左额顶骨骨髓炎误诊为颅骨纤维结构不良症1例

1 临床资料 女，47岁。持续头痛、头昏1月余。近期无头部外伤史和感染病史。体检：体温正常，神志清楚，左额顶部较对侧稍隆起，压痛（-），神经系统体征（-）。颅脑CT示左额顶骨明显增厚，密度增高，内侧面粗糙不平，左额叶受压，中线结构无移位。颅骨正侧位片示左额顶骨密度增高。血常规检查：白细胞7．61×10^9/L，中性粒细胞75．1％。尿常规、胸片、腹部B超和盆腔B超均正常。以“颅骨纤维结构不良症”行手术治疗，     

Extracellular signal regulated kinases 1/2 signal pathway and responses of astrocytes after diffuse brain injury

BACKGROUND: The treatment of diffuse brain injury during an acute period is focused on relieving degrees of secondary brain injury. Generation and development of pathological changes of secondary brain injury depend on signal conduction, so down-regulating over response of astrocyte through interfering a key link of signal conduction pathway may bring a new thinking for the treatment of diffuse brain injury. OBJECTIVE: To observe the effect of over activity of extracellular signal regulated kinases 1/2 (ERK1/2) signal pathway on the response of astrocyte during an acute period of diffuse brain injury. DESIGN: Completely randomized grouping and controlled animal study. SETTINGS: Department of Neurosurgery, the Third Affiliated Hospital, Nanchang University; Department of Neurosurgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. MATERIALS: A total of 158 healthy male SD rats, of 11 weeks old, weighing 320–370 g, were provided by Experimental Animal Faulty, Tongji Medical College, Huazhong University of Science and Technology. Rabbit-anti-phosphorylated ERK1/2 (pERK1/2) polyclonal antibody was provided by R&D Company; rabbit-anti-glial fibrillary acidic protein (GFAP) polyclonal antibody, SP immunohistochemical kit and horseradish peroxidase (HRP)-labeled goat-anti-rabbit IgG by Santa Cruz Company; specific inhibitor U0126 of ERK1/2 signal pathway by Alexis Company. METHODS: The experiment was carried out in the Laboratory of Neurosurgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from September 2004 to March 2006. ① Detection of pERK1/2 expression: A total of 110 rats were randomly divided into sham operation group (n =5), model group (n =35), high-dosage U0126 group (n =35) and low-dosage U0126 group (n =35). Rats in the sham operation group were only treated with incision of epicranium and fixation of backup plate, but not hit. Rats in the model group were used to establish diffuse brain injury models based on Marmarou free falling body without drug intervention. Rats in the high- and low-dosage U0126 groups were injected into caudal vein with 0.1 and 0.05 mg/kg U0126, respectively, and then, rats were hit to establish injured models. Every 5 rats were collected from model, high- and low-dosage U0126 groups at 5, 30 minutes, 3, 12, 24, 72 hours and 7 days after diffuse brain injury to detect pERK1/2 expression in cortex of parietal lobe based on Western blot technique. ② Distribution of pERK1/2 and positive GFAP cells in brain tissue: Another 48 rats were randomly divided into sham operation group (n =3), model group (n =15), high-dosage U0126 group (n =15) and low-dosage U0126 group (n =15). The intervention and administration were dealt as the same as those mentioned above. Every 3 rats were collected from model, high- and low-dosage U0126 groups at 30 minutes, 3, 12, 24 and 72 hours after model establishment to observe the distribution of pERK1/2 and postive GFAP cells in brain tissue which was cut from coronal section at Bregma –4.8 mm layer with immunohistochemical staining. MAIN OUTCOME MEASURES: pERK1/2 expression in cortex of parietal lobe and distribution of pERK1/2 and positive GFAP cells in brain tissues. RESULTS: ① pERK1/2 expression: After diffuse brain injury, pERK1/2 expression in cortex of parietal lobe was rapidly increased in the model group, reached at peak at 5 minutes and then decreased gradually. But the expression was still in a high level until the 72nd hour and fallen to the basic level on the 7th day. pERK1/2 level was lower in high- and low-dosage U0126 groups than that in model group at various time points (P < 0.01); meanwhile, pERK1/2 level was lower in high-dosage U0126 group than that in low-dosage U0126 group. The results showed that there was a certain dosage dependence on pERK1/2 expression. ② Distribution of pERK1/2 and positive GFAP cells in brain tissue: Positive expression of pERK1/2 lasted in brain tissue from 30 minutes to 72 hours after diffuse brain injury (P < 0.05). In addition, from 30 minutes to 3 hours, brown-yellow stained cells were mainly distributed in plasma, but rarely in nucleus. A lot of positive cells had tree-like apophysis, which was similar to neurons. With the time passing by, more and more nuclei manifested positive stains; moreover, nuclei mainly manifested positive staining until 24 hours after diffuse brain injury. Immune-positive pERK1/2 cells were widely distributed in brain tissue, especially mainly in binding site between deep cortex and cerebral white matter, and then in hippocampus. In addition, ependymal cell and vascular endothelial cells of choroids plexus also manifested strongly positive staining. As compared with model group, positive cells were decreased gradually in high- and low-dosage U0126 groups. However, number of positive cells was less in high-dosage U0126 group than that in low-dosage U0126 group. CONCLUSION: Diffuse brain injury strongly induces the activity of ERK1/2 signal pathway and response of astrocyte; in addition, U0126 can inhibit response of glial cells during an acute period, and the effect manifests dosage dependence.     

