立体定向穿刺引流术治疗高血压脑出血37例的体会

目的探讨利用立体定向技术治疗高血压脑出血最佳时机和方法,总结临床疗效。方法针对出血量在30～40ml高血压脑出血患者在发病48～72小时,利用立体定向排空术及尿激酶溶解术。结果所有病例术后随诊6个月,按ADL分级法:I级10人,II级19人,III级5人,级3人,无死亡病例。结论立体定向血肿排空术加尿激酶溶凝块治疗高血压脑出血能在短期内明显提高疗效,立体定向手术治疗高血压脑出血要严格把握手术指征(即出血量在30～40ml之间)和手术时机,在发病48～72小时后手术,可以降低再出血及颅内感染,同时降低致残率,明显提高生命质量。     

立体定向手术治疗高血压脑出血68例临床分析

目的探讨立体定向手术治疗高血压脑出血适应症、禁忌症,以及影响预后的因素如手术时机、血肿量、血肿破入脑室、再出血、尿激酶的应用等。方法回顾性分析应用CT定位通过立体定向手术治疗高血压脑出血、术后应用尿激酶溶解68例。结果术后再次出血3例,以日常生活能力(ADL)分级法：ADL1 10例、ADL2 29例、ADL3 16例、ADL4 6例、ADL5 7例。结论选择临床分级轻、中型及脑疝未形成的病人．手术时机以发病后6～24小时内应用立体定向手术及尿激酶溶解治疗效果优良。     

立体定向治疗高血压脑出血(附35例临床分析)

目的探讨利用立体定向技术治疗高血压脑出血最佳时机和方法。方法针对出血量在30~40ml高血压脑出血患者在发病48~72小时,利用立体定向排空术及尿激酶溶解术。结果所有病例术后随诊6个月,按ADL分级法:I级10人,II级19人,III级5人,IV级1人,无死亡病例。结论立体定向手术治疗高血压脑出血要严格把握手术指征(即出血量在30~40 ml之间)和手术时机,在发病48~72小时后手术,可降低再出血及颅内感染同时降低致残率,明显提高生命质量。     

高血压脑出血立体定向碎吸术后再出血

高血压脑出血的立体定向碎吸术具有局麻下操作简单、创伤小、并发症少 ,但是 ,易并发再出血的缺点。我院自 1 997～ 1 999年共有 61例行立体定向碎吸术 ,有 5例发生术后再出血 ,现报告如下 :临床资料本组 5例 ,男 4例 ,女 1例 ,年龄 48～ 64岁。均为基底节出血 ,最少 50 ml、最多 80 ml,5例均有偏瘫 ,2例浅昏迷状态、2例嗜睡状态、1例清醒 ,均无脑疝出现。手术方法 :先安装立体定向框架 ,CT扫描并确定血肿中心靶点 ,择无重要功能区且距血肿较近处颅骨钻孔 ,向靶点置入 Backlund排空器 ,缓慢碎吸抽出50 %～ 70 %血肿 ,并于排空后置管引流 ,…     

微侵袭手术治疗高血压脑出血

目的为了了解微侵袭手术治疗脑出血适应证、禁忌证，以及影响预后的因素如血肿量、手术时机、血肿破入脑室、再出血等。方法自1997年～2000年间运用计算机体层摄影（CT）定位，通过脑立体定向和神经内窥镜技术、小骨瓣开颅、脑室穿刺术治疗高血压脑出血，术后用尿激酶溶解共50例。结果手术1个月后按GOS临床评分方法评定近期疗效：优8例，良14例，中14例，差12例，死亡2例。术后6个月生存质量按ADL评分：ADL110例，ADL216例，ADL312例，ADL410例，ADL5O例。结论通过比较病情分级、血肿量、手术时机、血肿是否破入脑室与疗效的关系。我们认为病人临床分级轻、中型，血肿量在15～40ml之间，手术时机以发病后24～72h内运用脑立体定向穿刺＋纤溶治疗效果最佳。     

高血压脑出血的手术治疗进展

高血压脑出血占卒中病人的10%～30%,其病死率和致残率占脑血管病患者的首位.出血部位、出血量、出血速度以及年龄、手术时机、手术方法与患者的预后密切相关.在严格掌握手术适应症和手术时机的前提下,显微手术治疗与立体定向碎吸加尿激酶溶解术、神经内镜辅助清除血肿等术式相比,已显示出"微创"、效果较优的趋势.术后维持血压稳定并有效控制血压,防止再出血和脑缺血,控制脑水肿,改善局部脑血流是治疗成功的保证.     

