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61.
颅内破裂动脉瘤手术时机的选择 总被引:5,自引:0,他引:5
目的探讨颅内破裂动脉瘤不同手术时机与临床预后的关系.方法回顾性分析121例前循环动脉瘤,其中延期手术夹闭97例,早期24例,采用不同的统计方法分析不同手术时机对预后的影响.结果早期手术夹闭24例中除1例V级患者于术后3d死亡和1例Ⅲ级患者于术后2月因颅内感染死亡外,余22例均获得优或良疗效;平均住院18.2d,无1例再出血,延期手术的97例平均住院时间是前者的2倍,14例发生再出血.结论早期显微外科治疗颅内破裂动脉瘤,尤其对Hunt&HessI~Ⅲ级患者,有利于缩短住院时间,降低保守治疗期间再出血的危险性,而对于Ⅳ~V级脑肿胀患者,早期手术的困难程度相应增加. 相似文献
62.
Konrd S. Konrdsson Lars Holme Nielsen Bjrn I. R. Carlborg Britt Borgkvist 《The Laryngoscope》2000,110(2):264-264
Objectives: To elucidate the pressure transfer between intracranial and labyrinthine fluids in patients with well‐defined unilateral Meniere's disease. Study Design: Eleven patients previously exposed to hypobaric pressure agreed to be investigated further with the tympanic membrane displacement (TMD) technique. TMD was used to indirectly analyze perilymph pressure changes as the result of changes in body position. Methods: Repeated measurements for both the diseased and the healthy ears were made with the patients supine and then in a sitting position. The TMD parameters for the maximum inward displacement, the Vi, and the mean volume displacement, the Vm, were calculated and compared. Results: The paired comparison showed statistically significant larger Vi values for both ears in the supine position. A similar tendency was observed for the Vm value. This difference of the Vi was significantly larger for the diseased ear compared with the currently healthy ear. The results were compared to the audiometric and electrocochleographic results previously obtained on the same patients when they were subjected to hypobaric pressure. Patients who experienced the largest differences in hearing level thresholds in the lower frequencies also showed the greatest differences in TMD values as the result of postural changes. Conclusions: Despite the limited number, the statistically supported results suggest a relation between the efficiency of the routes of pressure transfer and the observed effect of hypobaric exposure. The results also indicate that for the patients tested, the routes of communication are more effective in the diseased ear than in the healthy ear—a condition that may relate to the pathogeneses of Meniere's disease. 相似文献
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66.
Moyamoya病发生、发展及转归实验研究 总被引:4,自引:2,他引:2
目的研究Moyamoya病的发生、发展及转归过程。方法建立Moyamoya病的实验动物模型。结果颈动脉逐渐狭窄或闭塞的过程是内弹力纤维变性、断裂后,中膜平滑肌细胞沿断裂处向内膜游走、深入增生的过程。早期,因侧支循环血管建立不完善,脑组织缺血、缺氧出现多灶性脑软化坏死。随时间延长,脑内大量小动脉及毛细血管代偿性增生,其血管壁腔大壁薄,形成异网。同时5个粟粒状或囊状动脉瘤.蛛网膜下腔、脑室内及脑实质内有小的出血灶。结论Moyamoya病临床表现早期以缺血性脑血管病为主,后期以出血性脑血管病为主,是由Moyamoya病理的演变过程所决定的,是疾病的发展规律。 相似文献
67.
68.
苏成林 《菏泽医学专科学校学报》1999,11(2):12-13
目的探讨原发性脑室出血的临床表现、脑CT征象及其与治疗的关系;方法回顾性分析28例经CT证实原发性脑室出血病人的临床表现及CT征象;结果多有头痛、呕吐等脑膜刺激征表现,无脑局灶受损体征,脑CT均示原发脑室出血;结论原发性脑室出血的诊断依靠脑CT,Ⅰ型脑室出血宜行侧脑室外引流术,预后较差,Ⅱ、Ⅵ型可行腰穿脑脊液置换术.预后较好。 相似文献
69.
