耳源性颅内并发症

本文报告耳源性颅内并发症25例,其中大脑脓肿6例,小脑脓肿6例,脑膜炎8例,侧窦感染5例。治愈22例,死亡3例,病死率为12％。本文对病因和诊断问题进行了简要讨论。我们自1976年5月至1984年5月共施行乳突根治术560例,其中颅内并发症25例,占同期手术的4.48％。     

耳源性颅内并发症三例

耳源性颅内并发症三例王丽玢，许侠随生活水平提高，医疗条件改善，慢性化脓性中耳炎之并发症明显减少，但仍是威胁人民健康的常见病。现将我院近几年收治耳源性颅内并发症３例报告如下。１临床资料一般资料：男性２例，女性１例，年龄范围１６至２８岁。病史：多有耳流脓...     

耳源性颅内并发症诊治体会

现将我院耳鼻喉科 1986～ 1999年收治的 2 1例中耳炎伴颅内并发症的诊治体会 ,报告如下。1　临床资料1.1　一般资料 :本组 2 1例 ,男 15例 ,女 16例。年龄16～ 6 9岁。 2 1例均有慢性化脓性中耳炎病史 ,病程 1～ 50年。其中胆脂瘤型中耳炎 16例 ,骨疡型 5例。 2 1例中 ,化脓性脑膜炎 11例 ,局限性硬膜外脓肿 9例 ,乙状窦血栓性静脉炎 10例 ,颞叶脓肿 3例。1.2　治疗方法 :2 1例中 ,2 0例行单纯乳突凿开 ,清除乳突病灶 ,9例硬膜外脓肿病例 ,在术中打开鼓室天盖 ,行硬膜外脓肿引流 ,10例乙状窦血栓性静脉炎病例 ,均探查乙状窦骨板 ,凿开骨板 ,…     

耳源性颅内并发症75例分析

<正> 1980年至1989年10年间,我科手术治疗中耳乳突炎446例。其中75例并发耳源性颅内并发症,占中耳乳突手术16.82%。现报道如下, 临床资料一、性别与年龄:男性56例,女性19例,男女之比为2.9∶1;年龄最小6岁,最大50岁;其中11～20岁40例,～30岁16例,共占总数74.6%。二、中耳乳突病变及侧别:右侧35例,左侧40例,两侧无明显差异。75例慢性中耳乳突炎中,胆脂瘤性66例,占88%;骨疡性7例,占9.3%;慢性单纯性2例,占2.6%。三、发病地区:74例来自农村地区,1例为     

耳源性颅内外并发症患者的临床观察及护理

耳源性颅内外并发症患者的临床观察及护理孙秀云，刘素芬，郑献民耳源性颅内外并发症为耳科主要问题之一，我科于１９８６年～１９９２年收住急、慢性化脓性中耳炎患者４７８例、其中伴有颅内外并发症者１３２例，现将临床观察及护理体会报告如下：１临床资料１．１一般资...     

耳源性颅内并发症26例临床分析

我院自1986年以来共遇经临床和手术诊断证实为耳源性颅内并发症26例,均行扩大中耳乳突根治疗,清除病灶和周围脓肿开放引流,26例均治愈,治愈率100%.1 临床资料26例中乙状窦周围脓肿14例,硬膜外脓肿4例,脑膜炎并发脑脓肿2例,脑脊液漏2例,硬膜外脓肿并发脑膜炎4例.其中19例为单发并发症,7例为两种以上并发症.年龄最小8岁,最大30岁.临床症状和体征:26例全部有耳痛和头痛,21例体温升高,5例烦躁不安,巴氏征( )4例,克氏征( )4例,视乳头水肿10例,颈部强直10例.     

