缺血性脑血管病合并2型糖尿病患者全脑血管造影特点分析

目的探讨缺血性脑血管病合并2型糖尿病患者全脑血管造影的特点。方法应用荷兰飞利浦公司生产的FD-20 C型臂血管造影系统,对247例缺血性脑血管病合并2型糖尿病(糖尿病组)患者与372例缺血性脑血管病不合并2型糖尿病(对照组)患者的全脑血管造影结果进行比较。结果糖尿病组与对照组血管狭窄程度差异有统计学意义(χ2=31.57,P<0.05);糖尿病组中,中重度狭窄和闭塞的患者明显多于对照组(χ2=30.34,P<0.05)。两组均以多支血管病变为主,但糖尿病组多支血管病变的发生率明显高于对照组(72.05%vs53.56%),且以弥漫性血管病变(64.63%)和无侧支血管代偿(71.18%)为主,而对照组以非弥漫性血管病变和无侧支血管代偿为主。在糖尿病组中,随着糖化血红蛋白的增加,中重度狭窄和闭塞、多支病变及弥漫性病变发生率逐渐明显增加,有侧支代偿的比例逐渐减少,各组间均有统计学意义。结论缺血性脑血管病合并2型糖尿病患者全脑血管狭窄程度更重,常表现为多支血管病变、弥漫性血管病变并且侧支代偿少,血糖控制不佳加重上述损害。     

缺血性脑血管病的数字减影全脑血管造影分析

目的探讨缺血性脑血管病的数字减影全脑血管造影(DSA)表现及临床意义。方法211例缺血性脑血管病患者行DSA检查,以了解颅内外血管病变及侧支循环建立情况并进行综合分析。结果检出颅内外血管病变患者152例(72．04%),共累及病变血管180支,以颈动脉病变为主(53．33%),颅外动脉病变的发生率(67．78%)明显高于颅内动脉(32．22%)(P＜0．05)。结论颈动脉病变在缺血性脑血管病的发生中起重要作用。     

高同型半胱氨酸血症型高血压患者脑血管病变特点

目的比较脑梗死合并高同型半胱氨酸血症(HHcy)型高血压(H型高血压)及原发性高血压患者脑血管病变特点。方法检测258例脑梗死合并高血压患者的同型半胱氨酸(Hcy)水平,根据Hcy水平分为H型高血压组及高血压组。采用DSA检查患者的脑血管病变情况。结果 H型高血压组112例,高血压组146例。两组间性别、年龄、收缩压、舒张压,以及吸烟、饮酒史比率差异均无统计学意义(均P0.05)。两组均以颈内动脉(ICA)及大脑中动脉(MCA)受累多,以颅内血管狭窄病变为主。与高血压组比较,H型高血压组颅内血管病变及重度脑血管狭窄发生率显著增高,侧支循环比率显著降低(均P0.05)。结论脑梗死合并H型高血压患者血管狭窄较多,程度较重,且侧支代偿较少。     

106例缺血性脑血管病患者全脑血管造影分析

目的分析缺血性脑血管病患者颅内外动脉狭窄的分布。方法对我院实施DSA检查的106例缺血性脑血管病的结果进行分析,均经头颅CT排除脑出血,TCD及颈动脉彩超检查后怀疑有动脉狭窄的缺血性脑血管病。所有患者均实施选择性全脑血管造影术,椎动脉和颈动脉均有正侧位血管造影像;根据患者的DSA检查结果,分析动脉狭窄的部位、受累血管数目及血管狭窄形态;重度狭窄的病例予以支架治疗和球囊成型术。结果血管造影结果提示89.6%患者有不同程度的血管狭窄或闭塞,其中75.5%为前循环受累,37.7%为后循环受累。前循环受累血管中以颈内动脉(56.6%)和大脑中动脉(26.4%)受累最常见,后循环受累血管中以椎动脉(33.0%)最多见。支架治疗和球囊成型术临床疗效显著。结论缺血性脑血管病造影显示大部分患者有肯定的脑血管狭窄和闭塞。脑梗死患者血管病变以颈内动脉病变为主,椎基底动脉供血不足亦以颈内动脉病变多见,支架治疗和球囊成型可作为重度狭窄的治疗方法。     

缺血性脑血管病的DSA结果分析

目的探讨缺血性脑血管病数字减影全脑血管造影(DSA)的检查结果及临床意义。方法对120例缺血性脑血管病患者行DSA检查,观察及评价颅内外血管病变的直接征象及侧支循环建立情况,分析影像结果与临床表现的相关性。结果检出颅外颈动脉病变者86例(71.67%),共累及血管93支,以颈动脉狭窄为主50支(53.76%),其它动脉43支(46.24%);颅外动脉狭窄62支(66.67%),颅内动脉狭窄31支(33.33%),颅外动脉狭窄的发生率明显高于颅内动脉;颈内动脉颅外段狭窄33支(53.23%),颈内动脉颅内段7支(22.58%),颈内动脉颅外段狭窄明显高于颈内动脉颅内段。结论颈动脉病变在缺血性脑血管病的发生中起重要作用,DSA检查在缺血性脑血管病的诊断中有重要的应用价值。     

