老年性外伤性前房出血预后探讨

目的探讨老年性外伤性前房出血的并发症及预后.方法将一组32例老年性外伤性前房出血,与另一对照组35例其他成年外伤性前房出血病人进行比较.结果老年性外伤性前房出血患者易发生继发性前房出血(59.83%vs,25.71%,P＜0.001),积血吸收时间长(15.2±2.3vs,9.5±1.5,P＜0.05),继发性青光眼、玻璃体积血及晶体脱位发生率显著增高(P＜0.001～0.025).结论老年性外伤性前房出血并发症高、视力影响大、预后差.     

老年脑血管病患者头发微量元素测定

采用PIXE测定70例老年脑血管病患者发铬、硒、锰、铁、铜、锌的含量,并以30例健康老年人为对照。结果发现发铬、硒含量疾病组明显降低,发锰含量脑梗塞组明显升高。认为脑血管病的发病与体内铬、硒含量降低有关,脑梗塞的发病还与体内高锰含量有关。发铁、铜、锌含量与脑血管病间无明显关系。     

社区因症就诊检出老年人早期大肠癌63例临床分析

目的分析因症就诊检出老年人早期大肠癌的临床病理特征.方法卢湾区建立大肠癌二级预防网络的10年期间检出106例早期(DukesA期)大肠癌,其中63例(59.43%)为老年人.结果老年组早期大肠癌检出率后5年较前5年显著增加(P＜0.05).老年组三项肛肠症状(便血、大便习惯改变、腹痛腹块)的持续时间均较中青年组显著缩短(P分别＜0.01或＜0.05).老年组慢性疾病伴发率达68.25%,较中青年组(16.28%)显著升高(P＜0.001),但两组的5年生存率无显著差别.结论本研究结果提示,尽管老年早期大肠癌病人伴发重要脏器慢性疾患比例较高,但只要能早期诊断和治疗,远期疗效仍令人满意.     

Ultrastructural studies of amyloid fibrils and senile plaques in human brain

Summary Amyloid fibrils and senile plaques in brains with Alzheimer's disease, senile dementia and Down's syndrome were examined by light and electron microscopy. In addition, replicas of amyloid fibrils, made by a quick freezing method from a brain with Down's syndrome, were examined. All amyloid masses forming the cores of senile plaques consisted of numerous amyloid fibrils spreading from the walls of small blood vessels to the surrounding parenchyma. The amyloid fibrils ran in various directions, forming bundle-like groups in a geometrical array. They appeared as rods with hollow structures consisting of an array of globular units in the replicas, while they showed bead-like structure in the tissue specimens of 500-nm thick sections. The ultrastructure of replicas reveals a new finding on the structure of amyloid fibrils in the human brain.     

Laminar distribution of neocortical senile plaques in senile dementia of the alzheimer type

Summary A prospective longitudinal study was undertaken in a geriatric hospital on women over 75 years of age, clinically diagnosed as either intellectually normal or having senile dementia of the Alzheimer type (SDAT) of varying degrees of severity. Mental impairment was assessed prospectively. Fifteen brains from this population were studied to evaluate quantitatively the distribution of senile plaques (SP) in relation to cortical lamination. SP density in four neocortical areas (first temporal gyrus; supramarginal gyrus calcarine area; precentral gyrus) was significantly correlated with the degree of mental impairment. SP distribution in the cortical layers was evaluated by an indirect method and appeared to be fairly constant from one case to another. Significantly higher SP densities were observed in layers II and III of the temporal and occipital samples, while minimal values were noted in layer I. Lower densities of SP were found in layers V and IV of the occipital and temporal lobes. These data suggest a selective vulnerability of some areas of cortical projections in SDAT.This work was presented at the meeting of the Société Française de Neurologie (Paris; 7, March 1985) and at the meeting of the club Français de Neuropathologie (Marseilles, 28, June 1985)Partly supported by INSERM (PRC Santé Mentale et Cerveau no. 133015) and FRMF     

老年人急性心肌梗死的临床特点

目的　探讨老年人急性心肌梗死的临床特点。方法　回顾性分析 2 0 1例急性心肌梗死患者的临床资料。根据年龄分为 3组 ,<6 0岁为非老年组 ,6 0～ 79岁为老年组 ,≥ 80岁为高龄组。分别对其临床表现进行对比分析。结果　非老年组中典型胸痛常见 (89.3% ) ,诱发因素与不恰当生活习惯有关。老年组、高龄组临床症状不典型及多变 ;梗死面积广泛 ;并发症多而危重 ;伴存疾病多 ,干扰诊治 ;病死率高。结论　老年人急性心肌梗死的临床表现特点是年龄越大 ,越不典型 ,病情越危重 ,预后不良。     

