【公告】德国脊柱临床和科研年会

weisskopf

Medical Records for Admisson
  Medical Number: 701721
General information

Name: Liu Side
Age: Eighty
Sex: Male
Race: Han
Nationality: China
Address: NO.35, Dandong Road, Jiefang Rvenue, Hankou, Hubei. Tel: 857307523
Occupation: Retired
Marital status: Married
Date of admission: Aug 6th, 2001
Date of record: 11Am, Aug 6th, 2001
Complainer of history: patient’s son and wife
Reliability: Reliable

Chief complaint: Upper bellyache ten days, haematemesis, hemafecia and unconsciousness for four hours.
Present illness:
   The patient felt upper bellyache about ten days ago. He didn’t pay attention to it and thought he had ate something wrong. At 6 o’clock this morning he fainted and rejected lots of blood and gore. Then hemafecia began. His family sent him to our hospital and received emergent treatment. So the patient was accepted because of “upper gastrointestine hemorrhage and exsanguine shock”.
   Since the disease coming on, the patient didn’t urinate.                                          
Past history
   The patient is healthy before.
   No history of infective diseases. No allergy history of food and drugs.
Past history
Operative history: Never undergoing any operation.
Infectious history: No history of severe infectious disease.
Allergic history: He was not allergic to penicillin or sulfamide.
Respiratory system: No history of respiratory disease.
Circulatory system: No history of precordial pain.
Alimentary system: No history of regurgitation.
Genitourinary system: No history of genitourinary disease.
Hematopoietic system: No history of anemia and mucocutaneous bleeding.
Endocrine system: No acromegaly. No excessive sweats.
Kinetic system: No history of confinement of limbs.
Neural system: No history of headache or dizziness.
Personal history
He was born in Wuhan on Nov 19th, 1921 and almost always lived in Wuhan. His living conditions were good. No bad personal habits and customs.
Menstrual history: He is a male patient.
Obstetrical history: No
Contraceptive history: Not clear.
Family history: His parents have both deads.
Physical examination

T 36.5℃, P 130/min, R 23/min, BP 100/60mmHg. He is well developed and moderately nourished. Active position. His consciousness was not clear. His face was cadaverous and the skin was not stained yellow. No cyanosis. No pigmentation. No skin eruption. Spider angioma was not seen. No pitting edema. Superficial lymph nodes were not found enlarged.
Head
   Cranium: Hair was black and white, well distributed. No deformities. No scars. No masses. No tenderness.
   Ear: Bilateral auricles were symmetric and of no masses. No discharges were found in external auditory canals. No tenderness in mastoid area. Auditory acuity was normal.
   Nose: No abnormal discharges were found in vetibulum nasi. Septum nasi was in midline. No nares flaring. No tenderness in nasal sinuses.
   Eye: Bilateral eyelids were not swelling. No ptosis. No entropion. Conjunctiva was not congestive. Sclera was anicteric. Eyeballs were not projected or depressed. Movement was normal. Bilateral pupils were round and equal in size. Direct and indirect pupillary reactions to light were existent.
   Mouth: Oral mucous membrane was not smooth, and there were ulcer can be seen. Tongue was in midline. Pharynx was congestive. Tonsils were not enlarged.  
Neck: Symmetric and of no deformities. No masses. Thyroid was not enlarged. Trachea was in midline.
Chest
  Chestwall: Veins could not be seen easily. No subcutaneous emphysema. Intercostal space was neither narrowed nor widened. No tenderness.
  Thorax: Symmetric bilaterally. No deformities.
  Breast: Symmetric bilaterally.
  Lungs: Respiratory movement was bilaterally symmetric with the frequency of 23/min. thoracic expansion and tactile fremitus were symmetric bilaterally. No pleural friction fremitus. Resonance was heard during percussion. No abnormal breath sound was heard. No wheezes. No rales.
  Heart: No bulge and no abnormal impulse or thrills in precordial area. The point of maximum impulse was in 5th left intercostal space inside of the mid clavicular line and not diffuse. No pericardial friction sound. Border of the heart was normal. Heart sounds were strong and no splitting. Rate 150/min. Cardiac rhythm was not regular. No pathological murmurs.
Abdomen: Flat and soft. No bulge or depression. No abdominal wall varicosis. Gastralintestinal type or peristalses were not seen. Tenderness was obvious around the navel and in upper abdoman. There was not rebound tenderness on abdomen or renal region. Liver and spleen was untouched. No masses. Fluidthrill negative. Shifting dullness negative. Borhorygmus not heard. No vascular murmurs.
Extremities: No articular swelling. Free movements of all limbs.
Neural system: Physiological reflexes were existent without any pathological ones.
Genitourinary system: Not examed.
Rectum: not exaned

Investigation
Blood-Rt:  Hb 69g/L RBC 2.70T/L WBC 1. 1G/L PLT 120G/L
History summary

1.        Patient was male, 80 years old
2.        Upper bellyache ten days, haematemesis, hemafecia and unconsciousness for four hours.
3.        No special past history.
4.        Physical examination: T 37.5℃, P 130/min, R 23/min, BP 100/60mmHg Superficial lymph nodes were not found enlarged. No abdominal wall varicosis. Gastralintestinal type or peristalses were not seen. Tenderness was obvious around the navel and in upper abdoman. There was not rebound tenderness on abdomen or renal region. Liver and spleen was untouched. No masses. Fluidthrill negative. Shifting dullness negative. Borhorygmus not heard. No vascular murmurs. No other positive signs.
5.        investigation information:  
   Blood-Rt:  Hb 69g/L RBC 2.80T/L WBC 1.1G/L PLT 120G/L

