“微创颅内血肿清除术”专题高研班将举办

由中国医院协会（原中华医院管理学会）主办的全国神经内科主任（微创颅内血肿清除术）临床适宜技术高研班，拟定于2006年9月10日至15日在安徽省黄山市举办，培训费980元，食宿统一安排，费用自理。学习期满授予学员Ⅰ类继续教育学分。     

CT定位立体定向治疗超早期高血压脑出血

高血压脑出血是病死率和致残率都很高的脑血管病，在超早期清除血肿，降低颅内压，使受损的脑功能得以恢复是十分必要的。我院自2000年12月-2004年12月，采用CT定位立体定向方法治疗超早期高血压脑出血36例获得满意疗效，现报告如下。     

有机磷中毒胃肠道内毒物清除方法的改进

目的：彻底清除胃肠道内毒物，提高有机磷中毒患者的抢救成功率。方法：本科自2004年至今对45例有机磷中毒患者，运用新方法清除毒物。结果：死亡1例，其余患者抢救成功。均未发生“反跳”。结论：新方法能有效清除胃肠道内毒物，提高抢救成功率，值得推广。     

伴随结节性硬化的浸润性视网膜星形细胞瘤4例

众所周知，视网膜星形细胞瘤常伴有结节性硬化的表现。视网膜星形细胞瘤一般是发生在视网膜神经纤维层的无蒂轻度隆起性病变。临床上可以是单侧发生，也可以是双侧发生。可以单个病灶，也可以多个病灶。可以是透明的，也可以是不透明的。可以有钙化，也可以没有钙化。视网膜星形细胞瘤相对固定的伴有眼内结节性硬化，很少表现为浸润性增长。在很少的情况下视网膜星形细胞瘤可以表现出浸润性增长，造成局部严重并发症。     

重型高血压基底节区出血改良翼点入路手术与小骨窗清除术预后对比分析

目的探讨重型高血压基底节区出血手术的治疗方法。方法对41例重型高血压基底节区出血患者采用改良翼点入路治疗与41例小骨窗清除术比较。结果ADL评定疗效。改良翼点组:Ⅰ级17.1%,Ⅱ级24.4%,Ⅲ级29.3%,Ⅳ级17.1%,Ⅴ级2.4%,死亡9.8%,恢复良好(达Ⅲ级以上)70.7%;小骨窗组:Ⅰ级9.8%,Ⅱ级12.2%,Ⅲ级14.6%,Ⅳ级29.3%,Ⅴ级4.9%,死亡29.3%,恢复良好36.6%。P<0.05。结论改良翼点入路与小骨窗清除术相比,具有止血彻底,血肿清除率高,可及时有效的解除脑疝对脑干的压迫,从而降低病死率,改善预后。     

单肺通气低氧血症的防治

单肺通气的主要目的是为了防止病侧肺的分泌物或血液流入对侧肺，确保气道通畅，避免交叉感染和病灶扩散，同时塌肺也有利于手术进行，减轻非切除部分肺的损伤。临床上要严格掌握其适应证和禁忌证。本文着重谈谈单肺通气低氧血症的防治。     

创伤性脑损伤病人术中低血压的危险因素分析

创伤性脑损伤(traumaticbraininjury,TBI)如脑挫伤、硬脑膜外血肿和硬脑膜下血肿的病人,在开颅血肿清除和去骨瓣减压手术过程中可能发生术中低血压(intraoperativehypotension,IHT)。低血压可加重脑缺血性损伤,并能使颅内压(ICP)进一步的升高乃至死亡。而低血压发生以后,采取容     

Clearance of beta- amyloid from the CSF by the choroid plexus： implications in drug development for treatment of Alzheimer＇s disease

The formation of insoluble aggregates of beta - amyloid peptide （ A ） within the brain extracellular fluid is a critical event in the etiology of Alzheimer＇s disease （AD）. In theory, an unbalanced A kinetics can be due to its over production, inadequate metabolic cleaning, or an improper balance of import or export of A or related molecules at brain barriers. We investigated the role of the choroid plexus, which forms a barrier between blood and brain cerebrospinal fluid （ CSF）, in regulating A in the CSF. A uptake from CSF was determined as its volume of distribution （ VD ） into isola- ted rat choroid plexus tissue by using [^125I] A 1-40 and along with a extracellular space marker [^14C ] sucrose. The choroid plexus exhibited a definite capacity in sequestering [^125I] A 1-40 from the surrounding CSF. Uptake of [^125I] A by the choroid plexus was saturable, time - and temperature - dependent, and not ttffected by addition of transthyretin or apolipoprotein E3. Studies with cultured monolayers of primary choroid epithelial cells indicated that A permeability across cells, corrected by [ ^14C] sucrose, was greater from the CSF -facing membrane than from the blood -facing membrane. Similarly, cellular accumulation of [ ^125 I ] A was concentrative from both directions and was greater from the CSF -facing membrane. Quantitative real- time RT- PCR, immunodetection and enzyme activity assays further revealed the presence of several key enzymes involved in A production, e. g. , amyloid precursor protein and beta - secretase, and in A metabolism and alternate processing, e. g. , insulin degrading enzyme, endothelin - converting enzyme - 1, neprilysin and alpha - secretase. Overall, these results suggest the choroid plexus selectively cleanses A from the CSF by an undetermined mechanism （s） ; moreover, it has the capacity to degrade A , suggesting a vital role of this tissue in maintaining A homeostasis. The perspectives of drug development for treatment of AD by reducing A from brain extracellular fluid as a new strategy will be discussed.     

完全性后组颅神经麻痹患者行气管切开的护理

后组颅神经 (IX .X .XI)位于桥脑小脑角的尾端 ,吞咽神经和迷走神经位居面神经和听神经的下方[1] 。后组颅神经完全麻痹的患者不仅吞咽反射消失 ,往往还伴有咳嗽反射减弱或消失 ,故必须行气管切开手术 ,以保证脑组织的血氧循环及有利于呼吸道分泌物的清除 ,从而预防呕吐、呛咳、误吸而导致的肺部感染的发生 ,而该类患者不同于常规气管切开病人。我院 2 0 0 2年 6月～ 2 0 0 2年 12月共收治 3例完全性后组颅神经麻痹的患者 ,经积极气管切开、血管扩张剂和神经营养药等治疗 ,均已痊愈。现将气管切开的护理经验报道如下。1　病例介绍病例 1,…