鼓室穿刺治疗腭裂渗出性中耳炎的临床评价

目的　探讨腭裂修复同期 ,鼓室穿刺对腭裂伴分泌性中耳炎患者中耳功能及听力损失的影响。方法　将 80例 ( 14 6耳 )患有分泌性中耳炎的腭裂患者 ,随机分为实验组 ( 78耳 ) :常规腭裂修复术 ,术毕作鼓室穿刺。对照组 ( 68耳 ) :单纯腭裂修复术。术后 6个月两组均进行鼓室图、脑干听觉诱发电位检查 ,并进行比较。结果　实验组术后无论与术前比较 ,还是与对照组术后比较 ,鼓室图、V波反应阈值及轻、中度听力损失 ,均有显著进步 (P <0 0 1) ;术后半年内实验组听力恢复早 ,而且治愈率高 ( 96 2 % ,75 /78) ,明显优于对照组 ( 3 8 2 % ,2 6/68)。结论　腭裂修复同期鼓室穿刺 ,不仅有助于改善伴有分泌性中耳炎腭裂患者的中耳功能 ,提高听力 ;而且可避免或减少粘连性中耳炎的发生     

Heart rate fluctuations in diabetic patients with cardiac vagal dysfunction: a spectral analysis

The autonomic nervous control of cardiac function during active orthostatic load has been studied by measuring the power spectrum of heart rate fluctuations in 16 insulin-dependent diabetic patients and 14 age-matched control subjects. The patients were subdivided into two groups: 8 with normal respiratory sinus dysrhythmia (RSA+) and 8 with reduced respiratory sinus dysrhythmia (RSA-). In RSA- patients the total power (0.01-0.50 Hz) was significantly reduced compared with control subjects (4.7 versus 15.5 min-2, 2p less than 0.05) and the pattern of heart rate fluctuations was characterized by a relative increase in the low-frequency component (0.01-0.05 Hz) as compared with RSA+ patients and control subjects (45% versus 24% and 27%, both 2p less than 0.01). There was also a significant reduction in the high-frequency component (0.15-0.50 Hz) as compared with RSA+ patients and control subjects (17% versus 36% and 33%, both 2p less than 0.05). During standing, a significant increase in total power was found only in control subjects (2p less than 0.01) and the difference between control subjects, and RSA+ and RSA- patients reached significance (32.2 versus 15.1 and 12.7 min-2, 2p less than 0.02 and 2p less than 0.01). The pattern of heart rate fluctuations in RSA- patients showed no significant change on standing. These results suggest that the reduced overall heart rate variability in diabetic patients with cardiac autonomic neuropathy is associated with a typical heart rate fluctuation pattern.     

Comparative effects of stimulation of the trigeminal ganglion and the superior sagittal sinus on cerebral blood flow and evoked potentials in the cat

The superior sagittal sinus (SSS) and the trigeminal ganglion (Vg) of anesthetized cats were stimulated electrically and field potentials in the upper cervical spinal cord and regional cerebral blood flow were recorded. Stimulation of the entire ganglion produced smaller field potential changes in two regions (medioventral area (MVA); dorsolateral area (DLA] of the upper spinal cord than did stimulation of the sagittal sinus (Vg/SSS response ratio = 17% for the MVA and 48% for the DLA). Stimulation of the trigeminal ganglion increased blood flow in only the frontal and parietal cortices (+93% and +33%), whereas stimulation of the sinus produced both larger changes in these areas (+137% and +139%) and also produced changes in regional cerebral blood flow in the thalamus (+122%).     

颈交感神经对血管源性头痛痛觉传导的影响

目的采用电刺激大鼠上矢状窦(SSS)区硬脑膜,观察颈上交感神经节(SCG)摘除术前后在延髓和上颈段三叉神经脊束核一氧化氮合酶(NOS)阳性神经元数目的变化,以探讨交感神经系统在血管源性头痛(如偏头痛)涉及的伤害觉信息传递中的作用。方法以雄性SD大鼠(体重为220～250g)为实验对象,行颈上交感神经节摘除术后再手术暴露其SSS,然后电刺激SSS区硬脑膜,应用免疫组织化学染色技术,观察延髓和上颈段三叉神经脊束核NOS表达的变化。结果NOS免疫反应阳性神经元主要分布在三叉神经脊束核和上颈段脊髓的第Ⅰ、Ⅱ板层,双侧对称。假手术对照组、SCG摘除组每张切片的NOS阳性神经元数分别为150.2±10.3、223.0±11.6,SCG摘除组NOS阳性神经元数目较假手术对照组明显增加(P<0.05)。结论颈交感神经系统参与了头部血管源性疼痛(如偏头痛)中伤害性感觉信息导致的疼痛的产生、传导及调节过程。     

