106例缺血性脑血管病患者全脑血管造影分析

目的分析缺血性脑血管病患者颅内外动脉狭窄的分布。方法对我院实施DSA检查的106例缺血性脑血管病的结果进行分析,均经头颅CT排除脑出血,TCD及颈动脉彩超检查后怀疑有动脉狭窄的缺血性脑血管病。所有患者均实施选择性全脑血管造影术,椎动脉和颈动脉均有正侧位血管造影像;根据患者的DSA检查结果,分析动脉狭窄的部位、受累血管数目及血管狭窄形态;重度狭窄的病例予以支架治疗和球囊成型术。结果血管造影结果提示89.6%患者有不同程度的血管狭窄或闭塞,其中75.5%为前循环受累,37.7%为后循环受累。前循环受累血管中以颈内动脉(56.6%)和大脑中动脉(26.4%)受累最常见,后循环受累血管中以椎动脉(33.0%)最多见。支架治疗和球囊成型术临床疗效显著。结论缺血性脑血管病造影显示大部分患者有肯定的脑血管狭窄和闭塞。脑梗死患者血管病变以颈内动脉病变为主,椎基底动脉供血不足亦以颈内动脉病变多见,支架治疗和球囊成型可作为重度狭窄的治疗方法。     

中青年与老年脑梗死患者脑动脉狭窄分布的DSA分析

目的应用数字减影血管造影对中青年与老年脑梗死患者脑动脉狭窄的分布特征进行分析。方法选择脑梗死患者86例,根据患者年龄分为中青年组（年龄〈60岁）48例,老年组（年龄≥60岁）患者38例,应用数字减影血管造影技术（DSA）对患者脑动脉病变血管狭窄程度及分布进行分析。结果 1老年组患者在颅外动脉病变以及前循环狭窄发生率明显高于中青年组（P〈0.05）,而颅内动脉病变以及后循环狭窄发生率却明显低于中青年组（P〈0.05或P〈0.01）,在脑血管病变及颅内外动脉同时受累发生率上,两组差异无统计学意义（P〉0.05）;2中青年组最常见为重度狭窄,发生率高于轻度及中度狭窄（P〈0.05）,好发部位为椎动脉开口处,发生率高于颈内动脉起始段及大脑中动脉MI段（P〈0.05）;老年组最常见为重度狭窄（P〈0.05）,好发部位为椎动脉开口处及颈内动脉起始段,发生率高于大脑中动脉MI段（P〈0.05）。结论中青年患者最常受累血管为颅内血管,病变发生部位多以椎动脉起始处居多;老年患者最常受累血管为颅外血管,最常受累血管为椎动脉起始处及颈内动脉。     

缺血性脑血管病患者脑动脉狭窄的分布特征及其危险因素分析

目的 探讨缺血性脑血管病患者脑动脉粥样硬化性狭窄闭塞的分布特点,分析并比较颅内、外动脉粥样硬化性狭窄的危险因素.方法 对206例连续行主动脉弓及全脑血管造影检查的缺血性脑血管病患者的临床与血管造影资料进行分析,比较不同动脉病变类型患者间的危险因素的差异.结果 206例患者中,131例存在脑动脉狭窄或闭塞.脑动脉狭窄的好发部位主要为颈内动脉起始部和椎动脉起始部,颅外动脉病变(EAD)的发生率为71.0%,颅内动脉病变(IAD)的发生率为67.9%.青年患者大部分为单纯IAD,主要累及大脑中动脉(MCA);而中年及老年患者以颅内外病变并存比例最高,病变最好发于颈内动脉起始部.吸烟对于颅内、外动脉狭窄的影响较大,血脂异常、同型半胱氨酸血症对于颅内动脉狭窄的影响较大,高龄、高血压、冠心病和糖尿病对颅外动脉狭窄的影响较大.结论 颅外动脉粥样硬化性狭窄闭塞病变的发生率高于颅内.不同动脉粥样硬化性病变类型患者的危险因素有所不同.     

