破裂和未破裂脑动脉瘤的比较

脑动脉瘤可因患者出现蛛网膜下腔出血(SAH)、动眼神经和视神经等脑神经功能障碍以及头痛头晕等症状而被发现,而有些病例却是因其他原因进行体检时偶然被发现。前者为破裂动脉瘤,后者为未破裂脑动脉瘤,二者不仅在诊断发现上不同,而且在其病变结构、临床特性等方面也有所不同。     

破裂和未破裂脑动脉瘤的比较

脑动脉瘤可因患者出现蛛网膜下腔出血(SAH)、动眼神经和视神经等脑神经功能障碍以及头痛头晕等症状而被发现，而有些病例却是因其他原因进行体检时偶然被发现。前者为破裂动脉瘤，后者为未破裂脑动脉瘤，二者不仅在诊断发现上不同，而且在其病变结构、临床特性等方面也有所不同。     

未破裂颅内动脉瘤的治疗

未破裂颅内动脉瘤包括偶然发现的动脉瘤、多发性颅内动脉瘤中的未破裂动脉瘤以及有临床症状但未出血的动脉瘤。该类动脉瘤虽未破裂，但都存在破裂出血的风险。破裂风险因动脉瘤的大小、位置和患者自身情况的不同而存在差异，应通过综合评价各种危险因素来确定个性化治疗方案。     

颅内未破裂微小动脉瘤是否需要治疗?

近年来,由于神经影像学的进步和普及,越来越多的无症状或症状轻微的颅内未破裂动脉瘤(unruptured intracranial aneurysms,UIAs)被检出,对其自然风险的评价和干预措施安全性的评价,引起了医师和患者的高度重视。预防性治疗虽然可避免动脉瘤破裂出血所造成的灾难性的后果,但绝大部分患者的UIAs终生不会破裂。目前,无论是开颅手术还     

颅内未破裂动脉瘤的治疗现状

颅内动脉瘤最主要的危险是破裂后引发蛛网膜下腔出血（SAH）。有文献报道,85％的SAH是因为动脉瘤破裂引起的。因此有学者提出,应当对未     

积极治疗颅内未破裂动脉瘤

由中国医师协会神经外科医师分会、首都医科大学宣武医院、中国国际神经科学研究所（CHINA-INI）、中国脑血管病杂志编委会联合主办的第六届中国脑血管病论坛于2009年4月25—27日在北京成功举行。本次会议对目前临床脑血管病防治的一些热点或有争论的问题,由国内外知名专家作为正反方,进行辩论。这些问题虽然不能期望通过几次辩论就达成共识,但勇于质疑传统观念,培养对问题不确定性思考的理念,是推动科学研究不断向前发展的动力。“辩者,言之信也”。本期刊登此次会议一些专家热点交锋的问题——颅内未破裂动脉瘤是否需要治疗,以期引起读者的思考。同时诚挚欢迎广大读者参与讨论,或提出你们在治疗脑血管疾病临床实践中的困惑和疑点,以便在第七届中国脑血管病论坛上与国内外专家共同研讨。     

颅内未破裂动脉瘤的破裂风险和治疗策略

<正>非创伤性蛛网膜下腔出血的患者中80%是由其颅内动脉瘤破裂引起的~([1]),蛛网膜下腔出血(subarachnoid hemorrhage,SAH)是脑卒中疾病中最为凶险的一种,死亡率最高可达50%~([2])。防治颅内未破裂动脉瘤面临两难选择。目前所知的未破裂动脉瘤破裂危险因素包括患者自身特点和动脉瘤特点两方面,患者特征危险因素包括高龄、女性、日本血统或芬兰血统、吸烟史、既往SAH史、高血压史等,动脉瘤特征包括大动脉瘤、动脉瘤增大、位于后循环位     

颅内未破裂微小动脉瘤的研究进展

颅内动脉瘤是成年人常见的脑血管疾病。临床治疗的大多数颅内动脉瘤虽都以急性蛛网膜下腔出血(SAH)起病,但实际上未破裂动脉瘤的患病率远高于SAH。目前临床流行病学调查显示,颅内未破裂动脉瘤患病率在成年人约为2%～6%[1],其中,微小动脉瘤(直径≤3 mm)所占比例约为6.2%～     

未破裂颅内动脉瘤患者57例

随着CTA、MRA、DSA检查的普及率升高,检查中偶然发现未破裂动脉瘤的概率增高。据统计人群中颅内动脉瘤的患病率为1%~5%〔1,2〕。本院2011年9月至2012年9月共诊断57例未破裂动脉瘤患者(72个未破裂动脉瘤),其中包括20例因蛛网膜下腔出血起病,检查中偶然发现伴随的非责任动脉瘤患者。这些未破裂动脉瘤均经头部CTA或DSA确诊。     