Bilateral macular hemorrhage after laser in situ keratomileusis 总被引:2,自引:0,他引:2
José Domingo Luna Victor Eduardo Reviglio Claudio Patricio Juárez 《Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie》1999,237(7):611-613
· Background: This is the first report of a bilateral submacular hemorrhage after LASIK surgery in an extreme myo pic patient.
A 31-year-old man underwent bilateral surgery for correction of –16.75+0.75×70° and –16.50+0.50×55°. · Methods: Case report. ·
Results: One day after surgery the patient’s uncorrected visual acuity was in the 20/50 range OU and by 17 days after surgery
his visual acuity had declined to 20/200 range. Fundus examination showed multifocal subretinal macular and posterior pole
hemorrhages. Fluorescein angiography showed some macular lesions compatible with lacquer cracks. · Conclusions: Preoperative
and postoperative fundus examination is important to detect this phenomenon. Patients should be informed of this rare complication.
Received: 2 June 1998 Revised version received: 16 November 1998 Accepted: 17 November 1998 相似文献
70.
B. Dahl B. Bergholt G. E. Cold J. Astrup B. Mosdal K. Jensen J. O. Kjærsgaard 《Acta neurochirurgica》1996,138(3):265-273
Summary The purpose of this study was to compare the effect of hyper-ventilation and indomethacin on cerebral circulation, metabolism and pressures in patients with acute severe head injury in order to see if indomethacin may act supplementary to hyperventilation. Fourteen severely head injured patients entered the study. Intracranial pressure (ICP), mean arterial blood pressure (MABP) and cerebral perfusion pressure (CPP) were monitored continuously. Within the first four days after the trauma the CO2 and indomethacin vasoreactivities were studied by measurements of cerebral blood flow (CBF) (Cerebrograph 10a, intravenous133Xe technique) and arterio-venous difference of oxygen (AVdO2). Ischaemia was evaluated from changes in CBF, saturation of oxygen in the jugular bulb (SvjO2), lactate and lactate/oxygen index (LOI). Data are presented as medians and ranges, results are significant unless otherwise indicated.
Before intervention ICP was well controlled (14.8 (9–24) mmHg) and basic CBF level was 39.1 (21.6–75.0) ml/100 g/min). The arterio-venous oxygen differences were generally decreased (AVdO2 = 4.3 (1.8–8.1) ml/100 ml) indicating moderate luxury perfusion. Levels of CMRO2 were decreased (1.54 (0.7–3.2) ml/100 g/min) as well.Duringhyperventilation (APaCO2 = 0.88 (0.62–1.55) kPa) CBF decreased with 11.8 (–33.4–29.7) %/kPa and ICP decreased with 3.8 (0–10) mmHg. AVdO2 increased 34.0 (4.0–139.2) %/kPa, MABP was unchanged, CMRO2 and CPP increased (CPP = 3.9 (–10–20) mmHg). AVD (lactate) and LOI were unchanged. No correlations between CBF responses to hypocapnia and outcomes were observed.An i.v. bolus dose ofindomethacin (30 mg) decreased CBF 14.7 (–16.7–57.4) % and ICP decreased 4.3 (–1–17) mmHg. AVdO2 increased 27.8 (–40.0–66.7)%, MABP (MABP = 4.9 (–2–21) mmHg) and CPP (CPP = 8.7 (3–29) mmHg) increased while CMRO2 was unchanged. No changes in AVd (lactate) and LOI indicating cerebral ischaemia were found.Compared to hyperventilation (changes per 1 kPa, at PaCO2 level = 4.05 kPa) the changes in MABP, CPP and CBF were significantly greater after indomethacin, while the changes in AVdO2, ICP, SvjO2, and LOI were of the same order of magnitude.Nocorrelation between relative reactivities to indomethacin and CO2, evaluated from changes in CBF and AVdO2, or between the decrease in ICP after the two procedures were found. Thus, some patients reacted to indomethacin but not to hyperventilation, and vice versa.These results suggest that indomethacin and hyperventilation might act independently, or in a complementary fashion in the treatment of patients with severe head injury. 相似文献