红细胞对创伤性脑内出血大鼠脑含水量及HO-1表达的影响

目的研究大鼠创伤性脑内出血(TICH)中红细胞对脑含水量和血红素氧合酶-1(HO-1)表达的影响,并分析二者的关系,以探讨红细胞在TICH后脑水肿形成中的作用机制。方法120只大鼠随机分为创伤性脑损伤组(TBI组),TBI加注全血组(WB组),TBI加注溶解红细胞组(LRBC组)和TBI加注压积红细胞组(PRBC组),每组30只。4组均采用自由落体打击法造成大鼠脑外伤。后3组借助立体定向仪分别向伤区脑皮质内注射全血、溶解红细胞或压积红细胞,造成TICH模型。每组于伤后1、3、5d分别处死10只大鼠,5只测伤区脑组织含水量,5只用免疫组化法检测HO-1的表达。结果4组组内比较:TBI、WB和PRBC3组第3d的脑含水量最高(分别为82.85%±0.60%,85.00%±1.12%,84.93%±1.21%),LRBC组第1d的含水量最高(84.44%±0.85%;4组间比较,1d时LRBC组含水量最高,3d时WB和PRBC组含水量最高。在WB、PRBC和LRBC组,HO-1阳性表达的强弱与脑含水量的高低变化相一致。结论红细胞在TICH后迟发性脑水肿的形成中有重要作用,其机制涉及红细胞的降解产物。     

新生儿颅内出血的CT诊断（附80例报告）

目的：探讨新生儿颅内出血的CT表现。方法；对1998年5月至2003年5月因难产、窒息、早产的新生儿进行头颅CT检查。结果；蛛网膜下腔出血(SAH)62例；脑实质出血(ICH)5例；硬膜下出血(SDH)15例；脑室内出血5例；混合型出血12例。结论：新生儿颅内出血的CT表现具有一定的特征性；CT对颅内出血的诊断具有重要价值。     

侧脑室引流术治疗脑室出血医院感染分析

目的 分析治疗脑室出血侧脑室引流术后感染发生率，探讨预防感染的方法及措施。方法 根据留管时间将患者分为甲、乙两组，按单侧引流及双侧引流分为A、B组，术后观察插管部位的感染发生情况，同时定期做血培养监测。结果 甲、乙组之间，经统计学处理P＜0．01，差异有高度显著性，A、B两组比较，P＞0．05，差异无显著性。结论 留管1～2周时间是安全的，超过2周，感染率上升，双侧引流术后感染率高于单侧引流者，此外，患者的全身状况及免疫力也与感染率明显相关。     

宫腔镜诊治围绝经期子宫出血(附138例报告)

目的 :探讨宫腔镜在诊治围绝经期异常子宫出血 (perimenopausaluterinebleeding ,PMUB)的价值。方法 :回顾分析PMUB 138例用宫腔镜诊治的临床资料。结果 :138例中子宫内膜息肉 5 5例 ,子宫颈息肉 2 9例 ,粘膜下子宫肌瘤 4 0例 ,子宫内膜增生过长 6例 ,子宫内膜不典型增生 3例 ,子宫内膜癌 1例 ,正常子宫内膜 4例。总体检查阳性率为 97 10 %。术中 1例发生子宫穿孔并发症。术后随访 2 ～12个月 ,随访率为82 6 1% ,患者症状明显改善 10 6例 ,满意率为 92 98%。结论 :用宫腔镜诊断PMUB有相当高的特异性和准确性。可同时治疗良性病变 ,减少不必要的开腹手术 ,是治疗PMUB的首选方法。     

Spontaneous mesenteric hemorrhage associated with ehlers-danlos syndrome

The vascular type of Ehlers-Danlos syndrome is a genetic disorder of connective tissue and is frequently associated with catastrophic arterial complications. Its surgical treatment is extremely difficult because of the fragility of vessels. This article describes three patients with vascular type of Ehlers-Danlos syndrome who developed mesenteric hemorrhage due to spontaneous arterial rupture. The clinical and molecular characteristics of the disease are briefly reviewed.     