                        Impression: upper gastrointestine hemorrhage
                   Exsanguine shock

weisskopf

著名的血液学家Ernest Beutler即将于2006年8月28日～ 9月2日来华参加由上海交通大学医学院附属瑞金医院、上海血液学研究所主办的“2006亚太血液及肿瘤基础和临床研究教育中心年会 暨2006国家级继续医学教育学习班：血液-肿瘤学诊断及研究技术新进展”会议。大会还特邀陈竺、陈赛娟、王振义院士，以及贝尔生理及医学奖评委会主席Jan-ake Gustafsson作精彩的报告。
同往届一样：本次亚太血液及肿瘤基础和临床研究教育中心年会 暨2006国家级继续医学教育学习班旨在为血液学和肿瘤学科临床医师提供具有国际水平的临床和基础继续教育平台，提高中国国内乃至整个亚太地区血液肿瘤学科临床研究的教育水平，培养血液肿瘤学科临床研究领域的高级专业人才，最终推动具有国际标准的临床研究在国内的开展。本次会议邀请了国内外相关领域的领军人物作为大会特邀发言人，并被批准为国家级继续教育项目。
热爱临床及实验血液学的工作者们将有机会与血液学领域内的国内及国际一流大师交流和学习，会议内容详见附件内的agenda。

