抗血小板治疗在血管内治疗缺血性脑血管病中的应用

血管内治疗能显著降低缺血性脑血管病的致残、病死及卒中复发率。随着神经介入技术 和材料以及患者筛选策略的进步，缺血性卒中患者应用血管内治疗也日益增加。抗血小板治疗作为 缺血性卒中预防和治疗的重要手段，是血管内治疗中的重要一环，阿司匹林、氯吡格雷等是基石性 抗血小板药物，但具体的用药方案尚不统一。本文回顾和总结了国内外指南针对缺血性脑血管病行 血管内治疗患者的抗血小板策略建议，以及重要血管内治疗研究中采用的抗血小板治疗方案，以期 为神经介入医师行血管内治疗时抗血小板药物的应用提供参考。     

颈动脉支架置入术后支架内血栓形成研究进展

颈动脉支架内血栓形成是颈动脉支架置入术后的严重并发症，可导致患者严重瘫痪甚至 死亡。然而迄今为止，针对颈动脉支架内血栓形成，仍没有统一的治疗方式。虽然有很多病例报道了 颈动脉支架内血栓形成的处理方法，但是仍缺少随机双盲试验或大型临床试验来证实其可靠性、安 全性。在临床上，与手术操作相关的颈动脉支架内血栓形成，是颈动脉支架内血栓形成的最主要原 因。除此之外，抗血小板治疗不充分或停止抗血小板治疗、高凝状态、抗血小板药物抵抗也可导致 颈动脉支架内血栓形成。目前，抗血小板及抗凝治疗、溶栓治疗、颈动脉内膜剥脱术及颈动脉支架 术、机械取栓或血栓抽吸治疗等均有报道，无论何种治疗方式，使患者快速获得血管再通是颈动脉 支架内血栓形成治疗的关键。     

应用动力髋螺钉、Gamma钉与股骨近端髓内钉治疗高龄患者股骨转子间

目的：对比观察动力髋螺钉、Gamma钉与股骨近端髓内钉治疗高龄患者股骨转子间骨折的生物相容性及临床疗效。 方法：选择2006-06/2008-03解放军第二军医大学长海医院骨科收治的股骨转子间骨折患者95例，男26例，女69例，年龄70~88岁。根据Evans分型系统，95例患者随机分为3组，动力髋螺钉内固定治疗组(n=30)，Gamma钉内固定治疗组(n=30)和股骨近端髓内钉内固定治疗组(n=35)，3组患者分别采用动力髋螺钉、Gamma钉和股骨近端髓内钉进行治疗。记录术中、术后出血量，手术时间，住院时间；观察骨折愈合情况、术后并发症及材料与宿主的组织相容性；术后9个月采用Harris评分标准对患髋进行评估。 结果：3组患者均获得随访。①Gamma钉内固定治疗组和股骨近端髓内钉内固定治疗组术中出血量少于动力髋螺钉内固定治疗组(P < 0.05)；各组间手术时间两两相比差异无显著性意义(P > 0.05)，但统计结果显示，动力髋螺钉内固定治疗组相对最长，股骨近端髓内钉内固定治疗组相对最短。3组患者住院时间差异无显著性意义(P > 0.05)。②动力髋螺钉内固定治疗组并发髋内翻1例，伤肢短缩1例。Gamma钉内固定治疗组术后股骨干骨折1例，无伤肢短缩等并发症。股骨近端髓内钉内固定治疗组伤口全部Ⅰ期愈合，无并发症发生。Gamma钉内固定治疗组中2例切开组织液化，2例切开表浅感染，无切开深部感染；动力髋螺钉组中3例出现切开组织液化，2例切开表浅感染，1例切开深部感染。均未出现内固定物切出股骨头或断裂等内固定失效现象。③髋关节Harris功能评分显示，动力髋螺钉内固定治疗组优23例，良4例，可3例，优良率90.0%。Gamma钉内固定治疗组优24例，良4例，可2例，优良率93.3%。股骨近端髓内钉内固定治疗组优32例，良2例，可1例，优良率97.1%。3组间差异无显著性意义(P > 0.05)。 结论：应用动力髋螺钉、Gamma钉和股骨近端髓内钉治疗老年股骨转子间骨折，在疗效方面无明显差异。Gamma钉和股骨近端髓内钉可缩短手术时间、减少术中出血量及术后并发症。对于稳定性骨折，3种内固定装置均可选择，而动力髋螺钉具有价格便宜的优点；对于不稳定性骨折，股骨近端髓内钉、Gamma钉由于生物力学上的优势，都是不错的选择。     

