硬通道与软通道治疗高血压脑出血疗效观察

目的观察硬通道与软通道治疗高血压脑出血的临床疗效。方法选择高血压脑出血病人64例,随机分为观察组与治疗组。观察组实施颅内血肿硬通道微创穿刺粉碎清除术;治疗组行软通道微创定向置管引流术。治疗中观察患者血肿清除情况,治疗3个月后评定2组患者临床治疗效果。结果 2组患者血肿清除情况、临床效果均显著。但2组间疗效相近(P>0.05),差异无统计学意义。结论硬通道微创穿刺粉碎清除术与软通道微创定向引流术均是治疗高血压脑出血的有效方法,2组方法疗效相近,均值得推广应用。     

不同手术方式治疗高血压脑出血137例分析

目的探讨高血压脑出血外科治疗选择最佳手术方式,提高生存率,减少致残率。方法回顾分析137例高血压脑出血患者的临床资料采用普通骨瓣开颅显微镜下血肿清除去骨瓣减压术,小骨窗开颅显微镜下血肿清除术,微创穿刺置软管血肿引流术,血肿破入脑室者配合脑室外引流等术式,探讨不同手术方式适应证。结果 90 d后骨瓣开颅组34例ADLⅠ-Ⅲ级20例,优良率58.8%;小骨窗开颅组49例,ADLⅠ-Ⅲ级39例,优良率79.6%;微创穿刺组54例ADLⅠ-Ⅲ级45例,优良率83.3%。结论不同手术方式有不同适应证,术前根据不同病情,多参数评估高血压脑出血,选择最合适的手术方式,术前多参数评估高血压脑出血,选择最合适的个性化的不同手术方式,利用显微和微创神经外科技术治疗高血压脑出血,可以提高患者生存率,减少致残率,提高疗效,改善预后。     

微创术和小骨窗开颅术治疗高血压脑出血临床疗效分析

目的探讨微创治疗高血压性脑出血的疗效。方法高血压脑出血患者70例,随机分为小骨窗组及微创组。小骨窗组予以小骨窗开颅术治疗,微创组予以微创颅内血肿清除术治疗,观察并比较2组间的疗效。结果微创组在血肿清除率、病死率以及神经功能恢复方面均明显优于对照组(P<0.05)。结论微创颅内血肿清除术治疗高血压脑出血是一种较好的方法,能明显减少患者的病死率,并能有效改善患者的神经功能缺损程度。     

微创穿刺血肿抽吸术治疗老年高血压脑出血的疗效观察

目的比较微创穿刺血肿抽吸术与小骨窗显微血肿清除术治疗老年高血压脑出血的疗效。方法选择老年高血压脑出血患者113例,随机分为2组,实验组57例采用微创穿刺血肿抽吸术治疗,对照组56例采用小骨窗显微血肿清除术治疗。对比2组临床疗效、并发症发生率及生活质量。结果实验组临床疗效、术后并发症发生率及术后1a生活质量评分比较均优于对照组,差异有统计学意义(P0.05)。结论微创穿刺血肿抽吸术治疗老年高血压脑出血效果显著,安全可靠,更适合于治疗老年性高血压性脑出血。     

小骨窗和微创穿刺治疗基底节区高血压脑出血

目的探讨小骨窗开颅血肿清除术和微创穿刺术对治疗基底节区高血压脑出血的疗效对比。方法自2003年8月至2006年6月我们对收治的基底节区高血压脑出血外科手术病人按随机分成两组,分别采用小骨窗开颅和微创穿刺手术治疗,每组病人数29例。以GCS判定治疗效果。结果两种术式治疗基底节区高血压脑出血在显效率、有效率、死亡率均无统计学差异。结论两种术式各有优缺点,术式选择要根据具体情况决定。由于微创穿刺可能的穿刺偏差及再出血,小骨窗术式相对较为可靠.     

