脑动静脉畸形的血管内栓塞治疗

应用国产NBCA经血管内栓塞治疗脑AVM 32例，效果满意。讨论了NBCA的特点、栓塞的适应证、栓塞导管的置入技术、栓塞剂的配制、栓塞技术要点及栓塞后并发症的防治等问题。     

NBCA胶栓塞脑膜瘤后血液灌注的动态变化

目的探讨NBCA胶栓塞脑膜瘤血液灌注的动态变化。方法通过CT灌注影像学技术,观察NBCA胶栓塞的脑膜瘤在不同时间点栓塞区、未栓塞区以及周围脑组织血液灌注的动态变化。结果 NBCA胶栓塞脑膜瘤后,肿瘤以及瘤周脑组织的CT灌注参数随着栓塞时间的延长有一定规律,其中肿瘤栓塞区缺血改变在栓塞后第7~10天达最高峰,随时间的延长,未栓塞区也存在缓慢的缺血改变,其缺血变化与栓塞区规律类似。结论明确NBCA胶栓塞脑膜瘤后血液灌注的动态变化,为临床脑膜瘤手术治疗的最佳时机提供了理论基础。     

丁氰酯类医用胶栓塞脑动静脉畸形后的病理学(国产与进口产品对比研究)

目的:本文是对国产α-氰基丙烯酸异丁酯(IBCA)、α-氰基丙烯酸正丁酯(NBCA)和进口NBCA栓塞脑动静脉畸形(AVMs)后病理学对比研究.方法:32例脑AVMs用国产IBCA、NBCA和进口NBCA经过1～3次栓塞后,最短10h,最长193d行脑AVMs切除,所有标本经HE及弹力纤维染色,光学显微镜观察病理变化.结果:①管腔内有胶样物质;②血管壁及周围脑组织急性期以多核白细胞浸润为主,伴血管壁变性、坏死,中晚期以淋巴细胞和嗜酸粒细胞浸润为主(中晚期管腔内大量异物巨细胞反应);③血管壁纤维化、钙化;④未发现栓塞剂移至管脏外或脑实质内的现象,被栓塞的血管腔内未见血管重生及再通现象.国产NBCA与进口NBCA病理变化相似.结论:①IBCA和NBCA可做永久性栓塞剂;②国产IBCA、NBCA可代替进口同类产品;③IBCA和NBCA的病理变化相似;④未发现有致畸致癌作用,无AVM复发.     

NBCA胶栓塞治疗小脑后下动脉远端动脉瘤2例

目的探讨NBCA胶栓塞小脑后下动脉远端动脉瘤的可行性.方法用介入法将漂浮导管置入载瘤动脉近端,注入高浓度NBCA胶将动脉瘤及载瘤动脉闭塞,对病人进行临床随访.结果 2例PICA远端动脉瘤病例经治疗后恢复良好,随访至今无再出血发生.结论高浓度NBCA胶栓塞治疗小脑后下动脉远端动脉瘤是可行的.     

NBCA栓塞治疗脑动静脉畸形并发症分析

目的探讨NBCA栓塞治疗脑动静脉畸形(AVM)的并发症的发生率及高危因素.方法回顾性研究469例施行NBCA栓塞治疗的脑AVM的临床和影像学资料,总结并发症的情况以及分析他们的血管构筑学特征.结果469例脑AVM共行1108次栓塞,每例栓塞1～8次,平均2.3次;共发生并发症11例(出血性并发症4例,缺血性并发症7例),其中死亡2例,植物生存l例,轻度永久性神经功能缺损1例,短暂性神经功能缺损7例.结论本组脑AVM行NBCA栓塞治疗有较低的手术相关并发症.但对于栓塞高危病人,应采取特殊的栓塞策略.     

以动静脉瘘为主的脑动静脉畸形的栓塞治疗

目的探讨以动静脉瘘为主的高血流量脑动静脉畸形(AVM)的血管内栓塞治疗方法.方法将Spinnaker-1.5F微导管送至AVM近动静脉瘘口处,超选择造影测量动静脉微循环时间,先用液态弹簧圈2～3枚经微导管作初步填塞以减慢血流,再根据不同微循环时间配制不同浓度NBCA胶(17%～33%)栓塞AVM.结果采用液态弹簧圈和NBCA胶联合栓塞13例以动静脉瘘为主的AVM,完全栓塞3例,90%栓塞5例,60%栓塞3例,40%栓塞2例,无一例出现并发症.结论采用液态弹簧圈联合NBCA胶能安全、有效地治疗以动静脉瘘为主的脑动静脉畸形.     