金属植入物治疗老年肱骨远端骨折20例：与7例保守治疗的比较

背景：金属植入物内固定治疗年青肱骨远端骨折患者具有明显的优势，优良率为65%~100%。老年此类骨折患者由于骨质疏松和全身状况等原因，是否有必要接受金属植入物的内固定治疗干预，尚缺乏验证。 目的：探讨金属植入物内固定治疗老年患者肱骨远端骨折手术效果，并与保守治疗及年青患者作比较。 方法：选择2002-01/2007-06皖南医学院弋矶山医院骨一科收治的27例肱骨远端骨折老年患者，年龄68(60~76)岁；其中20例肘关节实施开放复位金属植入物内固定治疗，7例进行保守治疗。术后3，6，12周临床和影像学评估分析患者伸屈功能、关节面台阶和前倾角，并与文献中中青年患者内固定治疗效果进行比较。 结果与结论：27例均获得随访，随访7~28个月，其中26例骨性愈合。金属植入物内固定组1例不愈合，为非感染性骨不连，患者因全身情况而拒绝进一步治疗；无钢板断裂，2例存在螺钉松动，3例克氏针松动，但不需要手术干预。金属植入物内固定组患者伸屈功能、关节面台阶和前倾角评定结果及优良率明显优于保守治疗组(P < 0.01)。内固定治疗组不愈合率(骨折部位和截骨部位)、感染、异位骨化、神经损伤以及和金属植入物相关的症状与文献中年中青年患者比较差异无显著性意义。与其他关节内骨折一样，老年肱骨远端骨折患者也需要金属植入物内固定治疗干预，只要遵循基本的外科和内固定的原则，保持前倾角和关节的完整性，均能获得一定的恢复。     

神经外科疾病的血管内治疗

神经外科疾病的血管内治疗又称介入神经放射治疗，因治疗所用导管为3F以下，有的甚至微细到1.5F（0.49mm），故又称之为微导管血管内治疗。     

非Galen静脉的脑动静脉瘘的诊断与治疗

目的探讨脑内动静脉瘘的I临床特点及经血管内栓塞与显微外科手术治疗脑内动静脉瘘的经验。方法6例经血管内栓塞治疗，1例栓塞后手术治疗，l例单纯采用显微外科手术处理瘘口。结果术后颅内杂音立即消失，临床症状显著改善。未发生严重并发症。随访5个月～2年病情无复发。结论血管内栓塞治疗可以直接准确地堵塞瘘口恢复正常的脑血液循环。在栓塞中挤压同侧或双侧颈总动脉可以降低瘘口的血流速度和压力，有益于栓塞成功。对不能采用血管内治疗的病例，手术夹闭瘘口是理想的选择。     

慢性颈总动脉闭塞血管内开通治疗的临床分析

目的探讨血管内开通治疗颈总动脉闭塞的技术要点、安全性及近期疗效。方法2010年12月至2013年1月血管内开通治疗颈总动脉8例。结果8例血管内开通均获得成功，术后即刻灌注明显改善，近期随访未再发生缺血性卒中。结论血管内开通是治疗颈总动脉安全而有效的方法，短中期结果令人满意。     

