颅内动脉瘤破裂出血患者血清PRL、GH的动态变化

目的　测定颅内动脉瘤破裂出血患者血清泌乳素 (PRL)、生长激素 (GH)的含量变化 ,探讨其与病情演变的关系。方法　对 3 5例颅内动脉瘤破裂出血患者发病后 1～ 3d ,发病后 7～ 9d ,发病后 13～ 15d血清PRL、GH进行动态观察 ,用TCD检测大脑中动脉血流速度 (VMCA)。结果　颅内动脉瘤破裂出血患者血清PRL、GH发病后 1～ 3d、发病后 7～ 9d各均值明显高于对照组 (P <0 .0 5 ) ,尤以发病后 7～ 9d变化最明显 ;术前、术后有脑血管痉挛组和非脑血管痉挛组也有明显差异 (P <0 .0 5 )。结论　血清GH、PRL含量与蛛网膜下腔出血 (SAH)的病情演变、脑血管痉挛 (CVS)有关     

Tetrasomy 9p: Tissue-limited idic(9p) in a child with mild manifestations and a normal CVS result. Report and review

Supernumerary isochromosomes resulting in autosomal tetrasomy are rare and have been described only for 12p, 18p, and 9p. Nineteen previous cases of tetrasomy 9p have been reported, and in 6 cases, tissue-specific mosaicism was implied with the i(9p) cell line present exclusively or predominantly in blood. We report on an infant who had apparently normal chromosomes (46,XY) on CVS. He was referred for genetic evaluation because of mild developmental delay and minor anomalies. In 75% of blood cells he had an extra isodicentric 9p chromosome (pter→q12→pter). The interpretation of tetrasomy 9p was confirmed by elevated GALT activity. No tetrasomy 9p cells were seen in 100 skin fibroblasts. This case demonstrates the tissue specific mosaicism in tetrasomy 9p which rendered the anomaly undetectable by CVS. It also demonstrates the mild end of the clinical spectrum associated with tetrasomy 9p. © 1993 Wiley-Liss, Inc.     

X-linked lymphoproliferative disease: prenatal detection of an unaffected histocompatible male

Chorionic Villous Biopsy (CVS) for diagnosis of XLP was undertaken at 10 weeks gestation in an obligate carrier. The fetus was found to be male by cytogenetic analysis. XLP (Xq25-q26) is closely linked to the RFLP markers DXS10, DXS37 and DXS42, but only DXS10 (distal to XLP) was informative for prenatal diagnosis in this family. RFLP analysis using this marker gave a 7% risk that the fetus was affected, based on the known recombination frequency between DXS10 and XLP. Further investigation was then undertaken to obtain a rapid and more accurate diagnosis using the three highly polymorphic PCR based markers. These were the AC repeat markers DXS424 (XL5A) and DXS425 (XL90A3) and the tetramer repeat marker within HPRT. DX425 is approximately 10 cM proximal to DXS10 and HPRT but is not known with certainty to map proximal or distal to XLP. DXS424 is proximal to DXS10 and HPRT and was inferred to be proximal to XLP on the basis of map distance from HPRT estimated by linkage analysis of data from CEPH pedigrees. This was confirmed by a recombinant in the XLP family between DXS424 and DXS425, placing DXS424 proximal to XLP. Diagnosis by linkage using DXS424 and DXS425, at least one of which is proximal to XLP, and distal markers DXS10 and HPRT, increased the accuracy of diagnosis using flanking marker analysis to greater than 99% that the fetus was unaffected. HLA DR typing of the CVS showed that the fetus was DR identical to a male sibling with XLP. HLA compatibility was confirmed at delivery by full HLA typing and MLC.(ABSTRACT TRUNCATED AT 250 WORDS)     

奥力保克防治蛛网膜下腔出血后脑血管痉挛的临床观察

目的探讨奥力保克对蛛网膜下腔出血（SAH）后脑血管痉挛（CVS）的治疗作用。方法将42例蛛网膜下腔出血住院患者随机分成两组,奥力保克组（20例）和对照组（22例）。两组均于发病48 h内接受治疗,对照组用脱水、止血等常规疗法;奥力保克组在常规疗法基础上加用奥力保克5.0 mg,3次/d,口服,共3-4周。结果1个月内,奥力保克组的CVS发生率、死亡率明显低于对照组（P〈0.05）,再出血发生率两组比较无明显差异（P〉0.05）。结论奥力保克防治SAH后CVS疗效确切,并能促进神经功能的尽快恢复,且无增加再出血的危险。     