高血压脑出血不同手术方法疗效的比较

目的比较高血压脑出血大骨瓣开颅血肿清除术与CT定位微创软通道血肿腔穿刺手术的疗效。方法对2009年7月至2012年2月收治的96例高血压脑出血进行分组治疗：微创组（CT定位微创软通道血肿腔穿刺术）51例,开颅组（大骨瓣开颅血肿清除术）45例,比较两组患者的并发症、远期疗效及死亡率。结果与开颅组比较,微创组患者术后并发症发生率（26．0％）较少,死亡率（4．0％）较低,差异有统计学意义（P〈0．05或P〈O．01）。结论高血压脑出血微创手术的疗效肯定,能降低死亡率、致残率,提高患者生存质量,手术操作简单,值得基层医院参考。     

硬通道穿刺和侧裂入路手术治疗基底核区高血压脑出血的临床研究

目的对比硬通道穿刺血肿清除术和经侧裂入路血肿清除术对基底核区高血压脑出血的疗效。方法回顾性分析85例基底核区高血压脑出血病人的临床资料,其中硬通道穿刺手术38例（微创组）,经侧裂手术47例（开颅组）。结果两种术式治疗基底核区高血压脑出血在有效率、病死率均无统计学差异（P〉0.05）。结论两种术式均疗效确切,可根据病人具体情况选择。开颅手术相对较可靠,硬通道穿刺更适合老年病人。     

早期小骨窗开颅血肿清除术治疗表浅部位高血压脑出血31例

目的总结早期小骨窗开颅血肿清除术治疗表浅高血压脑出血临床疗效。方法回顾性分析近3年来我科收治的早期采用显微镜下小骨窗开颅血肿清除术治疗的31例脑出血患者临床资料。结果采用小骨窗开颅血肿清除术的3l例患者全部存活，存活的31例患者中，预后按日常生活能力分级，I级21例，Ⅱ级6例，Ⅲ级3例，Ⅳ级1例。结论早期小骨窗开颅血肿清除术治疗表浅的高血性脑出血具有疗效确切、创伤小、直视下血肿清除彻底、止血彻底和病人康复快等优点。     

微创小骨窗血肿清除加腰大池引流术治疗高血压脑出血的临床疗效观察

目的探讨高血压脑出血治疗微创小骨窗血肿清除术联合腰大池引流术的临床价值。方法选择我院2012—2013年收治的高血压脑出血患者102例,随机平均分为2组,分别行标准大骨瓣开颅血肿清除术与微创小骨窗血肿清除联合腰大池引流。结果观察组患者术后GCS评分改善明显优于对照组,术后1个月与6个月GOS评分改善明显优于对照组,术后6个月的Barthel指数、语言障碍、运动功能障碍评分明显优于对照组。结论微创小骨窗血肿清除联合腰大池引流术治疗高血压脑出血能够有效改善患者神经昏迷情况,对临床预后有良好的作用,还可明显改善语言与运动功能恢复,临床价值较高。     

小骨窗微创开颅术与颞叶微创穿刺引流术治疗基底节区高血压脑出血疗效对比

目的比较小骨窗微创开颅术和颞叶微创穿刺引流术两种术式治疗基底节区高血压脑出血的临床疗效。方法将74例基底节区高血压脑出血患者按手术方式不同随机分为观察组和对照组,对照组36例采用颞叶微创穿刺引流术治疗,观察组38例行小骨窗微创开颅术,对2组患者术后相关临床指标进行分析比较。结果术后血肿清除率观察组优于对照组,2组术后病死率、再出血率及术后肺部感染、消化道出血等并发症比较差异无统计学意义（P〈0.05）;生存患者远期生活质量观察组优于对照组,差异有统计学意义（P〈0.05）。结论小骨窗微创开颅术较颞叶微创穿刺引流术治疗高血压脑出血具有更好的临床疗效,可提高中等量基底节区高血压脑出血患者的远期预后。     

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 -