颅内多发动脉瘤破裂出血急性期的血管内治疗

目的总结急性期内栓塞治疗颅内多发动脉瘤破裂出血的临床经验。方法对20例43个颅内多发动脉瘤病人行血管内治疗．其中单纯Marx或GDC弹簧圈栓塞囊状动脉瘤28个，颅内支架或球囊导管重塑技术辅助Matrix弹簧圈栓塞宽颈动脉瘤11个．水解弹簧圈栓塞不规则动脉瘤3个．双支架技术栓塞梭形动脉瘤1个。结果动脉瘤完全闭塞36个，95％闭塞5个，90％闭塞2个。术后随访3个月～2年，无死亡、复发、出血。结论根据颅内多发动脉瘤的结构特点采用不同栓塞材料和方法治疗，有利于提高颅内多发动脉的致密栓塞程度，减少动脉瘤的复发和再出血。     

早期血管内栓塞治疗破裂的颅内多发性动脉瘤

目的评估电解式可脱性铂金弹簧圈(GDC)早期血管内栓塞治疗以蛛网膜下腔出血为首发症状的颅内多发性动脉瘤的效果.方法回顾性分析自1998年1月至2000年5月经血管内栓塞治疗的20例颅内多发性动脉瘤病人,共44个动脉瘤.12例病人中所有动脉瘤都在前循环,8例病人至少有1个动脉瘤在后循环.根据Hunt和Hess评分,Ⅰ级4例,Ⅱ级7例,Ⅲ级6例,Ⅳ级3例.结果18例病人1次治疗将所有动脉瘤栓塞,其余2例在1周内分2次治疗.43个(97.6%)动脉瘤得以完全栓塞(占59%)和次全栓塞(占38.6%),与操作有关的并发症为5%,无死亡病例.临床随访平均10个月,无再出血,GOS评分Ⅰ和Ⅱ级18例.结论GDC早期血管内栓塞治疗以蛛网膜下腔出血为首发症状的颅内多发性动脉瘤是安全有效的,并应尽可能在1次治疗中将所有动脉瘤栓塞.     

GDC栓塞治疗颅内动脉瘤的探讨(附66例报告)

目的 探讨GDC栓塞颅内动脉瘤时机及手术技巧。方法 经全脑DSA检查，66例颅内动脉瘤患者全部实施血管内GDC栓塞治疗。股动脉入路57例，颈动脉入路9例。结果 完全栓塞50例，次全栓塞15例，失败1例。15例患者于栓塞术后半年复查脑血管造影，14例显示瘤腔内无造影剂充盈，另1例动脉瘤腔较原来有所增大，再次栓塞治疗。结论 GDC是颅内动脉瘤栓塞治疗的有效材料，为外科手术提供了补充。     

颅内动脉瘤的血管内栓塞治疗

目的探讨血管内栓塞治疗颅内动脉瘤的疗效。方法回顾性分析了34例颅内动脉瘤的血管内栓塞治疗,其中3例行球囊瘤内栓塞治疗,5例行载瘤动脉球囊闭塞术,26例行GDC栓塞治疗。结果26例GDC栓塞患者中,100%栓塞16例,90~95%栓塞8例,不到90%栓塞2例;术中出现脑血管痉挛3例,脑血栓形成2例,未出现动脉瘤破裂;34例病人出院时按格拉斯哥预后评分(GOS)评价结果,良好26例,中残6例,重残2例,无植物生存及死亡病例;术后随访无再出血病例。结论由于血管内治疗技术和材料的不断进步,尤其是GDC的广泛应用,多数颅内动脉瘤可以进行有效的血管内栓塞治疗。     

电解弹簧圈治疗颅内动脉瘤疗效分析

本文就电解式可脱性弹簧圈（GDC）栓塞治疗颅内动脉瘤的临床疗效、影响因素、病理改变等作一综述。1　疗 效　　自1995年通过美国联邦食品与药品委员会（FDA）批准用于临床以来，GDC已在全世界被广泛用于颅内动脉瘤的血管内栓塞治疗，其疗效令人振奋。尤其对于手术夹闭缺乏指征的动脉瘤，GDC栓塞手术大大提高了动脉瘤治疗的可行性和治疗效果。1．1 栓塞程度　GDC主要的作用是通过物理填塞瘤腔，使动脉瘤与载瘤动脉血流完全或基本隔离，孤立动脉瘤，从而达到治疗目的。因此，对动脉瘤瘤体的栓塞程度及栓塞的稳定性，很大程度上决定了G…     

