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1.
目的 探讨3.0T MR三维时间飞跃(3D-TOF)与三维稳态采集快速成像(3D-FIESTA)序列融合图像在三叉神经及面神经显微血管减压术(MVD)术前评估三叉神经、面神经与邻近血管关系的价值。方法 回顾性分析经MVD治疗的36例三叉神经痛(TN)及31例面肌痉挛(HFS)患者的影像学资料。分析2名医师评判三叉神经、面神经与邻近血管关系的一致性,分别比较TN及HFS症状侧及无症状侧神经血管压迫(NVC)征象出现率的差异;以手术结果为金标准,计算3D-TOF与3D-FIESTA序列融合图像对症状侧神经与血管关系的诊断效能。结果 2名医师评价症状侧及无症状侧三叉神经及面神经与血管关系的一致性均好(P均<0.001)。TN及HFS患者症状侧NVC征象出现率均明显高于无症状侧(χ2=26.13、20.81,P均<0.001)。3D-TOF与3D-FIESTA序列融合图像诊断三叉神经与血管关系的准确率、敏感度、特异度、阳性预测值和阴性预测值分别为97.22%(35/36)、97.06%(33/34)、100%(2/2)、100%(33/33)和66.67%(2/3);诊断面神经与血管关系的准确率、敏感度、特异度、阳性预测值和阴性预测值分别为93.55%(29/31)、96.55%(28/29)、50.00%(1/2)、96.55%(28/29)和50.00%(1/2)。结论 3D-TOF与3D-FIESTA序列融合图像能清晰显示神经与血管的空间关系,可为MVD提供可靠的影像学依据。  相似文献   

2.
Objective To evaluate the efficacy of the combination of gynecologic imaging reporting and data system (GI-RADS) ultrasonographic stratification and 3D contrast-enhanced ultrasonography (3D-CEUS) in identifying malignant lesions from benign ovarian masses. Methods Both of 2D ultrasound (2D-US) and 3D-CEUS were performed on 102 patients with ovarian masses. The perfusion characteristics of ovarian masses were observed with 3D-CEUS,and the 2D-US features of ovarian masses were analyzed based on GI-RADS. Simple and multiple Logistic regression analysis were used to investigate whether the independent risk predictors in differential diagnosis of benign and malignant ovarian could be confirmed. In addition, ROC curves were drawn. The diagnostic efficacy of GI-RADS combined with 3D-CEUS scoring system was evaluated and compared with that of only GI-RADS. Results Simple and multiple Logistic regression analysis confirmed that there were 8 independent predictors of malignant masses, including large papillary projections (≥ 7 mm), separated or wall thickness ≥ 3 mm, central blood flow, the proportion of solid part ≥ 50%, combination of ascites, high level enhancement, uneven distribution of contrast media in enhanced solid part and the vascular with characteristics as dense, tortuous and anfractuous. When using 4 points as the cut-off, the area under the curve (AUC) of GI-RADS combined with 3D-CEUS scoring system in identifying malignant ovarian masses was 0.969, higher than that of only GI-RADS (0.839; Z=1.64, P=0.029). Furthermore, the scoring system showed higher sensitivity, specificity, positive predictive value, negative predictive value and accuracy (all P<0.001). Conclusion The combination of GI-RADS with 3D-CEUS can be more effective to distinguish malignant lesions from benign ovarian masses.  相似文献   