血管内栓塞治疗脑动静脉畸形的临床探讨

目的探讨脑动静脉畸形（cAVM）的血管内栓塞治疗效果及综合治疗。方法在DSA监视下，经股动脉穿刺插管应用血管内栓塞技术治疗cAVM20例，栓塞剂为α-氰基丙烯酸正丁酯（NBCA）。结果6例达到完全或90％以上栓塞，10例60％～70％栓塞，4例50％左右栓塞。未能完全栓塞的14例中，4例接受手术治疗，其中3例痊愈，1例单侧肢体乏力，肌力Ⅲ级；6例接受立体定向放射治疗，2例痊愈，4例病灶缩小。结论血管内栓塞治疗cAVM的方法安全性好，损伤小，单纯栓塞可治愈部分cAVM，栓塞深部的供血动脉可降低手术的风险，并可减少cAVM体积使之适合放射治疗。血管内栓塞治疗是cAVM综合治疗的重要组成部分。     

破裂性前交通动脉瘤急性期血管内治疗和手术夹闭对照研究

目的：比较破裂性前交通动脉瘤急性期微弹簧圈栓塞和手术夹闭的疗效。方法回顾性分析122例前交通动脉瘤患者的临床资料，按治疗方法分为血管内治疗组和手术夹闭组；比较2组1个月内病死率和3个月生活能力评分。结果血管内治疗组79例，死亡3例，手术夹闭组43例，死亡5例，血管内治疗组与手术夹闭组病死率比较差异无统计学意义（χ2＝2.786，P＞0.05）。存活患者发病后3个月Barthel指数作生活量表（ADL ）评分，血管内治疗组ADL I级68例，手术夹闭组29例，2组比较差异有统计学意义（χ2＝5.934，P＜0.05）。结论破裂性前交通动脉瘤急性期微弹簧圈栓塞治疗可提高患者远期生活质量。     

显微手术治疗椎管内肿瘤25例临床分析

目的探讨椎管内肿瘤的诊断和治疗。方法回顾性分析2000年至2007年收治的25例椎管内肿瘤患者的临床资料。结果椎管内良性肿瘤24例，完整切除23例，术后恢复良好22例，1例无明显改善；1例次全切除。另1例为恶性肿瘤，次全切除，7年后复发，再次手术治疗。结论MRI对于椎管内肿瘤有很高的定位和定性诊断价值，手术是椎管内肿瘤的惟一有效的治疗方法，手术时间越早效果越好；对于椎管内外哑铃型肿瘤可以一期切除。     

Book

Book Reviews in this Article Brian Norht (ed.). Jamieson's first notebook of head injury, 3 ed. Butterworth, London, 1984. Pp. 100. £ 6.00. Neil Brooks (ed.). Closed head injury. Psychological, social, and family consequences. Oxford University Press, 1984. Pp. 231. Mental health care in developing countries: a critical appraisal of research findings Report of a WHO Study Group. WHO, Geneva, 1984. Pp. 59. S.fr. 6.00 C. J. J. Avezaat & J. H. M. Van Eijndhoven: Cerebrospinal fluid pulse pressure and craniospinal dynamics. A theoretical, clinical and experimental study. A. Jongbloed en Zoon, Hague, 1984. Pp. 339. Dfl. 90.00. Victor M. Haughton (ed.). Computed tomography of the spine. Churchill Livingstone, Edinburgh, 1983. Pp. 221. £27.00 M. D. Lezak. Neuropsychological assessment. 2nd. ed. Oxford University Press, Oxford, 1983. Pp. 768. £22.50 Stuart W. Young: Nuclear magnetic resonance imaging, basic principles. Raven Press, New York, 1984. Pp. 163. $24.00 Ellsworth C. Alvord Jr, Marian W. Kies, Anthony J. Suckling (eds.). Experimental allergic encephalomyelitis. A useful model for multiple sclerosis. Alan R. Liss, Inc., New York, 1984. Pp. 574. £52.00 W. K. Amery, J. M. Van Nueten & A. Wauquier (eds.). The pharmacological basis of migraine therapy. Pitman, London, 1984. Pp. 287. £18.50 F. Clifford Rose (ed.). Progress in migraine research 2. Pitman, London, 1984. £35.00 G. Fieschi, G. L. Lenzi & C. W. Loeb (eds.): Effects of aging on regulation of cerebral blood flow and metabolism. Karger, Basel, 1984. Pp. 258. Sw.Fr. 164.00 M. Swash & M. S. Schwartz: Biopsy pathology of muscle. Chapman & Hall, London, 1984. Pp. 206. £20.00 J. Wertheimer & M. Marois (eds.). Senile dementia: Outlook for the future. Alan R. Liss, New York, 1984. Pp. 532. £52.00 I. Gamstorp & H. B. Sarnat (eds.). Progressive spinal muscular atrophies. Raven Press, New York, 1984. Pp. 243. $60.00 John H. Tyrer & Mervyn J. Eadie (eds.) Clinical and experimental neurology. ADIS Health Science Press, Sydney, 1984. Pp. 264. £60.00     