weisskopf

耳鼻喉科试题系列答案（1）
一.  名词解释：
1.胆脂瘤：是一种位于中耳内的囊性结构，而非真性肿瘤。囊的内壁为复层鳞状上皮，囊内充满脱落上皮、角化物质及胆固醇结晶，囊外以一层厚薄不一的纤维组织与邻近骨壁或组织紧密相连。
2.窦口鼻道复合体：鼻和鼻窦炎症性疾病的发病机理和病理生理学现代概念认为：中鼻甲、中鼻道及其附近区域的解剖结构的生理异常和病理改变最为关键，该区域称为窦口鼻道复合体。
3.吴氏静脉丛：老年人下鼻道外侧壁后部近鼻咽处有表浅扩张的鼻后侧静脉丛。
4.咽后间隙：位于椎前筋膜与颊咽筋膜之间，上起颅底，下至上纵隔，相当于第1、2胸椎平面，两侧仅以薄层筋膜与咽旁间隙相隔，中线处被咽缝将其分左右两部份。
5.先天性喉蹼：为胚胎喉23期（8周）发音时喉前部未能打开所致。
二．简答题：
1.  简述鼻源性头痛的特点
由鼻病引起的头痛称为鼻源性头痛,一般分为两类:感染性和非感染性.疼痛的性质一般为纯痛和闷痛。（1）一般都有鼻部病变，如鼻塞、脓涕等，多在窦内脓性物排出后缓解；（2）鼻急性炎症时加重；（3）多为深部头痛；（4）鼻腔粘膜收缩或使用表面麻醉剂后，头痛可以减轻；（5）头痛有一定部位和时间。
2．简述喉癌的分型及各自的临床特点
根据喉癌发生的部位，将喉癌分为声门上型、声门型和声门下型。其临床表现分述如下：
声门上型：早期可无显著症状。可能有喉部不适感；以后可出现吞咽疼痛，放射至耳部。痰中带血，有臭味。该区淋巴管丰富，易出现淋巴结转移，预后较差。
声门型：早期出现声嘶，进行性加重。肿块较大时能阻塞声门引起呼吸困难。该区淋巴管较少，不易向颈淋巴结转移，且容易早期诊断，预后较好。
声门下型：早期症状不明显，不易发现。肿瘤溃烂时出现咳嗽及痰中带血；向上侵犯声带时，可出现声嘶；肿瘤增大可阻塞声门下出现呼吸困难。常有气管前或气管旁淋巴结转移。
2.  简述颈部肿块skandalakis的“4个80%规律”与“3个7规律”
关于颈部肿块的性质，skandalakis总结了4个80%，即80%是肿瘤，其中80%是恶性，恶性中80%是淋巴结转移，原发癌中80%来自锁骨上。关于病程skandalakis总结出3个7的规律，即7天者多为炎症，7个月者多为肿瘤，7年者多为先天性肿块。
3.  试述面神经全长的分段及分支
面神经的全长可分为8段：1.运动神经核上段；2.运动神经核段；3.小脑脑桥角段；4.内耳道段；5.迷路段；6.鼓室段；7.乳突段；8.颞骨外段。
自上而下，面神经的分支有：1.岩浅大神经；2.镫骨肌神经；3.鼓索神经；4.面神经出茎乳孔后发出分支；5.面部分支：（1）颞支；（2）颧支；（3）颊支；（4）下颌缘支；（5）颈支.
三.问答题:
1.  详述感音神经性耳聋的病因及鉴别诊断
感音神经性聋
　　1．先天性：常由于内耳听神经发育不全所致，或妊娠期受病毒感染或服用耳毒性药物引起，或分娩时受伤等
　　2．后天性：有下列几种原因：
（1） 传染病源性聋：各种急性传染病、细菌性或病毒性感染，如流行性乙型脑炎、流行性腮腺炎、化脓性脑膜炎、麻疹、猩红热、流行性感冒、耳带状疱疹、伤寒等均可损伤内耳而引起轻重不同的感音神经性聋。
（2） 药物中毒性聋：多见于氨基糖甙类抗生素，如庆大霉素、卡那霉素、多粘菌素、双氢链霉素、新霉素等，其他药物如奎宁、水杨酸、顺氯氨铂等都可导致感音神经性聋，耳药物中毒与机体的易感性有密切关系。药物中毒性聋为双侧性，多伴有耳鸣，前庭功能也可损害。中耳长期滴用此类药物亦可通过蜗窗膜渗入内耳，应予注意。
　　（3）老年性聋：多因老年血管硬化、骨质增生，使螺旋器毛细胞和螺旋神经节供血不足，发生退行病变，或中枢神经系统衰退，导致听力减退。
　　（4）外伤性聋：颅脑外伤及颞骨骨折损伤内耳结构，导致内耳出血，或因强烈震荡引起内耳损伤，均可导致感音神经性聋，有时伴耳鸣、眩晕。轻者可以恢复。耳部手术误伤内耳结构也可导致耳聋。
　　（5）突发性聋：是一种突然发生而原因不明的感音神经性聋。目前多认为急性血管阻塞和病毒感染是引起本病的常见原因。病变可累及螺旋器，甚或前庭膜、蜗窗膜破裂。耳聋可在瞬间显现，也可在数小时、数天内迅速达到高峰，多为单侧，亦有双耳患病，伴耳鸣，有的可伴眩晕。早期治疗可获得较好效果。
　　（6）爆震性聋：系由于突然发生的强大压力波和强脉冲噪声引起的听器急性损伤。鼓膜和耳蜗是听器最易受损伤的部位。当人员暴露于90dB（A）以上噪声，即可发生耳蜗损伤，若强度超过120dB以上，则可引起永久性聋。鼓膜损伤与压力波强度有关，表现为鼓膜充血或鼓膜穿孔。耳聋的程度与噪声强度、暴露次数以及压力波的峰值、脉宽、频谱、个体差异等因素有关，耳聋性质多为感音神经性聋或混合性聋。
　　（7）噪声性聋：是由于长期遭受85dB(A)以上噪声刺激所引起的一种缓慢进行的感音神经性聋。主要表现为耳鸣、耳聋，纯音测听表现为4000Hz谷形切迹或高频衰减型。亦可出现头痛、失眠、易烦躁和记忆力减退等症状。其耳聋程度主要与噪声强度、暴露时间有关，其次与噪声频谱、个体差异亦有一定关系，有人发现2000Hz～4000Hz的噪声最易导致耳蜗损害。
2.  试述功能性鼻窦内窥镜手术的理论基础
借助内窥镜的良好照明，通过对鼻腔深部结构清晰的观察，直接清除病变组织、纠正解剖异常、开放鼻窦的开口，从而使鼻窦与外界相通，保证鼻腔鼻窦的通气引流，依靠鼻腔及鼻窦的自身生理功能的恢复来治愈鼻窦炎和鼻息肉的目的。
3.  简述鼻咽癌的临床表现
临床特点：
鼻部症状：早期可有出血症状，表现为吸鼻后痰中带血或擤鼻时涕中带血。早期痰中或涕中仅有少量血丝，时有时无。晚期出血较多，可有鼻血。
耳部症状：耳鸣、听力减退、耳内闭塞感，鼻咽癌发生在鼻咽侧壁，侧窝或咽鼓管开口上唇时，肿瘤压迫咽鼓管可发生单侧性耳鸣或听力下降，还可发生卡他性中耳炎。
头痛：为常见症状，可为首发症状或唯一症状。早期病人可能是神经血管反射引起，或是对三叉神经第一支末梢神经的刺激所致。晚期病人常是肿瘤破坏颅底，在颅内蔓延累及颅神经所引起。
复视：由于肿瘤侵犯外展神经，常引起向外视物呈双影。滑车神经受侵，常引起向内斜视、复视，复视占6.2％～19％。常与三叉神经同时受损。
面麻： 肿瘤侵入海绵窦常引起三叉神经第1支或第2支受损；肿瘤侵入卵圆孔、茎突前区、三叉神经第3支常引起耳廓前部、颞部、面颊部、下唇和颏部皮肤麻木或感觉异常。
颈部淋巴结转移症状：鼻咽癌容易发生颈部淋巴结转移，颈部淋巴结转移常为鼻咽癌的首发症状。
远处转移： 鼻咽癌可出现远处转移率。常见的转移部位是骨、肺、肝等。

weisskopf

颈椎病的临床症状较多，主要有后枕部疼痛、颈部麻木、头部姿式变化可引起头痛发作、上肢无力、手指发麻、下肢乏力、行走困难、头晕、恶心、呕吐，甚至视物模糊、心动过速等。临床上根据患者的症状不同进行不同的分型。


