3D-CTA对出血性脑血管病的诊断价值评估

目的探讨3D-CTA检查对出血性脑血管病的诊断价值及安全性。方法对出血性脑血管病中DSA检查阳性的46例病人与之前所做的CTA结合三维重建结果进行对比分析,探讨3D-CTA对出血性脑血管病病因诊断的准确率。结果 所有患者均检查顺利,无1例出现异常情况。与DSA及介入栓塞、动脉瘤夹闭术中所见作比较,3D-CTA能够清晰显示38个动脉瘤病灶,可以观察到瘤体大小、瘤颈宽度及与载瘤动脉的关系,完全吻合率达到100%;5例DSA显示动静脉畸形,3D-CTA显示4例,检出率80.0%;2例在DSA检查中未发现,3D-CTA诊断为动脉瘤,检出率91.6%,其中小脑下前动脉1例,大脑前动脉A2段1例。结论 3D-CTA具有无创伤,检测迅速,定位准确,检查费用较低等优点,可作为脑血管疾病的诊断和介入治疗筛选的方法,尤其可作为脑动脉瘤和动静脉畸形所致蛛网膜下腔出血的首选检查方法。     

旋转DSA及三维重建在颅内动脉瘤诊断中的价值

目的探讨三维旋转DSA对颅内动脉瘤的诊断价值。方法使用荷兰PHILIPS公司数字减影机．对20例疑有动脉瘤的蛛网膜下腔出血患者作旋转DSA检查．并行三维重建，再与常规DSA检查比较．得到关于动脉瘤的定位、动脉瘤清晰度、瘤颈及血管分支的解剖图像。结果常规DSA检查发现16例16个动脉瘤．其中3例3个动脉瘤的方向和载瘤动脉及周围血管解剖关系显示不清，1例1个动脉瘤的颈部显示不清；4例阴性。加摄旋转DSA检查并行三维重建后，明确诊断颅内动脉瘤的18例18个．2例未见动脉瘤；且动脉瘤的全貌．瘤颈的位置与结构及周围血管分支的解剖关系显示清晰．避免了因血管重叠而产生的对动脉瘤的遮挡。结论旋转DSA可更好、更清晰的连续显示动脉瘤的颈部及周围的血管解剖结构，加三维重建后动脉瘤的大小、方向、与载瘤动脉周围血管的关系成立体解剖结构．即提高了动脉瘤的血管造影诊断准确性．又为手术和介入治疗提供更为准确的参考价值。     

CTA、DSA在出血性脑血管病诊治中的对比研究

目的探讨CT血管造影（CTA）和数字减影血管造影（DSA）诊治出血性脑血管病的价值。方法对65例出血性脑血管病行CTA检查,采用最大强度投影（MIP）和容积成像显示（VR）技术进行三维重建;分析脑血管显示情况并将结果与DSA和（或）手术结果比较。部分动脉瘤病例术后行CTA和DSA复查。结果 CTA对出血性脑血管病的敏感性为83.1%,特异性为100%。能明确动脉瘤的部位、大小、瘤颈及瘤体与载瘤动脉的空间关系;能可靠地显示动静脉畸形的位置、形态、供血动脉和引流静脉。CTA不能很好地反应动脉瘤夹闭情况。结论 CTA是有效的血管成像技术,对出血性脑血管疾病有重要的诊治价值,临床疑诊为出血性脑血管病患者可作为一种筛选方法。CTA不适合动脉瘤术后的复查。     

三维CT血管造影在脑动静脉畸形诊治中的初步应用经验

目的 评估三维CT血管造影（3D－CTA）在脑动静脉畸形诊断及术前评估中的应用。方法 对我科收治的25例脑动静脉畸形患者采用3D－CTA检查，并同期行脑数字减影血管造影（DSA），比较两种检查的结果。结果 3D－CAT显示了24例动静脉畸形，3D－CTA在显示畸形血管闭、供血动脉和引流静脉的三维构造以及空间关系上优于DSA，并能显示三者与颅骨的关系。3D－CTA虽未能发现1例小型小脑动静脉畸形，但其显示了一个位于小脑后下动脉（PICA）远端的供血动脉动脉瘤，并确定了出血系动脉瘤而非动静脉畸形。3D－CTA可以模拟手术入路时可观察到的血管构造，有助于正确判断动静脉畸形的各种成分，提高手术的安全性。结论 3D－CTA对脑动静脉畸形的诊断及其术前评估有其独特的价值。尤其适合于大型脑动静脉畸形、动静脉畸形合并动脉瘤以及颅内巨大血肿怀疑系动静脉畸形破裂者。它与DSA可互补，但尚无法取代DSA。     

旋转DSA技术在脑动脉瘤中应用价值的探讨

目的 :评价旋转 DSA技术在脑动脉瘤检查中的应用价值。方法 :通过对常规 DSA筛选出的 10 4例疑脑动脉瘤患者前瞻性的进行旋转 DSA检查 ,比较两者准确率。结果 :在脑动脉瘤检查中旋转 DSA技术特异性高 ,同时 ,对显示动脉瘤整体形态特别是瘤颈及其与载瘤动脉的关系有其特殊的价值。结论 :脑动脉瘤检查中旋转 DSA是常规脑血管 DSA的很好的补充技术。     