动脉瘤性蛛网膜下腔出血脑脊液中NO含量与TCD对症状性脑血管痉挛的诊断价值

目的　评价动脉瘤性SAH后脑脊液 (CSF)中一氧化氮 (NO)含量变化和TCD对症状性脑血管痉挛的诊断价值。方法　MRA检查并经脑血管造影加以证实的动脉瘤性SAH患者 56例 ,所有患者应用 2MHz探头经颞窗探测MCA的血流速度 ,将血管痉挛程度分为轻度痉挛 (12 0～ 14 0cm s)、中度痉挛(14 0～ 2 0 0cm s)、重度痉挛 (>2 0 0cm s) ,并通过高效液相色谱法测定其住院当天、3d、7d、14d脑脊液中NO的代谢产物亚硝酸盐 (NO-2 )和硝酸盐 (NO-3)含量。分析其含量变化与脑血管痉挛的关系。同期收治的意外发现的未破裂的动脉瘤患者 14例作为对照。结果　NO含量测定表明在SAH的第 7天明显增高 (P <0 .0 1)。部分出现症状性痉挛的患者 ,TCD检查MCA血流虽无明显增快 (P >0 .0 5) ,但NO含量却明显增高 (P <0 .0 1)。结论　NO含量变化与脑血管痉挛症状的发生、发展相一致 ,是监测脑血管痉挛的发生、发展的可靠指标 ,与TCD联合应用对症状性脑血管痉挛的诊断意义更大。     

蛛网膜下腔出血并发脑血管痉挛的防治

目的：探讨蛛网膜下腔出血（SAH）并发脑血管痉挛（CVS）的防治方法。方法：对45例SAH并发CVS的病例进行临床分析。给予常规治疗,钙离子拮抗剂止血脱水等,同时采用持续腰穿外引流对其防治。结果：45例患者均有良好效果。结论：对SAH并发CVS要采取综合治疗,以降低死亡率。     

NF-κB、ICAM-1在实验性SAH后基底动脉壁上的表达变化

目的 探讨免疫炎症反应在蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后脑血管痉挛(cerebral vasospasm,CVS)发病机制中的作用.方法 应用新西兰家兔经枕大池二次注血制成SAH动物模型.在各相应时间点运用数字减影血管造影(digital subtraction angiography,DSA)、HE染色和免疫组化等方法 ,观察兔基底动脉管壁形态以及核转录因子kappaB(nuclear factor-kappaB,NF-κB)、细胞间粘附因子-1(intercellular adhesion molecule,ICAM-1)在管壁上表达的动态变化.结果 在SAH后第3天基底动脉血管腔已开始狭窄,第7天达到高峰,之后狭窄渐减轻,14d时基本接近正常.SAH后3d NF-κB表达增加,5～7d表达持续在一个较高的水平,随后开始下降;ICAM-1表达变化趋势与NF-κB相似,但在表达高峰时相上稍迟于后者.结论 NF-κB、ICAM-1在血管壁上的表达变化与CVS的发生时相密切相关,提示由其参与介导的血管壁炎症反应可能在CVS的发生和发展过程中起了重要的作用.

Abstract：

Objective To evaluate the possible effect of inflammatory reaction in the pathogenesis of CVS after SAH.Methods The "double-hemorrhage" model of vasospasm Was performed by two injections of autologous aterial blood into the cisterna magna of Newzealand rabbits.We oberserved morphological changes and the rule of expression and activity of NF-κB and ICAM-1 in basilar artery(BA)walls by DSA,light microscope and immunohistochemistry.Results The "double-hemorrhage"model of vasospasm was succeeded to be made.The BA vasospasm Was obvious on 3d after autologous aterial blood wa8 first injected into the cisterna magna,and peaked on 7d,and then relieved.On 14d,there was almost no abnormality in the arterial wall.Upregulation of NF-κB expression started on 3d,became stronger on 5d to 7d,and then decreased.The upregulation of ICAM-1 expression in the BA walls Was similar with NF-κB,but was a bit later to tively correlated with the vasospasm.Inflammatory reaction in arterial walls mediated by NF-8κB may play a key mle in the process of CVS after SAH.