人工脑脊液置换治疗高血压性脑室出血

目的研究高血压性脑室出血的新疗法。方法将60例高血压性脑室出血患者随机分为研究组与对照组,研究组给予药物加人工脑脊液置换治疗,对照组给予药物加侧脑室引流术治疗,比较两组患者的治疗效果。结果两组患者治疗后15、90、180d临床疗效间差别均有显著性意义(P<0.01)。结论人工脑脊液置换术可能成为高血压性脑室出血的有效治疗方法。     

子宫内膜异位症患者血清及腹腔液中血小板衍生生长因子、血管细胞粘附分子水平的变化及其意义

目的通过检测子宫内膜异位症(EMs)患者血清及腹腔液中血小板衍生生长因子(PDGF)、血管细胞粘附分子-(VCAM-1)浓度,探讨PDGF和VCAM-1在EMs发病中的作用。方法选取手术后病理证实为EMs的40例患者为EMs组,其中I~II期17例,III~IV23例;非EMs组20例作为对照组。应用酶联免疫吸附法(ELISA)检测血清及腹腔液中PDGF和VCAM-1水平。结果EMs组血清及腹腔液中PDGF、VCAM-1水平均明显高于对照组(P<0.01)。随EMs期别的增加,其血清和腹腔液中PDGF、VCAM-1含量呈上升趋势;EMsIII~IV期水平显著高于I~II期(P<0.05)。EMs患者PDGF与VCAM-1呈正相关性(P<0.05)。结论EMs患者PDGF、VCAM-1表达水平升高,在EMs的发生发展中具有重要作用。     

腰大池持续外引流的临床观察与护理

笔者报道72例腰大池持续外引流病人的观察与护理。认为对于腰穿持续外引流的病人，观察脑脊液的性质、量，严密观察病情变化，加强引流管的护理及基础护理，增强营养，是提高治愈率，减少并发症的重要措施。     

Seminal Fluid and the Expression of MHC Class I Antigens in the Placenta of the Rat

PROBLEM : To determine whether seminal fluid influences the expression of MHC class I antigens on the surface of basal trophoblast cells in the placenta of the rat. METHODS : Transfer of DA × DA embryos into a WF (allogeneic) or DA (syngeneic) recipient made pseudopregnant by hormonal treatment followed by mating with a vasectomized male (seminal fluid) or by mechanical stimulation (no seminal fluid). Antigen expression was determined by electron microscopic immunocytochemistry using the appropriate gold-labeled monoclonal antibodies. RESULTS : Seminal fluid did not affect the expression of MHC class I antigens on the surface of the basal trophoblast in either allogeneic or syngeneic matings. CONCLUSIONS : The suppression of the expression of paternal class I antigens on the surface of the basal trophoblast cells in allogeneic pregnancies most likely occurs at the genome level shortly after fertilization.     

头低位模拟失重状态对前庭功能的影响

为研究头低位模拟失重对运动病症状、垂直视动眼震（ＶＯＫＮ）及体液重新分配的影响，在头低位－１０°的模拟失重状态下，采用大视野的垂直视动刺激，观察１８名正常人的运动病症状、ＶＯＫＮ、激素（ＡＶＰ、ＶＩＰ、ＣＯＲＴ、ＡＬＤＯ）的反应特点。结果表明，头低位－１０°状态下的大视野垂直视动刺激可以诱发出明显的运动病症状，头低位－１０°的垂直视动刺激比坐位更容易诱发运动病。坐位状态ＶＯＫＮ慢相速度有明显的方向性不对称，敏感组ＶＯＫＮ方向性不对称有显著差异（Ｐ＜０．０５）。头低位－１０°时ＶＯＫＮ的不对称现象不明显，向下方向运动的ＶＯＫＮ慢相速度显著增加。分析指出，头低位－１０°状态下垂直视动刺激比坐位和秋千刺激的贡献率大。尿中ＣＯＲＴ（皮质醇）在秋千和头低位的垂直视动刺激前后有显著性增加。提示：大视野的垂直视动刺激与头低位－１０°两种刺激的结合可能成为预测空间运动病的方法之一．     

Progressive peri‐implantitis. Incidence and prediction of peri‐implant attachment loss.

