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Traumatic hemorrhage of brain stem is a serious and irreversible brain damage.It consti- tutes one of the important causes of death in patients with acute cranio-cerebral injury.Un- fortunately,this condition is rarely diagnosed antemortemly,although much has been learnt recently regarding its clinical manifestations. In the present series of 33 fatal cases of acute cranio-cerebral injury,10 cases of brain stem hemorrhage were found on autopsy.Definite focal hemorrhages in the brain stem were seen grossly in... Traumatic hemorrhage of brain stem is a serious and irreversible brain damage.It consti- tutes one of the important causes of death in patients with acute cranio-cerebral injury.Un- fortunately,this condition is rarely diagnosed antemortemly,although much has been learnt recently regarding its clinical manifestations. In the present series of 33 fatal cases of acute cranio-cerebral injury,10 cases of brain stem hemorrhage were found on autopsy.Definite focal hemorrhages in the brain stem were seen grossly in 6 cases and microscopically in another 4 cases.The most common site of hemorrhage, was found to be on the dorsal part of the pens, periaqueductal area and median raphe.In 3 cases Hemorrhage was also found in the segmental part of the mid-brain.Bleeding might have been either petechial or massive with clot formation. Death occurred to about half of these patients within 24 hours after injury,while the rest survived for varying periods,the longest being 53 days. 对10例外伤性脑干出血死亡病例进行了临床及病理资料的分析。发现致伤机制都属于加速性损伤。脑干出血部位均见于桥脑背部,大脑导水管周围或正中缝附近,其中3例同时伴有中脑被盖部出血。本组中半数于伤后24小时内死亡,但少数病例是尚可维持较长生存时间,最长者达58天。对脑干损伤综合征作了简单的描述。本组患者同时合并急性颅内血肿者5例,其中4例虽经血肿清除术,但未取得预期疗效,另一例钻孔探查阴性,尸检见巨大脑内血肿,并已破入脑室内。对产生脑干出血的机制作了简单的讨论。认为可根据病人(1)受伤当时的意识状态,(2)出现脑干损伤综合征的时间,及(3)致死时间,作为区别是原发性或继发性脑干损伤的标准,并提出外伤性脑干出血系脑干不可逆性损伤的一种表现,目前对脑干出血还不能找到其特征性的临床表现,因此仍是诊断中有待解决的问题。关于防治工作方面,强调提出对防止继发性脑干损伤的发生或防止其发展为不可逆性阶段的重要意义,因此应当仔细观察病情的发展动向,经常保持戒备状态,及时识别颅内血肿,迅速予以手术处理,并提出在清除血肿后尚有明显脑疝存在时的处理步骤及采用其他各种综合治疗的重要性。 A new surgical technic of tubing was introduced to establish free communication via the occluded foramen of Luschka in atresia of out-let of the fourth ventricle. This procedure has the advantages of being technically simple and may be conveniently employed following exploratory confirmation of the condition during posterior fossa craniotomy. Other advantages and draw-backs pertaining to this operation were compared with those of other methods currently in use.Three case so operated upon for non-tumoral occlusion... A new surgical technic of tubing was introduced to establish free communication via the occluded foramen of Luschka in atresia of out-let of the fourth ventricle. This procedure has the advantages of being technically simple and may be conveniently employed following exploratory confirmation of the condition during posterior fossa craniotomy. Other advantages and draw-backs pertaining to this operation were compared with those of other methods currently in use.Three case so operated upon for non-tumoral occlusion of the fourth ventricular outlet were reported in this article postoperatively. Two of them have been followed up for more than 10 years, and the other one for several months. All of them are enjoying their normal life without untoward effects. 介绍了一种安装导管的新手术,以便将第四脑室脑脊液引流至枕大池,用于治疗第四脑室出口的狭窄或闭销。此种技术简便易行,可于颅后窝探查明确诊断后必要时采用。文中就此种方法的优缺点同其它习用的若干手术进行了比较。 报告了3例非肿瘤性闭锁患者,用此种导管引流术后其中2例经过长达十余年的随访观察,患者一直情况良好,另1例术后为期数月,均无不良反应。 A report of long-term follow-up results of 259 cases with Pott'sparaplegia was presented. All the patients were treated with combinationof chemotherapy and various operations. The overall recovery rate was87. 6%, improvement rate 7.0% and failure rate 5. 4%. According to this retrospective study, it was suggested that the mainfactors influencing the therapeutic efficacies should include the age of thepatient, duration and severity of paraplegia, pre- and postoperative compli-cations, pathological impairments... A report of long-term follow-up results of 259 cases with Pott'sparaplegia was presented. All the patients were treated with combinationof chemotherapy and various operations. The overall recovery rate was87. 6%, improvement rate 7.0% and failure rate 5. 4%. According to this retrospective study, it was suggested that the mainfactors influencing the therapeutic efficacies should include the age of thepatient, duration and severity of paraplegia, pre- and postoperative compli-cations, pathological impairments of the spinal cord and the operativeprocedures. 本文总结了获得长期随访的259例脊柱结核截瘫,采用全身支持疗法和抗结核药物结合不同类型的手术,使截瘫的治愈率达87.6%,好转7.0%,无效仅5.4%。通过本组病例分析认为,患者年龄,截瘫的时间、程度和并发症,手术途径,脊髓的病理损害以及治疗是否彻底是影响疗效的主要因素。
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