未成年人颅内静脉窦血栓形成的临床特点和治疗

目的分析未成年人颅内静脉窦血栓(CVST)形成的原因、临床表现和治疗结果。方法回顾性分析21例经影像学确诊为CVST的未成年患者的临床表现、影像学特征、治疗方法及预后。其中11例患者仅接受抗凝治疗,10例患者接受抗凝联合血管内介入治疗。结果①在21例CVST患者中,16例存在明显病因,最多见的是感染病史10例(47.6%),其他病因包括头部外伤病史、早孕流产史、血液系统疾病等。②20例(95.2%)患者以头痛、呕吐等颅内压升高症状为首发症状,病程中可伴有癫痫发作、偏瘫、意识障碍、复视、视盘水肿等。③DSA显示受累静脉窦区均未显影,累及上矢状窦的12例,横窦16例,直窦4例,乙状窦12例,病变≥2个静脉窦的有17例(80.9%)。④经单纯抗凝药物治疗、血管内介入治疗后,痊愈7例,好转13例,死亡1例;3～6个月影像学随访,痊愈18例,好转1例。结论感染因素是本组未成年人CVST的主要病因,未成年人CVST累及≥2个静脉窦的比例较高。经抗凝和血管内治疗后,未成年人CVST的预后良好。     

后循环脑梗死患者临床及影像学特征分析

目的分析后循环脑梗死(posterior circulation cerebral infarction,PCCI)患者的临床表现、影像学特点、发病原因。方法选取头颅MRI提示有明确PCCI病灶的患者356例(PCCI组),回顾性分析其临床表现特点及影像学特征,另选前循环脑梗死(ACCI)患者853例(ACCI组),比较2组病因分型的差异。结果 PCCI患者临床症状中占前3位的分别为言语不清105例(29.5%),头晕/眩晕98例(27.5%)、肢体无力86例(24.2%);远段梗死是PCCI最常见的梗死部位(45.8%),累及部位最常见为丘脑20.2%;PCCI组动脉粥样硬化性血栓形成较ACCI组多见,差异有统计学意义(P<0.05)。结论 PCCI的临床表现复杂,PCCI最常见的梗死部位为远段,动脉粥样硬化血栓形成为PCCI最常见的发病原因。     

小儿急性偏瘫

小儿急性偏瘫是小儿时期较常见的脑血管病变 ,由多种病因引起 ,以脑动脉血管闭塞或狭窄为主要病理改变 ,以急性一侧肢体瘫痪为主要临床表现 ,多见于婴幼儿。1　病因及病理以感染引起的脑血管炎是本病最常见的原因 ,脑外伤、血栓形成、脑栓塞、颅内出血、脑血管畸形、自身免疫性疾病、全身性疾病、特发性缺血性中风及癫痫等均可引起脑动脉血管闭塞或狭窄 ,脑组织供血不足 ,缺血缺氧 ,致相对应的脑组织缺血坏死 ,引起对侧肢体瘫痪等症状。1.1　感染所致的脑血管炎　颅内感染时 ,病原体直接侵犯脑血管引起血管炎是导致小儿急性偏瘫的常见原因 ,…     

反复头痛的肥厚性硬脑膜炎致静脉窦血栓形成1例

头痛是临床最常见的症状之一，其发病机制非常复杂，不同的病因治疗方法不同，明确病因十分重要。静脉窦血栓形成是由多种病因所致的脑静脉回流受阻的血管病，临床表现以头痛为主，肥厚性硬脑膜炎（hypertrophic pachymeningitis，HP）是一种少见的中枢神经系统慢性无菌性炎性疾病，其特点是硬脑膜纤维性增生，可影响到矢状窦、乙状窦、横窦、大脑镰、小脑幕等。由硬脑膜纤维性增生而导致的静脉窦血栓形成，引起反复头痛，比较少见，现将临床诊治的1例资料报道如下。     

脑静脉窦血栓形成的影像学特征与早期诊断

目的 探讨脑静脉窦血栓形成(CVT)的早期临床和影像学特点，以利于CVT的早期诊断。方法 回顾性分析42例确诊的、有完整影像学资料的CVT患者的临床表现和颅脑CT、MR、数字减影血管造影(DSA)结果。结果 42例CVT患者早期的常见症状有头痛(100％)、局灶性神经功能缺损(67％)和癫痫发作(57％)，多被误诊为动脉性脑梗死、脑内占位或脑炎。影像学上39例可见静脉性脑梗死特征(引流区域脑实质肿胀和出血性梗死)，23例颅脑MR上可见T2WI病灶远大于弥散加权项(DWI)上的病灶，且坏死灶多仅位于皮层(87％)。T2WI上脑静脉窦流空信号消失有确诊价值，对上矢状窦血栓(96％)较侧窦血栓更敏感(50％)。DSA显示相应的静脉窦闭塞及静脉侧支循环，脑动静脉循环时间延长。结论 头痛、癫痫发作和局灶性神经功能缺损是CVT早期的常见症状，但缺乏特征性。熟识影像学上静脉性脑梗死的特征性表现(脑实质肿胀明显，但坏死轻微且常常伴有出血)，对CVT的早期诊断至关重要，颅脑MR上T2WI上脑静脉窦流空信号消失有确诊价值。对于MR无法确诊的病例，颅脑磁共振静脉血管造影(MRV)或13SA可明确诊断。CVT病灶功能障碍区域大而坏死轻微时，提示预后较好。     

