原发性延髓“心”形出血1例报道

临床上延髓出血是少见的脑出血类型,在文献中多以个案报道形式呈现,而双侧延髓内侧出血更为少见。本文介绍了1例老年男性患者,既往高血压病史多年,平日血压控制不佳,此次以“头晕、头痛伴恶心、呕吐”急性发病,后出现饮水呛咳、吞咽困难、失语、四肢瘫痪等症状。完善头颅CT提示双侧延髓内侧呈“心”形的高密度灶,明确诊断为延髓出血,并考虑此次发病与高血压有关。本文介绍了该患者的诊治经过,并从病因、临床表现、辅助检查、治疗以及结局等方面加以讨论,以期增加临床医师关于此病的诊治经验。     

延髓出血1例报告

患者,男,47岁,因突发右肢体麻木、无力伴吞咽困难、饮水呛咳半天,于2009年3月入院.入院前于晨起突发右上肢麻木、无力,右手无法持物,抬举费力,右下肢拖拽伴吞咽困难、饮水呛咳、言语含糊、声音嘶哑,能够理解旁人对话,恶心、呕吐胃内容物数次,非喷射性.     

GAS、SS在重型颅脑损伤合并急性胃粘膜病变中的动态变化

目的观察重度颅脑损伤合并急性胃粘膜病变（AGML）患者血液中胃泌素（GAS）、生长抑素（SS）水平的动态变化，并探讨其机制与意义。方法采用放射免疫法检测45例重度颅脑损伤患者伤后第1d及第3、7、10d血清GAS及血浆SS的水平，同时观察AGML病变情况。结果重度颅脑损伤后血清GAS水平高于正常对照组；血浆SS水平低于正常对照组，并发现AGML患者血清GAS水平高于无AGML患者；血浆SS水平低于无AGML患者。结论GAS和SS均参与了重度颅脑损伤合并AGML的发生和发展，对GAS、SS的动态检测可作为重度颅脑损伤并AGML的预测指标。     

早期进食对颅脑损伤后应激性胃粘膜损伤的防治效果观察

目的观察早期（72h内）进食对颅脑损伤后应激性胃粘膜损伤（SGML）的预防效果。方法62例中、重型颅脑损伤患者随机分为两组。观察组28例，伤后72h内进全流质饮食；对照组34例，常规禁食。结果观察组发生SGML5例（17．9％），对照组16例（47．1％），两组比较差异显著（P〈0．05）。结论本结果提示早期进流质饮食对颅脑损伤后SGML有防治作用。     

延髓呼吸中枢损伤后神经营养因子基因表达特点的免疫组化研究

目的为临床应用神经营养因子（ｎｅｕｒｏｔｒｏｐｈｉｃｆａｃｔｏｒｓ,ＮＴＦｓ）疗法治疗脑干呼吸中枢损伤提供理论和实验研究基础。方法实验动物采用ＳＤ大鼠,以直流电解损毁法建立一侧延髓呼吸中枢损伤动物模型,采用免疫组化染色法对损伤后不同时间点ＮＴＦｓ基因的表达特点进行了研究。结果神经营养素－３（ｎｅｕｒｏｔｒｏｐｈｉｎ－３,ＮＴ－３）和神经生长因子（ｎｅｒｖｅｇｒｏｗｔｈｆａｃｔｏｒ,ＮＧＦ）的表达最为活跃,脑源性神经营养因子（ｂｒａｉｎ－ｄｅｒｉｖｅｄｎｅｕｒｏｔｒｏｐｈｉｃｆａｃｔｏｒ,ＢＤＮＦ）和成纤维细胞生长因子（ｆｉｂｒｏｂｌａｓｔｇｒｏｗｔｈｆａｃｔｏｒ,ＦＧＦ）也有一定表达。结论在延髓呼吸中枢的局灶性损伤后,ＮＴ－３、ＮＧＦ、ＢＤＮＦ和ＦＧＦ可能在延髓呼吸神经元受损后的自我保护及修复中发挥了活跃的作用     

颅脑损伤合并急性上消化道出血32例临床分析

颅脑损伤合并急性上消化道出血３２例临床分析（摘要）万刚姜炬芳一、临床资料男２１例，女１１例，年龄７～７２岁，平均年龄３８．３岁，经ＣＴ和手术证实：脑挫伤１２例，硬膜外血肿１０例，硬膜下血肿６例，脑内血肿３例，硬膜下积液１例，均并发呕血、黑便确诊为急性...     

