脑动脉狭窄的CTA、DSA对比研究临床意义

目的以数字减影血管造影(DSA)为参照,比较电子计算机断层扫描血管成像(CTA)诊断脑动脉狭窄的准确性,评价其临床价值。方法对150例1月内进行CTA和DSA检查的可疑脑血管狭窄的患者进行对比,研究CTA对脑动脉狭窄的诊断价值。结果从所研究的总的病变部位来分析:CTA与DSA符合率为98.27%(454/462);CTA阴性而DSA阳性者为1.73%(8/462);CTA阳性而DSA阴性者为1.30%(6/462);以DSA作为"金标准";CTA诊断脑动脉狭窄的敏感性为99.57%(460/462),特异性为98.27%(454/462),假阳性为1.32%(6/454),假阴性为1.76%(8/454)。按不同部位分层分析:颈总动脉、颈内动脉起始段、大脑中动脉M1段、椎动脉开口、椎动脉V1、V2段的敏感性和特异性均为100%;颈内动脉岩段至终末端假阴性为10.26%(8/78),椎动脉V3、V4段和基底动脉假阳性为15.34%(6/39)。结论 CTA在诊断脑动脉狭窄方面的敏感性、特异性均很高,可以作为脑血管病的重要诊断和筛查方法。但对颈内动脉岩段至终末端和椎动脉V3、V4段还存在一定的漏诊和误诊率,对于在脑血管病的诊断和治疗方案的决定中还要结合DSA进行全面评价。     

64排VCT脑血管成像对烟雾病诊断价值的探讨

目的 探讨64排CT血管成像(CTA)对烟雾病的诊断价值.方法 采用64排螺旋CT行脑CTA检查,处理技术为容积再现(VR)、多平面重建(MPR)及最大密度投影(MIP).结果 CTA能清晰显示颈内动脉颅内段,脑基底动脉环等部位血管狭窄,闭塞的形态,管壁状况及狭窄程度,且能清晰显示增多迂曲的脑基底部的异常血管网.结论 CTA检查可作为烟雾病首选的无创检查方法.     

64层CTA诊断颅内动脉瘤的临床意义

目的评价64层计算机断层扫描动脉成像(64层CTA)在颅内动脉瘤(AN)诊断中的临床价值。方法 108例高度疑诊动脉瘤患者均给予64层CTA检查,后行DSA证实。结果 108例患者经64层CTA检出98个动脉瘤,均得到DSA检查证实,其中14例颈内和颅内小动脉瘤由全脑DSA检查后发现。结论64层CTA作为无创检查颅内动脉瘤的手段,在诊断前交通动脉瘤及大脑中动脉瘤可取代DSA成为颅内动脉瘤诊断的首选,但在高度怀疑有颈内动脉瘤及颅内小血管动脉瘤时尚需进行DSA检查进一步明确。     

椎-基底动脉缺血性眩晕的CTA与DSA对照研究

目的 探讨螺旋CT血管造影（CTA）对椎－基底动脉缺血性眩晕的诊断价值。方法 对40例临床诊断为椎－基底动物缺血性眩晕的患者行CTA和数字减影血管造影（DSA）检查，并进行分析比较。结果 CTA对椎动脉狭窄程度的评价与DSA呈高度相关（r＝0．826，P＜0．001），对发育不良、血管扭曲的判断与DSA完全一致，对椎动脉起始端钙化和开口位置的显示优于DSA。结论 CTA能清晰地显示全程椎－基底动脉系统，是诊断椎－基底动脉缺血性眩晕的一项较实用的客观可靠的检查手段。     

头CTA对椎基底动脉供血不足的诊断意义

目的探讨多层螺旋CT血管成像(CTA)对椎基底动脉供血不足病因诊断的价值。方法对46例确诊为椎基底动脉供血不足的患者进行CTA和数字减影血管成像(DSA)检查,比较阳性率。结果 DSA显示的40例血管狭窄除1例CTA未检出外,余在CTA上均显示为同样程度的狭窄,CTA未出现假阳性。结论CTA作为椎基底动脉供血不足的辅助检查手段安全、方便、快速且准确,可作为椎基底动脉供血不足的首选检查方法。     

头颈部CTA在脑梗死患者中的应用价值

目的探讨头颈部CTA在脑梗死患者中的应用价值。方法选择我院收治的脑梗死患者100例为研究对象,均经临床资料及数字减影动脉血管造影(DSA)确诊。在临床诊断过程中均采用多排螺旋CT血管成像技术(CTA)及颈部血管彩色超声检查,明确患者颈动脉狭窄情况。结果由CTA检出脑梗死82例,正确检出率82%,病变血管共200处,主要分布在颈总动脉、颈总动脉分叉处、颈内动脉、椎基底动脉、大脑前动脉、大脑中动脉及大脑后动脉,而颈部血管彩色超声检出74例,2组比较差异有统计学意义(P0.01)。结论头颈部CTA对脑梗死患者检出效果较好,且使用安全,费用低廉,对不符合动脉造影适应证的患者尤为适用。     

