青年急性进展型脑梗死患者进展与治疗前后血清高敏C-反应蛋白和D-二聚体水平的变化及临床意义

目的 探讨青年急性进展型脑梗死患者进展与治疗前后血中D-二聚体(D-D)、高敏 C-反应蛋白(hs-CRP)含量变化与脑梗死发展的关系.方法 选择急性脑梗死 A 组(未发生进展)30例、B组(发生进展)20例和正常对照组50例分别测定其hs-CRP、D-D进展及治疗前后含量并加以分析.结果 青年急性进展型脑梗死组D-D和 hs-CRP含量明显高于对照组和非进展型脑梗死组(P＜0.01); D-D和 hs-CRP含量经统计学处理呈正相关(r=0.64,P＜0.01);而且脑梗死在治疗和有效控制后D-D和 hs-CRP含量明显下降(P＜0.01).结论 血中D-D和 hs-CRP与青年急性进展型脑梗死的发生、发展及预后有密切关系,可作为评估的指标之一,对于脑梗死的进展预测和干预处理有一定临床价值. Abstract： Objective To study the correlation between the levels of D-Dimer(D-D),high sensitive C-reactive protein(hs-CRP) in serum of the young patients with acute progressive cerebral infarction before and after the proceeding and treatment. Methods Levels of hs-CRP, D-D were detected respectively in serum of the 20 young patients with acute progressive cerebral infarction, the 30 young patients with acute non- progressive cerebral infarction and 50 healthy people sampled as control group and correlation were analysed before and after the proceeding and treatment. Results Compared with healthy person and young patients with non-progressive cerebral infarction, the levels of D-D and hs-CRP in serum of young patients with progressive cerebral infarction were significantly higher (P＜0.01). The level of D-D was positively correlated with that of hs-CRP,The levels of D-D and hs-CRP in serum of patients with cerebral infarction were significantly lower than before after having been treated and intervented effectively. Conclusions The levels of D-D,hs-CRP are closely related to the existence and development of the young patients with cerebral infarction. The levels of D-D and hs-CRP can be used as one of the assessment indexes of the young patient's conditions and is helpful for clinic forecast and intervention of acute progressive cerebral infarction.     

以运动障碍起病的癌性周围神经病7例临床分析

目的 对以运动障碍起病的癌性周围神经病患者的临床特点进行分析,提高早期诊断率.方法 收集我院2005年至今临床诊断的以运动障碍起病的癌性周围神经病患者,对其临床特点、辅助检查结果进行分析.结果 共收集病例7例,均以运动障碍就诊,平均发病年龄(59±17)岁,脑脊液检查显示蛋白正常或轻度增高,肌电图检查显示神经源性损害.结论 对中老年以运动障碍起病的亚急性或慢性周围神经病,用常见周围神经病原因不能解释时应进行全面检查以发现潜在的肿瘤. Abstract： Objective To improve the early diagnostic accuracy by clinical study of paraneoplastie peripheral neuropathy with onset of weakness. Methods The patients with paraneoplastic peripheral neuropathy with onset of weakness were included since 2005 in our hospital,and their clinical features and examinations were analyzed. Results Seven cases with predominant weakness of limbs were included,with mean age(59±17)years.CSF examination showed normal or slightly increased protein level.Electrophysiological examination implied a primary damage restricted to the peripheral nerve. Conclusions The onset of middle age with movement disorders and sub-acute or chronic peripheral neuropathy,peripheral neuropathy with a common cause can not be explained should be overhauled to identify potential tumor.     

线粒体靶向递药系统的研究进展

线粒体控制着细胞凋亡的激活系统。肿瘤细胞的多种特征,包括无限的增殖能力、对抑制生长信号的不敏感、受损的细胞凋亡机制等都与线粒体的机能丧失有关。研究发现,肥胖、糖尿病等疾病的发生发展过程中均存在线粒体功能的紊乱,并且多种疾病的发生与线粒体DNA的变异有关。因此,为了防止或修复线粒体功能的损伤,寻找靶向线粒体的递药系统越来越重要。针对线粒体的结构特征,该文综述了国内外不同线粒体靶向策略的研究进展。     

