Clinical characteristics of adult epilepsy patients in the 1997 Hong Kong epilepsy registry

Objective　To study the clinical characteristics of 2952 patients with epilepsy who had received drug treatment from the neurology outpatient clinics of eight major hospitals in Hong Kong. Methods　Retrospective review of outpatient records. Results　1601 (54.3%) males and 1351 (45.7%) females with a median age of 35.8 years (range, 10-94.8) were studied. Seizure types included generalized tonic-clonic in 80.7% of patients, complex partial in 28.3%, simple partial in 14.4%, atypical absence in 2.6% and myoclonic in 1.4%, and 30.4% of patients had more than one seizure type. EEG, CT brain, MRI brain and neuropsychological evaluation were obtained in 81.2%, 61.7%, 17.0% and 2.2% of patients, respectively. The etiology of epilepsy was cryptogenic in 59.9%, symptomatic in 35.1% and idiopathic in 3.9%; the commonest were intracranial infection, cerebral vascular disease, cranial trauma and perinatal insult. Phenytoin, carbamazepine and valproate were the most frequently used drugs and 25.9% of patients were taking more than two drugs. 48.3% of patients had active seizures in the past six months and 26.4% were considered to have unsatisfactory control of their epilepsy. Medical refractoriness of epilepsy was associated with a history of perinatal insult, intracranial infection, congenital brain malformation, intracranial neoplasm, cerebral vascular disease, hippocampal sclerosis, mental retardation and a history of status epilepticus (P<0.05). Conclusion　In this local cohort of adult patients with epilepsy under specialist care, there were a considerable number of patients falling into the category of cryptogenic epilepsy. Risk factors associated with medical refractoriness are similar to previous studies.     

Complications of transsphenoidal surgery for sellar region: intracranial vessel injury

Background Intracranial vessel injury is a severe complication of transsphenoidal surgery （TSS） for lesions of sellar region. The purpose of this study was to improve recognition of the complication.
Methods The clinical data of 400 cases of TSS for sellar region from 1964 to 2004 were reviewed retrospectively. Ten patients with complications of intracranial vessel injury were included in this study, 7 underwent transsphenoidal microsurgery and 3 underwent endoscopic TSS. Subarachnoid hemorrhage （SAH） occurred in 8 cases, hemorrhage of cavernous sinus in one, and post-operative cerebral hemorrhagic infarction caused by thrombosis of injured right internal carotid artery in one. The clinical data of all the patients were analyzed.
Results The SAH resulted from hemorrhage of residues of tumor in 2 patients and from damaged sellar and arachnoidea in 6 patients. The cause of hemorrhage of anterior intercavernous sinus was malformation of anterior intercavernous sinus. The reason of thrombus of internal carotid artery was manipulation of operation. Three patients died and six patients were cured. One patient lived with hemiplegia.
Conclusions The cause of intracranial vessels injury of TSS is complicated. Detailed anatomic knowledge of seller and skilled operation is helpful to reduce the complication.     

The circadian rhythm of blood pressure and the effect of sa lt intake in salt-sensitive subjects

Objective To investigate the effect of salt intake on the circadian rhythm of blood pressure and the characteristics of ambulatory blood pressure (ABP) in salt-sensitive (SS) subjects. Methods Twenty-three normotensive subjects and forty-three patients with essential hypertension were included in this study.Salt sensitivity was determined with a chronic dietary salt loading test and an acute venous saline loading test, respectively.24-hour ABP measurements were performed twice in normotensive subjects when they were on a high salt diet and when they had a low salt diet.Blood and urine samples were collected for measurement of plasma norepinephrine concentration (PNE), plasma renin activity (PRA), angiotensin Ⅱ, aldosterone, erythrocyte sodium content and urinary sodium excretion.24-hour ABP readings were also obtained in patients with essential hypertension when antihypertensive drugs were discontinued for at least 2 weeks. Results High salt intake attenuated the circadian rhythm of blood pressure in SS normotensive subjects, and the nocturnal decline in blood pressure was smaller in SS patients with essential hypertension than in salt-resistant (SR) patients.The level of PNE was higher and the suppression of PRA was smaller in SS subjects than in SR subjects when they had a high salt diet, and the urinary sodium excretion decreased and the erythrocyte sodium content increased significantly in SS subjects on high salt intake. Conclusions High salt intake caused an abnormal circadian rhythm of blood pressure in SS subjects.The blunted nocturnal decline in blood pressure may be a characteristics of SS patients with essential hypertension.     

