Eighty-one patients with acute upper digestive tract bieeding were treated in the intensive care unit (ICU) of the neuro surgery between Mar. 1986 and Apr. 1992. Of them 75 cases were treated by routine therapy, the cure being in 35 (43.2%), improvement in 24 (29.6%), death 16 (19.75%). While digital subtraction angiography (DSA) was applied in 3 patients repeated bleeding, and the bleeding seats were shown on it. Consequentially, two of the 3 cases stopped bleeding and other one got impovement by embolization procedure. In addition, Omeprazole, a new inhibitor of gastric acid secretion, was used in 3 bleeding cases, with a satisfactory effect. The authors believe that ICU is most favourabie to medical management of such patients.

Objective To discuss the correlation of Wiskott-Aldrich syndrome (WAS) with autoimmune disease of the central nervous system and its possible pathogenesis by reporting one case of the disease and reviewing related literature.Methods One case of WAS complicated with demyelinating disease of the central nervous system was reported.The patient' s clinical symptoms,laboratory examinations (such as blood tests,immune function tests,etc) and imaging features were analyzed.The patient's blood DNA was extracted and performed gene testing.And related literature was reviewed.Results The patient showed typical clinical symptoms of WAS,including eczema,thrombocytopenia and immune deficiency,complicated with demyelinating disease of the central nervous system.The DNA testing showed C400G ＞ C p.(ALa134Pro) mutation,which is a missense mutation.The 134th amino acid in protein was changed from alanine to proline.The patient also showed the symptoms of demyelinating disease of the central nervous system,which drew our attention.This was the first report on WAS complicated with demyelinating disease of the central nervous system,which was perhaps caused by a gene mutation.Conclusions WAS complicated with demyelinating disease of the central nervous system is possibly resulted from the gene mutation,which leads to the expression disorder of WAS protein.And then non-red hematopoietic cells lead to signal transduction and cytoskeleton recombination disorders in response to environment stimulus,which produces lymphocytes immigration,signal transduction and immune synaps formation disorders.

Fourteen patients with vascular stenosis in carotid artery system were treated using angioplasty and stenting.The stenosis was located at bifurcation in 6 cases, intracranial internal carotid artery in 3, horizontal segment of middle cerebral artery in 3, and original segment of common carotid artery in 2. Depending on the long and degree of stenosis,different types of SMART stents and Biodivysio stents were selected for the endovascular angioplasty via the femoral approach in 13 cases. Balloon dilatation angioplasty was performed in one case. All the angioplasties in 14 cases were successfal. Different improvement was achieved in patients with neurological defects and no stroke was found in NIHSS after endovascular angioplasty. Following up 3 to 14 months, there was no TIA and other ischemic neurological defect. The primary results of our group showed that endovascular angioplasty and stenting are effective and safe for carotid stenosis. It should be one of the favorable choices for the treatment of vascular stenosis in catotid artery system.

To identification the immunization activation of recombinant Leptospira gene vaccine from many-siden MethodsThe guinea pigs were immunized with recombinant Leptospira gene vaccine [plasmid vector pT7-7 was negtive control ,inactivated whole cell vaccine (WCV) was positive control]. Then spleen cells were taken out. Particularity lymphocyte transformation test(LTT),IL-2 and IL-6 activation of these spleen cells were determined by MTT and 3H-TdR respectively. Results1)The Relative transformation index of gene vaccine group was significance higher than pT7-7 group (vaccin group: 2. 19±0. 18, pT7-7 group 1.42±0. 27 ( P＜0. 005 ); 2 ) the activation of IL- 2 and IL- 6 from recombinant gene vaccine group waw significance stronger than pT7-7 group (vaccine group IL-2:34. 8±3.11,IL-6:94. 6±6.03, pT7-7 group IL-2:20. 4±3. 05,IL-6: 67±6.28), (P＜0. 005). Conclusion1) The activation of Th1 and Th2 lymphocyte cell were increased in the guinea pigs with gene vaccine immunized. It suggested the recombinant Leptospira gene vaccine could elicit an extremely strong immunization effect of T-cell cooperate with B-cell and the gene vaccine was equal the WCV(P＞0. 05)but the gene vaccine sideeffect was small and the applying prospect was good.