BOOKS

Books review in this article:
The suppression of experimental allergic encephalomyelitis and multiple sclerosis. Ed. by A. N. Davison & M. L. Cuzner.
Neurotransmitters. Comparative aspects. Ed. by J. Salanki & T. M. Turpaev.
Neurobiology of cerebrospinal fluid. Vol. 1. Ed. by J. H. Wood.
The management of pain. Ed. Beks, J. W. F. Excerpta     

Intranasal sumatriptan for the acute treatment of migraine

Two double-blind, placebo-controlled, randomised, multicenter, multinational, parallel-group studies were carried out to identify the optimum dose of intranasal sumatriptan for the acute treatment of migraine. Study medication was taken as a single dose through one nostril in the first study, and as a divided dose through two nostrils in the second study. Totals of 245 and 210 patients with a history of migraine were recruited into the one-and two-nostril studies, respectively. In both studies, headache severity had significantly improved at 120 min after doses of 10–40 mg sumatriptan compared to placebo (P < 0.05) and the greatest efficacy rates were obtained with 20 mg sumatriptan. With 20 mg sumatriptan 78% and 74% of patients experienced headache relief in one- and two-nostril studies respectively. Sumatriptan was generally well tolerated, the most frequently reported event being taste disturbance. The results of the two studies are similar and indicate that administering sumatriptan as a divided dose via two nostrils confers no significant advantage over single-nostril administration. The publication committee members were as follows: Prof. C. Dahlöf Gothenburg; Prof. N. E. Gilhus, Bergen; Dr. V. Lüben, Giessen; Dr. R. Salonen, Tampere; Prof. J. M. Warier, Strasbourg; Ms E. Ashford, Glaxo Group Research Limited, Greenford; Mr. R. Dawson, Glaxo Group Research Limited, Greenford; Mrs D. Noronha Glaxo Group Research Limited, Greenford.Principal investigators were as follows: One nostril study France: Dr. N. Brion, Le Chesnay; Prof. G. Chazot, Lyon; Dr. P. Dano, Marseille; Prof. A. Destee, Lille; Dr. M. Schwob, Paris; Prof. J.M. Warter, Strasbourg. Germany: Dr. J. Brand, Konigstein; Dr. R. Enkelmann, St. Goar; Prof H. D. Langohr, Fulda; Dr. V. Lüben, Giesssen; Dr. M. Mockesch, Weinheim; Dr. H Pistauer, Preetz; Dr. Schimek, Giegen; Dr. E. Siegel, Munich. Norway: Dr. J. S. Aasen, Fredrikstad; Prof. N. E. Gilhus, Bergen; Dr. I. Monstad, Elverum; Dr. T. Mörland, Skien; Dr. K. Nestvold, Nordbyhagen; Dr. O. Roald, Oslo; Dr. R. Salvesen, Bodö; Prof. O. Sjaastad, Trondheim; Dr. B. Stadnes, Drammen; Dr. K. A. Tjörstad, Stavager.Two Nostril study Eire: Dr. A. Rynne, Dublin. Finland: Dr. M. Farkkila, Helsinki; Dr. H. Havanka, Kemi; Dr. T. Jolma, Pori; Dr. H. Kilpelainen, Savonlinna; Dr. E. Koivunen-Tapio, Jyvaskyla; Reunanen, Oulu; Dr. E. Sako, Turku; Dr. R. Salonen, Tampere. Sweden: Dr. B. Andersson, Gävle; Dr. C. Behring, Vasteras; Prof. C. Dahldf, Gothenburg; Dr. S. E. Eriksson, Falun; Dr. Hindfelt, Malmö; Dr. H. Hultberg, Osmo; Dr. F. Johansson, Umea; Dr. C. Muhr, Uppsala     