NBCA和ONYX栓塞治疗不同类型脑动静脉畸形的对比研究

目的对比分析NBCA和ONYX两种液态栓塞系统对不同类型脑动静脉畸形（AVM）的栓塞率，对NBCA和ONYX的有效性作出评价。方法选取1998年1月至2005年6月经过NBCA和ONYX栓塞治疗的50例脑AVM病人，NBCA组30例，ONYX组20例。男32例，女18例，平均33．5岁。对两组间不同大小、供血动脉类型、供血动脉支数脑AVM的栓塞率对比分析。全部数据采用秩和检验，应用SAS 6．12统计软件分析。结果对中型、皮质多支供血和浅部引流的脑AVM，ONYX的栓塞率高于NBCA。两者对小型、单支供血的脑AVM均有较高的栓塞率。结论对中型、皮质动脉多支供血的脑AVM，ONYX栓塞率比NBCA高。对大型和混合供血的脑AVM，NBCA与ONYX两者的栓塞率并无统计学意义。对于小型脑AVM，两种栓塞剂均有着较好的栓塞率。穿支供血的脑AVM不适合经动脉行血管内栓塞。对于体积较大的伴有广泛供血和位于功能区的AVM，可以分次栓塞，并结合手术和立体定向放射治疗。     

丁氰酯类医用胶栓塞脑动静脉畸形后的病理学（国产与进口产品对比研究）

目的：本是对国产a-氰基丙烯酸异丁酯(IBCA)、a-氰基丙烯酸正丁酯(NBCA)和进口NBCA栓塞脑动静脉畸形(AVMs)后病理学对比研究。方法：32例脑AVMs用国产IBCA、NBCA和进口NBCA经过1～3次栓塞后，最短10h，最长193d行脑AVMs切除，所有标本经HE及弹力纤维染色，光学显微镜观察病理变化。结果：①管腔内有胶样物质；②血管壁及周围脑组织急性期以多核白细胞浸润为主．伴血管壁变性、坏死，中晚期以淋巴细胞和嗜酸粒细胞浸润为主(中晚期营腔内大量异物巨细胞反应)；③血管壁纤维化、钙化；④未发现栓塞剂移至管腔外或脑实质内的现象，被栓塞的血管腔内未见血管重生及再通现象。国产NBCA与进口NBCA病理变化相似。结论：①IBCA和NBCA可做永久性栓塞剂；②国产IBCA、NBCA可代替进口同类产品；③IBCA和NBCA的病理变化相似；④未发现有致畸致癌作用．无AVM复发。     

栓塞材料甲基丙烯酸共聚物和丁氰酯胶的对比研究

目的　评价两种血管内液体栓塞材料甲基丙烯酸共聚物 (eudragit)和α 氰基丙烯酸正丁酯 (NBCA)的栓塞效果和病理学变化。方法　采用eudragit混合液和NBCA栓塞 2 4只家兔右侧颈外动脉分支血管 ,观察栓塞术后家兔全身一般状态、血管造影影像学变化及光镜和电镜下的组织形态学改变。结果　Eudragit混合液栓塞动物血管时易通过微导管 ,不产生堵塞、粘连微导管现象 ,可诱发血栓形成 ,能产生有效的血管栓塞作用 ,无毒、副作用 ,无血管再通现象。栓塞后急性期无炎症反应 ,亚急性期和慢性期发生轻、中度管腔内和血管周围的炎症反应。Eudragit和NBCA的对比研究可见NBCA栓塞的血管异物反应明显 ,血管内膜广泛受损 ,管壁坏死严重 ,这可能表明NBCA的毒性重于eudragit。结论　甲基丙烯酸共聚物混合液作为一种非粘性液体栓塞材料具有良好的血管栓塞作用 ,是一种较理想的新型液体栓塞材料。     

脑动静脉畸形血管内栓塞术和围手术期的处理

目的 探讨脑动静脉畸形应用ONYX胶和NBCA胶行血管内栓塞的临床疗效和围手术期并发症的处理.方法 本组17例,男14例,女3例,年龄22～56岁,平均39岁.首发症状头痛2例,脑出血10例,癫(癎)3例,肢体功能障碍2例.5例应用ONYX胶,12例应用NBCA胶行血管内栓塞.结果 本组完全栓塞11例,大部分栓塞6例,患者术后均无严重并发症发生,术后1周左右出院.结论 ONYX胶比NBCA胶具有更好的弥散性、易于控制、不粘管等优点,且其操作可控性好,不易栓塞正常血管,因此减少了再通和复发的可能性,可以使脑动静脉畸形获得较高的治愈率,尤其对于较大的AVM的栓塞治疗效果显著.术后严密监测病情变化,严格控制血压,及时进行对症处理,消除不利因素,防止并发症发生.     