胶质瘤误诊为耳源性颅内并发症二例

例 1:男 ,6岁 ,因左侧口眼歪斜 40ｄ ,头痛、头晕、恶心呕吐 2 0ｄ ,左耳流脓 10ｄ而入院。专科检查 ,左外耳道见红色肉芽状组织 ,鼓膜被阻挡 ,颈强直 (± ) ,左侧末梢性面瘫 ,眼震 (- ) ,闭目直立试验 (+ ) ,行走试验偏右侧。眼科会诊 ,左眼球外展受限 ,无复视。神经科会诊未引出病理体征。头颅ＣＴ正常。徐氏位示乳突炎 ,肉芽组织送检为炎性物。诊断 :中耳炎 ;左周围性面瘫 ;颅内并发症。于 1990- 0 9- 15行左中耳乳突改良根治 ,颅内探查术 ,乳突呈亚急性炎症 ,鼓室盖自然破坏 1ｃｍ× 2ｃｍ ,硬脑膜表面见肉芽组织 ,岩部骨质部分破坏 ,其…     

耳源性颅内外并发症129例临床分析

分析129例耳源性颅内外并发症的治疗方法及效果。方法：回顾总结129例耳源性颅内外并发症的临床资料。结果：127例颅内外并发症治愈，2例脑脓肿死亡。治愈率达98．5％。结论：经乳突腔填塞法治疗耳源性脑脓肿，疗效良好。彻底清除耳的病灶，形成宽大的外耳道口，可有效减少复发，提高治愈率。     

老年人颅内压增高的临床特点(附35例分析)

分析老年颅内高压病人35例,其主要原因是高血压脑出血(占57.1％);临床表现不够典型;病死率31.4％.结合老年人的生理状况,分析了老年人颅内压增高的临床特点.     

耳源性破伤风1例

目的:总结耳源性破伤风的临床诊断、鉴别诊断及治疗的经验。方法:总结1例诊疗经验并复习相关文献。结果:经及时诊断并治疗患者痊愈。结论:遇有慢性化脓性中耳炎病史者,如伴有咀嚼不便、张口困难、面部表情肌功能异常,均应详细采集病史,排除口腔颌面部病变后,应考虑破伤风的可能。早期准确诊断并及时治疗,预后一般较好。     

Clinical presentation and incidence of complications in patients with coeliac disease diagnosed by relative screening

Background

There is an increased prevalence of coeliac disease (CD) among relatives of those with the disease.

Aims

To compare the clinical features in patients with CD detected via family screening with those in patients diagnosed routinely.

Methods

Information on screening was provided to relatives of patients. Those who wished to be screened were tested for endomysial and/or tissue transglutaminase antibodies. Duodenal biopsy was performed in those with positive antibodies. The clinical details of the relative screening group were compared with those of 105 patients diagnosed routinely.

Results

183 relatives underwent screening, of whom 32 had positive serology, 24 had histology diagnostic of CD, six had normal biopsies and two declined duodenal biopsy. Patients in the relative screening group were younger with a median age of 33 years (range 17–72 years) compared to the routine group which had a median age of 54 years (range 25–88 years). In the relative screening group, there was a male preponderance (M:F ratio 16:8), anaemia at presentation was significantly less common (13% v 58%; p<0.001) and osteoporosis was less frequent (9% v 22%; p<0.244) compared with the routine group. 65% of the relative screening group had gastrointestinal symptoms or anaemia at diagnosis.

Conclusions

Patients detected by family screening are younger with a male preponderance, but fewer had anaemia and osteoporosis.     

复杂颅内动脉瘤介入治疗并发症分析

目的探讨复杂颅内动脉瘤介入治疗并发症的病因、处理和预防。方法对36例复杂颅内动脉瘤的病史资料,分析治疗中并发症产生原因和处理体会。结果32个治疗的复杂动脉瘤中,8例术中或术后出现并发症,其中动脉瘤破裂1例,颅内血管破裂1例,血管痉挛2例,支架轻微移位、塌陷1例,弹簧圈脱出1例,弹簧圈断裂1例,手术失败1例。致一过性神经功能缺失2例,长久性神经功能缺失2例,死亡1例。结论选择适当介入方法和介入材料将直接影响到复杂颅内动脉瘤介入治疗并发症的发生,及时合理处理也是关键。     

