表现为短暂性脑缺血发作的硬膜下血肿1例报告

1病例
　　患者,男,77岁,主因发作性言语不清6d、一过性肢体麻木无力3d于2016?02?21入院。入院前6d患者出现发作性言语不清,持续1～2min后缓解,每天发作1～2次,无头痛、头晕、肢体麻木无力等症。3d前出现一过性言语不清伴右上肢麻木无力,持续3～5min后缓解,无头痛、恶心、呕吐,无记忆力下降、意识障碍、抽搐等症。既往有高血压病史2年,口服“硝苯地平缓释片每次20mg,每日2次”治疗,血压维持于130／90mmHg。无糖尿病、冠心病史。门诊以“左侧颈内动脉系统短暂性脑缺血发作”收入院治疗。入院查体：血压150／90mmHg,心率74次／分,心、肺、腹等一般查体均未见异常,神经系统查体无阳性定位体征。入院检查：血、尿常规正常;血糖、肝、肾功能、电解质、凝血四项、心肌三项均未见异常,心电图示窦律,电轴正常。同型半胱氨酸26．62μmol／L。急查头颅CT示两侧额颞顶部慢性硬膜下血肿（图1）。追问病史,患者1个月前曾有头部碰撞硬物史。行颅脑MRI平扫示两侧额颞顶部硬膜下血肿,脑萎缩;头颈CTA显示颈部及颅内血管未见明确狭窄;动态脑电图未见异常,诊断为慢性硬膜下血肿。因患者硬膜下血肿量不大,无意识障碍,头颅CT显示中线无移位,行保守治疗,给予脑保护、营养神经、预防脑血管痉挛等治疗。7d后,复查头颅CT示左侧额、顶部慢性硬膜下血肿,右侧额部硬膜下积液（图2）。患者入院后无短暂性脑缺血发作（TIA）。     

补阳还五汤治疗疑难病3例

早在清代王清任（公元1768～1831年）就已采用补阳还五汤治疗“血痹”（血脉滞塞、肢体麻木不仁、半身不遂）获得较好疗效，至今仍一直沿用。作者在多年临床实践中，运用加味扑阳还五汤治疗了一些疑难病症，取得较好疗效，现报道3例。1慢性硬脑膜下血肿张某，男，62岁。因间断头痛、头晕2年，加重伴少气无力、反应迟钝20d，于1994年8月1日初诊。证见：血压17／11kPa，精神疲惫，面色白，头痛固定于左前额部。舌质暗红，舌尖有瘀斑，脉沉细弱。神经系统检查未见异常。追问病史，2年前有头部撞伤史，因当时头皮未破，无其它症状，故未作任何…     

人血白蛋白治疗地高辛中毒所致二度Ⅱ型房室传导阻滞1例

谭某，男，81岁。因“胸闷、心悸3天，伴恶心、呕吐1天”于2006年9月17日入院。无胸痛、头晕、头痛等其他症状。有“类风湿”病史10余年，“房颤”史5年。患者自9月9日起，门诊给予地高辛0．25mg／d口服治疗房颤。入院查体：T36℃，HR30次／min，BP13．30／7．8kPa，心脏查体提示房颤律，两肺、腹部均未见异常，双下肢无水肿。白细胞8．2×10^9／L，N73％。血沉55mm／h，抗“O”（-），RF（-），其他肝肾功能、电解质、酸碱平衡均正常。ECG：①慢速型房颤；     

重度子痫患者急行开颅血肿清除术1例

女患，30岁，因“停经4月突发头痛、呕吐，右侧肢体乏力10时”入院，既往两次妊娠，分别于孕8＋月、5＋月时因“妊高症”终止妊娠。入院检查：BP193／121mmHg（1mmHg≈—0．133kPa）双肺湿性啰音，     

