A Robust Method for Ventriculomegaly Detection from Neonatal Brain Ultrasound Images

Ventriculomegaly is the most commonly detected abnormality in neonatal brain. It can be defined as a condition when the human brain ventricle system becomes dilated. This in turn increases the intracranial pressure inside the skull resulting in progressive enlargement of the head. Sometimes it may also cause mental disability or death. For these reasons early detection of ventriculomegaly has become an important task. In order to identify ventriculomegaly from neonatal brain ultrasound images, we propose an automated image processing based approach that measures the anterior horn width as the distance between medial wall and floor of the lateral ventricle at the widest point. Measurement is done in the plane of the scan at the level of the intraventricular foramina. Our study is based on neonatal brain ultrasound images in the midline coronal view. In addition to ventriculomegaly detection, this work also includes both cross sectional and longitudinal study of anterior horn width of lateral ventricles. Experiments were carried out on brain ultrasound images of 96 neonates with gestational age ranging from 26 to 39 weeks and results have been verified with the ground truth provided by doctors. Accuracy of the proposed scheme is quite promising.     

口服氟康唑预防老年人使用抗生素后继发真菌感染的临床分析

目的 探讨口服氟康唑对于老年人使用抗生素后继发真菌感染的预防作用.方法 将66例使用抗生素的老年患者随机分为治疗组及对照组,治疗组在使用抗生素同时给予口服氟康唑(100 mg/ d),对照组仅给予抗生素治疗.结果 抗生素治疗14 d中发现,治疗组继发真菌感染率明显低于对照组(P＜0.05).治疗前后及疗程中每周抽血查肝...     

神经外科术后颅内感染50例临床治疗观察

［摘要］目的　探讨神经外科术后颅内感染的临床治疗效果．方法　选取2014年1月至2015年1月来弥勒市人民医院进行神经外科手术治疗的50名术后颅内感染的患者作为本次的研究对象．其中25例患者采用静脉注射抗生素的治疗方式,15例患者采用鞘内以及静脉抗生素注射的治疗方式治疗,10例患者采用鞘内抗生素注射、静脉治疗以及腰大池置管引流的方式进行治疗,然后观察3组患者的临床治疗效果．结果　50例治疗患者中37例患者痊愈、8例患者显效、3例患者有效、2例患者治疗无效．结论　对于神经外科进行手术的患者来说,要想最大可能地降低其颅内感染的几率,就要根据患者的实际情况来服用抗生素,然后根据感染程度的不同来制定不同的治疗方案．     

CNS toxoplasmosis presenting with obstructive hydrocephalus in patients of retroviral disease--a case series

CNS toxoplasmosis presenting as hydrocephalus is a very rare entity. We present three cases of HIV positive patients whose brain imaging revealed hydrocephalus and who improved with anti toxoplasma medication along with intravenous steroids and did not require any CSF shunting procedures. The mechanism of hydrocephalus in CNS toxoplasmosis is usually due to compression of CSF outflow pathway by ring enhancing lesions but even in their absence hydrocephalus can be rarely seen due to ventriculitis. Hence in HIV positive patients with unexplained hydrocephalus CNS toxoplasmosis should be considered and such patients if started on treatment early have a good prognosis without requiring neurosurgical intervention.     

脑外伤行脑室引流后严重脑室炎的原因及处理

目的探讨脑外伤后行脑室外引流术后严重脑室炎的原因及处理。方法对8例脑外伤后行脑室外引流术后严重脑室炎患者，行双侧侧脑室穿刺，一侧用敏感抗生素慢速滴注冲洗，另一侧置管引流治疗，并且给予亚低温和高氧液及全身支持对症等治疗。结果治疗14d后各患者体温和脑脊液均恢复正常，伤后半年随访，根据GOS预后评分，持续植物状态1例，中残3例，恢复良好4例。结论脑外伤后行脑室外引流术后严重脑室炎患者采用敏感抗生素冲洗侧脑室、亚低温、高氧液及全身支持对症等治疗，可降低伤残率和死亡率。     

