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51.
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Abstract It is well established that thrombolytic therapy increases the risk of secondary intracerebral hemorrhage in ischemic stroke
patients. However, the term “intracerebral hemorrhage” (ICH) covers a wide spectrum from tiny spots of blood to massive space-occupying
hematoma. We will review the etiology and clinical consequences of secondary hemorrhage after thrombolysis in ischemic stroke
patients and discuss the ability of magnetic resonance imaging (MRI) to predict this phenomenon. MRI is a highly sensitive
tool for detection of hemorrhagic transformation after ischemic stroke. The definitions of a so-called symptomatic hemorrhage
after ischemic infarction differ considerably and will also be described. Attributing a causal relationship of a clinical
deterioration to a secondary hemorrhage is not easy and should be only addressed when it exceeds at least 30% of the infarct
volume. In other patients, secondary hemorrhage might be regarded as side effect of reperfusion within the region with the
most severe perfusion deficit. Cerebral microbleeds (CMBs) are a frequent finding in patients with leukoaraiosis and appear
to be a general marker of various types of bleeding- prone small vessel disease and a predictor of recurrent vascular events.
Current data do not support the hypothesis that the detection of CMBs is a useful diagnostic criterion for the exclusion of
patients with CMBs from thrombolytic therapy. However, an increased risk for the rare patients with numerous CMBs can not
be ruled out.
相似文献
54.
Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the
Millennium Development Goals (MDGs) adopted by the international community in 2000. The health-related MDGs cannot be achieved
if vulnerable populations do not have access to skilled personnel and to other necessary inputs. This paper focuses on the
geographical dimension of access and on one of its critical determinants: the availability of qualified personnel. The objective
of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health
personnel, and to identify and assess the strategies developed to correct them. It reviews the recent literature on determinants,
barriers and the effects of strategies that attempted to correct geographical imbalances, with a focus on empirical studies
from developing and developed countries. An analysis of determinants of success and failures of strategies implemented, and
a summary of lessons learnt, is included. 相似文献
55.
56.
L. Dvorakova J. Sikora M. Hrebicek H. Hulkova M. Bouckova L. Stolnaja M. Elleder 《Journal of inherited metabolic disease》2006,29(4):591
Summary We present the third case of Niemann–Pick disease type C without neurological symptoms. The patient was a 53-year-old woman
without significant prior health problems who died of acute pulmonary embolism. Autopsy findings of hepatosplenomegaly, lymphadenopathy
and ceroid-rich foam cells raised the suspicion of the visceral form of acid sphingomyelinase deficiency (Niemann–Pick disease
type B; NPB) or a much rarer disorder, variant adult visceral form of Niemann–Pick disease type C (NPC). To verify the histopathological
findings, SMPD1, NPC1 and NPC2 genes were analysed. Two novel sequence variants, c.1997G>A (S666N) and c.2882A>G (N961S) were detected in the NPC1 gene. No pathogenic sequence variants were found either in the SMPD1 gene mutated in NPB or in NPC2 gene. The pathogenicity of both NPC1 variants was supported by their location in regions important for the protein function. Both variations were not found in
more than 300 control alleles. Identified sequence variations confirm the diagnosis of the extremely rare adult visceral form
of Niemann–Pick disease type C, which is otherwise dominated by neurovisceral symptoms. Although only three patients have
been reported, this (most probably underdiagnosed) form of NPC should be considered in differential diagnosis of isolated
hepatosplenomegaly with foam cells in adulthood.
Electronic supplementary material Supplementary material is available for this article at 相似文献
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Background
In meningitis, the cerebrospinal fluid contains high levels of innate immune molecules (e.g. complement) which are essential to ward off the infectious challenge and to promote the infiltration of phagocytes (neutrophils, monocytes). However, epithelial cells of either the ependymal layer, one of the established niche for adult neural stem cells, or of the choroid plexus may be extremely vulnerable to bystander attack by cytotoxic and cytolytic complement components. 相似文献59.
60.