直线加速器放射外科治疗脑血管畸形的临床评价

报告采用立体定向放射外科方法治疗脑血管畸形３０％。８０％等剂量区的靶剂量设计为１５－２０ＧＹ。在１－２年内畸形血管团完全及次全闭塞率为６７％。１例放疗后６个月死于出血，其余病人随访期间均未发现再出血。癫痫为首发症状者其控制率灰８１．８％。４例出现后期放疗反应，表现为较广泛的白质水肿，其中２例开颅手术，切除的畸形血管均已闭塞。     

伽玛刀治疗脑血管畸形（附61例分析报告）

本文分析了伽玛刀治疗６１例脑血管畸形患者（ＡＶＭ４１例，ＡＯＶＭ２０例），经６个月、２年随访，结果１６个月以内血管巢闭塞占５４％，１８～２４个月闭塞占８０％；癫痫消失５６％（平均１．１年）；术后有１例再出血死亡（占ＡＶＭ２．４％）。作者探讨了影响畸形消失的有关因素，认为在允许范围内，剂量大，病灶消失速度快；病灶容积小，消失速度快；儿童病灶消失快。癫痫控制率偏低，若结合ＰＥＴ综合定位和处理，可望提高癫痫治愈率。对位于重要功能区或容积过大脑血管畸形，可先予其他处理，残余部分再行伽玛刀治疗。     

立体定向放射外科与癫痫

立体定向放射外科与癫痫谭启富从１９６８年～１９９５年６月全球３３７８５例进行放射外科治疗病人中，癫痫１０１例，仅占０．３％。原因：１．致痫灶定位困难；２．机理不明。一、立体定向放射外科（ＳＲＳ）治疗癫痫的根据：１．实验证实猫钴源性癫痫，放疗后癫痫发作...     

伽玛刀治疗脑血管畸形（附61例分析报告）

本文分析了伽玛刀治疗６１例脑血管畸形患者，经６个月￣２年随访。结果１６个月以内血管巢闭塞占５４％，１８￣２４个闭塞占８０％，癫痫消失５６％，术后１例再出血死亡，作者探讨了影响畸形消失的有关因素，认为在充许范围内，剂量大，病灶消失速度快，病灶容积小，消失速率快，儿童病灶消失快。癫亲控制率偏低，若结合ＰＥＴ％综合定位和处理，可望提高癫痫治愈率。对位于重要功能区或容积过大脑血管畸形，可先予其他处理，残余     

脑海绵状血管畸形与动静脉畸形对放疗的不同反应

目的 探究脑海绵状血管畸形(CMs)与动静脉畸形(AVMs)的结构差异和对于放射外科治疗反应的不同.方法 实验样本共33例,包括放射外科治疗后的CMs 3例,放射外科治疗后的AVMs 3例,未经照射的CMs 6例,未经照射的AVMs 17例和健康对照4例.取材后立即处理,并应用光学显微镜和透射电子显微镜观察5组间的超微结构差异.结果 CMs显示管腔直径与血管壁的厚度较大而且缺乏内皮下成纤维细胞,肌成纤维细胞和平滑肌细胞.CMs放射外科治疗后形成部分蛋白质凝块(管腔的19％ ～22％),在放射治疗后长达6年后也未出现完整的血管闭塞.AVMs观察到由纤维蛋白血栓组成永久性的血栓,使血管完整的闭塞(管腔的91％ ～ 98％).照射诱导病灶周围的脑组织发生神经元丢失和神经原纤维变性.结论 CMs与AVMs的血管结构及细胞成分的不同导致它们对放射外科治疗的反应不同.     