巨大脑积水硬膜下血肿穿刺引流术1例

1临床资料 患者,女,33岁,因头痛伴呕吐3d入院,既往先天性脊柱裂并行手术治疗,伴先天性脑积水。入院查体：生命体征平稳,头围64cm,脊柱侧弯,神经系统检查无阳性体征。头颅CT检查示：“左侧额颞顶部慢性硬膜下血肿;脑积水”（图1,见封三）。诊断为：“慢性硬膜下血肿,脑积水”。入院后在局麻下行血肿穿刺引流术,     

锁骨下静脉置管输液致壁层胸膜外积液1例

患者，女，68岁。因头痛、头晕伴心悸12h于2007年2月25日住院。BP186／110mmHg（1mmHg=0．133kPa），意识淡漠。心界向左扩大，心率70次／min，律不整，有偶发性早搏。双肺呼吸音清。左侧上下肢肌力0级。头颅CT示：右侧大脑中动脉大面积陈旧性梗死灶，左侧基底节区点状梗死灶。入院诊断：（1）3级高血压；（2）冠状动脉粥样硬化性心脏病；（3）腔隙性脑梗死；（4）脑梗死后遗症。患者需要长期输液治疗，且四肢浅静脉输液困难，于2007年3月16日9：30行右锁骨下静脉穿刺置管。穿刺方法：右侧锁骨下进路。     

单纯以重症哮喘为表现的血液透析首次使用综合征1例

病例女,34岁,因“夜尿增多1^＋年,乏力、头晕半月”于2007年5月14日入院。入院后检查：BP146／98mmHg,慢性贫血貌。双肺呼吸音清,未闻及干湿罗音。Hb69∥L,尿蛋白（3＋）,肾功监测：Bun（28—34）mmol／L、Scr（744—768．7）umol／L,体液免疫、乙型肝炎标记物等均为阴性,B超示双侧肾脏体积偏小。既往有15’年“过敏性哮喘”发作史,对“青霉素”、花粉等过敏,表现为皮肤瘙痒、流鼻涕、喘息等,自喷“必可酮”可缓解。近4年“哮喘”发作减少。诊断“慢性。肾功能衰竭,尿毒症”,安排右颈内静脉置管拟行血液透析治疗。     

以窦房传导阻滞为特点的甲状腺功能亢进症一例

患者女，38岁，因反复发作性头晕、晕厥2年于2006年8月11日入院。2年前患者出现发作性头晕，多次活动时突发眼前发黑，随之意识不清，历时约1min能自行缓解。在当地医院测血压185／80mmHg（1mmHg=0．133kPa），一直以“高血压病”诊治，但病情渐加重。发病以来，患者体重下降、多汗、乏力，未服用B受体阻滞剂等减慢心率药物。入院查体：血压165／75mmHg，无突眼，     

急性输卵管卵巢脓肿误诊为阑尾炎合并卵巢囊肿1例分析

刘某，女性，38岁，已婚。持续性下腹痛五天，加重5小时，于1995年8月23日16时入院、入院前五天无诱因出现下腹疼痛，入院前5小时，又出现下腹痛、恶心、头晕、心慌等症状。查体：KT：36．9℃、P：86次／分，BP：16／10．6kPa。下腹部肌紧张（±）、压病＋＋）、反跳痛（＋）、麦氏点压痛（＋）、腹水征（-）、肠呜减弱。妇查：宫颈轻度糜烂、无宫颈举痛及摇摆痛，子宫前位，鸭卵大，表面光滑，无压痛。子宫左侧可们及一约鸡卵大之囊性包块，触痛明显。“B”超示，子宫左侧有一约4．5cmX5cm椭圆形无回声区。实验室检查；WBC18．6X109／…     

