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1.
Objective: The purpose of this study was to differentiate between cerebral amyloid angiopathy (CAA) and hypertension (HTN) based on hemorrhage pattern interpretation. Methods: From June 1994 to Oct., 2000, 83 patients admitted to our service with acute intracerebral hemorrhage (ICH) were investigated retrospectively; 41 patients with histologically proven diagnosis of cerebral amyloid angiography and 42 patients with clear history of hypertension were investigated. Results: Patients with a CAA-related ICH were significantly older than patients with a HTN-related ICH (74.0years vs 66.5 years, P＜0.05). There was a significantly higher number ofhematomas≥30 ml in CAA (85.3%) when compared with HTN (59.5%). No basal ganglional hemorrhage was seen in CAA, but in 40.5% in HTN. In CAA-related ICH, subarachnoid hemorrhage (SAH) was seen in 26 patients (63.4%) compared to only 11 patients (26.2%) in HTN-related ICH.Intraventricular hemorrhage was seen in 24.4% in CAA, and in 26.2% in HTN. Typical features of CAA-related ICH included lobar distribution affecting mainly the lobar superficial areas, lobulated appearance, rupture into the subarachnoid space, and secondary IVH from the lobar hemorrhage. More specifically, multiplicity of hemorrhage, bilaterality, and repeated episodes also strongly suggest the diagnosis of CAA. Multiple hemorrhages, defined as 2 or more separate hematomas in multiple lobes, accounted for 17.1% in CAA-related ICH. Conclusion: There are certain features in CAA on CT and MRI and in clinical settings. To some extent, these features may contribute to distinguishing CAA from HTN related ICH. 相似文献
2.
Study of clinical features of amyloid angiopathy hemorrhage and hypertensive intracerebral hemorrhage 总被引：3，自引：0，他引：3
詹仁雅 童鹰 沈剑峰 LANG E. PREUL C. HEMPELMANN R.G. HUGO H.H. BUHL R. BARTH H. KLINGE H. MEHDORN H.M 《Journal of Zhejiang University. Science. B》2004,(10)
Objective: The purpose of this study was to differentiate between cerebral amyloid angiopathy (CAA) and hypertension (HTN) based on hemorrhage pattern interpretation. Methods: From June 1994 to Oct., 2000, 83 patients admitted to our service with acute intracerebral hemorrhage (ICH) were investigated retrospectively; 41 patients with his-tologically proven diagnosis of cerebral amyloid angiography and 42 patients with clear history of hypertension were investigated. Results: Patients with a CAA-related ICH were significantly older than patients with a HTN-related ICH (74.0 years vs 66.5 years, P<0.05). There was a significantly higher number of hematomas>30 ml in CAA (85.3%) when compared with HTN (59.5%). No basal ganglional hemorrhage was seen in CAA, but in 40.5% in HTN. In CAA-related ICH, su-barachnoid hemorrhage (SAH) was seen in 26 patients (63.4%) compared to only 11 patients (26.2%) in HTN-related ICH. Intraventricular hemorrhage was seen in 24.4% in CAA, and in 26.2% in HTN. Typical features o 相似文献
3.
[目的]探讨大鼠脑出血双侧纹状体区细胞凋亡的时程变化规律和早期立体定向血肿抽吸术干预治疗对细胞凋亡的影响.[方法]雄性Sprague-Dawley(SD)大鼠80只,随机分成正常对照组,假手术组,脑出血自然恢复组,6 h血肿抽吸组,12 h血肿抽吸组以及24 h血肿抽吸组.采用立体定向注入Ⅶ型胶原酶建立脑出血模型.采用原位末端标记法检测出血周边组织细胞的凋亡.[结果]①大鼠脑出血周边组织12 h出现凋亡细胞,3d凋亡细胞达峰值,11 d仍有凋亡细胞表达.②血肿抽吸术干预后出血周边组织凋亡细胞数与脑出血组对应时间点比较显著下降(P<0.05).③6 h血肿抽吸组与24 h血肿抽吸组比较细胞凋亡数明显低于24 h血肿抽吸组,差异有显著性(P<0.05).[结论]立体定向血肿抽吸术干预治疗大鼠脑出血可明显影响细胞凋亡的表达,脑出血各种临床治疗的“时间窗”应为出血后12 h之内.早期(6 h)立体定向血肿抽吸术治疗可以显著减少脑出血后细胞凋亡. 相似文献
4.