伽玛刀治疗颅内疾病3094例临床报告

目的： 探讨立体定向放射手术（伽玛刀） 对颅内疾病的疗效。方法： 用１．５Ｔｅｓｌａ 磁共振仪和γ－ ｐｌａｎ 计算机联网定位, γ－ ｐｌａｎ４．０ 版剂量规划系统作治疗方案设计, 剂量规划, 对３０９４ 例不同类型的颅内疾病包括肿瘤、血管畸形及功能性疾病等实施立体定向放射外科治疗, 病种达２０ 余种,年龄１．１～８６ 岁,周边剂量９～７５Ｇｙ,中心剂量１８～１５０Ｇｙ,等剂量曲线３０％ ～９０％ ,靶点数１～１２ 个。结果： 随访１０～４７ 个月, 统计结果表明： 伽玛刀疗效是确切的。对脑动静脉畸形, 随防一年半以上, 完全闭塞率可达４４．６％ , 体积越小, 周边照射剂量越大, 闭塞率越高。对颅内肿瘤的生长控制率, 良性肿瘤≥８０．０％ , 恶性肿瘤≥６６．７％ ,对功能性疾病的治疗有效率, 帕金森病为８５．２％ , 三叉神经痛为７６．９％ 。结论： 伽玛刀是治疗颅内疾病又一种可选择方法。治疗技术良好, 指征掌握严格, 可提高疗效, 降低并发症。     

100例脑血管畸形的临床病理分析

本文了１００例经放射和／或手术病理证实的脑血管畸形。其中男多于女。１０～４０岁发病者最多见，占５６％。其中脑实质内血肿最常发生，占３７％，是同期非外伤性脑实质内血肿的２．８％。其次是蛛网膜下腔出血，占３２％，为同期自发性蛛网膜下腔出血的７．２％。本组中再出血率为２８．５％。大畸形较小畸形易再出血。６０例手术病理发现９３％为动－静脉畸形，５％为海绵状血管瘤，２％为毛细血管扩张症。８例血管造影示“闭塞     

脑动静脉畸形立体定向放射外科治疗后的出血危险

脑动静脉畸形(AVM)的处理主要目的是消除颅内出血的危险。立体定向放射外科对直径<3cm的AVMs,术后2～3年中畸形血管闭塞率达80％。但其主要缺点是术后AVM在闭塞过程中仍存在出血危险。而这种危险是增加、减少或无变化均不能明确预测。为此,作者回顾性研究了一组放射外科病例的治疗体会。     

脑动静脉畸形伽玛刀治疗的疗效与影响因素

目的 分析脑动静脉畸形伽玛刀治疗结果与影响因素。方法 回顾62例脑动静脉畸形患者伽玛刀治疗结果。拟定治疗病灶大小、病灶部位、有无出血经过、畸形血管团的影像特征、放射剂量、性别、年龄等变量为患者治疗结果的影响因素，以闭塞效果和并发症为考察对象，采用卡方检验和Logistic回归模型，确定单、多因素条件下治疗结果的影响因素。结果 62例患者中，44例有效，总有效率为71％。与治疗有关的不良临床反应者10例，占16．1％。单因素相关分析发现，与闭塞效果和并发症显著相关的因素分别为边缘剂量、病灶容积、畸形血管巢中有无瘤样扩张的血管和病灶的容积、部位；多因素Logistic回归模型中，显著相关的因素则分别为病灶的大小、畸形血管巢中有无瘤样扩张的血管和病灶的容积、部位。结论 伽玛刀是治疗动静脉畸形安全有效的方法。一些放射和病理因素可影响治疗效果。     

放射外科治疗后长达23年已闭塞脑动静脉畸形的磁共振成像

本文作者报告了经伽玛刀(γ-刀)放射外科治疗18例脑动静脉畸形(AVM)病人的结果。报告了18例病人在治疗后平均已14年(8～23年)并已证实脑AVM已闭塞10年(4～17年)的磁共振成像(MRI)结果。在放射治疗后及随访期病人均无症状。5例病人(28％)在相应闭塞的脑AVM部位有囊肿形成。囊肿形成及在MRI上呈现的对比增强与照射剂量无统计学上的相关性。18例病人中11例(61％)呈现的对比增强与靶区内血管巢的再血管化无关。3例病人(17％)在原先脑AVM部位示增高的T_2加权信号,可用神经胶质增生或脱髓鞘(demyelination)解释。此种改变与剂量有关。本文描述了无症状脑AVM病人经放射外科长达23年MRI显示囊肿形成,对比增强及增高的T_2加权信号。本文并提供了有关放射外科对正常组织长期效应新的和基本的信息,且对小型脑AVM经放射外科治疗后MRI听见提供了基本说明。     