3.
We aimed to prospectively evaluate the clinical and bacteriological effects of piperacillin in children with pneumonia. Twenty-eight patients (6 months to 5 years of age) with pneumonia were treated with piperacillin. In the same period, 95 strains of Haemophilus influenzae and 41 strains of Streptococcus pneumoniae were isolated in our department and the minimum inhibitory concentration (MIC) of piperacillin was determined. The clinical efficacy of piperacillin was excellent in 4 cases, good in 23, and fair in 1; the response rate was 96.4% (27/28). Among the isolates from our department, there were 4 strains (9.8%) of penicillin-susceptible S. pneumoniae (PSSP), 32 strains (78.0%) of penicillin-intermediate-resistant S. pneumoniae (PISP), and 5 strains (12.2%) of penicillin-resistant S. pneumoniae (PRSP). Against S. pneumoniae, the MIC50 and MIC90 for piperacillin were 0.5 μg/ml and 2 μg/ml, respectively. Panipenem showed the best results, followed by piperacillin, ampicillin, and flomoxef. Among the isolates from our department, there were 51 strains (53.7%) of β-lactamase-negative ampicillin-susceptible H. influenzae, 42 strains (44.2%) of β-lactamase-negative ampicillin-resistant H. influenzae, 1 strain (1.1%) of β-lactamase-positive ampicillin-resistant H. influenzae, and 1 strain (1.1%) of β-lactamase-positive amoxicillin-clavulanic acid-resistant H. influenzae. The MIC50 and MIC90 for piperacillin against H. influenzae were 0.0625 μg/ml and 0.125 μg/ml, respectively. Tazobactam/piperacillin and piperacillin showed the best results, followed by panipenem, ampicillin, and flomoxef. Piperacillin proved to be very useful for the treatment of pneumonia in children.  相似文献   

4.
We prospectively investigated the relationship between the clinical efficacy of treatment of pulmonary Mycobacterium avium complex (MAC) disease and drug-sensitivity testing of MAC isolates for antituberculous drugs, new quinolone antibiotics, and clarithromycin (CAM). Fifty-two patients who satisfied the diagnostic criteria of the American Thoracic Society (ATS) and who received treatment between April 1998 and December 2005, using combined therapy of rifampicin (RFP), ethambutol (EB), streptomycin (SM), and CAM, were enrolled in this study. The causative microorganisms isolated were Mycobacterium avium in 30 patients and M. intracellulare in 22 patients. Although separation of the two strains showed drug sensitivity testing to have slightly better minimal inhibitory concentrations (MIC) for M. intracellulare than for M. avium, there were no significant differences in the sputum eradication rate or clinical improvement between the two strains. The MICs of various antibiotics for the isolated MAC strains were as follows: RFP, 0.125–8 μg/ml; CAM, 0.25–16 μg/ml; SM, 2–128≦ μg/ml; EB, 128≦ μg/ml; levofloxacin (LVFX), 1–32 μg/ml; sparfloxacin (SPFX), 0.5–16 μg/ml; and gatifloxacin (GFLX), 0.25–8 μg/ml. The isolated MAC strains showed the same excellent drug sensitivity test results for RFP, new quinolones, and CAM, but they showed resistant drug-sensitivity results for EB and SM. Regarding the relationship between clinical efficacy and the MICs of RFP, EB, CAM, and SM, there was a good relationship only for CAM. Although the ATS has not yet recommended routine drug susceptibility testing of CAM, we believe that drug susceptibility testing of CAM should be performed before the initial treatment is undertaken for pulmonary MAC disease.  相似文献   

5.
AIM:To estimate the prognosis of Bell palsy,METHODS:Blink relex (BR),electromyography(EMG),motor latency(ML) and amplitude (AMP) of facial nerve were performed in 42 patients with Bell‘‘‘‘s palsy.The patients were followed about half a year.RESULTS:(1) When 1 of the 3R waves related with the ill side existed or appeared in 3 weeks after onset,97% patients could recover completely.THe recovery time was realted to the time of the occurrence of R wave.(2) When 1 of the 3R waves appeared in the 4th week.60% patients could recover completely,When none of the 3 wasves appeared after the 4th week,100% patients could not recover completely.EMG showed spontaneous activities in 3 of the 6 patients in the 4th week.(3) Motor latency and amplitude of facial nerve were examined when the illness stopped developing.All patients had normal lalencies,5 patinets‘‘‘‘ amplitudes reduced more than 90%.3 of the 5 patients did not appear the related R waves after the 4th week.CONCLUSION:BR might provide the early sign of good prognosis of Bell‘‘‘‘s palsy ,BR together with EMG and ML and AMP of facial nerve might provide the later sign of poor prognosis.  相似文献   

