52例尿毒症患者移植前后脑电图,脑地形图的对比分析

对５２例尿毒症患者作肾移植前后脑电图，脑电地形图检查对比，主前ＥＥＧ异常率５５．８％，术后降至４０．４％，术前ＢＥＡＭ异常率６９．８％，术后降至５１．９％，且异常程度改善，但病程长，术前尿素氮＞３５．７ｍｍｏｌ／Ｌ者恢复慢，分析术前异常率高，其中一个原因亦与血透治疗有关。值得注意的是肾移植术后广泛应用环孢素，致术后ＥＥＧ、ＢＥＡＭ恢复与肾功能的恢复不呈正相关，提示应用ＥＥＧ，ＢＥＡＭ观察患者脑损害     

52例尿毒症患者肾移植前后脑电图、脑地形图的对比分析

对５２例尿毒症患者作肾移植前后脑电图（ＥＥＧ）、脑电地形图（ＢＥＡＭ）检查对比分析。术前ＥＥＧ异常率５５．８％，术后降至４０．４％，术前ＢＥＡＭ异常率６９．８％，术后降至５１．９％，且异常程度改善，但病程长，术前尿素氮＞３５．７ｍｍｏｌ／Ｌ者恢复慢，分析术前异常率高，其中一个原因亦与血透治疗有关。值得注意的是肾移植术后广泛应用环孢素，致术后ＥＥＧ、ＢＥＡＭ恢复与肾功能的恢复不呈正相关。提示应用ＥＥＧ、ＢＥＡＭ观察患者脑损害状况以及药物的神经毒性作用，可为临床提供简便有价值的参考。     

异丙酚,硫喷妥钠和羟丁酸钠麻醉诱导中脑电图及脑地形图功…

脑电图（ＥＦＧ）、脑地形图（ＣＴＭ）能客观地评定大脑的机能活动，凡是作用于大脑的麻醉药均可通过ＥＥＧ及ＣＴＭ功率的变化进行比较。本试验４５例ＡＳＡＩ￣Ⅱ级的脑科患者，随机分成三组，在静脉氟芬合剂的先导下，分别给予等效剂量的异丙酚（Ｉ组），硫喷妥钠（Ⅱ组）、羟丁酸钠（Ⅲ组），用ＳＷ系列智能脑电监测仪持续描记脑电变化。结果三组用药后ＥＥＧ均首先应用β高频兴奋活动，最大效应期，Ｉ组无δ波出现，ＣＴＭ最大     

中国肾移植排斥反应临床诊疗指南(2016版)

尿毒症是影响人类健康的重大疾病,最有效的治疗手段是肾移植。自从美国Murry 1954年成功地进行了第1例临床肾移植以来,已有60余年的发展历程,全球有近百万尿毒症患者接受肾移植手术而获得第2次生命。随着肾移植的外科技术日臻成熟,组织配型技术的普遍开展、围术期抗体诱导治疗和新型强效免疫抑制剂的广泛应用,     

尿毒症频发心力衰竭患者肾移植15例

目的：探讨尿毒症频发心力衰竭(心衰)患者肾移植的可行性及安全性。方法：回顾性分析15例继发于尿毒症的顽固性心衰患者肾移植围手术期处理方法及临床效果。结果：14例患者安全度过围手术期，3个月后心脏缩小，心功能明显改善，移植肾功能正常；1例在术后第8天死于心肺功能衰竭。结论：顽固性心衰尿毒症患者可行肾移植，心衰并非肾移植的绝对禁忌证，只要受体选择合适，治疗及时得当，患者可安全度过肾移植围手术期。     

男性患者肾移植前后性相关激素、微量元素及勃起功能情况调查

目的　探讨男性尿毒症患者在血液透析期、肾移植术后的性相关激素、微量元素和勃起功能情况及其相互间的关系。方法　回顾性分析 1 999年 3月～ 2 0 0 2年 1 2月期间 6 80例肾移植中的1 36例男性患者 (实验组 )肾移植前后的随访资料 ;对照组为 30例肾功能正常的男性。结果　实验组尿毒症患者在血液透析期间的性相关激素、微量元素和勃起功能情况与对照组比较 ,差异有显著性(P <0 .0 0 1 ) ;肾移植术后 ,其性相关激素、微量元素和勃起功能情况和血液透析期间比较 ,差异有显著性 (P <0 .0 1 )。结论　血液透析不能改善尿毒症患者在性相关激素、微量元素和勃起功能方面的异常 ;而肾移植术多能改善这些异常 ,尤其是勃起功能的改善 ,提高了尿毒症患者的生活质量。     