复发性后循环脑梗死患者血管病变特点

目的探讨复发性后循环脑梗死患者脑血管病变的特点。方法对62例复发性后循环脑梗死患者进行DSA检查,分析血管病变的部位、性质和程度。结果本组58例(93.5%)患者有血管狭窄,其中重度狭窄41例(66.1%),轻中度狭窄17例(27.4%);血管动脉硬化的患者4例(6.4%)。单纯前循环血管病变3例(4.8%),单纯后循环血管病变18例(29.0%),前后循环血管均病变41例(66.1%)。椎动脉病变53例(85.5%),颈内动脉38例(61.3%),基底动脉14例(22.9%),大脑中动脉6例(9.7%),颈总动脉3例(4.8%)。结论复发性后循环脑梗死患者的主要血管病变部位在椎动脉和颈内动脉,血管病变的主要病理特征为动脉粥样硬化及在此基础上形成的血管狭窄,且以重度狭窄最为多见。     

后循环短暂性脑缺血发作患者数字减影脑血管造影评价

目的 利用数字减影脑血管造影（DSA）方法观察后循环短暂性脑缺血发作患者脑血管的结构异常情况,探讨其临床价值.方法 对136例后循环短暂性脑缺血发作的患者进行DSA检查,分析其临床资料及血管学资料.结果 在所有患者中,脑血管造影发现血管病变88例,在没有明确的血管病变的48例患者中,椎动脉发育不良16例,单纯胚胎型大脑后动脉10例.结论 后循环短暂性脑缺血发作患者中脑血管造影检查阳性率高,提示在动脉粥样硬化基础上,脑血管狭窄特别是椎基底动脉系统血管狭窄为其重要病因;在无明确血管狭窄的患者中,椎动脉发育不良、胚胎型大脑后动脉可能是后循环短暂性脑缺血发作的重要病理、生理基础.     

超早期脑梗死的血管造影分析

目的 观察缺血性脑卒中超早期血管造影显示的血管狭窄或闭塞的比例及其分布。方法 观察对象为发病6h以内中度至重度的缺血性卒中,头颅CT排除出血,拟选择进行动脉内溶栓的患者。全部进行高选择性颈部和颅内血管造影。同步检查正侧位血管造影相和连续动态电影录像。必要时增加检查斜位相。使用血管直径和血管床灌注评分(TIMI)判断血管狭窄程度。分析血管狭窄部位、受累血管数目以及血管狭窄形态。结果 共收集了30例患者,平均57岁,其中男性23例。发病至血管造影时间(218±64)min。头颅CT显示陈旧脑梗死灶2例,可疑低密度9例,其余正常。血管造影显示87％患者有血管狭窄或者闭塞,其中20例(77％)为前循环受累,6例(23％)后循环受累;另外还发现10条无临床症状的血管狭窄或者闭塞。4例(13％)血管造影正常。大脑中动脉和颈内动脉受累最为常见。后循环受累的血管中以椎动脉最为常见。多部位和多血管受累达11例(37％)。高度狭窄的血管中需要高选择加压才显示血管残腔。1例患者同时有双侧后交通动脉起始部动脉瘤。结论脑梗死6 h内超早期血管造影显示大部分患者有肯定的脑血管狭窄或者闭塞。在选择治疗的方法和治疗途径上应该考虑不同的血管狭窄程度、部位和同时受累的血管数目。     

后循环缺血患者脑血管病变的特点

目的探讨后循环缺血患者脑血管病变的特点。方法对74例后循环缺血患者进行CT血管成像(CTA)检查,分析血管病变的部位、性质和程度。结果本组74例后循环缺血患者中61例(82.4%)被CTA证实有血管病变。其中,血管动脉粥样硬化病变8例(10.8%),血管狭窄38例(51.4%),血管纤细22例(29.7%),血管发育不良12例(16.2%)。单纯前循环血管病变7例(9.5%),单纯后循环血管病变21例(28.4%),前后循环均有血管病变例33例(44.6%);前循环血管病变以颈内动脉颅外段狭窄为主,后循环血管病变以椎动脉颅外段和大脑后动脉病变最为多见;前、后循环血管病变狭窄程度均以重度为主。结论后循环缺血患者的主要血管病变部位在椎动脉颅外段和大脑后动脉,其次为颈内动脉颅外段;最常见的病变性质是动脉粥样硬化和血管狭窄,且以重度狭窄最为多见。     