The aim of this prospective study was to characterize an implant patient population exhibiting clinical signs of peri‐implantitis and to determine subsequently the incidence of progressive attachment loss. The predictive values of diagnostic parameters were evaluated. 25 patients with 54 endosseous implants that had been loaded for 41±15 months were included in the study. Clinical parameters included the assessment of plaque, bleeding on probing, probing depth, attachment levels, and Periotest® values. Probing measurements were performed in duplicate by means of a controlled force electronic probe (Periprobem). Peri‐implant crevicular fluid samples were collected and assayed for neutral proteolytic enzyme (NPE) activity (Periocheck®). Analysis of duplicate baseline probing data revealed a high degree of reproducibility (mean difference: 0.1±0.3mm). A minimum threshold of 1.0mm (>3×S.D.) loss of probing attachment was chosen to classify a site as positive for breakdown. Alternatively, the tolerance method was employed to identify sites with progressive attachment loss. After 6 months, irrespective of the analytical method, 6 percent of all sites (in 19% of the implants) and 28% of the patients had experienced further per attachment loss. There were significant differences ( p <0.05) in mean plaque (73% vs. 45%) and NPE (36% vs. 12%) scores between patients with progressive peri‐implantitis and those with stable peri‐implant conditions. Both bleeding on probing and the NPE‐test were characterized by high negative predictive values, and thus negative scores can serve as indicators for stable peri‐implant conditions. For monitoring peri‐implant health during recall visits, attachment level recordings with a controlled force electronic probe in conjunction with enzymatic diagnostic tests of the host response can be recommended.     

Frequency and causes of shunt revisions in different cerebrospinal fluid shunt types

Summary Shunt complications and revisions are common in hydrocephalic patients treated with a ventriculo-atrial or a ventriculo-peritoneal shunt. The reported revision rate differs very much but the rate of revision is close to 50% in many papers. Data from 884 hydrocephalic patients treated with various shunt types in the period 1958–1989 were recorded retrospectively in order to evaluate the frequency of revision for various shunt types and secondly to analyse the specific reasons for the shunt revisions.The rate of shunt revision was 45%. The Pudenz shunt was revised more often (62%) than the remaining shunt types. The Hakim and the Orbis-Sigma shunts had fewer revisions (35% and 27%, respectively) than the other observed shunt types. A defect of or an obstruction in the ventricular catheters was a frequent cause of revision followed by a defect or an obstruction of the distal catheter, a displacement of the distal catheter and an acute infection. Because of the higher rate of revision for the Pudenz shunt the rate of the above mentioned specific complications is also higher in most of the subgroups for that specific shunt type. Driven by these experiences it is reasonable to seek to develop and introduce new shunt types in an attempt to reduce the complication rate.     

急性颅脑损伤患者脑脊液中兴奋性和抑制性氨基酸含量改变及其临床意义

采用氨基酸自动分析仪检测了１８例急性颅脑损伤患者脑脊液中谷氨酸、天门冬氨酸、牛磺酸、甘氨酸、丙氨酸、γ－氨基丁酸、脯氨酸含量的动态变化。结果发现，伤情越重、预后越差的患者，脑脊液中牛磺酸、γ－氨基丁酸、丙氨酸含量伤后早期升高越明显，恢复至正常的时间也越长；其中２例早期死于急性弥漫性脑肿胀、脑水肿的患者，伤后当天脑脊液中牛磺酸含量分别为９２．６和５１．５μｍｏｌ／Ｌ，是对照值的９．６倍和５．４倍，γ－氨基丁酸含量分别为１１９．８和２４６．２μｍｏｌ／Ｌ，是对照值的２．７倍和５．５倍。表明伤后脑脊液中牛磺酸、γ－氨基丁酸和丙氨酸含量的动态变化可初步反映颅脑损伤的严重程度及颅脑损伤患者的脑功能恢复状况，并可能与急性脑水肿、脑肿胀的病理生理过程有关。     

Cerebrospinal fluid cytology in granulocytic sarcoma with meningeal extension but without bone marrow involvement

Granulocytic sarcoma (GS) is a localized tumour of immature granulocytes that is usually associated with myelogenous leukaemia. We report an unusual case of mastoid GS with meningeal extension but no bone marrow involvement on presentation. Histological examination of the surgical specimen and the characteristic cerebrospinal fluid (CSF) cytology showing cytoplasmic granulations and Auer bodies led to the diagnosis of GS. Positive cytochemical staining of the immature CSF cells for naphtol-ASD chloroacetate esterase and myeloperoxidase confirmed their myeloid origin. Immunophenotyping did not reveal common acute lymphoblastic leukaemia antigen, cytokeratin, T or B-cell antigens. The patient underwent surgical resection of the localized tumour, followed by radiation therapy, intrathecal and systemic chemotherapy, as if he had acute myelogenous leukaemia (AML). He did not develop AML in the 21 months after the tumour resection. This case emphasizes the value of CSF cytological examination of tumour cells and the use of an immumocytochemical marker for differentiating GS from malignant lymphoma.