颅内动脉瘤血管内栓塞治疗的临床效果

目的探讨可脱性弹簧圈及可脱性球囊血管内栓塞治疗颅内动脉瘤的效果及技术要点。方法对1328例来自华南地区部分省市的颅内动脉瘤应用微导管技术，在数字减影血管造影监视下行血管内栓寒治疗，其中85例90个动脉瘤用机械式可脱性弹簧圈（MDS)栓塞，825例847个动脉瘤用电解式可脱性弹簧圈（GDC)栓塞67例巨大动脉瘤中37例片可脱性球囊闭塞载瘤动脉．18例用GDC．11例川EDC，1例用MDS闭塞载瘤动脉。结果成功栓塞1328例1370个动脉瘤，1322例痊愈，6例死亡。栓寒程度：100％栓寒1281个(包括载瘤动脉闭塞者)，95％栓寒65个，90％栓塞20个，80％栓寒4个术中动脉瘤破裂9例，并发脑梗死5例，1例微弹簧末端逸出并顽固性脑血管痉挛。2例复发者冉给予GDC栓塞而治愈．结论血管内栓塞治疗颅内动脉瘤是一种比较安全、可靠、有效的治疗手段，动脉瘤较大者，术后复发率高；术前反复蛛网膜下腔出血者，术中动脉瘤破裂的可能性较大。     

颅内动脉瘤显微手术夹闭栓塞治疗后再破裂(附2例报告)

目的 探讨颅内动脉瘤栓塞后复发的原因、处理措施。方法 对2例自发性蛛网膜下腔出血病人行血管造影及栓塞治疗，动脉瘤再破裂出血后行显微外科手术治疗。结果 2例病人经血管造影证实均为后交通动脉瘤，用GDC行栓塞治疗，分别在栓塞后7个月、21个月再次发生蛛网膜下腔出血，血管造影检查及手术发现为动脉瘤复发并破裂，即行显微手术夹闭动脉瘤。结论 颅内动脉瘤血管内栓塞治疗后再复发的主要原因有：栓塞不致密或栓塞不全，以及血流动力学的影响。对再破裂动脉瘤宜行手术予以夹闭。     

自发性蛛网膜下腔出血的病因诊断及介入治疗

目的通过数字减影脑血管造影（DSA）对自发性蛛网膜下腔出血（SAH）作病因诊断及颅内动脉瘤的介入治疗。方法对246例SAH患者行DSA检查以明确其出血原因。对138例确诊动脉瘤患者用GDC或EDC行血管内栓塞治疗。结果246例SAH患者DSA检查发现颅内动脉瘤155例（63．0％），其中动脉瘤合并脑动静脉畸形（AVM）3例，动脉瘤合并烟雾病1例，AVM 15例（6．1％），烟雾病10例（4.1％），高血压动脉硬化39例（15，9％），原因不明27例（11．0％）。138例颅内动脉瘤栓塞患者中1例术中出血死亡，1例术后1h再出血死亡；动脉瘤栓塞术后经DSA随访90例，随访时间为1个月至6．5年，发现13例再通（其中2例因再出血行DSA复查发现再通），再通率为14.4％，13例再通患者经再栓塞后未发生再出血。结论自发性SAH的主要原因是脑动脉瘤，DSA是明确SAH病因的可靠方法，GDC或EDC血管内栓塞治疗颅内动脉瘤安全有效，但有一定复发率，故应注意随访。     

