脑膜癌病的临床与病理特点

目的探讨脑膜癌病的临床与病理特点。方法回顾性分析142例脑膜癌病患者的临床及脑脊液(CSF)细胞学资料和免疫细胞化学标记结果。结果本组患者临床特点:头痛123例(86.62%),头晕19例(13.38%),发热26例(18.31%),视物模糊10例(7.04%)。CSF检查及免疫标记:全部患者CSF中均发现癌细胞;癌细胞上皮膜抗原(EMA)( ),细胞角蛋白(CK)( ),CD14(-),胶质纤维酸性蛋白(GFAP)(-)。其中99例(69.72%)CK低分子( )、高分子(-),诊断为转移性腺癌;33例(23.24%)CK高分子( )、CK低分子(-),诊断为转移性鳞癌;10例(7.04%)CK高分子( )、CK低分子( ),考虑为腺鳞癌。105例找到原发灶,其中67例(47.18%)确诊为肺癌;23例(16.20%)在消化道内找到原发灶;9例(6.34%)为乳腺癌;子宫内膜癌、卵巢癌、肝癌各1例。另有37例(26.06%)未找到原发灶。诊断明确的患者中,15例失访,另90例中有82例(91.11%)于确诊后3～14个月死亡。未找到原发灶的患者中,有6例失访,另31例中有28例(90.32%)在确诊后2～13个月内死亡。结论脑膜癌病患者以头痛、头晕为主要临床表现,并可伴有发热及视物模糊。CSF细胞学检查是诊断脑膜癌病的主要依据,通过免疫细胞化学的方法,可以确定转移癌细胞。脑膜癌病患者预后较差。     

小鼠不完全性脑缺血、再灌注时脑膜血流量的变化及尼莫地平的作用

目的：观察双侧颈总动脉阻断后脑血流的变化。方法：结扎双侧颈总动脉观察小鼠不完全性脑缺血及其再灌注时脑膜血流量的变化。结果：结扎颈总动脉后小鼠脑膜血流量在几秒钟内骤然下降，血流量较结扎前降低约８５．９％±６．４５％。同时血管中红细胞运动近停滞状态，血管再通时脑血流处于低灌注状态，血流量下降３４．４７％±１１．６９％，此时脑缺血再灌后脑组织实际上处于一种慢性缺血状态。再灌注１０ｄ后，小鼠脑海马ＣＡ１区神经细胞数明显减少。尼莫地平可以解除再灌注时的脑血流低灌状态。并防止由此所引起的脑海马ＣＡ１区神经细胞的缺失。结论：缺血后及时给予尼莫地平具有积极的治疗意义。     

脑膜病变MRI异常强化类型与病因的相关性分析

目的 探讨各种脑膜病变脑膜MRI强化类型与病因的关系。方法 回顾性分析78例资料完整，MRI增强扫描脑膜异常强化的非脑膜瘤。结果 78例中，脑膜癌病16例（硬脑膜-蛛网膜型2例，软脑膜-蛛网膜下腔型11例，混合型3例）；感染性脑膜炎18例（硬脑膜-蛛网膜型3例，软脑膜-蛛网膜下腔型13例，混合型2例）；脑梗死22例（软脑膜-蛛网膜下腔型18例，混合型4例）；开颅术后15例（硬脑膜-蛛网膜型10例，混合型5例）；硬膜下积液（血肿）7例，均为硬脑膜-蛛网膜型。结论 MRI双倍剂量Gd-DTPA增强扫描对脑膜病变敏感性高，脑膜强化类型与各种病因侵犯脑膜三层结构的方式和程度有关。     

MRI evaluation of bulky tumor masses in the mesentery and bladder involvement in peritoneal carcinomatosis

AIM: Peritonectomy procedures with intraperitoneal chemohyperthermia are an effective but costly treatment for peritoneal carcinomatosis (PC). Consequently a proper selection of patients is necessary. We evaluated the benefit of MRI prior to surgery, in the detection of two of the main surgery contraindications: bulky mesenteric tumors and bladder implants. METHODS: Three experts retrospectively reviewed abdominal and pelvic MRI from 19 cases of surgically proved PC (ovary: 7; colorectal: 7; gastric: 2; pseudomyxoma peritonei: 2; appendix: 1). RESULTS: Mesenteric tumors were always identified as hypersignal masses on axial and coronal fat suppression gadolinium-enhanced T1 images (n=3). Three out of five bladder implants were detected. The two cases of bladder implants that were not detected on MRI were missed because the bladder was not filled. The best sequence for the detection of bladder involvement was axial T2-weighted images with bladder filling. CONCLUSIONS: Evaluating the preoperative resectability of PC is crucial for patient management. MRI seems to reliably detect bulky mesenteric tumors and bladder implants on condition the bladder is filled and appropriate sequences are used.     

