新生隐球菌性脑膜炎22例临床及预后分析CSCD

目的分析新生隐球菌性脑膜炎的临床特点、治疗及预后。方法回顾性分析22例患者的临床资料。结果合并基础疾病者17例(77.27%),误诊12例(54.55%)。隐脑以颅高压、脑脊液低糖高蛋白为主。22例患者均经病原学确诊。先用两性霉素B(AmB)或脂质体+5-氟胞嘧啶(5-FC)治疗者18例,待患者症状好转、脑脊液真菌转阴后,改用口服或静滴氟康唑(FCZ)巩固维持治疗,1例脑室扩大行侧脑室外引流术,2例因颅高压行Ommaya囊植入治疗。随访观察治愈6例,好转8例,死亡5例。结论 AmB+5-FC+FCZ联合治疗效果好。     

新生隐球菌性脑膜炎22例临床及预后分析

目的分析新生隐球菌性脑膜炎的临床特点、治疗及预后。方法回顾性分析22例患者的临床资料。结果合并基础疾病者17例(77.27%),误诊12例(54.55%)。隐脑以颅高压、脑脊液低糖高蛋白为主。22例患者均经病原学确诊。先用两性霉素B(AmB)或脂质体+5-氟胞嘧啶(5-FC)治疗者18例,待患者症状好转、脑脊液真菌转阴后,改用口服或静滴氟康唑(FCZ)巩固维持治疗,1例脑室扩大行侧脑室外引流术,2例因颅高压行Ommaya囊植入治疗。随访观察治愈6例,好转8例,死亡5例。结论 AmB+5-FC+FCZ联合治疗效果好。     

套式颅椎研制成功

第二军医大学属附长征医院与上海手术器械九厂共同研制的套式颅椎获得成功,7月20日在上海通过鉴定。套式颅椎由三部分组成,即带有厘米刻度的颅椎、套管和固定螺旋。在局麻下,锥刺头皮和颅骨,连同套管穿透颅骨和硬脑膜,拔出颅椎,保留套管,随即将予先准备的脑室引流管按脑室方向,顺套管放入脑室内,待脑脊液流出后,拔出套管,再用缝线固定引流管,这样便可在不开颅的情况下进行脑室造影或引流手术。     

脑池注射促甲状腺素释放激素可诱发大鼠胃损伤

电刺激或损毁脑的某些部位可引起胃溃疡和/或影响应激引起的胃损伤。脑内的调节肽与胃肠道损伤以及抗损伤过程也有密切关系。据报道,脑室注射促甲状腺素释放激素(TRH)(3～10μg)可加重由消炎痛、5-羟色胺和阿斯匹林等诱发的大鼠胃损伤,脑池或脑室注射TRH(10～30μg)亦加重冷冻加束缚产生的胃损伤。Goto 和Tache 最近报道,不加束缚的大鼠给禁食24小时在室温下脑池注射TRH,可在4小时后诱发胃损伤。TRH 在0.01～1μg 的剂量范围内呈量效关系。另外,一种稳定的TRH 类似物,RX 77368[焦性     

耐药性结核性脑膜炎研究进展

结核性脑膜炎是由结核杆菌引起的中枢感染性疾病,是肺外结核病中最严重的一种,其多侵袭脑膜,有时可累及脑实质、脊髓,有很高的致死率。结核病在发展中国家中的感染趋势尤为突出。我国为人口大国,抗结核治疗和预防的形势异常严峻。随着抗结核药物的广泛使用,耐药性结核性脑膜炎患者数量增加,严重影响了结核性脑膜炎的预后。在耐药性结核性脑膜炎患者的治疗中,早期诊断、经验性治疗、调整治疗方案对患者的预后尤为重要。本文对耐药性结核性脑膜炎的分布、临床诊断、基因检测、治疗方案及预后进行系统性的总结。     

腰池引流脑脊液治疗隐球菌性脑膜炎的临床价值探讨

隐球菌性脑膜炎是中枢神经系统真菌感染引起的一种慢性非化脓性脑膜炎。该病在我国仍以散发为主,AIDS患者隐球菌性脑膜炎的发病率较高,近年来发病呈明显上升的趋势;其治疗主要依靠有效的抗真菌药物,国内外文献报道其病死率仍高达25％～60％;颅内高压是本病致死的主要原因。本文报道我科1997年1月～2006年1月收治的24例隐球菌性脑膜炎患者,对其中14例患者早期进行了腰池脑脊液（CSF）持续引流,能迅速改善症状,使患者安全度过颅内高压危险期。与对照组10例对比观察,报告如下。     