Elevated suicide risk among patients with multiple sclerosis in Sweden

Results from previous studies of suicide risk among patients with multiple sclerosis (MS) are inconsistent. This may be explained partly by differences in methodology and study populations. The purpose of our study was to investigate suicide risk among hospital patients with MS in Sweden. During the period 1969-1996, 12,834 cases were recorded in the Swedish Hospital Inpatient Register, with 77,377 hospital admissions, in which MS was a primary or secondary diagnosis at discharge. The mean follow-up time for the whole cohort was 9.9 (SD 7.3) years. When the data for these MS patients were linked to the Swedish Causes of Death Register for the same period, 5,052 (39.4%) were found to have died. Among the 5,052 deaths, suicide was an underlying cause of death in 90 cases (1.8%). The mean period between the initial admission date with an MS diagnosis at discharge and the date of death for the 90 MS suicide cases was 5.8 (SD 5.1) years. This was significantly shorter (p = 0.002) than the mean of 7.9 (SD 6.4) years for MS cases who died due to other causes. Suicide risk, calculated as the standardized mortality ratio (SMR), was significantly elevated (SMR = 2.3) among both male and female MS cases compared with the general population. Suicide risk was particularly high in the first year after initial admission with an MS diagnosis, and among younger male MS cases. The mean age at the time of suicide was 44.5 (SD 12.4) years, and 58% of the suicides were committed within 5 years after the first admission with an MS diagnosis. The crude suicide rate among MS patients during the study period was 71 per 100,000 person-years. The rate was significantly higher (p < 0.001) in males (114) than in females (47), with an odds ratio of 2.4 (95% CI: 1.6-3.8). These findings have implications for suicide preventive measures in neurological practice.     

Gilles de la Tourette syndrome and deep brain stimulation

Gilles de la Tourette Syndrome (GTS) is characterized by multiple motor and one or more vocal/phonic tics. Psychopathology and co-morbidity occur in approximately 80-90% of clinical cohorts. The most common psychopathologies are attention deficit hyperactivity disorder, obsessive-compulsive behaviours, obsessive-compulsive disorder, depression, anxiety and certain behavioural disorders. In severe GTS patients who are refractory to medication and other therapies, deep brain stimulation (DBS) is investigated. To date there have been some 50-55 patients who have received DBS in 19 centres worldwide. Nine different brain targets in the thalamus, the pallidum, and the ventral caudate and anterior internal capsule have been stimulated. This paper reviews critically and in detail all studies published to date. Only two studies on just a few patients fulfil some of the evidence-based criteria. DBS for GTS is therefore still highly experimental.     

Herpes zoster and multiple sclerosis

BACKGROUND: Clinical experience suggests that young multiple sclerosis patients may have herpes zoster (HZ) earlier and more often than the general population. As there is evidence of a relationship between varicella zoster virus (VZV) and MS, a study of HZ and MS was undertaken. METHODS: Eight hundred and twenty-nine patient-members of the Manitoba Chapter of the Canadian Multiple Sclerosis Society were surveyed by mail. Six hundred and thirty-three (76%) responded. Questions included: age at diagnosis of MS, history of HZ (yes, no, probably), number of episodes of HZ and age at each occurrence, date of birth, and sex of respondent. The controls were consecutive patients with other neurological diseases (OND) attending local neurological or neurosurgical clinics, plus practice-based and population-based surveys of herpes zoster without reference to any other disease. The OND controls were assessed at the time of their outpatient visits. RESULTS: In the MS group with a positive/probable history of HZ, the HZ/MS rate was 106/633 (16.8%); in the practice-based survey the rate was 192/3534 (5.4%); and among the patients with OND it was 42/616 (6.8%). The HZ occurred at an earlier age in the MS group. The majority of male patients had HZ prior to the diagnosis of MS. The date of diagnosis is more likely to be a precise memory as opposed to the onset of symptoms. More than one attack of HZ was also more common in the MS group. CONCLUSIONS: This survey adds to the evidence that patients with MS have a unique relationship with the herpes zoster virus.     

