小脑幕切开术治疗重型颅脑损伤并小脑幕切迹疝22例分析

目的探讨小脑幕切开术在治疗重型颅脑损伤并小脑幕切迹疝患者中的作用。方法回顾性分析采用标准外伤大骨瓣减压术中行小脑幕切开术治疗重型颅脑损伤并小脑幕切迹疝患者的临床资料及疗效。结果22例患者中,生存18例,死亡4例,死亡率18．2％。18例生存患者,术后随访3个月以上,根据GOS评分：恢复良好8例,中残7例,重残2例,植物生存1例。结论小脑幕切开术能减轻继发性脑干损伤,在治疗重型颅脑损伤并小脑幕切迹疝患者中具有较好的疗效,能有效降低致死率和致残率。     

小脑幕缘切开术中引流环池脑脊液对颅脑损伤合并小脑幕切迹疝患者颅内压的影响

目的研究小脑幕缘切开术中引流环池脑脊液对降低颅脑损伤合并小脑幕切迹疝患者颅内压的作用。方法将40例颅脑损伤合并小脑幕切迹疝患者按随机数字表法分为两组。观察组（20例）在术中对环池脑脊液充分引流并计量,对照组（20例）术中对环池脑脊液不进行引流,两组术后监测颅内压5d,比较引流前后颅内压及侧脑室内压力的变化。结果观察组术后不同时间颅内压均值均低下对照组（P〈0．05）。观察组小脑幕缘切开前至环池脑脊液引流结束时侧脑室内压力下降均值较对照组下降均值高（P〈0.05）：结论小脑幕缘切开术中对环池脑脊液充分引流能恢复脑脊液循环通路,降低颅内压,提高减压效果。     

小脑幕切开术用于外伤性小脑幕切迹疝复位的临床体会

外伤性小脑幕切迹疝是重型颅脑损伤的严重并发症,病死率在40%～90%[1].2002年1月至2008年6月间我们采用小脑幕切开术治疗48例小脑幕切迹疝病人,效果良好,报告如下.     

重型脑外伤合并小脑幕切迹疝术中复位的临床观察

目的探讨重型脑外伤合并小脑幕切迹疝术中复位的临床疗效。方法选取我院2012-01—2014-01收治的100例重型脑外伤患者为研究对象。按照入院顺序随机分为观察组与对照组各50例,对照组应用传统手术方法治疗,观察组在对照组基础上实施小脑幕切迹疝术中复位。对比2组预后效果及颅内压的变化情况。结果观察组预后效果显著优于对照组,颅内压显著低于对照组,差异有统计学意义(P0.05)。结论重型脑外伤患者应用小脑幕切迹疝术中复位,颅内压显著降低,减压效果显著,患者预后良好,值得临床推广应用。     

小脑幕切开治疗脑疝后大脑后动脉梗塞

目的探讨小脑幕切开对小脑幕切迹疝后大脑后动脉梗塞的疗效。方法回顾分析72例颅脑损伤并小脑幕切迹疝患者的临床资料，其中39例患者仅行标准外伤大骨瓣减压，33例患者行标准外伤大骨瓣减压＋小脑幕切开术。结果术后动态CT显示小脑幕切开组发生大脑后动脉支配的枕叶及部分颞叶脑梗死明显低于小脑幕未切开组。结论颅脑损伤并小脑幕切迹疝患者行标准外伤大骨瓣减压＋小脑幕切开可以明显降低脑梗死的发生率、降低致残率、提高生存质量。     

重型颅脑损伤致脑疝的手术治疗体会

重型颅脑损伤所致小脑幕切迹疝死残率高，是颅脑损伤治疗的重点和难点。本文回顾我科1998年6月至2003年9月重型颅脑损伤所致小脑幕切迹疝患者89例经手术治疗获救的临床资料，分析其临床特点、手术方式、治疗效果，现报告如下。     

重型颅脑损伤致脑疝手术32例临床分析

本文回顾分析我科2002-01～2008-06重型颅脑损伤所致小脑幕切迹疝患者32例,经手术治疗的临床资料报告如下. 1 资料与方法     

颅脑创伤小脑幕切迹疝前驱期临床征象分析

目的探讨小脑幕切迹疝的前驱期临床征象,提高重型颅脑损伤的救治率。方法回顾分析我科小脑幕切迹疝病人的病历资料,总结脑疝发生前的临床表现和辅助检查,寻找小脑幕切迹疝前驱期较常见的临床征象。结果发生小脑幕切迹疝前主要临床表现有:GCS评分下降,识障碍程度加深,尿失禁,剧烈头痛,频繁呕吐,躁动。结论意识障碍程度加深、尿失禁、剧烈头痛、频繁呕吐、躁动为脑疝前驱期的特征性临床表现。患侧脑室、侧裂合并脑基底池的受压变窄为脑疝前驱期的特征性CT表现。有上述临床特点者应立即复查头CT,以便及时开颅手术,提高救治率。     

小脑幕裂孔切开联合大骨瓣减压治疗小脑幕切迹疝

目的研究小脑幕裂孔切开联合常规大骨瓣减压手术在小脑幕切迹疝病人中的临床疗效与实际应用价值。方法120例术前已发生小脑幕切迹疝的重型颅脑损伤及脑出血病人,按照患者入院顺序依次分为3组：标准大骨瓣减压组、内减压组和小脑幕裂孔切开组,每组40例,分别按照不同的手术原则进行手术。术后48h复查头颅CT,比较各组间的死亡率及脑干周围池改善率,对比各组间术后2周、4周GCS评分及术后24周GOS评分。结果术后小脑幕裂孔切开组死亡率显著低于标准大骨瓣减压组（P〈0.05）,但与内减压组比较无统计学显著性差异（P〉0.05）。脑干周围池改善率,小脑幕裂孔切开组显著高于大骨瓣减压组及内减压组（P〈0.01）。术后2周、4周GCS评分及术后24周GOS评分小脑幕裂孔切开组显著优于大骨瓣减压组及内减压组（P〈0.01）。结论小脑幕裂孔切开联合常规大骨瓣减压术治疗小脑幕切迹疝疗效肯定,可以显著降低病人的死亡率和伤残率,改善其预后,值得临床推广。     

小脑幕裂孔切开术在治疗重型颅脑损伤中的应用

目的探讨小脑幕裂孔切开术在重型颅脑损伤患者手术中的应用。方法对我科2004-06~2007-10期间收治的44例重型颅脑损伤合并有小脑幕裂孔疝的患者,在开颅清除血肿、去骨瓣减压的基础上加行小脑幕裂孔切开术。结果恢复良好24例(54.6%),中残6例(13.6%),重型4例(9.1%),植物生存4例(9.1%),死亡6例(13.6%)。结论小脑幕裂孔切开术有利于缓解小脑幕裂孔疝所致的脑干继发性损伤,降低病残率和病死率。     

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.     

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.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -