烟雾病10例临床分析

目的探讨烟雾病的临床特征、影像学诊断价值及治疗方法。方法回顾性分析10例烟雾病患者的临床特征和辅助检查结果及治疗。结果本组成人（7例）多于儿童（3例）；儿童临床表现以脑缺血症状为主；脑磁共振血管成像（MRA）或数字减影血管造影（DSA）检查显示颈内动脉虹吸部末端和大脑前或中动脉近端狭窄或闭塞，并有脑基底部异常血管网形成。结论烟雾病儿童主要表现为脑缺血症状；脑MRA或DSA的异常征象是早期诊断烟雾病的重要依据。早期诊断、及时治疗是改善烟雾病预后的有效方法。     

29例烟雾病的临床分析

目的分析烟雾病病例的临床特点,探讨烟雾病的诊断及治疗方法。方法回顾性分析29例烟雾病发病特征、脑血管影像特点及治疗结果。结果多为青壮年起病,主要有脑梗死、脑出血两种起病形式,临床表现为肢体麻木、无力、头痛、头晕、智力减退等症状;影像学表现为双侧大脑中动脉不同程度狭窄或闭塞,合并至少一侧异常血管网。结论常规进行MRA或CTA筛查可减少烟雾病的漏诊;药物治疗烟雾病效果有限,外科手术治疗可能有益于预防再出血和梗死的发生。     

甲状腺功能亢进合并颅内大动脉狭窄致青年急性脑梗死3例

甲状腺功能亢进合并颅内大动脉狭窄引起的青年急性脑梗死在临床上并不多见,尤其甲亢合并烟雾病更少见.该文回顾性分析3例甲状腺功能亢进合并颅内大动脉狭窄致青年急性脑梗死患者的临床表现、影像学特点及诊治过程.     

烟雾病的临床特点分析

目的探讨烟雾病患者的临床特点.方法用临床病例分析统计方法,对30例烟雾病患者的发病规律、临床特点进行归纳、分析.结果烟雾病多见于青少年,以急性和亚急性起病,多累及颈内动脉系统（21例,占70%）、椎基底动脉系统（6例,占20%）,可单独受累或并有颈动脉系统受累表现（3例,占10%）.CT或MRI检查可见神经系统受累表现,血管造影（DSA）证实有异常血管网形成.结论烟雾病以颈内动脉系统受累多见,血管造影是诊断本病的金标准.     

112例烟雾病患者的临床表现和影像学特征分析

目的 研究烟雾病患者的临床表现和影像学的特征.方法 回顾性分析1 12例烟雾病患者的临床症状及其影像学特征.结果 本研究纳入112例成年人,其中男性40例(35.71％),女性72例(64.29％),年龄20 ～ 80岁,平均年龄为(47.21±11.05)岁,临床表现主要以出血型脑卒中及缺血型脑卒中两方面起病,并以出血型脑卒中多见(99例,88.39％),CT血管成像(CTA)、磁共振血管成像(MRA)及数字减影血管造影(DSA)结果均可发现清晰的颅底异常增生血管网.结论 (1)成人型烟雾病的发病高峰可能为40 ～50岁,女性多于男性;以出血型脑卒中多见,合并脑动脉瘤或动脉畸形可能是成人型烟雾病发生脑出血的病因;(2)CTA可以作为一种快速有效的初步筛查及早期诊断烟雾病的检查方法.     

2例脑梗死合并肺栓塞报告

目的 探讨脑梗死急性期发生肺栓塞的可能因素及临床表现以及诊断.方法 对2例确诊肺栓塞的脑梗死急性期患者进行临床及辅助检查资料分析.结果 脑梗死急性期肺栓塞的发生与长时间卧床、合并各种慢性病及急性期感染、使用脱水药物等多种因素有关,临床表现多有胸闷、呼吸困难,诊断有赖于血D-二聚体、肺血管CT等辅助检查.结论 脑梗死急性期患者如合并各种基础病及感染,当临床出现胸闷、呼吸困难等症状而不能用心脏疾病解释时,一定要考虑到肺栓塞的可能,尽快完善相应检查以避免因漏诊而延误治疗.     