The Mortality and the Risk of Aspiration Pneumonia Related with Dysphagia in Stroke Patients

Background: Dysphagia may result in poor outcomes in stroke patients due to aspiration pneumonia and malnutrition. Goal: The aim of the study was to investigate aspiration pneumonia and the mortality rate in stroke patients with dysphagia in Taiwan. Methods: We selected 1220 stroke patients, divided them into dysphagia and nondysphagia groups, and matched them according to age; covariates and comediations from 2000 to 2005 were identified from the NHIRD 2000 database. The date of the diagnosed stroke for each patient was defined as the index date. All patients were tracked for 5 years following their index visit to evaluate mortality and the risk of aspiration pneumonia. We estimated the adjusted hazard ratio using Cox proportional hazard regression. Results: Within 1 year, the dysphagia group was 4.69 times more likely to develop aspiration pneumonia than the nondysphagia group (adjusted hazard ratio [aHR], 4.69; 95% confidence interval [CI] 2.83-7.77; P < .001). The highest significant risk of aspiration pneumonia was in the cerebral hemorrhage patients within 3 years of the index visit (aHR, 5.04; 95% CI 1.45-17.49; P = .011). The 5-year mortality rate in the dysphagia group was significantly higher than that in the nondysphagia group (aHR, 1.84; 95% CI 1.57-2.16; P < .001). Conclusion: Dysphagia is a critical factor in aspiration pneumonia and mortality in stroke patients. Early detection and intervention of dysphagia in stroke patients may reduce the possibility of aspiration pneumonia.     

Recovery of orientation following closed-head injury

The pattern of recovery of orientation to person, place, and time was investigated in 84 patients who were initially disoriented while hospitalized on the neurosurgery service after sustaining a closed-head injury (CHI) of varying severity. Results of daily administration of the Galveston Orientation and Amnesia Test revealed that the most common sequence of recovery of orientation was person, place, and time: accounting for about 70% of the patients. Return of orientation to time preceded reorientation to place in 13% of the patients while other orderings of reorientation were present in 11% of the cases. Temporal disorientation was initially characterized by backward displacement of the date from the actual date in 68% of the patients. The magnitude of this displacement progressively shrank as the patients became more oriented. Patients who exhibited the greatest backward displacement of the date had more severe and persistent impaired consciousness, were older and had longer durations of posttraumatic amnesia. These data support Ribot's hypothesis that older memories are relatively resistant to cerebral insult.     

Risk of cancer after the diagnosis of Parkinson's disease: a historical cohort study.

We investigated the risk of cancer after the diagnosis of Parkinson's disease (PD) through a historical cohort study. We used the medical records-linkage system of the Rochester Epidemiology Project to identify all incident cases of PD in Olmsted County, Minnesota from 1976 through 1995. Patients with PD were matched by age (+/- 1 year) and gender to referent subjects from the same population. For 196 patients and 185 referent subjects, we ascertained the incidence of cancer through medical records abstraction between the date of diagnosis (or index date) and death, loss to follow-up, or end of study. The risk of cancer was higher among patients than in referent subjects (relative risk [RR] = 1.64; 95% confidence interval [CI] = 1.15-2.35; P = 0.007). The RR did not change noticeably after adjustment for smoking. The increased risk was significant for nonmelanoma skin cancer (RR = 1.76; 95% CI = 1.07-2.89; P = 0.03), but not for other more severe types of cancer; therefore, we cannot exclude the occurrence of a surveillance bias. Among PD patients, there was no relation between the risk of cancer and the cumulative dose of levodopa received or the use of other PD medications.     

Improving survival in a large French ALS center cohort

The aim of this work was to determine whether survival changed during 2002-2009 at a French amyotrophic lateral sclerosis (ALS) center. We included all patients with ALS who were seen consecutively at the center from January 2002-May 2009. Participants were followed from date of first visit through death, date of censoring, or December 31, 2009, whichever occurred first. Cox proportional hazard models computed hazard ratios (HR; 95% confidence interval CI) of death, and flexible modeling of continuous predictors (splines) assessed trends in survival. We analyzed a total of 2,037 ALS patients, of whom 1,471 died before the end of follow-up. Median survival was 2.83?years from onset and 1.65?years from first visit. Compared to patients first seen before 2004, the HR of death was 0.97 (95% CI?=?0.85-1.11, p?=?0.6721) for patients first seen in 2004-2005, 0.96 (95% CI?=?0.83-1.10, p?=?0.5125) for 2006-2007, and 0.56 (95% CI?=?0.46-0.69, p?相似文献   

