Horizontal contralateral approach for the distal anterior cerebral artery aneurysm: technical note

Background

The authors present a modified interhemispheric approach for the distal ACA aneurysm to resolve several problems including the narrow surgical corridor, the difficulty of proximal control, and the aneurysmal projection toward the surgeon.

Methods

We refined the positions of the patient's head and the surgeon. The patient's head is fixed with flexion and tilted to the contralateral side. The surgeon sits on the contralateral side of the patient and not on the cranial side.

Results

The present approach allows the surgeon to comfortably use both hands in the horizontal operative filed, to obtain a minimum retraction of the brain, and to easily secure the proximal artery.

Conclusions

This modified interhemispheric approach is useful for a patient with the distal ACA aneurysm.     

妊娠自然流产合并血小板减少及其免疫相关性疾病分析

目的探讨妊娠期合并血小板减少以及妊娠合并血小板减少中发生自然流产与妊娠相关免疫疾病的关系。方法对55例妊娠期后血小板减少的孕妇进行回顾性分析。结果妊娠后血小板减少患者中心磷脂抗体（ACA）阳性和妊娠相关性血小板减少（PAT）占主要部分。55例患者中自然流产率为40％,PAT组与合并免疫相关疾病组的自然流产率没有统计学差异。结论妊娠期的免疫异常可能是导致妊娠期血小板下降及自然流产的根本原因。     

针刺左侧列缺穴对大脑前动脉血流动力学影响的研究

目的探讨针刺左侧列缺穴对健康青年大脑前动脉(ACA)的血流动力学影响,并探究列缺穴对不同性别受试者ACA的影响,为临床选取该穴治疗脑血管病提供依据。方法选取健康青年30例,分为3组进行试验,分别为男女混合组30例、女性组15例、男性组15例。针刺受试者左侧列缺穴,在针刺前(针刺前10 min)、入针后(进针得气时)、行针时(留针15 min)、出针时(留针30 min)、出针后(出针后10 min)运用TCD分别记录志愿者双侧ACA的血流动力学改变。结果 (1)男女混合:针刺左侧列缺穴,在出针时,双侧ACA的舒张期最大血流速度(Vd)较针刺前显著增加(P0.05)。(2)女性:针刺左侧列缺穴,在出针时,双侧ACA的舒张期Vd较针刺前显著增加(P0.05)。(3)男性:针刺左侧列缺穴,在出针10 min后,左侧大脑前动脉PI与行针时比较有所增加(P0.05)。结论针刺左侧列缺穴可增加健康青年双侧ACA血流速度,其中女性结果明显优于男性。列缺穴可作为女性ACA缺血性疾病的首选治疗穴位。男性选穴意义不大。     

a-β2GP1、ACA在早期先兆流产患者妊娠丢失中的临床意义

目的评价a-β2GP1、ACA在早期先兆流产患者妊娠丢失中的临床意义。方法采用前瞻性病例对照研究,对80例8～12周先兆流产患者(研究组)和35例正常孕妇(对照组)的血清a-β2GP1、ACA进行检测,并随访至妊娠结束。研究组根据妊娠结局分为足月分娩组以及妊娠丢失组。结果 80例先兆流产患者中,早期妊娠丢失者46例(57.5%),足月分娩者34例(42.5%)。早期流产者平均孕周为(10.5±1.2)周。a-β2GP1IgM型阳性率在妊娠丢失组(41.3%)较其他两组(14.7%,0%)更多见,差异有显著性意义(P<0.05)。IgG型各组间无明显差异。妊娠丢失组ACAIgM、IgG型阳性率较其它两组高,但差异无显著性差异。结论 a-β2GP1IgM会增加早期先兆流产患者妊娠丢失的风险。     

Thrombophilic screening in young patients (< 40 years) with idiopathic ischemic stroke: a controlled study

Introduction

Despite extensive clinical and laboratory investigations, the etiology of ischemic stroke remains unknown in approximately one third of patients.

Materials and Methods

Thirty-four consecutive patients less than 40 years old (Males 13, Females 21, mean age 26.6 years, range 2-39) with documented ischemic stroke underwent, one year after the acute event, laboratory evaluation of antithrombin, protein C, free and total protein S, activated protein C resistance, fibrinogen, factor VII:C, homocysteine levels and antiphospholipid antibodies (APA). Moreover, prevalence of F5 R506Q, F2 G2021A and homozygosis for thermolabile variant C677T of the methylenetetrahydrofolate reductase (MTHFR) were also evaluated and compared to the results obtained in 120 normal controls.

Results

Antithrombin and protein C levels resulted normal in all cases. One patient (2.9%) showed free protein S deficiency and 3 patients (8.8%) had activated protein C resistance. Homocysteine levels above 15 μmol/L were found in one patient (2.9%). APA were found in 21 patients (61.7%) and in only 2 out of 120 (1.66%) controls (OR = 95.31; 95% C.I.: 18.22-667.81). The multivariate analysis selected that the presence of APA was significantly associated with an increased risk of stroke (OR = 156.60; 95% C.I.: 25.99-943.47) in this cohort of patients. The combination between APA and cardiovascular risk factors determined a risk of 29-fold (OR = 29.31; 95% CI: 3.28-261.69).

Discussion

Our data suggest that the presence of APA is associated with an increased risk of idiopathic ischemic stroke in young patients. Furthermore, also the combination of APA and cardiovascular risk factors is significantly associated with development of idiopathic ischemic stroke.     

The cognitive functions of the caudate nucleus

The basal ganglia as a whole are broadly responsible for sensorimotor coordination, including response selection and initiation. However, it has become increasingly clear that regions of the basal ganglia are functionally delineated along corticostriatal lines, and that a modular conception of the respective functions of various nuclei is useful. Here we examine the specific role of the caudate nucleus, and in particular, how this differs from that of the putamen. This review considers converging evidence from multiple domains including anatomical studies of corticostriatal circuitry, neuroimaging studies of healthy volunteers, patient studies of performance deficits on a variety of cognitive tests, and animal studies of behavioural control. We conclude that the caudate nucleus contributes to behaviour through the excitation of correct action schemas and the selection of appropriate sub-goals based on an evaluation of action-outcomes; both processes fundamental to successful goal-directed action. This is in contrast to the putamen, which appears to subserve cognitive functions more limited to stimulus-response, or habit, learning. This modular conception of the striatum is consistent with hierarchical models of cortico-striatal function through which adaptive behaviour towards significant goals can be identified (motivation; ventral striatum), planned (cognition; caudate) and implemented (sensorimotor coordination; putamen) effectively.