6.
Objective To evaluate the therapeutic efficacy of gamma knife in treatment of primary trigeminal neuralgia Methods Retrospectively analysis of 120 cases with primary trigeminal neuralgia treated by gamma knife in our department From Jan. 2003 to Mar. 2008 were performed. All cases were treated with the 4 mm collimator and targeted at the proximal nerve at the root entry zone located by MRI. The target dose varied from 80 -90 Gy. Results After a follow-up of 20. 0 ±4. 5 months, complete relief of pain occurred in 69 patients (57. 5%), 50% -90% relief in 34 (28. 3%), relief less than 50% in 12(10.0%) but no relief in 5(4.2 %).The efficient rate was 95. 8% . The common complications include numbness, absence of corneal reflex. 83 patients (69. 2%) experienced temporal facial numbness and 14 patients (11. 7%) reported continuous numbness after treatment of the gamma knife. Conclusions Gamma knife radiosurgery is a minimally invasive technique for the treatment of primary trigeminal neuralgia with few complications.  相似文献   

7.
Objective To evaluate the therapeutic efficacy of gamma knife in treatment of primary trigeminal neuralgia Methods Retrospectively analysis of 120 cases with primary trigeminal neuralgia treated by gamma knife in our department From Jan. 2003 to Mar. 2008 were performed. All cases were treated with the 4 mm collimator and targeted at the proximal nerve at the root entry zone located by MRI. The target dose varied from 80 -90 Gy. Results After a follow-up of 20. 0 ±4. 5 months, complete relief of pain occurred in 69 patients (57. 5%), 50% -90% relief in 34 (28. 3%), relief less than 50% in 12(10.0%) but no relief in 5(4.2 %).The efficient rate was 95. 8% . The common complications include numbness, absence of corneal reflex. 83 patients (69. 2%) experienced temporal facial numbness and 14 patients (11. 7%) reported continuous numbness after treatment of the gamma knife. Conclusions Gamma knife radiosurgery is a minimally invasive technique for the treatment of primary trigeminal neuralgia with few complications.  相似文献   

8.
蒋立新 《中国临床康复》2002,6(18):2818-2819
Objective:To study the curative effect of rafing great auricular nerve with pediculated fasial tube in defective damage of facial nerve.Method:all the patients in the study were treated by grafting great auricular nerve which was covered by pediculated fascial tube near facial nerve trunk.Result:The 3 otogenic fascial paralysis patients had grade Ⅲ recovery of facial nerve function(30%-38%)2.0 to 2.5 years after the nerve grafting operation;2 post-traumatic facial paralysis patients had grade Ⅱ recovery of acial nerve function(69%-71%)2.5 to 3.5 years after the nerve grafting operation.Conclusion The grating of pediculatd fascial tube surrounded great auricular nerve can provide a biological environment with excellent bolld supply for the plerosis and regeneration of nerves and can accelerate the functioal recovery of nerves after the nerve grafing.  相似文献   

9.
A total of 16 isolates of Streptococcus pneumoniae and 18 isolates of Haemophilus influenzae were obtained from the blood of children admitted to the pediatric wards of hospitals in Hokkaido Kamikawa subprefecture between January 2003 and December 2005. The ages of the patients with S. pneumoniae or H. influenzae infection ranged from 2 months to 9 years and from 1 month to 4 years, respectively. The diagnoses of S. pneumoniae infection were as follows: pneumonia in 8 patients, occult bacteremia in 5 patients, and meningitis in 3 patients. The diagnoses of H. influenzae were: meningitis in 6 patients, pneumonia in 4 patients, occult bacteremia in 4 patients, epiglotitis in 2 patients, and facial cellulitis in 2 patients. Out of 16 S. pneumoniae isolates, penicillin-resistant strains with a mutation of 3 genes were observed in 7 children, and penicillin intermediate-resistant strains with a mutation of 1 or 2 genes were observed in 8 children. Out of 18 H. influenzae isolates, the β-lactamase-negative ampicillin-resistant strain with a substitution of 2 points in the ftsI gene was revealed in 2 children, the β-lactamase-negative ampicillin-resistant strain with a substitution of 1 point in the ftsI gene was observed in 4 children, the β-lactamase-positive amoxicillin/clavulanic acid-resistant strain with blaTEM-1 and ftsI with 2 substitutions in the ftsI gene was observed in 3 children, and the β-lactamase-positive ampicillin-resistant strain with blaTEM-1was not observed. The MBC90s of ampicillin, ceftriaxone, cefotaxime, meropenem, panipenem, and vancomycin against S. pneumoniae were 8 μg/ml, 1 μg/ml, 1 μg/ml 1 μg/ml, 0.25 μg/ml, and 0.5 μg/ml, respectively. Those of ampicillin, piperacillin, ceftriaxone, cefotaxime, meropenem, and panipenem against H. influenzae were >128 μg/ml, >128 μg/ml, 0.25 μg/mL, 1 μg/ml, 0.12 μg/ml, and 0.5 g/ml, respectively. It is suggest that the minimum bactricidal concentration (MBC) was dissociated from the minimum inhibitory concentration (MIC) in S. pneumoniae and H. influenzae with abnormal pbp genes.  相似文献   