Recovery of orientation following closed-head injury

Abstract

The pattern of recovery of orientation to person, place, and time was investigated in 84 patients who were initially disoriented while hospitalized on the neurosurgery service after sustaining a closed-head injury (CHI) of varying severity. Results of daily administration of the Galveston Orientation and Amnesia Test revealed that the most common sequence of recovery of orientation was person, place, and time, accounting for about 70% of the patients. Return of orientation to time preceded reorientation to place in 13% of the patients while other orderings of reorientation were present in 11% of the cases. Temporal disorientation was initially characterized by backward displacement of the date from the actual date in 68% of the patients. The magnitude of this displacement progressively shrank as the patients became more oriented. Patients who exhibited the greatest backward displacement of the date had more severe and persistent impaired consciousness, were older and had longer durations of posttraumatic amnesia. These data support Ribot's hypothesis that older memories are relatively resistant to cerebral insult.     

The prevalence and clinical characteristics of MS in northern Japan

In Japan, there is a low prevalence rate (PR) of multiple sclerosis (MS; 0.8-4.0/100,000) but a relatively high frequency of "optic-spinal form" MS (OS-MS). There have been no intensive epidemiologic frequency studies, however, in over 30 years. We performed a province-wide prevalence study of MS in the Tokachi province of Hokkaido, the northernmost island of Japan, and compared the observed clinical features with other populations in Japan and Western countries. Prevalence was determined on March 31, 2001. The primary sources for the case ascertainment were 13 hospitals that treated patients with neurologic diseases including MS in Tokachi. Patients were classified according to Poser's criteria. The prevalence rate of clinically definite or laboratory-supported definite MS (LSDMS) was 8.57 per 100,000 [31/361,726; male/female ratio=1:2.9, and age at onset=29.1+/-14.2 (mean+/-SD) years]. Out of the 31 patients, 5 (16%) were classified as OS-MS. The prevalence rate of MS in the Tokachi province was the highest reported in Orientals to date, although still low in comparison with Western communities at a similar latitude. In contrast to the previous reports in Japan, there was a relatively low frequency of OS-MS in Hokkaido.     

New natural history of interferon-beta-treated relapsing multiple sclerosis

OBJECTIVE: To investigate the impact of interferon-beta (IFNbeta) on disease progression in relapsing-remitting multiple sclerosis patients. METHODS: A cohort of 1,504 relapsing-remitting multiple sclerosis (1,103 IFNbeta-treated and 401 untreated) patients was followed for up to 7 years. Cox proportional hazards regression adjusted for propensity score inverse weighting was used to assess the differences between the two groups for three different clinical end points: secondary progression (SP) and irreversible Expanded Disability Status Scale (EDSS) scores 4 and 6. Times from first visit and from date of birth were used as survival time variables. RESULTS: The IFNbeta-treated group showed a highly significant reduction in the incidence of SP (hazard ratio [HR], 0.38, 95% confidence interval [CI], 0.24-0.58 for time from 1st visit; HR, 0.36, 95% CI, 0.23-0.56 for time from date of birth; p < 0.0001), EDSS score of 4 (HR, 0.70, 95% CI, 0.53-0.94 for time from first visit; HR, 0.69, 95% CI, 0.52-0.93 for time from date of birth; p < 0.02), and EDSS score of 6 (HR, 0.60, 95% CI, 0.38-0.95 for time from first visit; HR, 0.54, 95% CI, 0.34-0.86 for time from date of birth; p < or = 0.03) when compared with untreated patients. SP and EDSS scores of 4 and 6 were reached with significant delays estimated by times from first visit (3.8, 1.7, and 2.2 years) and from date of birth (8.7, 4.6, and 11.7 years) in favor of treated patients. Sensitivity analysis confirmed findings. INTERPRETATION: IFN-beta slows progression in relapsing-remitting multiple sclerosis patients.