HELLP综合征伴肝被膜下血肿2例

例1．患者27岁，孕3产1。主因宫内孕38周右上腹不适3d，头痛呕吐1d入院。患者末次月经2006年6月16日，2007年3月6日自觉右上腹胀满不适，渐加重。3月9日出现头痛头晕，呕吐1次。5年前孕足月剖宫产1次。入院查体：T37℃，P96次／min，R20次／min，BP152／106mmHg（1mmHg=0．133kPa）。贫血貌，全身皮肤轻度黄染，心肺听诊正常。右上腹压痛反跳痛，肝脾触诊不满意。     

Surgical treatment of poor grade middle cerebral artery aneurysms associated with large sylvian hematomas following prophylactic hinged craniectomy

The clinical characteristics of patients who presented in poor clinical grade due to ruptured middle cerebral artery aneurysms （MCAAs） associated with large sylvian hematomas （SylH） were ana- lyzed and an ingenious designed prophylactic hinged craniectomy was introduced. Twenty-eight pa- tients were graded into Hunt-Hess grades IV-V and emergency standard micro-neurosurgeries （aneu- rysm clipping, hematoma evacuation and prophylactic hinged craniectomy） were performed, and their clinical data were retrospectively analyzed. 46.43% of the patients reached encouraged favorable out- comes on discharge. The favorable outcome group and the poor outcome group significantly differed in terms of patients＇ anisocoria, Hunt-Hess grade before surgery, extent of the midline shift and time to the surgery after bleeding （P〈0.05）. There were no significant differences in age, sex, volume and location of the hematoma, size of aneurysm between the favorable and poor groups （P〉0.05）. However, ingen- ious designed prophylactic hinged craniectomy efficiently reduced the patients＇ intracranial pressure （ICP） after surgery. It was suggested that preoperative conditions such as Hunt-Hess grading, extent of the midline shift and the occurrence of cerebral hernia affect the prognosis of patients, but time to the surgery after bleeding and prophylactic hinged craniectomy are of significant importance for optimizing the prognosis ofMCAA oatients 19resenting with large SylH.     

Clinical curative effect analysis and predictors of prognosis in patients with temporal lobe epilepsy after anterior temporal lobectomy: results after five years

Background Anterior temporal Iobectomy （ATL） is the most common surgical treatment for temporal lobe epilepsy （TLE）although long-term prognosis is often less favorable than short-term outcomes. This study aimed to examine the outcomes of patients with TLE 5 years after undergoing ATL, and to seek possible predictors of prognosis. Methods We examined the clinical records of 121 patients with TLE who underwent ATL in our institution between January 2005 and December 2008. The Engel seizure classification was used to divide patients into ＂seizure free＂ and ＂non-seizure free＂ groups. Univariate and multivariate Logistic regression analyses were used to identify potential prognostic indicators, including history, clinical features of seizures, and magnetic resonance imaging （MRI） and video- electroencephalography （EEG） findings. Results The majority of patients were seizure free during the follow-up period： 71.9% 1 year after surgery; 71.6% after 2 years; 75.8% after 3 years; 78.8% after 4 years after surgery and 68.8% after 5 years. There were significant differences between seizure-free and non-seizure-free groups in terms of preoperative seizure duration, history of febrile seizures, type of seizure, and MRI and video-EEG findings （P 〈0.05）, but not in terms of sex, age at seizure onset, age at surgery, side of surgery, auras, family history of seizure, or history of traumatic brain injury, perinatal anoxia or intracranial infection history （P 〉0.05）. Multivariate Logistic regression analysis showed that a preoperative seizure duration 〈10 years, a history of febrile seizures, simple complex partial seizures, positive MRI findings, hippocampal sclerosis and unilateral localized video-EEG spikes predicted better outcome （P 〈0.05）. Conclusions ATL appears to be an effective means of treating TLE. Patients undergoing ATL for TLE require careful and comprehensive assessment to ensure optimal outcomes and to allow patients to make informed decisions about their treatment.     