缺血性脑血管病432例DSA结果分析

目的 探讨缺血性脑血管病脑血管造影结果,为进一步药物治疗、手术治疗及血管内介入治疗提供依据.方法 将2006-06～2009-12在我科住院行全脑血管造影的432例患者缺血性脑血管患者的临床资料进行回顾性分析,分析缺血性脑血管病患者血管情况.结果 检出颅内外动脉狭窄311例,累及动脉451支,其中颅外动脉狭窄305支(67.63%),颅内动脉狭窄146支(32.37%);病变血管狭窄程度分布:狭窄程度＜50%有239支(52.99%),50%～90% 104支(23.06%),91%～99% 72支(15.96%),血管完全闭塞的36支(7.98%).结论 DSA对缺血性脑血管病的诊断及治疗具有重要的意义,不仅可以直观地了解脑血管的形态,同时可以获得血流动力学的信息,为血管内介入治疗提供重要依据.     

血清胱抑素C与缺血性卒中患者脑血管造影下脑动脉狭窄的关系

目的探讨缺血性卒中患者胱抑素C(cystatin C,Cys C)与脑动脉粥样硬化性狭窄的关系。方法应用荷兰Philips公司生产的FD-20 C型臂血管造影系统,对299例缺血性卒中患者进行全脑血管造影及血浆Cys C检测,根据Cys C检测水平,分为对照组(Cys C正常)139例患者与异常组(Cys C异常)160例患者,比较其全脑血管造影。结果正常组(对照组)与异常组(病例组)脑动脉狭窄程度差异有统计学意义(χ2=16.94,P0.05);异常组中颅内外动脉中重度狭窄和闭塞的比率显著升高,且以无侧支循环代偿(73.13%)及弥漫性病变(65.63%)为主;随着Cys C的升高,脑动脉狭窄程度逐渐加重。结论 Cys C是缺血性脑卒中患者脑动脉粥样硬化性狭窄的一种危险因素,脑血管狭窄与Cys C升高有关,Cys C在一定程度上反映脑血管狭窄程度。     

缺血性脑血管病患者数字减影血管造影的研究

目的 应用数字减影血管造影(DSA)探讨缺血性脑血管病(ICVD)患者脑血管病变的特点.方法 对84例ICVD患者[其中脑梗死(CI)50例、椎-基底动脉供血不足(VBI)21例、短暂性脑缺血发作(TIA)13例]进行DSA检查,对颅内外病变血管的分布、血管狭窄程度及侧支循环代偿情况进行分析.结果 本组84例ICVD患者中,血管狭窄的检出率为82.1%(69例);检出颅内外病变血管166条,以前循环(59.6%)以及颅内动脉(66.9%)受累为主,单条血管病变的发生率以颈内动脉颅外段最高(21.7%);狭窄程度1～4级的血管分别占27.1%、40.4%,6.6%及25.9%;58.0%的CI患者、33.3%的VBI患者和23.1%的TIA患者出现Willis环侧支循环代偿.结论 DSA可准确评价ICVD患者颅内外病变血管的分布、狭窄程度以及侧支循环代偿情况,为临床治疗提供依据.     

Lp-PLA2与缺血性脑血管病患者脑动脉狭窄的关系

目的探讨缺血性脑血管病患者脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,LpPLA2)与脑动脉狭窄的相互关系。方法应用荷兰飞利浦公司生产的FD-20 C型臂血管造影系统,对355例缺血性脑血管病患者进行全脑血管造影及血浆Lp-PLA2检测,Lp-PLA2正常组患者(对照组)151例与Lp-PLA2升高组(病例组)204例患者的全脑血管造影结果进行比较。结果对照组与病例组脑动脉狭窄程度差异有统计学意义(χ2=15.69,P<0.05);随着Lp-PLA2的升高,脑动脉狭窄程度逐渐加重。结论 Lp-PLA2是缺血性脑血管病脑动脉狭窄的一种危险因素,脑血管狭窄与Lp-PLA2升高有关,Lp-PLA2在一定程度上反应脑血管狭窄程度。     

缺血性脑血管病合并2型糖尿病患者脑血管改变的影像学特点

目的探讨缺血性脑血管病合并2型糖尿病(DM)患者脑血管改变的影像学特点。方法 151例缺血性脑血管病患者根据世界卫生组织DM诊断标准分为糖尿病(DM)组(73例)和非糖尿病(NDM)组(78例);入组者进行全脑数字减影血管造影(DSA)检查,并对结果进行组间比较。结果 (1)DM组脑动脉狭窄发生率(76.7%)、多支血管狭窄率(73.2%)、颅内外血管狭窄并存率(48.2%)明显高于NDM组(60.2%、53.2%、21.3%)(均P<0.05);(2)DM组受累动脉依次为颈内动脉(ICA)、椎动脉(VA)、大脑中动脉(MCA),NDM组为VA、ICA、MCA;(3)DM组受累动脉中、重度狭窄常见,NDM组以轻、中度狭窄常见。结论缺血性脑血管病合并DM患者脑动脉狭窄的发生率高,好发于ICA、VA、MCA,以中、重度狭窄多见。     

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.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -