海洛因海绵状白质脑病1例报告及文献复习

目的探讨海洛因海绵状白质脑病（HSLE）的临床表现、影像学改变、病理特点及治疗。方法报告1例HSLE并进行文献复习。结果本例为35岁女性患者，以失眠、躯体不适及言语不流利为主要临床表现，既往有烫吸海洛因史，头颅MRI：双侧额顶枕叶、双侧基底节区、双侧小脑及脑干内可见对称性斑片状T2高信号T1低信号，经抗抑郁剂、改善血液循环及神经营养等治疗后，症状明显好转.结论HSLE是烫吸海洛因罕见的并发症，其诊断依靠明确烫吸海洛因史及具有特征性的MRI征象。     

海洛因海绵状白质脑病的诊断及功能障碍特点

海洛因海绵状白质脑病是近年引起人们关注的一类少见海绵状白质脑病,有其独特的病理及影像学改变。现就其功能障碍、病理特点、影像学改变及诊断特点等作一简要综述。     

1例海洛因海绵状白质脑病的护理

目的探讨海洛因海绵状白质脑病(HSLE)的临床特点及护理相关对策。方法对1例海洛因海绵状白质脑病患者进行对症治疗及相应护理包括:一般护理,严密观察病情变化,安全防范,用药护理,营造良好环境,稳定患者情绪,心理护理以及功能锻炼。结果经过28 d的治疗、护理后好转出院,生活基本能够自理。结论早期识别海洛因海绵状白质脑病的临床症状及早期治疗,精心、细致护理是获得疗效的关键。     

1例海洛因海绵状白质脑病的护理

目的 探讨海洛因海绵状白质脑病(HSLE)的临床特点及护理相关对策.方法 对1例海洛因海绵状白质脑病患者进行对症治疗及相应护理包括:一般护理,严密观察病情变化,安全防范,用药护理,营造良好环境,稳定患者情绪,心理护理以及功能锻炼.结果 经过28 d的治疗、护理后好转出院,生活基本能够自理.结论 早期识别海洛因海绵状白质脑病的临床症状及早期治疗,精心、细致护理是获得疗效的关键.     

海洛因海绵状白质脑病的临床和综合康复治疗

目前 ,吸毒已成为威胁人类健康的严峻社会问题。海洛因海绵状白质脑病 (ｈｅｒｏｉｎｓｐｏｎｇｉｆｏｒｍｌｅｕｋｏｅｎｃｅｐｈａｌｏｐａｔｈｙ,ＨＳＬＥ)正在引起医学界的重视[1 ,2 ] ,如何对其实施康复治疗 ,国内外鲜有报道。近年来我们连续收治 3例ＨＳＬＥ患者 ,采用综合康复治疗取得满意的近期疗效 ,报道如下。资料和方法一、临床资料3例 2 0 0 1年 1～ 8月在我科住院的ＨＳＬＥ患者 ,均为男性 ,均有烫吸海洛因史 ,否认静脉吸毒史 ,无其他药物应用史及家族遗传病史 ,均于戒毒过程中发病。 (1 )一般情况 :见表 1。 (2 )临床症状与体…     

海洛因海绵状白质脑病的诊断及功能障碍特点

海洛因海绵状白质脑病是近年引起人们关注的一类少见海绵状白质脑病，有其独特的病理及影像学改变。现就其功能障碍，病理特点，影像学改变及诊断特点等作一简要综述。     

二醋吗啡白质脑病的临床与影像学特征

背景：二醋吗啡（海洛因)引起的海绵状白质脑病是近年来出现的一种新病种，临床上对临床表现、病理改变与影像学特点分析较少。目的：探讨海洛因引起的海绵状白质脑病的临床和影像学特点。设计：以诊断为依据的回顾性研究。地点和对象：南华大学附属怀化医院神经内科收治患者6例，5例来自怀化市戒毒所，1例来自贵州省。方法：查看流行病学资料，临床实验室检查结果，体格检查，治疗资料以及头颅CT，MRI等影像学资料。主要观察指标：临床实验室检查结果以及头颅CT，MRI等影像学特点。结果：患者有吸食海洛因病史，在突然戒断复又吸食后发病，有小脑症状和白质病变的体征，CT，MRI表现为对称性片状白质损害、部位在小脑、基底核、内囊后肢和半卵圆中心，脑脊液检查为阴性。结论：海洛因引起的海绵状白质脑病有自己独特的流行病学特点，根据临床征象及特征性的影像学表现；生前诊断海洛因白质脑病是可能的。     