AN ANALYSIS FOR DEATH CAUSES IN 45 CASES OF LIVER CANCER TREATED WITH TRADITIONAL CHINESE DRUGS

Among the 165 cases of late-stage liver cancer treated in our hospital,65(39.4%)died,with an average survival time of 8.1 months and a median survival time of 7 months.Among the 65 dead patients,45 were treated with traditional Chinese drugs and 20 withwestern medicine.The average survival time was 8.4 months in the former and 7.3months in the latter group.The direct causes of death for the 65 patients were hepaticcoma,severe hemorrhage of the upper digestive tract,Heyd's syndrome,hepatorrhexis,respiratory failure,cardiac failure,etc.The incidence rates of hemorrhage of the upperdigestive tract and hepatorrhexis in the 45 patients treated with traditional Chinese drugswere obviously lower than those treated with western medicine.     

Clinical Observation on Effect of Xuesaitong Injection (血塞通注射液) as Auxiliary Treatment of Severe Craniocerebral Injury

Objective To evaluate the effect of Xuesai-tong injection (XSTI, 血塞通注射液 , a preparation of Panax Notoginseng) as auxilliary treatment of severe craniocerebral injury. Methods Eighty-seven patients with severe craniocerebral injury were selected and randomly divided into the treated group (n=44) and the control group (n = 43), they were treated with conventional treatment, and XSTI was given additionally to the treated group. Intracranial pressure (ICP) and Glasgow coma score (GCS) of all patients were measuredafter 1 or 2-week treatment, and Glasgow outcome scale (GOS) of them was determined 3 months later. Then the therapeutic effect in the two groups were compared. Results After treatment, the ICP was lower, GCS higher and GOS better in the treated group than those in the control group significantly, all showing statistical significance (P<0.05). Conclusion XSTI has marked clinical therapeutic effect in treating patients with severe craniocerebral injury.Original article on CJITWM (Chin) 2004 ;2     

Effects of thyrotropin-releasing hormone on acute experimental traumatic head injury in cats.

The effects of thyrotropin-releasing hormone (TRH) on early acute traumatic head injury in cats were evaluated by continuous intravenous infusion of TRH (2 mg/kg/h) or saline (2 ml/kg/h) for four hours, beginning one hour after injury. The results showed that TRH, administered intravenously, significantly increased the mean arterial pressure and cerebral perfusion pressure, decreased intracranial pressure, alleviated brain edema, and reduced the mortality rate. These effects promoted the recovery of neurologic function following traumatic head injury. Because of the significant central action and the ability to antagonize many pathophysiological effects of endogenous opioids or exogenous opiates except their analgesic effects, TRH and its analogues have broad prospects in the treatment of patients with CNS injuries or shock.

     

An experimental and clinical study on TXA_2 and PGI_2 content after head injury

The correlation of secondary brain injury with thromboxane A_2(TXA_2) and prostacy-clin (PGI_2) levels following head injury was studied in rats and patients.Thromboxane B_2(TXB_2) and 6-keto-PGF_(1α) in rat brain homogenate and TXB_2 in cerebral spinal fluid (CSF) ofpatients with severe head injury were determined by RIA.The effects of ligustrazini hydrochlo-rioi were also tested.The results showed that the concentration of TXB_2 and 6-keto-PGF_(1α) inrat brain was progressively increased within 3h after injury (P<0.01),and the ratio betweenTXB_2 and 6-keto-PGF_(1α)(T/K value) increased during the early stage after injury,along withthe tissue damage aggravation.After the use of ligustrazini hydrochlorioi,TXB_2 content inbrain decreased sharply accompanied with a drop in T/K value.Moreover,TXB_2 content inCSF increased within 7 d after injury (P<0.01),and it reached its peak value on the 3rd day.This could indicate that the metabolic imbalance between TXA_2 and PGI_2 might be one of theimportant factors in the development of secondary brain injury,and ligustrazini hydrochlorioiproved to have a protective effect on the brain tissue by normalizing the metabolism of TXA_2and PGI_2.In addition,the metabolic disorders of TXA_2 in the brain tissue of head injured pa-tients have much to do with the outcome of the patients.     

Evidence of apoptotic smooth muscle cells in proliferative intima of injured arteries

Objective To investigate the occurrence and extent of apoptosis in the course of restenosis. Methods The experimental models of vessel narrowness and intima thickness were established in minipigs’ iliac arteries by balloon injury and specimens were retrieved on the 1st, 3rd, 6th,12th and 30th days for dynamic observation. Apoptotic smooth muscle cells (SMCs) were detected by terminal deoxynucleotidyl transferase- mediated dUTP nick- end labeling (TUNEL). Results Apoptotic SMCs occurred only in the thickened intima 12 days after injury accompanied with the proliferative SMCs, the percentage of apoptosis was 1. 94%±0. 42% on the 12th day and 1. 36%±0. 31% on the 30th day respectively. The low frequency of apoptosis compared with the proliferative SMCs was a feature in the restenotic pathology. Conclusions Apoptosis participates in the pathogenetic process of intimal thickening and its level was low compared with proliferation. The findings suggest that attempts to modulate apoptosis after vessel injury constitute a theoretical approach to the prevention of restenosis.     