超声诊断先天性左顶骨部分缺损并颅内外血肿形成1例

患婴女,7 d.第二胎.出生后发现左头顶部包块6 d来诊.查体:体质量3 200 g,身长50 cm,营养中等,精神稍差.左侧头顶部皮下可触及一大小约60 mm×57 mm×35 mm囊状包块,边界尚清,质软,有波动感.     

探讨妇女分娩过程中胎头不正的临床诊断及处理

头位分娩中,胎头不论采取枕横位、枕后位或枕前位通过产道均可发生不均倾势（胎头侧屈）,但是以枕横位前不均倾势多见,枕前位和枕后位则罕见。不均倾位可分为前不均倾位和后不均倾位两种。前不均倾即胎头取侧屈位以前顶骨入盆，前顶骨下降到耻骨联合后，由于耻骨联合后面平直，不具备骶骨前的凹陷，前顶骨则无退让的余地，即使并无头盆不称，但顶乳突径难以通过骨盆入口，致使后顶骨架于骶岬上无法入盆，如有头盆不称，则困难更大。随着产程进展，胎头侧屈加重，可使胎头前耳降至耻骨联合后，前肩不但降至耻骨联合上，且侧屈的胎头垫于后肩下，胎头无法入盆，故几乎均需以剖宫产结束分娩。后不均倾位即胎头同样为侧屈姿势，以后顶骨入盆，并滑入骶岬下，称为后不均倾势，这样胎头是以额乳突径通过产道，胎头后顶多数能滑过骶岬先入盆，利用骶骨凹陷向后退让，使前项能从耻骨联合滑下，使胎头成均倾势，再向前旋转，按枕前位完成分娩机转。     

浮动骨瓣手术治疗颅狭症五例报告

报告了五例颅狭症,重点介绍了舟状颅畸形和短头畸形的手术方法,其中4例治愈,1例因发症死亡。对其临床表现、发病机制、诊断及鉴别诊断相传统手术方式比较等问题进行了探讨。     

Resection of parietal lobe gliomas： incidence and evolution of neurological deficits in 28 consecutive patients correlated to the location and morphological characteristics of the tumor

