脑动静脉畸形的静脉引流特征与出血危险性相关研究

本文对经过脑血管造影证实的５２例脑动静脉畸形（ＡＶＭ）的静脉引流特征与出血危险性的相关关系进行了研究。结果表明，脑ＡＶＭ的引流静脉数目与出血危险性呈负相关（Ｐ〈０．０５），引流静脉数目减少，出血率越高，越多出血率越少；引流静脉无早现的ＡＶＭ比早现的ＡＶＭ出血率高（Ｐ〈０．０１）；；引流静脉无或轻度扩张的ＡＶＭ的出血率明显高于有明显扩张的ＡＶＭ（Ｐ〈０．０５）；深静脉引流的脑ＡＶＭ出血率高，浅静脉引     

脑动静脉畸形的供应动脉及导出静脉与出血危险性的关系

本文通过分析５０例脑动静脉畸形（ＡＶＭ）的全脑数字减影血管造影（ＤＳＡ）资料及手术探查结果，探讨ＡＶＭ的深、浅及供血、引流血管数量与出血发生率的关系。经统计比较发现：深部较浅部ＡＶＭ出血率高；供应动脉条数多于导出静脉条数者及仅有单条导出静脉出血率最高，并与其他组有显著性差异（Ｐ＜０．０５、Ｐ＜０．０１）。因此，我们认为：在临床工作中对这些ＡＶＭ患者应给予足够的重视。     

脑动静脉畸形出血危险因素的研究

目的探讨脑动静脉畸形（ＡＶＭ）出血的危险因素。方法统计２８４例ＡＶＭ的数字减影脑血管造影所示病灶的解剖部位和大小、引流静脉的数目和类型，测定１８例供血动脉平均压力和以经颅多普勒超声检查７４例血流动力学参数，并分出血组和非出血组进行比较。结果小病灶、深部病变、单支静脉引流和深静脉引流者出血发生率显著增高，出血组病灶供血动脉平均压力高于非出血组，而血流速度则低于非出血组。结论脑ＡＶＭ出血与病变的大小、部位、引流静脉的类型和数目、供血动脉的压力及血流速度有关     

脑动静脉畸形动物模型的初步建立

目的：建立脑动静脉畸形（ＡＶＭ）动物模型。方法：以中国实验用小型猪的颅底微血管网（ｒｅｔｅｍｉｒａｂｉｌｅ）为畸形团，经颈动静脉吻合等建立脑ＡＶＭ动物模型；用ＮＢＣＡ胶和Ｅｍｂｏｓｐｈｅｒｅ颗粒分别栓塞；模型建立和栓塞前后行血管造影。结果：成功构建了具有供血动脉、畸形团和引流静脉的ＡＶＭ模型；造影动脉期显示血液经畸形团向引流静脉分流；栓塞时，胶在畸形团（微血管网）里弥散、聚合良好，颗粒可使其显影逐渐变淡、直至消失。结论：本方法对建立脑ＡＶＭ急性期动物模型更简单经济省时，并且可靠；该模型在血管结构，造影影像和栓塞行为上与人脑ＡＶＭ相似，适用于有关的研究和介入医师的培训。     

颅内动静脉畸形血管内栓塞治疗并发症分析

报告６０例颅内动静脉畸形（ＡＶＭ）血管内治疗后所产生的并发症。指出并发症的产生主要归结于：（１）误栓正常动脉或脑供血动脉分布到正常脑组织的分支被栓塞，产生新的神经功能缺失；（２）栓塞剂经脑ＡＶＭ瘘口将引流静脉栓塞造成畸形血管破裂出血；（３）一次过多栓塞了大型高流量ＡＶＭ，使原有症状加重。文中针对上述并发症产生的原因，结合病历探讨一些防治措施。     

脑动静脉畸形术中的多普勒超声应用研究

本文报道手术中应用两种不同型号的多普勒超声仪经脑皮层检测脑动静畸形（ＡＶＭ）１７例，仅１例住于皮层下３．５ｃｍ的ＡＶＭ以１０ＭＨｚ多普勒超声检测未显示病灶信号。ＡＶＭ供血动脉通端流速比近端快，脉动指数（ＰＩ）更降低，畸形血管因血流更紊乱，其流速低于邻近供血动脉、其ＰＩ比供血动脉远近端均低。多普勒超声应用于ＡＶＭ术中能提供ＡＶＭ精确定位资料，区分ＡＶＭ供血动脉和脑营养动脉，ＡＶＭ引流静脉和脑正常静脉，并检验ＡＶＭ切除是否彻底。     