缺血性脑血管病患者颅内外动脉狭窄分布研究

目的 研究缺血性脑血管病患者颅内外动脉狭窄分布特点.方法 本研究收集了1031例在院脑梗死和TIA患者的DSA资料,对其中资料完整的1000例患者进行分析.结果 DSA显示,1000例患者中有680例存在脑动脉狭窄,累计有1417条血管狭窄.发生部位依次为:大脑中动脉狭窄337条、椎动脉远端及基底动脉狭窄291条、颈内动脉颅外段狭窄280条、椎动脉起始段狭窄207条、颈内动脉虹吸段狭窄115条、大脑前动脉狭窄100条、大脑后动脉狭窄70条.大脑中动脉、椎基底动脉系统和颈动脉颅外段是最常见的动脉狭窄好发部位.颅内动脉狭窄331例,颅外动脉狭窄134例,颅内外动脉均见狭窄215例.结论 颅内动脉粥样硬化性狭窄仍是缺血性卒中的重要原因,最近三年,多发病变、颅外动脉病变检出率明显上升,值得关注,控制血压、血糖、血脂可预防脑动脉粥样硬化性狭窄的发生.     

缺血性卒中病变血管和侧支循环代偿的研究

目的 观察缺血性卒中患者的责任病变血管及其侧支循环代偿方式,探讨脑动脉闭塞或严重狭窄时侧支循环的代偿作用与牛津郡社区卒中项目(OCSP)临床症状分型之间的关系.方法对211例缺血性卒中患者采用OCSP分型(完全型前循环梗死36例,部分前循环梗死94例,后循环梗死31例,腔隙性梗死50例),进行数字减影全脑血管造影检查,判定梗死的责任血管、侧支循环是否建立及代偿方式.结果 检出有病变血管的患者198例,共累及病变血管206支,责任血管为颈内动脉98条、大脑中动脉54条、椎动脉27条、颈总动脉6条、基底动脉5条、锁骨下动脉4条、大脑前动脉及大脑后动脉各2条;经Willis环代偿98例,软脑膜支吻合115例,颅外代偿46例.结论脑动脉病变最多位于颈内动脉、大脑中动脉,其次位于椎动脉,前循环病变较后循环病变具有更高的梗死发生率;侧支循环代偿以Willis环最充分,软脑膜支吻合最常见;脑梗死的临床分型受病变血管与侧支循环代偿的综合影响.     

缺血性脑卒中患者的数字减影脑血管造影的研究

目的探讨缺血性脑卒中患者全脑血管造影的特点。方法对243例缺血性脑卒中患者进行全脑血管造影检查,回顾性分析脑动脉颅内动脉狭窄、颅外动脉狭窄的发生率及其分布情况。结果在243例缺血性脑卒中180例（74.07%）存在脑动脉狭窄或闭塞,前循环动脉狭窄或闭塞82例（45.46%）,后循环52例（28.89%）,前后循环均有46例（25.56%）。颅内动脉狭窄或闭塞48例（26.67%）,颅外动脉86例（47.78%）,颅内、外动脉均有46例（25.56%）。180例中共发现狭窄血管356支,单支血管病变82例,多支血管病变98例。颅外血管狭窄以颈内动脉颅外段最多,颅内血管狭窄以椎动脉颅内段和大脑中动脉为多。结论脑血管造影可以准确地评价缺血性脑卒中患者脑动脉狭窄的分布情况及其程度,为临床提供了诊治依据。     

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 -