中枢神经系统孤立性纤维性肿瘤2例临床病理分析

目的 总结中枢神经系统孤立性纤维性肿瘤的影像学表现、病理学特征及其诊断意义.方法 回顾性分析中枢神经系统孤立性纤维性肿瘤病人2例的临床表现、影像学特点、病理学表现、手术措施和治疗效果并随访.结果 患者表现占位病变和局部压迫症状.MR表现T1WI等信号,T2WI低信号,增强肿瘤不均匀强化.行肿瘤全切除术2例.病理检查见肿瘤由短梭形细胞无序散在胶原胶质中,细胞密集区域和稀疏区域相间,血管丰富区域呈血管外皮瘤样结构. CD34(+),Vim(+),EMA(-),S-100(-).患者随访至今未见复发.结论 孤立性纤维性肿瘤发病率低,临床易误诊.MR检查T2像的"黑白相间征"及显著不均匀增强的特点有助于诊断,病理检查可明确诊断.     

颅内原发黑色素瘤的MRI、CT分析

目的探讨颅内原发黑色素瘤的影像学表现,以提高对该病的认识和诊断正确率。方法回顾性分析经手术病理证实的4例颅内原发黑色素瘤MRI、CT表现;4例患者均进行MRI检查,其中3例同时行CT检查。结果CT平扫均为高密度,密度部分不均匀,增强扫描肿瘤明显强化。4例MRIT1WI肿瘤均表现为高信号为主,其中2例T2WI为低信号,2例为高低混杂信号,肿瘤内信号部分不均匀,增强后扫描肿瘤可见明显强化。结论颅内原发黑色素瘤MRI具有特征性表现,对于显示肿瘤范围、成分及脑膜的浸润和定性诊断较CT有优势。     

小脑发育不良性节细胞瘤的病理、影像学特点及治疗

目的探讨小脑发育不良性节细胞瘤(Lhermitte-Duclos disease,LDD)的病理和影像学特征;以及诊断与鉴别诊断、治疗与预后。方法回顾性分析8例LDD患者的临床资料及组织病理学、免疫组化检查结果;并结合国内外文献进行分析。8例患者均行手术切除肿瘤。结果 MRI表现为病灶多呈T_1WI等低信号相间的条纹状或层状结构,T_2WI为高信号区域内有低信号的条纹状。病理学检查:小脑叶片增大,板层结构异常,分子层增宽,蒲肯野细胞层及颗粒细胞层内散在分布形态异常、发育不良的神经元。免疫组化显示,肿瘤细胞NSE、Syn、NeuN、Cs A阳性,GFAP阳性,Ki-67增殖指数1。手术肿瘤全切除4例,次全切除3例,部分切除1例;术后症状均改善。结论 LDD的影像学特征为,MRI上病灶呈条纹状或层状结构的"虎斑纹征";病理特点为肿瘤与正常组织呈层状结构,发育不良的神经节细胞取代颗粒细胞,使分子层增厚,浦肯野细胞减少或消失。治疗采用手术切除肿瘤,患者的预后良好,术后无需放化疗。     

颅内血管外皮细胞瘤的诊断及治疗(附14例分析)

目的总结颅内血管外皮细胞瘤(HPC)的诊治经验。方法回顾性分析14例颅内HPC病人的临床资料和影像学表现。结果肿瘤全切除11例,次全切除3例。随访13例,随访时间5～62个月,恢复良好10例,死亡3例。颅内HPC的CT影像特点为平扫显示肿瘤呈等、高密度,未见瘤内钙化、邻近颅骨骨质增生及脑膜尾征等常见征象;MRI影像特点为T1WI显示肿瘤呈等、低混杂信号,T2WI显示肿瘤呈等或等、高混杂信号;增强后所有肿瘤明显强化,肿瘤多呈分叶状,窄基底附着硬膜,有丰富的血管流空,无脑膜尾征,无颅骨增生和钙化。结论颅内HPC具有比较典型的CT和MRI影像学特点,有助于临床诊断。颅内HPC首选手术治疗,术后可辅以放射治疗。     

侧脑室室管膜下室管膜瘤的诊断与治疗

目的研究侧脑室室管膜下室管膜瘤临床与影像学特点及其手术治疗效果,探讨其诊断及处理方法.方法回顾性分析了本科1998年5月至2003年5月间,12例经手术病理证实的侧脑室室管膜下室管膜瘤病例.结果侧脑室室管膜下室管膜瘤多见于中年,影像学表现为:CT平扫呈等或低密度,增强扫描强化不明显;MRI T1WI呈等或略低信号,T2WI呈高信号;MRI增强后见肿瘤无明显强化.手术全切11例,次全切除1例.随访9例,均无复发.结论侧脑室室管膜下室管膜瘤好发于中年.临床上遇到较长的病史,CT平扫呈等或低密度,MRI T1WI像呈等或略低信号,T2WI像呈高信号;CT、MRI增强后见无明显强化,位于侧脑室内肿瘤,应该考虑侧脑室室管膜下室管膜瘤的诊断.手术全切肿瘤,预后好,术后无需放疗.     

