免疫荧光细胞化学染色联合激光扫描共聚焦显微技术对脑膜癌病的诊断价值

目的探讨免疫荧光细胞化学染色与激光扫描共聚焦显微技术联合检测在脑膜癌病诊断中的价值。方法采用免疫荧光细胞化学染色法,以小鼠抗人单克隆上皮膜抗原(EMA)标记脑膜癌细胞及对照组脑脊液细胞,激光扫描共聚焦显微技术获得脑膜癌细胞扫描图像并定量检测上皮膜抗原相对荧光强度。结果上皮膜抗原主要表达于脑膜癌细胞的细胞质和细胞膜,着红色荧光,相对荧光强度为(44.84±1 3.05),与对照组(3.98±1.58)相比差异有统计学意义(t=43.954,P=0.001)。免疫荧光细胞化学染色联合激光扫描共聚焦显微技术对上皮膜抗原的检测阳性率为90%(1 8/20),高于常规MGG染色法[60%(12/20)],组间差异具有统计学意义(x~2=4.800,P=0.010)。结论免疫荧光细胞化学染色与激光扫描共聚焦显微技术联合检测脑脊液细胞上皮膜抗原表达变化,可为脑膜癌病的诊断、组织来源提供实验室依据。     

高血压对大鼠脑膜中动脉内皮依赖性舒张功能的影响及机制

目的:探讨自发性高血压大鼠脑膜中动脉内皮依赖性舒张功能降低的机制。方法:以WKY为对照,观察SHR大鼠脑膜中动脉环5-羟色胺预收缩后乙酰胆碱舒张性改变,考察一氧化氮途径,前列环素途径以及内皮源性超极化因子途径在SHR脑膜中动脉舒张功能的改变,反应特征表述为最大松弛百分率(Rmax)和产生一半最大松弛百分率时所需要ACh浓度的负对数(pIC50)。ANOVA Two-way和t检验分析组间差异。透射电镜法观察SHR脑膜中动脉内皮超微结构的改变。结果:WKY大鼠脑膜中动脉Rmax和pIC50分别为97%±1%和8.67±0.21,SHR Rmax和pIC50分别为39%±2%(P<0.001)和7.05±0.65(P<0.05);NO途径在WKY大鼠,Rmax和pIC50分别为53%±2%和6.89±0.33,在SHR Rmax和pIC50分别为32%±2%(P<0.001),和3.93±0.07(P<0.001);PGI2途径在WKY大鼠,Rmax和pIC50分别为8%±1%和4.58±0.30,在SHR Rmax和pIC50分别为8%±1%,(P>0.05),和4.52±0.27,(P>0.05);EDHF途径在WKY大鼠,Rmax和pIC50分别为35±5%和6.30±0.50,在SHRRmax和pIC50分别为14%±1%,(P<0.001),和3.85±0.07,(P<0.001)。电镜观察显示SHR脑膜中动脉出现部分内皮细胞脱落,内弹力膜不完整,有断裂现象。结论:NO-和EDHF-介导的舒张功能降低以及内皮超微结构受损参与导致SHR脑膜中动脉内皮依赖性舒张功能降低。     

颅内感染患者脑膜刺激征阴性的影响因素

目的探讨颅内感染患者出现脑膜刺激征阴性的影响因素。方法收集颅内感染患者269例,根据体格检查结果,分为脑膜刺激征阳性组和阴性组。记录患者一般情况、首诊时间、病史、体征、脑脊液检查和影像学结果等,比较两组间的差异,并进行Logistic回归分析。结果 269例患者中,脑膜刺激征阴性149例,阳性120例。病毒性颅内感染70.6%阴性,化脓性颅内感染16.7%阴性(P<0.05)。意识障碍、病理征、颅内压升高、脑脊液氯化物水平以及脑实质受累与脑膜刺激征阴性有关(P<0.05)。结论病毒感染、意识障碍、病理征阳性、脑脊液氯化物水平降低或脑实质受累的颅内感染患者容易出现脑膜刺激征阴性,颅内压升高的患者容易出现脑膜刺激征阳性。     

Difference in Cryptococcus neoformans cellular and capsule size in sequential pulmonary and meningeal infection: a postmortem study

Cryptococcus neoformans is an encapsulated yeast that primarily causes a life-threatening meningoencephalitis in immunosuppressed individuals especially those with HIV/AIDS. Its main virulence factor is its polysaccharide capsule which interferes with complement-mediated phagocytosis. C. neoformans infections ensue following inhalation of small desiccated less encapsulated propagules leading to pulmonary pneumonia or colonization of the host's respiratory tract. Numerous murine experimental studies have shown major discrepancies in cryptococcal cell and capsule enlargement between the lung and brain. In this report, we describe a nonmurine experimental model of the striking variability between cryptococcal cell and capsule size diameters in histology sections of postmortem lung and brain in a fatal cryptococcal infection in a heart transplant recipient.     