(1)神经根型：由于髓核的突出或脱出、骨质增生、黄韧带肥厚等改变，对脊神经根造成刺激和压迫，临床上出现上肢疼痛、无力、手指麻木、感觉异常等根性症状。


(2)脊髓型：由于压迫或刺激脊髓而出现髓性异常感觉、运动及反射障碍等症状。


(3)椎动脉型：因为椎动脉受刺激、压迫，造成以椎—基底动脉供血不足为主要症状的症候群，可产生偏头痛、耳鸣、眩晕、视力减退。


(4)交感神经型：因为颈部交感神经纤维受累，可出现恶心、心动过速等症状，此型往往与椎动脉型伴发。


此外，还有几种症状混合存在的，称混合型。


以上各型颈椎病，均能产生头痛。头痛总是位于枕部与枕下部，时常向同侧前额或眼部扩散。疼痛的性质是属于牵拉痛，有时为刺痛或钝痛，而不是搏动性或爆裂样痛，初起疼痛呈间歇性，可逐渐发展为持续性。除头痛之外，还可伴发上肢疼痛或麻感。头痛与上肢痛常同时加剧或减轻，而且头部动作与颈项姿势的改变可以引起上肢痛与头痛。

weisskopf

平时，如发生头痛，请不要急于服用止痛药，因为在未查清楚是何种原因引起头痛前，盲目服止痛药是有害的。用下列简便易行的非药物方法治疗，能起到一定的止痛效果。


卧床休息在床上躺10分钟，把头垫高，使精神放松。这对于减轻因紧张造成的头痛有效。


湿敷颈部大部分人用冷毛巾敷有效，也有人用热毛巾敷有效。冷毛巾每1分钟换一次，热毛巾每3分钟换一次。此法对减轻因头部血流障碍引起的头痛有效。


足浴取两只盆，分别倒入热水和冷水，然后双脚交替放入冷水热水中。这对于减轻血液循环引起的头痛有明显的效果。


擦身用干刷子从脚部往上轻擦身体10分钟，这对供血障碍和高血压引起的头痛有效。


呼吸运动打开窗户作深呼吸，然后非常缓慢地呼气，呼气时身体向前弯，吸气时挺直，持续15分钟。这对于减轻因脑缺氧引起的头痛有效。

weisskopf

腰穿全称腰椎蛛网膜下腔穿刺术。腰穿的目的是取脑脊液作进一步的化验检查。它属神经科的一项常规检查，也是诊断头痛的重要检查之一。


由于许多人对其意义和本质尚不了解，存在一定的误解(如认为腰穿是“抽脊髓”，会“伤害身体”等)，有些患者一提起腰穿就产生畏惧情绪，不愿接受穿刺检查，以致耽误诊断与治疗。其实作腰穿检查和对采集的脑脊液进行分析化验，对于区分器质性还是功能性原因引起的头痛，具有重要价值。


腰穿检查对头痛患者还有独特的诊断及治疗价值。如通过了解脑脊液压力，可以鉴别是高颅压还是低颅压性头痛；通过脑脊液中细胞成分改变的分析，可以识别有无脑出血或炎症；通过特殊的细胞学检查或微生物学检查，可以区分有无肿瘤、结核及隐球菌、寄生虫感染；通过腰穿还能了解椎管是否通畅，如向蛛网膜下腔注人造影剂或空气，则能显示脑室系统及脑室的形态，及时发现有无梗阻性脑积水存在。

weisskopf

坐骨神经痛是指开始于臀部并继续下传到腿部的疼痛。坐骨神经痛通常伴有腰背部疼痛，腰背部疼痛的程度可重于或轻于腿部的疼痛。“坐骨神经痛”是指穿行于腰背部然后通过臀部分布到腿部的坐骨神经受损后产生的疼痛。真性坐骨神经痛是由于突出的腰椎间盘压迫到坐骨神经其中一条起主要作用的神经根而产生的，由这种原因引起的腰背部疼痛比较少见。举个例子说，体育运动，休闲活动和重体力劳动导致的背部和腿部疼痛常被误诊为坐骨神经痛。医生们面临的问题就是要区分神经根痛和牵扯痛，神经根痛是因神经根发炎引起的，而牵扯痛则是肌肉骨骼扭伤或过度疲劳的结果。

weisskopf

症状真性坐骨神经痛最常见的症状就是大腿后侧，小腿下端以及足部的疼痛，这些部位的疼痛要比腰背部的疼痛严重。一般来说，患者会感到从臀部发展到腿部或足部的疼痛逐渐加重。真性坐骨神经痛会发展到膝盖以下的部位，了解这一点是十分重要的。通常，患者会首先感到腰背部疼痛，几天或几星期后才会感到腿部疼痛，之后，腿部疼痛的程度会超过腰背部疼痛，有时腰背部疼痛会完全消失。

但是如果坐骨神经痛的时间较长，疼痛就会局限于臀部和后腿部，这种情况下，患者会感到疼痛的部位不明确了，疼痛没有放射到小腿或是足部，但事实上在疾病的早期疼痛就已发展到那些部位了。一般来说，坐骨神经痛和外伤或运动没什么特定的联系。坐立，抬重物，喷嚏或肠运动都可能会使疼痛加剧。睡姿是最舒适的姿势。坐骨神经痛偶尔会伴有皮肤感觉异常，无力及肠膀胱功能减退，但这些症状很少见。

weisskopf

诊断和治疗

一份完整的病史和仔细的体格检查对于坐骨神经痛的诊断是十分重要的。神经根压力实验通过让受检者做出的动作和体位来确定坐骨神经痛的存在。医生引导受检者的腿向特定的方向移动，使坐骨神经轻微延伸。如果检查过程中受检者感到疼痛，那么疼痛的原因就是坐骨神经受损。