Mast Cell Degranulating Peptide Increases the Frequency of Spontaneous Miniature Postsynaptic Currents in CA3 Rat Hippocampal Neurons

Mast cell degranulating peptide (MCDP) is a neurotoxic agent isolated from bee venom. It produces a long-term potentiation in the hippocampus. We now report that MCDP, at nanomolar concentrations, induces a reduction of a transient voltage-dependent potassium current (ID) in CA3 rat pyramidal neurons and a persistent (>30 min) enhancement of the frequency of spontaneous miniature excitatory and inhibitory postsynaptic currents (m.e.p.s.c.s. and m.i.p.s.c.s.). M.e.p.s.c.s. and m.i.p.s.c.s. were recorded in the presence of bicuculline (30 microM) and 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX, 10 microM), respectively. The increased frequency of m.e.p.s.c.s. (408 +/- 60%) and m.i.p.s.c.s. (583 +/- 553%) was independent of the reduction of ID because 4-aminopyridine (4-AP, 30 microM - 2 mM) blocked ID but had no effects on m.e.p.s.c.s. and m.i.p.s.c.s. In the presence of the calcium channel blocker manganese (3 mM), MCDP still enhanced the frequency of m.e.p.s.c.s. (326 +/- 162%). It is concluded that MCDP augments the release of excitatory and inhibitory transmitter by an action, which is independent of calcium influx, through voltage-dependent channels.     

Book Reviews

Book reviewed in this article:
Human Chromosomes . By E. H. R. F ord .
Genetic Studies in Mental Subnormality. I. Familial idiopathic severe subnormality . By B. C. C lare D avison . II. The application of genetic principles in screening for metabolic disorders . By P. N. S wift , P. F. B enson and J. D. S tuddy .
Inquiring Man. The Theory of Personal Constructs . By D. B annister and F ay F ransella .
A Milieu Therapy Program for Behaviorally Disturbed Children . By M arjorie M c Q. M onkman .
Guide to Films on Mental Handicap . By T homas A. P ilkington .
Consumer's Guide to the British Social Services . By P hyllis W illmott .     

Books

Book Reviews in This Article:
B. S. Meldrum, R. J. Porter (eds.): New anticonvulsant drugs
H. H. Frey, W. Fröscher, W. P. Koella, H. Meinardi (eds.): Tolerance to beneficial and adverse effects of anti-epileptic drugs
A. Bernsmeier, A. Schroder, A. Struppler (eds.): Bodechtel: Differentialdiagnose neurologischer Krankheitsbilder
W. C. Koller (ed.): Handbook of Parkinson's disease
S. R. Markey, N. Castagnoli, Jr., A. J. Trevor, I. J. Kopin (eds.): MPTP: a neurotoxin producing a parkinsonian syndrome
J. B. Lohr, A. A. Wisniewski: Movement disorders
P. Jenner (ed.): Neurotoxins and their pharmacological implications
M. L. P. Apuzzo (ed.): Surgery of the third ventricle
J. Bethlem, C. Knobbout: Neuromuscular Diseases
R. L. Wood: Brain injury rehabilitation: a neurobehavioural approach     