孤立性脑桥梗死继发双侧小脑中脚华勒变性的临床及影像学特征

目的探讨孤立性脑桥梗死继发双侧小脑中脚华勒变性的临床和影像学特征。方法回顾性纳入2017年6月至2021年12月郑州大学第二附属医院收治的诊断为孤立性脑桥梗死后双侧小脑中脚华勒变性患者, 并通过检索中英文数据库收集在2001年1月至2021年12月期间报道的孤立性脑桥梗死后双侧小脑中脚华勒变性患者, 总结其临床及影像学特征。结果共纳入孤立性脑桥梗死后双侧小脑中脚华勒变性患者48例, 其中郑州大学第二附属医院收治的患者14例, 通过检索中英文数据库收集34例。男性33例(68.75%), 女性15例(31.25%), 年龄(65.8±10.7)岁(范围37～88岁)。大多数患者有血管危险因素, 以高血压最为常见。入院时以构音障碍和肢体无力为主要临床症状。全部48例患者的梗死部位均位于脑桥旁正中动脉供血区, 其中单侧37例(77.08%)(左侧18例, 右侧19例), 双侧6例(12.50%), 5例(10.42%)资料不全。诊断华勒变性时, 8例(16.67%)出现头晕或共济失调, 6例(12.50%)原有症状加重, 其余34例(70.83%)无新发症状或原有症状加重。所有患者双侧小脑中...     

孤立性胃静脉曲张的临床特点及内镜形态分析

目的:分析孤立性胃静脉曲张的临床和内镜形态特征。方法 :收集2007年1月至2015年5月期间我科经胃镜检查确诊为胃食管静脉曲张破裂出血的住院患者340例,其中孤立性胃静脉曲张38例(11.2%)。分析其病史资料、内镜所见、治疗情况及随访结果。结果:38例患者中常见病因分别为乙型肝炎后肝硬化(8例)、胰源性门静脉高压症(8例)及隐源性肝硬化(7例)。胃曲张静脉最常累及的区域分别为胃底大弯侧(84%)及胃底后壁侧(29%);形态上以多发结节状最常见(53%),其次为巨瘤状(37%);色泽上大多与周围正常黏膜相同(87%),且表面红色征少见(21%)。29例患者接受了内镜下硬化剂及组织黏合剂联合注射治疗术,所有患者对操作耐受良好,围手术期内未发生严重并发症。结论:孤立性胃静脉曲张为一少见疾病,其内镜形态复杂,缺乏明显色泽改变。胰源性门静脉高压症为其重要病因之一。内镜治疗可有效消退此类曲张静脉。     

原发性进行性失语的磁共振研究(附一例病例分析)

目的报道1例原发性进行性失语患者的脑内影像学特点,以探讨原发性进行性失语患者常见的病变部位,脑内血流量、代谢及语言功能区之间联系纤维的变化。方法利用西门子3.0T磁共振仪对1例确诊失语类型为感觉性失语的原发性进行性失语患者进行(1)常规磁共振;(2)磁共振灌注成像;(3)磁共振波谱分析;(4)磁共振扩散张量成像分析。结果常规磁共振成像显示左侧额叶及颞叶萎缩,功能磁共振显示左侧颞叶和额叶前部代谢较对侧明显减低,左侧颞极及额前部的血流量较对侧减低;左侧皮质脊髓束部分各向异性值及追踪到的纤维束较对侧减少,Broca区与Wernicke区之间的联系纤维与对侧相比减少。结论原发性进行性失语病变的部位主要在左侧颞叶、额叶,与对侧相应区域对比呈现低灌注、低代谢状态,Broca区与Wernicke联系纤维减少。     

近年儿童颅内静脉血栓形成的大样本文献回顾性分析

对近年来国内外报道的儿童大样本颅内静脉系统血栓形成(CVST)文献资料进行回顾性分析,探讨儿童CVST发病的危险因素、病因、临床表现、影像学表现及预后。国内CVST患儿男女比例为1.4∶1,高于欧洲和美国;CVST临床表现以颅内压增高、癫痫、局灶性神经症和全身症状为主,无特异性;与CVST有关的危险因素有高凝状态、感染和炎症性疾病,国内以鼻部和耳部的感染最常见。CVST最常累及上矢状窦,其次为横窦、乙状窦和直窦。发病年龄较晚、累及外侧静脉窦和/或乙状窦、无脑实质异常和积极予抗凝治疗均为认知功能良好的独立预测因素。CVST患儿临床表现无特异性,根据相关危险因素,开出特异性的检查是减少漏诊、误诊的主要手段。     

孤立性胃底静脉曲张患者的临床特征分析

[目的]分析孤立性胃底静脉曲张患者的临床特征。[方法]回顾性收集102例孤立性胃底静脉曲张患者的临床资料,并对其临床表现及相关化验检查进行分析。[结果]孤立性胃底静脉曲张的病因:肝硬化54例(52.94%);非肝硬化48例(47.06%),其中胰源性门脉高压29例(28.43%),其他19例(18.63%)。首发临床症状:呕血8例(7.84%),黑便8例(7.84%),同时出现呕血、黑便13例(12.74%),腹部不适症状34例(33.33%),乏力7例(6.86%),下肢水肿5例(4.90%)。非肝硬化患者中出现腹部不适症状比例明显多于肝硬化患者(43.75%∶24.07%,P0.05)。血常规检查:肝硬化患者白细胞、血小板分别为3.77×10~9/L、75.50×10~9/L均低于非肝硬化组的5.11×10~9/L、152.50×10~9/L,二者比较均差异有统计学意义(均P0.01)。肝肾功能结果:肝硬化患者丙氨酸氨基转移酶、天冬氨酸转氨酶、谷氨酰转肽酶、凝血酶原时间、胆红素均明显高于非肝硬化患者(均P0.01)。[结论]引起孤立性胃底静脉曲张最主要的病因为肝硬化门脉高压及胰源性门脉高压,肝硬化患者多存在脾功能亢进和肝功能异常。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.