56例短暂性脑缺血发作DSA分析

目的通过数字减影血管造影(DSA)研究短暂性脑缺血发作(transient ischemic attacks,TIA)与颅内-外供血动脉的关系,以探讨TIA的病因。方法对56例TIA患者行DSA全脑血管造影,观察颅内外供血动脉有无狭窄、狭窄程度及有无血管畸形等。结果 56例TIA患者中10例(17.86%)造影阴性,46例(82.14%)存在不同程度的责任血管病变,其中颅内外动脉狭窄40例(71.42%),动静脉畸形2例(3.57%),动脉瘤3例(5.36%),烟雾病1例(1.79%)。23例(41.07%)患者存在2处以上血管狭窄。结论颅内-外供血动脉狭窄是TIA的常见原因,动静脉畸形、动脉瘤、烟雾病等是TIA的少见病因,DSA对TIA患者病因检查有重要的临床价值。     

非高血压性自发性颅内出血病因及治疗研究

目的 分析非高血压性自发性颅内出血的病因,并对其治疗进行探讨.方法 对60例非高血压性自发性蛛网膜下腔出血(SAH)和42例脑实质内出血患者进行分析,均行DSA检查并采取相应治疗措施.结果 60例SAH的患者中,动脉瘤52例(86.67%),脑动静脉畸形(CAVM)1例(1.67%),动脉瘤合并CAVM 1例(1.67%),血液病1例(1.67%),造影阴性5例(83.33%);在42例脑实质出血(包括脑室出血)的患者中,动脉瘤15例(35.71%),CAVM 9例(21.43%),moyamoya病3例(7.14%),右侧椎动脉变细1例,海绵窦血栓性静脉炎1例,13例(30.95%)造影未发现异常.结论非高血压性SAH的主要原因为动脉瘤破裂,自发性脑实质出血的主要原因为动脉瘤和脑动静脉畸形破裂,临床DSA检查是确诊其病因的重要手段之一,自发性颅内出血病因的早期诊断和对因治疗具有重要临床意义.     

自发性蛛网膜下腔出血病因学分析

目的分析自发性蛛网膜下腔出血的病因分布及病因诊断所采取的检查手段。方法回顾性分析165例自发性蛛网膜下腔出血的病因分布及病因诊断的影像学检查。结果颅内动脉瘤61例(37.0%),烟雾病(Moyamoya病)8例(4.8%),脑动静脉畸形(AVM)3例(1.8%),硬脑膜动静脉瘘(DAVF)1例(0.6%),联合脑MRI诊断明确海绵状血管瘤1例(0.6%),首次检查不能明确病因者91例(55.2%)。结论颅内动脉瘤破裂是最为常见的SAH病因,其次为Moyamoya病和AVM。在SAH的病因诊断中,3D-DSA仍为首选检查,被认为"金标准"。在无法实施3D-DSA的条件下,可首先考虑行CTA检查。     

多层螺旋CT血管成像在椎基底动脉短暂性脑缺血发作诊断中的价值

目的探讨多层螺旋CT血管成像(MSCTA)在椎基底动脉短暂性脑缺血发作(TIA)诊断中的价值。方法50例椎基底动脉TIA的患者行头颈部MSCTA检查,其中8例在CTA检查后1~7 d行DSA检查。结果50例患者的100支椎动脉中MSCTA显示血管正常55支,轻度狭窄14支,中度狭窄9支,重度狭窄8支,先天发育不良(一侧椎动脉细小)5支,明显迂曲9支。8例患者的椎动脉管腔MSCTA评价结果与DSA一致。结论MSCTA能清晰显示椎动脉,对椎基底动脉TIA的病因诊断、治疗方案的确定以及预后估计有重要价值。     

多层螺旋CTA在自发性蛛网膜下腔出血病因诊断中的应用

目的探讨多层螺旋CTA在自发性蛛网膜下腔出血(SAH)病因诊断中的应用价值。方法对18例经CT平扫确诊的自发性蛛网膜下腔出血的患者行16层CTA检查以明确病因。结果 CTA显示18例自发性SAH,9例为动脉瘤,3例脑动静脉畸形,3例脑动脉硬化,1例烟雾病,2例阴性。阳性病例中5例经DSA、2例经手术证实,表现与CTA一致,2例CTA表现正常病例行DSA检查阴性1例,CTA漏诊动脉瘤1例。结论多层螺旋CTA对自发性蛛网膜下腔出血的病因诊断准确性高,能为临床诊治提供诊断依据和治疗指导,可作为自发性蛛网膜下腔出血病因诊断的首选检查方法。     