尿毒症肾移植患者围手术期人巨细胞病毒基因检测及意义

目的探讨尿毒症患者肾移植围手术期人类巨细胞病毒(HCMV)基因检测的意义。方法肾移植患者外周血标本56例,健康对照组外周血标本15例。采用荧光定量PCR(FQ-PCR)技术测定标本中HCMV基因拷贝数,结合临床表现进行综合分析。结果56例患者术前HCMV异常表达21例(37.5%),男17例,女4例,检测值(3.84±2.72)×104基因拷贝数/ml;移植术后异常表达增至25例(44.6%),检测值(5.32±4.72)×104基因拷贝数/ml。对照组15例,异常表达1例(6.7%)。结论尿毒症患者肾移植围手术期HCMV基因拷贝数检测可以作为HCMV活动性感染的预警,为临床早期诊断、预防和治疗提供依据。     

肾移植对慢性肾功能不全尿毒症期患者睾丸体积及生育力指数的影响

目的 探讨肾移植对男性慢性肾功能不全尿毒症期患者睾丸体积及生育力指数的影响.方法 解放军第117医院肾移植中心30例慢性肾功能不全尿毒症期患者于肾移植术前以及术后1个月、3个月和1年应用彩超进行睾丸体积监测,并与20名正常男性的睾丸体积比较.另检测40例尿毒症期和40例肾移植受者的精液,并根据公式[精子密度(×106/mL)×精子活动力×精子正常形态率]计算出生育力指数.结果 慢性肾功能不全尿毒症期患者的睾丸体积术前左侧为(6.82±1.49)mL, 右侧为(7.46±1.89)mL;肾移植术后1个月、3个月和1年左侧分别为(8.25±1.67)mL、(9.31±1.56) mL和(9.80±1.51)mL,右侧分别为(9.18±1.76) mL、(10.41±1.43) mL和(11.09±1.45)mL,肾移植受者术后1个月、3个月和1年的睾丸体积均大于尿毒症期患者,差异有显著性意义(均P<0.01).正常对照组生育力指数为13.03(14.26),肾移植受者的生育力指数为7.19(10.18), 而尿毒症期患者的生育力指数仅为0.23(0.76).尿毒症期患者的生育力指数比肾移植受者和正常对照组均小,差异有显著性意义(均P<0.01). 结论 慢性肾功能不全尿毒症期患者睾丸体积缩小,生育力指数下降, 而成功的肾移植可以明显改善尿毒症期患者的睾丸体积及生育力指数.     

肾移植术后肝脏损害的临床分析

肾移植术后肝脏损害的临床分析林玉梅，郑纪成，马卫闽随着肾移植手术的开展，术后出现肝脏损害在临床上颇为多见，我院１９８９年１月至１９９３年１２月共收治肾移植术后肝功能异常患者２０例，现报告如下。一、一般资料：男１６例，女４例，年龄２０～３０岁３例，３１...     

尿毒症和肾移植患者血清脂质及载脂蛋白水平测定

为了便于对尿毒症和肾移植患者并发心血管疾病趋势的分析，我们对６４例尿毒症患者和２０例肾移植患者分别用美国ＥｎｃｏｒｅⅡ型自动生化分析仪进行了７种血清脂质及载脂蛋白的测定。结果表明：尿毒症患者血清脂质及载脂蛋白含量与健康人相比，其中５种指标明显异常，已具备有发生冠心病的危险因素。而肾移植患者虽也有某些脂类指标异常，但Ａｐｏ－ＡＩ／Ａｐｏ－Ｂ１００比值这一重要指标正常，则发生冠心病的危险性较小。由此可     

Thrombosis of cortical vein: a case report

A 39-year-old woman presented with disturbed consciousness, left hemiparesis and headache. CT scan revealed subcortical hemorrhage in the right parietal region, which had lower density than usual intracerebral hemorrhage and was associated with irregular perifocal edema. Cerebral angiograms revealed narrowed cortical vein with irregular wall in the right parietal region, where delayed local blood flow into the deep cerebral veins through collateral vessels was noted. The diagnosis was subcortical hemorrhage due to thrombosis of cortical vein. Her symptoms and brain edema were progressive. To reduce intracranial pressure, evacuation of the hematoma was performed. The hematoma which existed 1cm under the right parietal cortex was about 20g in weight. She remarkably improved soon after operation. Frequency of sinovenous thrombosis has been reported to be about 10% of all cerebral ischemic diseases, however, localized venous thrombosis is rare among them. This is because it is not always symptomatic and it is difficult to make accurate diagnosis. Six cases of localized venous thrombosis were reviewed, in which accurate diagnosis were established by cerebral angiograms, CT scan and/or autopsy. Clinical and radiological features of this case were presented.     