小脑血管网织细胞瘤MRI诊断与鉴别诊断

目的探讨小脑血管网织细胞瘤MRI表现特点,总结其诊断和鉴别诊断要点。方法回顾分析经手术病理证实的30例小脑血管网织细胞瘤MRI表现。结果30例中发生于右侧小脑半球15例,左侧13例。双侧1例,小脑蚓部1例。其中囊性肿瘤26例．实质性4例。肿瘤最大径25～60mm。26例囊性肿瘤中25例平扫表现为圆形或类圆形脑脊液样长T1、长T2信号,1例肿瘤合并出血在T1WI及T2WI均呈明显高信号;23例可见壁结节,直径3～18mm;增强扫描所有病变囊壁和囊液均不强化,24例显示强化壁结节;4例实质性肿瘤呈稍长T1、长T2信号,增强扫描均明显强化。23例肿瘤边缘或内部可见1～2条流空血管影。结论囊性小脑血管网织细胞瘤MRI表现颇具诊断特征性,但有时需与小脑星形细胞瘤鉴别,实质性肿瘤需注意与转移瘤、髓母细胞瘤及脑膜瘤鉴别。     

Attempted suicide in children and adolescents in Hong Kong

Summary The case notes of 67 attempted suicide patients aged below 16 years were studied. They were admitted to a regional general hospital in Hong Kong following attempted suicide and were referred to a psychiatric unit between January 1980 and December 1984. Fifty were female. Nearly all were minor and impulsive attempts. 41 of them used either chemicals (e.g. detergent) or drugs. The most common difficulties preceding the attempts were problems with parents, school and boy- or girl-friends. The majority received only one or two treatment sessions. 52 of them were followed up 1–4 years later. The majority of them were functioning well at the time of follow-up. The implications for the etiology and management of attempted suicide in this age group were discussed.     

痉挛性斜颈的手术治疗(附580例报道)

目的 探讨痉挛性斜颈（ST）的手术方法及其疗效。方法 回顾性分析1995~2015手术治疗的580例痉挛性斜颈的临床资料。借助肌电图、CT或MRI等检查判断参与痉挛的肌群,将痉挛肌肉分为原动肌、协同肌、随动肌,对原动肌做去神经术和肌切断术,协同肌做去神经术,随从肌可不予处理,从而形成三种术式:术式一,面部旋向侧颈后痉挛肌肉选择性切除术;术式二,同侧颈神经 1~6后支选择性切断术;术式三,副神经切断术。旋转型ST和侧屈型ST采用二联术或三联术,后仰型ST采用双侧术式一和术式二组合,前屈型 ST采用双侧术式三组合,混合型ST分期采用颈部神经选择性切断术和肌肉选择性切除术。结果 565例术后随访6个月~15年;术后6个月评估疗效:痊愈429例,显效68例,进步52例,无效16例;优良率为88%。无死亡、无严重并发症。结论 选择性周围神经切断术及肌切断术是治疗痉挛性斜颈安全有效的方法。     

不同病理类型脑膜瘤的MRI特点及其临床意义

目的 分析不同病理类型脑膜瘤的MRI特点.方法 回顾性分析经手术和病理证实的428例脑膜瘤手术患者的病理类型;病理类型参照WHO 2007年版中枢神经系统肿瘤分型,利用PACS影像系统分析其MRI特点.结果 脑膜皮细胞型多为稍高或等T1、高T2信号,信号均匀;混合型可出现多种信号组合,内部不均匀;纤维型T1、T2多为等或稍低信号,信号均匀;砂粒体型多为低T1、T2信号,有时见到团状或斑块样信号;其他良性脑膜瘤少见,多为低或等T1信号,稍高T2信号;非良性脑膜瘤信号特征类似,多为低或等T1信号,稍高T2信号,内部囊变坏死多见,增强扫描强化不均匀.结论 不同病理类型脑膜瘤在MRI上信号表现有所不同.分析MRI信号特点,对术前判断肿瘤病理类型及术中肿瘤切除方式的选择有意义.