磁共振氢波谱显示海洛因海绵状白质脑病的特征

背景:以往磁共振波谱研究多用点解析波谱或单体素波谱,其兴趣区主要集中在MRI可见的病灶区,不能显示病灶边缘区的改变状况,而化学位移成像磁共振氢波谱(1H-MRS)检测方法可将检测范围扩大至整个脑部区域。目的:观察海洛因海绵状白质脑病患者的1H-MRS表现,分析其脑内N-乙酰天门冬氨酸、肌酸和胆碱的代谢规律。设计:病例-对照观察。单位:南方医院神经内科。对象:病例组为2005-08/2006-08南方医院神经内科收治的,经临床和影像诊断的海洛因海绵状白质脑病3例(男2例,女1例),对照组为10例同龄健康志愿者。方法:使用Siemens Megnetom Vision Plus1.5T超导MR系统和标准头部线圈,应用化学位移成像法对所有受试者行1H-MRS检查。主要观察指标:观察额、顶和枕叶白质中N-乙酰天门冬氨酸、肌酸和胆碱的水平、代谢图以及它们之间的比例关系。结果:13例受试者均进入结果分析。①N-乙酰天门冬氨酸:病例1的额、顶和枕叶白质低于对照组(79.50±21.65,96.75±16.14,77.05±22.47;146.07±15.49,117.77±14.56,120.83±16.02;P<0.05,0.01),病例2、病例3的顶叶白质低于对照组(87.50±7.89,80.65±11.73,P<0.01)。②肌酸:病例组和对照组无显著性差异(P>0.05)。③胆碱:除病例1额叶白质以外,病例组中均低于对照(P<0.01)。④病例组N-乙酰天门冬氨酸/肌酸比值在各部位均较对照降低,而胆碱/肌酸降低更明显。⑤病灶处N-乙酰天门冬氨酸和肌酸在代谢图中均为低信号。⑥在病灶边缘区,胆碱/肌酸比值有明显反转现象。未见乳酸波。结论:1H-MRS发现海洛因海绵状白质脑病患者脑的物质代谢变化明显大于MRI病灶范围,病灶周围影像正常部位已经有代谢改变。     

血浆置换治疗5例海洛因海绵状白质脑病的临床分析

目的分析海洛因海绵状白质脑病（HSLE）的临床特点和诊断治疗情况。方法对5例HSLE患者的临床症状、影像学及血浆置换治疗进行分析。结果3例临床症状改善,1例无变化,1例死亡。结论HSLE患者均有海洛因吸食或静脉注射史,临床主要表现一系列神经系统症状,影像学显示受累部位多位于双侧小脑半球,脑干桥脑、中脑,丘脑、内囊后肢,额颞叶,枕顶叶,皮层下白质和脑室周围白质,胼胝体压部、血浆置换(PE)可能有效。     

海洛因海绵状白质脑病急性意识障碍的临床及病理改变

目的 探讨海洛因海绵状白质脑病（heroin spongiform leukoencephalopathy,HSLE）急性意识障碍的临床及病理改变并进行病因分析.方法对2000-03～2006-10入院的39例HSLE患者中伴急性意识障碍的9例进行临床、CT和MRI分析.死亡的其中4例病例进行脑局部解剖,检查 HE染色、MBP免疫组化染色、caspase-3免疫组化染色以及TUNEL染色.利用显微镜观察分析脑不同部位细胞凋亡数及与caspase-3阳性细胞之间的关系.并选4例非脑部死亡病例作为对照.结果 9例以意识障碍起病的HSLE患者中,死亡5例.9例影像学均表现为广泛的白质损害,并合并有脑干病灶.HE染色及MBP免疫组化染色显示脑白质广泛脱髓鞘改变.在深层白质TUNEL阳性细胞和caspase-3阳性细胞的表达明显高于浅层白质（t=43.64,P＜0.01;t=13.78,P ＜0.01）和正常对照组.结论广泛的白质损害和脑干受累是HSLE急性意识障碍的主要原因,基础病因可能为HSLE少突胶质细胞凋亡导致白质空泡样变.     