很多坐骨神经痛患者会自然痊愈，有些需要治疗的病人通常接受的是保守治疗，包括一定时期的休息和活动限制，抗炎药物治疗。理疗，牵引，锻炼对病人完全恢复活动能力是很有好处的。如果疼痛十分严重，或到了病人无法忍受的程度，而且有客观依据（如磁共振扫描）证明疼痛的原因是椎间盘脱垂，可以考虑使用几种不同的手术方法。那些疼痛与神经损伤有关或伴有肌无力的患者术后的恢复情况要比没有肌无力症状的患者好的多。

weisskopf

麻木和乏力
麻木和无力是神经系统反常活动的表现。

麻木

当神经冲动不能从皮肤传至大脑时就会产生麻木的感觉。

有腰背部疾病的病人身体的某些部位可能会有麻木的感觉，尤其是腿和脚。这些部位的麻木通常提示病人可能有周围神经系统或中央神经系统（也就是脊髓和大脑）的神经损伤，一旦出现这类症状，我们必须给予足够的重视。

麻木可发生在皮肤的表面，也可发生于一些在体表开口的器官如口腔，阴道。

weisskopf

最常引起麻木的脊柱疾病包括以下四种：

脊神经根受压 — 因椎间盘突出而受压的神经
椎管狭窄 - 压迫感觉神经纤维引起感觉丧失
多发性脊髓硬化病
脊髓休克
最常引起麻木的脑部疾病包括以下五种：

脑休克
脑发作
先天性异常
脑震荡
其他非典型情况，如心理紊乱

weisskopf

肌无力

肌无力发生在信号不能顺利地由大脑传至肌肉或是肌肉本身有病变。

如果肌无力不是由诸如糖尿病之类的系统性疾病引起的，其原因就可能是神经或肌肉的问题。瘫痪则是肌无力最严重的表现。

和腰背部疼痛相关的肌无力的致病因素有很多，但引起全身性系统性肌无力的最普遍的原因却是缺乏运动。

一个人行走时的姿势，步态，步伐大小以及手臂摆动的幅度和次数会影响到胸背部和腰背部的几十块肌肉。无症状的微小的肌肉损伤会使人们在行走时以几种不同的方式进行补偿，有时人们甚至都察觉不到身体做出的这些调整。这些大大小小的身体调整日积月累，产生的多米诺骨牌效应有时就会导致腰背部疼痛。

weisskopf

肌无力的致病因素

肌病

就象影响皮肤的皮炎，影响神经的神经病一样，肌病损害的对象是肌肉组织，大多数时候会影响全身的肌肉。

肌病产生原因有以下几种：糖尿病及其它类型的内分泌异常，感染，自身免疫性疾病，中毒，以及遗传因素。

绝大多数肌病首先出现在靠近身体躯干的部位，如胸部肌肉，上肢骨端和大腿部的肌肉。
症状

患有肌病的病人在上楼梯的时候会感觉无力，膝盖会不自主地弯曲，甚至是拧瓶盖这种日常小事他们也会觉得有困难。

骨关节炎和骨质疏松症

这些类型疾病和年龄增大相关，它们会引起关节变形，进而导致椎骨骨折，随后就会产生神经损伤。因此导致肌无力的神经学上的病因包括以下几种：

休克
脊髓损伤
周围神经损伤或损坏 — 外伤，手术，或姿势体位引起的压力是主要损伤原因
肌病—— 一条或多条神经损坏引起的系统性反射减弱
骨质疏松症 / 骨关节炎—— 肌无力有时是这类疾病的次要并发症

weisskopf

疼痛
我们感觉到的疼痛实际上是一种对信号产生的反应，这种信号通过身体传导。它们产生于疼痛源，举个例子说，腰背部疼痛通过脊髓上传到大脑，然后产生所谓的疼痛感。
不同类型的疼痛

有些疼痛是神经源性的浅表痛，而有些则是深部疼痛。分清疼痛的类型是很重要的，因为不同类型的疼痛有着不同的治疗方法。

weisskopf

神经源性 的疼痛是由神经组织损伤引起的，一般呈剧烈疼痛或是刺痛，比如“神经根受压痛”。

深部痛是由神经系统外的损伤或疾病引起的。和神经源性疼痛的剧烈创伤样疼痛不同的是，此种疼痛呈持续性钝痛或是压迫感，比如“关节炎痛”。

weisskopf

慢性和急性腰背部疼痛

慢性腰背部疼痛通常呈腰背部某一区域的深部痛，酸痛，钝痛，或是剧痛，也可下传到腿部。患者可能会感觉到腿部无力，麻刺感，烧灼感或是针刺感。日常活动对于慢性腰背部疼痛患者来说有时都是困难的，甚至是无法完成的。举个例子说，他们可能无法正常工作，即使是非体力工作他们也不能胜任。慢性腰背部疼痛持续时间长，且不能被一般治疗方法所缓解。疼痛的原因可能是很早以前就已经治愈的外伤，也可能是某种持续性因素，比如神经损伤或是关节炎。
急性腰背部疼痛一般呈背部较低的部位的锐痛或是钝痛，某些部位的疼痛更为严重，比如背部左右侧，背部中央区，或是背部较低部位。急性背部疼痛呈间断发作，但发作频繁，而且疼痛程度不同。