Ventriculosubcutaneous shunt for temporary treatment of neonatal post-IVH hydrocephalus: a technical note

A technique for temporary ventricular drainage using a subcutaneous pouch is described for use in neonatal hydrocephalus after intraventricular hemorrhage. The advantages include continuous, valve-regulated ventricular decompression, no exposed tubing, avoidance of electrolyte imbalance and of the loss of CSF, obviation of the need for repeated tapping, and the ability to convert to a peritoneal shunt on an elective basis.     

含服米索前列醇预防选择性剖宫产产后出血

目的：探讨舌下含服米索前列醇预防剖宫产产后出血的效果。方法：将妊娠晚期单胎选择性剖宫产者200例随机分为两组,研究组110例，在第二产程末胎头娩出后舌下含服米索400μg，对照组90例，在胎儿娩出后静脉注射催产素20IU，观察产后2h出血量和用米索前后血压及用药后出现的副作用，结果：产后2h内的出血量，研究组与对照组分别为174．43ml和219.73ml，二组比较有显著性差异（P＜0．01），用米索前后血压比较，二组无显著性差异（P＞0．05），结论：舌下含服前列醇促进子宫收缩作用强于催产素，能减少产后出血，也适用于某些与血管变化有关的高危孕产妇，预防产后出血。     

产后出血159例临床分析及护理

目的　探讨产后出血的原因与影响因素。方法　回顾分析收治的产后出血 15 9例 ,数据处理采用χ2 检验。结果　产后出血发生率 3.5 % ,产后 2小时内出血者 88.6 7% ,出血原因宫缩乏力为 6 6 .6 7% ,影响因素有手术产、流产史、分娩史、妊娠合并症及产程延长等 ,统计学处理P <0 .0 1。结论　重视产后出血的影响因素 ,正确评估出血量及产妇产后 2小时留置产房观察是产后出血早期诊断的关键 ,其预防重点在于早期发现并针对不同原因及时正确处理     

Epilepsy After Stroke

A retrospective follow-up of 200 consecutive stroke patients [ischemic brain infarction (IBI) 157, intracerebral hemorrhage (ICH) 20, subarachnoid hemorrhage (SAH) 23] who were in need of ambulatory rehabilitation was conducted for a mean period of 40 months after stroke. Epilepsy developed in 33 (17%) patients. The occurrence of epilepsy was 14% in IBI, 15% in ICH, and 35% in SAH. Significantly more patients developed epilepsy in the SAH group than in the IBI group (8 of 23 vs. 22 of 157, p less than 0.05). Of the 33 patients, 15% had their first seizures within the first 2 weeks after stroke, and 55% developed epilepsy in 6 months. Forty-eight percent of the patients had generalized seizures. Antiepileptic drug (AED) treatment was started in 28 of 33 patients, of whom 17 still had seizures during follow-up. Epilepsy was an important consequence of stroke among patients who needed rehabilitation, especially in SAH patients. In most, this was due to arterial spasm leading to IBI.     

Clinical impact of CCM mutation detection in familial cavernous angioma

Introduction and background A 3-year-old Bosnian girl with a large symptomatic brainstem and multiple supratentorial cavernous angiomas, who underwent neurosurgical treatment, is presented. As multiple cavernomas are more common in familial cases, genetic analyses and neuroradiological imaging were performed in the patient and her parents to see whether there was any evidence for inheritance. This information is important for genetic counseling and provision of medical care for at-risk relatives. Currently, no recommendation is available on how to manage these cases.Results Genetic analyses demonstrated a novel CCM1 frameshift mutation (c.1683_1684insA; p.V562SfsX6) in the child and the asymptomatic 27-year-old mother. Sensitive gradient-echo magnetic resonance imaging of the mother revealed multiple supratentorial lesions, whereas analogous imaging of the father showed no pathological findings.Conclusion This case exemplifies that seemingly sporadic cases with multiple lesions might well be hereditary and that presymptomatic genetic testing of family members may identify relatives for whom clinical and neuroradiological monitoring is indicated.