副肿瘤综合征23例临床分析

目的 分析副肿瘤综合征患者的临床特点.方法 回顾性分析23例副肿瘤综合征患者的临床资料.结果 副肿瘤综合征患者的临床表现形式多种多样,23例患者中包括周围神经病11例,Lamber-Eaton综合征7例,运动神经元病2例,进行性多灶性白质脑病1例,进行性小脑变性1例,边缘系统脑炎1例.多为慢性或亚急性起病,18例先出现神经系统症状后进一步检查发现肿瘤,5例为发现肿瘤后出现神经系统症状.结论 早期识别副肿瘤综合征对隐匿性肿瘤的发现和治疗非常重要.     

以副癌综合征为突出表现的肺癌4例误诊分析

目的:探讨以副癌综合征为主要临床表现的肺癌的误诊原因,总结临床经验。方法:对4例误诊病人的病史、临床症状及辅助检查资料进行分析。结果:4例肺癌患者呼吸系统症状体征不明显或缺如而表现以肌肉、神经系统的临床症状为主从而导致误诊。结论:对肺癌的副癌综合征缺乏认识与误诊有直接关系。     

神经系统副肿瘤综合征27例并文献复习

目的 了解神经系统副肿瘤综合征的临床特点.方法 回顾分析我院神经内科住院的27例神经系统副肿瘤综合征患者的临床资料,并结合文献进行分析.结果 27例患者中己发现原发肿瘤,而后出现神经系统症状的有6例,占22.2％,首先出现神经系统症状的21例,占77.8％,神经系统损害中累及周围神经有8例,亚急性小脑变性7例,边缘叶脑炎1例,Lambert-Eaton 5例,脊髓受损表现2例,视神经受累2例,僵人综合征1例,亚急性运动神经元病1例.原发肿瘤为肺癌有19例,结肠癌1例,卵巢癌1例,乳腺癌2例,胰腺癌1例,肾癌1例,未找到原发肿瘤2例.结论 神经系统副肿瘤综合征临床表现多样,容易漏诊、误诊,早期明确诊断、筛查原发隐匿性肿瘤,对患者的预后起着至关重要的作用.     

神经系统副肿瘤综合征13例临床分析

正神经系统副肿瘤综合征(Paraneoplastic Neurological Syndromes,PNS)是指临床未发现的恶性肿瘤引起非转移性神经系统病征,它并不是由于肿瘤直接引起,也不是由于感染性、血管性或者代谢紊乱等原因引起,而是恶性肿瘤远隔效应所致~([1])。尽管神经系统副肿瘤综合征发病率非常低,还不到1/10 000~([2]),但因其临床表现缺乏特异性,且约50%患者症状早于恶性肿瘤发现,特别是在老     

以副癌综合征为首发症状的肺癌诊治体会(附12例报告)

肺癌是常见的恶性肿瘤之一,其发病率逐年上升而为各类肿瘤之首[1 ] 。临床表现有由原发肿瘤引起的症状;肿瘤局部扩张引起的症状;由癌远处转移引起的症状;癌作用于其它系统引起的肺外表现(副癌综合征)等。症状体征典型的患者就诊时,临床医师通过X线胸片、胸部CT、MRI、纤维支气管镜、痰脱落细胞学等相关检查可初步发现或明确诊断。但部分患者就诊时以副癌综合征为首发症状,极易误诊。本文对我院收治和转院后随访的以副癌综合征为首发症状的肺癌12例资料进行分析,探讨其临床特征及检查手段,以提高对本病的认识和早期诊断水平,减少误诊的发…     

脑出血急性期患者观察及护理

出血性脑血管瘤为神经系统常见病,死亡率高,预后差。因此必须密切观察病情及生命体征,正确的护理,才有可能挽救病人的生命。一、一般护理患者急诊送入病室后,立即为患者准备柔软而平整的床铺,将病人置仰卧位,头部放平。随之观察病人生命体征改变情况。检查病人是否有假牙,迅速     