急性腰背部疼痛有时可能是背部的外伤或是创伤引起的，但大多数时候无明显原因。急性背部疼痛患者，即使是严重患者，通常会在 6-8 周内明显好转或是完全恢复。

大约一半的腰背部疼痛是由外伤导致的急性疼痛。背部外伤造成的挫伤，肌肉撕裂，变形关节均可引起急性疼痛。有这些损伤的患者会感到疼痛，肌肉痉挛，活动能力减退。短期治疗通常是有效的。通过理疗，牵引，以及预防性锻炼，这些患者一般会在几周内完全康复。有时这些患者可能会再次受伤，这样的话他们必须再次接受短期治疗。一年内疼痛超过 3 次，或是长期持续性的腰背部疼痛已经影响到日常活动（如睡眠，坐立，行走，弯腰，骑马或开车），有这些情况的患者容易发展为慢性疼痛。

weisskopf

机械性腰背部疼痛也属于急性腰背部疼痛，这类疼痛会在运动或是咳嗽的时候加剧，休息时减轻。典型的机械性腰背部疼痛是由突出的椎间盘或是应力性骨折引起的，这种情况下的患者在脊柱向前运动时会感到疼痛。此外，体位，咳嗽，喷嚏及运动都会对来源于脊柱的疼痛产生影响。

如果急性腰背部疼痛十分严重而且下传到两腿部，这种疼痛就很有可能是由腰椎间盘疾病引起的，腰椎疾病是引起另外一种急性疼痛 - 真性坐骨神经痛的最常见原因。

weisskopf

急性腰背部疼痛的诊断

X 线：无痛非创伤性的成像方法，利用照相底片吸收电磁射线，这种射线的波长极短，小于 100 埃，可以穿透不同厚度的固态物质，能通过身体传播。这类影像就是我们通常所说的 X 光照片或相片，用于各类疾病的诊断和监控。
CAT Scan （计算机轴向 X 线断层摄像术）（或称为 CT scan( 计算机 X 线断层摄像扫描术 ) ）：另外一种无痛成像技术，利用计算机对不同轴向的 X 线整合处理，形成人体结构的三维图像。和目前所有可使用的成像技术相比，计算机 X 线断层摄像扫描术对骨，血液和软组织的成像质量是最好的。
MRI （磁共振成像） ： 非创伤性脊柱成像技术，检查时，磁铁围绕人体旋转，激发人体内的氢原子活动，同时扫描仪探测由这些被激发原子产生的能量。 MRI 技术能更好地体现脊柱结构的细节，因为人体的主要成分是有两个氢原子的水。这种检查方法对于脊柱疾病的诊断是最有价值的。
脊髓（ X 线）选影照片：进行此种检查时，需要将一种 X 线显影介质注射到包绕脊髓和神经的硬脊膜腔中去，然后对脊柱显影。通过这种技术，放射线医生能够对神经根进行显影，并且能够发现任何存在于椎管中的不正常现象，从而有助于脊柱疾病的诊断，比如神经受压或椎间盘破裂。
骨扫描 ：进行这种检查时需要将少量的显影标记物通过静脉途径注射到受检者体内，然后进行相关区域的扫描，扫描仪会检测到这些集中在高骨密度区域的标记物。当怀疑有肿瘤，感染，轻微骨折这些会引起骨密度增高的情况时，应采用骨扫描进行检查。骨扫描并不能代替以上说到的那些检查方法，但可以为排除一些严重疾病提供依据。

weisskopf

神经根病
医生们使用脊髓神经根病来描述由于神经根疾病而导致的疼痛以及其它一些如四肢麻木，麻刺感，无力等症状。神经根是脊髓束的分支，脊髓束沿着脊柱的每一节段将信号传到身体的其它部分。“ Radiculopathy ”这个词来源于两个拉丁词语，一个是“ radix ” , 意思是树之根，还有一个是“ pathos ”，意思是疾病。这种疾病的发生是由于突出的椎间盘或腰椎退行性变造成神经根直接受压并产生了炎症。脊髓神经根病表现为四肢由神经根感觉神经纤维支配的皮肤的疼痛和麻木感，以及同一神经根支配的肌肉的无力感。疼痛涉及到的神经根数目从一根到几根不等，同时还能影响双侧躯体的感觉。
通过感觉和运动神经实验，对神经根的分布进行图示描述，然后就能根据检查是症状和反应的分布来对病变神经根进行定位。

weisskopf

症状

坐骨神经痛是腰椎脊髓神经根病最常见的症状。这种疼痛能从腰背部放射至臀部，进而下传到腿部和脚部。感觉症状要多于运动症状，如出现肌无力则提示神经受压较为严重。疼痛有不同的性质和类型，有的表现为钝痛，酸痛，定位不准，有的则是锐痛，烧灼痛，定位准确。脊髓神经根疾病能提高触觉敏感性，也能使人感到神经根支配区域的皮肤麻木。如果您的腰背部疼痛同时伴有麻木感，麻刺感，尤其是伴有腿部肌肉的无力感，说明您的病情比较严重，应引起注意并去看医生。

weisskopf

诊断

造成脊髓神经根疾病的原因是多种多样的，但对腰背部和下肢重要部位的体格检查以及全身完整的体格检查是做出正确诊断的第一步。医生将会对腰背部的顺应性，活动度，还有一些特定的征象做检查，检查结果会提示哪些神经根受到了影响。这类检查通常还包括肌肉强度和一些反射以确定它们的功能正常。你还需要填写一份表格，内容包括您的疼痛，麻木，麻刺感以及无力症状在何处发生。

如果病人因背部疼痛来看医生的话，一系列常规的 X 线检查是必需的。磁共振检查和计算机断层扫描也可作为脊髓神经根疾病病因诊断的评价依据。磁共振扫描对于受压神经根的定位是十分有帮助的，因为它的特点就是清晰显示如神经和椎间盘这类软组织结构的。计算机断层扫描多被用来评价腰椎的骨结构，能显示神经根活动空间的大小。神经根通过一种叫神经孔的骨通道穿出脊髓腔，神经根特别容易在神经孔处受压。