成人结核性脑膜炎误诊原因分析

报告了成人结核性脑膜炎11例误诊,并收集国内报告的221例误诊病例,对结核性脑膜炎的误诊原因进行了综合分析。     

硬脑膜动脉海绵窦瘘的眼眶CT表现,DSA检查及栓塞治疗

笔者分析了５例硬脑膜动脉海绵窦瘘伴突眼，结膜充血的病例，全部经ＣＴ及ＤＳＡ检查，同时进行了栓塞治疗，经随访７－９个月未见复发，主要ＣＴ表现为：（１）眼球突出，结膜充血；（２）眼上静脉扩张；（３）海绵窦增大；（４）眼外肌增厚：（５）眶尖软组织肿胀。并讨论了诊断鉴别诊断，ＤＳＡ检查及有关治疗问题。     

Dexamethasone in the treatment of meningeal leukemia

To determine if dexamethasone has a role in the treatment of meningeal leukemia, 8 consecutive patients with acute lymphoblastic and signs or symptoms of CNS were included in the study. After the confirmation of leukemic blast cells on cerebrospinal fluid, they received intrathecal and IV dexamethasone; 3 days later the patients received “triple” intrathecal chemotherapy with dexamethasone, methotrexate and cytarabine, and the spinal fluid was studied again. All patients had good clinical response and 7 out of the 8 patients showed reduction on the CSF cell count after the use of dexamethasone alone. The results suggest that dexamethasone is a lympholytic agent that could play a more active role in the prevention and therapy of meningeal leukemia and should be preferred over hydrocortisone in the so called “triple” intrathecal chemotherapy for the prevention and treatment of CNS leukemia. © 1995 Wiley-Liss, Inc.     

Stimulation of cranial vessels excites nociceptive neurones in several thalamic nuclei of the cat

Summary Extracellular recordings were made in the thalamus of cats anaesthetized with chloralose and urethane following electrical, mechanical and chemical stimulation of the superior sagittal sinus or middle meningeal artery. Facial receptive fields were looked for using electrical and mechanical stimuli. The locations of fifty-six cells were verified histologically. Twenty six cells were located in the ventroposteromedial nucleus (VPM) and six in its ventral periphery (VPMvp). All units in VPM had facial receptive fields, usually involving the first trigeminal division. Cells with nociceptive receptive fields or responding to the craniovascular application of bradykinin were often found in the periphery or “shell” region of VPM. Other craniovascular nociceptive cells were found in VPMvp, in the posterior group and in the intralaminar complex. This study shows that craniovascular afferents in the cat project to several thalamic nuclei and implicate VPM especially in craniovascular nociception.     

高分辨CT诊断恶性弥漫性肺间质疾病的价值

目的：探讨高分辨CT（HRCT）诊断恶性弥漫性肺间质疾病的价值,加深对恶性弥漫性肺疾患HRCT表现的认识,从而提高肺间质疾病的诊断、鉴别诊断水平。方法：复习文献并回顾分析5例肺淋巴管癌病临床病例及其HRCT特点。结果：肺淋巴管癌病是恶性肿瘤致弥漫性肺间质病变最常见疾病,其HRCT特点：小叶间隔不均匀增厚,不均一的支气管血管束结节状增厚,胸膜不规则增厚,纵隔淋巴结肿大等,区别于良性肺间质病变HRCT改变。结论：HRCT作为常规的CT的一种补充,近年在肺部疾病影像学诊断中受到广泛重视,因其能清晰显示肺组织的细微结构,故可用于弥漫性肺疾病的诊断和鉴别诊断。