疲劳综合征妙方山大百人汤

疲劳综合征是指人在长期超负荷工作，或在巨大竞争压力下所出现的一系列症状、体征。中医诊治疲劳综合征，主要是根据病人病证表现进行辨证论治。疲劳综合征的症状、体征多数属于气阴两虚证，山大百人汤是笔多年来临床经验方，对疲劳综合征具有一定效果。如贾某身体欠佳，屡经西医诊断检查，未能得出明确结论；多次服用中西药，也未能取得明显治疗效果。笔根据病人病证表现特点辨为气阴两虚，用山大百人汤10剂，即取得明显治疗效果。病人又服用约20余天，所有症状、体征消失。     

世界银行卫生Ⅸ项目 性病艾滋病子项目

14.什么叫艾滋病相关综合征? 对具有艾滋病的某些全身性症状和体征,而尚未表现出机会性感染或肿瘤(如卡波西氏肉瘤或中枢神经系统淋巴瘤)的病人,称为艾滋病相关综合征(ARC)。此病介于慢性淋巴结病与出现罕见癌症和严重感染的艾滋病之间。估计有25％的艾滋病相关综合征病人会发展为艾滋     

症状性椎动脉起始部狭窄支架植入术围手术期护理

总结28例症状性椎动脉起始部狭窄支架植入术围手术期的护理,重点是术前重视宣教及抗凝药物的应用;术后严密监测生命体征及神经系统体征,继续实施药物治疗的护理,加强并发症的观察及出院指导。28例患者手术顺利,临床症状得到改善,随访6个月~4年,6例患者脑血管造影复查,1例出现50%的再狭窄,予以观察。     

职业性急性溴甲烷中毒6例临床分析

观察急性溴甲烷中毒患者是否遗留神经系统损害的后遗体征。方法:对6例急性溴甲烷中毒病人的临床资料进行分析,并对1例重度中毒病人进行了4年追踪观察。结果:急性溴甲烷中毒患者的临床表现以中枢神经系统损害为主,在重度中毒的病人可伴发周围神经病。一般认为,急性溴甲烷中毒的潜伏期为数分钟至48小时,长者可达5天以上。本组病人潜伏期为5～10天,潜伏期过后,相继出现中毒症状和体征。重度中毒病人可导致中枢神经系统功能障碍和神经系统症状、体征恢复不完全。结论:急性溴甲烷重度中毒患者可遗留共济失调、锥体束损害等神经系统后遗症。     

介入诊治颅内动脉瘤的观察与护理

目的:着重探讨电解可脱性微弹簧圈(GDC)栓塞治疗颅内动脉瘤的护理.方法:回顾性分析2004年8月～2005年1月对2例颅内动脉瘤经电解可脱性微弹簧圈栓塞治疗的围手术期护理和观察.结果:2例病人均成功置入电解可脱性微弹簧圈,症状、体征明显好转.结论:严密监测生命体征及穿刺部位有无血肿或出血,做好术前、术中、术后及并发症的观察护理,有助于颅内动脉瘤患者的恢复.     

恶性血液病化疗后并发肺部真菌感染的护理

目的探讨恶性血液病化疗后并发肺部真菌感染的护理经验。方法对38例合并肺部真菌感染的恶性血液病患者做好用药护理、保护性隔离措施、症状护理、饮食指导和心理护理。结果通过一系列的护理措施,38例真菌感染病人治愈23例(60.5%),好转8例(23.7%),治疗总有效率84.2%。治愈率和治疗总有效率较采取措施前有明显提高,不良反应发生率显著减少(P0.05)。结论对于恶性血液病化疗后并发的肺部真菌感染,在进行正规抗真菌药物治疗的同时,进行全方位的护理干预,可以显著提高治疗的效果,减少或减轻抗真菌药物带来的不良反应。     

Neurological presentations of AIDS--when to test for HIV.