Abstract：

Objective To explore the characters of different types of meningiomas on MRI and the significance for surgical treatment.Methods The clinical data of 428 patients with meningiomas underwent surgery in Southern hospital from January 2000 to January 2010 were analyzed retrospectively.The pathological types of meningiomas were identified according to WHO 2007 edition.The characters of meningiomas on MRI were analyzed by PACS software.Results The MRI images of meningothelial type were slightly high or equal signal on T1 image and high signal on T2 image; the images of transitional( mixed)type on MRI were different and the signals were hybrid.The signals of fibrous type were slightly low or equal on both T1 and T2 and homogeneous.The signals of psammomatous type were low on both T1 and T2, and sometimes cystic degeneration and necrosis were found within tumors.The rest of benign meningiomas were rare and usually showed low or equal signals on T1 image and slightly high signals on T2 image.The signals of non - benign meningiomas were mostly low or equal on T1 image and slightly high on T2 image, and cystic degeneration,necrosis and heterogeneous enhancement were common to be seen.Conclusions Specific characteristics on MRI could be seen in different types of meningiomas.The knowledge of their correlations is helpful for preoperative diagnosis and surgical treatment in patients with meningiomas.     

特异性shRNA干扰人慢病毒载体抑制U251细胞株Chk1、Chk2基因的表达

目的构建针对细胞周期检测点激酶1和2(Chk1和Chk2)基因的短发夹RNA(shRNA)表达载体,包装成慢病毒,建立稳定转染的细胞株,为探讨抑制Chk1和Chk2基因表达对脑胶质瘤细胞生物学行为调控的研究奠定基础。方法根据GenBank数据库提供的Chk1和Chk2基因核苷酸序列,选择设计2条能转录短发夹RNA(shRNA)的DNA序列,命名为Chk1-shRNA和Chk2-shRNA,同时设计1条非特异性序列作为阴性对照,命名为blank-shRNA。并与pLKO.1-TRC质粒载体连接,转化感受态大肠杆菌,挑取阳性克隆,抽取重组质粒,使用限制性内切酶EcoRⅠ、NcoⅠ酶切电泳,DNA测序鉴定,包装慢病毒。3组重组表达慢病毒载体转染胶质瘤细胞系U251,用嘌呤霉素筛选后挑选单克隆并扩增获得稳定株。逆转录酶-聚合酶连反应(RT-PCR)和Western blot分别在mRNA和蛋白水平上检测Chk1和Chk2的表达。结果重组质粒成功转化感受态大肠杆菌,经酶切琼脂糖凝胶电泳分析,结果表明寡核苷酸成功插入到预计位点,经测序鉴定,序列完全正确。嘌呤霉素对U251细胞的筛选浓度为4ug/ml,筛选出稳定转染三种质粒的U251细胞,Chk1-shRNA和Chk2-shRNA组细胞各自Chk1和Chk2的mRNA和蛋白表达水平明显低于blank-shRNA组。结论成功构建了针对Chk1和Chk2基因的shRNA慢病毒表达载体,转染后可抑制ChK1和Chk2基因的表达,为进一步研究Chk1和Chk2基因在脑胶质瘤细胞中的作用奠定了基础。     

血管内栓塞治疗15例假性动脉瘤

目的 回顾近十年来收治的15例假性动脉瘤，分析其发病机理、临床表现、影像学特点及治疗方法。方法 15例病人中男9例，女6例，平均年龄43．9岁（9－57岁）。外伤性9例，夹层所致4例，手术所致2例。颈内动脉11例，椎3例，颈外动脉1例。外伤性颈内动脉海绵窦瘘（TCCF）合并假性动脉瘤4例。影像学特点清嵝不位于血管分叉处，形状不规则，瘤底部常用“小壶”影。全部病例均采用局麻下经股动脉或颈动脉Seldinger′s穿刺，在系统抗凝情况下栓塞动脉瘤。结果 15例假性动脉瘤中保留载瘤动脉4例。全部病例栓塞后动脉瘤均消失。半年后血管造影随访复查未见动态瘤复发。结论 血管内栓塞是治疗假性动脉瘤的有效而首选的方法。     

