甲状腺功能亢进合并颅内多发动脉狭窄1例报告——烟雾综合征的早期改变

甲状腺功能亢进症(Hypenlnyroidism)简称甲亢,是由多种病因引起甲状腺呈高功能状态,其特征有甲状腺肿大、基础代谢率增高和自主神经系统失常等.临床发现甲亢患者可以同时合并有颅内动脉狭窄或闭塞[1～3],其中以颈内动脉末端和大脑中动脉最常累及,并且常对称出现,这一点与烟雾病的血管改变很相似.也有报道称甲亢可以合并"烟雾综合征"(Moyamoya syndrome,MMS)[4].     

Basedow截瘫的临床特点(附1例报告)

目的 探讨Basedow截瘫的临床特点.方法 回顾性分析1例Basedow截瘫患者的临床资料.结果 本例患者为亚急性起病,主要表现为双下肢无力,腱反射消失;甲状腺轻度肿大,心率快,发病前半年起出现明显消瘦.血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺球蛋白抗体、甲状腺过氧化物酶抗体水平升高.腰穿脑脊液检查细胞数(110×106/L)和蛋白含量(1.3 g/L)升高.肌电图示双下肢神经源性损害,运动、感觉神经传导速度减慢.经抗甲状腺药物治疗2周后上述症状明显好转,2个月后恢复正常.结论 Basedow截瘫的临床特点是甲状腺功能亢进(甲亢)后并发双下肢周围神经的损害;随抗甲亢治疗后而好转.     

甲状腺功能亢进合并颅内多发动脉狭窄1例报告(烟雾综合征的早期改变?)

甲状腺功能亢进症(Hyperthyroidism)简称甲亢,是由多种病因引起甲状腺呈高功能状态,其特征有甲状腺肿大、基础代谢率增高和自主神经系统失常等.临床发现甲亢患者可以同时合并有颅内动脉狭窄或闭塞[1-3],其中以颈内动脉末端和大脑中动脉最常累及,并且常对称出现,这一点与烟雾病的血管改变很相似.也有报道称甲亢可以合并"烟雾综合征"(Moyamoya syndrome,MMS)[4].     

烟雾病合并甲状腺功能亢进症10例临床分析

目的探讨烟雾病合并甲状腺功能亢进症(甲亢)的临床特点及其可能的发病机制。方法回顾性分析10例烟雾病合并甲亢患者的临床资料。结果本组10例患者中,男1例,女9例。所有患者均表现为缺血性脑血管病。其中DSA确诊烟雾病1例,CTA确诊4例,MRA确诊5例;双侧颈内动脉系统受累9例,单侧受累1例。结论对于烟雾病患者,尤其是女性,应常规行甲状腺功能筛查;而甲亢患者也应行脑血管病变筛查,以尽早发现脑血管病变,早期预防,避免卒中。     

甲状腺功能亢进症合并烟雾综合征

目的 分析和探讨经颅多普勒超声（TCD）筛查的甲状腺功能亢进症（甲亢）合并烟雾综合征的临床和 血管病变特征。 方法 总结北京协和医院和解放军307医院2000～2007年经TCD筛查诊断烟雾综合征患者13例，8例经 磁共振血管成像（MRA）、5例经数字减影血管造影（DSA）明确诊断；所有患者经协和医院内分泌科确 诊为甲亢，且甲状腺球蛋白抗体（TGAb）和髓过氧化物酶抗体（TPOAb）高，除外血管狭窄的其他常见 原因。 结果 13例患者中，男1例，女12例；11例表现为缺血性卒中（2例合并不自主运动），1例仅表现为不自 主运动，1例以头晕为临床主诉，后2例经TCD筛查发现血管狭窄。血管病变分布：11例为典型的颈内动脉 终末端（TICA）、大脑中动脉（MCA）、大脑前动脉（ACA）狭窄或闭塞，1例为颈内动脉虹吸段狭窄，1例 为双侧颈内动脉起始严重狭窄或闭塞。2例患者同时合并大脑后动脉（PCA）狭窄。随访发现，1例患者因 甲亢控制不佳复查TCD血管病变加重；而1例甲状腺功能稳定，缺血临床症状明显改善。4例患者行颞浅 动脉－大脑中动脉（MCA）血管融通术，术后缺血发作减少。 结论 TCD的临床应用使越来越多的甲亢合并烟雾综合征得以诊断；烟雾综合征患者常规行甲状腺 功能筛查十分必要；血管成形术可能是预防缺血性卒中的有效方法之一。     

