Objective To study the significance of ultrasound in diagnosing and treating carotid atherosclerotic stenosis.Methods 382 patients with cerebral ischemic disease were selected.The items examined by ultrasound included plaque size,echo and ulcus.The hemodynamic parameters recorded were peak systolic velocity(PSV) and end-diastolic velocity(EDV) of carotid artery at and proximal to stenosis.The rate of stenosis was calculated.Linear regression analyses of stenosis rate and PSV,stenosis rate and EDV were used to calculate the grading criteria of hemodynamic parameters of carotid stenosis.Results The cases with low echo-level plaque,equal echoplaque,high-level echo plaque,inhomogeneous echo plaque were 39,10,41,81 in cerebral ischemia patients and 6,6,27,2 in patients without cerebral ischemia history.The number of cases with plaque ulcus was 87 by DSA diagnostic criteria and 94 by ultrasound diagnostic criteria.PSV≥145 cm/s and EDV≥45 cm/s at stenosis,PSV/PSV≥2.0 at and proximal to stenosis,and PSV≥260 cm/s and EDV≥88 cm/s at stenosis,PSV/PSV≥3.6 at and proximal to stenosis were critical points of hemodynamic parameters for≥50%and≥70%carotid stenosis respectively.Conclusions It is proper to take ultrasound as first means for diagnosing carotid stenosis.PSV,EDV and PSV/PSV are the accurate hemodynamic parameters for assessing the severity of carotid stenosis.

脑外伤后脑积水(post-truaumatic hydrocephalus,PTH)是颅脑外伤后的一种严重并发症,常常导致患者病情迁延或恶化.脑室-腹腔分流术(ventriculoperitoneal shunt,V-P shunt)是目前治疗PTH的常规方法.但是其疗效常不能令人满意.本文回顾分析了解放军第309医院采用V-P分流术治疗的76例PTH,以对其疗效和影响因素进行评估.

Aim: To investigate the effects of tumor site, grade, patients age and regular chemotherapy on the survival time of the patients with glioma. Methods: The data of 80 patients operated for glioma were collected so as to establish Cox regressive model. Survival rates were counted and survival curves were drawn with Kapmeier-Meier methods. Single and multiple factors for survival were analyzed with Log-rank method and Cox regressive model. Results: Tumor grade (RR = 2.78) and regular chemotherapy (RR = 0.25) were the independent risk factors for the prognosis of patients with glioma. Conclusion: Glioma grade is the major prognostic factor, but the patients who accept the regular chemotherapy can extend their life spans significantly.

1 .临床资料 患者男,19岁,突然意识不清5 min,于1995年10月9日入地方医院,头部CT示左颞顶叶占位病变,诊断为胶质瘤,行开颅手术,近全切除肿瘤,去骨瓣减压,病理报告结核瘤.术后抗结核治疗,痊愈出院.1996年10月因言语不清、右肢体无力、行走困难1月行复查,头部MRI示左颞顶叶巨大占位病灶,为肿物复发,收入我院.

通过采用罂粟碱的不同给药途径研究比较其对脑血管痉挛(CVS)的防治效果.将43例动脉瘤患者随机分成A、B两组,A组术中经置人脑池的硅胶管用罂粟碱溶液持续灌洗;B组术后使用罂粟碱30mg肌肉注射,每日3次,共1周.结果显示,A组防治血管痉挛的效果明显优于B组.提示罂粟碱局部灌洗能有效防治脑动脉瘤术后血管痉挛.

1 临床资料 患者,男性,25岁,因左额部胶质瘤术后3个月复发二次 入院.查体:一般状况好,无发热、咳嗽、盗汗,颈无抵抗,神经 系统未见阳性体征.三大常规及肝、肾功能化验均正常,胸片 未见异常,头部CT示左额叶混杂密度不均匀强化,左例脑室 前角受压明显、肿瘤复发.行二次开颅,切除肿瘤,病理报告星 形细胞瘤Ⅱ-Ⅲ级,术中静点噻吗灵3.0g,预防感染,术后青霉 素960万U、磺胺嘧啶纳4.0 g联合应用.第2天开始发热、盗 汗、头痛、项抵抗,体温持续38.5℃,最高为39.5℃.腰穿,测脑 压380.0mmH2O,脑脊液常规:浑浊,细胞总数3.85×109/L、白 细胞2.95×109/L,多核90%,单核10%;生化:血糖3.51 mmol/L,蛋白质1.16g/L,Cl112.0mmol/L,细菌培养阴性,考 虑为颅内感染,改用噻吗灵6.0g分两次静滴.后体温降至37 ℃,头痛减轻,颈仍有抵抗.2d后腰穿复查脑压210.0mmH2O, 脑脊液常规:微浊,细胞总数9.50×108/L,白细胞1.30×108/L,多 核40%,单核60%;生化:糖3.27mmol/L,,蛋白质1.09g/L,Cl 118.0mmol/L.3 d体温又升至38.6℃,并盗汗.结核菌素试验 (++++),血液、CSF结明试验阳性,结核杆菌PCR阳性、血沉 40.0 mm/h.血常规:白细胞8.5×108/L,多核35%,单核65%, CSF培养阴性,考虑为结核性颅内感染.异烟肼0.8静脉滴注, 1次/d;链霉素25mg肌肉注射,1次/d;利福平0.6mg口服,1 次/晚;吡嗪酰胺0.5mg口服,3次/d.1周后体温正常,无头 痛,颈无抵抗,复查腰穿:脑压190.0mmH2O,脑脊液常规:微 浊,细胞总数2.0×107/L,白细胞1.0×107/L,生化:糖2.85 mmol/L,蛋白质0.48 g/L,Cl 128.0mmol/L,血沉12.0mm/h.病 人10d后出院,继续口服抗结核药物半年,随访2年,无脑肿 瘤复发及结核性脑膜炎复发.