高血压鼠局部脑梗塞后脑超微结构改变动态观察

本文选用肾血管性高血压鼠(RHR)复制大脑中动脉闭塞(MCAO)模型,其后2h至7d分8次取不同区域脑组织进行透射电镜动态观察超微结构的改变。显示局部脑梗塞后发生全脑性改变,其损害程度和出现时间梗塞区最早,以坏死为主,呈完全不可逆性损害;边缘区稍后,主要是微血管塌陷和微血栓形成及部分脑细胞坏死,呈部分可逆性损害,远隔区和镜区最迟,以内皮和星形细胞水肿为主,呈可逆性损害,认为用RHR复制MCAO,更接近于高血压性脑血管损害基础上发生脑梗塞的临床病理改变,全脑超微结构的动态性改变中微血管损害起着重要作用。     

The principal projection pathway between the olfactory bulb and the prepyriform cortex in the cat

The anatomy and neuroelectric properties of the lateral olfactory tract (LOT) were investigated in the cat. Electron micrographs were obtained from sampled areas across the rostro-caudal projection of the pathway. Fiber diameters were estimated and axon spectra were obtained from three regions corresponding to penduncle, mid-LOT, and caudal-LOT. The mean inside diameter for all measured axons was 1.13 ± 0.53 μm. The greatest number was found in the peduncle (approximately 600,000 axons). Mid-LOT and caudal-LOT each contained approximately 250,000 axons. Unmyelinated processes were estimated to be more numerous than the myelinated axons. Synaptic structures were also observed in the LOT. Crosssectional area measurements of the LOT were obtained from tissue repared for light microscopy. The area decreased from about 0.3 to 0.2 mm² across the projection from olfactory bulb to cortex. The anatomical data were used to predict the conduction properties of transmission over the LOT. The olfactory bulb mitral cells were stimulated electrically and conduction velocity and temporal dispersion were evaluated in the tract. The strength-duration and stimulus-response curves and the potential profile during stimulation were also obtained. The time constant for LOT axons was 0.3 msec. The stimulus-response curve was sigmoidal in shape for both presynaptic and postsynaptic responses. The relationship between input (the action potentials) and output (cortical postsynaptic potentials) was linear up to 90 times threshold. Action potentials were conducted at 20 m/sec across the pathway over the peduncle and decreased to about 10 m/sec in caudal aspects. The potential profile for action potentials decayed exponentially into the depths of the cortex whereas the synaptic potential was a surface negative dipole field. The axon spectra were convolved with the electrophysiological properties of the LOT Yto mathematically reconstruct action potentials. The empirically derived monoand biphasic curves fitted reasonably well with experimentally derived data under various stimulus conditions.     

On factors related to growth and rupture of intracranial aneurysms

Summary The incidence of calcification and of fatty plaques was investigated in 70 autopsy cases with 85 intracranial aneurysms. Seventy aneurysms had ruptured. Stereomicroscopic microradiographic and histopathological methods were utilized. Anomalies of the circle of Willis were observed in 55%, corresponding to what is usually found in previous aneurysm series. Fatty plaques and/or calcifications were observed in the aorta and carotid arteries in 60% and were more widely generalized in 24% of the cases. Several of the patients were relatively young. Fatty infiltration was found in the walls of all aneurysms. Adjacent to the plaques the walls of the aneurysms were thin and frequently bulging. Empty thin outpouchings were also found. The sites of rupture were related to the outpouchings. The fatty plaques were considered to be prestages of calcifications. Calcification was found in the walls of 25 aneurysms. In older patients fatty atheromatous plaques and calcifications were larger and situated nearer the necks of the aneurysms; in younger patients they were nearer the domes, often at the widest diameter of the aneurysms. The sites of rupture were close to the fatty plaques of calcifications and generally distal to them. The importance of using a microscope at operation is stressed.These studies have been supported by the Sigrid Jusélius foundation.     

Air rifle injury to the head

The authors reviewed 16 cases of air rifle injuries to the head, 14 of them were penetrating. While 50% of the victims were adults, almost all of the culprits were children. The entry wounds were mostly in the frontal area and around or exactly on the eye. None was perforating or through and through. The morbidities encountered were considered to be severe in 2 cases (hemiparesis), ocular injuries in 3 cases, and visual field defects in 3 cases. 1 patient died due to recurrent haemorrhage. The initial wound debridement and short course of antibiotic perioperatively seemed to be most important. Retained pellets were removed only if they were accessible. Considering the risk of morbidity and mortality and the fact that almost all of the culprits were children, air rifles should require adequate precautions and especially be kept out of the reach of children.