经额立体定向碎吸术与经颞徒手穿刺引流术治疗高血压脑出血的回顾性对比分析

目的比较经额立体定向碎吸术与经颞徒手穿刺引流术治疗高血压脑出血(20～40 ml)的疗效、预后、安全性和经济负担。方法回顾性分析聊城市人民医院神经外科2012年12月至2018年12月收治的127例高血压脑出血(20～40 ml)患者临床资料。其中,55例采用了经额立体定向碎吸术(经额碎吸组),72例接受了经颞徒手穿刺引流术(经颞引流组),分别根据手术操作时间评价其简易性,动态电子计算机断层扫描评价其近期疗效,并发症发生率评价其临床安全性,平均住院日及费用评价其社会经济负担;全部随访6个月,根据死亡率、改良Rankin量表评分(modified Rankin scale,mRs)评价其远期预后。结果经额碎吸组与经颞引流组比较,手术操作时间(2.2±0.5 VS 1.0±0.3)小时、发病后7天的血肿排空率(91.37±4.31 VS 75.23±5.29)%、住院期间再出血率(5.5 VS 8.3)%、颅内感染率(7.3 VS 9.7)%、平均住院日(10.5±2.5 VS 15.3±4.1)天、平均住院费分别为(18230.7±2035.2 VS 20386.3±4781.2)元、治疗后6个月死亡率(3.6 VS 5.6)%及mRs(2.32±0.28 VS 3.07±0.31)分,差异均有统计学意义(P0.05)。结论治疗高血压脑出血(20～40 ml),经颞徒手穿刺引流术简易快速,但经额立体定向碎吸术近期疗效及长期预后更好、临床安全性更高、社会负担更低,因此推荐为首选治疗方式。     

CT引导立体定向碎吸治疗高血压脑出血(附70例报告)

目的探讨CT引导立体定向碎吸排空、术后辅以尿激酶溶凝引流治疗高血压脑出血的应用价值。方法采用ASA-602型脑立体定向仪,在CT引导下进行血肿定位,使用Backlund排空针次全排空血肿,置管辅以尿激酶溶凝引流治疗高血压脑出血70例。其中6例因术后再出血,行开颅清除血肿。结果术中死亡1例,死于脑动静脉畸形(术前未获诊断)大出血。余69例出院时,预后良好27例,中残18例,重残13例,死亡11例。幸存的58例被随访6~24个月,其中良好32例,中残19例,重残6例,死亡1例。结论立体定向碎吸术是一种治疗高血压脑出血安全、微侵袭且疗效较为满意的手术方式;合理选择手术时机,有效控制术后高血压,防止再出血、坠积性肺部感染和深静脉血栓形成是改善患者预后、提高其生存质量的关键。     

钻颅血肿碎吸术治疗高血压脑出血术后再出血

目的评估钻颅血肿碎吸术,在高血压脑出血术后再出血的治疗效果.方法分析4例出血量大于30ml,病人年龄轻,病情进展快,甚至发生脑疝的患者行开颅血肿清除术、去骨瓣减压术后再出血的病例.结果经钻颅血肿碎吸术+尿激酶灌注引流治疗,全部存活,生活基本自理.结论高血压脑出血术后再出血,应用钻颅血肿碎吸术治疗是一种行之有效的治疗方法.     

早期、超早期立体定向手术治疗高龄高血压脑出血

早期、超早期立体定向手术治疗高龄高血压脑出血王勇军刘宗惠采用ＣＴ引导立体定向手术早期、超早期治疗７０岁以上严重高血压脑出血病人１１例。血肿位于基底节区８例；血肿位于丘脑３例。血肿量平均＜３０ｍｌ。发病２～６小时内手术８例，６～１２小时内手术３例。经２...     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -     

Summary of legislation of 1941 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -     

Asymmetry of on- and off-pathways of blue-sensitive cones of the retina of macaques

Macaque retinal ganglion cells whose receptive-field center recieves input from blue-sensitive cones show an overt asymmetry of the frequency of ON-center and OFF-center varieties, an asymmetry not present in ganglion cells whose center receives input from the other two cone types. A similar asymmetry of ON/OFF responses is found in the local electrotetinogram (d-wave) mediated by signals from blue-sensitive cones. ‘Blue-ON-center’ ganglion cells have larger receptive-field centers and shorter conduction latencies than other opponent-color varieties, suggesting an appreciable degree of receptor convergence and presumably large cell bodies. Intracellular stainings of these neurons with Procion Yellow show that they correspond to diffuse stratified (Parasol) ganglion cells whose flat-topped dendritic arborization stratifies in the sclerad half of the inner plexiform layer. In view of the known characteristics of macaque bipolar cells and of the ON/OFF asymmetry, it is proposed that these ganglion cells are postsynaptic to cone-specific flat bipolars possibly mediating sign-inverting synaptic contacts. The results also indicate a reversal, for the blue-cone pathway, of the ON/OFF lamination of the inner plexiform layer that has recently been described in other species.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.