颅内软骨瘤的诊断与治疗(附七例报道)

目的探讨颅内软骨瘤的临床特点及诊断与治疗原则。方法对1979-2004年我科收治的7例颅内软骨瘤患者的临床特点、影像表现及治疗方法与预后情况进行分析。结果7例颅内软骨瘤占本科同期收治的6303例颅内肿瘤的0．11％。本病多见于青壮年，病程2个月至10年。6例肿瘤位于颅底部中线旁硬膜外，并出现1例罕见的额顶部软骨瘤。6例颅底部肿瘤见骨质破坏与钙化，CT呈不均匀混杂密度影，2例有轻度强化；3例MRI显示T1WI呈低或混杂信号、T2WI呈高及混杂信号。肿瘤质地较硬。与重要神经血管相邻．不易全切除。2例病理报告肿瘤生长活跃，均复发。结论颅内软骨瘤发病率低，病程长，多见于颅底部中线旁，多见骨质破坏与钙化。诊断时需要与脑膜瘤、颅咽管瘤及脊索瘤相鉴别。颅内软骨瘤的治疗原则为手术切除，颅底部软骨瘤不易全切除。     

颅内血管外皮细胞瘤3例临床分析

目的探讨颅内血管外皮瘤的诊断及治疗。方法回顾性分析3例经术后病理证实的颅内血管外皮瘤患者的临床、影像学资料及病理结果,并结合相关文献进行总结。结果颅内血管外皮瘤临床较少见,症状多以头痛为主;MRI可见血管流空影;术后病理检查示CD34(+~+++),EMA(-),Vimentin(+),GFAP(-);需与脑膜瘤鉴别;术后需进行放疗。3例患者均行手术治疗,完整切除肿瘤,于术后1~3个月进行放疗,随访期间未见肿瘤复发、转移。结论颅内血管外皮瘤容易误诊,需根据影像学资料和病史仔细诊断,最终由病理结果确诊,手术切除辅以放疗是首选治疗手段;术后需随访观察肿瘤的复发或转移。     

中枢神经系统恶性黑色素瘤的临床特征及预后分析

目的探讨中枢神经系统恶性黑色素瘤(MM)的临床特征、预后及其影响因素。方法回顾性分析2015年1月至2021年9月郑州大学第一附属医院神经外科收治的26例手术切除并经病理学证实为中枢神经系统MM患者的临床资料, 其中颅内MM 23例, 椎管内MM 3例。采用Kaplan-Meier法分析颅内MM和椎管内MM患者生存期的差异;并采用单因素log-rank检验和多因素Cox回归分析探讨颅内MM患者的预后影响因素。结果 26例中枢神经系统MM患者的临床表现无特异性, 术前部分患者的MRI T1、T2像均呈短信号, 但仍无法明确诊断。所有患者的手术均顺利完成, 其中16例行肿瘤全切除, 10例行大部分切除(1例位于椎管内);术后病理学检查均证实为MM, 其中3例行BRAF V600E突变基因检测, 1例为阳性。26例患者均获得临床随访, 中位随访时间为9个月(2～58个月);3例患者术后MM复发行二次肿瘤切除手术;至末次随访, 24例患者死亡, 2例(颅内MM)存活, 其中1例为BRAF V600E突变患者, 靶向治疗7个月行头颅MRI检查显示颅内多发转移灶接近消失。23例颅内MM患者的中位生...     

颅内黑色素瘤的诊断和治疗

目的 讨论颅内黑色素瘤的临床特点、影像学特征及治疗方案.方法 回顾性分析11例经证实的颅内黑色素瘤患者的资料,分析其临床表现、影像学特征,并对其临床特点和治疗方案进行讨论.结果 头部CT及MRI多可见瘤周有点状或条索状卫星灶.典型的黑色素瘤MRI表现为T1WI高信号、T2WI低信号,该表现具有特异性.11例手术中,4例全切,6例近全切,1例多发性转移瘤部分切除.术后患者多在3-12个月内死亡,最长不超过2年,平均生存期不到6个月.结论 颅内黑色素瘤发病率低,误诊率高,治疗以手术切除为主,放化疗及免疫疗法仅可使部分患者受益,预后极差.     

脊膜瘤的诊断与显微手术治疗

目的探讨脊膜瘤的诊断及显微手术治疗效果。方法回顾性分析28例经病理学证实的脊膜瘤患者的MRI影像学资料、临床表现、手术方式及预后。28例均行显微手术治疗,其中5例采用后路锥板切除肿瘤摘除术,17例采用后路半椎板切除肿瘤摘除术,6例采用后路椎板棘突截取原位回植术。结果MRI示肿瘤位于枕骨大孔区2例、颈椎5例、胸椎14例、腰椎7例,肿瘤直径1．1～3．4cm,T1WI及T2WI呈等或稍低信号,增强后肿瘤明显强化,常有脊膜尾征。肿瘤全切除25例,大部分切除3例。随访11月～5年,症状改善25例,症状未改善或加重3例,其中2例复发后再次手术。结论MRI检查能清楚地显示脊膜瘤与周边组织关系,利于手术方式的选择;采用显微手术切除脊膜瘤治愈率高,术后并发症少。     

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     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

利培酮对精神分裂症患者生活质量的影响

目的：比较利培酮与氟哌啶醇对精神分裂症患者生活质量的影响。方法：对门诊72例服用氟哌啶醇及74例服用利培酮的精神分裂症患者用生活质量综合评定问卷（GQOLI）、阳性与阴性症状量表（PANSS）、副反应量表（TESS）进行评定。结果：利培酮组患者治疗后生活质量有所提高,而氟哌啶醇组患者生活质量有所下降。结论：利培酮治疗有利于患者提高生活质量。     

Effect of high simple dose of cisplatinum and of radiation on the brain of rabbit

Abstract

In former studies of intracarotid and intravenous administration of cisplatinum, separate and combined with brain irradiation, we found no cerebral damage. In this study! gradually increasing high doses (above the therapeutic ones) of cisplatinum were administered intravenously to one series of rabbits arid increasing high amounts of irradiation (above the therapeutic amounts) were given to another series. Although the rabbits that received highest doses of irradiation developed areas of alopecia and skin ulcers on the head! the general clinical and histopathologic examination of the rabbits brains in both series was normal. The purpose of this study was to establish the effects of high doses of intravenous cisplatinum and irradiation on the rabbits brains. [Neural Res 1997; 19: 216–218]