10.
目的 探讨超高频超声在2型糖尿病患者腓肠神经损伤中的应用价值.方法 选取有神经症状的糖尿病组、无神经症状糖尿病组和正常对照组的腓肠神经,分别为56条、64条和60条.应用22 MHz超高频超声测量并比较各组神经形态学指标,包括截面积(CSA)、厚/宽比(T/W ratio)以及最粗的神经束厚度(MT)等.结果 ①超声在各组中均可清晰显示腓肠神经的神经外膜、神经束膜和神经束等结构.②对照组、无症状组和症状组的T/W ratio和MT均依次增高,差异具有统计学意义(P<0.05),CSA在三组间差异无统计学意义(P=0.257).结论 超高频超声可显示糖尿病患者的腓肠神经形态学特征,有望为糖尿病皮神经损伤提供一种新的形态学评价工具.
Abstract:
Objective To evaluate the morphological changes of sural nerve in patients with type 2 diabetes mellitus by hyperfrequency ultrasound.Methods Fifty-six sural nerves of symptomatic group,64 sural nerves of asymptomatic group,and 60 sural nerves of control group were identified by 22 MHz Ultrasound.The thickness/width (T/W) ratio,cross-sectional areas (CSA) and the maximum thickness of neuronal fascicles (MT) of the sural nerve were calculated in transverse sonograms.Results ①Ultrasound can clearly show these structures of sural nerve such as epineurium,perineurium and nerve bundles and so on.②In symptomatic group,asymptomatic group and control group,T/W ratio and MT were gradually increased,and the differences among the three groups were statistically significant (P<0.05).Whereas,there were no statistically significant differences in CSA among the three groups (P=0.257).Conclusions22 MHz ultrasound may be a valuable tool in evaluating the diabetic cutaneous nerve neuropathy  相似文献   

11.
目的探讨富含神经生长因子(NGF)和神经碎片的生物套管在周围神经损伤再生修复过程中的作用。 方法建立动物模型,将SD大鼠随机分成4组,分别为A对照组、B自体神经外膜小间隙吻合单纯添加自体神经碎片组、C自体神经外膜小间隙吻合同时添加NGF和自体神经碎片组、D生物套管吻合同时添加NGF和自体神经碎片组;观察各组一般形态、显微镜下吻合口处神经恢复形态以及组织学表现。采用方差分析比较各组有髓神经纤维数、施旺细胞数以及运动神经传导速度(MNCV)值的组间差异,组间的两两比较采用LSD-t检验。 结果(1)A组大鼠在第8周时足底溃疡出现明显自愈,右下肢开始出现自主活动,部分足底溃疡的大鼠在第12周时仍未出现明显的自愈,右下肢无活动;其余实验组出现右下肢足底溃疡的大鼠在第8周时出现明显的自愈,并且右下肢表现出自主活动。第12周时A组大鼠右下肢足趾仍然呈挛缩状态,不能自由活动,而其余3组右下肢足趾大部分恢复自主活动。(2)纵切面见B组、C组、D组所构建的小间隙管腔内均可见到再生神经纤维。第12周时,A组有髓神经纤维数目为(22.30±4.66)根/400视野,B组有髓神经纤维数目为(51.60±4.45)根/400视野,C组有髓神经纤维数目为(56.20±4.66)根/400视野,D组有髓神经纤维数目为(59.20±5.81)根/400视野,组间差异具有统计学意义(F=298.48,P<0.001);抗S-100染色单位视野下,A组施旺细胞数目为(16.00±2.24)根/400视野,B组施旺细胞数目为(21.00±3.40)根/400视野,C组施旺细胞数目为(30.20±3.03)根/400视野,D组施旺细胞数目为(34.80±3.35)根/400视野,组间差异具有统计学意义(F=197.63,P<0.001)。术后第12周时,A组MNCV值为(7.57±1.79)m/s,B组MNCV值为(11.49±1.12)m/s,C组MNCV值为(13.86±2.03)m/s,D组MNCV值为(20.16±2.48)m/s,组间比较差异具有统计学意义(F=188.80,P<0.001)。D组对周围神经损伤的修复后的有髓神经纤维数目、施旺细胞数目以及MNCV均具有明显优势,与A组、B组、C组比较,差异均具有统计学意义(t=26.55、5.45、2.15,P<0.001、<0.001、=0.034;t=21.87、16.05、5.35,P均<0.001;t=23.19、15.97、11.60,P均<0.001)。 结论本实验证实自体神经碎片与NGF的联合应用,明显提高周围神经再生微环境中神经损伤修复效果。  相似文献   