脑卒中合并真性红细胞增多症19例临床分析

Objective To explore the clinical features and treatment of stroke complicating polycythemia vera(PV). Methods Clinical data of 19 cases of stroke complicating PV were analysed retrospectively.Results ①Among all the cases, cerebral infarction complicating PV were 14 cases (14/19,73.4%), among the 14 cases, 12 cases(12/14,85.7%) of multiple cerebral infarction, 2 cases(2/15,13.3%) of transientischemis attack ;2 cases (2/19,10. 5 %) of cerebral hemorrhage, 1 case (1/19,5.3 %) of subarachnoid hemorrhage (SAH). The patients's clinical manifestation, physical sign, hemogram, marrow characteristic were consistentwith that of PV diagnosis criteria. ② Imageology check show that small infarction focus were common (13/19,68.4%). Lobe of brain, basal ganglia, capsula intema were common place of cerebral infarction. The density of hemorrhagic focus was asymmetrical, there was obvious edema around the hem orrhagic focus. ③Applied vein blood-letting and small dose chemotherapy, 7 cases were covery, 11 cases were obviously inproved, 1 case of stroke was invalid. Conclusion The cerebral infarction is common in stroke complicating PV. Among all the stroke complicating PV cases, multiple cerebral infarction are the most common, cerebral hemorrhage and subarachnoid hemorrhage are few, vein blood-letting and small dose chemotherapy has a good curative effect for the patients.     

脑卒中合并真性红细胞增多症19例临床分析

Objective To explore the clinical features and treatment of stroke complicating polycythemia vera(PV). Methods Clinical data of 19 cases of stroke complicating PV were analysed retrospectively.Results ①Among all the cases, cerebral infarction complicating PV were 14 cases (14/19,73.4%), among the 14 cases, 12 cases(12/14,85.7%) of multiple cerebral infarction, 2 cases(2/15,13.3%) of transientischemis attack ;2 cases (2/19,10. 5 %) of cerebral hemorrhage, 1 case (1/19,5.3 %) of subarachnoid hemorrhage (SAH). The patients's clinical manifestation, physical sign, hemogram, marrow characteristic were consistentwith that of PV diagnosis criteria. ② Imageology check show that small infarction focus were common (13/19,68.4%). Lobe of brain, basal ganglia, capsula intema were common place of cerebral infarction. The density of hemorrhagic focus was asymmetrical, there was obvious edema around the hem orrhagic focus. ③Applied vein blood-letting and small dose chemotherapy, 7 cases were covery, 11 cases were obviously inproved, 1 case of stroke was invalid. Conclusion The cerebral infarction is common in stroke complicating PV. Among all the stroke complicating PV cases, multiple cerebral infarction are the most common, cerebral hemorrhage and subarachnoid hemorrhage are few, vein blood-letting and small dose chemotherapy has a good curative effect for the patients.     

脑卒中合并真性红细胞增多症19例临床分析

目的探讨脑卒中合并真性红细胞增多症（PV）的临床特点及治疗方法。方法对19例脑卒中合并PV患者的临床资料进行回顾性分析。结果①本组PV并发脑梗死14例（14／19,73．4％）,其中多发性脑梗死12例（12／14,85．7％）;短暂性脑缺血发作2例（2／15,13．3％）;脑出血2例（2／19,10．5％）;蛛网膜下腔出血（SAH）1例（1／19,5．3％）。均符合PV的临床表现和体征及血象、骨髓象的改变;②影像学检查显示脑梗死以多发小梗死灶多见（13／19,68．4％）,常见于脑叶、基底节、内囊;脑出血的出血灶内密度不均匀,周边水肿明显;③本组采用静脉放血加小剂量化疗治疗,脑卒中痊愈7例,显著进步11例,无效1例。结论脑卒中合并PV以脑梗死多见,其中又以多发性梗死为主,并发脑出血和SAH较少,采用静脉放血加小剂量化疗治疗的效果较好。     

自发性食管破裂6天手术治愈1例

患者男,45岁,汉族.入院前5天,晚餐后2小时突发右胸刺痛,伴有胸闷、气短,但无暴饮暴食、酗酒和恶心、呕吐,急诊入当地县医院.入院第二天拍胸部X光片显示:右侧胸腔大量积液、少量积气.行胸腔闭式引流术,两天内共引流出黄色混浊液体5000ml.因病情渐加重,住院后第3天在当地医院行开胸探查术,术中未明确诊断,仅行胸腔闭式引流.术后第2天进流食部分经胸管引出,为进一步治疗转来我院.     