30例隐球菌脑膜炎治疗引起的肝损及防治

新型隐球菌脑膜炎（隐脑）是由新型隐球菌感染引起的脑膜炎,是中枢神经系统最常见的真菌感染,其病情重、病死率高。目前国内外学者一致推荐两性霉素B（AMB）、5-氟胞嘧啶（5FC）、氟康唑（FCZ）作为治疗隐脑的主要药物。但因这些药物引起不良反应较显著：有即刻反应、外周血象白血球减少、低钾血症,有肝损,其中肝功能损害发生率高,故了解AMB、5FC、FCZ的不良反应及其防治显得尤为重要。     

去甲肾上腺素、多巴胺及γ-氨基丁酸与高压氧惊厥发作的关系

大鼠经高压氧暴露后,脑内去甲肾上腺素含量下降,脑室内预先注射6-羟基多巴胺,高压氧惊厥发作的潜伏期明显缩短。a_2受体阻断剂育亨宾加强了高压氧惊厥的发作,β受体阻断剂心得安有保护作用。上述结果表明中枢肾上腺素递质抗高压氧惊厥的作用很可能是通过a_2受体实现的。虽然加压后脑内多巴胺含量下降,但脑室注射多巴胺受体阻断剂氟哌丁醇不能改变高压氧惊厥发作的潜伏期,因此尚不能肯定脑内多巴胺系统与高压氧惊厥有直接的联系。脑室注射Υ-氨基丁酸对高压氧惊厥的影响不显著,然而脑室注射Υ-氨基丁酸15分钟后测定其脑内含量与对照组相比无差异,故还不能排除Υ-氨基丁酸与高压氧惊厥有关。     

成人结核性脑膜炎的护理体会

作者介绍了成人结核性脑膜炎（简称结脑）的护理体会。认为：护士除了要精确地掌握结脑的临床分期与护理要点外,还要重视抗结脑药物治疗的护理,使患者都通过治疗和护理获得早日康复。     

结核性脑膜炎的诊断和治疗

结核性脑膜炎(TBM)是一种严重的肺外结核性,约占全部结核病的1%。TBM的死亡率和致残率高,至今仍是发展中国家最严重的疾病之一。儿童患者及合并HIV感染的结核性脑膜炎患者死亡率明显增高。结核性脑膜炎的具体发病机制仍不清楚,细菌和宿主的遗传因素在结脑的发病机制中发挥了至关重要的作用。尽管现代医学技术的进展,TBM的早期诊断仍存在困难。TBM的诊断依赖于临床表现、实验室检查以及影像学检查,脑脊液细菌涂片或培养找到结核分枝杆菌可确诊。早期诊断和治疗尤为关键。临床上往往从经验判断开始抗结核治疗。WHO指南推荐至少六个月的抗结核治疗。然而,部分指南推荐延长抗结核治疗至9-12个月。早期使用类固醇类激素可降低死亡率。抗结核药物耐药性与高死亡率相关。该综述描述了结脑的各个方面,重点强调结核性脑膜炎的早期诊断和治疗。     

A rhesus monkey model for continuous infusion of drugs into cerebrospinal fluid

A new rhesus monkey model with two intraventricular catheter systems was developed to examine the pharmacokinetics and neurotoxicity of chemotherapeutic agents administered by continuous intraventricular infusion. A lateral ventricular catheter system implanted in the lateral ventricle and attached to a subcutaneous access port on the animal's back is used for infusion of drugs into the ventricle. A Pudenz catheter implanted in the fourth ventricle and connected to a subcutaneous Ommaya reservoir permits repetitive CSF sampling in unanesthetized animals. The model was evaluated in five animals for over 12 months for catheter patency, surgical complications, and utility in studying the pharmacokinetics of continuous intraventricular infusion of methotrexate. There were no perioperative complications. Three of the five monkeys maintained both systems successfully. The other two animals developed staphylococcal ventriculitis, one at 7 days as a result of manipulation of the incision by the animal leading to cellulitis around the catheter site and subsequent ventriculitis, the other at 5 months. Both animals were treated successfully with antibiotics and catheter removal. An infusion of 0.05 mg of methotrexate over 24 hours maintained ventricular drug concentrations of 1 mol/L without evidence of neurotoxicity. This new model has applications both for the development of continuous intraventricular infusion as a therapeutic approach for the treatment of meningeal cancers in humans and as a research tool to study the distribution and elimination of drugs from the CSF.     