目的:通过CT检查,对新生儿窒息的预后进行更好的评价。方法:选择114例窒息新生儿,其中26例早产儿、88例足月儿进行研究,选择48例无窒息新生儿,其中20例早产儿、28例足月儿进行对照分析。将其分为轻度窒息、重度窒息;根据CT表现,将新生儿缺血缺氧性脑病(HIE)分为轻、中、重度。按照Apgar评分标准进行评分。结果:114例窒息新生儿中,轻度窒息78例,重度窒息36例,颅内出血48例,治愈109例,死亡5例。结论:轻度窒息新生儿发生HIE后,轻、中度较多,而重度窒息后发生HIE的新生儿重度者较多。轻度HIE新生儿,经积极治疗后,预后较好,重度HIE特别是合并颅内出血者预后较差。早产儿的额叶、枕叶低密度改变不能作为新生儿缺血缺氧性脑病的依据,应根据有无窒息史及临床症状和体征来判断。 相似文献
5.
目的:探索新生儿惊厥的病因,临床特点和治疗方法.方法:对我院最近6年96例住院新生儿惊厥患者的临床资料,治疗措施的有效性进行分析总结.结果:新生儿惊厥病因最多见的是新生儿缺氧缺血性脑病45例(46.87%),其次是颅内出血18例(18.75%),低钙惊厥12例(12.5%),此三种病因占全部病例的78%以上.结论:减少新生儿惊厥发生的关键是做好围产期保健,提高治愈率的方法是快速止惊,纠正缺氧,尽早病因治疗. 相似文献
6.
Background
Antithrombotic therapy using new oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) has been generally shown to have a favorable risk-benefit profile. Since there has been dispute about the risks of gastrointestinal bleeding (GIB) and intracranial hemorrhage (ICH), we sought to conduct a systematic review and network meta-analysis using Bayesian inference to analyze the risks of GIB and ICH in AF patients taking NOACs.Methods
We analyzed data from 20 randomized controlled trials of 91 671 AF patients receiving anticoagulants, antiplatelet drugs, or placebo. Bayesian network meta-analysis of two different evidence networks was performed using a binomial likelihood model, based on a network in which different agents (and doses) were treated as separate nodes. Odds ratios (ORs) and 95% confidence intervals (CIs) were modeled using Markov chain Monte Carlo methods.Results
Indirect comparisons with the Bayesian model confirmed that aspirin+clopidogrel significantly increased the risk of GIB in AF patients compared to the placebo (OR 0.33, 95% CI 0.01–0.92). Warfarin was identified as greatly increasing the risk of ICH compared to edoxaban 30 mg (OR 3.42, 95% CI 1.22–7.24) and dabigatran 110 mg (OR 3.56, 95% CI 1.10–8.45). We further ranked the NOACs for the lowest risk of GIB (apixaban 5 mg) and ICH (apixaban 5 mg, dabigatran 110 mg, and edoxaban 30 mg).Conclusion
Bayesian network meta-analysis of treatment of nonvalvular AF patients with anticoagulants suggested that NOACs do not increase risks of GIB and/or ICH, compared to each other.7.
8.
Geng QIAN Hong-bin LIU Jin-wen WANG Chen WU Yun-dai CHEN 《Journal of Zhejiang University. Science. B》2013,14(8):736-742
Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10 202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage. 相似文献
9.
探讨传统中药蜕皮甾酮对大鼠实验性蛛网膜下腔出血后早期脑血管痉挛的干预效应。90只SD大鼠随机分为假手术组、SAH组、EDS干预组,观察各实验组大鼠24h死亡率和神经功能缺损、局部脑血流量及形态学变化。结果表明,与假手术组比较,SAH组大鼠有明显的神经功能缺损,局部脑血流量下降,基底动脉管腔缩小,内膜皱缩呈波纹状等形态学异常、EDS干预后神经功能缺损好转,局部脑血流量在EDS干预后12h增加,形态学也有不同程度改善。蜕皮甾酮能改善大鼠实验性蛛网膜下腔出血后早期脑血管痉挛。 相似文献
10.