胰岛素对2型糖尿病并发老年性痴呆认知功能影响的研究

目的　观察 2型糖尿病并发老年性痴呆胰岛素治疗后简化智能量表 (MMSE)评分的变化。方法　将198例 2型糖尿病并发老年性痴呆患者随机分为两组 ,治疗组 10 0例 ,皮下注射胰岛素 ;对照组 98例 ,口服二甲双胍 ,3个月为 1个疗程 ,观察血压、血脂、空腹及餐后 2h血糖、糖化血红蛋白、C -肽及MMSE评分。结果　治疗 3个月后 ,两组患者的空腹及餐后 2h血糖和糖化血红蛋白较治疗前差异显著下降 (P <0 0 1) ,且治疗后两组间比较差异无显著性意义 (P >0 0 5 ) ;治疗组MMSE评分较治疗前差异有显著性意义 (P <0 0 1) ,而对照组差异无显著性意义(P >0 0 5 ) ;两组患者治疗前后C -肽水平差异无显著性意义 (P >0 0 5 )。结论　应用胰岛素治疗 2型糖尿病并发老年性痴呆可显著提高MMSE评分 ,改善患者的认知功能     

Regional weight loss of the cerebral cortex and some subcortical nuclei in senile dementia of the Alzheimer type

Summary All the cerebral cortex and some subcortical nuclei from six examples of senile dementia of the Alzheimer type (SDAT) and six age- and sex-matched controls have been dissected and weighed. The weight of the parietal and temporal cortex are significantly reduced. The parietal lobe shows the largest weight loss and this is most obvious in the precuneus and the superior lobule. The posterior cingulate, the middle and superior temporal, the supramarginal and the superior frontal gyri also show significant weight reduction. Weight loss of the amygdala is more than that of the hippocampus, the caudate nucleus and the putamen, but the weights of all are reduced significantyl. These results are rather unexpected but are consistent with other data (e.g. the clinical parietal lobe syndrome and focus of glucose hypometabolism in Alzheimer's disease). They indicate that prominent changes occur in SDAT in the association areas of the parietal lobe as well as in the amygdala.Supported by The Brain Research Trust     

老年性痴呆的BEAM和CT诊断价值

本文分析了经头颅ＣＴ诊断的７２例脑萎缩患者的脑电地形图（ＢＥＡＭ）的结果，资料表明，临床诊断的老年性痴呆者与临床上无显著痴呆表现者的ＢＥＡＭ的改变有显著性差异，但其脑萎缩的程度则无明显差异。作者认为在老年性痴呆的辅助检查时，ＢＥＡＭ较头颅ＣＴ扫描更有价值。     

Serial reconstruction of β-protein amyloid plaques: relationship to microvessels and size distribution

The suggestion that the amyloid plaques in Alzheimer disease are formed by abnormal leakage from microvessels is mainly based on the finding that many plaques are topographically associated with microvessels. However, because the microvessel network is dense and amyloid plaques are numerous, the frequently observed association may result from chance contact, especially for larger plaques. Therefore, we determined the frequency of this association as a variable of plaque size. If all the amyloid plaques are associated with microvessels, a constant and high rate of association would be expected for all plaque sizes. On the other hand, if the association is a chance contact, larger plaques would show more frequent contact than smaller ones. Sections were double-immunostained for amyloid plaques and microvessels, with antibodies raised against β-protein and collagen type IV, respectively. Amyloid plaques were reconstructed using 12 serial sections (7 μm thick) from the entorhinal cortex of two Alzheimer patients. With reconstruction we determined the size distribution of amyloid plaques as well as the influence of size on vascular association. All the amyloid plaques larger than 42 μm were associated with microvessels, however, the smaller the amyloid plaques, the less frequently they were associated with microvessels. Interestingly, although diffuse amyloid plaques occur in all size classes, core-containing amyloid plaques have a more discrete size. We conclude that the topographical relationship between amyloid deposition and capillaries does not support the leakage theory for amyloid plaque formation.