颈部肿块和瘢痕病变致颈动脉窦过敏综合征(附2例报告)

报告１例鼻咽癌颈淋巴结转移致颈动脉窦过敏综合征和１例全喉切除加颈淋巴结清扫术术后瘢痕形成出现颈动脉窦过敏综合征。对耳鼻咽喉科相关疾病引起的颈部肿块和瘢痕病变压迫颈动脉窦所致颈动脉窦过敏综合征的致病原因、临床表现及诊断、治疗原则进行了讨论。此类患者在临床上少见,易误诊,应引起重视。     

脑梗死患者颈动脉彩色多普勒超声研究

目的 探讨颈动脉粥样硬化及其危险因素与不同类型的脑梗死间的关系。方法：根据头颅ＣＴ或ＭＲＩ结果将１８８例脑梗死患者分成四个亚组：皮层梗死组（ＣＩ）,皮层下梗死组（ＳＣＩ）,椎－基底动脉支配区梗死组（ＶＢＡＩ）及心源性脑栓塞组（ＣＥＩ）,用彩色多勒超声（彩超）对各型脑梗死患者颅外颈动脉粥样硬化严重程度进行评估,并对可能危险因素进行探讨。结果 ３０％的ＣＩ组患者,１０％ＣＥＩ患者,６．９％ＶＢＡＩ患者     

Modulatory effect of nitric oxide on acetylcholine-induced activation of cat petrosal ganglion neurons in vitro

The inhibitory effect of nitric oxide (NO) on carotid chemosensory responses to hypoxia has been attributed in part to an antidromic inhibition of chemoreceptor cells activity. However, NO may also modulate the activity of the primary sensory neurons because NO is produced in the soma of these neurons located in the petrosal ganglion. Since a population of petrosal neurons is selectively activated by acetylcholine (ACh), we studied the effects of NO-donor, sodium nitroprusside (SNP), and the NO-synthase inhibitor, Nomega-nitro-l-arginine methyl ester (l-NAME), on the responses evoked in the carotid sinus nerve (CSN) by ACh applied to the petrosal ganglion in vitro. ACh (1 microgram-1 mg) increased the frequency of action potentials recorded from the CSN in a dose-dependent manner. SNP (10-50 microM) reduced the sensibility and amplitude of the CSN response to ACh, although the maximal response appears less affected. The withdrawal of SNP from the superfusion medium increased the sensibility of the responses to ACh. l-NAME (1-2 mM) slightly increased the sensibility of the ACh-induced responses, effect that persisted after l-NAME withdrawal. These results suggest that NO may play a role as modulator in this autonomic primary sensory ganglion.     

Microembolization from a carotid mural thrombus detected by transcranial Doppler

Over the last few years, many authors have described the possibility of using transcranial Doppler to demonstrate the passage of microemboli in the cerebral arteries. We report the case of a 44-year-old woman with thrombotic diathesis and thrombocytosis who was admitted twice within a short period of time (one and a half months) to a neurological department because of multiple cerebral infarctions. On the occasion of the second admission, a colour-Doppler examination of the epiaortic vessels, which had previously been negative, showed a carotid lesion due to a mural thrombus and, on the same side as the carotid lesion, transcranial Doppler detected short-duration, high-intensity signals in the middle and anterior cerebral arteries, an expression of the passage of microemboli.As already described by other authors in similar clinical situations, our case confirms that transcranial Doppler can identify the passage of microemboli in the circle of Willis.

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Sommario Negli ultimi anni è stata descritta da molti autori la possibilità di dimostrare mediante Doppler transcranico il passaggio di microemboli nelle arterie cerebrali. Riportiamo il caso di una donna di 44 anni con diatesi trombotica e trombocitosi ricoverata per due volte, a breve distanza di tempo (un mese e mezzo), in ambiente neurologico per infarti cerebrali multipli. In occasione del secondo ricovero l'esame Color-Doppler dei vasi epiaortici, che era risultato negativo in precedenza, ha evidenziato una lesione carotidea riferibile a un trombo murale e al Doppler transcranico sono stati rilevati, omolateralmente alla lesione carotidea, segnali di breve durata ed alta intensità nelle arterie cerebrali media e anteriore, espressione di passaggio di microemboli.Come già descritto da alcuni autori in situazioni cliniche simili, il nostro caso conferma la possibilità di individuare, mediante Doppler transcranico, il passaggio di microemboli nel circolo cerebrale.