目的：探讨护理措施及康复指导对高血压性脑出血患者治疗效果的作用。方法：随机抽取我院自2011年1月至2013年12月62例住院治疗的高血压性脑出血患者,作回顾性分析,总结护理经验及康复指导措施,为救治今后接诊的高血压性脑出血患者提供参考依据。结果：通过采取常规的护理措施及预防并发症的护理措施后,62例高血压性脑出血患者中基本痊愈36例、部分恢复22例、死亡4例。结论：对高血压性脑出血患者在临床治疗期间进行有效的护理措施及康复指导,可提高治愈率,有效降低死亡率及致残率,提高患者的生活质量。 相似文献
11.
Philip V. Scribano Kathi L. Makoroff Kenneth W. Feldman Rachel P. Berger 《Child abuse & neglect》2013
The diagnosis of abusive head trauma (AHT) remains a significant public health problem with limited prevention success. Providing protection from further harm is often challenged by the difficulty in identifying the alleged perpetrator (AP) responsible for this pediatric trauma. The objective of this study was to evaluate demographic and clinical characteristics of children with AHT and the relationship between APs and their victims in a large, multi-site sample. Understanding the AHT risks from various caregivers may help to inform current prevention strategies. A retrospective review of all cases of AHT diagnosed by child protection teams (CPT) from 1/1/04 to 6/30/09 at four children's hospitals was conducted. Clinical characteristics of children with AHT injured by non-parental perpetrators (NPP) were compared to parental perpetrators (PP). There were 459 children with AHT; 313 (68%) had an identified AP. The majority of the 313 children were <1 year of age (76%), Caucasian (63%), male (58%), receiving public assistance (80%), and presented without a history of trauma (62%); mortality was 19%. Overall, APs were: father (53%), parent partner (22%), mother (8%), babysitter (8%), other adult caregiver (5%); NPP accounted for 39% of APs. NPPs were more likely to cause AHT in children ≥1 year (77% vs. 23%, p < 0.001) compared to PP. Independent associations to NPP included: older child, absence of a history of trauma, retinal hemorrhages, and male perpetrator gender. While fathers were the most common AP in AHT victims, there is a significant association for increased risk of AHT by NPPs in the older child, who presents with retinal hemorrhages, in the hands of a male AP. Further enhancement of current prevention strategies to address AHT risks of non-parental adults who provide care to children, especially in the post-infancy age seems warranted. 相似文献
12.
本文回顾性研究和分析1991年1月至1997年5月经CT平扫证实的42例无偏瘫型脑出血患者．其结果表示：在42例病例中,对例（78.6％）大于60岁活动中起病35例（83.3％）．临床表现多种多样．38例入院时神志清醒,入院前与入院后CT平扫发现出血位于脑的不同部位,且量较少,约0．5～60ml（平均79±11.5ml,出血破入脑室10例（23.8％）本文显示：无偏瘫型脑出血临床症状多种多样,典型的症状不是很明显,所以给诊断带来困难．放对此类病人应尽早行头CT平扫,同时应详细采集病史和进行神经系统查体,以助确诊和避免误诊． 相似文献
13.
目的:探讨磁共振成像(MRI)和经颅多普勒(TCD)评价后循环缺血的价值。方法:对56例诊断为后循环缺血患者的临床资料进行回顾性分析。结果:头颅MRI发现脑干、小脑、枕叶梗死灶共46个;椎基底动脉磁共振血管造影显示达39例(69.6%)双侧椎动脉不对称、粗细不均,10例(17.9%)一侧椎动脉起始段不同程度狭窄,1例锁骨下动脉狭窄。TCD显示血流速度异常者40例(71.4%),频谱异常36例(64.3%)。结论:MRI和TCD能给后循环缺血的诊断提供客观依据;MRI优于TCD。 相似文献
14.