侧脑室前角穿刺脑脊液外引流治疗 高血压丘脑出血破入脑39 例临床分析

目的:探讨侧脑室前角穿刺脑脊液外引流治疗高血压丘脑出血破入脑室患者的临床效果。方法:回顾性分析2005年1月至2010年12月应用侧脑室前角单侧或双侧穿刺外脑脊液引流治疗39例高血压丘脑出血破入脑室患者的临床效果(ADL分级)。结果:39例高血压丘脑出血破入脑室患者死亡8例,占20.51%,存活者31例,占79.49%。对存活者随访3个月,按日常生活能力(ADL)分级,ADL1～3级23例,占74.19%,ADL4级7例,占22.58%,ADL5级1例,占3.23%。结论:侧脑室前角穿刺脑脊液外引流术治疗高血压丘脑出血破入脑室者是一种操作简单、损伤小、有效的治疗方法。     

Brain Ventricular System and Cerebrospinal Fluid Development and Function: Light at the End of the Tube

The brain ventricular system is a series of connected cavities, filled with cerebrospinal fluid (CSF), that forms within the vertebrate central nervous system (CNS). The hollow neural tube is a hallmark of the chordate CNS, and a closed neural tube is essential for normal development. Development and function of the ventricular system is examined, emphasizing three interdigitating components that form a functional system: ventricle walls, CSF fluid properties, and activity of CSF constituent factors. The cellular lining of the ventricle both can produce and is responsive to CSF. Fluid properties and conserved CSF components contribute to normal CNS development. Anomalies of the CSF/ventricular system serve as diagnostics and may cause CNS disorders, further highlighting their importance. This review focuses on the evolution and development of the brain ventricular system, associated function, and connected pathologies. It is geared as an introduction for scholars with little background in the field.     

An Assay for Permeability of the Zebrafish Embryonic Neuroepithelium

The brain ventricular system is conserved among vertebrates and is composed of a series of interconnected cavities called brain ventricles, which form during the earliest stages of brain development and are maintained throughout the animal''s life. The brain ventricular system is found in vertebrates, and the ventricles develop after neural tube formation, when the central lumen fills with cerebrospinal fluid (CSF) ^1,2. CSF is a protein rich fluid that is essential for normal brain development and function^3-6.In zebrafish, brain ventricle inflation begins at approximately 18 hr post fertilization (hpf), after the neural tube is closed. Multiple processes are associated with brain ventricle formation, including formation of a neuroepithelium, tight junction formation that regulates permeability and CSF production. We showed that the Na,K-ATPase is required for brain ventricle inflation, impacting all these processes ^7,8, while claudin 5a is necessary for tight junction formation ⁹. Additionally, we showed that "relaxation" of the embryonic neuroepithelium, via inhibition of myosin, is associated with brain ventricle inflation.To investigate the regulation of permeability during zebrafish brain ventricle inflation, we developed a ventricular dye retention assay. This method uses brain ventricle injection in a living zebrafish embryo, a technique previously developed in our lab¹⁰, to fluorescently label the cerebrospinal fluid. Embryos are then imaged over time as the fluorescent dye moves through the brain ventricles and neuroepithelium. The distance the dye front moves away from the basal (non-luminal) side of the neuroepithelium over time is quantified and is a measure of neuroepithelial permeability (Figure 1). We observe that dyes 70 kDa and smaller will move through the neuroepithelium and can be detected outside the embryonic zebrafish brain at 24 hpf (Figure 2).This dye retention assay can be used to analyze neuroepithelial permeability in a variety of different genetic backgrounds, at different times during development, and after environmental perturbations. It may also be useful in examining pathological accumulation of CSF. Overall, this technique allows investigators to analyze the role and regulation of permeability during development and disease.     

