Prothrombotic factors in neonates with cerebral thrombosis and intraventricular hemorrhage

Aim : To investigate whether the factor V Leiden mutation (FVL), the prothrombin gene G20210A variant or the methylenetetrahydrofolate reductase (MTHFR) C677T genotype are risk factors for central nervous system (CNS) thrombosis or intraventricular hemorrhage (IVH) in neonates. Methods : Thirteen full-term infants with cerebral infarct documented with magnetic resonance imaging were assessed with the whole spectrum of assays for thrombophilia including the three DNA-based prothrombotic factors. The frequency of congenital defects was compared with that observed in 38 healthy full-term infants. The genetic defects were also assessed in 55 premature neonates, gestational age <32wk, 17 of whom developed IVH, grade II-IV. The remaining 38 premature neonates without IVH were used as controls. Results : In the CNS thrombosis group: a prothrombotic factor was detected in 53% of patients and an underlying disease or a triggering event in 61.5%. The frequency of FVL in thrombosed neonates was higher (23%) than in the group of healthy full-term infants (10.5%), although it did not reach statistical significance. IVH developed in 30.9% of premature neonates. Apart from several maternal or neonatal risk factors for IVH, FII G20210A was found in a considerably higher prevalence in the cohort of neonates with IVH (12%) than in those without (2%), although the difference was not statistically significant.
Conclusion : The pathogenesis of cerebral thrombosis or IVH in neonates is multifactorial. Along with underlying diseases or triggering events, congenital prothrombotic factors (FVL or FII G20210A) showed a trend towards a higher frequency in full-term infants with CNS thrombosis or premature neonates with IVH than in controls. However, their contribution to neonatal cerebral thrombosis or IVH remains to be determined.     

经蝶窦鞍内手术并发蛛网膜下腔出血6例报告

目的:提高对蝶窦鞍内肿瘤经蝶窦鞍内手术并发蛛网膜下腔出血(SAH)这种少见并发症的认识。方法:对6例垂体肿瘤经蝶窦鞍内手术并发SAH的临床资料进行分析。SAH的出血原因为肿瘤残体出血2例,损伤鞍隔或蛛网膜出血4例。结果:死亡2例,治愈4例。结论:经蝶窦鞍内手术并发SAH的发生原因复杂,熟悉鞍区解剖结构和熟练操作技术可明显减少该并发症;一旦发生这种并发症应给予综合性治疗。     

电针对脑出血大鼠脑组织病理形态学及脑组织含水量和神经损伤积分值的影响

目的 :观察电针对大鼠脑出血模型的疗效。方法 :选择胶原酶加肝素联合注射法诱导脑出血大鼠模型 ,观察电针不同穴位对其脑组织病理形态学、脑含水量和神经损伤积分值的影响。结果 :电针水沟组 (取水沟、上星穴 )、电针风府组 (取风府、哑门穴 )均可明显改善胶原酶加肝素联合注射法诱导大鼠脑出血模型的脑组织形态学损害和神经行为功能的缺损 ,降低因出血导致的血肿周围组织的水肿 ;且电针水沟组在改善大鼠脑出血模型的脑组织形态学损害和神经行为功能的缺损方面 (72h姿势反射和平衡反射积分值 )优于电针风府组。结论 :电针水沟、上星和电针风府、哑门对大鼠脑出血损伤均有一定程度的保护作用 ,且前者的保护作用优于后者     

Case Report: Intracerebral Hemorrhage After γ-Knife Surgery for Metastatic Brain Tumor

The authors report a case of a 69-year-old man with metastatic brain tumors who died of spontaneous intracerebral hemorrhage 3 days after -knife surgery. He had been suffering from lung cancer with multiple systemic metastasis. Preoperative magnetic resonance images showed two well-defined round lesions with intratumoral hemorrhage in the left frontal and right occipital lobe. There was no bleeding tendency in the hematological examination and the patient was normotensive. -Knife surgery was performed on both lesions in a single session. However, the patient died of massive intracerebral hemorrhage from the left frontal lesion 3 days after the surgery. There have been no previous reports of mortality resulting from spontaneous intracerebral hemorrhage after -knife surgery in metastatic brain tumors documented in the literature. It is likely that the two events, -knife surgery and spontaneous intracerebral hemorrhage, occurred separately and were not associated. However, it is worth noting that there is a possibility of bleeding after -knife surgery, especially in a metastatic brain tumor with preexisting intratumoral hemorrhage as in our case.     

