RHEUMATOID DISEASE WITH JOINT AND PULMONARY MANIFESTATIONS
RHEUMATOID DISEASE WITH JOINT AND PULMONARY MANIFESTATIONS
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DOI：
10.1136/bmj.2.4583.816
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发表时间：
1948-01-01
影响因子：
105.7
通讯作者：
BALL, RE
中科院分区：
文献类型：
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作者：
ELLMAN, P;BALL, RE
本例眩晕复发是否由于神经节切除后对肾上腺素或肾上腺素样小体过敏所致（因为病人又在努力工作，精神压力很大），或者在个别情况下，耳朵的一些交感神经纤维是否也可能在更大或更小的程度上起源于对侧，这是未知的，但麦角胺给药后有明显改善的事实表明，前一种观点更有可能是两种观点中的一种，在这种情况下，切断节前纤维并剥离和结扎或切断椎动脉将是首选的手术。这在最近的病例中已经完成，对眩晕具有相同的有益效果，此外，它还具有避免霍纳综合征的优点。耳鸣的结果显然是不可预测的，尽管总体上它是减少的-在三个案例中，它是完全缓解的。耳鸣的症状是什么？耳鸣的症状是什么？耳鸣的症状是什么？每个病人都患有伴随性神经性耳聋，除了最近的两个病例外，所有的病例都有空气和骨传导听力的改善（有些耳朵非常明显）。如果神经性耳聋非常严重，则无法缓解，我们认为，沿着这些路线进一步开展沿着工作，将大大有助于阐明这种令人痛苦的疾病及其伴随的耳鸣和神经性耳聋的病因和病理。值得注意的是，已经有一系列的胸骨切开术单独治疗耳鸣（稍后发表），但我们在此阶段不对交感神经在耳鸣中的作用作进一步的评论。与此同时，一种新的治疗M6 nibre综合征的手术方法，比旧的内耳手术破坏具有巨大的优势，在我们的处置。
Whether the recurrence of vertigo in this case was due to hypersensitivity to adrenaline or adrenaline-like bodies following excision of the ganglion (for the patient was hard at work again and under considerable mental strain), or whether some sympathetic fibres to the ear may also originate on the opposite side to a greater or lesser extent in individual cases, is not known, but the fact that there has been a marked improvement on the administration of ergotamine would suggest that the former view is the more likely of the two, in which case division of the pre-ganglionic fibres together with stripping and ligation or division of the vertebral artery would be the operation of choice. This has now been done in more recent cases with the same beneficial result on the vertigo, added to which it has the advantage of avoiding a Horner's syndrome. The result upon the tinnitus is apparently unpredictable, though on the whole it was reduced-in three cases it was completely relieved. The relief seems to be more pronounced with the pulsating type of tinnitus than with the continuous variety. Each patient suffered from concomitant nerve deafness, and in all except the last two most recent cases there has been improvement (in some ears very markedly) of hearing by both air and bone conduction. If the nerve deafness is very severe it is beyond relief.It is felt that further work along these lines will greatly aid in elucidating the aetiology and pathology of this distressing complaint and its accompanying tinnitus and nerve deafness. It is interesting to record that a further series of stellectomies has been performed for tinnitus alone (to be published later), but we forbearto make further comment on the role of the sympathetic on tinnitus at this stage. In the meantime a new surgical method of treating M6nibre's syndrome, having tremendous advantages over the old surgical destruction of the internal ear, is at our disposal.