JOA）评分评估疗效。随访时间大于6个月。结果 38例中,34例（89.5%）疗效优良。术后VAS评分[（1.0±1.5）分]较术前[（7.9±1.1）分]明显降低（P<0.05）。术后腰椎JOA评分[（21±5.7）分]较术前[（7.4±4.6）分]明显提高（P<0.05）。经椎间孔入路和经椎板间入路的手术疗效无明显差异。结论 经皮脊柱内镜下选择椎间孔入路或椎板间入路均可有效、安全并且微创地治疗腰5-骶1腰椎间盘突出症。     

Post-infectious transverse myelitis and thoracic spina bifida: report of a case

The patient, a 30 year-old man, dentist, started having an influenza-like infection which lasted five days, with malaise, muscle pain throughout the body and fever. One day before the hospital admission he presented urinary retention followed in the next day by ataxia and numbness sensation in both feet and lower third of his legs. The neurological examination disclosed a thoracic spinal cord impairment at T9-T10 level and the diagnosis of a post- infectious transverse myelitis was made. The plain Rx of the spine showed a spina bifida oculta in the T7 vertebra, which is roughly at the same level of the T9-T10 spinal cord segment. An iodinated myelography showed no abnormalities. The CSF examination showed small increase in the white cells (6.4 cells/cu.mm). The patient received dexamethasone (4. 5g /day) and two weeks later was entirely free of symptoms. The authors think that the congenital bone defect (spina bifida) might have played a role in the development of the myelitis, probably because of an ontogenetically determined "vulnerable point" ("locus minor resistentia ") at that level, either anatomical or immunological.     

纳米粒包裹氨基吡啶亚乙基双磷酸甜菜碱对巨噬细胞的选择性清除作用

背景：氨基吡啶亚乙基双磷酸甜菜碱（2-(2-aminopyrimidinio) ethylidene-1,1-bisphosphonic acid betaine,ISA）是一种新近人工合成的效力极强的双磷酸酯,将其用纳米粒包裹后通过巨噬细胞的吞噬作用而导入细胞,可以达到选择性清除巨噬细胞的目的。 目的：拟验证纳米粒包裹ISA对单核/巨噬细胞选择性的清除作用。 设计、时间及地点：分组设计、对比观察,于2003/2007分别在以色列希伯莱大学和解放军总医院实验室完成。 材料：ISA由以色列希伯莱大学药学院合成;聚乳酸/乙醇酸共聚物 (50∶50),相对分子质量123 400;聚乙烯醇,相对分子质量30 000~70 000。 方法：采用双相乳化系统和溶剂蒸发技术制备纳米粒包裹的ISA,另以ISA溶液和等量不含ISA的纳米粒为对照。 主要观察指标：①纳米粒形态、大小及纳米粒中ISA含量。②纳米粒中ISA体外释放率。③ISA对培养巨噬细胞、平滑肌细胞增殖的影响。④激光扫描共聚焦显微镜观察培养细胞对荧光标记纳米粒吞噬作用。 结果：所制备的纳米粒直径500 nm,表面呈负电荷（-40 mV）,ISA包裹率高（17.6%~19.0%）,扫描电镜检查见其大小均匀。体外实验证实,ISA在纳米粒包裹后对巨噬细胞、平滑肌细胞增殖抑制作用明显增加,并且对巨噬细胞增殖的抑制作用尤为明显。激光扫描共聚焦显微镜观察发现荧光标记的纳米粒分别与巨噬细胞、平滑肌细胞孵育后,纳米粒可快速进入巨噬细胞内,且包裹ISA的纳米粒对巨噬细胞有明显损伤作用,而平滑肌细胞内无纳米粒。 结论：ISA经纳米粒包裹后可选择性清除单核/巨噬细胞,而对非吞噬细胞影响较小。     

Malformations of the spinal cord in 53 patients with spina bifida studied by magnetic resonance imaging