Relations of intracranial pressure, creatine kinase and brainstem auditory evoked potential in patients with traumatic brain edema.

We studied the relations of intracranial pressure (ICP),creatine kinase (CK) and bralnstem auditory evoked potential (BAEP) in 44 patients with traumatic brain edema who were admitted to our hospital from June 1990 to February 1991. There were 30 males and 14 females, with age range from 9 to 67 years. The results showed that the abnormal BAEP could reflect the severity of cerebral edema in acute head injury and was related to ICP and serum CK levels. When ICP>30 mmHg (4kPa), the abnormality of BAEP was more obvious than that of the control group (P<0.05); the serum CK levels were also elevated markedly. In patients with ICP over and below 4kPa, the rate of abnormal BAEP was 38.46% and 77.78% respectively (P<0.05). The serum CK level in the normal group or in the group with moderate abnormality of BAEP was significantly different from that in the group with severe abnormality or lack of BAEP (274.8± 98.24 U/L vs 705.3± 364.27 U/L; P<0.001). After treatment, the ICP returned to normal, and the BAEP norm     

Diagnosis and treatment of diffuse brain injury

Objective To explore pathogenesis, imaging findings, diagnostic and therapeutic methods of diffuse brain injury (DBI) in order to improve the cure rate and decrease mortality and deformity. Methods A retrospective analysis was done upon injury causes and types, treatment measures and prognosis of 871 cases with DBI. Results The main causes for DBI were traffic accidents and fall from height. The main types of DBI were diffuse axonal injury and diffuse brain edema, which could be complicated with subarachnoid hemorrhage,brain contusion, intracranial hemorrhage and brain hematoma. On admission, there were 660 cases (75. 8%) with Glasgow Coma Scales (GCS) of 8 or less, among whom there were 365 cases (41. 9%) with GCS of 3-5. The cure rate was 75. 4% (675/871), and the mortality rate 19.7% (172/871). But the mortality rate of those with GCS of 5 or less was as high as 39. 2% (143/365). Conclusion The diagnosis of DBI is mainly based on the clinical manifestation and the imaging findings of CT and MRI. Comp     

中药大黄在神经外科应用研究进展

大黄是一味应用广泛的传统中药,大黄具有多种有效成分和广泛的药理作用,应用于临床多种危重病症的抢救治疗。研究表明,大黄具有多重脑保护作用。中药大黄对重型颅脑损伤具有多靶点治疗作用。可以防止消化道出血:减轻脑组织继发损伤;协同降低颅内压,减轻脑水肿;减少并发症,从而提高颅脑损伤救治效果。     

Clinical and Experimental Study of effects of rhubarb on gastrointestinal blood flow perfusion in critical illness

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亚低温对颅脑损伤颅内压及脑氧代谢影响的研究

OBJECTIVE: To observe the changes in intracranial pressure (ICP) and brain tissue oxygen tension (PO(2)) and their significance in severe head injury treated by moderate hypothermia (33-35 degrees Celsius). METHODS: Eighteen patients with severe head injury were treated with moderate hypothermia group and probes were deployed in the cerebral cortex for measuring their ICP and PO(2) under continuous monitoring. Another 14 similar patients receiving the same treatment but without hypothermia served as the control group. RESULTS: In moderate hypothermia group the ICP gradually decreased and PO(2) increased after 24 hours of hypothermia, with obvious difference from the control group (P<0.05). CONCLUSION: Moderate hypothermia can obviously reduce ICP and improve brain tissue oxygen metabolism to lower the morbidity and mortality rate of severe head injury.     

家兔内囊出血时脑温与体温的动态分析

目的:探讨家兔内囊出血模型脑温及体温的动态变化,为进一步研究内囊出血条件下的脑循环障碍及脑保护提供参考.方法:采用立体定位方法制作家兔内囊出血模型,应用RM-6240B生物信号采集处理系统连续测定内囊出血前后脑温、直肠温以及血压和颅内压的变化.结果:内囊出血后,脑温降低(与出血前比较:P＜0.01)、直肠温无明显变化(与出血前比较:P＞0.05),颅内压升高(与出血前比较:P＜0.01)、血压下降(与出血前比较:P＜0.01).结论:内囊出血可导致颅压升高,颅内灌注压下降,血液循环受到严重影响,颅内脑组织血流量减低,从而出现局部脑温下降.     