Visual navigation in adolescents with early periventricular lesions: knowing where, but not getting there

Visual navigation in familiar and unfamiliar surroundings is an essential ingredient of adaptive daily life behavior. Recent brain imaging work helps to recognize that establishing connectivity between brain regions is of importance for successful navigation. Here, we ask whether the ability to navigate is impaired in adolescents who were born premature and suffer congenital bilateral periventricular brain damage that might affect the pathways interconnecting subcortical structures with cortex. Performance on a set of visual labyrinth tasks was significantly worse in patients with periventricular leukomalacia (PVL) as compared with premature-born controls without lesions and term-born adolescents. The ability for visual navigation inversely relates to the severity of motor disability, leg-dominated bilateral spastic cerebral palsy. This agrees with the view that navigation ability substantially improves with practice and might be compromised in individuals with restrictions in active spatial exploration. Visual navigation is negatively linked to the volumetric extent of lesions over the right parietal and frontal periventricular regions. Whereas impairments of visual processing of point-light biological motion are associated in patients with PVL with bilateral parietal periventricular lesions, navigation ability is specifically linked to the frontal lesions in the right hemisphere. We suggest that more anterior periventricular lesions impair the interrelations between the right hippocampus and cortical areas leading to disintegration of neural networks engaged in visual navigation. For the first time, we show that the severity of right frontal periventricular damage and leg-dominated motor disorders can serve as independent predictors of the visual navigation disability.     

Serial MRI findings in neuro-Beh?et disease]

Beh?et disease is a systemic disorder characterised by the triad of recurrent aphthous ulcers of the mouth, genital ulcers and uveitis. Neurological involvement is estimated at 10-25% in Beh?et disease (neuro-Beh?et). These include diplopia, pseudobulbar palsy, cranial nerve palsies, cerebeller ataxia, and cerebral and spinal sensory and motor disturbances. A case of neuro-Beh?et disease is reported. A 51-year-old man was admitted with TIA attack. He had been suffering from recurrent oral and genital ulcers for several months before admission. Neurological examination on admission revealed poor mental activity, left facial nerve palsy and left hemiparesis. Lumbar puncture showed CSF pleocytosis. CT and MRI revealed multiple lesions in the cerebral hemisphere and the brain stem. CT showed spotty high density areas with perifocal low density areas in the frontal, temporal and parietal lobe which were enhanced with contrast materials. T1 weighted image of MRI revealed iso intensity areas with perifocal low intensity areas which were enhanced with Gd-DTPA in the frontal, temporal and parietal lobes. T2 weighted image revealed low intensity areas with perifocal high intensity areas in the same regions shown in the T1 weighted image. Moreover ring-like enhanced lesions with Gd-DTPA were revealed in the brain stem and corona radiata in the T1 weighted image. After high dose steroid treatment, he showed marked clinical improvement. CSF pleocytosis was normalized and the lesions were gradually reduced in size and were no longer enhanced with Gd-DTPA. MRI findings are well correlated with clinical features.(ABSTRACT TRUNCATED AT 250 WORDS)     

The association of intracranial meningioma with arteriovenous malformation and aneurysm (author's transl)

A rate case was reported in which a brain tumor was also found in a patient who had an intracranial arteriovenous malformation and a cerebral aneurysm separately. A 56-year-old man was admitted with motor weakness and repeated convulsions in the left lower limb. Preoperative right and left carotid angiograms showed an arteriovenous malformation in the left parietal region and a left internal carotid artery aneurysm, but both the carotid angiograms and brain scintigrams could reveal no brain tumor. After the radical operation for these two lesions, pneumoencephalography, right serial carotid angiography and brain scintigraphy were performed, demonstrating a right parasagittal tumor. The tumor was totally removed and histological findings were fibrous meningioma.     

Calcified epidural hematoma-report of a case incidentally found 16 years after head injury (author's transl)

A calcified epidural hydroma, or old hematoma, was incidentally found in the left parietal region of a 55-year-old man presenting status epilepticus due to uremia after a lapse of 16 years following head injury. The hydroma (10x7x1.2 cm) was extirpated operatirelly. There was an extensive calcificantion in the wall, and the outer wall showed bone-like metaplasia and hemosiderin deposit. No skull fracture was discernible. The dura and the brain surface neighboring the hydroma were gloslsly normal. The patient eventually died of uremia.     