程丑夫教授论治情志病验案举隅

程丑夫是国家级名老中医,湖南中医药大学第一附属医院主任医师、教授、博士生导师,享受政府特殊津贴专家,出身于中医世家,从医40余年,经验丰富,对于内科系统及疑难杂症的治疗颇有心得,笔者有幸跟师学习,聆听教诲,受益匪浅,现将程师论治情志病的经典验案略陈一二。1思虑伤脾案患者肖某,女,27岁。初诊：2014年5月20日。半年前因婚变后出现忧心忡忡,多思多虑,近1月来反复腹部胀满,刻诊：腹胀,食后为甚,呃逆,无反酸,通气后可减轻,无腹痛,不欲食,夜寐不安,二便调。舌红苔厚白腻,脉弦,BP：110／70mmHg。     

益智健脑颗粒联合针灸对阿尔茨海默病大鼠学习记忆的影响

目的观察益智健脑颗粒联合针灸对阿尔茨海默病（Alzheimers disease,AD）大鼠学习记忆的影响。方法将大鼠随机分为假手术组（A组）、模型组（B组）、针灸组（C组）、益智＋针灸组（D组）各10只,B、C、D 3组分别以海马CA1区注射β淀粉样蛋白25-35（Aβ25-35）造模,A组注射等量的双蒸水,各组分别治疗20 d后行Morris水迷宫试验,观察大鼠学习记忆能力变化。结果B组较A组的平均潜伏期明显延长,差异具有统计学意义（P〈0.05）;与B组比较,C组、D组的平均潜伏期明显缩短,过台次数增多,差异具有统计学意义（P〈0.05,P〈0.01）;与C组比较,D组的潜伏期缩短,过台次数增多,差异具有统计学意义（P〈0.05）。结论益智健脑颗粒联合针灸能够提高Aβ25-35介导的AD模型大鼠的学习记忆能力。     

补肾活血方对PCOS大鼠模型卵巢中PAI-1mRNA表达的影响

目的探讨补肾活血方对大鼠PCOS模型卵巢局部纤溶酶原激活物抑制因子-1（PAI—1mRNA）表达的影响。方法选用未成年24d龄SD雌性大鼠60只,随机分为模型组、克罗米酚组、补肾活血方高剂量组、补肾活血方低剂量组、正常对照组5组。用Bogovich法建立大鼠多囊卵巢病理模型。以克罗米酚为对照。用原位杂交法观察补肾活血方对多囊卵巢大鼠局部PAI—1mRNA的影响。结果模型组卵巢局部PAI—1mRNA存在卵泡膜间质细胞显著增高,用补肾活血方高、低剂量与克罗米酚药后,卵巢局部PAI-1mRNA的表达明显降低．差异具有统计学意义（P〈0．05、P〈0．01）。补肾活血方高剂量组与克罗米酚组比较,差异具有显著统计学意义（P〈0．01）;低荆量组与克罗米酚组比较差异无统计学意义（P〉0．05）,补肾活血方高、低剂量组比较,低剂量组卵泡膜间质细胞上PAI-1的基因表达增高更明显,但二者差异无统计学意义（P〉0．05）。结论PAI-1mRNA可能与多囊卵巢综合征的发病机制有关。以补肾活血立法的补肾活血方能降低多囊卵巢大鼠局部PAI—1mRNA的显著增高表达．降低PAI—1mRNA卵巢局部的作用。提示补肾活血方可能通过PAI—1mRNA途径促进卵巢排卵的机制。     

Liuwei Dihuang,a traditional Chinese herbal formula,suppresses chronic inflammation and oxidative stress in obese rats