低分子肝素钙联合氯吡格雷治疗进展性脑梗死疗效观察

120例进展性脑梗死患者随机分为两组,对照组给予氯吡格雷75 mg,1次/d;治疗组给予低分子肝素钙0.6 ml皮下注射,每12 h 1次,同时给予氯吡格雷,用法同对照组.疗程均为10d.结果 发现,治疗组总有效率(98.3%)明显高于对照组(81.7%),P<0.05;治疗组治疗后神经功能缺损程度评分较治疗前及对照组治疗后明显减少(P<0.05).提示低分子肝素钙联合氯吡格雷治疗进展性脑梗死疗效确切,使用安全.     

脑桥中央和脑桥外髓鞘溶解症的临床分析和影像学特点

目的 探讨脑桥中央和脑桥外髓鞘溶解症的临床及神经影像学特点.方法 分析5例脑桥中央髓鞘溶解症和2例脑桥外髓鞘溶解症患者的临床特点,包括基础疾病、起病前诱因、临床表现、头颅MRI特点、治疗及预后情况.结果 7例患者均有慢性形成低钠血症后被快速纠正的病史,以意识改变、构音和吞咽困难、四肢瘫痪等为临床表现.5例脑桥中央髓鞘溶解症的MRI表现为脑桥部位对称性的T1加权低信号灶、T2加权高信号灶,均呈典型"蝙蝠翅"样的改变;2例脑桥外髓鞘溶解症者分别在丘脑、基底节区域有对称性的T1加权低信号、T2加权高信号病灶.5例患者基本痊愈.结论 髓鞘溶解症的发病与低钠血症及过快补钠有关,缓慢纠正慢性形成的低钠血症是预防的关键. Abstract： Objective To investigate the clinical features and neuroimaging features of myelinolysis in central pontine and extrapontine. Methods The clinical features of 5 patients with central pontine myelinolysis and 2 cases with extrapontine myelinolysis were analyzed,including the inducing factors,clinicalmanifestations,cranial MRI,treatrnent and prognosis. Results All the seven patients had the history of rapidity of correcting chronic hyponatraemia, The common clinicalrranifestations included change of consciousness, dysphasia,dysphagia tetraplegia etc. The MRI of 5 cases of central pontine myelinolysis showed pontine parts of the symmetry T1-weighed low signal lesions,T2-weighed high signal lesions,all showed typical change like "Bat Wing". Two cases of extrapontine myelinolysis respectively in the hypothalamus、basical ganglia region of summetry T1-weighed low signal,T2-weighed high signal lesions.Five examples were basically cured. Conclusions The incidence of myelinolysis is related to hyponatremia and rapidity of correcting chronic hyponatraemia,and avoiding the rapidity of correcting chronic hyponatraemia is the key point for preventing its happening.     

膀胱全切术后导尿管不能拔出1例

患者，男性，43岁，因无痛肉眼血尿1天入院。查彩超：右肾积水：右输悄管扩张；右输尿管下段占位不除外；膀胱内占位不除外。膀胱镜检查：膀胱三角区偏右侧一直径约4cm菜花样肿瘤，肿瘤无蒂，表面渗血，掩盖右侧输尿管开口。核磁共振结果：右侧输尿管下段癌累及膀胱突入膀胱腔内，膀胱癌累及右侧输尿管下段，右肾及输尿管积水。病理报告：膀胱三角区移行细胞癌Ⅱ级；膀胱癌累及右侧输尿管可能性大。根据检查结果，诊断：膀胱移行细胞癌Ⅱ级，行膀胱癌根治，正位回肠代膀胱术。将膀胱、前列腺及精囊腺切除，保留前列腺尖部被膜。按Studer回肠膀胱术：用远段回肠40cm折叠成U形，