Brain abscess following cerebral infarction: a case report

The authors report a case of brain abscess following cerebral infarction. A 73-year-old man was admitted to our clinic with symptoms of right hemiparesis and total aphasia. CT scan revealed abnormal low density area in the left fronto-temporo-parietal region. Cerebral angiography demonstrated occlusion of the left middle cerebral artery at the M1 portion. On the 16th hospital day, an episode of generalized seizure with high fever appeared, and intermittent high fever persisted thereafter. Two months after admission, CT scan revealed several cystic lesions with marked ring enhancement at the site of cerebral infarction, suggesting multiple abscesses. Aspirations of left frontal and parietal abscesses were accomplished and the cultures of the pus disclosed Proteus vulgaris. Due to progressive hydrocephalus, a ventriculoperitoneal shunt was constructed one month later. Repeated CT scans showed a gradual diminution of the abscesses. It is considered that the blood-brain barrier is broken and the local immunological system against bacteria may be weakened when the brain is damaged by ischemia. Brain abscess seems to be developed in such circumstances even under the influence of transient bacteremia which originates in other parts of the body. Therefore the possibility of cerebral abscess should be suspected if patients with cerebral infarction suffer from the symptoms such as fever, neck stiffness or disturbance of consciousness.     

The glutamate AMPA receptor antagonist,YM872, attenuates cortical tissue loss,regional cerebral edema,and neurological motor deficits after experimental brain injury in rats

A massive increase in extracellular glutamate is thought to contribute to brain damage after traumatic brain injury. We examined the neuroprotective effect of the AMPA receptor antagonist YM872 in a rat head injury model using the fluid-percussion procedure. Male Sprague-Dawley rats were subjected to right lateral (parasagittal) fluid-percussion brain injury or sham injury. At 15 min postinjury, they received either YM872 (20 mg/kg/h, 20 mg/3 mL) or normal saline (vehicle) intravenously for 4 h. The administration of YM872 significantly improved the composite neuroscore at 1 and 2 weeks postinjury (p < 0.05), and markedly reduced the volume of tissue loss in the injured cortex (p < 0.05). It also significantly reduced cerebral edema in the ipsilateral parietal cortex at 48 h postinjury (p < 0.01). These results indicate that the posttraumatic administration of YM872 may be neuroprotective by ameliorating cortical tissue loss and regional cerebral edema, and suggest the importance of AMPA receptors in traumatic brain damage involving secondary injury processes.     

Primary angiitis of the central nervous system mimicking tumor-like lesion--case report

A 60-year-old man presented with a rare case of primary angiitis of the central nervous system mimicking a tumor-like lesion and manifesting as slight disorientation, left hemiparesis, and motor aphasia. Computed tomography showed multiple low density lesions in the left frontal lobe, brain stem, and right parietal lobe. Magnetic resonance images revealed a slightly enhanced mass lesion in the right parietal lobe with surrounding brain edema. Serum, cerebrospinal fluid, and other image examinations did not show any abnormal findings, so surgical removal of the right parietal mass was performed. Histological examination revealed that the mass consisted of hemorrhagic infarction without cellular atypia. Proliferations of endothelial cells in small and medium arteries, and infiltration of macrophages in the perivascular space were detected in the infarction tissues. The histological diagnosis was primary angiitis of the central nervous system.     

Left atrial myxoma with cerebral oncotic aneurysms with special reference to the importance of serial angiography

A case of atrial myxoma with cerebral oncotic aneurysms was presented. A 37 year-old woman was admitted complaining of right hemiparesis, and episodes of syncope. Neurological examination on admission revealed a right arm monoparesis, a right hemisensory disturbance, and a motor aphasia. Computed tomography (CT) demonstrated low density areas in the left fronto-parietal region, and multiple discrete enhancing high density spots scattered bilaterally in the parietal lobes. Cerebral angiography showed multiple fusiform peripheral aneurysms especially in the distribution of the bilateral middle cerebral arteries. Cerebral emboli from the cardiac source were suspected, and an echocardiography was performed, which disclosed a huge villous mass in the left atrium. The cardiac mass was resected uneventfully under cardiopulmonary bypass. It proved to be a left atrial myxoma. Postoperatively, her neurological deficit persisted. After the resection of the cardiac tumor, follow-up angiographies were undertaken twice. The second angiography performed 6 months later revealed spontaneous resolution or stabilization of most of the aneurysms detected before. On the other hand, newly-developed aneurysms were seen at the sites which had seemed normal previously on the first angiography. No remarkable changes were seen on the third one except the slight enlargement of one of the aneurysms in the middle cerebral territory. At 3 years she was neurologically stable. Because of the paucity of knowledge concerning the natural history of cerebral oncotic aneurysms and lack of definite treatment for them, long-term follow-up including serial angiography is mandatory after the resection of left atrial myxoma.