246例非高血压性自发性脑出血的病因与DSA分析

目的 探讨非高血压性自发性脑出血的病因并分析其DSA结果。方法 非高血压性自发性脑出血246例，全部做了DSA检查。结果 脑动静脉畸形l16例(47．2％)，以顶、颞叶从MVM见。颅内动脉瘤85例(34．6％)，以Willis环动脉瘤多见。Moyamoya病15例(6．1％)。硬脑膜动静脉瘘7例(2．8％)。23例DSA未发现异常。结论 非高血压性自发性脑出血常见病因是脑动静脉畸形和颅内动脉瘤，临床DSA检查是确诊病因的重要手段之一。     

首次脑血管造影阴性的自发性蛛网膜下腔出血的诊断与治疗

自发性蛛网膜下腔出血(SAH)约占脑血管病的15%,多为脑动脉瘤,其次是动静脉畸形和高血压动脉硬化[1].少见的原因包括烟雾病、血液系统疾病等[1-2].大多数SAH能够明确病因,但仍有部分SAH患者首次脑血管造影阴性[2-6].研究显示,首次DSA阴性的SAH患者,再次造影的阳性率可达到2%～24%[3-4].本文对120例首次DSA阴性的SAH患者进行回顾性分析,探讨其病因以及处理的方法.     

青年非高血压脑出血病因的DSA分析

目的探讨应用数字减影血管造影技术(DSA)对非高血压青年脑出血患者的诊断价值。方法对165例非高血压脑出血青年患者行数字减影脑血管造影,对患者出现脑出血的原因进行总结分析。结果 DSA检查阳性患者为129例,阳性率为78.2%。病因包括动脉瘤、动静脉畸形及烟雾病。其中动脉瘤95例(73.6%),年龄37~44岁,平均(41.35±2.17)岁,临床主要表现为昏迷及眼部玻璃体出血;动静脉畸形23例(17.8%),年龄21~39岁,平均(29.13±6.27)岁,临床主要表现为前期的癫痫发作合并眼睛同向偏盲;烟雾病11例,占8.5%(11/129),年龄18~23岁,平均(21.16±1.25)岁,临床主要表现为前期肢体麻木症状。结论数字减影脑血管造影对青年非高血压脑出血病因诊断明确,引起脑出血主要病因为动脉瘤。     

旋转数字减影血管造影三维重建在脑血管疾病诊断 及鉴别中的应用价值

目的 分析旋转数字减影血管造影（DSA）三维重建技术在脑血管疾病患者诊断与鉴别中 的应用价值。方法 选取 2016 年 1 月至 2018 年 1 月甘肃省武威市人民医院放射介入室 80 例疑似脑血 管疾病患者,均采取常规 DSA、旋转 DSA 三维重建技术进行检查,观察两种检查方式对患者脑血管病变 显示结果与脑血管疾病检出率,比较两种检查方式显示动脉瘤颈与载瘤动脉的关系。结果 常规 DSA 检查发现 59 例颅内动脉瘤（共 59 个动脉瘤）,6 例大脑中动脉梗死,4 例动静脉畸形,11 例疑似脑血管病; 经旋转 DSA 三维重建技术检查发现 61 例颅内动脉瘤（包括 2 例多发动脉瘤,共 65 个动脉瘤,分布为：颈 内与后交通动脉 25 个,大脑中动脉 6 个,大脑前与前交通动脉 23 个,基底动脉 7 个,椎动脉 4 个）,8 例大 脑中动脉梗死,6 例动静脉畸形（包括顶叶脑动静脉畸形 3 例,枕叶脑动静脉畸形 1 例,颞叶脑动静脉畸 形1例,小脑动静脉畸形1例）,3例烟雾病（清晰显示血管异常）,海绵窦瘘（清晰显示瘘口部位与回流静脉） 2例;旋转DSA三维重建对脑血管疾病检出率为100%,明显高于常规DSA的91.25%（χ2 =5.378,P＜0.05）; 对于动脉瘤颈与载瘤动脉的关系,旋转 DSA 三维重建显示清楚率为 100%,明显高于常规 DSA 显示清楚 率 49.15%（χ2 =43.040,P＜ 0.05）。结论 旋转 DSA 三维重建技术可以直观、立体并且清晰地显示脑部 病变血管情况,为脑血管疾病鉴别及临床诊治提供更准确、有效的指导。     

蛛网膜下腔出血临床表现及病因分析

蛛网膜下腔出血是神经内外科常见疾病,近几年来发病率有增高趋势。蛛网膜下腔出血原因很多,最主要最常见的原因为颅内动脉瘤,动脉硬化,脑动静脉畸形,烟雾病(moyamga),颅脑损伤,脑肿瘤,造血系统疾病,原因不明等。本文重点分析我院1977～1987年收治123例因动脉瘤,动静脉畸形。烟雾病引起的蛛网膜下腔出血。     

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.