     

Inflammatory mechanisms in Alzheimer's disease

In recent years many studies have indicated an involvement of inflammatory mechanisms in Alzheimer's disease (AD). Acute-phase proteins such as 1-antichymotrypsin and c-reactive protein, elements of the complement system, and activated microglial and astroglial cells are consistently found in brains of AD patients. Most importantly, also cytokines such as interleukin-6 (IL-6) have been detected in the cortices of AD patients, indicating a local activation of components of the unspecific inflammatory system. Up to now it has remained unclear whether inflammatory mechanisms represent a primary event or only an unspecific reaction to brain tissue damage. Therefore, we investigated whether IL-6 immunoreactivity could be found in plaques prior to the onset of neuritic changes, or whether the presence of this cytokine is restricted to later stages of plaque pathology. we confirmed our previous observation that IL-6 is detectable in a significant proportion of plaques in the brains of demented patients. In AD patients IL-6 was found in diffuse plaques in a significant higher ratio as would have been expected from a random distribution of IL-6 among all plaque types. This observation suggests that IL-6 may precede neuritic changes, and that immunological mechanism may be involved both in the transformation from diffuse to neuritic plaques in AD and in the development of dementia.     

Arterial spasm as a finding intimately associated with the onset of vascular headache

Summary A patient with migraine headaches of the cluster variant type is presented in whom vasospasm of the middle cerebral artery, the anterior cerebral artery and the internal carotid artery triggered a pain episode identical in character and severity to the headaches which had led to her investigation. Vasospasm associated with the painful phase of headache in this case conflicts with the more accepted theory that the pain phase of a vascular headache is related to vasodilatation of cerebral or extracerebral vessels. The literature is reviewed.     

Release of endogenous catecholamines in two different regions of the nucleus of the solitary tract as influenced by carotid occlusion

Summary The effects of carotid occlusion on the release of catecholamines in the nucleus of the solitary tract (NTS) were investigated in anaesthetized cats. Two aspects of the nucleus (rostral or intermediate NTS) were superfused bilaterally through push-pull cannulae with artificial CSF and the release of the endogenous dopamine, noradrenaline and adrenaline was determined in the superfusate radioenzymatically. The superfusion rate was 150 l/min or 800 l/min. In some experiments, superfusion of the intermediate NTS was carried out after denervation of the aortic arch.In the rostral NTS superfused at a rate of 150 l/min, bilateral carotid occlusion led to a rise in blood pressure and decreased the release rate of dopamine. These changes continued after occlusion termination. The release rate of noradrenaline was transiently diminished during occlusion. The release of this amine was also decreased after occlusion termination. The release rate of adrenaline was not influenced during carotid occlusion, but it was found to be diminished after termination of the occlusion. Superfusion of the rostral NTS at a rate of 800 l/min also reduced the release rate of adrenaline after termination of carotid artery occlusion. In the intermediate NTS (superfusion rate 150 l/min) similar effects of the carotid occlusion on the release rates of dopamine and noradrenaline were observed. In this aspect of the NTS, denervation of the aortic arch abolished the decrease in the noradrenaline release during carotic occlusion, while the release rates of dopamine and adrenaline were decreased during and after termination of the carotid occlusion.The results suggest that (a) the rise in blood pressure in the carotid sinus after termination of a carotid occlusion decreases the release rates of noradrenaline and adrenaline in the NTS, (b) the decrease in the release of noradrenaline during carotid occlusion is due to impulses originating from the baroreceptors of the aortic arch.Thus, impulses from carotid sinus and aortic arch modify the release rates of noradrenaline in the NTS so as to counteract blood pressure changes.Supported by the Fonds zur Förderung der wissenschaftlichen Forschung Send offprint requests to A. Philippu at the above address     

Deposition of β/A4 protein along neuronal plasma membranes in diffuse senile plaques