Book Reviews

Book reviewed in this article: Psychiatric Presentations of Medical Illness. Somatopsychic Disorders. Richard C. W. Hall (ed.) The Epilepsies. A Critical Review. Robert B. Aird, Richard L. Masland, and Dixon M. Woodbury. Epilepsy. One Hundred Elementary Principles. Roger J. Porter. Merkmale Epileptischer Bildnerei mit Pathographie Van Gogh. Manfred in der Beeck. Living with Epilepsy. Margaret W. Sullivan. H. Houston Merritt. Memorial Volume. Melvin D. Yahr. (ed.) Pediatric Neurology. Third Edition. Thomas W. Farmer (ed.). Games, Sports, and Exercises for the Physically Handicapped. Third Edition. Ronald C. Adams, Alfred N. Daniel, Jeffery A. McCubbin, and Lee Rullman. Evoked Potentials. Colin Barber (ed.). Neurologic Emergencies. Michael P. Earnest (ed.). Neurology: The Physician's Guide. Robert G. Feldman (ed.). Astrocytes: Normal, Reactive, and Neoplastic. Philip E. Duffy Bender Gestalt Screening for Brain Dysfunction. Patricia Lacks. Brain Tumors in Children. Principles of Diagnosis and Treatment. Clinically Important Adverse Drug Interactions. Volume 2. Nervous System, Endocrine System and Infusion Therapy. J. C. Petrie (ed.). Cortical Integration. Basic, Archicortical, and Cortical Association Levels of Neural Integration. Current Issues in Toxicology. H. C. Grice (ed.). Current Therapy in Neurologic Disease 1985 · 1986. Richard T. Johnson. The Developing Human Brain. Growth and Epidemiologic Neuropathology. F. H. Gilles, A. Leviton, and E. C. Dooling. Guide to Clinical Studies and Developing Protocols. Bert Spilker. Magnetic Resonance Annual. Herbert Y. Kressel (ed.). The Metabolism of the Human Brain Studied with Positron Emmission Tomography. Torgny Greitz, David H. Ingvar, and Lennart Widen. Nuclear Magnetic Resonance Imaging. Basic Principles. Stuart W. Young. Oligodendroglia. William T. Norton (ed.). Palate Development: Normal and Abnormal Cellular and Molecular Aspects. Current Topics in Developmental Biology, vol. 19. Ernest F. Zimmerman.     

Books Received

J. D. Spillane : an Atlas of Clinical Neurology
Multiple Sklerose. Herausgegeben von F. W. Bronisch
P. M. Jeavons & G. F. A. Harding : Photosensitive epilepsy
Antiepileptische Langzeitmedikation. Ed. by H. Helmchen
CEAN 'Computerized EEG Analysis '. Ed. by Guiliano Dolce and Helmut Künkel
Biochemistry and Neurology. Ed. by H. Bradford & C. Marsden     

Need for a national epilepsy control program

This article briefly outlines the proposed national epilepsy control program. The content of the article is based on four meetings held by invitation of the Ministry of Health. Invitees by ministry – Drs. D. C. Jain, M. Gourie Devi, V. Saxena, S. Jain, P. Satish. Chandra, M. Gupta, K. Bala, V. Puri, K. S. Anand, S. Gulati, S. Johri, P. S. Chandra, M. Behari, K. Radhakrishnan, D. Bachani. Presentations were made by Dr. M. Tripathi.The program will involve all neurologists across the country in teaching and training at state levels and a central monitoring committee.     

Book reviews

Book Review in this Article
S. Finger & D. G. Stein: Brain damage and recovery.
Persistent pain. Modern methods of treatment, vol. 3. Ed. by S. Lipton & J. Miles.
The therapy of pain. Ed. by M. Swerdlow.
John R. Hughes: EEG in clinical practice.