Nine of 122 patients dead from AIDS in central London presented with neurological disease, confirmed pathologically in seven. Seven had no other major systemic manifestations. AIDS needs to be considered in the differential diagnosis of meningitis, dementia, diffuse and focal encephalopathies, brainstem syndromes, myelopathy, visual failure and peripheral nerve syndromes. As AIDS becomes more widespread there will be an increasing need for diagnostic HIV testing in many neurological syndromes.     

A study of the symptom patterns of psychiatric referrals in a tropical diseases unit

Undoubtedly the commonest psychiatric conditions seen in patients from the tropics are reactive depression and hysterical illness. These may both be seen as responses to stress, often over a prolonged period. Although typical depressive and hysterical syndromes are seen in all races, severe tiredness seems to be the principal hysterical symptom amongst Europeans as opposed to bizarre somatic symptoms in Negroes and Asians. Headaches are an important depressive sign in Negroes and Asians. Diarrhoea and abdominal pains may be linked directly to anxiety and depression or may emerge as an unconscious defence against insoluble problems.     

Rapid evidence assessment of approaches to community neurological nursing care for people with neurological conditions post‐discharge from acute care hospital

Neurological conditions represent leading causes of non‐fatal burden of disease that will consume a large proportion of projected healthcare expenditure. Inconsistent access to integrated healthcare and other services for people with long‐term neurological conditions stresses acute care services. The purpose of this rapid evidence assessment, conducted February–June 2016, was to review the evidence supporting community neurological nursing approaches for patients with neurological conditions post‐discharge from acute care hospitals. CINAHL Plus with Full Text and MEDLINE were searched for English‐language studies published January 2000 to June 2016. Data were extracted using a purpose‐designed protocol. Studies describing community neurological nursing care services post‐discharge for adults with stroke, dementia, Alzheimer's disease, Parkinson's disease, multiple sclerosis or motor neurone disease were included and their quality was assessed. Two qualitative and three quantitative studies were reviewed. Two themes were identified in the narrative summary of findings: (i) continuity of care and self‐management and (ii) variable impact on clinical or impairment outcomes. There was low quality evidence of patient satisfaction, improved patient social activity, depression scores, stroke knowledge and lifestyle modification associated with post‐discharge care by neurological nurses as an intervention. There were few studies and weak evidence supporting the use of neurology‐generalist nurses to promote continuity of care for people with long‐term or progressive, long‐term neurological conditions post‐discharge from acute care hospital. Further research is needed to provide role clarity to facilitate comparative studies and evaluations of the effectiveness of community neurological nursing models of care.     

Wernicke's encephalopathy following reduced food intake due to depressive disorders

Wernicke's encephalopathy (WE) is an unexpected common neurological disorder caused by thiamine deficiency often due to alcohol abuse, but WE-not alcohol related is also frequent. A prolonged reduction of food intake can cause WE. This condition can arise in depression disorders, especially in the early stages of these psychiatric syndromes. WE is characterized by the triad of signs: ataxia, ocular dysfunctions and confusional state. However, they rarely appear together and this makes the diagnosis particularly difficult, especially when there is not a history of alcohol abuse. Electroencephalography, since in the early stage of the disease, can be helpful in detecting pattern of metabolic encephalopathy. We describe three cases of thiamine deficiency responsible of WE, caused by a decrease in appetite and food intake due to the onset of a depressive disorder. In our series, the most frequent symptom observed at the onset of the disease was the motor incoordination. We recommend to perform quickly thiamine infusion in all depressed patients with a history of reduced food intake, presenting to Emergency Department with recent onset of motor incoordination, with or without alterations in eyes’ movements and confusional state, after exclusion of other neurological conditions.     