原发性延髓出血（附5例临床分析）

原发性延髓出血(primary medullary hemorrhage,PMH)极为罕见,随着影像学的发展,使人们对PMH的诊断及预后的认识进一步加深,发病率及治愈率较传统文献报道有明显提高,现将5例经MRI或CT证实的PMH病例报道如下(表1)。     

颅脑损伤合并上消化道出血的预防和治疗

颅脑损伤合并上消化道出血在颅脑损伤中并不少见。我科于1997年1月至2001年3月期间共收治颅脑损伤789例,其中196例合并上消化道出血,占24.8％。现报告如下。 1 临床资料 1.1 一般资料 本组男132例,女64例,年龄在9～83岁,平均年龄38.6岁,GCS评分3～15分。     

重型颅脑损伤并急性上消化道出血48例疗效分析

目的 :报告 48例重型颅脑损伤并急性上消化道出血临床分析以利于提高诊治水平。方法 :在积极纠正出血性休克的同时 ,早期鼻饲 ,给予冰盐水洗胃 ,应用止血药物、抗酸药物、内镜下止血及手术治疗。结果 42例疗效满意 ,6例因颅脑损伤较重 ,加之反复消化道出血死亡     

重型颅脑损伤继发应激性胃粘膜病变的危险因素分析

目的 探讨重型颅脑损伤患者继发应激性胃粘膜病变的危险因素。方法 回顾性分析2 164例重型颅脑损伤患者的临床资料。结果 本组患者共发生应激性胃粘膜病变439例,发生率为20.3%。年龄≥60岁、GCS评分为3~4、血压升高或降低、血糖≥8.2 mmol/L、体温≥40.5 ℃、pH值<7.35、氧饱和度≤85%的患者继发应激性胃粘膜病变的几率明显增高（P<0.05）。结论 本研究结果提示颅脑损伤程度越严重、高龄、血压升高或降低、高血糖及高热、酸中毒及低氧血症可能是重型颅脑损伤患者继发应激性胃粘膜病变的危险因素。     

原发延髓生殖细胞瘤二例报告及文献复习

目的 报告2例原发延髓生殖细胞瘤病例并文献复习.方法 通过手术治疗明确诊断,并进行随访.结果 2例病例均手术治疗,生殖细胞瘤诊断成立.1例术后放化疗,肿瘤完全消失.另1例未行放化疗,术后肿瘤复发,病人术后8个月死亡.结论 原发延髓生殖细胞瘤罕见,手术辅以放疗及化疗病人能取得良好预后.     

延颈髓髓内室管膜瘤预后相关因素分析

目的 探讨手术治疗的延颈髓髓内室管膜瘤的预后相关因素.方法 对30例手术治疗的延颈髓髓内室管膜瘤病例进行研究并随访,采用KPS评分和改良McCormick分级对手术前后功能进行评价.结果 疼痛为最主要症状,手术可缓解大部分症状;延颈髓髓内室管膜瘤预后与病程显著相关,与年龄、术前KPS评分、肿瘤全切与否、肿瘤长度及放疗等差异无统计学意义;男性预后较差;病理Ⅱ级全切组与近全切加放疗组预后差异无统计学意义.结论 显微外科手术可有效治疗延颈髓髓内室管膜瘤;早期发现、诊断和手术是良好预后的重要因素,未全切者术后行放疗可改善预后.

Abstract：

Objective To analyze the factors affecting the operative prognosis of intramedullary ependymomas in medulla oblongata and cervical cord.Method Thirty patients harboring intramedullary ependymomas in medulla oblongata and cervical cord were operated.The preoperative and postoperative status was taken by follow - up and evaluated by Karnofsky Performance Scale (KPS) and Modified McCormick classification system.Results Pain was one of the most common symptoms which could be relieved by operation; there was no statistic significance of age, gender, preoperative status, radical resection and length of the tumor or radiotherapy, while interval was significantly associated with outcomes.The outcome of male was worse than female.There was no significant difference in postoperative status between patients of WHO Ⅱtreated by complete resection and those treated by incomplete resection and radiotherapy.Conclusions Microsurgery is an effective approach for treating intramedullary ependymomas in medulla oblongata and cervical cord.The early detection, diagnosis and radical resection are the key for good prognosis.Postoperative radiotherapy is a beneficial adjuvant treatment.     

Fos-determined distribution of neurons activated during the Bezold-Jarisch reflex in the medulla oblongata in conscious rabbits and rats

Experiments were performed in unanaesthetized rabbits and rats to investigate the distribution, within the medulla oblongata, of neurons activated during the Bezold-Jarisch reflex. Repeated intravenous injections of phenylbiguanide evoked depressor and bradycardic responses in both rabbits and rats. Fos-positive neurons were present in the nucleus tractus solitarius and in the caudal ventrolateral medulla oblongata. Double-label tyrosine hydroxylase (TH) immunohistochemical studies in the ventrolateral medulla showed that most Fos-positive neurons in the caudal ventrolateral medulla were TH-negative neurons scattered between A1 noradrenaline cells, in the rabbit and in the rat. Approximately 20% of neurons in the caudal ventrolateral medulla in rabbits, and 50% in rats, were immunoreactive for both Fos and TH. Some Fos-positive, TH-negative neurons in the caudal ventrolateral medullawere retrogradely labelled with cholera toxin B-Gold after injection of this tracer into the sympathoexcitatory region of the rostral ventrolateral medulla. Our data suggests that neurons in the nucleus tractus solitarius, and rostrally projecting TH-negative neurons in the caudal ventrolateral medulla, are part of the pathway by which stimulation of cardiopulmonary receptors inhibits sympathetic vasomotor tone to decrease blood pressure during the Bezold-Jarisch reflex.     