颅内动脉瘤破裂出血后假性动脉瘤形成的实验和临床研究

目的探讨颅内动脉瘤破裂出血后在其破口周围可以形成假性动脉瘤,对其应早期诊断尽快治疗,防止再出血,提高治愈率,降低死残率。方法通过用兔建立的假性动脉瘤与真性动脉瘤合并假性动脉瘤的动物模型,探讨假性动脉瘤形成的机理,并结合临床在治疗颅内动脉瘤破裂出血早期、DSA造影影像分析及GDC血管内栓塞动脉瘤时所见的情况进行分析。结果用创伤与显微外科相结合的方法,可以成功建立假性动脉瘤,其形成过程分为动脉瘤破裂出血期、假性动脉瘤形成前期、假性动脉瘤形成期及假性动脉瘤增大破裂出血期四个阶段。颅内动脉瘤破裂出血早期行DSA血管造影时可见其影像形态不规则呈哑铃状、双腔与瘤囊顶鼓出小泡等表现,血管内栓塞治疗可见(1)GDC只能进入靠近载瘤动脉的瘤腔,并将其栓塞,完全不进入远离载瘤动脉的瘤腔,栓塞后透视下见未充填GDC的瘤腔内有造影剂滞留,栓塞后造影见动脉瘤完全闭塞,随访造影见动脉瘤完全消失;(2)GDC完全填塞靠近载瘤动脉的瘤腔,部分填塞远离载瘤动脉的瘤腔,栓塞后造影见动脉瘤完全消失,随访造影动脉瘤消失;(3)GDC将靠近与远离载瘤动脉的两个瘤腔完全填塞,栓塞后造影见动脉瘤完全闭塞,随访造影见动脉瘤消失。结论颅内动脉瘤破裂出血后,在其破口周围可以形成假性动脉瘤,对伴有假性动脉瘤的颅内     

电解可脱性弹簧圈早期血管内栓塞颅内破裂动脉瘤及相关问题讨论

目的探讨早期电解可脱性弹簧圈(GDC)血管内栓塞颅内动脉瘤的临床疗效及应用价值。方法急诊用GDC血管内栓塞治疗颅内动脉瘤52例。结果成功栓塞52例共计55个颅内动脉瘤。51例痊愈,1例死亡。完全栓塞(>95%)栓塞32个,大部分栓塞(80%~95%)20个,部分栓塞(<80%)3个。并发动脉瘤破裂2例,其中1例痊愈,1例死亡。并发脑梗死3例,局部溶栓后,遗留轻偏瘫和单瘫。2例弹簧圈末端遗留于动脉瘤外,经抗凝治疗未发生并发症。3例复发再次栓塞后治愈。结论早期GDC血管内栓塞治疗颅内动脉瘤是一种较为安全、可靠、有效的治疗方法。     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

The organization of the connections between the cortex and the claustrum in the monkey

The distribution of labelled cells and of extracellular granules in the claustrum has been studied after injections of horseradish peroxidase in several areas of the neocortex. The frontal and parietal lobes are related to the anterior and posterior halves respectively of the claustrum, and the occipital and temporal cortex to the posterior and inferior margins. Parts of the claustrum related to areas of the cortex in the frontal lobe overlap considerably in the antero-posterior dimension with parts related to widely separated but interconnected areas of the parieto-temporal cortex. Areas of cortex within one lobe which are interconnected are related to parts of the claustrum which overlap in the dorsoventral dimension.     

A projection to the striatum from the medial subdivision of the posterior group of the thalamus in the cat

Injections of wheat germ agglutinin-conjugated horseradish peroxidase in the lateral part of the caudate nucleus or the putamen of the cat result in retrograde thalamic cell-labeling in the rostral extension of the medial subdivision of the posterior group (POM). Autoradiography after [³H]amino acid injection of POM reveals a dense and discontinuous distribution of axons in the lateral half of the caudate and putamen concentrated at their middle rostrocaudal levels. This newly discovered thalamostriatal projection of POM may account for somatosensory activity observed in striatal cells.     

Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala

The amygdala of all tetrapod vertebrates receives direct projections from the main and accessory olfactory bulbs, and the strong similarities in the organization of these projections suggest that they have undergone a very conservative evolution. However, current ideas about the function of the amygdala do not pay sufficient attention to its chemosensory role, but only view it as the core of the emotional brain. In this study, we propose that both roles of the amygdala are intimately linked since the amygdala is actually involved in mediating emotional responses to chemical signals. The amygdala is the only structure in the brain receiving pheromonal information directly from the accessory olfactory bulbs and we have shown in mice that males emit sexual pheromones that are innately attractive for females. In fact, sexual pheromones can be used as unconditioned stimuli to induce a conditioned attraction to previously neutral odorants as well as a conditioned place preference. Therefore, sexual pheromones should be regarded as natural reinforcers. Behavioural and pharmacological studies (reviewed here) have shown that the females' innate preference for sexual pheromones is not affected by lesions of the dopaminergic cells of the ventral tegmental area, and that the systemic administration of dopamine antagonists do not alter neither the attraction nor the reinforcing effects of these pheromones. Anatomical studies have shown that the vomeronasal amygdala gives rise to important projections to the olfactory tubercle and the islands of Calleja, suggesting that these amygdalo-striatal pathways might be involved in the reinforcing value of sexual pheromones.     