The incidence of associated malformations of the hindbrain and spinal cord in patients with spina bifida was investigated by a clinical and magnetic resonance study. The incidence of these malformations in combination with spina bifida was 49/53 (92.5%). Fiftytree children born with spina bifida aperta (40 patients) or spina bifida occulta (13 patients) formed the study group. The incidence of the various malformations were: Chiari malformations, type I, 10/53 (19%), and type II, 20/53 (38%); syringomyelia, 13/53 (24.5%); hydromyelia 4/53 (7.5%); tethered cord malformation, 35/53 (66%); diastematomyelia 2/53 (4%). Thirty-seven of the 49 patients with associated malformations had no clinical signs at the time of our study. The results point to the fact that in the pediatric age group, associated spinal defects often remain asymptomatic.     

A rare case of massive NF1 with invasion of entire spinal axis by neurofibromas: case report

Neurofibromatosis type-1 (NF1) is a type of phakomatosis inherited in an autosomal dominant fashion. Also called 'von Recklinghausen disease' or 'peripheral neurofibromatosis', it comprises 90% of all neurofibromatosis (NF) cases. It is characterized by multiple peripheral nerve sheath tumors of benign character called neurofibromas. Surgical intervention is indicated when myelopathy and motor losses develop in the case of paraspinal neurofibromas, which are frequently localized to the cervical and lumbar regions. The level of surgical intervention required should be carefully considered and should take into account neurophysiological tests of paraspinal neurofibroma cases that allow estimation of the risk that the neurofibromas will invade the complete spinal axis. The best results are obtained with patients showing minimal neurological deficits during the pre-operative period. Little improvement may be expected from the patients who develop complete transection syndrome during the postoperative period. In the present paper, we discuss an NF1 case in which paraspinal neurofibromas were observed along the complete spinal axis of a 32-year-old male patient who arrived at the clinic reporting increasingly intense pins and needles and weakness. We discuss the patient's diagnosis, treatment, and prognosis, and relate this case to the literature.     

Post-operative paraplegia with spinal myoclonus possibly caused by epidural anaesthesia: case report

We report a patient who developed paraplegia following percutaneous nephrolithotresis of the left kidney under epidural anaesthesia. The cause of the paraplegia was unknown, but occlusion of the anterior spinal artery or central arteries and arachnoiditis, possibly due to the epidural anaesthesia, may have taken part in the onset and progression of the paralysis. The patient had spinal myoclonus corresponding to the spinal levels where myelomalacia was found by magnetic resonance (MR) imaging.     

肾移植后他克莫司与五酯胶囊合用致高血钾症1例

背景：肾移植患者由于免疫抑制剂的药物肝毒性,肝功能异常发生率高,对临床出现肝功能异常者,需护肝治疗。但合用护肝药必须监测免疫抑制剂浓度。 目的：探讨肾移植患者他克莫司与五酯胶囊合用对他克莫司浓度及血生化的的影响。 方法：回顾性分析1例以他克莫司为免疫抑制剂的肾移植患者加服及停用五酯胶囊时他克莫司浓度及肾功能、血生化变化。患者因“慢性肾小球肾炎,慢性肾功能不全”于1998-06起行血液透析治疗。2000-08行同种异体尸体肾移植,移植后免服他克莫司+吗替麦考酚酯+泼尼松。移植后4个月患者出现肝功能异常,加用联苯双酯。2010-07-25患者停用联苯双酯,改服五酯胶囊。2010-07-29患者停用五酯胶囊。 结果与结论：服用他克莫司的肾移植受者,合用五酯胶囊,他克莫司血浓度显著升高。由5.3 ng/L升至24.7 ng/L,并合并高血钾症,停用五酯胶囊1周,他克莫司浓度由24.7 ng/L降至6.1 ng/L,血钾由6.4 mmol/L降至4.6 mmol/L。提示移植肾功能稳定的肾移植受者,在加用五酯胶囊,必须严密监测他克莫司血浓度及肝肾功能、电解质,及时调整他克莫司用量,保护移植肾功能。