目的:探讨零缺陷护理模式对脑出血患者术后神经康复效果与生活质量的影响。方法:纳入赣州市人民医院2016年3月至2018年1月收治的、行手术治疗的100例脑出血患者作为研究对象,随机分为观察组(n=50)和对照组(n=50)。对照组采用心理疏导、健康宣教、切口护理、饮食指导等常规护理,观察组在对照组的基础上采用零缺陷护理模式。两组均干预1个月,收集并分析两组患者神经功能评分(NIHSS)、生活自理能力评分(FIM)及生活质量变化情况。结果:观察组干预后NIHSS评分低于对照组,差异具有统计学意义(P<0.05);观察组干预后FIM评分高于对照组,差异具有统计学意义(P<0.05);观察组一般健康状况、生活能力、生理职能、情感职能、躯体疼痛、生理机能、精神健康、社会功能评分均高于对照组,差异具有统计学意义(P<0.05)。结论:零缺陷护理模式能提高脑出血患者患者神经功能修复,提高患者日常生活活动能力,提高患者临床预后效果。 相似文献
15.
研究大鼠脑出血给予三七总皂甙治疗后,神经元Bcl-2和Bax的表达有无变化,并观察脑出血大鼠在不同时间点相干/湿重法测定脑含水量的变化.神经行为学检测结果表明,脑出血组大鼠的神经功能评分分值升高;2d后治疗组大鼠与脑出血组相比分值下降（P＜0.01）.免疫组织化学结果显示,治疗组Bcl-2的阳性表达较脑出血组高（P＜0.01）、Bax的阳性表达较脑出血组低（P＜0.01）,Bcl-2/Bax蛋白比值增高;脑含水量即12 h开始增加,24 h后比较明显,48 h达高峰,7d之后与正常组无明显差异.三七总皂甙治疗组48 h ～72h干预后,脑含水量明显低于其脑出血组（P＜0.05）. 相似文献
16.
文章介绍了小骨窗开颅治疗老年性高血压性脑出血的手术方法。在2002年1月至2003年8月期间我们利用CT定位，小骨窗开颅治疗老年性高血压脑出血25例。术后12h内复查头颅CT，血肿清除达90％以上，术后6个月生存质量按ADL评价，Ⅰ级5例(20．0％)，Ⅱ级11例(44．0％)，Ⅲ级5例(20．0％)，Ⅵ级1例(4.0％)，Ⅴ级1例(4.0％)，Ⅵ级2例(8．0％)。结论：高龄并非高血压性脑出血手术禁忌，采取小骨窗开颅微创术可取得较满意效果。 相似文献
17.
目的 :分析剖宫产对母儿的影响 ,以评估剖宫产的安全性。方法 :对泰州市人民医院 2 0 0 0年 1月 - 1 2月全年剖宫产病例的手术指征 ,产后出血量 ,新生儿出生后Apgar评分等资料进行了综合分析。结果 :全年剖宫产 5 5 4例 ,占分娩总数 3 6 42 %,其中 :剖宫产后大出血2 7例 ,占 4 87%,新生儿窒息 (Apgar <7分 ) 6 0例 ,占 1 0 83 %。结论 :为了真正提高产科质量 ,必须严格掌握剖宫产指征 ,才能提高母儿的安全性。 相似文献
18.
Po HU Xiang-gui YUAN Xin-yang HU Fa-rong SHEN Jian-an WANG 《Journal of Zhejiang University. Science. B》2013,14(8):729-735
Objective:Gorham-Stout syndrome (GSS) is a rare disorder of uncertain etiology and unpredictable prognosis. This study aims to present a comprehensive understanding of this rare entity. Methods:A literature search in PubMed and three Chinese databases was performed to screen histologically proven GSS cases among Chinese residents in the mainland. We analyzed the patients’ clinical characteristics, the value of different treatment modalities and their influence on the clinical outcome. Results:Sixty-seven cases were finally enrolled. There were 43 men (64.2%) and 24 women (35.8%). The mean age at diagnosis was 28 years (1.5-71 years). The most common clinical symptoms included pain (n=40, 59.7%), functional impairment (n=13, 19.4%), and swelling (n=12, 17.9%). The radiographic presentation of 37 cases (55.2%) was disappearance of a portion of the bone. The others presented as radiolucent foci in the intramedullary or subcortical regions. A total of 42 cases provided data on therapy, these included surgery (n=27, 40.3%), radiation therapy (n=6, 9.0%), surgery combined with radiation therapy (n=2, 3.0%), and medicine therapy (n=7, 10.4%). For 30 of these 42 cases, follow-up data were available:21 cases had the disorder locally controlled and 9 had a symptom progression. Fortunately, the disease is not fatal in the majority of cases. Conclusions:GSS has no specific symptoms and it should be taken into consideration when an unclear massive osteolysis occurs. The efficacies of different treatment modalities are still unpredictable and further research is required to assess the values of different treatments. 相似文献
19.
