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101.
G. F. Hamann 《Der Radiologe》1997,37(11):843-852
Summary
This review focuses on the pathophysiological changes in acute cerebral ischemia, with special emphasis on disturbances of
the cerebral blood flow (CBF) and the associated penumbra concept. Alternatively, the model of peri-infarct depolarization
is demonstrated. Metabolic and molecular changes caused by cerebral ischemia and reperfusion are discussed, namely energy
failure, release of glutamate with an excitatoric burst, calcium influx in neurons, generation of free radicals, activation
of different proteases, disturbances of protein synthesis, induction of gene expression and apoptosis, loss of membrane integrity,
edema formation and microvascular disturbances. In summary, the pathophysiological changes after focal cerebral ischemia and
reperfusion are most adequately described by a network of interacting different mechanisms of tissue alterations. The simple
concept of a cascade of ischemic effects which would be easy to block seems to be less applicable. A time window of approximately
6 h for the acute stroke therapy is postulated on the base of the above mentioned pathophysiological changes. The recently
introduced treatment regimen with optimized basic treatment, recanalization using thrombolysis and neuroprotection by different
agents is presented. Different modes of a possible intervention are discussed. Modern concepts of stroke therapy including
stroke-unit care and thrombolysis with add-on neuroprotection seem to have potential for improving the outcome of acute stroke
patients.
相似文献
102.
Kentaro Yamashita Hiroyuki Tsukuda Yasuyo Mizukami Jun Ito Shigeo Ikuta Yoshihiro Kondo Hiroshi Kinoshita Yasunori Fujisawa Kohzoh Imai 《Journal of gastroenterology》1997,32(5):684-688
A case of hepatic infarction with portal thrombosis is reported. A 63-year-old woman with liver cirrhosis and esophageal varices
was admitted for treatment of the esophagel varices. Endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy
(EIS) were performed. Two months later, she experienced right hypochondralgia and right flank pain. Serum transaminase levels
were suddenly elevated, and computed tomography scans of the liver showed multiple small nodular lesions. Her condition worsened,
and she died of hepatic failure. Autopsy revealed splenic and portal vein thrombosis, multiple hepatic infarction, and evidence
of chronic pancreatitis. We believe that liver cirrhosis and chronic pancreatitis were the main risk factors for the portal
thrombosis, and the treatment for esophageal varices appeared to have triggered the thrombosis. The hepatic infarction was
caused by the portal thrombosis. 相似文献
103.
林尚泽 《中华耳鼻咽喉头颈外科杂志》1994,(4)
报道1例严重鼻衄伴高血压、动脉硬化患者,经常规方法止血无效,行患侧颌内动脉超选择性栓塞术。术后鼻出血停止,但出现脑梗塞、昏迷,经抢救无效,于术后第9天死亡。认为对有动脉硬化的患者,应不用或慎用超选择性动脉栓塞术。 相似文献
104.
急性心肌梗死再灌注期间的心电变化特征 总被引:1,自引:1,他引:0
目的 探讨急性心肌梗死 (AMI)再灌注期间的心电变化特征。方法 46例经急诊冠状动脉造影明确为成功再灌注的AMI,其中 2 4例接受溶栓治疗和 2 2例接受直接经皮腔内冠状动脉成形 ,于发病的 6小时内以动态心电图技术持续2 4小时监测心电图变化 ,并与 1 5例无灌注者进行对比。结果 ①再灌注发生后 ,相应导联ST段迅速下降 ,约 2小时达较低水平 ;同时 ,T波正向振幅进行性降低 ,距再灌注 0~ 2 2 (2 7± 4 5)小时呈现T波倒置并逐渐加深。②再灌注后的 1小时内 ,室性心律失常明显增加 ,6~ 8小时后显著减少。结论 AMI早期再灌注发生后呈现特征性心电变化 ,及时识别这些特征将有助于临床评估再灌注状态和危险度分层 相似文献
105.
D. Douglas Miller Henry G. Stratmann Leslee Shaw Beaver R. Tamesis Mark D. Wittry Liwa T. Younis Bernard R. Chaitman 《Journal of nuclear cardiology》1994,1(1):72-82
Background
A total of 137 consecutive patients with recent uncomplicated myocardial infarction (n=31) or unstable angina (n=106) were studied to determine the relative prognostic value of predischarge clinical risk stratification and intravenous dipyridamole stress sestamibi (MIBI) myocardial tomography in patients unable to exercise maximally after an acute ischemic coronary event. 相似文献106.
107.
108.
Summary
Forty-one patients demonstrating clinical symptoms for cerebral infarction were investigated by magnetic resonance imaging
with diffusion-weighted echo-planar imaging (DWI) and T2-weighted imaging (T2WI). In 8 patients only DWI showed the cerebral
lesions clearly. One patient with positive DWI and T2WI suffered from HSV encephalitis. DWI is superior to T2WI in assessment
of small cortical infarcts and cerebral infarction in patients with preexisting vascular lesions. DWI is not specific, so
other causes like cerebral hematoma and encephalitis have to be considered.
相似文献
109.
肌钙蛋白T在诊断急性心肌梗死中的应用 总被引:2,自引:0,他引:2
采用肌钙蛋白T半定量试纸条检测急性心肌梗死16例,心绞痛13例,以20例健康体检者为对照组。结果显示,AMI组阳性反应15例,心绞组仅1例阳性,对照组均为阴性,结果提示,TnT半定量试纸条检测法在AMI诊断中,敏感性和特异性较高,方法简便方便,尤其适用于急诊室,内科监护病房及基层医院使用。 相似文献
110.
Adrià Arboix Lluis García-Eroles Emili Comes Montserrat Oliveres Miquel Balcells Gustavo Pacheco Cecilia Targa 《European journal of neurology》2003,10(4):429-435
We assessed predictors of spontaneous early neurological recovery after acute ischemic stroke by means of multivariate analysis in a cohort of 1,473 consecutive patients treated at one academic center. At hospital discharge, spontaneous neurological improvement or good outcome was defined as grades 0-2 of the Rankin scale, and poor outcome (no improvement or in-hospital death) as grades 3-5. Spontaneous recovery of neurological deficit at the time of discharge from the hospital was observed in 16% of patients with cerebral infarction (n = 238). Dysarthria-clumsy hand syndrome improved in 44% of patients and was the only variable significantly associated with in-hospital functional recovery in three logistic regression models that in addition to lacunar syndromes, included demographic variables, cardiovascular risk factors, and clinical variables [odds ratio (OR) 2.56], neuroimaging findings (OR 2.48), and outcome data (OR 2.39), respectively. Clinical factors related to severity of infarction available at stroke onset have a predominant influence upon in-hospital outcome and may help clinicians to assess prognosis more accurately. Our work gives a contribution into prognostic factors after acute ischemic stroke. With regard to patterns of stroke, dysarthria-clumsy hand syndrome was a significant predictor of spontaneous in-hospital recovery in ischemic stroke patients. 相似文献