显微手术治疗高血压脑出血32例

1对象与方法我科2003年2月～2003年12月应用显微手术治疗高血压脑出血32例,其中男22例,女10例;年龄38～76岁,平均55.3岁.均有高血压病史.入院时间2h～3 d.有意识障碍者25例.出血部位:基底核区28例,小脑2例,皮质下2例.幕上血肿量30～80 ml,小脑血肿量平均20～30ml.手术方法:全麻,对优势半球外侧型血肿和优势半球皮质下出血在距血肿最近处头皮作4～5 cm直切口;对出血距侧裂近或破入侧裂内、优势半球基底核区出血、非优势半球内侧型,特别是血肿位置靠前者,均行经侧裂入路,取颞部发际缘后"S"形或小弧形切口.     

高原地区高血压脑出血规范化外科治疗(附20例分析)

对高原地区高血压脑出血(主体为脑实质出血)采用显微微创血肿清除手术、小骨窗碎吸手术、多种方法联合综合手术等外科治疗手段进行初步临床讨论。现将我科2002年1～6月资料完整的20例高血压脑出血的手术方法及结果报告如下。资料与方法1.一般资料:男14例,女6例,年龄32～77岁,平均年龄65.5岁。2.临床表现:清醒3例,朦胧或嗜睡2例,昏迷15例。瞳孔散大5例,偏瘫或单瘫16例,失语5例,视物不清2例,GCS3～8分14例,9～14分6例。3.血肿部位:外囊出血6例,枕叶皮层下出血2例,额叶出血1例,小脑出血1例,丘脑及基底节区出血10例,出血量30～100ml不等。4.手…     

高血压脑出血术后再出血危险因素分析

我科自 1994～ 2 0 0 0年共施行高血压脑出血的手术 196例 ,术后发生再出血 2 4例 ,现就其再出血危险因素及预防措施进行分析并报道如下。临床资料本组 2 4例病人中 ,男 19例 ,女 5例 ;年龄 35～ 70岁 ,平均 5 2岁。再出血时间为 6ｈ～ 9ｄ ,2 4～ 72ｈ有10例 ,占 83% ;再出血部位 :基底节区出血 18例 ,丘脑出血 6例 ;术前血肿量 35～ 80ｍＬ ,平均 5 7ｍＬ ;病人均有高血压病史 ;术后再出血部位与术前出血部位一致。本组病例再出血危险因素如下 :1、术后高血压危象引起再出血 6例 ,2次手术治疗后好转。2、术中血压偏低引起术后再出血 4例 ,…     

4992例颅内手术后并发术后出血的调查

术后颅内出血是神经外科一种严重甚或致死性并发症.本文作者总结1976年1月～1986年11月 4992例开颅手术后40例并发出血的病例.出血部位:脑内24例(60%)、硬膜外11例(28%)硬膜下3例(7.5%)、鞍内2例(5%),33例血肿位于手术部位,7例在远隔部位;作者对每一例特别观察了高血压病史,术中、术后高血压表现(>160/90mmHg),术前、术后凝血机制障碍,手术体位及原发病的病理情况与术后血肿形成的相互关系.本组5例高血压与术后血肿形成有关,该组患者术后高血压与出现症状的时间无持续的关系.高血压病人在术后5     

高血压性脑出血微创伤治疗

一般资料:本组共64例高血压性脑出血,其中男48例,女16例,年龄26~70岁,平均60.5岁,均有高血压病史。清醒8例,病情Ⅰ级20例,Ⅱ级26例,Ⅲ级10例;一侧瞳孔散大14例,双侧瞳孔散大1例。出血量、手术方式、出血部位、手术时间及结果:出血量25~80ml 56例,80ml以上8例。出血血肿破入脑室加侧脑室外引流术外,余均局麻小切口直视下微创伤部分血肿     

小骨窗开颅治疗高血压脑出血98例临床分析

1对象与方法我院2000年1月～2003年12月采用小骨窗开颅术治疗高血压脑出血98例,其中男63例,女35例;年龄34～74岁,平均54岁.发病至手术时间2～6 h 51例,12～120 h 47例.出血部位:基底核区56例,皮质下28例,丘脑区6例,单纯脑室出血4例,外囊区4例;破入脑室32例.高血压脑出血病情分级:Ⅰ级6例,Ⅱ级18例,Ⅲ级31例,Ⅳ级32例,Ⅴ级11例.发生脑疝21例.血肿量40～150 ml,平均72.2ml.     

经颅穿刺治疗颅内血肿60例分析

微创手术自 1967年贾保祥教授首先应用于临床 ,至今已有3 0余年历史 ,至 90年代ＹＬ -Ⅰ型颅内血肿粉碎穿刺针成功研制 ,使该项技术更趋成熟 ,简便 ,易于掌握。本院于 1998年引进该项技术 ,成功治疗 60例颅内血肿患者 ,疗效较满意。1　临床资料1 1　一般资料　本组男 3 5例 ,女 2 5例 ,年龄最大 89岁 ,最小 3 1岁 ,平均 5 8 8岁。1 2　出血原因和疾病种类　高血压 41例 ,脑外伤引起慢性硬膜下血肿 15例 ,脑血管畸形 4例。1 3　出血量及出血部位　出血量最大 12 0ｍｌ,最小 40ｍｌ ,平均75ｍｌ。出血部位 :基底节区出血 14例 ,脑叶出血 2 0例…     

CT颅表定位器应用体会(附21例报告)

我科1993年1月～1993年6月间采用自行仿制的CT颅表定位器,辅助定位处理颅内占位病变21例,效果满意,报告如下。临床资料本组21例中,男9例,女12例。年龄15～70岁,平均39.3岁。诊断为基底节区血肿15例(脑外伤出血2例,高血压脑出血13例),血肿量在30～60ml不等。脑内浅表部位小占位病灶6例,其中小脓肿4例,结核瘤2例。病灶体积最大3×3×2.5cm,最小0.5×     

经皮锥颅穿刺抽吸术治疗高血压脑出血22例临床分析

自1996年6月至1998年4月对22例高血压脑出血病人采用经皮锥颅穿刺抽吸术（下称手术组）治疗,并与24例高血压脑出血病人保守治疗（下称对照组）进行对比观察,结果发现手术组病死率明显低于对照组,存活病人生存质量方面也明显优于对照组,现总结如下。1临床资料1．1一般资料两组病例均确诊为高血压脑出血,手术组22例,年龄42～71月岁,平均59岁,其中男性14例,女性8例;对照组24例,年龄40～70岁,平均58．5岁,其中男性17例,女性7例。1．2出血部位及出血量两组病人CT扫描所见,手术组基底节区血肿18例,皮层下血肿4例,其中破入脑室者…     

自体颅骨瓣腹壁下埋藏后早期回植70例临床分析

我科在2005年6月至2010年6月间采用腹壁下埋藏的自体颅骨瓣结合钛颅骨锁早期回植共70例,效果满意,现报告如下. 一、对象与方法 1.一般资料:本组70例,男48例,女22例;年龄16 ～60岁,平均35岁;本组病例入院后均行颅内血肿清除+去骨瓣减压术,其中单纯硬膜外血肿5例,硬膜下血肿合并脑内血肿30例,硬膜下血肿合并脑挫裂伤25例,高血压脑出血10例.     

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 -