Naidoo S 《Child abuse & neglect》2000,24(4):521-534
OBJECTIVE: The aim of the present study was to determine the head, face and neck injuries associated with child abuse cases in the Cape Peninsula, Cape Town. South Africa. METHOD: A retrospective, record-based analysis (n = 300) of non-accidental injuries at a Children's Hospital over a 5-year period (1992-1996) was carried out. RESULTS: The mean age of the sample was 4.75 years--54.3% were boys and 45.7% were girls. Most of the crimes were committed in the child's own home (88.7%). Crimes were reported by mothers (48.7%), grandmothers (11.7%) and day hospitals (13%). Ninety percent of the perpetrators were known to the victim. The majority of the perpetrators were male (79%)--20% the perpetrators were the mother's boyfriend; 36% the father or step father, and in 12% the mother was responsible. Thirty-five percent of perpetrators were under the influence of alcohol or drugs when they committed the offence: 64.7% of cases suffered serious injuries, 48.7% had to be hospitalized, four children were critically injured and died. The head, face, neck, and mouth were the sites of physical injury in 67% of the 300 cases reviewed. The face was the most frequently injured (41%) part of the body, with the cheek being the most common site for the injury. The range and diversity of the oro-facial injuries included skull fractures, subdural hematomas, retinal hemorrhages, bruises, burns, and lacerations. Injuries to the mouth included fractured teeth, avulsed teeth, lacerations to the lips, frenum, tongue, and jaw fractures. CONCLUSIONS: The main conclusions of this study were (i) under 2-year-old children were most at risk from abuse (36%); (ii) the number of the reported injuries to the oral cavity was extremely low (11%); and (iii) no dentists participated in the examination of any of the patients. Intra-oral injuries may be overlooked because of the medical examiner's unfamiliarity with the oral cavity. Oral health professionals should be consulted for diagnosis, advice and treatment. 相似文献
20.
Anne-Marie van Cappellen van Walsum Dylan J.H.A. Henssen 《Anatomical sciences education》2022,15(2):317-329
Polarized light imaging (PLI) is a new method which quantifies and visualizes nerve fiber direction. In this study, the educational value of PLI sections of the human brainstem were compared to histological sections stained with Luxol fast blue (LFB) using e-learning modules. Mental Rotations Test (MRT) was used to assess the spatial ability. Pre-intervention, post-intervention, and long-term (1 week) anatomical tests were provided to assess the baseline knowledge and retention. One-on-one electronic interviews after the last test were carried out to understand the students’ perceptions of the intervention. Thirty-eight medical students, (19 female and 19 males, mean age 21.5 ± SD 2.4; median age: 21.0 years) participated with a mean MRT score of 13.2 ± 5.2 points and a mean pre-intervention knowledge test score of 49.9 ± 11.8%. A significant improvement in both, post-intervention and long-term test scores occurred after learning with either PLI or LFB e-learning module on brainstem anatomy (both P < 0.001). No difference was observed between groups in post-intervention test scores and long-term test scores (P = 0.913 and P = 0.403, respectively). A higher MRT-score was significantly correlated with a higher post-intervention test score (rk = 0.321; P < 0.05, respectively), but there was not a significant association between the MRT- and the long-term scores (rk = −0.078; P = 0.509). Interviews (n = 10) revealed three major topics: Learning (brainstem) anatomy by use of e-learning modules; The “need” of technological background information when studying brainstem sections; and Mnemonics when studying brainstem anatomy. Future studies should assess the cognitive burden of cross-sectional learning methods with PLI and/or LFB sections and their effects on knowledge retention. 相似文献