原发性脑室出血并全脑室铸型的手术治疗体会

目的探讨原发性脑室内出血全脑室铸型的手术治疗效果以及注意事项。方法随机选取我院神经外科原发性脑室内出血全脑室铸型患者48例,其中29例行开颅右额叶皮质造瘘,显微镜下清除侧脑室血肿减压(A组),19例采用双侧侧脑室钻孔引流血性脑脊液(B组)。术后两组均行脑室外引流+尿激酶脑室内注射治疗,术后治疗随访3个月,观察疗效及预后。结果 A组术后恢复良好15例,好转10例,死亡4例;颅内感染3例,癫痫3例,无脑积水患者;GOS评分:5分2例,4分13例,3分7例,2分3例,1分4例;救治成功率86%。B组术后恢复良好1例,好转10例,死亡8例;颅内感染4例,癫痫2例,脑积水5例;GOS评分:5分0例,4分1例,3分5例,2分5例,1分8例;救治成功率57.8%。两组GOS评分差异有统计学意义(P<0.05)。结论经额叶造瘘脑室血肿清除术加术后引流是抢救治疗急性脑室内出血并全脑室铸型的有力方式。     

脑室外引流和腰大池持续引流术联合应用治疗脑室内积血

目的探讨脑室内积血的不同治疗方法,以期降低脑室内感染率,达到脑室内积血更有效的引流。方法对164例脑室内积血的患者,分别采用单纯脑室外引流（EVD）术（75例）及EVD＋腰大池持续引流术（89例）治疗,对两种方法的治疗效果进行对比分析。结果术后30d时,EVD＋腰大池持续引流组感染率2．2％,明显低于单纯EVD组的12．0％（P〈0．05）;脑积水发生率4．5％,明显低于单纯EVD组的13,3％（P〈0．05）;生活自理率68．5％,明显高于单纯EVD组的50．7％（P〈0．01）。两组均无死亡病例。结论对脑室内积血患者,采用EVD＋腰大池持续引流治疗优于单纯EVD治疗。     

A randomized trial of one versus three doses of Augmentin as wound prophylaxis in at-risk abdominal surgery.

In a randomized prospective trial of prophylactic antibiotics in at-risk abdominal surgery, one dose of intravenous Augmentin (amoxycillin 250 mg and clavulanic acid 125 mg) on induction has been compared with three 8 hourly doses in 900 patients. Wound infection rates which included minor and delayed infections were very similar in those given one dose: 48/449 (10.7%) compared with those given three doses: 49/451 (10.9%) 95% confidence limits - 4.25% + 3.9%. There were more septic and sepsis-related deaths in those patients given one dose (14 deaths) than in those given three doses (7 deaths) P > 0.1 95% CL - 0.4% + 3.0%. However, there were more very elderly patients in the one dose group: 64% of the deaths were aged over 80 and all but one had an emergency operation. There was no difference in the other outcome measures studied which included non-fatal deep sepsis, length of postoperative hospital stay, duration of postoperative fever or the use of antibiotics for postoperative infection. One dose of a suitable intravenous antibiotic gives prophylaxis against wound infection in at-risk abdominal surgery which is at least as effective as multiple doses. However, there may be a risk of overwhelming systemic sepsis in very elderly patients having emergency surgery.     

Immunosuppression induction with daclizumab and antithymocyte globulin in cardiac transplantation: clinical experience with 8 cases.