3D—CTA,MRA和DSA对脑动静脉畸形成像的对照性研究

目的：评价数字减影血管造影（ＤＳＡ）、三维计算机断层扫描血管造影（３Ｄ－ＣＴＡ）和磁共振血管成像技术（ＭＲＡ）对于脑动静脉畸形（ＡＶＭ）甩像的价值。方法 ４３例ＡＶＭ前瞻性对照研究,结果 ３Ｄ－ＣＴＡ阳性率１００％,与ＤＳＡ比较;供血动脉的来源,数目和形态１００％吻合,引流静脉３３例完全吻合（７８．６％）,９例部分吻合（２１．４％）;病灶部位、大小以及深度１００％吻合。ＭＲＡ阳性率９５．８％,１例假阴性（４．２％）。与ＤＳＡ影像比较,供血动脉１７例完全吻合（７０．８％）,６例部分吻合（２５．０％）;引流静脉１４例完全吻合（５８．３％）,９例部分吻合（３７．５％）,病灶部位、大小以及深度９８．５％吻合。结论 ＤＳＡ是脑ＡＶＭ成像的“金标准”。３Ｄ－ＣＴＡ和ＭＲＡ技术的发展为ＡＶＭ影像不诊断提供了高准确性,无创性的     

脑动静脉畸形出血危险因素的分析与研究

本文对我院1990年至1995年收治的284例脑动静脉畸形进行了出血危险因素的分析与研究。包括动静脉畸形的大小、部位、引流静脉的数目和类型、平均供血动脉压力和经颅多普勒的检查等。结果表明：小型、深部病变，单支静脉引流和深静脉引流都是增加动静脉畸形出血的因素，血流速度和病灶大小与出血倾向有关，而高的供血动脉平均压力是动静脉畸形出血病理生理学的重要因素。     

脑动静脉畸形栓塞术中及术后出血原因探讨

治疗脑ＡＶＭ３００例，栓塞１３０５次，解剖治愈１０８例（３６％，其中７０例栓塞后手术切除），发生各种并发症２２例（７．３％），其中最严重为栓塞后出血，共１４例（４．７％），全部经股动脉插管，应用带孔球囊导管及Ｍａｇｉｃ导管，栓塞剂为ＩＢＣＡ或ＮＢＣＡ与碘苯酯的混合剂。栓塞后即刻发生出血者８例，２４小时以上者３例，其余则为３～１９小时。出血后紧急手术清除血肿和畸形团切除９例，脑室引流１例，保守治疗４例。结果１４例中６例完全治愈，３例遗有轻度单肢瘫，植物生存１例，死亡４例。分析出血的原因可能为：（１）大面积ＡＶＭ的治疗中，一次闭塞的体积过大，４例；（２）在同一支血管内反复插管栓塞，２例；（３）栓塞前后未能很好降血压，２例；（４）未能先选择畸形团的“薄弱部分”栓塞，１例；（５）带孔球囊撑破血管，３例；（６）栓塞过程中的机器故障，２例。     

脑动静脉畸形的流量和供血动脉压力测定

根据经颅多普勒超声和血管造影的数据资料，对６３例脑动静脉畸形（ＡＶＭ）的分流量进行计算，并通过微导管测量了１５条供血动脉内的压力。结果显示ＡＶＭ的动静脉分流量在出血组为２７２±２４５ｍｌ／ｍｉｎ，非出血组为８７６±４３３ｍｌ／ｍｉｎ（Ｐ＜０．０１）。不同供血动脉的压力差别很大０．６～１０ｋｐａ（５～７５ｍｍＨｇ），出血组为６．２±１．９ｋＰａ，癫痫组为２．５±１．２ｋｐａ（Ｐ＜０．０１）。认为脑ＡＶＭ出血的血液动力学因素为相对的高阻力低流量，流量和压力分析尚可有助于预警“正常灌注压突破”综合征的发生。     

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.