多层螺旋CT血管成像诊断颈动脉海绵窦瘘

目的探讨颈动脉海绵窦瘘(CCF)的解剖病理基础及螺旋CT血管成像(MSCTA)表现,提高MSCTA对CCF的诊断能力。方法12例经DSA证实的CCF均进行了螺旋CT平扫、增强扫描及血管成像重建。结果CCF的MSCT及CTA表现为:海绵窦扩大及眼上静脉扩张12例,并与颈内动脉同时显影;其他属支静脉扩张6例;对侧海绵窦扩大4例,与DSA检查结果一致。患侧眼球突出12例。颅底、眶壁骨折5例。眼球壁模糊、增厚5例。脑挫伤、出血4例。眼外肌增粗1例。结论螺旋CT及其血管成像诊断CCF简单、快捷、准确、可靠,特别是在外伤性CCF中,是首选的检查及诊断方法。     

横窦和窦汇的浅表解剖学标志

目的为神经外科手术准确定位横窦的下缘和窦汇确定出一个可靠的浅表解剖学标志。方法对10例经10%甲醛溶液固定的尸头标本进行逐步解剖,测量各相关解剖结构到横窦下缘的距离。结果实验所收集的数据表明在定位横窦下缘和窦汇时,上项线及枕外隆凸尖不是一个可靠的浅表解剖学标志。而以半脊肌附着点作为浅表解剖学标志比以上项线作为浅表解剖标志更准确、可靠。本组10例标本中,无1例的半脊肌附着点超过横窦下部边界3mm,并且它可以作为一个可靠的浅表解剖学标志用以定位接近中线部分的横窦。结论这些发现可以帮助神经外科医生在治疗后颅窝和颅颈接合处病变而进行的各种中线入路手术时更准确的定位横窦。     

跨矢状窦脑膜瘤术中矢状窦的处理

目的总结跨矢状窦脑膜瘤术中矢状窦的处理方法.方法对26例跨矢状窦脑膜瘤及受累矢状窦进行切除,依具体情况重建或不重建矢状窦.结果该组病人无手术死亡,手术后均未加重原有神经功能障碍,无脑血液回流障碍,7例重建矢状窦者未发现有矢状窦内血栓形成.结论矢状窦旁脑膜瘤的治疗除肿瘤切除外,对受累上矢状窦处理是否彻底对预防术后复发是至关重要的.对受累矢状窦应按具体情况按一定的原则进行积极处理.     

手术显微镜下上颌窦自然口扩大术

手术显微镜下行上颌窦自然口扩大术治疗３３例慢性上颌窦炎患者，报告其手术方法及疗效，并与同期行传统上颌窦根治术（柯陆二氏手术）的疗效进行比较，结果表明该手术疗效明显优于柯陆二氏手术。     

Cerebellopontine angle ganglioneuroblastoma

Summary The CT, MR and histological features of a rare ganglioneuroblastoma of the cerebellopontine angle and cavernous sinus are reported.     

The traumatic dural sinus injury — a clinical study

Summary In a period of 13 years 978 cases of severe head injuries were operated on in our clinic. An analysis of the medical reports includes injuries of the superficial dural sinus (39 cases=4%): among these injuries of the anterior and central part of the superior sagittal sinus (66 per cent), injuries of the transverse sinus (18 per cent), injuries of the posterior part of the superior sagittal sinus (8 per cent), and combined injuries of different dural sinuses (8 per cent).Clinical data, i.e. the causes of accident, radiological examination results, intracranial lesions, operation technqiues and outcome are analysed and discussed. The analysis of cases with dural sinus injuries shows a high mortality rate (total mortality rate: 16 patients=41%; intra-operative mortality rate: 8 patients=20%).