在多数情况下，只有在决定手术后才会进行计算机断层扫描或磁共振检查，这是因为科学研究表明，表面上无任何腰背部疼痛症状的人磁共振检查却显示有椎间盘突出，椎间盘突出会导致神经根受压。因此，磁共振检查通常用于那些诊断不明的病例，或是非手术治疗无效，而且外科医生需要确定解除疼痛的手术方法的病例。

weisskopf

治疗

医生会根据你的诊断结果和你商量治疗方案。对于那些没有肌无力神经受压征象的患者来说，第一线的治疗包括非甾体类抗炎药，休息以及理疗。软性背部支架或腰部支架的使用有助于放松腰背部。

对于那些因神经根受压而产生肌无力症状的患者来说，手术治疗是首选。因为肌无力证明有神经受损（受损比仅有疼痛症状的情况严重得多），解除神经根受压状态是当务之急。大多数情况下，只有在经过一定时期的理疗，休息，药物治疗后，疼痛，麻木和无力症状仍得不到充分缓解的情况下，才会考虑手术治疗。

weisskopf

New roles for growth factors

During embryonic development, nerve cells hesitantly extend tentacle-like protrusions called axons that sniff their way through a labyrinth of attractive and repulsive chemical cues that guide them to their target.
While several recent studies discovered molecules that repel motor neuron axons from incorrect targets in the limb, scientists at the Salk Institute for Biological Studies have identified a molecule, known as FGF, that actively lures growing axons closer to the right destination. Their findings appear in Neuron.

"The most important aspect of our finding is not necessarily that we finally nailed the growth factor FGF as the molecule that guides a specific subgroup of motor neurons to connect to the muscles that line our spine and neck," says senior author Samuel Pfaff, Ph.D., a professor in the Gene Expression Laboratory, "but that piece by piece, we are uncovering general principles that ensure that the developing nervous system establishes proper neuronal connections."

Understanding how axons find their destinations may help restore movement in people following spinal cord injury, or those with motor neuron diseases such as Lou Gehrig's disease, spinal muscle atrophy, and post-polio syndrome. Failure to establish proper connectivity in the brain may also underlie autism spectrum disorders and mental retardation.

The multitasking members of the FGF growth factor family regulate blood vessel formation, wound repair, lung maturation, and development of skeletal muscle, blood and bone marrow cells. The Salk study adds on more job to an already long list.

"Our study emphasizes that the nervous system does not necessarily rely on an entirely new set of molecules to govern axon navigation, but instead uses growth factors already involved in embryonic development in clever and novel ways," Pfaff says.

Skeletal muscle consists of thousands of muscle fibers, each controlled by one motor neuron whose cell body lies in the brain or spinal cord. Connections between muscle and nerve cells are established embryonically when newborn neurons extend axons to "wire" the appropriate muscle fiber.

The wiring process is highly orchestrated -each motor neuron has already pledged allegiance to a particular muscle fiber before it reaches out to connect with its predetermined partner. But until now, scientists could only speculate how the invisible bond was formed.

"The question was how do these motor neurons know where to go," says Pfaff. "It would be a disaster if you wanted to move your arm and instead bent your back."

Earlier studies suggested that muscles lining the spine sent out chemical cues as a siren song for specific motor neurons known as MMCm cells. But when attempts to identify the enticing substance failed, many started to doubt its existence.

After screening numerous candidates, the Pfaff team found not only that FGF is expressed in target muscle, but that FGF "sensors," known as FGF receptors, are expressed in MMCm motor neurons. Furthermore, MMCm axons could not "hear" their muscle partner's call and failed to reach their destination in mouse mutants lacking the sensor molecule.

Finally, using mice engineered to express a fluorescent protein in MMCm neurons, the investigators demonstrated that only the glowing neurons extended axons in the direction of target cells expressing FGF.

"After a lot of hard work, we narrowed it down to FGFs and showed that they were indeed the long sought-after mysterious substance," says Pfaff. Neural stem cells can now be coaxed to develop into motor neurons in a test tube. In that artificial environment, explains Pfaff, "Most external cues that guide immature motor neurons during embryonic development will be missing." Hence the need to identify axon guidance factors. He continues, "It is not enough to make the right cell type, you need to connect them to the right target. Growth factors like FGF may be crucial to persuade and guide them towards the desired destination."

Additional contributors to this study included first author Ryuichi Shirasaki, Ph.D., a former postdoctoral fellow in Pfaff's lab and now a faculty member at Osaka University, Japan; postdoctoral fellow Joseph W. Lewcock, Ph.D.; and research assistant Karen Lettieri, both at Salk.

weisskopf

New male contraceptive

Men and women have long been promised a male version of the female contraceptive pill. But the first new male contraceptive to market may not be hormonal at all.
Researchers received Food and Drug Administration approval for a 90-man study of the Intra Vas Device (IVD), a nonhormonal contraceptive that stops sperm in their tracks. The study, to take place in Seattle, Washington and St. Paul, Minnesota, will bring men one step closer to having their first new contraceptive in more than a century.

"reliminary studies in animals and men show that this doesn't have the side effects of hormonal methods," said Jim Stice, president of Shepherd Medical Company, a consortium of researchers and entrepreneurs developing the device. "The concept is pretty simple: A set of tiny plugs block sperm as they travel through a tube called the vas deferens. Men don't need to worry that they'll have acne or gain weight or have their sex drive go up or down--all things that can happen when you manipulate hormones."