OBJECTIVE： To investigate the anti-inflammatory, anti-oxidative stress, and adipokine-ameliorating effects of Liuwei Dihuang （LWDH）, a traditional Chinese herbal formula, in obese rats. METHODS： After 2 weeks of acclimation with free access to regular rodent chow and water, obese-prone-caesarean-derived （OP-CD） rats were fed a modified AIN-93G diet containing 60% energy from fat. Treatment was performed twice daily by gavage feeding with 500, 1 500, or 3 500 mg/kg body weight LWDH suspended in water （n=12 rats per group）. Twelve obese-resistant-CD （OR-CD） rats were fed the atherogenic diet and gavaged with water, and served as the normal control. Blood biomarkers of inflammation, oxidative stress and adiponectin were measured post-sacrifice and used to determine the treatment effect of LWDH and assess the suitability of OR/OP-CD rats for studying these parameters. RESULTS： After 9 weeks of treatment, LWDH lowered serum C-reactive protein （CRP） and tumour necrosis factor-α （TNF-α） levels. Serum interleukin-6 （IL-6） levels showed a tendency towards reduction, but were not significantly different from the OP-CD control. Liver superoxide dismutase （SOD） activity was increased in response to all three doses of LWDH, while the levels of reduced （GSH） and oxidized glutathione （GSSG） and thiobarbituric acid reactive substances （TBARS） were unchanged. Serum adiponectin levels were increased in response to oral administration of LWDH at the dose of either 500 or 1 500 mg/kg body weight. In addition, comparisons between OR-CD and OP-CD rats revealed differential, and for some biomarkers, conflicting characteristics of high-fat diet-fed OP-CD rats in reference to obese human subjects in terms of inflammatory and oxidative stress biomarkers and circulating adiponectin levels. CONCLUSION： The results show, for the first time, the anti-inflammatory, anti-oxidative stress and adiponectin-ameliorating effects of LWDH in obese rats. The suitability of the OP-JOP-CD rat model as     

表皮生长因子受体酪氨酸激酶抑制剂在非小细胞肺癌应用的瓶颈——获得性耐药

以表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitor,EGFR-TKI）分子靶向治疗研究为肇始,转化性研究使基础实验和临床实践间的鸿沟迅速填平,改变着人们认识治疗肺癌的视角。无可否认,EGFR-TKI上市后极大地延伸了肿瘤学家治疗肺癌的手段,但不管从临床经验、临床研究数据、分子生物学层面还是文献计量学的角度,     

WHO西太区与“世界中医药学会联合会”中医名词术语国际标准比较研究：精、神、气、血、津、液部分

精、神、气、血、津、液是中医理论中6个非常重要的概念，有关术语在《WHO西太区传统医学国际标准名词术语》中一共收录了59条，“世界中医药学会联合会”（以下简称世中联）《中医基本名词术语中英对照国际标准》中收录了58条。血、津、液的内涵较为具体，有一定的物质基础，理解并不困难。翻译上虽有差异，但亦不难统一。精、神、     

New Mechanism of Herb-herb Interaction between Ginseng and Trogopterus Based on CYPs in Rat Livers

The study was designed to investigate the potential mechanism of herb-herb interaction between ginseng and Trogopterus （Trg） based on Cytochrome P450 isozymes （CYPs） in rat livers. We estimated the influence on CYP1A2, CYP2E1, and CYP3A1/2 activity caused by ginseng and Trg used in combination. The CYP1A2 and CYP2E1 enzyme activity were induced by ginseng and Trg used in combination. And this induction effect was caused via inducing CYP1A2 and CYP2E1 protein expression which was supposed caused by inducing the gene expression of CYP1A2 and CYP2E1.     

中医疗法治疗运动性疲劳的研究进展

随着竞技体育的发展，运动员经常承受着大负荷、超强度的体力训练，因此极易产生运动性疲劳。疲劳的出现使肌内压增高，局部缺血，造成氧化代谢、H^＋排出率与pH值降低，血乳酸增高，从而影响肌纤维神经传导速度和肌内收缩力量，减弱了肌肉保护能力。致使较多的冲击力传到骨骼上，故易导致疲劳骨折的发生,严重影响了运动员的训练和比赛成绩，对运动员身心产生不必要的伤害。运动性疲劳消除手段的研究一直是竞技体育工作和运动医学关注和研究的焦点。