OBJECTIVE: To review the clinical experience of immunosuppression induction therapy to prevent acute rejection in 8 patients with cardiac transplant. METHODS: Between June, 2000 and May, 2002, 8 patients with end-stage dilated cardiomyopathy undergoing orthotopic cardiac transplantation received induction therapy with two-dose daclizumab (1.0 mg/kg), given intravenously within 12 h before cardiac-transplantation surgery and two weeks thereafter, and with an initial 5-day course of intravenous antithymocyte globulin (100 mg/d) following transplantation. Cyclosporine or tacrolimus, mycophenolate mofetil or azathioprine, and prednisolone were applied for immunosuppression maintenance. RESULTS: No death occurred during the follow-up. Routine endomyocardial biopsies in all cases performed in the early stage detected only mild rejection, and no acute allograft or renal dysfunction was found. Three patients developed opportunistic infection, and only one had late acute rejection in the 14th post-transplantation month. CONCLUSIONS: Induction therapy with intravenous daclizumab and antithymocyte globulin is effective to prevent acute rejection and alleviate organ dysfunction in cardiac transplantation, but might increase the chance of infections.     

赛尼哌结合抗胸腺细胞球蛋白免疫诱导在心脏移植中应用的临床经验(附8例报告)

目的总结本组8例心脏移植受者应用免疫诱导方案治疗的临床经验。方法8例终末期扩张型心肌病患者接受同种异体原位心脏移植术,免疫诱导采用术前12 h内及术后第14天2剂赛尼哌1.0 mg/kg(抗白介素-2受体抗体)结合术后前5 d 5剂抗胸腺细胞球蛋白(ATG)100 mg/d的方法,免疫抑制维持治疗采用环孢素A(或他克莫司) 骁悉(或硫唑嘌呤) 泼尼松三联方案。结果全组无死亡,移植后早期心内膜心肌活检无明显急性排斥反应,无移植物功能不全,无明显急性肾功能不全;3例发生机会性感染,1例远期发生急性排斥反应。结论心脏移植围术期采用2剂赛尼哌结合5剂ATG进行免疫诱导治疗方案能有效预防移植心脏急性排斥反应和减少器官功能损害,但可能增加感染的发生率。     

同时应用不同引流管行双侧脑室引流效果研究

目的 探讨同时应用不同的脑室引流管治疗侧脑室出血的治疗效果.方法 选取我科2009年3月至2011年1月行脑室外引流术患者65例为对照组,选取2011年2月至2012年12月行脑室外引流术患者72例为观察组,采取两种不同的脑室外引流方式进行脑室外引流,比较两组患者引流情况及颅内感染、脑积水发生率.结果 单纯采用普通脑室外引流装置进行引流,颅内感染10例,占15.38％,术后脑积水4例,占6.15％.而同时应用不同脑室外引流装置进行引流,发生颅内感染4例,占6.16％,脑积水1例,占1.54％.结论 根据患者的脑室内出血情况,同时应用不同引流管行双侧脑室引流,解决了传统的脑室外引流装置的不足,能够有效引流脑脊液以防止脑积水的加重,并且有效地防止了颅内感染的发生,引流效果满意.     

腰椎后路椎间融合术后伤口深部感染的处理

目的评估手术清创或保守治疗方法在腰椎后路椎间融合术后伤口深部感染治疗中的临床疗效。方法收集2001年1月-2005年1月收治的213例因腰椎退行性疾病而接受后路椎间融合内固定术患者的临床资料,对其中7例确诊为伤口深部感染患者（3.3%）采用手术清创或者延长抗生素使用时间等保守治疗,6例患者行手术清创,1例使用针对性较强的敏感抗生素治疗。手术清创者在术中分别使用体积分数为2%的过氧化氢、生理盐水反复浸泡、冲洗伤口,质量浓度为0.1%的苯扎溴铵和生理盐水冲洗后明胶海绵填塞消灭死腔,严密缝合伤口。结果 1例患者取出内固定,有2例患者椎间融合器位置重置。术后延长抗生素静脉滴注和口服时间,直至红细胞沉降率和血常规白细胞计数达正常后3-4d。术后随访时间2.5-6.4年,平均3.6年。随访期内无再次感染的患者。Oswestry残障评分显示3例患者下肢功能轻度残碍,3例中度残障,1例患者重度残障。结论腰椎椎间融合术后深部椎间隙感染没有必要取出椎间融合器,可以采用手术清创或保守治疗等方法处理。     