颅内未破裂动脉瘤介入治疗术后神经系统并发症的危险因素分析

目的 探讨颅内未破裂动脉瘤介入治疗过程中发生程序相关性并发症的危险因素及临床特点,为临床降低程序相关性并发症的发生提供对策。 方法 回顾性收集2010年1月至2017年1月间在第二军医大学长海医院接受介入治疗的未破裂颅内动脉瘤患者,分析其临床及影像学特点,并对程序相关性并发症可能的危险因素行单因素和多因素分析。 结果 1196例患者中有60例(0.89%)发生程序相关性并发症。单因素分析结果显示高血压病(P=0.026)、吸烟(P=0.038)、既往脑梗死病史或短暂性脑缺血发作史(P=0.000)、心血管合并症(P=0.002)、动脉瘤直径>10mm(P=0.000)、不规则形态或有子囊(P=0.008)、支架类型(P=0.001)与程序相关性并发症相关,多因素分析结果显示既往脑梗死病史或短暂性脑缺血发作史病史(P=0.000,OR=3.407)、心血管合并症(P=0.003,OR=3.175)、动脉瘤直径>10mm(P=0.000,OR=3.139)和不规则形态或有子囊(P=0.026,OR=2.096)是程序相关性并发症的独立危险因素。 结论 既往脑梗死病史或短暂性脑缺血发作史病史、心血管合并症、动脉瘤直径>10mm和不规则形态或有子囊是颅内未破裂动脉瘤发生程序相关性并发症的独立危险因素。     

Ocular manifestations of intracranial germinomas: three cases report and literature review

Intracranial germinomas are malignant neoplasms of gonadal origin, which have some features in terms of age, sex, and clinical manifestations. They mainly occur in children and adolescents. Patients with intracranial germinomas mainly manifest with hypothalamic pituitary axis dysfunction and/or compression syndromes. Visual disturbance is one of the most significant clinical presentations, which is mainly caused by tumor cell infiltration into the optic pathway. In this article, we present three cases of patient with intracranial germinoma to analyze the ocular manifestations. All the three patients presented with endocrine symptoms in the early stage and with visual disturbances (including decreased visual acuity and visual field defects) later. In general, germinoma is diagnosed by its characteristic radiological appearance, supported by tumor markers and/or stereotactic biopsy. However, decisive diagnoses were established when ocular manifestations were presented. A suspicion for germinoma should be considered, when young patients manifest visual disturbances accompanied by endocrine symptoms.

     

颅内蛛网膜囊肿手术治疗的临床分析

目的:探讨颅内蛛网膜囊肿的手术治疗方式及其疗效。方法:回顾性分析72例手术治疗的颅内蛛网膜囊肿患者的临床资料,神经内镜下囊壁部分切除+囊肿-脑室或脑池造瘘术16例,显微镜下囊肿切除术4例,显微镜下囊壁部分切除+囊肿-脑池造瘘术32例,囊肿-腹腔分流术20例。随访6个月～6 a(平均2.2a)。结果:67例患者经治疗后症状改善,有效率93.1%,随访CT或MRI显示83.3%(60/72)幕上蛛网膜囊肿体积显著减小,幕下蛛网膜囊肿体积无明显变化但症状显著改善。结论:有症状的蛛网膜囊肿患者均应积极治疗。针对不同患者选择合适的手术方式对预后有重要意义。神经内镜手术创伤小、并发症少,应继续推广应用。     

血管内栓塞治疗颅内微小动脉瘤的临床研究

目的回顾性探讨和分析血管内栓塞治疗颅内微小动脉瘤(动脉瘤直径≤3.0mm)的临床可行性、难度及其适应证。方法总结分析55例经血管内栓塞治疗的颅内微小动脉瘤的相关临床因素,包括术前患者的临床一般状况、Hent-Hess分级、血管内栓塞治疗的并发症以及临床预后。结果 55例患者均进行血管内栓塞治疗,其中50例为破裂动脉瘤,5例为未破裂动脉瘤。血管内完全栓塞30例(54.55%),近全栓塞和部分栓塞25例(45.45%)。栓塞术中动脉瘤破裂出血4例(7.27%),术后再出血1例(1.81%),术后死亡1例(1.81%)。术后6个月随访显示,临床治愈47例(85.46%),轻度肢体活动功能障碍5例(9.09%),重度肢体活动障碍2例(3.64%),无复发及颅内再出血。结论血管内栓塞治疗颅内微小动脉瘤是有效、可行的;另外,结合患者的临床状况、预后选择最佳血管内治疗方案也很重要。