This will be the second contraceptive study of the IVD in men. In the pilot study, the method was very effective: All 30 men either had no sperm in their semen or had levels too low to cause a pregnancy. Early monkey studies showed reversibility after seven months of use, but reversibility studies in men have thus far only tested same-day insertion and removal.

Elaine Lissner, director of the nonprofit Male Contraception Information Project, is cautiously optimistic. "The Holy Grail of contraception is a long-term, reversible method without any hormonal side effects," she said. "Right now the IVD developers can't guarantee that it's reversible in men like it has been in animals, so they're billing it as a kinder, gentler vasectomy. But if it turns out to be reversible, they're going to have a line out the door."

The concept of blocking sperm in the vas deferens is not new: each year about 500,000 American men get vasectomies, a simple 15-minute procedure in which the vas deferens is cut and its ends closed off. About one in six American men over 35 already has a vasectomy. However, vasectomy is generally considered permanent, leaving younger men with condoms as their only option.

Men in long-term relationships, such as Jacob Kostecka, 29, are likely to be the first ones interested in the IVD. "My wife doesn't want to take hormonal methods, and I don't blame her. I wouldn't want to take that stuff and have it mess with my body either! But most other methods are clumsy and ruin the moments of intimacy we have together. Something like this could be really appealing."

The news about the IVD comes on the heels of the announcement that RISUG, a vas deferens-based male contraceptive developed in India, will resume trials in men. RISUG has been shown reversible in animals. Researchers in China are also having success with a new vas deferens device, though theirs is not being billed as reversible.

Kirsten Thompson, director of the Male Contraceptive Coalition, stresses that men can help speed development of these methods. "Men clearly want to know about these options--our website gets thousands of visitors each week. But there are still questions to be answered about the IVD's reversibility," she said. She added that "Men who don't want any more children and live near a study site can help answer those questions by volunteering. Otherwise, the best thing they can do is spread the word."

weisskopf

217 new targets for anti-cancer drugs
Medical Research News
Published: Tuesday, 18-Apr-2006
By identifying novel genes critical to cancer progression, biologists at the U.S. Department of Energy's Argonne National Laboratory have expanded the number of drug targets researchers have available for study to find ways to stop tumors in their tracks.
The report is published in Cancer Research.

The study centers on capillary formation, or angiogenesis, a process shown to be essential to tumor progression as tumors attract capillaries to provide oxygen essential for growth and frequently use those same vessels to send out metastatic cells. By zeroing in on these capillary-forming proteins, drug researchers may be able to treat a tumor by directly cutting off its blood supply.

Drug researchers, using tools available since the human genome was sequenced, seek specific targets to develop more precise cancer drugs with fewer side effects. "Once you have a unique target," explained biologist Diane Rodi, "you don't have the side effects of the drugs - most cancer drugs are anti-growth drugs that kill all the growing cells in the body. Most cancer therapies are not very specific and that is why they are so toxic."

The Argonne biologists identified 217 proteins involved only in capillary formation -- morphogenesis -- by finding all the gene products turned on during capillary formation and subtracting out those related only to growth, or proliferation, in a novel process called subtractive transcriptomics.

Argonne biologists grew human endothelial cells - the cells involved in blood vessel formation - on a tumor tissue-mimicking plate. As the capillaries grew over an 8-hour period, researchers isolated RNA samples at intervals - at 30 minutes, 1 hour, 2 hours, 4 hours and 8 hours. To determine which genes do not contribute specifically to blood vessel formation, endothelial cells were grown on gelatin-coated plastic. RNA was isolated at the same intervals as on the tumor tissue-mimicking plate.

Each RNA sample was tested using microarray analysis at the University of Chicago. The microarrays hold 44,000 samples of known RNA coded by the human genome. A reaction reveals the RNA that is being produced at each stage of the biological process. RNA codes for proteins.

"We wanted to find the proteins that are only made when the endothelial cells are making a capillary, not when they are just growing," Rodi said. "We took all of the genes that were made on the tissue plate and subtracted out those from the plastic plate. And we were left with 217."

The researchers sought the proteins in the capillaries using commercially available antibodies. Of the 16 morphogenesis-specific proteins tested, all were found in the capillaries after they were completely formed.

The capillary research revealed a bonus insight into a still mysterious nature of cells - their polarity. Cells are not the same all over their surface - different sections perform different tasks like acting as environmental sensors or making little "feet" to mediate cell movement. But researchers do not yet know all of the genes which are involved in polarity.

The majority of the 217 proteins identified by the Argonne group manage movement within the cell, long distance migration, cytoskeletal reorganization and cellular stickiness - all processes involved in cell polarity. The Argonne study revealed that more angiogenic genes are involved in polarity than previously believed, and identified a large number of novel proteins which may be rate-limiting for the angiogenic process.

"This information will help with developing new drugs," Rodi said. "Once you know a gene product helps out in a process, then it automatically becomes a possible drug target."

The next step is to find antibodies to the rest of the 217 genes - only about 50 are commercially available - and determine if they all are present in the capillaries. They are relying on a novel approach to express human proteins high throughput in bacteria that other Argonne biologists are in the process of developing. Long-term research could lead to new medications for cancer as well as for eczema, macular degeneration and rheumatoid arthritis - other diseases involving pathological capillary formation.