烟雾病36例临床特点及影像学分析

目的研究烟雾病(MMD)的临床及影像学特征。方法回顾性分析36例MMD患者,观察其临床及影像学特点。结果本组病例多为儿童及青壮年起病,女性居多。病程为多发,主要有脑梗死和短暂脑缺血发作、脑出血、蛛网膜下腔出血等起病形式,临床表现为肢体麻木无力、偏瘫、失语、头痛、视力改变等症状;CTA及DSA在脑底动脉环发现血管闭塞、狭窄及烟雾状毛细血管网形成,CTA对本病有一定阳性发现。结论对于儿童及青壮年反复发作的脑卒中患者要考虑MMD的可能,建议及早进行DSA或CTA检查。     

经颅多普勒超声对诊断儿童烟雾病的价值探讨

目的:探讨分析经颅多普勒超声(TCD)检查在儿童烟雾病诊断中的应用价值。方法:选择疑似烟雾病患儿24例,均进行TCD检查察看其颅内血管血流动力学改变,并以经头颅磁共振血管成像(MRA)为确诊依据,分析TCD对儿童烟雾病的诊断效果。结果:(1)MRA确诊20例烟雾病,而TCD检查中能够明确诊断的有18例,其诊断确诊率为90.0%;(2)在血流动力学变化方面,TCD检测出双侧颈内动脉末端及大脑前、中动脉狭窄样改变、闭塞样改变均与MRA的影像特征相符合,且TCD能够检测出眼动脉、前后交通动脉等侧支代偿血管的搏动指数、血速改变。结论:TCD虽然无法直观显示血管的形态与走向,但其对烟雾病的检查结果与MRA相符,且具有操作简便、无创、重复性好、经济等优势,能够探及细小烟雾血管血流信号并可通过颈总动脉压迫试验鉴别颅内动脉和了解侧支循环功能状态。因此,在临床上可将TCD检查用于疑似烟雾病筛查及辅助诊断中。     

成人型烟雾病的临床特征与经颅多普勒超声分析

目的研究成人型烟雾病的临床特点及经颅多普勒超声(TCD)检测对诊断烟雾病的临床价值。方法归纳64例经磁共振血管成像(MRA)或数字减影血管造影(DSA)确诊的年龄≥14岁的成人型烟雾病患者的临床特征及经颅多普勒(TCD)的血流动力学改变。结果 36~45岁为发病高峰年龄。最常见的首发症状包括TIA和脑梗死在内的缺血性表现共33例(51.5%);最常见的确诊症状包括TIA和脑梗死在内的缺血性表现共32例(50.0%)。有21例(32.8%)患者在首次发作时,先行TCD筛查而后经MRA或DSA全部确诊。以非脑出血症状确诊的46例患者中29例(63%)先经TCD筛查而后行DSA或MRA确诊烟雾病。结论成人型烟雾病首发及确诊症状均以缺血性血管病表现为主,TCD是筛选烟雾病的有效方法。     

烟雾病3例的磁共振诊断

烟雾病指双侧颈内动脉（ICA）末端及大脑前、中动脉起始部进行性狭窄或闭塞，以颅底软脑膜和穿通动脉形成细小密集的吻合血管网为特征的慢性脑血管闭塞性疾病，该病血管造影呈烟雾状，故又称“烟雾病”。病因不明确，以往需用脑血管造影来明确诊断，现在MRI和MRA的发展不仅可对此病定性诊断．还可了解因动脉狭窄或闭塞继发的脑实质病变。已成为该病的首选方法。     

卡马西平联用尼美舒利相关粒细胞缺乏症

1例78岁男性患者因带状疱疹神经痛、慢性阻塞性肺疾病合并感染,给予头孢唑肟钠（2.25 g静脉滴注,1次/d）、卡马西平（0.2 g口服,2次/d）、尼美舒利（100 mg口服,2次/d）、二羟丙茶碱（0.5 g静脉滴注,1次/d）、甲钴胺（0.5 mg口服,3次/d）、地塞米松（5 mg,静脉滴注1次）、盐酸哌替啶（25 mg,肌内注射1次）和盐酸布桂嗪（100 mg,肌内注射3次）等药物治疗。第7天,停用头孢唑肟钠,改为磷霉素钠（8 g静脉滴注,1次/d）。第11天,血常规检查示白细胞计数1.6×10^9/L,中性粒细胞0.03,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.9×10^9/L。立即停用所有药物,给予对症支持治疗。第15天,外周血白细胞计数0.9×10^9/L,中性粒细胞0.02,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.7×10^9/L。行骨髓穿刺检查,诊断为粒细胞缺乏症。第17天患者出现右肺气胸、肺不张。第20天出现急性呼吸衰竭、多脏器衰竭合并重症感染,经抢救无效死亡。     