二醋吗啡白质脑病的临床与影像学特征

背景:二醋吗啡(海洛因)引起的海绵状白质脑病是近年来出现的一种新病种,临床上对临床表现、病理改变与影像学特点分析较少。目的:探讨海洛因引起的海绵状白质脑病的临床和影像学特点。设计:以诊断为依据的回顾性研究。地点和对象:南华大学附属怀化医院神经内科收治患者6例,5例来自怀化市戒毒所,1例来自贵州省。方法:查看流行病学资料,临床实验室检查结果,体格检查,治疗资料以及头颅CT,MRI等影像学资料。主要观察指标:临床实验室检查结果以及头颅CT,MRI等影像学特点。结果:患者有吸食海洛因病史,在突然戒断复又吸食后发病,有小脑症状和白质病变的体征,CT,MRI表现为对称性片状白质损害、部位在小脑、基底核、内囊后肢和半卵圆中心,脑脊液检查为阴性。结论:海洛因引起的海绵状白质脑病有自己独特的流行病学特点,根据临床征象及特征性的影像学表现;生前诊断海洛因白质脑病是可能的。     

Reversible spongiform leucoencephalopathy after inhalation of heated heroin

OBJECTIVE: To describe the clinical course and imaging findings in a young man who developed a spongiform leucoencephalopathy from heroin-vapour inhalation, and to discuss the treatments which may have contributed to the unexpected favourable outcome in this case. DESIGN: Case report. SETTING: Intensive care unit of a university teaching hospital. PATIENT: A patient who developed a near fatal toxic leucoencephalopathy with impressive clinical recovery and reversible white matter changes on imaging. MEASUREMENTS AND RESULTS: Successive computed tomography scans and magnetic resonance imaging over 7 months showed evolution from bilateral extensive involvement of the cerebral white matter to almost complete resolution accompanied by the development of periventricular lesions suggestive of necrosis. Despite the fact that the patient had stretching spasms for several days, the outcome was favourable with prolonged supportive care and antioxidant therapy by ubiquinone (coenzyme Q). CONCLUSION: This case demonstrates that prolonged intensive care is of paramount importance in patients with spongiform leucoencephalopathy after inhalation of heated heroin, that abnormalities of cerebral white matter may be slowly regressive, and supports the use of coenzyme Q in severe forms of the disease.     

海洛因所致海绵状白质脑病的影像学表现

目的阐述吸食海洛因所致海绵状白质脑病的影像学表现及CT、MR的诊断价值。方法搜集15例具有吸食海洛因病史患者的CT与MR影像资料。其中12例患者进行了MR检查，检查序列包括T1WI、TWI，FLAIR序列；6例进行了CT横断面检查。结果（1）MR表现：12例患者中，双侧幕上半球脑白质、小脑半球、内囊后肢和膝部及胼胝体压部表现为对称性均匀或不均匀的长T1低信号、长T2高信号病变，小脑齿状核形态信号正常。其中4例患者中脑中央可见椭圆形长T1、长T2信号影。（2）CT表现：双侧幕上半球、小脑半球、内囊后肢及膝部均见对称性、沿白质分布的低密度4例。双侧小脑半球类圆形，双侧内囊后肢条形对称性低密度伴左侧放射冠区多发斑片状低密度1例。双侧内囊后肢和膝部、胼胝体膝部及双侧幕上半球脑白质密度对称性减低1例。结论吸食海洛因所致海绵状白质脑病具有典型的影像学表现，MR较CT更能揭示病变的特征，高压氧治疗有助于病情缓解。     

吸食海洛因所致脑白质病变的CT表现（附10例分析）

目的：探讨吸食海洛因脑白质病变的CT表现特点，方法：回顾性分析10例吸食海洛因患者的脑部CT表现，结果：7例均有双侧大球脑白质对称性广泛性密度减低，双侧基底节内囊后肢及小脑半球脑白质对称性密度减低，2例表现为基底节内囊后肢及小脑半球脑白质对称性密度减低，1例表现为小脑半球脑白质对称性密度减低。结论：大脑及小脑半球脑白质，基底节区对称性密度减低是吸食海洛因所致脑白质病变特征性CT表现，尤以小脑改变最明显。     

Laboratory study of the effectiveness of filters used by heroin injectors

Aims: (a) To compare in the laboratory the effectiveness of various filters at removing particles from heroin injections; (b) To measure the amount of heroin retained by the filters; and (c) To describe the relevance of these preliminary findings to future research.