创伤性脑损伤并发脑积水的危险因素

目的探讨中、重型创伤性脑损伤(TB I)后脑积水的发生率和危险因素。方法分析394例中、重度TB I患者,探讨性别、年龄、入院时GCS评分、开颅去骨瓣减压术,以及是否伴有脑室出血和弥漫性蛛网膜下腔出血等,对创伤后脑积水发生的影响。结果394例中、重型TB I患者中,33例(8.38%)发生脑积水,时间在伤后2~4周;高龄患者创伤后脑积水的发生率明显增加(P<0.01);脑积水与开颅去骨瓣减压术、脑室出血和弥漫性蛛网膜下腔出血等有关(P<0.01)。结论高龄患者、开颅去骨瓣减压术、脑室出血和弥漫性蛛网膜下腔出血是创伤后脑积水发生的危险因素。     

Antibiotic use and overuse for appendicectomy in Antigua and Barbuda

The use of antibiotics for appendicectomy in Antigua and Barbuda, from January 1998 to December 1999, was examined with respect to current Surgical Infection Society guidelines from developed countries. There were 143 cases of appendicectomy performed at Holberton Hospital. The mean patient age and standard deviation (SD) was 28.1 +/- 15.8 years, 57% female. Pathology showed inflammed appendix only in 56%, peri-appendiceal abscess/perforation in 17%, "fibrosed" appendix in 10% and normal appendix in 17%. Postoperative infection (wound infection, fever > three days) was seen in 7/24 (29%) of cases with peri-appendiceal abscess/perforation and 2/119 (1.7%) of the other cases. A subset of 88 cases had antibiotic use reviewed: 3/88 (3.4%) were given no antibiotics, 7/88 (8%) were given one antibiotic, 5/88 (5.7%) were given two antibiotics, 72/88 (81.8%) were given three antibiotics and 1/88 (1.1%) was given four antibiotics. Parenteral antibiotics were given a mean and SD of 5.39 +/- 1.94 days followed by oral antibiotics in 18/88 (20.5%) cases. Those with appendiceal abscess/perforation were treated parenterally for mean and SD of 6.56 +/- 2.35 days, not significantly different from others. Most frequent antibiotics used were gentamicin, metronidazole and ampicillin/penicillin/cloxacillin/cephradine (81.8%). The Surgical Infection Society recommends starting prophylactic antibiotics before surgery, using appropriate spectrum agents for less than 24 hours if not contaminated and less than five days if infected. It may be possible to safely reduce antibiotic use for appendicectomy in Antigua and Barbuda.     

腰大池持续引流预防脑出血破入脑室后慢性脑积水的研究

目的研究腰大池持续引流对脑出血破入脑室后慢性脑积水的预防效果。方法对120例脑出血破入脑室患者随机分组,对照组常规治疗,实验组除常规治疗外行腰大池置管持续引流。为规避手术方式不同对脑积水发生率的影响,实验组和对照组间按有无去骨瓣减压各分两个亚组;将实验组和对照组的慢性脑积水的发生率进行总结分析。结果实际有效病例115例,实验组中非减压亚组的脑积水发生率明显低于对照组中非减压亚组,组间差异具有显著性意义（P〈0．05）。结论腰大池持续引流能减少脑出血破入脑室后慢性脑积水的发生,对以脑室积血为主,不需要开颅去骨瓣减压手术的病例,效果尤其显著。     