甲状腺功能亢进合并烟雾综合征一例报道

<正>烟雾病(moyamoya disease)是一组以双侧颈内动脉末端及其大分支血管进行性狭窄或闭塞,且在颅底伴有异常新生血管网形成为特征的脑血管疾病,病因不明,而其他症状或影像学特征与其类似的系统性病变则称为烟雾综合征(moyamoya syndrome,MMS)[1]。近年来国内外文献相继报道了甲状腺功能亢进症(以下简称"甲亢")患者合并烟雾病的病例,推测二者可能存在一定的联系,但其发病机制仍     

甲状腺试验在精神科的应用

很久以来,内科医生了解甲状腺疾病可以出现精神症状。甲状腺功能亢进(甲亢)可以出现焦虑、惊恐、轻躁狂和其他情绪障碍;而甲状腺功能低下(甲低)则可以出现抑郁、无力、记忆损害,甚至引起明显的精神病。传统上,明显甲低的发现依赖躯体体征和症状,如怕冷,毛发、皮肤和声音的改变以及血清甲状腺素(T_4)降低,在明显临床症状和T_4降低出现之前,甲低的发现则需要对丘脑下部-垂体-甲状腺轴的生理有更多的了解和有关的实验室检查。明显甲低有游离甲状腺指数(FTI)或游离T_4降低,有时总三碘甲状腺素(T_3)降低。甲低早     

儿童烟雾病临床和影像学特征

目的探讨儿童烟雾病的临床和影像学特征。方法详细询问患儿病史,进行体检和影像学检查。对儿童烟雾病患者的病因、临床特征、影像学等进行分析总结。结果发病年龄2岁2个月～12岁。6例临床表现为肢体无力或偏瘫,其中3例以此为首发症状;惊厥4例,头痛2例,头晕2例,感觉障碍1例。2例行头颅CT检查者均显示有缺血性改变。6例均行头颅磁共振成像(MRI)检查,4例显示急性脑梗死或小腔隙灶或软化灶,2例无脑实质无异常。6例头颅磁共振血管成像(MRA)检查,均显示颈内动脉虹吸部末端和大脑前或中动脉狭窄或闭塞,脑基底部有异常血管网形成。结论儿童烟雾病多表现为短暂性脑缺血发作(TIA),临床以肢体无力或偏瘫、惊厥为常见症状。MRI联合MRA检查是诊断儿童烟雾病的主要方法之一。     

亚临床甲亢并周期性瘫痪的临床分析

目的 分析亚临床甲亢并周期性瘫痪的临床特点.方法 测定总T3、总T4、游离T3、游离T4、促甲状腺素,并回顾分析8例亚临床甲亢并周期性瘫痪的临床资料.结果 青壮年男性发病,低钾型周期性瘫痪为主要临床表现,无明显甲状腺功能亢进症表现,测定总T3、总T4、游离T3、游离T4正常,促甲状腺素下降,补钾治疗有效.结论 青壮年男性亚临床甲亢的主要临床特点是低钾型周期性瘫痪.     

重症肌无力合并甲状腺机能亢进的临床特点

目的　研究重症肌无力 (MG)合并甲状腺机能亢进 (甲亢 )的临床特点。方法　回顾性分析1983～ 2 0 0 2年我院神经科 2 831例MG中合并甲亢的 2 0 7例患者的临床资料。结果　MG合并甲亢的发病率为7 31% ,男女比例为 0 6 8∶1;<5 0岁发病 192例 (92 78% ) ,先有甲亢 114例 (5 5 0 7% ) ,MG眼肌型 134例(6 4 73% ) ,合并胸腺疾病 4 9例 (2 3 6 7% ) ,有明确诱因 2 7例 (13 0 4 % ) ;经肾上腺糖皮质激素及抗甲亢联合治疗 ,16 5例患者 (79 71% )的MG症状得到改善 ,6 1例 (36 97% )甲亢痊愈。结论　MG合并甲亢以女性较多 ,发病年龄集中在儿童及青壮年 ;MG以眼肌型多 ;甲亢多先于MG发生 ,肾上腺糖皮质激素与抗甲亢联合治疗效果较好。     

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.