彩色多普勒超声判定食管静脉曲张破裂出血危险性的价值

通过对肝硬化者行超声检测,预测食管静脉出血,结果显示,出血组门静脉及胃左静脉管径均增粗,但胃左静脉曼明显,门静脉血流速减慢而胃左静脉增快;出血组胃左静脉均呈离肝血流,其分流指数明显增大.胃左静脉的管径及血流速与门静脉比较具有显著的变化,其分流指数和血流方向在预测出血方面具有更大的价值.     

CT门脉血管成像对肝硬化食管胃静脉曲张治疗的价值评估

内镜治疗方法是目前处理肝硬化门脉高压引起的食管胃底静脉曲张重要的手段。然而,静脉曲张存在不同的分流特征可影响治疗方法的选择及预后的效果。回顾性分析肝硬化门脉高压患者CT门静脉成像特点,测量门静脉主干及脾静脉、胃左静脉、肠系膜上静脉等主要分支管径,记录门脉侧支循环开放的具体位置、曲张程度及数量,比较CT成像结果与胃镜分型特点,并进行统计学和临床分析。多层螺旋CT门静脉成像(CTPV)可以清晰显示门脉系统和侧支血管,并可详细了解分流的解剖学特征,准确确定分流类型,对于血管管径的测量也具有很好的准确性。CTPV检查对于食管胃底静脉曲张治疗方法选择、用药剂量以及预后评估有较大临床意义。     

CT门静脉成像在食管胃静脉曲张栓塞术后的应用价值

探讨CT门静脉成像(CTP)在食管胃底静脉曲张栓塞术后疗效评价中的价值。23例门静脉高压上消化道出血患者采用经皮经肝食管胃底曲张静脉栓塞术(PTVE),用TH胶栓塞食管胃底曲张静脉及其相关侧支循环血管。栓塞前、后各进行了CT门静脉成像检查,观察TH胶的位置、范围和曲张静脉的残存情况。CT门静脉成像显示23例食管胃底曲张静脉及相关侧支血管内可见TH胶充填,TH胶位置准确、固定,无移位、游走现象,5例可见曲张静脉残留。CT门静脉成像可以直观显示和评价食管胃底静脉曲张栓塞的治疗效果。     

CT门静脉成像在食管胃静脉曲张栓塞术后的应用价值

探讨CT门静脉成像(CTP)在食管胃底静脉曲张栓塞术后疗效评价中的价值.23例门静脉高压上消化道出血患者采用经皮经肝食管胃底曲张静脉栓塞术(PTVE),用TH胶栓塞食管胃底曲张静脉及其相关侧支循环血管.栓塞前、后各进行了CT门静脉成像检查,观察TH胶的位置、范围和曲张静脉的残存情况.CT门静脉成像显示23例食管胃底曲张静脉及相关侧支血管内可见TH胶充填,TH胶位置准确、固定,无移位、游走现象,5例可见曲张静脉残留.CT门静脉成像可以直观显示和评价食管胃底静脉曲张栓塞的治疗效果.     

门静脉血流改变对晚期高位胆管癌的诊断价值

通过探讨正常人与高位胆管癌病人之间的门静脉血流改变,发现两者之间有明显的不同。所以门静脉血流改变在诊断高位胆管癌方面具有重要意义。     

门脉高压症药物治疗中的血管收缩与扩张

通过肝脏的血流由于肝前、肝内或肝后性梗阻而引起门静脉压力超过 10～ 12ｍｍＨｇ者 ,称为门脉高压症 (ＰＶＨ )。门脉高压症药物治疗主要是针对食道静脉曲张出血的治疗和对再出血的预防。治疗的目的是通过药物作用降低门静脉和曲张静脉的压力 ,从而减低曲张静脉的血管壁张力 ,防止曲张静脉破裂出血。药物治疗在门脉高压症治疗中占有重要地位。用唯物辨证法方法对血管活性药物治疗门脉高压症的观点加以剖析 ,对提高我们临床治疗及辩证思维水平是有益的。1　血管收缩剂和血管扩张剂是矛盾事物的两方面血管收缩剂的作用 :研究证实 ,肝硬化门…     

门静脉血流改变对晚期高位胆管癌的诊断价值

通过探讨正常人与高位胆管癌病人之间的门静脉血流改变,发现两者之间有明显的不同.所以门静脉血流改变在诊断高位胆管癌方面具有重要意义.     