Intravascular stent placement for a fusiform aneurysm of the posterior cerebral artery: case report

This article presents the case of a 45-year-old woman with a fusiform, broad-based, actually ruptured aneurysm of the posterior cerebral artery. The patient was successfully treated with stent placement and follow-up angiography demonstrated occlusion of the dome and the body of the aneurysm. Due to the limited neurosurgical treatment options, stent placement should be considered in patients with fusiform aneurysm of the posterior cerebral artery aneurysms.     

实验性蛛网膜下腔出血基底动脉的形态学研究

【目的】应用蛛网膜下腔出血（SAH）的大鼠模型，对基底动脉进行形态学测定和组织病理学检查，动态观察SAH的病理演变过程，进一步探讨脑血管痉挛（CVS）的发生机制。【方法】50只SD大鼠随机分为对照组和SAH第1、3、5、7天组，改良枕大池2次注血法，建立SAH的模型。在相应时段处死取基底动脉，应用光学显微镜进行形态学测定，应用透射电子显微镜观察基底动脉超微结构变化。【结果】（1）光学显微镜检查：与对照组相比，SAH组发生了明显的血管痉挛，表现为血管直径减小、管壁增厚、管腔周长减少、内弹力膜皱褶，同时可见痉挛血管细胞增殖现象明显。尤以第5天组最显著（P〈0．05）。出血第1、3、5、7天组基底动脉直径分别减少了46．34％、33．95％、50．59％、17．21％；管壁厚度分别增加了98．55％、75．58％、159．27％、19．21％；管腔内周长分别减少了56．30％、45．97％、62．50％、25．77％。（2）透射电子显微镜观察：与对照组比较，SAH组内皮细胞出现类凋亡样变化，包括内皮细胞膜起泡，胞质凝聚，胞浆空泡变，核染色质凝聚、趋边。以第5天组最显著，伴有大量内皮细胞的剥离导致内弹力膜的裸露，平滑肌细胞的坏死。至第7天组，血管痉挛有所缓解，内皮细胞凋亡、坏死减轻。【结论】SAH后CVS的发生与血管周围细胞的增殖以及基底动脉内皮细胞类凋亡样变化相一致，表明凋亡和血管细胞增殖可能是CVS发生机制中非常重要的因素。同时该大鼠模型可以很好地模拟人类SAH的病理演变过程。     

Extracorporeal membrane oxygenation for pulmonary hemorrhage in microscopic polyangiitis

Microscopic polyangiitis （MPA） is characterized by an inflammatory process of the vessel walls and is classified according to the smallest vessels involved. Diagnosis is based on clinical manifestations, anti-neutrophil cytoplasmic autoantibody （ANCA） testing, and histology. In this disease, pulmonary hemorrhage is seen in 30% of patients and is associated with an eight-fold increase in mortality. Classically, MPA involves the kidneys and upper and lower respiratory tracts. Due to the perceived risk of increased bleeding secondary to the use of systemic anticoagulation, extra corporeal membrane oxygenation （ECMO） is often not used to treat patients with hemorrhage suffered from MPA. Here we report a case of a 50-year-old woman with MPA that was successfully supported with ECMO.     

脑出血后应激性溃疡的分析

目的探讨脑出血后应激性溃疡与出血部位、出血量的关系。分析早期使用奥美拉唑对应激性溃疡的预防。方法对98例急性脑出血患者进行随机分组，按出血部位、出血量比较应激性溃疡的发生率，A组使用奥关拉唑，B组不使用奥美拉唑。如B组出现消化道出血后加用奥美拉唑。结果脑出血后应激性溃疡与脑出血的出血部位、出血量有关。结论早期使用奥美拉唑可降低应激性溃疡的发生率且副作用少。     

刺激乳头对产后出血的影响：（附300例分析）

本文对1992年8月至1992年12月在辽宁省彰武县正常分娩、非高危妊娠的300例产妇进行产后出血的前瞻性研究。其中200例为实验组,当胎儿前肩娩出后刺激双侧乳头以增强子宫收缩;另选条件相似的100例产妇为对照,不作任何干预,对比第三产程时间及产后2小时和产后24小时的出血量。结果证明:胎儿前肩娩出后刺激乳头能减少产后出血发生率,对照组产后出血发生率为20％,刺激乳头组产后出血发生率仅为10.51％,二组差异显著,P<0.05。此方法简便易行,适于推广应用。     

Umbilical cord ulceration and intestinal atresia

Umbilical ulceration is an extremely rare complication in the perinatal period. We encountered a case of intestinal atresia complicated by massive intrauterine hemorrhage due to the umbilical cord ulceration. This is the fifth reported case demonstrating an association between the umbilical cord ulceration and intestinal atresia.