MRA、CTA评估脑侧支循环的临床应用价值

目的探讨磁共振血管成像(MRA)、计算机断层摄影血管成像(CTA)评估脑侧支循环的临床应用价值。方法收集2015年1月—2016年12月就诊于兰州军区兰州总医院神经内科行数字减影血管造影(DSA)检查明确为单侧颈内动脉(ICA)或大脑中动脉(MCA)M1段重度狭窄或闭塞的患者64例,其中同期行MRA和DSA检查57例,CTA和DSA检查12例,CTA和MRA检查5例,采用Kappa一致性检验分别评估MRA原始图像(MRA-SI)与DSA、CTA原始图像(CTA-SI)与DSA及MRA-SI与CTASI结果的一致性。结果 MRA-SI与DSA(K=0.269,P0.05)、MRA-SI与CTA-SI(K=0.282,P0.05)评估脑侧支循环结果的一致性均较差。CTA-SI与DSA评估脑侧支循环呈中度一致(K=0.444,P0.05)。结论(1)DSA仍是评估脑侧支循环的金标准,不能被MRA和CTA取代;(2)无法行DSA检查时,可考虑行CTA检查予以初步评估。     

CT血管造影对重型颅脑创伤的早期监测及预后判定

目的 探讨CT血管造影(CTA)对重型颅脑创伤早期监测及预后判定的作用.方法 对58例重型颅脑创伤患者术前及术后使用128层螺旋CT行头颅CTA动态检查.结果 重型颅脑创伤后CTA显示脑血管主要发生五种变化:血管移位、动脉痉挛或闭塞、动脉穿支减少、脑深静脉狭窄或闭塞、大脑浅静脉狭窄或闭塞.大动脉痉挛或闭塞者预后差,大脑深静脉如大脑内静脉和基底静脉同时闭塞者预后极差,大脑浅静脉的狭窄或闭塞反映了颅内压的变化.结论 CTA可用于重型颅脑创伤的早期监测及预后判定.     

缺血性脑血管病患者颅内外动脉狭窄分布研究

目的 研究缺血性脑血管病患者颅内外动脉狭窄分布特点.方法 本研究收集了1031例在院脑梗死和TIA患者的DSA资料,对其中资料完整的1000例患者进行分析.结果 DSA显示,1000例患者中有680例存在脑动脉狭窄,累计有1417条血管狭窄.发生部位依次为:大脑中动脉狭窄337条、椎动脉远端及基底动脉狭窄291条、颈内动脉颅外段狭窄280条、椎动脉起始段狭窄207条、颈内动脉虹吸段狭窄115条、大脑前动脉狭窄100条、大脑后动脉狭窄70条.大脑中动脉、椎基底动脉系统和颈动脉颅外段是最常见的动脉狭窄好发部位.颅内动脉狭窄331例,颅外动脉狭窄134例,颅内外动脉均见狭窄215例.结论 颅内动脉粥样硬化性狭窄仍是缺血性卒中的重要原因,最近三年,多发病变、颅外动脉病变检出率明显上升,值得关注,控制血压、血糖、血脂可预防脑动脉粥样硬化性狭窄的发生.     

64层螺旋CT对头颈部血管病变的临床价值探讨

目的探讨64层螺旋CT血管成像对头颈部血管病变的临床价值。方法34例疑头颈部血管病变的患者行64层螺旋CT头颈部血管成像(CTA),扫描数据在ADW 4.3工作站用不同的后处理技术进行血管后重建。结果34例患者的双侧颈内动脉(ICA)、椎动脉(VA)、大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)及Willis环均能显示,共检出狭窄76段,闭塞2段,动脉瘤5例;血管异常起源3例,正常者14例。结论64层螺旋CT血管成像可以清晰显示头颈部血管病变,对临床诊疗起重要指导作用。     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Micro-affirmations and Recovery for Persons with Mental Health and Alcohol and Drug Problems: User and Professional Experience-Based Practice and Knowledge

Recurrent factors contributing to a recovery process from co-occurring mental health and addiction problems mentioned by users and professionals have been analyzed as part of working alliances and helpful relationships. Still, we lack knowledge about how helpful relationships are developed in daily practice. In this article, we focus on the concrete construction of professional helpful relationships. Forty persons in recovery and fifteen professionals were interviewed. The interviews were analyzed according to thematic analysis, resulting in three themes presented as paradoxes (1) My own decision, but with the help of others; (2) The need for structures and going beyond them; and (3) Small trivial things of great importance. Micro-affirmations have a central role in creating helpful relationships by confirming the individuals involved as more than solely users or professionals. More attention and appreciation should be paid to practices involving micro-affirmations.

     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.