非选择性β受体阻滞剂在门静脉高压患者中的应用

门静脉高压是肝硬化患者最常见的并发症,而门静脉高压所致的食管胃底静脉曲张破裂出血则是肝硬化患者最常见的死亡原因。非选择性β受体阻滞剂是目前用于降低门静脉高压以预防食管胃底静脉曲张破裂出血和再出血的一线药物,非选择性β受体阻滞剂可通过降低门脉血流量,从而降低门脉压力,然而,近年来有报道提示非选择性β受体阻滞剂可增加门脉高压患者的死亡率。本文将对非选择性β受体阻滞剂的作用及其在门静脉高压患者中临床运用做一综述。     

门静脉高压症的外科治疗观

门静脉高压症的外科治疗主要有门体静脉断流术和门体静脉分流术,这两种手术方式反映了唯物辩证法的对立统一规律。辩证唯物主义认为,人的认识过程是实践、认识、再实践、再认识,循环往复以至无穷的发展过程。随着实践的深入,医疗技术的进步,医疗设备的更新,近来兴起了分流加断流联合手术、TIPSS及肝移植术治疗门脉高压症。     

门静脉高压症的外科治疗观

门静脉高压症的外科治疗主要有门体静脉断流术和门体静脉分流术,这两种手术方式反映了唯物辩证法的对立统一规律.辩证唯物主义认为,人的认识过程是实践、认识、再实践、再认识,循环往复以至无穷的发展过程.随着实践的深入,医疗技术的进步,医疗设备的更新,近来兴起了分流加断流联合手术、TIPSS及肝移植术治疗门脉高压症.     

侵袭性垂体腺瘤的个性化治疗

近10多年来,不断有新的方法应用于临床治疗食管胃底静脉曲张破裂出血并取得很大进展,如药物的联合应用、经颈内静脉肝内门体分流术、经内镜食管曲张静脉套扎术及硬化剂注射术、冠状静脉栓塞术、肝移植等。对以上治疗方法及其利弊、选择原则等进行了分析。     

门脉高压症治疗观点之辩

对立统一规律是辩证法的实质,在唯物辩证法的理论体系中占有核心地位。门脉高压症的外科治疗有分流术与断流术两种不同的手术方法,这两种方法从治疗机制上看是矛盾的,用对立统一观来认识这两种手术的联系并揭示门脉高压外科治疗发展的哲学依据。     

Regional cerebral blood flow response to recognition memory versus semantic classification tasks

Two randomly assigned groups, N = 7 each, of neurologically normal patients were composed. One group, RM, had regional cerebral blood flow measurements during a recognition memory probe test; the other group, SC, had rCBF measurements during a semantic classification task, using the same stimulus and response features as the RM task. Thus, the groups differed only in the cognitive instruction they were executing. The RM group showed a significantly lower change from resting baseline to activation, in mean left hemisphere initial slope index, than did the SC group. The RM group, but not the SC group, showed a significant inverse correlation between occipital flow and accuracy of memory performance as indicated by d′. Correlations between age and hemispheric initial slope index, and between homologous left and right hemisphere sites, were also described. The results are considered to support an anatomical basis for the distinction between episodic and semantic memory and to suggest that occipital flow may diminish with accurate memory performance because of an upstream demand of blood in the medial temporal lobes.     

Focal changes in cerebral blood flow produced by monetary incentive during a mental mathematics task in normal and depressed subjects

The purpose of this experiment was to determine the effect of incentive-induced arousal on the diffuse and regional cerebral blood flow (rCBF) response during cognitive activation for normal and depressed groups. Two normal rest CBF measurements were followed by two mental mathematics activation CBF measurements. For the first activation measurement, half the subjects in each group were offered monetary incentive for correct performance and half the subjects received no monetary incentive. All subjects were offered monetary incentive on the final activation run. The effect of monetary incentive on the first activation run was to increase CBF activation at four detectors in the left hemisphere. Incentive did not affect the CBF activation response when introduced following practice on the activation task (on the final run). Depressed groups had lower resting blood flow than normals, but the distribution of flow and the CBF response to incentive were almost identical in the two groups.     

