132例缺血性脑血管病患者DSA分析

目的采用经颅多普勒（TCD）进行缺血性脑血管病（ICVD）筛查,并与DSA检查进行对比研究,以了解TCD在诊断缺血性脑血管病中的价值,同时分析缺血性脑血管病患者颅内外动脉狭窄或闭塞发生的特点。方法回顾性分析132例诊断为缺血性脑血管病的患者,先有21例患者同时行DSA及TCD检查,进行对比研究。另有111例ICVD患者行DSA检查,明确有无脑供血动脉的狭窄或闭塞及其位置,判断责任血管。结果与DSA结果相比较,TCD特异性为98.5%,敏感性为61.9%。132例ICVD患者中发现脑供血动脉狭窄或闭塞85例（64.4%）,烟雾病9例（6.8%）,动脉瘤5例（3.8%）,1例颈内动脉海绵窦瘘,1例颈内动脉起始部狭窄合并另一侧颈内动脉起始部夹层,可判断责任血管68例（68.0%）,脑梗死组的脑供血动脉狭窄或闭塞发生率高于短暂性脑缺血发作（TIA）组（P〈0.05）,脑梗死患者中颅内病变多于颅外病变（P〈0.05）,而TIA患者颅内外病变发生率差异无统计学意义。结论 TCD可作为筛查缺血性脑血病的常用方法,特异性高,但敏感性一般。中国人缺血性脑血管病患者中,脑梗死颅内动脉病变发生率高于颅外动脉,但在TIA患者中,差异无统计学意义。     

症状性颈内动脉重度狭窄或闭塞患者的侧支循环评估

目的 探讨症状性颈内动脉重度狭窄或闭塞患者的侧支循环评估。方法 选取中国人民解放军火箭军总医院(原第二炮兵总医院)神经内科住院的症状性颈内动脉重度狭窄或闭塞患者41例,首先采用德国EME公司TC-2000S型经颅彩超多普勒(Transcranial Doppler,TCD)仪,常规检测双侧颈总动脉及颈内动脉、颅内Willis环及相关主要动脉分支,进行侧支循环评估; 进一步采用德国西门子64层螺旋CT扫描机行CT血管成像(CT angiography in diagnosis,CTA)检查,明确颈内动脉病变的存在; 再应用PHILIPS FD20 DSA数字减影机行全脑血管造影术并进行侧支循环评估,评估颈内动脉闭塞性病变后的侧支循环代偿能力,评估眼动脉侧支循环通路的开放情况及作用。结果 41例患者颈内动脉重度狭窄24例,颈内动脉闭塞17例。TCD显示ACoA开放5例,占12.2%,DSA为4例,占9.76%; TCD显示PCoA开放5例,占12.20%,DSA为3例,占7.32%; TCD判断OA开放25例,占60.98%,DSA为23例,占56.11%; TCD提示LA开放3例,占7.32%,DSA提示2例,占4.88%; TCD显示无侧支循环开放者16例,占39%,DSA为14例,占34.15%。TCD和DSA在评估侧支血管开放数量方面无显著差异(P>0.05)。TCD评估眼动脉开放在颈内动脉重度狭窄和闭塞的患者中有显著差异(P<0.05)。颈内动脉重度狭窄患者和闭塞患者的TCD及DSA侧支循环评估无显著差异(P>0.05)。OA单独开放患者较无OA开放患者PI值高。狭窄组MCA的PI值低于闭塞组,狭窄组OA最高流速低于闭塞组(P<0.05)。颈内动脉狭窄组OA单独开放数量<闭塞组(P<0.05)。结论(1)TCD与DSA在评估侧支循环血管开放数量方面的作用基本一致,TCD可作为CTA和DSA侧支评估之前的初筛手段,可以独立作为侧支循环评估的检查手段;(2)眼动脉是否参与侧支循环及眼动脉的的开放程度与颈内动脉本身病变程度有关。眼动脉作为次级侧支通路参与侧支循环的程度与病情严重程度具有一定相关性,在颈内动脉慢性闭塞性患者眼动脉单独开放的比例>重度狭窄的患者,重度狭窄的患者OA最高流速低于闭塞组患者,这说明颈内动脉慢性闭塞性患者其OA开放后提供的灌注代偿作用相对更大。     

