脑后部可逆性脑病综合征(PRES)的临床MR诊断

目的：探讨MR对PRES的临床诊断价值。方法应用3.0 T MR对30例PRES患者进行常规扫描，其中19例同时行MRA检查，13例行MRV检查。结果 PRES病变主要累及顶枕叶，双侧基本对称；病变主要位于脑白质内，也可累及其它部位。PRES病变的特点是呈长T 1长T 2信号，边缘不清，无明显占位效应。MRA及MRV均无异常发现。结论 MR对PRES可以作出准确诊断，对临床有重要的指导意义。     

Neuroimaging and Neurologic Complications after Organ Transplantation

Neurologic complications are common after transplantation and affect 30-60% of transplant recipients. The etiology of most of the posttransplant neurologic disorders is related to the opportunistic infections, both systemic and involving central nervous system (CNS), toxicity of immunosuppressive medications, and the metabolic insult created by the underlying primary disease and the transplant procedure. Neuroimaging studies are one of the key tools in the evaluation and enable early diagnosis of neurologic complications in transplant patients, especially posterior reversible leukoencephalopathy syndrome, central pontine myelinolysis, intracerebral hemorrhage, and fungal and bacterial abscesses. Magnetic resonance imaging (MRI) is the preferred technique, but each of the available neuroimaging techniques offers a unique insight into the pathophysiologic mechanisms underlying neurologic complications of transplantation. The role of neuroimaging in this population includes early detection of calcineurin inhibitor neurotoxicity, opportunistic infections, neoplasia, metabolic disorders, or cerebrovascular diseases. In addition, we can monitor longitudinal progression of disease and treatment response.     

乌司他丁对大鼠胰性脑病保护作用的实验研究

目的 :探讨乌司他丁对大鼠急性出血坏死性胰腺炎时对脑组织损害的保护作用 ,为胰性脑病的治疗提供实验依据。方法 :将 90只SD大鼠随机分为正常对照组 ,急性出血坏死性胰腺炎诱导组和乌司他丁处理组 ,经胰胆管逆行注射 5%牛磺胆酸钠建立大鼠ANP模型 ,12h后处死动物 ,测定血清TNFα水平 ,并检测脑组织含水量、脑微血管内白细胞聚集及附壁现象。结果 :经乌司他丁处理后 ,血清中乌司他丁水平、脑组织含水量、脑组织MDA含量、脑微血管内白细胞聚集及附壁现象显著降低(P <0 .0 1)。结论 :乌司他丁可以减轻急性出血坏死性胰腺炎时脑损害的发生和发展     

Acute encephalopathy associated with influenza and other viral infections

Acute encephalopathy is the most serious complication of pediatric viral infections, such as influenza and exanthem subitum. It occurs worldwide, but is most prevalent in East Asia, and every year several hundreds of Japanese children are affected by influenza-associated encephalopathy. Mortality has recently declined, but is still high. Many survivors are left with motor and intellectual disabilities, and some with epilepsy. This article reviews various syndromes of acute encephalopathy by classifying them into three major categories. The first group caused by metabolic derangement consists of various inherited metabolic disorders and the classical Reye syndrome. Salicylate is a risk factor of the latter condition. The second group, characterized by a systemic cytokine storm and vasogenic brain edema, includes Reye-like syndrome, hemorrhagic shock and encephalopathy syndrome, and acute necrotizing encephalopathy. Non-steroidal anti-inflammatory drugs, such as diclofenac sodium and mephenamic acid, may aggravate these syndromes. Severe cases are complicated by multiple organ failure and disseminated intravascular coagulation. Mortality is high, although methylprednisolone pulse therapy may be beneficial in some cases. The third group, characterized by localized edema of the cerebral cortex, has recently been termed acute encephalopathy with febrile convulsive status epilepticus, and includes hemiconvulsion-hemiplegia syndrome and acute infantile encephalopathy predominantly affecting the frontal lobes. Theophylline is a risk factor of these syndromes. The pathogenesis is yet to be clarified, but an increasing body of evidence points to excitotoxicity and delayed neuronal death.     

Arachidonic acid metabolites in CSF in hypoxic-ischaemic encephalopathy of newborn infants

The aim of this study was to evaluate the cerebral synthesis of eicosanoids in the asphyctic newborn and to investigate the relation between the prostanoid profiles in cerebrospinal fluid (CSF) and the appearance and severity of hypoxic-ischaemic encephalopathy (HIE). Levels of 6-keto-PGF _1-α, TXB₂, PGE₂ and PGF_2-α in CSF were measured in 40 full term newborns during the first day of life. Thirty of these newborns had birth asphyxia and were divided into three groups: 10 without HIE, 12 with mild HIE and 8 with moderate-severe HIE. They were compared to a control group of 10 non-hypoxic newborns. Determinations of the metabolites in CSF were performed by RIA and expressed as pg/ml (mean ± SD). The CSF TXB₂ (thromboxane A₂ metabolite) in asphyxiated newborns was always higher than in the control group (28.12 ± 10.6), and related to the severity of HIE ( p = 0:005): without HIE (50.84 ± 16.4; p = 0:02), mild HIE (80.65 ± 12.64; p ± 0:01) and moderate-severe HIE (178.14 ± 20.5; p < 0:01). The CSF 6-keto-PGF _1-α (prostacyclin metabolite) in asphyxiated newborns was always higher than in the control group (80.55 ± 12.56), but indirectly related to the severity of HIE: without HIE (240.95 ± 28.12; p < 0:01), mild HIE (183.65 ± 30.1; p < 0:01) and moderate-severe HIE (140.55 ± 25.12; p < 0:01). In the moderate-severe HIE group, the increase in TXB₂ was higher than the rise in 6-keto-PGF _1-α.     

鸟氨酸-天门冬氨酸联合乳果糖治疗肝性脑病疗效观察

目的探讨鸟氨酸-天门冬氨酸(雅博司)联合乳果糖治疗肝性脑病的疗效.方法选择56例肝性脑病患者,在综合性治疗的基础上,给鸟氨酸-天门冬氨酸20g/d静脉滴注;乳果糖20ml口服或鼻饲,每日三次.另选36例患者作为对照组,给一般综合性治疗,同时给乙酰谷酰胺1.0g/d静脉滴注,分别治疗20天.结果治疗组病死率明显下降,与对照组相比,有显著性差异(x2=4.02,P＜0.05),在降低血氨及促进脑电图改善方面,两组也存在显著性差异.结论雅博司联合乳果糖治疗慢性重型肝炎合并的肝性脑病,疗效显著,值得研究和应用.