Attention, emotion, and deactivation of default activity in inferior medial prefrontal cortex

Attention deactivates the inferior medial prefrontal cortex (IMPC), but it is uncertain if emotions can attenuate this deactivation. To test the extent to which common emotions interfere with attention, we measured changes of a blood flow index of brain activity in key areas of the IMPC with positron emission tomography (PET) of labeled water (H(15)2O) uptake in brain of 14 healthy subjects. The subjects performed either a less demanding or a more demanding task of attention while they watched neutral and emotive images of people in realistic indoor or outdoor situations. In the less demanding task, subjects used the index finger to press any key when a new image appeared. In the more demanding task, subjects chose the index or middle finger to press separate keys for outdoor and indoor scenes. Compared to the less demanding task, in a global search of all gray matter, the more demanding significantly lowered blood flow (rCBF) in left IMPC, left and right insula, and right amygdala, and significantly raised blood flow in motor cortex and right precuneus. Restricted searches of rCBF changes by emotion, at coordinates of significant effect in previous studies of the medial prefrontal and temporal cortices, revealed significant activation in the fusiform gyrus, independently of the task. In contrast, we found no effect of emotional content in the IMPC, where emotions failed to override the effect of the task. The results are consistent with a role of the IMPC in the selection among competitive inputs from multiple brain regions, as predicted by the theory of a default mode of brain function. The absent emotional interference with the deactivation of the default state suggests that the inferior prefrontal cortex continued to serve the attention rather than submit to the distraction.     

Residual differences in language processing in compensated dyslexics revealed in simple word reading tasks

Using regional cerebral blood flow as an index of cerebral activity we studied dyslexic and control subjects during simple word reading tasks. The groups were pre-tested for reading skill and the dyslexic group had a lower reading performance but could read and comprehend standard texts. The aim was to elucidate differences in the cerebral activation pattern during reading. The tasks were simple enough that performance differences between the groups could be excluded. We found specific differences between the two groups that were dependent on the language task. When the visual route for language information was used, minor qualitative differences were found between the groups pertaining to the dominant hemisphere. Increasing the complexity of the task by using pseudowords activated the left frontal region more in the dyslexic group than in the control group. A similar effect was seen in a minor region in extrastriate lateral occipital cortex (BA 19). This finding indicates that the dyslexics used areas in these regions that the controls did not. On the other hand, the dyslexics activated less in the right angular gyrus, right dorsolateral prefrontal cortex, and in the right pallidum. Reading skill correlated with the level of activity in the right frontal cortex. We conclude, that cerebral activation pattern elicited by reading is different in dyslexics compared to controls in spite of an almost complete functional compensation.     

再论门静脉高压症的治疗观

门静脉高压症的治疗主要是断流术和分流术,就此笔者于１７年前在本刊发表过文章进行论述。１７年后,此病的治疗观出现以下进展和变化：１,对立和统一：这两种手术联合施行可产生优势互补,代偿充分者更适合做分流术,否则以断流术为宜,这是观念上的突破;２,有创和微创：微创概念和技术的出现,使治疗手段多样化和观念更新,医生有了更多的选择;３,治标和治本：肝移植的临床一改门静脉高压的治标手段而向治本手段发展。     

Patterns of regional cerebral blood flow during attempted reading aloud by stutterers both on and off haloperidol medication: Evidence for inadequate left frontal activation during stuttering

Two stutterers, both recent college graduates, were subjected to regional cerebral blood flow measurements while attempting to read aloud. Each one received two measurements, one of which was under the influence of haloperidol, 3 mg daily. Both subjects showed improvement on medication, allowing a stuttering versus essentially no stuttering comparisons for each subject. Both subjects showed higher Broca's area flow in the right compared to the left hemisphere, during stuttering. Both showed higher Wernicke's area flow in the left compared to the right hemisphere, however, during stuttering. During reading aloud without stuttering, however, the Brocas's area flows were reversed, now showing a left hemisphere advantage. The results were interpreted as consistent with H. M. Sussman and P. F. MacNeilage's (1975, Neuropsychologia, 13, 19–26) proposal that stutterers exhibit conventional left cerebral dominance for speech reception, but inadequate left cerebral dominance for speech production.