麻醉大鼠左心室插管新方法

目的：探索在0．014’’经皮冠状动脉（PTCA）指引导丝引导下行大鼠左心室插管的方法。方法：30只Wistar大鼠,先后在PTCA导丝引导经右侧颈外动脉,左侧颈外动脉插管至左心室并行血流动力学测定：结果：30只大鼠成功完成一次左心室重复插管,27只大鼠完成重复插管：结论：PTCA指引导丝引导下左心室插管安全并可重复操作。     

Antineoplastic effects of natural killer cells sorted with flow cytometry on brain tumors

For the purpose of FCM, we have developed a new method of sterile sorting of NK cells by negative selection using FITC-labelled monoclonal antibodies. In this method, over 95% lymphocytes with large granular lymphocytes (NK cells) were obtained by exclusion of Leu-1 and HLA-DR positive cells from human peripheral blood. From the results of cytotoxicity test of NK cells against 4 types of glioma cell lines and 6 kinds of cultured cells from surgical materials, the antineoplastic effect was recognized in 4 out of 6 surgical materials. Administration of NK cells through an Ommaya tube in 2 brain tumor patients caused no side effects. This technique is clinically applicable because 1) NK cells are easy to obtain, 2) NK cells show antineoplastic effect on brain tumors, and 3) the sensitivity can be evaluated in individual patients.     

脑室镜和腹腔镜辅助脑室腹腔分流术治疗老年脑积水的疗效

目的:探讨脑室镜和腹腔镜辅助脑室腹腔分流术治疗老年脑积水的疗效。方法:选择我院90例老年脑积水患者,按随机数字表法平均分为A、B、C 3组各30例,A组患者给予传统脑室腹腔分流术治疗,B组患者给予腹腔镜辅助下脑室腹腔分流术治疗,C组患者给予脑室镜和腹腔镜综合辅助下脑室腹腔分流术治疗,比较3组患者治疗有效率及术后并发症发生率。结果:C组患者治疗有效率为90.0%,明显高于A组63.3%及B组76.7%,比较差异具有统计学意义(均P0.05);C组患者术后感染及分流管堵塞并发症发生率明显低于A组和B组,比较差异均有统计学意义(均P0.05);B组和C组脑实质内出血发生率均低于A组,与A组比较差异具有统计学意义(P0.05)。结论:脑室镜和腹腔镜综合辅助下脑室腹腔分流术治疗老年脑积水的疗效显著,术后并发症少,值得推广。     

Right Ventricular Endomyocardial Fibrosis Presenting With Ventricular Tachycardia And Apical Thrombus - An Interesting Presentation

Endomyocardial fibrosis is a progressive disease of unknown origin affecting children and young adults. It involves inflow portion of right and/or left ventricle and apex. It may be associated with thrombus. Literature regarding right ventricular endomyocardial fibrosis with thrombus is scarce. Here we report a rare case of right ventricular endomyocardial fibrosis presenting as ventricular tachycardia and echocardiographic evidence of apical thrombus. Interestingly there was no pulmonary involvement or evidence of deep venous thrombosis. This case also underscores the importance of urgent echocardiography in diagnosis of obscure cases of ventricular tachycardia.     

Restricted expression of cardiac myosin genes reveals regulated aspects of heart tube assembly in zebrafish.

The embryonic vertebrate heart is divided into two major chambers, an anterior ventricle and a posterior atrium. Although the fundamental differences between ventricular and atrial tissues are well documented, it is not known when and how cardiac anterior-posterior (A-P) patterning occurs. The expression patterns of two zebrafish cardiac myosin genes, cardiac myosin light chain 2 (cmlc2) and ventricular myosin heavy chain (vmhc), allow us to distinguish two populations of myocardial precursors at an early stage, well before the heart tube forms. These myocardial subpopulations, which may represent the ventricular and atrial precursors, are organized in a medial-lateral pattern within the precardiac mesoderm. Our examinations of cmlc2 and vmhc expression throughout the process of heart tube assembly indicate the important role of an intermediate structure, the cardiac cone, in the conversion of this early medial-lateral pattern into the A-P pattern of the heart tube. To gain insight into the genetic regulation of heart tube assembly and patterning, we examine cmlc2 and vmhc expression in several zebrafish mutants. Analyses of mutations that cause cardia bifida demonstrate that the achievement of a proper cardiac A-P pattern does not depend upon cardiac fusion. On the other hand, cardiac fusion does not ensure the proper A-P orientation of the ventricle and atrium, as demonstrated by the heart and soul mutation, which blocks cardiac cone morphogenesis. Finally, the pandora mutation interferes with the establishment of the early medial-lateral myocardial pattern. Altogether, these data suggest new models for the mechanisms that regulate the formation of a patterned heart tube and provide an important framework for future analyses of zebrafish mutants with defects in this process.