小脑、延髓多发性血管母细胞瘤一例

目的探讨多发性血管母细胞瘤(VHL病)的临床表现、诊断及治疗。方法对1例后颅窝的VHL诊治过程进行回顾分析。结果 VHL病的诊断靠病史及影像检查。结论详细的病史和全面的影像学检查有助于早期诊断和治疗,改善预后。     

Effects of lateral hypothalamic stimulation on medulla oblongata and gastric vagal neural responses

Recordings were made of neural activity in the medial to lateral region of the dorsal nucleus of the vagus in the medulla oblongata (NDV), and from the gastric branch of the vagal nerve (gastric vagus) in rats. Gastric acid secretion following lateral hypothalamic (LHA) stimulation was observed, and NDV neurons were identified by stimulation of the peripheral end of the gastric vagus. NDV-neurons responded to LHA stimulation with latencies of about 5 msec, and about 6.5 msec to the peripheral stimulation of the gastric vagus. Out of 274 NDV neurons, which were located by their spontaneous discharge, 186 (67.9%) responded to LHA stimulation. Gastric acid secretion (with either short or long latency) occurred in 8.6% (16/186) of these cases. These 16 neurons were considered to be ‘gastric secretory’ neurons and are discussed as such. The results imply that some LHA neurons, which are either concerned with or directly control gastric acid secretion, communicated by at least one path (probably polysynaptic) to the medulla oblongata and then via the vagus to the oxyntic cells of gastric glands.     

Corticotropin-releasing factor immunostaining in the rat spinal cord and medulla oblongata: An unexpected form of cross-reactivity with substance P

By use of two antisera (alpha-CRFA, alpha-CRFB) raised against conjugates of o-CRF and bovine thyroglobulin, cryostat sections of formaldehyde-fixed gelatin models containing o-CRF can be stained. The staining intensity was quantitated by use of an automated microfluorimeter and was shown to be dependent on the concentration of o-CRF (1-300 microM) added to the gel. Determination of the CRF staining intensity after incorporation of o-CRF-related peptides and fragments indicated that both antisera reacted with the C-terminal region of o-CRF. They showed poor cross reactivity with r-CRF fixed in the gel. In the same models, r-CRF could be immunostained efficiently by use of an antiserum (alpha-CRFC) raised to a conjugate of r-CRF and thyroglobulin. This antiserum reacted with the N-terminal and midportion parts but not with the C-terminal fragment of o-CRF fixed in the gels. By use of both o-CRF antisera nerve fibers can be stained in the rat hypothalamus (median eminence) and in the medulla oblongata (spinal trigeminal tract and nucleus) and spinal cord (dorsal horn). Immunoinhibition experiments showed that o-CRF caused a concentration-dependent quenching (0.001-1 microM) of the immunostaining of o-CRF-containing models, rat median eminence and medulla oblongata preparations. alpha-CRFC also stained CRF immunoreactive (CRFi) fibers in the rat hypothalamus with an equal distribution to that found with the o-CRF antisera. However, no immunostaining was found in the spinal trigeminal nucleus and tract and in the dorsal horn, indicating that these fibers store different CRF-related products from those found in the hypothalamus. The CRFi in the medulla oblongata and spinal cord induced by alpha-CRFA was completely abolished 1 week after treatment of adult rats with capsaicin, a substance known to deplete Substance P (SP) from those areas. Gels incorporated with SP showed a concentration-dependent increase (range 10-1000 microM) in immunostaining with both o-CRF sera but not with the r-CRF antiserum. In addition, incubation of o-CRF sera with SP caused a concentration-dependent quenching (range 10-100 microM) of immunostaining in SP-containing models. SP at a concentration of 100 microM was also effective in quenching the CRFi in the dorsal horn and spinal trigeminal area. Quenching was also obtained with the C-terminal part of o-CRF (range 0.002-0.1 microM), which indicates that both CRF antisera contain an immunoglobulin which recognizes determinants on CRF as well as on SP.(ABSTRACT TRUNCATED AT 400 WORDS)     

Direct projections from the reticular formation of the medulla oblongata to the anterior cingulate cortex in the mouse and the rat

After injections of horseradish peroxidase into the anterior cingulate cortex of the mouse and the rat, labeled neurons were observed in different nuclei of the reticular formation of the rostral medulla oblongata: ventral part of the nucleus gigantocellularis, nucleus paragigantocellularis and nucleus lateralis reticularis. Other labeled neurons lay scattered outside the nuclear boundaries, often close to the ventral-most border of the medulla. The projection to the cingulate cortex is sparse, with rarely more than 3 cells per case, but constant. Injections into other cortical areas (visual, motor and somatosensory cortex) did not produce labeling in the medullary reticular formation.     