伊布利特联合胺碘酮转复持续性房颤的有效性及安全性研究

目的 探讨运用循证护理模式对脑卒中恢复期患者在社区家庭康复中的干预效果。 方法 选取80例首发脑卒中患者作为研究对象，采用随机数字表法分为常规组和观察组各40例。常规组采用常规社区家庭康复护理方法，而观察组实施循证护理模式，即采用循证护理路径制定出适合患者的最佳社区家庭康复护理方案。评估2组患者干预前后的心理状态、神经功能缺损程度、日常生活能力和运动功能，比较2组患者干预后的总有效率、生活质量、疾病复发率和护理满意度。 结果 观察组干预后的总有效率高于常规组（P＜0.05）；观察组干预后的DSI评分、CSS评分、Barthel指数和MAS评分均优于常规组（P＜0.05）；观察组患者干预后的复发率低于常规组，护理满意度高于常规组（P＜0.05）。 结论 在脑卒中恢复期患者的社区家庭康复中，实施循证护理模式能够改善患者的心理状况及运动功 和日常生活能力，降低复发率，提高患者生活质量；能够增进护患间信任及和谐关系。     

Some neurological and psychiatric complications of the disorders of the hypothalamo-hypophyseal system

Connection between the central nervous system and the endocrine system is extremely complex. The hypothalamus serves as a crucial centre for the integration and coordination of autonomic functions by neuronal and hormonal pathways. It plays a central role in the homeostatic regulation of internal physiological conditions. It controls growth and reproduction, stress reactions, and determines rhythmicity, periodicity and timing of physiological processes. Beside its well-known functions, antidiuretic hormone has a role in social behavior as it enhances aggression via vasopressin receptor 1A. Oxitocin is affected in the formation of maternal behavior, and in other social interactions, like the pair bounding, as well as in analgesia and pain modulation. The corticotrop-releasing hormone acts as a neurotransmitter, it has a special role in stress-behavior, anxiety, and depression, and it blocks deep sleeping. Among the neurotransmitters and neuropeptids of the hypothalamus, serotonin, norepinephrine, GABA, cholecystokinin, neuropeptide-Y, Agouti-related protein, alpha-MSH and ghrelin have essential importance in the eating disorders. The levels of leptin and galanin determine whether formation of anabolic or catabolic neurotransmitters should take place. In the thermoregulation the central thermoreceptors play role, and suprachiasmatic nucleus is responsible for circadian rhythm, through "timing genes". The diseases of the hypothalamus cause most frequently bulimia or anorexia, hypersomnia, impotency, and attacks of anxiety. The most common expansive process of the hypothalamus is craniopharyngioma. The lack or diminution of vasopressin causes diabetes insipidus, while inappropriate antidiuretic hormone secretion induces Schwartz-Barter syndrome. Fr?hlich-, Kleine-Levin- or Prader-Willi syndromes have characteristic neuropsychiatric features. The main psychiatric symptom of hypopituitarism is a combination of dementia and delirium. The most characteristic neurological sign of pituitary adenoma is the visual field defect. Carpal tunnel syndrome, obstructive sleeping apnoe and headache are typical neurological features in somatotrop adenomas.     

循证护理模式在脑卒中患者社区家庭康复中的应用研究

目的探讨运用循证护理模式对脑卒中恢复期患者在社区家庭康复中的干预效果。方法选取80例首发脑卒中患者作为研究对象,采用随机数字表法分为常规组和观察组各40例。常规组采用常规社区家庭康复护理方法,而观察组实施循证护理模式,即采用循证护理路径制定出适合患者的最佳社区家庭康复护理方案。评估两组患者干预前后的心理状态、神经功能缺损程度、日常生活能力和运动功能,比较两组患者干预后的总有效率、生活质量、疾病复发率和护理满意度。结果观察组干预后的总有效率高于常规组(P<0.05);观察组干预后的DSI评分、CSS评分、Barthel指数和MAS评分均优于常规组(P<0.05);观察组患者干预后的复发率低于常规组,护理满意度高于常规组(P<0.05)。结论在脑卒中恢复期患者的社区家庭康复中,实施循证护理模式能够改善患者的心理状况及运动功和日常生活能力,降低复发率,提高患者生活质量;能够增进护患间信任及和谐关系。