颈动脉内膜剥脱术治疗颈动脉狭窄的临床分析

目的 探讨颈动脉狭窄行颈动脉内膜剥脱术(carotid endarterectomy,CEA)的疗效与相关并发症。方法 回顾性分析52例颈动脉狭窄并行CEA的病例资料,术前病人均行头颈CTA、颈部血管超声,采用全身麻醉,术中非补片外翻式剥脱,并行TCD脑血流量与栓子监测。结果 术后复查头颈CTA、颈动脉超声、磁共振脑血流灌注成像,52例颈动脉狭窄均解除、血流通畅,手术总时长(125±13) min。术中转流15例(28.8%),用时(28±6) min。术后发生声音嘶哑6例(11.5%),脑过度灌注1例(1.9%),耳后感觉麻痹3例(5.8%),皮下血肿2例(3.9%),脑梗死2例(3.8%,其中死亡1例)。随访3～6个月,再狭窄1例(1.9%)。结论 CEA是一种相对安全的手术方式。术前全面检查评估,术者精细操作,术中运用TCD检测,能够有效减少脑卒中发生率。     

颈动脉内膜剥脱术60例临床分析

目的总结颈动脉内膜剥脱术(carotid endarterectomy,CEA)治疗有症状颈动脉粥样硬化性狭窄的疗效及并发症。方法回顾性分析60例应用CEA治疗颈动脉粥样硬化性狭窄病人的临床资料,探讨手术适应证、疗效及手术并发症的预防。结果手术效果良好57例,术区血肿行再次手术清除1例,对侧脑梗死偏瘫1例。1例死于术后急性肾功能衰竭。随访6个月复查CTA,5例出现再狭窄。结论 CEA治疗颈动脉粥样硬化性狭窄是一种简单、安全的方法,个体化围手术期处理可以降低高危病人的病死率。     

颈动脉支架置入术和内膜剥脱术治疗颈动脉狭窄的随机对照研究

背景:颈动脉狭窄是脑卒中的重要原因.颈动脉支架置入术(carotid-artery stenting,CAS)和颈动脉内膜剥脱术(carotid endarterectomy,CEA)是治疗颈动脉狭窄的可选择手段,但以往对比研究,如症状性重度颈动脉狭窄患者动脉内膜剥脱术与血管成形术比较(EVA-3S)、保护性支架血管成形术与颈动脉内膜剥脱术比较(SPACE)及国际颈动脉支架研究(ICSS)关于CAS和CEA孰优孰劣的报道存在矛盾.     

血管成形术治疗症状性重度颈动脉狭窄的临床研究

目的 探讨颈动脉内膜剥脱术(carotid endarterectomy,CEA)和颈动脉支架成形术(carotid artery stenting,CAS)治疗症状性重度颈动脉狭窄的近期和中期临床效果.方法 回顾性地分析了2016年1月至2018年12月在我院接受CEA或CAS治疗的203例症状性重度颈动脉狭窄患者的...     

颈动脉内膜剥脱术治疗颈动脉狭窄

<正>颈动脉粥样硬化斑块造成的血管狭窄及闭塞是缺血性脑卒中的重要原因之一。颈动脉内膜剥脱术(carotid endarterectomy,CEA)被证实是治疗颈动脉粥样硬化性狭窄的有效方法。2012年3月至7月,我科对16例颈动脉粥样硬化性狭窄患者施行颈动膜内膜剥脱术,术后疗效较好,现总结报告如下:一、对象与方法 1.一般资料:本组男9例,女7例;年龄46~72岁,平均58岁。     

颈动脉内膜斑块剥脱术中的配合及护理

目的总结颈动脉内膜斑块剥脱术(CEA)中配合及护理要点。方法对17例颈动脉粥样硬化狭窄病人行CEA治疗的手术配合过程进行回顾性分析。结果手术均顺利完成,无不良并发症发生。结论优质、高效、规范的护理配合是CEA成功的关键之一。     

颈动脉支架置入术并发症及处理方法

众所周知,严重的颈动脉狭窄是发生同侧脑卒中的重要危险因素。与药物治疗比较,颈内动脉内膜剥脱术(carotid endarterectomy,CEA)能明显降低发生脑卒中的危险性[1]。颈动脉球囊扩张和支架置入术(carotid angioplasty and stenting,CAS)     

基于免疫组化法研究MMP-2、MMP-14与颈动脉粥样斑块易损性的相关性

目的研究基质金属蛋白酶-2(matrix metalloproteinase-2,MMP-2),MMP-14与颈动脉粥样斑块易损性的关系,探讨影响斑块稳定性的相关因素。方法选取2018年1月～2019年6月在连云港市第一人民医院神经外科行颈动脉内膜剥脱术(endarterectomy,CEA)患者55例。术前根据基于颈部血管超声(carotid doppler ultrasonography,CDU)的多模式影像学检查、术后粥样斑块HE染色特征,将粥样斑块组织分为稳定斑块组23例及易损斑块组32例。应用免疫组织化学法定位分析MMP-2及MMP-14在稳定斑块组及易损斑块组中表达的分布差异。结果免疫组化结果显示MMP-2,MMP-14在颈动脉粥样斑块中表达分布,其在易损斑块组中分布水平明显高于稳定斑块组(P 0.05),且在溃疡型斑块,斑块纤维帽破裂等处分布较高。结论 MMP-2和MMP-14在颈动脉粥样斑块中的表达水平与斑块易损性存在显著相关性,是影响斑块稳定性的重要因子。     

症状性颈动脉狭窄合并同侧未破裂动脉瘤的手术治疗

目的探讨颈动脉狭窄合并颅内未破裂动脉瘤患者的手术治疗。方法分析2015年2例1期行动脉瘤夹闭+颈动脉内膜剥脱术(CEA)的症状性颈动脉狭窄合并同侧未破裂的颅内动脉瘤患者的临床资料。结果该两例患者均先行颅内动脉瘤夹闭术,然后1期行CEA。术后患者症状消失,复查头颈上胸段CTA,可见动脉瘤完全夹闭,颈动脉斑块完全切除,血流通畅,患者痊愈出院。术后3个月随访,两例患者症状消失,复查头颈上胸段CTA颈动脉未见再狭窄。结论颈动脉狭窄合并颅内动脉瘤是一种比较特殊的脑血管疾病,该类患者外科手术治疗过程中的血压控制是手术成功的重要问题,本文选择在电生理监测下先行动脉瘤夹闭,解除由于血压波动导致动脉瘤破裂的危险,然后再行CEA。     

颈动脉活动性斑块的临床、超声及影像和病理学特征分析

目的对颈动脉活动性斑块的临床、超声、影像和病理学特征及治疗方案进行分析,提高对该类疾病的认识。方法回顾性分析2012年1月-2016年12月5例超声检查发现颈动脉活动性斑块患者的临床资料。结果 5例患者中4例影像学表现为责任动脉供血区分水岭及皮质多发新鲜脑梗死。3例颈动脉超声检查显示为动脉粥样硬化性狭窄远端带蒂活动性斑块,2例为颈动脉斑块上膜样稍强回声信号,随心动周期做往复运动。3例行颈动脉内膜剥脱术,2例病理显示活动性斑块为吞噬脂质的组织细胞及胆固醇结晶聚集,1例显示动脉粥样硬化性斑块表面纤维帽不完整,表面可见纤维素样渗出。结论颈动脉活动性斑块是缺血性卒中的高危因素。其超声学及病理学特征不同,决定了其导致缺血事件发生的机制不同,在不能明确其性质的前提下,颈动脉内膜剥脱术可能是最佳的治疗方案。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -