超早期微创引流术治疗高血压脑出血效果观察

我院2005-06开始应用CT引导下立体定向微创钻孔颅内血肿抽吸引流术超早期(发病6h内)治疗高血压脑出血,取得较好的疗效,现报告如下。1资料与方法1.1一般资料钻孔组60例中男38例,女22例;年龄45～79岁,平均56.6岁。全部有高血压史,出血位于基底节区51例,皮质下9例,均经颅脑CT扫描确诊。入院时发病<6h。开颅组53例中男39例,女14例;年龄38～76岁,平均     

50例高血压脑出血微创穿刺引流术的护理体会

我科自2010-01-2011-12对50例高血压脑出血患者行微创穿刺引流术治疗,经精心护理,取得良好的治疗效果,现将护理体会总结报告如下. 1 资料与方法 1.1 一般资料本组50例高血压脑出血患者均为2010-01-2011-12我科住院病人,男38例,女12例;年龄38～80岁,平均60岁;均有高血压史;经脑CT检查证实为脑出血,其中左基底节区出血28例,右基底节区出血22例;出血量30～90 mL;均行微创穿刺引流术,手术时间在发病后12～72 h.     

经侧裂-岛叶入路与经颞部皮质入路治疗基底节区脑出血疗效对比

2010-06—2012-06我院对128例自发性基底节区脑出血患者分别采用经显微镜下经侧裂-岛叶入路与经颞叶皮质入路清除血肿,现将两种术式治疗高血压脑出血的疗效对比结果报道如下。1对象与方法1.1临床资料回顾分析2010-06—2012-06入住我科的高血压性基底节区脑出血128例患者,术前行急诊颅脑CT扫描明确诊断,男74例,女54例;年龄33～74岁,平均49.1岁。2组患者性别构成比及年龄分布、术前意识状态(按照格拉斯哥昏迷评分)差异无明显统计学意义(P>0.05)。血肿量计算以术前急诊CT为依据,按照多田公式(血肿体积V=长径L×宽径W×层厚S×1/2)简易计算血肿体积,其中侧裂入路组血肿体积45～90mL,平均(63.8±14.5)mL;颞部     

小骨窗经外侧裂显微手术治疗基底节区脑出血

脑出血是常见病,致残率和病死率高.基底节区脑出血发病率约占高血压脑出血70％左右[1].本文选取2004年6月～ 2012年11月期间,采用小骨窗经外侧裂显微手术治疗基底节区脑出血患者320例,取得较好的效果,现报告如下. 资料与方法 1.临床资料:男182例,女138例.年龄32～80岁,平均48.5岁.既往有明确高血压病史295例.术前GCS评分4～5分68例,6～8分107例,9 ～12分95例,13 ～14分50例.     

微创血肿清除术结合脑脊液置换治疗脑出血40例分析

脑出血死亡率高 ,破入脑室者更高。我科自 1999-0 6～2 0 0 3 -0 6采用CT定位行微创血肿清除术 ,结合腰穿脑脊液置换治疗脑出血 40例 ,效果显著 ,现报告如下。1　临床资料1 1　病例　本组男 40例 ,女 2 0例 ,年龄 2 0～ 80岁 ,平均 5 6 6岁 ,有高血压病史者 46例。患者全部经CT扫描证实为脑实质出血为主 ,且全部破入脑室。出血部位 :基底节区 3 6例 ,丘脑 12例 ,额叶 6例 ,颞顶叶 6例 (已排除脑干及小脑出血、血凝障碍和血管瘤出血 )。出血量 (按多田氏公式计算 ) 3 0～ 13 0ml ,平均65ml。入院时病情按GCS评分为 3～ 11分 ,平均 6分。脑…     

微创钻孔引流术治疗高血压性基底节脑出血(附40例报道)

目的 探讨微创钻孔引流术治疗高血压性脑出血(HBGH)的安全性和疗效.方法 40例诊断为HBGH患者,在CT扫描简易定位后,经单孔穿刺血肿,吸出部分血肿后留置引流.对其临床、影像和预后资料进行回顾性总结.结果 本组平均住院时间为(20.5±3.5)d,出院时基本痊愈19例,显著进步12例,进步4例,无变化1例,死亡4例.结论 对于出血量较少(<50 mL)且未出现脑疝的HBGH患者,微创钻孔引流术安全有效.     