单侧颈动脉阻塞性病变时侧支循环募集的特征分析

目的以数字减影血管造影为检查方法,分析单侧颈动脉阻塞性病变时侧支循环的募集特征。方法选择2007年1月～2011年11月北京大学首钢医院神经科DSA检查患者336例,观察每位患者的颈动脉及颅内动脉狭窄程度、Willis环组成及其他侧支循环出现情况。结果 (1)颈动脉狭窄程度与COW各段的完整性均不相关。(2)颈动脉狭窄率≤85%者均未见有代偿侧支。颈动脉86%～99%狭窄者85.7%患者代偿侧支有ACOA和PCA经软脑膜动脉通路,未见PCOA和OA通路;闭塞组则4条通路都有开放,最多是ACOA通路(92.3%),其次是PCA和OA通路(46.2%)。就代偿程度而言,ACOA通路代偿较充分,级别较高。(3)相关分析显示,各代偿通路开放与否及代偿程度均与颈动脉狭窄程度相关,其中ACOA通路、总的侧支通路数和代偿级别与之重度相关。结论 Willis环各段不因颈动脉狭窄程度的发展而改变;侧支循环只出现于颈动脉≥86%狭窄者,各侧支通路开放与否及侧支代偿程度均与颈动脉狭窄程度相关;单侧颈动脉狭窄后,ACOA是最重要的侧支通路。     

短暂性脑缺血发作与颅内外血管狭窄的关系

目的探讨短暂性脑缺血发作(TIA)与颅内外血管狭窄的关系。方法给68例TIA患者进行颈部B超、经颅多普勒(TCD)以及心脏超声检查,对其中56例有明显脑血管狭窄的患者进一步行数字减影血管造影(DSA)检查。结果56例行DSA检查的患者中,显示大脑中动脉狭窄(或闭塞)6例,颈内动脉狭窄(或闭塞)21例,锁骨下动脉狭窄8例,椎基底动脉狭窄(或闭塞)28例。大动脉狭窄性TIA44例,其中颈内动脉系统16例,椎基底动脉系统28例;栓塞性TIA18例,其中颈内动脉系统15例,椎基底动脉系统3例;腔隙性TIA4例;血管痉挛性TIA2例。结论TIA患者大多存在颅内外血管狭窄,其与TIA有密切关系。     

颈内动脉重度狭窄或闭塞患者的侧支循环与神经功能的单因素分析

目的 探讨颈内动脉重度狭窄或闭塞患者侧支循环的代偿作用与临床神经功能缺损程度的关系. 方法对52例连续颈内动脉狭窄或闭塞所致的脑梗死患者入院时行神经功能缺损评分(NIHSS)评分,利用数字减影脑血管造影技术(DSA)评估颅内动脉的侧支循环代偿情况.应用统计学方法探讨两者之间的关系.结果 DSA发现52例患者18例出现颈内动脉闭塞,单侧颈内动脉重度狭窄28例,6例双侧重度狭窄.52例患者中出现前交通动脉代偿18例,后交通动脉代偿8例,前后交通动脉同时代偿12例,14例患者未出现Willis环血管的代偿.无Willis环代偿组与Willis环代偿组NIHSS评分平均秩次分别为35.75和23.09,两组差异有统计学意义(P<0.05).前交通代偿组与后交通代偿组NIHSS评分平均秩次分别为12.42和15.94,两组差异无统计学意义(P<0.05).结论颈内动脉狭窄或闭塞时可通过多种方式进行有效的代偿.NIHSS评分与血管代偿及阻塞位置显著有关.DSA对侧支循环的判定在治疗干预中显得尤为重要.     