Intermediate grade meningeal melanocytoma of cervical spine

Background  Meningeal melanocytoma is a rare, benign melanotic tumor of the leptomeninges, which occurs anywhere in the cranial or spinal regions but most commonly in supratentorial and thoracic spine regions. The literature on this entity consists of case reports; therefore, there is no agreement on the most effective therapy of this tumor, although total excision seems to be the best therapeutic option. Case history  We report a 17-year-old girl with intermediate grade meningeal melanocytoma involving the C6 nerve root with spinal cord compression resulted in progressive tetraparesis. Clinical and radiological examinations suggested the possibility of an intradural extramedullary solid mass. The tumor was removed subtotally through cervical laminotomy followed by rapid improvement of most neurological deficits. This tumor was unusual because of its very hyperintense homogenous signal on T1-weighted images, invasion of the arachnoid membrane, and extension into the neural foramina. Black dots on the surface of the cord were thought to represent an organized blood clot until the frozen section suggested a melanocytic tumor. Discussion  We discuss the distinction of meningeal melanocytoma from other melanocytic tumors of the leptomeninges. Conclusion  Melanocytic tumors should be considered in the differential diagnosis when a hyperintense lesion of the leptomeninges is identified on T1-weighted images or a very dark mass similar to charcoal or organized hematoma is found in the surgical field. The best management is complete tumor resection, but radiotherapy is reserved in cases of subtotal resection and multiple lesions. Locally aggressive nature of tumor and possibility of recurrence warrant regular follow-up.     

吉非替尼一线治疗非小细胞肺癌脑膜转移１２例分析

目的　观察吉非替尼作为非小细胞肺癌（ＮＳＣＬＣ）脑膜转移一线治疗方案的疗效和不良反应。方法　１２例ＮＳＣＬＣ脑膜转移患者服用吉非替尼２５０ｍｇ,１／日,直至疾病进展。结果　１２例患者获ＣＲ８.３％,ＰＲ４１.７％,ＤＣＲ７５.０％,中位总生存期１０.２个月,中位无进展生存期７.８个月。药物引起的毒副反应大部分为１～２级,未因不良反应而减停。结论　吉非替尼一线用于ＮＳＣＬＣ脑膜转移安全有效,值得进一步研究。     

颅内血管周细胞瘤与孤立性纤维瘤的影像与病理对照

目的对比分析颅内血管周细胞瘤与孤立性纤维瘤的影像学差异。材料与方法回顾性分析经手术病理证实的颅内血管周细胞瘤18例,孤立性纤维瘤10例,所有病例均行MR平扫及增强扫描,对其影像征象进行对照分析。统计学方法采用单因素分析,计数资料组间比较采用卡方检验。结果血管周细胞瘤与孤立性纤维瘤在与附着硬膜的关系、硬膜尾征征象方面无统计学意义(P＞0.05);在肿瘤形态、T2WI信号、囊变坏死及出血、瘤周水肿、骨质破坏及强化方式方面差异有统计学意义(P＜0.05)。前者肿瘤形态多呈分叶状、不规则形, T2WI等高信号,囊变坏死及出血多见,瘤周水肿较明显,颅骨破坏可见,增强后明显强化;后者肿瘤形态多呈类圆形或椭圆形,T2WI有低信号区,囊变坏死及出血少见,瘤周水肿轻,无颅骨破坏,增强后明显强化,并有延迟强化。结论颅内血管周细胞瘤与孤立性纤维瘤影像表现存在一定差异。     

肿瘤软脑膜-蛛网膜转移的CT、MRI诊断

目的研究肿瘤软脑膜蛛网膜转移的ＣＴ、ＭＲＩ表现,并探讨两种检查方法对该病的诊断价值。方法回顾分析２１例肿瘤软脑膜蛛网膜转移的临床及影像学资料。病变经ＣＴ检查１６例,ＭＲＩ检查７例,其中经两种方法检查者２例。结果全部病例软脑膜蛛网膜下腔均出现病理性强化,其中１０例呈弥漫性,８例呈结节性,３例呈弥漫与结节混合性。弥漫性强化沿脑和脑干表面分布,并延伸入脑沟、脑池;结节性强化病灶数目１个或多个不等,直径０．２～３．０ｃｍ。病变见于基底脑池及相邻蛛网膜下腔者共１８例。伴室管膜结节性强化４例,天幕增厚强化１０例,脑积水１３例,合并脑内转移９例。结论增强ＣＴ和ＭＲＩ对病变的诊断具有重要临床意义,且ＭＲＩ优于ＣＴ。但两者在定性诊断上均有局限性。正确诊断有赖于结合临床资料和影像征象的综合分析     

脑脊液CEA与细胞学联合检测对脑膜癌病的探讨

目的探讨脑脊液细胞学与脑脊液CEA联合检测对脑膜癌病临床检测价值。方法脑脊液细胞学采用迈格姬染色法,脑脊液CEA检测采用酶联免疫法。结果40例脑膜癌病患者中脑脊液细胞学检查阳性36例,CEA检测阳性26例,两者联合检测阳性39例。结论对于脑膜癌病脑脊液细胞学是最好的确诊依据,CEA则是较好的辅助诊断依据,两者联检可提高敏感性。     

恶性肿瘤脑膜转移的MRI征象分析

目的探讨恶性肿瘤脑膜转移的高分辨力MRI影像学特征。方法选择有全身恶性肿瘤病史、临床可疑并经手术病理或脑脊液检查证实的脑膜转移瘤患者90例。回顾性分析脑膜转移瘤的MRI分布、形态、信号特征及其强化的模式。结果本组脑膜转移瘤病例90例,在MRI平扫影像上得以显示者19例。其中,11例的分布类型表现为软脑膜型,占12.22%;8例的分布类型表现为硬脑膜型,占8.89%。在MRI增强扫描影像上90例病变均得以显示。其中,32例的分布类型表现为软脑膜型,占35.55%;48例的分布类型表现为硬脑膜型,占53.33%;10例的分布类型表现为全脑膜型,占11.11%。结论 MRI增强扫描在全身脏器恶性肿瘤脑膜转移瘤的诊断、分型和治疗指导方面,具有突出的应用价值。