OBJECT： The goal of this study is to report the incidence and clinical evolution of neurological deficits in patients who underwent resection of gliomas confined to the parietal lobe. METHODS： Patient demographics, findings of serial neurological examinations, tumor location and neuroimaging characteristics, extent of resection, and surgical outcomes were tabulated by reviewing inpatient and office records, as well as all pre- and postoperative magnetic resonance （MR） images obtained in 28 consecutive patients who underwent resection of a glial neoplasm found on imaging studies to be confined to the parietal lobe. Neurological deficits were correlated with hemispheric dominance, location of the lesion within the superior or inferior parietal lobules, subcortical extension, and involvement of the postcentral gyms. The tumors were located in the dominant hemisphere in 18 patients （64%）; had a mean diameter of 39 mm （range 14-69 mm）; were isolated to the superior parietal lobule in six patients （21%） and to the inferior parietal lobule in eight patients （29%）; and involved both lobules in 14 patients （50%）. Gross-total resection, documented by MR imaging, was achieved in 24 patients （86%）. Postoperatively, nine patients （32%） experienced new neurological deficits, whereas seven （25%） had an improvement in their preoperative deficit. A correlation was noted between larger tumors and the presence of neurological deficits both before and after resection. Postoperatively higher-level （association） parietal deficits were noted only in patients with tumors involving both the superior and inferior parietal lobules in the dominant hemisphere. At the 3-month follow-up examination, five of nine new postoperative deficits had resolved. CONCLUSIONS： Neurological deterioration and improvement occur after resection of parietal lobe gliomas. Parietal lobe association deficits, specifically the components of Gerstmann syndrome, are mostly associated with large tumors that involve both the superior and inferior parietal lobules of the dominant hemisphere. New hemineglect or sensory extinction was not noted in any patient following resection of lesions located in the nondominant hemisphere. Nevertheless, primary parietal lobe deficits （for example, a visual field loss or cortical sensory syndrome） occurred in patients regardless of hemispheric dominance.     

颅顶骨萎缩症的影像诊断

患者，女，57岁。双侧顶骨凹陷多年，凹陷渐深，为排除恶性病变摄头颅正侧位片检查。体检：局部皮肤毛发正常，双侧顶骨区凹陷变形，局部无压痛。神经系统检查无异常。X线所见：头颅前后位片（图1）双侧顶骨对称性碟状凹陷长约6cm，部在距中线向两侧约2.5cm处开始。     

急性硬膜外血肿迅速消退三例报告

本组3例.男1例,女2例.年龄13～58岁.均为车祸伤,头部着地.3例伤后昏迷1～10min,均有头痛、呕吐等症状.查体均有头皮下血肿.X线检查例1见左颞顶骨线状骨折,例3见左枕骨线状骨折.3例均行CT扫描,例1见左颞顶骨骨折伴颞部硬膜外血肿,最厚处1.0cm,长3.5cm;例2见左颞部硬膜外血肿,最厚处0.8cm,长2.0cm;例3见左枕骨骨折伴硬膜外血肿,最厚处1.0cm,长2.0cm,内有点状积气,中线结构无移位.     

问号氏切口在额颞顶急性硬膜下血肿清除减压术中的应用

目的：探讨问号氏切口显露法在急性硬膜下血肿清 减压术中的应用。方法；应用该切口显露方法对36例急性 上血肿施行了血肿清除减压术。结果：完全恢复12例，中残11例，功能恢复率（中残＋完全恢复）占63.9%；3例重残，1例植物生存，9例死亡，预后不良率占36.1%。结论：问号氏切口显地具有显露充分，清除减压快速、彻底等显著特点，在急性硬膜下血肿清减压术中有较大应用价值。     

甲状旁腺功能亢进致对称性颞顶骨菲薄症一例

患者男，32岁。因头部外伤后不能言语伴恶心呕吐2h入院。查体：躁动，运动性失语，四肢活动可，病理征阴性。头CT检查见右侧颞顶部硬膜外血肿，量约40ml，左额部硬膜外血肿10ml，右侧脑室受压，中线结构轻度左移。骨窗像见双侧颞顶骨骨质对称性变薄，局部外板及板障消失。X线检查：颞顶骨对称性凹陷，局部颅板变平、变薄，内外板界限不清。