12.
面、听神经与中间神经及回返穿通动脉关系的解剖学研究   总被引:2,自引:0,他引:2  
目的:提供有实用价值的小脑脑桥角手术的解剖学资料。方法:对20具甲醛固定的成人尸颅进行测量,观察了小脑脑桥角内回返穿通动脉与中间神经的位置关系。结果:回返穿通动脉出现率为100%,回返穿通动脉位于面神经、前庭蜗神经之间有32侧(80%),88%位于面听神经中外2/3,位于中间神经外侧的28侧(70%),中间神经内侧的4侧(12%)。结论:为小脑脑桥角手术中神经及血管的保护起指导意义。  相似文献   

13.
背景:在过去20余年中,围绕着胆囊收缩素的临床应用以及在神经损伤中的作用进行了广泛的研究。目的:探讨胆囊收缩素在神经损伤后的作用及其可能的作用机制。方法:通过检索近年来关于胆囊收缩素的生物学特性及其在神经系统中的生物学作用相关文献,从动物实验的细胞、器官水平对这些相关研究成果作回顾性分析,总结胆囊收缩素在神经损伤后的作用及其可能的作用机制等方面的研究。结果与结论:胆囊收缩素及其受体在体内的广泛分布,其在生理及病理状态下的作用也复杂多样,但对胆囊收缩素的神经保护作用的研究还不充分,大部分实验还仅局限于对现象的观察,胆囊收缩素对神经保护的作用机制尚值得深入研究,为最终应用于临床奠定基础。  相似文献   

14.
Migraine and nerve block   总被引:4,自引:0,他引:4  
Migraine is essentially an episodic headache usually accompanied by neurological disorder, vomiting, photo- and phonophobia and malaise. The sensory nerves in the cerebral blood vessels are activated during migraine attack. The trigeminal systems is the sensory system that innervation cranial vessels and dura mater via its first ophthalamic division. Pain fibers from the trigeminal nerve descends to the second cervical cord segment where fibers from the occipital region transverse the dorsal root ganglion to converge on second order neurons. C2 root ganglion block therapy is the most efficacious treatment of the acute attack of migraine. Stellate ganglion block is a usefulness of amelioration of the sensory nerves of the intracranial vessels and prevention of migraine headache.  相似文献   

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干细胞及神经导管支架修复神经缺损   总被引:1,自引:0,他引:1  
背景:组织工程的发展为神经缺损的修复提供了可能,种子细胞与导管支架制成的复合体是构建组织工程神经的核心。目的:从干细胞的组织工程应用及构建具有良好生物相容性的导管支架材料角度,探索如何更好的修复神经损伤。方法:以"干细胞,神经损伤,修复,神经导管,神经支架材料"为中文关键词,以"stem cells,nerve damage,repair,nerve guide conduit material,scaffold materials,nerve tissue engineering"为英文关键词,采用计算机检索CNKI和Medline数据库1996-01/2011-01有关不同来源干细胞和导管支架材料修复神经缺损的相关文章,排除重复研究或Meta分析类文章,筛选纳入30篇文献进行评价。结果与结论:移植神经干细胞可以在神经系统存活、增殖、迁移,在不同部位分化为相应的细胞,因此给神经修复领域带来新的希望。另外,随着生物材料的发展,神经导管材料修复神经缺损也取得了优良的效果,具有良好的应用前景。将神经干细胞复合导管可降解生物材料有望能更好的满足神经支架的要求,达到修复和重建的目的。  相似文献   

