Clinical and long-term follow-up study in patients with spontaneous subarachnoid haemorrhage of unknown aetiology

Summary Clinical characteristics and the outcomes of 50 patients with confirmed subarachnoid haemorrhage (SAH) of unknown aetiology were evaluated. Twenty-nine of these patients were interviewed with a mean follow-up of 7.7 years. Seven patients experienced early rebleeding during hospitalization, and one patient experienced late rebleeding during the follow-up period.On admission to the hospital the consciousness level was clear in 43 of the patients, drowsy in 6, and semicomatose in only 1. Of 10 patients who underwent computerized tomography (CT) within 3 days after SAH, 6 showed no abnormal CT findings and 3 had mild subarachnoid blood. Another patient showed severe SAH. Neurological deficit due to symptomatic vasospasm persisted in only 1 case.Two patients died after re-bleeding during hospitalization, and two others died during the follow-up, thereby representing an overall mortality rate of 8%. Of the latter cases, one died of an unrelated disease, and the other died suddenly from an unknown cause. The remaining forty-six patients (92%) had a good outcome. These results confirm previously reported clinical characteristics, namely that the symptoms of the majority of such cases are mild, the incidence of symptomatic vasospasm is rare, the risk of late re-bleeding is very low (less than 1% per year), and the prognosis is good. The CT findings suggest that some of these features resulted from only mild SAH. Thus, SAH of unknown aetiology seems to be a disease entity with a good prognosis.     

腰椎间盘突出连续硬膜外阻滞疗效观察

目的：探讨连续硬膜外阻滞治疗腰椎间盘突出的适应证和疗效相关因素。方法：经腰(骶)部穿刺,1％利多卡因连续硬膜外腔阻滞法。结果：随访151例,随访8～31个月,优良83例(55．0％),疼痛明显改善,以中央型和腰痛为主的椎间盘突出较为有效。结论：本封闭法疗效与椎问盘突出部位、类型有关,可适用于疼痛严重的椎间盘突出。     

先秦社会时空方位观对中医理论的影响

先秦社会的五行阴阳以及四风系统的时空方位观对中医理论发展有着很大影响 ,说明中医理论是在接受先秦时期科学技术思想及社会观念发展起来的 ,有许多内容尚待探讨 ,如仅用秦汉后的观点去认识是会有偏误的。     

实验性面神经麻痹次级突触间隙扫描电镜观察

目的：探讨面神经麻痹面肌运动点的兴奋性与运动科板次级突触间隙的关系方法岙神经麻痹模型,应用盐酸消化法制作口轮匝肌招揽世镜标本者观察。结果：压１０ｓ组镒级突触间隙隙沟数量比对照侧减少而变浅。压榨３０ｓ组次级突触间隙隙沟明显减少平坦。结论：运动点失神经支配程度表明次级突触间隙病变程度,也表明面神经受损伤程度。     

鼻咽癌咽旁间隙受侵面颈联合野照射疗效观察

目的：评价鼻咽癌咽旁间隙受侵受面颈联合野照射长期疗效。方法：从１９９１年１月至１９９３年１２月,经ＣＴ诊断咽旁间隙侵犯,实行面颈联合野照射的鼻咽癌病人４９例,按临床分期分层随机抽取同时期非面颈联合野射４９例病人为对照组。５年局控率、生存率计算用Ｋａｐｌａｎ－Ｍｅｉｅｒ法,Ｌｏｇ－ｒａｎｋ作显著性检验。计数资料用χ＾２检验。结果：面颈联合野组生存率、局控率曲线图明显高于非面颈联合野组（Ｐ〈０．０５）     

颈椎间隙的应用解剖学研究

在 32具成人尸体 (男、女各半 )正中矢状断面上 ,选取脊柱C2 -T1段进行观测 ,取相邻椎骨的前缘、中份、后缘测量它们之间的距离 ,以及解剖左、右侧椎间孔 ,测量椎间孔的最大垂直高度及最大宽度。结果 :椎体间间隙的高度、前缘为 3 48～ 5 .38mm ,中份为 4 84～ 7 14mm ,后缘为 3 0 5～ 3 84mm ;椎间孔的高度为 7 0 0～ 8 10mm ,宽度为 5 0 0～ 7 35mm。以上对颈椎间隙的定量研究为颈椎病变的影像诊断和临床手术提供解剖学依据。     