Evidence for the collateral innervation of the esophagus and the heart from neurons in the compact formation of the nucleus ambiguus of the rat

We investigated whether the heart receives collateral projections from the neurons which innervate the esophagus with a retrograde double-labeling method using two fluorescent tracers. Following injections of True Blue (TB) into the esophagus and Diamidino Yellow (DY) into the heart, about 21.9% of the labeled esophageal motoneurons in the compact formation of the nucleus ambiguus (AmC) were retrogradely double labeled. No single-labeled cardiac motoneurons were found in the AmC. The present results provide anatomical substrates for the esophagocardiac reflex.     

Role of the paraventricular nucleus in the projection from the nucleus of the solitary tract to the olfactory bulb

Electrophysiological experiments were performed on anesthetized rats to determine the effects of lesions of the paraventricular nucleus on the amplitude of evoked potentials recorded in the periglomerular layer of the olfactory bulb after nucleus of the solitary tract electrical stimulation. Lesions of the paraventricular nucleus enhance the amplitude of both the positive and negative components of the evoked potential in the olfactory bulb. The pathway from the paraventricular nucleus to the olfactory bulb seems to exert a suppressive influence over the projection from the nucleus of the solitary tract to the olfactory bulb under these conditions.     

On the origin of the serotonergic input to the intermediate lobe of the rat pituitary

Single stimulations of the vagina and cervix were performed between proestrus and the first day of diestrus with a stimulator designed to grade the intravaginal penetration of a rod. The percent incidence of pseudopregnancy after this stimulation was exponentially related to the extent of intravaginal penetration and was also affected by the stage of the cycle at which the stimulation was performed. At 10.00 h on proestrus, an exponential increase in the incidence of pseudopregnancy was observed with shallow penetrations, while an exponential decrease was found when deeper penetrations were applied. Such negative exponential correlation had disappeared at 22.00 h on proestrus. At that time, also, some responses were elicited by very shallow penetrations (17 mm) and all the animals responded to penetrations of 20 mm or more. Sensitivity to cervicovaginal stimulation at 10.00 h on estrus was lower than that at 22.00 h on proestrus and it was even lower at 10.00 h on the first day of diestrus. The response to 18 mm of penetration was studied every 3 h between 10.00 h on proestrus and 10.00 h on estrus, and then every 12 h until 10.00 h on the first day of diestrus. This stimulation was usually ineffective to induce pseudopregnancy, except for a brief period encompassing the night between proestrus and estrus, when a peak in the incidence of responses was reached. This peak sensitivity could be advanced following the s.c. administration of 250 and 500 ng of LH-RH at 11.00 h on proestrus. Other doses were ineffective. The peptide (500 ng) was unable to induce pseudopregnancy in rats that received no cervicovaginal stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)     

On the development of the stratification of the inner plexiform layer in the chick retina

This study investigated the development of the subdivision of the chick inner plexiform layer (IPL). The approach included an immunohistological analysis of the temporal and spatial expressions of choline acetyltransferase, of the neural-glial-related and neural-glial cell adhesion molecules (NrCAM and NgCAM, respectively) and axonin-1, and of inwardly rectifying potassium (Kir) channels in 5- to 19-day-old (E5-E19) embryos. Ultrastructural investigations evaluated whether synaptogenesis accompanies the onset of differentiation of the IPL. We found that the differentiation of the IPL started at E9. Distinct cholinergic strata appeared, NrCAM immunoreactivity showed a poorly defined stratification, and Kir3.2 was expressed in the IPL and in the inner nuclear layer. From E10 until late E14, NgCAM- and axonin-1-immunoreactive strata emerged in an alternating sequence from the outer to the inner IPL. During this period, the NrCAM pattern sharpened, and eventually five bands of weaker and stronger immunoreactivity were found. Conventional synapses formed at the beginning of E9, and stratification of the IPL also began on the same day at the same location. Synaptogenesis and stratification followed a gradient from the central to the peripheral retina. The topographic course of differentiation of the IPL generally corresponded to the course of maturation of ganglion and amacrine cells. Synaptogenesis and the expression of G-protein-gated Kir3.2 channels accompanied the onset of stratification. These events coincide with the occurrence of robust and rhythmic spontaneous neuronal activity. The subsequent differentiation of the IPL seemed to be orchestrated by several mechanisms.