以发作性头痛为主要表现的莱姆病两例报道

莱姆病是一种由蜱传播的感染性疾病，１９７５年首先在美国发现，８０年代国内陆续有人报道。本病是一种可累及多个系统的疾病。以发作性头痛为主要表现者尚未报道。本文报道两例以发作性头痛为主要表现的莱姆病，对其临床特征进行了描述，并对其治疗进行了讨论。作者指出，及时明确诊断对于莱姆病头痛的治疗十分重要。     

1例特重型格林-巴利综合征的护理

格林-巴利综合征（GBS），又称急性感染性多发性神经根炎，其主要病变是周围神经广泛的节段性脱髓鞘，部分病例有轴索性变性，是一种较为严重的涉及自身免疫的周围神经病。多从四肢对称性软瘫开始，病情逐渐加重．可累及颅神经和呼吸肌；也有首先从颅神经开始．逐渐波及全身随意肌者。大约25％的患者发生不同程度呼吸肌麻痹。而呼吸肌麻痹是GBS主要的死亡原因。近期我们收治1例首先出现颅神经受累，逐渐波及全身随意肌的GBS；经医护密切合作，抢救获得成功。     

丙戊酸钠相关高血氨脑病1例报告及文献回顾

患者男,18岁,因患癫痫用卡马西平治疗3个月疗效欠佳,改用丙戊酸钠0.2 g/d治疗40余天.之后,患者突然出现四肢抽搐、意识丧失收入院.经抢救意识恢复,患者述眩晕、复视、恶心、呕吐、耳鸣.检查:构音障碍、眼球震颤、共济失调等症状.入院第4天,患者血氨为117.6 μmol/L,血常规、肝、肾功能检测均正常,头颅MRI未见明显异常.停用丙戊酸钠后症状好转,再次服用该药,再次出现头晕.立即停用丙戊酸钠,改用氯硝西泮治疗后症状消失,血氨降至66 μmol/L.     

Bickerstaff脑干脑炎合并吉兰-巴雷综合征1例报告

患者,男34岁。视物成双伴左上肢无力1d于2003年8月6日入院。患者于8月5日感头晕,视物成双,左上肢无力。第二天加重并出现吞咽困难。发病1周前曾感冒发热,体温最高39℃。查体：神清,右侧外展受限。左鼻唇沟浅,咽部软腭动度差,     

EFFECT OF ACUPUNCTURE ON VASOACTIVE INTESTINAL PEPTIDE IN ISCHEMIC CEREBRO VASCULAR DISEASES

Background and purpose: Vasoactive intestinal peptide (VIP) appears to play an important role as a neurotransmitter or neuromediater in ischemic cerebrovascular diseases (ICVD). The effect of acupuncture, which is used in treatment of ICVD with good efficiency, on VIP has not been known. For finding the mechanism of acupuncture in treatment of ICVD and the effect of electro-acupuncture on VIP, the present study was performed. Materials and methods: 59 patients with acute ICVD were randomly divided into two groups. Electro-acupuncture and routine treatment were given in Group 1 (n= 29), and routine treatment was used alone in Group 2 (n= 30). The cerebrospinal fluid (CSF) and blood were taken before the beginning of treatment and after a course of treatment in both groups. The control group consisted of 38 cases of non-ICVD. VIP was measured by radioimmunoassay. Results: The level of CSF VIP in patients with acute ICVD was significantly lower than that in the controls, while the levels of plamsa VIP showed no significant difference between the ICVD and control groups, and the level of CSF VIP was not significantly correlated with the level of plasma VIP. After acupuncture treatment, the level of CSF VIP was increased and showed no significant difference as compared with the control group. Conclusion: Acupuncture might alleviate the disturbance of metabolism of VIP in CNS.     

氯氮平、奥氮平与其他抗精神分裂症药物联用的疗效与安全性

近年,抗精神分裂症药物联合使用有日益增加的趋势.本文现对氯氮平、奥氮平与其他抗精神分裂药物联合使用的疗效与安全性作一简要回顾.氯氮平和舒必利联用有较肯定的疗效,但可致血清催乳素水平升高或锥体外系反应加剧.氯氮平和氨磺必利联用患者病情似可全面改善,但可致血清催乳素水平升高.氯氮平和利培酮联用的临床疗效和安全性试验显示不同的结果.奥氮平和其他某些典型抗精神病药联用治疗效果有所增强.奥氮平与利培酮联用似有助于改善难治性精神分裂症患者症状.笔者认为应对这些联用的利弊作进一步的评估,以利于合理安全用药.     

GAP-43 Expression and Pathological Changes of Temporal Infarction in Rats and Effects of Batroxobin

To study the changes of the expression of growth-associated protein-43 (GAP-43) and pathology in temporal infarction of rats photochemically induced and the effects of batroxobin. METHODS: Immunohistochemical technique and hematoxylin-eosin stain was used to show the changes of the expression of GAP-43 and pathology. RESULTS: In infarction group, GAP-43 expression was markedly increased on the infarction and surrounding tissues at 24 h cerebral infarction. The expression reached peak level at 72 h after cerebral infarction and was decreased at 7 d after cerebral infarction. However, in batroxobin-treated group, GAP-43 expression was increased and the pathological changes were much slight as compared with infarction group. CONCLUSION: The expression of GAP-43 increases in infarction of temporal neocortex and batroxobin promotes the expression of GAP-43 and ameliorates the pathological changes in infarction of temporal neocortex.     

肌营养不良的发病机理

肌营养不良为遗传性疾病,其发病机理仍不明。现有三种学说:神经源、血管及膜学说。前两种似已过时。膜学说渐受重视,它可能代表一类新的遗传性障碍。血管学说远在30年代,就有人认为本病肌肉变性是由于供血不足引起。1961年Demos发现患者及携带者之臂舌循环时间延长;现又提出     

抗惊厥药物之作用机理

有人认为假想的氨基酸神经介质谷氨酸及r一氨基丁酸(**8A)是抽搐活动中之重要生化因素。谷氨酸被认为系兴奋性突触介质,GABA为抑制性介质。放置谷氨酸于脑局部、静注或注人脑室,增加抽搐灶之棘波活动,放置**8A于脑局部,静注     

硫化氢中毒所致神经系后遗症1例报告

硫化氢中毒所致神经系后遗症,国内尚少报道,现将我院观察的1例报告如下。病例报告陈××,男性,39岁。患者于1977年8月5日下午,营救因清除污水而昏倒的4名工人时,亦昏倒在池旁,被他人救出急送医院。同时经卫生防疫站检疫,证实污水中放出大量硫化氢。患者按硫化氢中毒治疗。昏迷3～4小时后,出现兴奋躁动,大汗淋漓1日,3天后意识恢复。第7日突然双目失明,四肢不能动,数日后,呕血并排柏油便,血压进