TCD对颅内动脉狭窄或闭塞诊断的临床研究

目的分析经颅多普勒超声(TCD)对颅内动脉狭窄或闭塞诊断的意义。方法回顾性分析50例疑为颅内动脉狭窄或闭塞的脑血管病患者(观察组)和30例正常体检者(对照组)的TCD结果(主要针对大脑中动脉、大脑前动脉、椎动脉和基底动脉等血管),并与MRA及DSA结果作对比分析。结果观察组与对照组所查脑血管平均血流速度有明显差异(P<0.05);以DSA检查为金标准,TCD结果的假阳性率为17.2%,假阴性率为17.1%,特异性为82.8%,敏感性为82.9%;与MRA检查相比,对颅内动脉狭窄或闭塞的阳性检出率无显著差异(P>0.05)。结论 TCD可作为诊断颅内动脉狭窄和闭塞的常用辅助检查手段。     

TCD联合CDUS评估单侧颈内动脉起始段病变侧支循环通路与缺血性脑血管病的关系

目的探讨单侧颈内动脉起始段重度狭窄或闭塞时各侧支循环通路出现的概率与缺血性脑血管病(ICVD)的关系。方法选取单侧颈内动脉起始段狭窄≥70%或闭塞患者176例,其中ICVD 89例作为症状组,无ICVD 87例作为无症状组。统计侧支循环通路构成情况和大脑中动脉(MCA)峰值血流速度(PSV),分析侧支循环开放通路以及MCA-PSV与ICVD的关系。结果症状组前交通动脉(ACOA)开放48例(53.93%),后交通动脉(PCOA)开放37例(41.57%),颈外动脉向颈内动脉(ECA-ICA)开放39例(43.82%),MCA-PSV比值(0.354 6±0.178 1)%,MCA-PSV显著减慢37例(41.57%);无症状组ACOA开放79例(90.80%),PCOA开放57例(65.52%),ECA-ICA开放23例(26.44%)。MCA-PSV平均比值(0.501 1±0.2001)%,MCA-PSV显著减慢18例(20.69%)。无症状组一级侧支开放率显著高于症状组;症状组二级侧支开放率显著高于无症状组;无症状组MCA-PSV比值显著高于症状组(P0.05),无症状组MCA-PSV显著减慢人数明显少于症状组(P0.05)结论单侧颈内动脉起始段重度狭窄或闭塞患者是否出现ICVD与一级侧支循环的建立有关,与侧支循环的供血代偿能力有关。     

110例脑梗死患者的全脑数字减影血管造影的临床研究

目的探讨脑梗死患者与颅内-颅外段动脉狭窄或闭塞的关系及其临床意义。方法选择符合脑梗死诊断标准的110例患者行全脑数字减影血管造影(DSA)检查,对颈内动脉系统脑梗死(ICA-CI)和椎-基动脉系统脑梗死(VB-CI)患者的颅内-颅外段动脉狭窄或闭塞进行分析比较。结果 110例脑梗死患者中85例(77.27%)有动脉狭窄或闭塞。其中25例(22.73%)为单纯颅外段动脉狭窄或闭塞,41例(37.27%)为单纯颅内段动脉狭窄或闭塞,19例(17.27%)为颅内-颅外段动脉多发性狭窄或闭塞。DSA共检出动脉狭窄或闭塞173支,颅外动脉段狭窄或闭塞65支(37.57%),颅内段动脉狭窄或闭塞108支(62.43%)。颅内段动脉狭窄或闭塞发生率(62.43%)明显高于颅外段动脉(37.57%)。颅外段动脉狭窄或闭塞的好发部位依次为:颈内动脉颅外段26支(15.03%),椎动脉颅外段19支(10.98%),颈总动脉14支(8.09%),锁骨下动脉6支(3.47%)。颅内段动脉狭窄或闭塞的好发部位依次为:大脑中动脉37支(21.39%),颈内动脉颅内段25支(14.45%),椎动脉颅内段18支(10.40%),大脑后动脉11支(6.36%),大脑前动脉9支(5.20%),基底动脉8支(4.62%)。ICA-CI组单纯颅外段动脉狭窄或闭塞高于VB-CI组(P<0.05),ICA-CI组单纯颅内段动脉狭窄或闭塞高于VB-CI组(P<0.01),ICA-CI组颅内-颅外段动脉多发狭窄或闭塞低于VB-CI组(P<0.05)。ICA-CI组单纯颅内段动脉狭窄或闭塞高于单纯颅外段动脉窄或闭塞,VB-CI组单纯颅内动脉段狭窄或闭塞高于单纯颅外动脉段狭窄或闭塞(P<0.05)。动脉狭窄及粥样硬化斑块与年龄、高血压、低血压、糖尿病、高甘油三酯(TG)、高总胆固醇(TC)、高低密度脂蛋白(LDL-C)、冠心病、肥胖、吸烟、酗洒有密切关系(均P<0.05)。结论 DSA检查有助于脑梗死患者的颅内-颅外段主要供血动脉狭窄与闭塞诊断,对脑梗死的治疗有重要指导作用。     