无创颅内压监护在外科治疗大面积脑梗塞中的应用

目的:探讨无创颅内压监护在治疗大面积脑梗塞中的指导作用及判断预后的价值。方法:22例大面积脑梗塞患者,当3.53 kPa≤颅内压(ICP)≤5.53 kPa,采用去大骨瓣外减压术;当ICP>5.53 kPa,均采用去大骨瓣外减压术+内减压术。结果:术后3月按格拉斯哥结果评分(GOS),3.53 kPa≤ICP≤5.53 kPa组(14例),良好及中残13例(59%);5.53 kPa相似文献   

亚低温对颅脑损伤颅内压及脑氧代谢影响的研究

目的探讨重型脑损伤患者亚低温(33~35℃)治疗前后颅内压(ICP)、脑组织氧分压(PO2)的变化及临床意义。方法32例重型颅脑损伤患者分为亚低温组及对照组,放置ICP脑组织PO2光纤探头,持续监测ICP及脑组织PO2。结果亚低温治疗24h后ICP逐渐下降,脑组织PO2逐渐上升,与对照组比较差异有显著性(P<0.05)。结论亚低温治疗能明显降低重型颅脑损伤患者ICP,改善脑组织氧代谢,使患者死亡率及致残率降低。     

大黄治疗颅脑损伤致急性肾功能衰竭的临床研究

目的探讨大黄对颅脑损伤致急性肾功能衰竭的治疗作用及安全性。方法选择颅脑损伤致急性肾功能衰竭患者106例,随机分为观察组和对照组各53例。对照组予常规系统治疗;观察组在对照组治疗的基础上加用大黄治疗。结果治疗1~36 d呼吸和心律异常平均出现例次、平均颅内压(ICP)、血浆BUN平均水平和平均最高水平、同为血透治疗时平均需要血透治疗次数观察组低于对照组(P<0.001),多尿期出现时间、尿常规正常(血尿、尿蛋白、尿红细胞及潜血消失)时间观察组早于对照组(P<0.001);血浆Cr平均水平、平均最高水平观察组低于对照组(P<0.005);应激性溃疡出现率、需要血透治疗例数、无效率观察组低于对照组,显效率、总有效率观察组高于对照组(P<0.05);观察组在大黄治疗期间及停药后均未发现明显的不良反应。结论大黄用于颅脑损伤急性肾功能衰竭的救治,疗效可靠,使用安全。     

颅内压监测对重型颅脑外伤患者死亡率的影响

目的观察颅内压监测对降低重型颅脑外伤患者死亡率的作用。方法300例重型颅脑外伤患者（GCS评分〈9分）按随机数字表法分为监测组和对照组各150例,两组患者入院后2d内均给予降颅内压治疗,其中监测组加用颅内压监测,对比两组患者伤后14d的死亡率。结果监测组患者死亡率低于对照组（P〈0．05）,颅内压监测降低重型颅脑外伤患者死亡率（OR=0．63,95％可信区间：0．41-0．94,P=0．020）。结论颅内压监测有助于及时发现颅内情况变化及指导治疗,可能改善重型颅脑外伤患者预后。     

重型颅脑损伤中期并发症的防治(附248例报告)

目的探讨重型颅脑损伤中期严重并发症的预防及治疗方法.方法对248例重型颅脑损伤患者(GCS 3～8分),采用早期鼻饲预防消化道出血,监测血清渗透压,预防肾功能衰竭,早期气管切开预防肺部并发症,及用亚低温减轻脑继发性损伤等方法进行治疗.结果248例重型颅脑损伤患者中,消化道出血28例,肾功能衰竭6例,肺炎52例.此三种并发症发生率为34.6%,总死亡率为27.4%.结论积极预防及治疗重型颅脑损伤患者中期并发症,可降低其死亡率.     

亚低温对重型颅脑损伤后脑水肿的影响

目的 研究亚低温对重型颅脑损伤（SHI）后脑水肿的影响及其临床意义。方法 36例SHI患者,随机分为常规治疗对照组和常规治疗+亚低温治疗组,各18例。亚低温方法：患者接受冰帽、冰毯和冰袋降温措施处理及冬眠Ⅰ辅助降温,保持肛温在33℃左右,并维持3~5 d。手术后病人均监测颅内压。每例病人伤后0、1、3、7、14、21 d各行一次头颅CT检查,分析比较两组颅内压、伤灶脑水肿体积变化和预后状况。结果 颅内压：对照组和治疗组伤后第3天分别是（2.87±0.26）kPa和（1.67±0.23）kPa （P<0.01）;第7天分别为 （3.15±0.24）kPa和（1.78±0.24）kPa （P<0.01）。伤灶脑水肿体积：对照组在伤后第14天最大 [（140.90±22.95）cm3],治疗组在伤后第3天最大[（95.83±14.97）cm3],治疗组比对照组在伤后第14天减少42%（P<0.05）。伤后一周内转清醒率：对照组为22.2%（4/18例）,治疗组为55.6%（10/18例）（P<0.05）;残死率：对照组为61.1%（11/18例）,治疗组为33.3%（6/18例）。结论 亚低温能减轻脑水肿、稳定颅内压和改善预后。