Intrapulmonary gas mixing and dead space in artificially ventilated dogs

In this study we have investigated the effects of breath holding and of the physical properties of gases on four different respiratory dead spaces (V _D): the Fowler, the physiological, the washout and the inert gas dead space. The experiments were performed with dogs which were ventilated artifically with breathing patterns with different post-inspiratory breath holding times (t _a) of 0, 0.5, 1.0 and 2.0 s. Tracer amounts of acetone, ether and enflurane were infused continuously into a peripheral vein and a bolus of a mixture of krypton, Freon12 and SF₆ was introduced into the peritoneal cavity. After reaching steady state, samples of arterial blood, mixed venous blood and mixed expired air were taken simultaneously. From the partial pressures (P _a, P _¯V and P respectively) we determined the excretion (=P/P_¯V), retention (R=P_a/P_¯V) and the physiological dead space fraction (V _D,phys/V _T=(1 P/P_a) for each gas, where V _T is tidal volume. Further, we recorded the expirograms of the six tracer gases and of CO₂ from which the Fowler dead space fractions (V _D,Fowler/V _T) of the different gases were determined. Also the washout dead space fractions (V _D,washout/V _T) for He and SF₆ were determined as well as the inert gas dead space fraction (V _D,MIGET/V _T) with the use of the multiple inert gas elimination technique (MIGET).With the exception of V _D,phys/V _T for SF₆, all dead space fractions decreased with increasing t _a. V _D,phys/V _T for the poorly soluble gas SF₆ was considerably larger than V _D,phys/V _T for the remaining gases. For the highly soluble acetone V _Fowler/V _T was considerably smaller than V _D,Fowler/V _T for the other gases. V _{D,washout,SF6}/V _T was always larger than V _D,washout,He/V _T and V _D,Fowler,SF6/V _T. Further, V _D,phys/V _T was larger than V _D,Fowler/V _T for SF₆ and acetone. However, for gases with intermediate solubility in blood V _D,phys/V _T tended to be smaller than V _D,Fowler/V _T. We conclude that the respiratory dead spaces are affected by the breathing pattern and by the physical properties of gases, i.e. their diffusivity in alveolar gas and their solubility in blood or lung tissue.     

Respiratory effects of tracheal gas insufflation in spontaneously breathing COPD patients

Objective To evaluate the effect of tracheal gas insufflation (TGI) in spontaneously breathing, intubated patients with chronic obstructive pulmonary disease (COPD) undergoing weaning from the mechanical ventilation.Design A prospective study in humans.Setting Polyvalent intensive care unit (14-bed ICU) in a 700-bed general university hospital.Patients Twelve patients with chronic obstructive pulmonary disease (COPD) who required intubation and mechanical ventilation were studied. All patients met standard criteria for weaning from mechanical ventilation. Seven patients (group 1) had been transorally intubated during episodes of acute respiratory failure. Five patients, all men (group 2), had previously undergone tracheostomy and had a transtracheal tube in place.Interventions Intratracheal, humidified, O₂-mixture insufflation (TGI) was given via a catheter placed in distal or proximal position. Gas delivered through the intratracheal catheter was blended to match the fractional of inspired gas through the endotracheal tube. Continuous flows of 3 and 6 l/min in randomized order were used in each catheter position. Prior to data collection at each stage, an equilibration period of at least 30 min was observed, and thereafter blood gases were analyzed every 5 min. A new steady state was assumed to have been established when values of bothP _aCO₂ and CO₂ changed by less than 5% between adjacent measurements. The last values of blood gases were taken as representative. The new steady state was confirmed within 35–50 min. Baseline measurements with zero were made at the beginning and end of the experiment.Results This study shows that V_T, MV,P _aCO₂, and V_D/V_T are reduced in a flow-dependent manner when gas is delivered through an oral-tracheal tube (group 1). The distal catheter position was more effective than the proximal one. In contrast, when gas was delivered through tracheostomy (group 2), TGI was ineffective in the proximal position and less effective than in group 1 in distal position.Conclusion Under the experimental conditions, tracheal gas insufflation decreased dead space, increased alveolar ventilation and possibly reduced work of breathing. From the preliminary data reported here, we believe that TGI may help patients experiencing difficulty during weaning.     

Atrial natriuretic peptide (ANP) attenuates brain oedema accompanying experimental subarachnoid haemorrhage

Summary The effects of centrally administered atrial natriuretic peptide (ANP) on the brain water and electrolyte contents were investigated in a rodent subarachnoid haemorrhage (SAH) model. SAH caused statistically significant increases in the brain sodium and water contents, while the potassium content did not change significantly, indicating that the brain oedema could be classified as having a primarily vasogenic component. Two g or 5 g of rat ANP administered into the lateral ventricle at the time of SAH induction statistically significantly decreased the water and sodium accumulation measured 90 minutes following SAH. The same treatment did not inhibit development of brain oedema measured 3 hours following SAH. However, when 5 g of ANP was administered intraventricularly at the time of SAH induction and also 90 minutes later, the brain oedema 3 hours following SAH was again reduced statistically significantly. These effects of ANP were found not to be mediated by primary changes in serum osmolality and electrolyte concentrations.The present results confirm that centrally administered ANP may act directly on the central nervous system to inhibit brain water and sodium accumulation in SAH-induced brain oedema. The potentials of influencing the central neuro-endocrine system as a novel way of the treatment of brain oedema are discussed.Supported by Grant OTKA I/3 2728 and ETT T110/ 1990.     

Identification of the central vestibular projections in man: a positron emission tomography activation study

The cerebral representation of space depends on the integration of many different sensory inputs. The vestibular system provides one such input and its dysfunction can cause profound spatial disorientation. Using positron emission tomography (PET), we measured regional cerebral perfusion with various vestibular stimulations to map central vestibular projections and to investigate the cerebral basis of spatial disorientation. We showed that the temporoparietal cortex, the insula, the putamen, and the anterior cingulate cortex are the cerebral projections of the vestibular system in man and that the spatial disorientation caused by unilateral vestibular stimulation is associated with their asymmetric activation.