Design: A laboratory‐based investigation. Injections were prepared with street heroin obtained from the police, copying the methods of injectors. Pieces of cigarette filter, hand‐rolling cigarette filter, cotton wool from buds and commercially produced syringe filters were tested. The Coulter Multisizer (IIe) was used to count and size particles; Capillary Zone Electrophoresis was used to measure the amount of heroin retained in the filters.

Findings: All methods of filtration reduced the amount of particles, with the commercially produced syringe filter producing the largest reduction. The syringe filter retained the most heroin after use; however, less drug material was evident on the spoon, suggesting further work is needed with a range of quantities. The cigarette, hand‐rolling and cotton bud filters all retained some drug with no significant difference detected between the different filters.

Conclusions: This preliminary study suggests all the filters tested may convey health benefits. Further work is needed with varying quantities of drug, acid and water and to establish safety in use. Then future studies can establish the health consequences for injecting drug users from the use of such filters.     

Wound botulism associated with black tar heroin and lower extremity cellulitis

Wound botulism is a rare and potentially fatal disease. The use of black tar heroin has spawned an increase in the incidence of the disease, with the majority of cases occurring in California. The use of botulism antitoxin and surgical debridement are recommended to decrease hospital stay. For this to be effective, the diagnosis of wound botulism first must be considered, followed by an aggressive search for any area of infection that may be debrided. This case report demonstrates several factors to consider in patients presenting with symptoms of botulism poisoning: occurrence away from the Mexico border, no obvious abscess, and the need for prolonged ventilatory support. This case report documents a prolonged hospital stay, possibly caused by delay in administration of antitoxin in a patient with cellulitis that was not considered appropriate for debridement.     

海洛因依赖者HIV和HCV感染情况分析

目的：了解海洛因依赖者HIV、HCV感染现状。方法对565例海洛因依赖者进行HIV、HCV血清学检测,比较不同性别、不同民族的海洛因依赖者感染病毒的情况。结果在565例海洛因依赖者中,男性的HIV、HCV和HIV/HCV合并感染率分别为14．57％（72/494）、59．72％（295/494）、13．36％（66/494）,女性分别为19．72％（14/71）、77．46％（55/71）、16．90％（12/71）,男性HCV感染率显著低于女性（P＜0．05）。汉族与维吾尔族海洛因依赖者之间比较,HIV、HCV及HIV/HCV合并感染率差异均有统计学意义（P＜0．05）。结论海洛因依赖者是感染HIC、HCV的高危人群,需加强毒品和传染病预防知识的宣传教育,以控制疾病传播,减少疾病发生。     

Determination of the clearance factor for transmissible spongiform encephalopathy agents during the manufacturing process of polygeline

Objective: To determine the safety of polygeline, a gelatine-derived plasma substitute produced from bovine bones, in terms of safety for bovine spongiform encephalopathy (BSE) by evaluating the ability of the manufacturing process of polygeline to eliminate agents related to transmissible spongiform encephalopathy (TSE) through the validation of three main production steps. Design: Laboratory scale experimental process (in duplicate) using 20 % hamster-adapted 263K scrapie-infected brain homogenate as infective titrated source (10⁹ LD₅₀/2 ml), added to each material before being processed and titrated in hamsters. Experiment 1: time/temperature dependency of gelatine autoclaving. Experiment 2: cross-linking and distillation. Experiment 3: final sterilization. Monitoring period: 1 year with daily animal clinical observation. Histology of all brains. Setting: LCG-RBM laboratories, Italy; strict GLP compliance. Measurements and results: Heating the gelatine (at conditions lower than those used in production process) was very effective in inactivating the infectivity of TSE agents. Clearance factors were reproducible, dependent upon time and temperature, reaching a total theoretical process clearance in the range of 9.2–13.8 [6.9 + 2.3 ( + 4.6)] log₁₀ LD₅₀. Conclusions: These experimental results provide further important data confirming the safety of the procedural steps; this complements the safety due to the careful sourcing of the raw material. There is high assurance that there is no significant risk of TSE transmission to humans by the therapeutic administration of polygeline. Received: 13 August 1999 Final revision received: 7 January 2000 Accepted: 24 February 2000