短暂性脑缺血发作与颅内、外动脉狭窄之间的关系探讨

目的探讨短暂性脑缺血发作(TIA)与颅内、外动脉狭窄的发生率、分布特征、狭窄程度以及与侧支循环之间的关系。方法 107例TIA患者均进行DSA检查,明确有无颅内、外动脉狭窄及其狭窄的部位和程度,并判断有无侧支循环的建立。结果 93例DSA阳性患者存在颅内、外动脉狭窄和闭塞共计156处。颅内动脉狭窄最多见于大脑中动脉,共46处(29.5%),颅外动脉狭窄病变多见于颈内动脉开口处,共22处(14.1%)。重度狭窄及闭塞组侧支循环发生率明显高于轻度、中度狭窄组。结论颅内、外动脉狭窄是TIA发病的重要基础,并且颅内动脉狭窄是较颅外动脉狭窄更为重要的TIA发病因素。     

颈内动脉严重狭窄时脑部症状与Willis环侧支循环建立的关系

目的应用经颅超声多普勒(TCD)检测颈内动脉(ICA)严重狭窄,探讨Willis环的侧支循环与临床症状之间的相关性.方法分析34例ICA严重狭窄患者(其中有症状组16例和无症状组18例)侧支循环的类型、大脑中动脉(MCA)的平均血流速度(Vm)、脉动指数(PI)及频谱改变,并与30例正常人进行对照.结果存在3种侧支循环类型前交通动脉(ACOA)型,后交通动脉(PCOA)型,眼动脉(OA)型.无症状组的侧支循环中,ACOA型占88.9%,狭窄侧MCA Vm为59.1±8.7cm/s;有症状组ACOA型占50%,有4例未检出侧支循环,狭窄侧MCA Vm为48.6±7.3cm/s(P＜O.OO1).所有患者狭窄侧的MCA PI减低(p＜O.001),且频谱低平呈波浪状,波峰变钝,失去收缩峰的特征.结论TCD可以发现ICA严重狭窄患者Willis环侧支循环的显著异常改变,研究Willis环的侧支循环对ICA产重狭窄患者治疗和授后的判断其有重要的临床价值.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Micro-affirmations and Recovery for Persons with Mental Health and Alcohol and Drug Problems: User and Professional Experience-Based Practice and Knowledge

Recurrent factors contributing to a recovery process from co-occurring mental health and addiction problems mentioned by users and professionals have been analyzed as part of working alliances and helpful relationships. Still, we lack knowledge about how helpful relationships are developed in daily practice. In this article, we focus on the concrete construction of professional helpful relationships. Forty persons in recovery and fifteen professionals were interviewed. The interviews were analyzed according to thematic analysis, resulting in three themes presented as paradoxes (1) My own decision, but with the help of others; (2) The need for structures and going beyond them; and (3) Small trivial things of great importance. Micro-affirmations have a central role in creating helpful relationships by confirming the individuals involved as more than solely users or professionals. More attention and appreciation should be paid to practices involving micro-affirmations.

     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.