18.
目的:建立双侧正中神经、尺神经多节段运动神经传导速度(MCV)、潜伏期(LAT)和波幅(AMP)的正常值。方法:200例健康志愿者,男100例,女100例,分别按年龄分成5组,正中神经记录点在拇短展肌,刺激点分别为掌点、腕点、肘点、腋点、Erb点;尺神经记录点在小指展肌,刺激点分别为腕点、肘下点、肘上点、腋点、Erb点,记录各段MCV、LAT、AMP值。结果:正中神经、尺神经多节段MCV 、LAT、AMP与性别、侧别无相关性;年龄与正中神经各段MCV、LAT、AMP及尺神经AMP有关。 结论:双侧正中神经、尺神经多节段运动神经传导的准确检测对临床疾病诊断有重要价值。  相似文献   

19.
干细胞及神经导管支架修复神经缺损   总被引:1,自引:0,他引:1  
背景:组织工程的发展为神经缺损的修复提供了可能,种子细胞与导管支架制成的复合体是构建组织工程神经的核心.目的:从干细胞的组织工程应用及构建具有良好生物相容性的导管支架材料角度,探索如何更好的修复神经损伤.方法:以"干细胞,神经损伤,修复,神经导管,神经支架材料"为中文关键词,以"stem cells,nerve damage,repair,nerve guide conduit material,scaffold materials,nerve tissue engineering"为英文关键词,采用计算机检索CNKI和Medline 数据库1996-01/2011-01 有关不同来源干细胞和导管支架材料修复神经缺损的相关文章,排除重复研究或Meta分析类文章,筛选纳入30 篇文献进行评价.结果与结论:移植神经干细胞可以在神经系统存活、增殖、迁移,在不同部位分化为相应的细胞,因此给神经修复领域带来新的希望.另外,随着生物材料的发展,神经导管材料修复神经缺损也取得了优良的效果,具有良好的应用前景.将神经干细胞复合导管可降解生物材料有望能更好的满足神经支架的要求,达到修复和重建的目的.  相似文献   

20.
周围神经再生与神经生长因子给药途径的关系   总被引:1,自引:0,他引:1  
目的:应用周围神经损伤模型,局部和全身给予神经生长因子,观察对周围神经再生的影响。方法:实验于2001-06/2003-05在大连医科大学神经解剖研究室完成。选用体质量180~200gSD大鼠36只,随机分为3组,即全身用药组、全身对照组和局部用药组。其中局部用药组,右侧后肢为实验组,左侧后肢为对照组。切除大鼠5mm长的坐骨神经,两断端用硅胶管桥接形成再生室。局部用药组向右侧再生室内注入0.5mL神经生长因子;向左侧再生室内注入等量生理盐水为对照。全身用药组按5mL/kg腹腔内给药。对照组腹腔内注入等量盐水。术后9周对各组动物进行电镜观察及轴突计算机图像分析,采用辣根过氧化物法逆行追踪观察脊髓前角运动神经元的标记情况。结果:36只大鼠全部进入结果分析。①再生坐骨神经电镜观察结果:局部用药组及全身用药组的结果基本一致,有髓神经纤维髓鞘较厚、轴突直径较粗,髓鞘厚呈板层样排列,神经再生活跃。而对照组中有髓神经纤维髓鞘较薄、直径细小。②轴突计算机图像分析:用药组轴突数目优于对照组[局部:(2781±170),(1758±103)个/μm2;全身:(2840±127),(1786±112)个/μm2,P均<0.01];用药组轴突直径亦优于对照组[局部:(1.11±0.18),(0.64±0.17)μm,全身:(1.16±0.15),(0.87±0.17)μm,P均<0.01]。③辣根过氧化物酶标记结果:实验组脊髓腰段横切片中,可见较多标记的前角运动神经元,而对照组中则少见。全身用药组与局部用药组结果相似。结论:全身和局部应用神经生长因子对周围神经再生有明显的促进作用。神经生长因子也支持运动神经元存活。  相似文献   

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