正常颅内压脑积水与脑萎缩的鉴别及分流疗效随访

目的探讨正常颅压脑积水与脑萎缩的鉴别及分流疗效随访。方法回顾分析本院从2005年1月至2009年中20例正常压力脑积水患者,分析其临床表现、影像学特征（CT与MRI）及脑脊液检查,排除脑萎缩所致脑室扩大病例（10例）。患者行常规脑室腹腔分流术。结果 20例患者仅行一次脑室腹腔分流术症状改善明显：完全缓解15例,3例部分缓解,2例症状改善不明显。并发症：硬膜下积液1例,脑皮层内血肿1例,术后癫痫发生1例。结论规范正常颅压脑积水的诊断步骤及脑室腹腔分流术适应证。     

四叠体池蛛网膜囊肿分型与神经内镜治疗策略

目的 探讨应用神经内镜治疗不同类型四叠体池蛛网膜囊肿的方法、策略和疗效.方法 北京世纪坛医院自2005年11月至2009年11月接受神经内镜手术治疗了12例四叠体池蛛网膜囊肿导致的梗阻性脑积水患者,并进行了分型、采取相应的治疗方案,同时对手术方式、并发症和疗效进行探讨和分析.12例患者平均年龄3岁7个月,均有不同程度的临床症状,其中Ⅱ型7例,Ⅲ型5例.术后随访6-24个月,且手术前后均行脑脊液电影成像检查.结果 本组12例患者术后恢复良好,无颅神经进一步损伤症状,无脑脊液漏,无感染及死亡.术后3例硬膜下积液患者随访6个月后自行消失,间断发热7例,经对症治疗痊愈.囊肿及脑室形态明显缩小8例,轻微缩小3例.结论 根据我们对四叠体池囊肿患者的分型,应用神经内镜实施不同手术方案,囊肿得到有效治疗,重建了脑脊液循环,神经导航使内镜手术更加精确和安全.     

Third ventricular cavernous angioma

Third ventricular cavernous angiomas are rare vascular malformations of the brain. We report an eight-year old boy with a rare third ventricular cavernous angioma that hemorrhaged presenting with symptoms of acute hydrocephalus. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed a heterogenous ill-defined, solid and cystic intraventricular mass in the third ventricle which was mildly enhanced with contrast and there was associated hydrocephalus. The mass was removed with success and follow up after two years revealed no neurological abnormalities.     

侧脑室引流管在结核性脑膜炎脑积水治疗中放置时间的评估与研究

目的 对侧脑室引流管在结核性脑膜炎脑积水治疗中放置时间及拔管时机进行评估,观察临床转归.方法 选择符合条件的结核性脑膜炎中、重度脑积水患者226例,分为改良脑室引流组（治疗组）127例和常规脑室引流组（对照组）99例,全部病例均行规范的全身抗结核、脱水及激素治疗.治疗组患者在局麻下改良脑室外引流,对照组按常规侧脑室额角穿刺外引流.两组患者均于术后第2天行脑室注射抗结核药物,引流两周后行24h夹闭导管试验,按拔管指征评估拔管可能性,进行疗效判定.结果 治疗组127例中,引流时间窗符合拔管指征者76例,提前拔管19例,延迟拔管32例,导管放置时间（27.6±17.3）d,3例继发颅内感染,总有效率为74.8％（95/127）,颅内感染发生率2.3％;对照组99例中,引流时间窗符合拔管指征者56例,提前拔管29例,延迟拔管14例,导管放置时间（18.9±15.2）d,7例继发颅内感染,总有效率为69.7％（69/99）,颅内感染发生率7.1％.两组疗效对比差异无统计学意义（x2=3.75,P ＞0.05）,两组脑室外引流导管放置时间比较差异有统计学意义（t=2.413,P＜0.05）,两组颅内感染发生率比较差异有统计学意义（x2=4.92,P ＜0.05）.结论 结核性脑膜炎合并中、重度脑积水患者应早期行侧脑室外引流,配合脑室内注射药物治疗,效果显著,可使部分患者避免V-P分流手术.改良脑室外引流能降低颅内感染的发生率.妥善评估侧脑室引流管在结核性脑膜炎脑积水治疗中放置时间及拔管时机是取得良好预后的关键.