CT引导下脑内血肿穿刺引流术治疗基底节区脑出血疗效分析

目的观察分析CT引导下脑内血肿微创穿刺引流术治疗基底节区脑出血的临床疗效。方法选择2010-09—2012-09于我院就诊的基底节区脑出血患者80例,随机均分为微创穿刺引流组和保守治疗组各40例,分别比较2组患者的血肿残存体积及神经功能、日常生活能力的预后恢复情况。结果微创组的血肿体积由术前的(36.33±8.04)mL至术后的3d的(18.28±5.25)mL及术后14d的(12.38±4.25)mL,而保守治疗组则从术前至术后3d、7d分别为(35.31±7.06)mL、(30.56±6.35)mL、(26.52±5.27)mL,2组术后比较差异有统计学意义(P<0.05),微创组的血肿体积下降更明显;从评分结果可以看出,微创组与保守治疗组相比,神经功能及日常生活能力恢复更好,2组比较差异有统计学意义(P<0.05)。结论采用CT引导下的微创穿刺引流术治疗基底节区脑出血疗效满意。     

微创颅内血肿抽吸引流术早期预后影响因素分析

目的 探讨微创颅内血肿抽吸引流术治疗幕上脑出血的近期手术疗效,并寻找影响近期手术疗效的 相关因素。 方法 收集自2010年7月至2014年2月收入首都医科大学附属北京天坛医院神经内科重症监护室,接 受微创颅内血肿抽吸引流术的幕上脑出血患者作为研究对象,收集了卒中危险因素、血液学指标、患 者的临床特征及手术相关信息,并随访患者术后30 d或出院时格拉斯哥评分（Glasgow score,GCS）, 通过单因素分析及多因素Logistic回归分析,寻找对近期手术疗效有影响的因素。 结果 入组患者共94例,其中男性60例,年龄23～84岁,平均（54.85±12.70）岁。术后30 d/出院时 预后,清醒或轻度意识障碍（GCS 13～15分）者62例（65.9%）,中重度意识障碍（GCS≤12分）或死 亡者32例（34.1%）。多因素Logistic回归分析中年龄较高（OR 1.06,95%CI 1.00～1.12）、术前GCS较低 （OR 0.59,95%CI 0.43～0.80）是患者预后不良的独立预测因素。 结论 微创颅内血肿抽吸引流术治疗幕上脑出血的短期预后不良与患者年龄较高、术前GCS评分低 有关。     

基底节区高血压脑出血的小骨窗微创手术与钻孔引流术的对比研究

目的比较小骨窗微创手术与钻孔引流术两种术式治疗高血压脑出血的效果。方法采用随机的方法,选择基底节区高血压脑出血患者126例,其中小骨窗微创手术51例,钻孔引流术75例,以拉斯哥预后（GOS）评分为效果评价指标,比较两种术式效果差异。结果两种术式治疗效果有显著性差异,小骨窗微创手术预后生活质量量好于钻孔引流术。结论对于出血量为40～80ml的基底节区高血压脑出血,采用小骨窗微创手术,患者预后生活质量比钻孔引流术好。     

钻孔引流术联合重组组织型纤溶酶原激活剂治疗高血压性脑出血

目的 探讨钻孔引流术联合重组组织型纤溶酶原激活剂（rt-PA）治疗高血压性基底节区出血的临床疗效。方法 2015年4月至2017年3月收治高血压性基底节区出血87例,利用CT辅助定位血肿中心,采用钻孔引流术治疗,术后注入rt-PA。术后随访3~6个月。结果 颅内血肿均于术后2~4 d清除;术后发生再出血4例、颅内感染6例。术后3~6个月GOS评分1分1例,2分5例,3分21例,4分32例,5分28例。结论 钻孔引流术联合rt-PA治疗高血压性基底节区出血效果良好,并发症少。     

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.