Summary The origin of the extracellular -amyloid protein (/A4) found in senile plaques and the cellular mechanisms responsible for its deposition in cerebral tissues are still an unresolved issue in Alzheimer's disease. In this study we analyzed in detail the distribution of various epitopes of /A4 in relation to local cellular elements in diffuse plaques of the hippocampal region. We also correlated our findings with the presence and distribution of non-/A4 epitopes of the amyloid precursor protein (APP) and with synaptophysin immunoreactivity in the cortical neuropil. Discontinuous /A4-immunoreactive deposits were found along dendrites, and around the soma of neurons included in the plaques. Furthermore, increased synaptophysin reactivity with slightly dilated synaptophysin-immunolabeled presynaptic terminals were found in diffuse plaques. APP epitopes could not be found in diffuse plaques. However, some of the APP antibodies, mainly those to the C-terminal portion of APP, and antibodies to /A4 recognized clusters of flat vesicular profiles (0.6–1.4 m in width and 2–3 m in length) in the neuropil of cortical areas where plaques had developed. Our findings are compatible with a neuronal origin of /A4 in diffuse plaques and with a primary release of /A4 at synaptic sites along the immunostained neurites. They also suggest that diffuse plaques might be preceded by minute lesions of the neuropil where /A4 is not yet released from the precursor molecule.     

老年斑、神经元纤维缠结与硫酸多糖

老年斑 (senileplaques ,SP)、神经元纤维缠结 (neurofib rillarytangles,NFTs)是老年性痴呆最典型的病理特征 ,其中SP的主要成分为 β样淀粉蛋白 (Aβ) ,NFTs主要由异常修饰的tau蛋白组成。许多研究发现硫酸多糖与SP、NFTs的形成密切相关。大量文献报道硫酸多糖与淀粉样前体蛋白(APP)、Aβ以及tau蛋白具有高度亲和性 ,它不仅可以促进APP的异常代谢 ,导致Aβ的大量产生 ,诱导其形成纤丝并聚集、沉积于细胞外 ,而且还可促进tau蛋白发生高度磷酸化 ,形成成对螺旋丝 (PHF)并聚集成NFTs。但也有文献报道外源性硫酸多糖具有促进APP的神经营养作用 ,抑制Aβ纤丝的形成 ,并增强磷酸酯酶PP2B的活性 ,从而减少tau蛋白的磷酸化修饰。并且硫酸多糖的糖基组成、糖链长度、硫酸基的数目及位置不同 ,它在SP、NFTs的形成过程中扮演的作用也不同 ,所以可通过分子结构改造而使硫酸多糖表现抑制SP、NFTs形成的活性 ,从而达到抗老年性痴呆的作用     

LDL-C/HDL-C比值及颈动脉粥样硬化性狭窄与脑梗塞发病关系的探讨

目的 研究低密度脂蛋白胆固醇(LDL-C)／高密度脂蛋白胆固醇(HDL-C)比值以及颈动脉粥样硬化性狭窄与脑梗塞发病的关系，并探讨其预测脑梗塞发生的价值。方法 应用彩色多普勒显保仪对非脑梗塞组患者328例(高血压198例、糖尿病82例、高血压伴糖尿病48例)和脑梗塞组患者260例进行颈动脉检测，观察颈动脉狭窄程度；同时检测两组患者的LDL-C/HDL-C比值水平。结果 脑梗塞组颈动脉重度狭窄发生率明显高于非脑梗塞组(P＜0．01)；LDL-C/HDL-C比值水平及异常率也明显高于非脑梗塞组(P＜0．01)，相关分析显示与甘油三酯(TG)、总胆固醇(Tch)、LDL和HDL-C相比，该比值显示了更有意义的与脑梗塞的相关关系(β＝0．357，P＝0．001)，经多元逐步回归分析显示，与TG、Tch、LDL-C和HDL-C相比，该比值显示了更有意义的回归关系，其标准方程式为：γ(脑梗塞)＝0．339(糖尿病史) 0．278(LDL-C) 0．187(高血压史)(P＜0．贴，复相关系数为0．534)。结论 应用颈动脉超声判定颈动脉重度狭窄和检测LDL-C/HDL-C比值水平及异常率对预测脑梗塞的发生有一定的实用参考价值。