新一代分流器（Surpass）治疗未破裂颅内动脉瘤的安全性和疗效

对于颅内动脉瘤患者,治疗的主要目标是预防出血。已经研制出新一代的腔内装置——SuJl）aSs分流器,用于重建载瘤动脉并闭塞动脉瘤。荷兰拉德伯德大学内梅亨医学中心神经外科的DeVries等进行了一项前瞻性单中心研究。采用Surpass治疗各种复杂性未破裂动脉瘤患者,在6个月时进行临床和血管造影随访,前瞻性收集数据。     

Treatment Options for HIV-Associated Tuberculosis

The vicious interaction between the human immunodeficiency virus (HIV) infection and tuberculosis (TB) pandemics poses special challenges to national control programs and individual physicians. Although recommendations for the treatment of TB in HIV-infected patients do not significantly differ from those for HIV-uninfected patients, the appropriate management of HIV-associated TB is complicated by health system issues, diagnostic difficulties, adherence concerns, overlapping adverse-effect profiles and drug interactions, and the occurrence of paradoxical reactions after the initiation of effective antiretroviral therapy. In this article, recommended treatment strategies and novel approaches to the management of HIV-associated TB are reviewed, including adjuvant treatment and options for treatment simplification. A focused research agenda is proposed in the context of the limitations of the current knowledge framework.     

Treatment Options for Orthopedic Device-related Infections

Though uncommon, prosthetic joint infections are a devastating complication of total joint replacement surgeries and are a cause of significant morbidity. Although complete removal of all foreign material followed by a prolonged course of directed antibiotic therapy is the optimal treatment for such infections, many factors, such as patient health, cost, available bone stock, and timing of infection influence the type of treatment that is chosen. We review the different treatment options for prosthetic joint infections, including surgical modalities and antibiotic choice, duration, and suppression.     

Treatment Options for Hepatitis Delta Virus Infection

The hepatitis D virus (HDV), the smallest virus known to infect man, causes the most severe form of chronic viral hepatitis, hepatitis delta. It is estimated that about 15 to 20 million people are suffering from chronic HDV infection. HDV is a defective satellite virus depending on the hepatitis B surface antigen (HBsAg) for transmission. Chronic hepatitis delta is associated with a rapid progression of liver fibrosis and a high prevalence of liver cirrhosis, even in younger patients. Immunization against hepatitis B virus (HBV) protects from HDV infection, but there is no specific vaccine against HDV available for HBsAg-positive individuals. Treatment options for hepatitis delta patients are limited. So far, only interferon-alpha has shown an antiviral efficacy against HDV. Recent trials showed sustained virological response rates concerning HDV in 25 %–30 % of patients treated with pegylated interferons. HDV is dominant over HBV in the majority of cases, but HBV DNA-positive subjects should be treated with HBV polymerase inhibitors. Combination therapy of pegylated interferon-alpha and adefovir showed a more pronounced HBsAg decline, but the exact role of combination therapies in hepatitis delta requires further investigation. Alternative future treatment strategies may include prenylation inhibitors and HBV entry inhibitors, which are in early clinical development.     

Treatment Options in Myocarditis

Although viral myocarditis has been mostly attributed to enterovirus and adenovirus infection until recently, the association with parvovirus B19 in Europe and hepatitis C virus in Asia has lately been noted. Clinical trials of antiviral agents, such as interferons, are in progress. Whereas immunosuppression with corticosteroids or cyclosporine is ineffective, immunosuppressors that do not promote viral replication, such as FTY720, are promising new approaches. The inhibition of nuclear factor-kappaB and angiotensin II effectively suppresses inflammation in experimental viral myocarditis.In the EMCV animal model Pycnogenol inhibits viral replication, suppresses the expression of pro-inflammatory cytokines and mast cell-related mediators, and improves inflammation and myocardial necrosis. Pimobendan, FTY720 and Pycnogenol are promising agents for the treatment of viral myocarditis.     

主动脉窦瘤破裂的外科治疗

目的:总结我院1992年12月至2004年2月13例主动脉窦瘤破裂的外科治疗经验,进一步探讨其疾病特点及手术方法.方法:13例病人(男性7例、女性6例)在中低温体外循环下行主动脉窦瘤修补术,7例病人同期行室间隔缺损修补术,2例同期行房间隔缺损修补术,1例同期行主动脉瓣成形术,2例同期行主动脉瓣替换术,其他1例.阻断时间(67.46±26.13)分,体外循环时间(103.29±38.05)分.结果:本组病例无死亡.1例病人术后早期出现频发室性早搏、室性二联律,静脉滴注利多卡因有效.所有病人治愈出院,随诊无一例复发.结论:主动脉窦瘤破裂是罕见的心脏疾病,尽早手术是唯一有效的治疗方法.采用主动脉及右心房或主动脉及右心室双切口利于心肌保护和确切修补主动脉窦瘤、纠正合并畸形.