颅脑损伤患者并发肺部感染的护理体会

目的：为了使并发肺部感染的病人更多、更好、更早的痊愈。方法：通过对32例颅脑外伤并发肺部感染病人的严密观察,采取更换体位、超声雾化、有效排痰训练等有效的护理措施干预,从而控制了肺部感染。结果：痊愈17例,占53.1%;显效12例,占37.5%,无效2例,占6.2%;死亡1例,占3.1%;实践证明,有效的护理干预对提高患者治疗成功率有着重要意义。     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

Genomic profiling associated with recurrence in patients with rectal cancer treated with chemoradiation

PURPOSE: Stage II and III adenocarcinoma of the rectum has an overall 5-year survival rate of approximately 50%, and tumor recurrence remains a major problem despite an improvement in local control through chemotherapy and radiation. The efficacy of chemoradiation therapy may be significantly compromised as a result of interindividual variations in clinical response and host toxicity. Therefore, it is imperative to identify those patients who will benefit from chemoradiation therapy and those who will develop recurrent disease. In this study, we tested whether a specific pattern of 21 polymorphisms in 18 genes involved in the critical pathways of cancer progression (i.e., drug metabolism, tumor microenvironment, cell cycle regulation, and DNA repair) will predict the risk of tumor recurrence in rectal cancer patients treated with chemoradiation. PATIENTS AND METHODS: A total of 90 patients with Stage II or III rectal cancer treated with chemoradiation were genotyped using polymerase chain reaction (PCR)-based techniques for 21 polymorphisms. RESULTS: A polymorphism in interleukin (IL)-8 was individually associated with risk of recurrence. Classification and regression tree analysis of all polymorphisms and clinical variables developed a risk tree including the following variables: node status, IL-8, intracellular adhesion molecule-1, transforming growth factor-beta, and fibroblast growth factor receptor 4. CONCLUSION: Genomic profiling may help to identify patients who are at high risk for developing tumor recurrence, and those who are more likely to benefit from chemoradiation therapy. A larger prospective study is needed to validate these preliminary data using germline polymorphisms on tumor recurrences in rectal cancer patients treated with chemoradiation.     

甘草酸单铵结合氦-氖激光治疗银屑病62例

目的用甘草酸单铵结合低能量氦-氖激光,观察治疗银屑病患者。方法62例寻常型银屑病患者,分为两组,A组用低能量氦-氖激光血管内照射,同时用甘草酸单铵静脉滴注,共36例;B组仅用甘草酸单铵,共26例。通过30d治疗。结果总有效率82.2%,其中A组有效率88.9%,B组73.1%(经Ridit检验,U＝2.76,P＜0.01),两组差异有极显著性意义。结论甘草酸单铵结合氦-氖激光治疗银屑病,比单用甘草酸单铵效果好。     

A fetus with meckel-gruber syndrome associated with isomerism

Abstract. Meckel-Gruber syndrome (MKS) is an autosomal recessive lethal malformation. As far as we know, the rate of incidence for the syndrome is 0.02 per 10,000 births. It is estimated that Meckel-Gruber syndrome accounts for 5% of all neural tube defects in Finland. Objective. The aim of this study is to present a case of a fetus with Meckel-Gruber syndrome associated with complete left isomerism. Method. The fetus was obtained after medical interruption of the pregnancy during the fifteenth gestational week. The mother was 36 years old and in a consanguineous marriage. The antenatal ultrasound examination revealed a polymalformative syndrome, leading to a postmortem examination. The fetopathological study of the fetus was conducted at the Centre for Maternity and Neonatology, Tunis, Tunisia, in 2008. Results. The female fetus had a significantly deformed ballooning abdomen, pes equinovarus, flexion of the wrist and a total posterior cleft palate. The central nervous system abnormalities were occipital encephalocele, cystic dilatation of the fourth ventricle, agenesis of corpus callosum and hydrocephalus. The study of the internal organs found dextrocardia, irregular lobulation of the lungs, left isomerism, and polysplenia. The microscopic examination revealed bilateral cystic dilation of the kidneys, fibrous proliferation of the liver and ectasic dilatation of the billiary ducts, representing a ductal plate malformation of the liver. Conclusion. The case is diagnosed with Meckel-Gruber syndrome associated with complete left isomerism, cleft palate and possibly Dandy-Walker syndrome.