Dorsal medullary injection of atrial natriuretic factor (ANF) excites vagal efferents and inhibits gastric motility

Atrial natriuretic factor (ANF)-immunoreactive fibers are found in the dorsal motor nucleus of the vagus (DMN) along with receptors for that peptide. Previous investigations showed that ANF injections into the DMN did not influence cardiovascular functions. Since the DMN is largely (but not exclusively) involved with the control of gastrointestinal functions, we hypothesized that ANF may act on gastric, rather than cardiovascular vagal efferents. Injections of ANF (20 pmol rat atriopeptin III in 20 nl) into the DMN evoked a vagally dependent reduction in gastric motility. In a separate electrophysiological study, 10 of 15 (66%) antidromically identified DMN neurons were excited by micropressure-applied ANF (25-500 fmol in 50-1000 pl). We propose that ANF-containing neurons in the DMN reduce gastric motility by activating vagal efferents that synapse with inhibitory neurons in the gastric enteric nervous system.     

Autoradiographic localization of 5HT1 binding sites in autonomic areas of the rat dorsomedial medulla oblongata.

Serotonin (5HT) binding sites in autonomic portions of the dorsomedial medulla oblongata of the rat were localized using autoradiographic techniques with radioactive ligands that express high affinity for the 5HT1 (3H-5HT), 5HT1A (3H-8OH-DPAT), or 5HT1B (125I-CYP with isoproterenol) receptor subtypes. 5HT1A sites were densely distributed in the nucleus tractus solitarius (NTS), with the highest densities localized to the interstitial subnucleus and the central subnucleus. 5HT1B sites were also found in the NTS, with the highest densities localized to the substantia gelatinosa subnucleus. The dorsal motor nucleus of the vagus nerve and nucleus ambiguus exhibited low densities of 5HT1B sites. However, the nucleus intercalatus, a cerebellar relay nucleus that also contains dendrites of vagal parasympathetic preganglionic neurons and receives autonomic forebrain afferent input, showed very dense 5HT1B sites. The promontorium, paratrigeminal islands, and the dorsomedial portion of the trigeminal nucleus (DM5), which are areas of viscerosomatic integration, exhibited high densities of both 5HT1A and 5HT1B sites. The area postrema contained low levels of both 5HT1A and 5HT1B sites. Visceral deafferentation via cervical vagotomy or nodose ganglionectomy caused a significant decrease in 5HT1A sites in the interstitial subnucleus of the NTS ipsilateral to the lesion. No changes were seen in 5HT1B sites. These studies suggest that 5HT1A and 5HT1B sites are involved in the processing of visceral sensory information in the NTS and associated areas. Based upon viscerotopic organization of the NTS, 5HT1A sites appear preferentially distributed in portions of the NTS that are associated with the coordination of swallowing, respiration, and cardiovascular function, while 5HT1B sites appear preferentially distributed in areas of the NTS associated with gastrointestinal, hepatic, pancreatic, and cardiovascular function. However, since these association were not absolute and there was a great deal of overlap between the two sites, speculation regarding their specific functions in autonomic control must await pharmacological examination.     

Noradrenaline concentration and turnover in nuclei of the hypothalamus and the medulla oblongata at two stages in the development of renal hypertension in the rat

The noradrenaline concentration and the α-methyl-para-tyrosine (α-MPT)-induced disappearance of noradrenaline were determined in several nuclei of the hypothalamus and the medulla oblongata of renal hypertensive rats (two-kidney Goldblatt hypertension). A decreased α-MPT-induced disappearance of noradrenaline was found in the nucleus interstitialis striae terminals and nucleus paraventricularis 3 days after renal artery constriction, when blood pressure was slightly, but significantly higher than that of sham operated rats. At this stage the α-MPT-induced disappearance of noradrenaline was enhanced in the nucleus commissuralis and the A₁ of hypertensive rats while the noradrenaline concentration in the A₁-region was significantly elevated. No significant differences were found in both parameters in hypothalamic and medullary nuclei 3.5 weeks after the operation, when hypertension had fully developed. These findings are indicative of the occurence of transient changes in the activity of noradrenergic neurons located in the medulla oblongata and projecting to the hypothalamus during the initiation of the development of two-kidney Goldblatt hypertension.