三维重建结合手术体位改变在老年脑动脉瘤介入治疗中的应用分析

目的研究三维重建结合手术体位改变于老年脑动脉肿瘤介入治疗中的临床疗效。方法选择30例经CT证实为蛛网膜下腔出血(SAH)的60岁以上患者做为研究对象,股动脉插管后行造影,使用数字减影血管造影(DSA)系统对患者采集的原始影像学资料进行三维重建结合,并使用advantage workstation工作站进行后期处理得到3D图像。在工作站重建处理同时,将超过DSA系统C臂机架患者使用头颅固定架保证透视图像中患者头颅为正位。结果 30例患者中15例经动脉造影可清晰显示动脉瘤,12例患者瘤体与周围血管的关系显示不甚清楚,进行三维重建,清晰显示患者动脉瘤体及其周围血管间的关系。另外3例患者DSA系统无法显示正位头颅图像,通过使用头颅固定架旋转适宜角度,可清晰显示脑动脉瘤。结论老年脑动脉瘤患者基础疾病较多,脑动脉瘤血管充盈不充分或角度投射不当,血管走行重叠等,造成手术中动脉瘤的显示不清楚,可以通过DSA检查结合血管三维重建并进行手术中体位的适当改变可以弥补因机械无法达到的体位,使具体操作更加清晰地显示瘤体与载瘤动脉间的关系,提高手术的成功率。     

3D—TOF法磁共振血流成像对脑血管疾病的诊断价值

报告55例脑血管疾病的3D-TOF法和MRA和常规MRI(其中21例经DSA证实)。结果3D-TOF法MRA不仅能较为清晰地显示脑血管疾病的异常血管,且能作出定性、定位诊断。提出3D-TOF法MRA对脑血管疾病的诊断价值高于MRI、SPECT、X-CT,尤其是动静脉畸形、静脉型血管畸形(静脉瘤)、瘤体直径>5mn的动脉瘤和严重狭窄和闭塞的动脉。     

双平板DSA机进行颅脑CTA检查在脑血管病诊治中的应用价值

目的 探讨经静脉注射造影剂在双平板DSA机器上行颅脑CTA成像技术在脑血管病诊治中的应用价值。方法 2011年5月~2017年12月利用双平板DSA机进行CTA检查75例疑似脑血管病。应用双平板DSA机器，通过静脉注射造影剂旋转采集全脑影像，利用三维后处理工作站重建全脑血管成像。结果 采集的数据重建影像可完整显示1~4级脑血管结构、大脑前中后动脉及其分支情况，对有病变血管的供血动脉和分支结构也能显示；能清楚显示需要测量的长径、宽径、结构、起始部位、瘤颈的宽窄等。75例中，发现动脉瘤58例，动静脉畸形7例，阴性10例。6例动脉插管困难的病例，使用DSA机进行CTA检查，发现脑动脉瘤5例，其中4例穿刺患侧颈总动脉置鞘完成介入手术，1例经桡动脉入路完成介入治疗。本文所有病例成功进行数据采集以及后处理，无并发症及不良事件。结论 双平板DSA机器能做CTA检查，是技术的发展，能够为抢救病人争取时间，为手术提供更多的信息，对急诊手术更加安全地实施起到重要作用     

双能量CT血管造影术在头颈部血管病变诊断中的应用

目的 探讨双能量CT血管造影术(DECTA)在头颈部血管疾病诊断中的临床应用价值.方法 广州军区广州总医院放射科自2009年2月至2009年8月应用DECTA检查疑有头颈部血管病变患者146例,结果阳性患者中16例接受全脑血管造影(DSA)检查.比较DECTA和DSA检查的影像资料及诊断结果.结果 DECTA检查表现正常69例,显示头颈部血管疾病77例(77/146,52.74%).其中15例患者DSA检查显示头颈部血管疾病,与DECTA检查相符(15/16,93.75%),包括动脉瘤8例,颅内动脉、椎动脉局限性狭窄4例,颈动脉粥样硬化并狭窄、颜面部血管畸形和颅内血管畸形各1例.另1例患者CTA检查发现2个小动脉瘤,而DSA检查未发现.结论 DECTA能清晰地显示头颈部血管病变及肿瘤供血动脉,与全脑DSA结果符合率高,对于诊断颈部和颅内血管病变具有较高的敏感性.     

旋转DSA技术在脑血管疾病中的应用

目的探讨旋转DSA技术在脑血管疾病巾的应用价值。方法回顾性分析214例脑血管3D成像的经验,通过旋转血管造影技术重建脑血管三维影像,然后选择3D路径功能在其引导下完成对病灶的治疗。结果116例蛛网膜下腔出血病人中常规造影仅发现动脉瘤69例,3D血管成像发现92例（行弹簧圈栓塞治疗61例）。37例动脉狭窄病人中行支架成形29例,单纯球囊扩张2例,其他6例。29例脑血管畸形病人中在3D路径引导下Onyx栓塞21例,开颅手术切除5例,其他3例。造影结果阴性或其他疾病56例。结论3D—DSA技术能提高动脉瘤诊断的准确性,并能提高动脉瘤、动脉狭窄和动静脉畸形在治疗时的安全性,缩短手术时间,减少病人和术者的受线量。     

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.