急性外伤性颅内血肿双侧开颅术的临床疗效分析

目的探讨双侧开颅术治疗急性外伤性颅内血肿的临床应用方法及疗效。方法对21例急性外伤性颅内血肿行双侧开颅术患者的临床资料进行回顾性分析。结果术后3个月至半年随访,本组患者恢复良好13例、轻度残疾2例、重度残疾1例、植物生存0例、死亡5例,死亡率为23.8%。结论双侧开颅术治疗急性外伤性颅内血肿应严格掌握手术指征,及早发现及处理迟发性颅内血肿,可有效降低患者的病死率。     

儿童外伤性脑梗塞的CT,MRI与临床研究

儿童脑梗塞临床少见,而儿童外伤性脑梗塞临床罕见,目前国内尚无专题报告。CT问世前,外伤性脑梗塞多误诊为颅内血肿、脑挫裂伤、硬膜下血肿等。近年CT使外伤后脑梗塞得以临床确诊。现将我院收治的16例儿童外伤性脑梗塞报告如下。     

10例硬脑膜外血肿术后合并脑梗塞分析

硬脑膜外血肿是位于颅骨内板与硬脑膜之间的血肿，好发于幕上半球凸面，十分常见，约占外伤性颅内血肿的30％左右。我科1998年至2002年共行硬脑膜外血肿清除术194例，其中10例术后出现脑梗塞，现报告如下。     

手术治疗外伤性多发性颅内血肿的体会

目的 探讨手术治疗外伤性多发性颅内血肿的临床效果.方法 对2007年7月至2010年2月收治的122例外伤性多发性颅内血肿患者均采用手术治疗.结果 122例外伤性多发性颅内血肿患者中,持续植物状态生存9例,重残13例,中残20例,良好67例,术后死亡13例.死亡原因为颅内血肿量大,脑挫裂伤严重并脑水肿致脑疝,最后导致脑...     

双侧外伤性颅内血肿的手术治疗体会

目的探讨双侧外伤性多发性颅内血肿的手术时机和手术方式。方法对47例双侧幕上外伤性多发性颅内血肿手术病人的临床资料进行回顾性分析。结果术后恢复良好32例，中残7例，重残3例，植物生存2例，死亡3例。结论选择合适的手术时机和恰当的手术方式可改善双侧外伤性多发性颅内血肿患者的预后。     

外伤性颅内血肿术后再发血肿18例分析

外伤性颅内血肿术后再发血肿１８例分析叶绪昌，毛世春，张继伟，刘建雄，陈世洁，余辉，官利民，张作洪我科于１９８８～１９９２年治疗外伤性颅内血肿术后再发血肿１８例，现报告如下：临床资料本组男１２例，女６例，年龄１６～６５岁。１６例经手术证实，１例尸检发现...     

急性颅脑损伤术后继发对侧迟发性血肿诊治分析

目的探讨急性外伤性颅内血肿清除术后继发对侧迟发性血肿的诊治，以提高疗效。方法对36例外伤性颅内血肿清除术中及术后并发对侧迟发性血肿病人的临床资料进行回顾性分析。结果36例对侧迟发性血肿均行手术治疗，其中恢复良好16例，中残6例，重残3例，死亡11例。结论在清除急性外伤性颅内血肿后，若术中发生急性脑肿胀或术后病情恶化．应考虑对侧迟发性血肿形成的可能，及时钻颅探查或复查头颅CT，及早治疗可改善预后。     

改良式大骨瓣减压联合脑池引流术在外伤性颅内血肿脑疝形成患者中的应用

目的：探讨改良大骨瓣减压联合脑池引流术在外伤性颅内血肿脑疝形成患者中的应用价值。方法将外伤性颅内血肿并发脑疝患者154例，根据知情同意权分成2组，每组77例；实验组采取改良大骨片减压联合脑池引流术，对照组采取改良大骨片减压术，对比2组GCS评分、并发症等临床指标。结果术后实验组患者颅内压（ICP）和格拉斯哥评分（GCS）明显改善，与对照组相比差异有统计学意义（ P＜0.001）；术后恢复良好率明显高于对照组，术后病死率和并发症发生率明显低于对照组，差异均有统计学意义（P＜0.05）。结论改良大骨片减压联合脑池引流术治疗外伤性颅内血肿并发脑疝患者能有效降低病死率、减少并发症，提高临床疗效，改善预后，值得临床应用。     

急性外伤性颅内血肿开颅血肿清除术后迟发血肿相关因素分析

目的 分析颅内血肿开颅血肿清除术患者的临床特征及术后出现迟发血肿的危险因素.方法 以我院2009-03-2013-03收治的68例急性外伤性颅内血肿开颅手术治疗患者为研究对象,根据是否发生迟发血肿进行分组,采用Logistic回归模型分析术后迟发血肿危险因素.结果 多因素Logistic回归分析结果显示血浆凝血酶时间、手术时机、颅骨骨折为发生迟发血肿的危险因素.结论 急性外伤性颅内血肿患者多伴有重型颅脑损伤和颅内占位,术后迟发血肿一般发生于术后12 h内,以脑内血肿、硬膜外血肿、硬膜下血肿为常见,血浆凝血酶时间延长、手术时机短、合并颅骨骨折为高危因素,应引起高度关注.     

特急性外伤性颅内血肿个体化手术时机与方案

目的 探讨个体化手术治疗特急性外伤性颅内血肿的疗效。方法 回顾性分析2009年1月至2018年1月手术治疗的126例特急性外伤性颅内血肿的临床资料，急诊常规急诊开颅手术61例（常规手术 组），个体化手术65例（个体化手术组）。结果 与常规手术组相比，个体化手术组术中脑膨出、术后迟发性血肿、颅骨缺损、脑积水、继发性癫痫的发生率均显著降低（P<0.05）；术后6个月，按GOS评 分评估预后，个体化手术组恢复良好率明显增高（P<0.05）。结论 对于特急性外伤性颅内血肿，个体化手术方案能显著提高疗效，减少并发症发生率。     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -