弥漫性轴索损伤的临床诊断和处理(附223例报告)

目的 探讨弥漫性轴索损伤（DAI）的发病情况。影像学表现，诊断及处理方法，以提高临床疗效。方法 回顾性分析我院颅脑损伤抢救中心惦治的223例DAI患的临床和影像学资料。结果 本组患中入院时GCS≤8分的共173例（77.6%)，其中GCS≤5分的有100例（44.8%)。本组的总死亡率为29.1%(65/223),GCS≤5分的死亡率为43%（43/100）。亚低温治疗的患，GCS平均为4.4分。死亡率为30.8%(12/39)。结论 DAI的诊断主要根据其临床表现结合CT，MRI资料。治疗上宜采用综合治疗方式。早期应用亚低温治疗能提高疗效。应在临床加以推广。     

弥漫性轴索损伤45例临床报告及治疗体会

目的探讨弥漫性轴索损伤(DAI)的临床特点、诊断及治疗方法。方法回顾性总结45例DAI的临床特点、影像学资料、治疗措施及预后。结果 45例DAI患者中,恢复良好9例,中残15例,重残11例,死亡10例。结论 DAI原因多为车祸伤及高空坠落伤,结合临床表现与影像学资料可早期诊断,及时采取综合治疗措施可降低患者致残率、改善预后。     

老年人弥漫性轴索损伤临床探讨(附36例报告)

目的探讨弥漫性脑轴索损伤(DAI)老年患者的发病率及临床特点,为临床诊治老年DAI提供依据.方法对住院治疗36例老年患者临床特点、影像学特征及治疗加以分析.结果患者于伤后3～24个月根据GOS评估法判定疗效:恢复良好4例,轻残8例,重残5例,植物生存5例,死亡14例.结论老年人DAI发病率高,昏迷时间长、伤情重、伤情复杂,合并伤及并发症多,死亡率高、救治难度大,但通过积极合理治疗,是能够提高患者生存率的.     

亚低温治疗重度弥漫性轴索伤的临床研究

脑的弥漫性轴索伤(DAI)尤其是重度DAI常常是颅脑损伤患者死亡的主要原因之一,也是造成伤后植物生存和严重致残的最常见原因.90年代以来,DAI已日益受到学者的重视,诊断及治疗及时与否可直接影响患者的预后.我科近年来应用亚低温等综合措施治疗重度DAI,取得较好疗效.     

鼠神经生长因子对弥漫性轴索损伤患者MBP和S100β蛋白的影响及疗效观察

目的 探讨鼠神经生长因子对弥漫性轴索损伤(DAI)患者血清中髓鞘碱性蛋白(MBP)和S100β蛋白的影响及脑保护作用.方法 收录符合诊断标准的60例DAI患者并随机分为鼠神经生长因子治疗组和对照组各30例,用ELISA法分别检测2组患者治疗前及治疗后各时间点血清中MBP和S100β蛋白水平,于治疗后的第7、14天对2组患者进行格拉斯哥昏迷评分(GCS),90 d后格拉斯哥预后评分(GOS)评判疗效.结果 治疗组血清中MBP和S100β蛋白水平显著低于对照组,且治疗组格拉斯哥昏迷评分、预后评分明显高于对照组(P<0.05).结论 鼠神经生长因子可显著降低DAI患者血清中MBP和S100β蛋白表达水平,具有明显神经保护作用.     

脑弥漫性轴索损伤后凝血功能的改变及亚低温治疗的影响

目的探讨亚低温治疗对脑弥漫性轴索损伤(DAI)后凝血功能改变的影响。方法对分别采用亚低温治疗和常温治疗的47例DAI患者的临床资料进行对比分析。结果DAI患者伤后血小板计数、纤维蛋白原定量及D-二聚体含量均显著高于正常对照组(P<0.05)。经亚低温治疗后DAI患者的血小板计数、纤维蛋白原定量明显降低,其水平接近正常对照组(P>0.05),D-二聚体也较治疗前显著降低(P<0.05),但仍高于正常对照组(P<0.05)。常温治疗组DAI患者血小板计数,D-二聚体含量仍显著高于正常对照组(P<0.05),纤维蛋白原定量却显著低于正常对照组(P<0.05)。结论经亚低温治疗可以降低DAI后升高的血小板计数、纤维蛋白原定量及D-二聚体含量。     

25例脑弥漫性轴索损伤临床分析

目的探讨脑弥漫性轴索损伤(DAI)的临床特征、诊断与治疗。方法回顾性分析我院25例DAI住院病人的临床资料、影像学特征。结果本组25例脑弥漫性轴索损伤患者诊治正确,抢救成功21例(84%),其中恢复良好7例,中残10例,重残3例,植物生存状态1例,死亡4例(16%)。结论脑弥漫性轴索损伤的病死率较高,早期诊断与综合治疗是降低DAI病死率和致残率的关键。     

弥漫性轴索损伤36例报告

目的 阐述弥漫性轴索损伤(DAI)在脑外伤中的重要性,对其诊断、预后进行评估。方法 对我院收治的36例DAI进行回顾性研究,对其受伤机制、CT表现、临床特征、治疗方法及愈后进行分析。结果 本组36例DAI占同期重型颅脑损伤17.8％;保守治疗26例,手术10例;死亡20例,植物生存3例,重残2例,轻残6例,痊愈5例。结论 DAI在脑外伤中占较高比例,DAI患者致残率、植物生存发生率及死亡率极高。意识障碍是其典型临床表现,CT与MRI所示程度往往与临床表现不符。采用保守或手术治疗,或可挽救部分病人生命。其预后与DAI严重程度密切相关。     

弥漫性轴突损伤的病理变化及其机制

弥漫性轴突损伤(Diffuse axonal injury,DAI)存在于各种程度的颅脑损伤中[1]. 这种损害可引起植物生存、重残或痴呆等严重后果.虽然脑损伤的诊断方法和治疗措施在不断改进,但其疗效仍不够理想,其原因之一就是由于DAI的存在[2].综合近年文献 ,讨论DAI的机制,病理学变化及其转归,以促进对DAI的认识和治疗手段的提高,改善轴突损伤的预后.     

大剂量白蛋白治疗弥漫性轴索损伤36例疗效观察

目的 探讨大剂量白蛋白对弥漫性轴索损伤(DAI)患者的临床治疗作用。方法 大剂量白蛋白治疗DAI36例与同等 条件下未用大剂量白蛋白的患者39例进行比较。结果 实验组觉醒天数为(30.80±2.36)d,对照组为(46.60±6.78)d,两组比较差 异显著(P<0.05)。实验组恢复良好11例(30.5％),死亡9例(25.0％);对照组分别为6例(15.3％)及15例(38.5％),两组比较均差 异显著(P<0.05)。实验组血液流变学4项指标较对照组下降明显(P<0.05)。结论 DAI早期应用大剂量白蛋白治疗可降低死亡 率,提高良好率,缩短昏迷时间。     

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 -