抗精神病药物与肝损害的研究进展

在精神科临床用药过程中,肝功能异常的发生十分常见。有共识的容易产生肝损害的抗精神病药物有氯丙嗪、多虑平等。出现肝损害时,临床医师往往采取保肝治疗、减药、换药治疗等方式。目前临床上使用的抗精神病药物品种繁多,其中非典型抗精神病药物得到了较普遍的使用,并逐渐取代了典型抗精神病药物的地位。     

原发性低颅压综合征15例临床分析

原发性低颅压综合征是指自发性颅内压<70mmH2O的情况下所引起的一系列临床症状。原发性低颅压综合征临床上并不多见,但此类病症治疗过程中非常棘手,好转后复发率高[1]。笔者回顾性分析我院神经内科2005-01—2011-12住院的15例低颅压综合征患者的临床资料,现总结如下。     

手-口综合征临床分析

回顾分析11例手-口综合征患者临床和影像学特点,结果显示:均为单侧病变,急性腔隙性梗死10例、脑出血1例;以丘脑缺血性卒中(5例)常见,其次分别为顶叶(3例)和脑干(3例),其中3例治疗过程中病情加重。随访3个月,治疗后2例遗留单侧口周和指尖麻木感、1例病情进展遗留偏身感觉障碍。延髓至顶叶神经传导功能受损可引起手-口综合征,尽管多数患者预后良好,但个别患者仍有病情进展风险。     

重视Duchenne型肌营养不良症的康复治疗

康复治疗对改善Duchenne型肌营养不良症患者生活质量、延缓病情进展至关重要,一些国家业已制定了康复治疗指南,我国尚缺乏这方面的指导性研究和意见。为了提高临床医师对该病症康复治疗的认识,现对其病情分期、临床特征,以及康复治疗的一般原则、常用方法和注意事项进行概述,为临床康复治疗提供一些参考。     

对冲性额叶脑挫裂伤合并枕骨骨折的临床特点及治疗（附198例报告）

目的探讨对冲性额叶脑挫裂伤合并枕骨骨折的临床特点和治疗方法。方法回顾性分析198例对冲性额叶脑挫裂伤合并枕骨骨折患者的临床资料,其中急诊手术治疗28例,保守治疗170例（因病情变化,在保守治疗过程中改行手术治疗34例）。结果出院后随访6月～12年,按GOS评分评定预后,恢复良好156例,中残13例,重残17例,死亡12例。结论对冲性额叶脑挫裂伤合并枕骨骨折的患者入院后如果病情危重,危及生命,应急诊手术治疗;如意识障碍较轻,可保守治疗,尽可能延期手术,减少迟发性硬膜外血肿的发生。     

激素联合环磷酰胺治疗视神经脊髓炎谱系疾病:1例报告及文献复习

目的:报道激素联合环磷酰胺治疗视神经脊髓炎谱系疾病患者1例,并对相关文献进行复习。方法:对1例诊断为视神经脊髓炎谱系疾病患者进行相关实验室检查(包括水通道蛋白4)和辅助检查,并基于临床实践,给予激素联合环磷酰胺治疗。结果:该患者以渐进性右眼视物模糊伴右侧肢体无力、麻木起病,诊断为视神经脊髓炎谱系疾病。治疗方面,先给予激素冲击治疗,但患者病情不断进展且对激素产生依赖性,遂加用环磷酰胺,使患者的病情得到了有效控制。结论:对于视神经脊髓炎谱系疾病激素治疗不佳的患者,激素联合环磷酰胺治疗可以明显改善其临床症状。     

伴癫痫持续状态、运动障碍和低通气综合征的自身免疫性脑炎:1例报告及文献复习

目的:总结自身免疫性脑炎的临床特征,以减少临床误诊。方法:回顾性分析1例年轻的女性自身免疫性脑炎患者的诊疗过程及随访资料。结果:该患者以发热起病,病情迅速进展,并伴有癫痫持续状态、运动障碍和低通气综合征。诊断为自身免疫性脑炎后,给予免疫治疗。病程3个月时,病情逐渐趋于稳定,并渐趋好转;病程15个月时进行随访,预后较好。结论:临床上对于出现精神障碍、肌张力运动障碍和癫痫的年轻患者,应及时进行自身免疫性脑炎的血清抗体检测和脑脊液检查,以明确诊断。     

出血性脑梗死23例CT与临床分析

目的　探讨出血性脑梗死 (HI)的CT表现及临床特点。方法　通过CT和临床检查 ,对 2 3例患者进行观察分析。结果　HI多见于病情加重或经治疗持续不缓解或癫发作者 16例 ( 69 6% ) ,病后 1～ 2周内HI发生率达 91 3 5 % ,且均见于大面积脑梗死患者。CT表现分二型 :血肿型和非血肿型。结论　脑栓塞和大面积脑梗死患者症状加重或治疗后无明显好转者 ,建议发病后 1～2周内进行颅脑CT复查。治疗中应依据影像及病情变化而进行分别治疗。     

灯盏花素治疗急性脑梗死32例疗效观察

目的 :观察灯盏花素治疗急性脑梗死的临床疗效。方法 :对我院自 1999年 11月～ 2 0 0 0年 11月住院的 3 2例急性脑梗死病人随机分成治疗组和对照组 ,治疗组应用灯盏花素 ,对照组应用川芎嗪 ,同时根据病情给予脱水、降血压、神经细胞活化剂、控制血糖及血脂等。结果 :灯盏花素治疗急性脑梗死安全有效。     

进展性脑梗塞超早期溶栓技术研究

目的:观察进展性脑梗塞超早期溶栓技术的疗效与安全性。方法:846例患者随机分为治疗组和对照组各423例。治疗组:首次病情进展至溶栓时间≤3小时,溶栓前、后应用脑保护液治疗;对照组:首次病情进展至溶栓时间3～6小时,溶栓前、后未应用脑保护液治疗。两组均采用动或静脉溶栓及抗凝强化治疗,常规治疗相一致。在治疗后10天、30天分别进行临床疗效评定,治疗后6个月进行日常生活能力随访。结果:治疗组采用超早期溶栓技术治疗后的治愈率、总有效率、神经功能缺损恢复的程度和安全性均明显优于对照组(P<0．01)。结论:本技术能显著提高进展性脑梗塞的治愈率、降低死亡率,减少并发症,提高患者的生存质量。     

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.     

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.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

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

Psychiatric Quarterly -