Objective To observe the effect of selective intra-arterial thrombolytic therapy for central retinal artery thrombosis. Methods 100 000-250 000U of urokinase were injected into the ophthalmic artery via a catheter in the ophthalmic artery or the internal carotid artery to carry out the thrombolytic therapy. Results The visual acuity was significantly improved from light perception or finger counting to 0.1 in 8 of a total of 26 cases, partially improved in 10 cases, and no change in vision in 8 cases. The time interval from the onset of the disease to thrombolysis was within 8 days in the 18 patients who showed improvement, 3 of them showed significant improvement, of whom 2 received the treatment within 3 days. Conclusion Selective intra-arterial thrombolytic therapy is effective for the treatment of central retinal artery thrombosis. The effect was closely related to the time interval from the onset of the disease to thrombolysis. The thrombolytic therapy should be carried out as soon as possible.

r governments and mescal institutions in their prevention and control.

Objective To evaluate the efficacy and safety of the endovascular interventional minimally invasive techniques(IMIT)for treatment of carotid artery iniury. Methods A total of 111 cases of carotid artery injury diagnosed by digital subtraction angiography(DSA)were treated with IMIT.Except for 1 case of extracranial segment injury of internal carotid artery treated with transcatheter stentgraft placement to obturate the rupture of carotid artery,the other 110 cases of intracranial segment injury of internal carotid artery(ICA)were treated with embolization with balloons in 73,embolization with coils in 12,injection of NBCA and PVA in 6,stent-graft placement in 11 and embolization with multiple materials in 8. Results Angiography demonstrated rupture of extracranial segment of internal carotid artery and arteriovenous fistula(AVF)at the neck in 1 case,traumatic carotid cavernous fistula(TCCF)in 83.traumatic pseudoaneurysm at intracranial segment of carotid artery in 14 and both TCCF and pseudoaneurysm in 13.The interventional treatment succeeded in all cases and interual carotid arteries were well protected in 62 cases.Completion angiography documented complete obliteration of the fistulas,with complete disappearance of the clinical symptoms in 110 cases and improvement in 1.Minor complications occurred in 2 cases,without death occurred.During the follow-up for 1-14 months,16 cases reexamined with DSA,which showed that the symptoms of 3 cases reoccurred,2 of whom were cured by re-embolization and 1 was under clinical observation. Conclusions IMIT including transcatheter selective embolization and stent-graft implantation is minimally invasive,safe and effective for treatment of carotid artery injury.

BACKGROUND: Functional injury of brain and limb induced by hemorrhage of cerebral arteriovenous malformation could be restored by rehabilitative treatment OBJECTIVE: To investigate the curative effect of rehabilitation on restoration of the functional injury of the brain and limbs induced by bleeding of hemorrhage cerebral arteriovenous malformation (AVM) after embolization.DESIGN: Case analysis.SETTING: Department of Interventional Medicine of General Hospital of Chinese PLA.PARTICIPANTS: From January 1996 to December 2001, a total 56 patients who were diagaosed as cerebral hemorrhage or intraventricle hemorrhage by CT or MRI scanning was selected from General Hospital of Chinese PLA.METHODS: All 56 patients with cerebral arteriovenous malformation were diagnosed by DSA. Rehabilitative treatment was performed with α-butyl cyanoac-rylate or radian surgery. Rehabilitative therapy were as follow: [1] Electric stimulate: S J-Ⅱ type nerve-muscle therapy instrument was used to stimulate the muscles (flexor and extensor) of limbs in the involved side, intensity of which is from weak to strong and frequency of which was from 2 to 3 or 4 per day; [2] Acupuncture: The selected points are:Fengchi, Fengfu, Yintang, Shangxing, Baihui, Quchi, Waiguan, Hegu,Huantiao, Zusanli, Yanglingquan, Sanyinjiao, Taichong, et al. In those who suffered aphasia, lianquan, Jinjin, Yuye were selected. Once a day and a period of treatment was 2 weeks; [3] physical training: the passive movement on the joint in the involved limbs were performed in grade 0 to 1 of muscle strength, the balance training of sitting on bed or standing beside the bed in grade 1 to 2, walking training in grade 2 to 3. The training intensity should be from weak to strong gradually. The items of observation were the improvement in speaking, sense and activity in limbs in the involved side. Evaluation of myodynamia was referenced to 6 grading method of Lovett.MAIN OUTCOME MEASURES: [1] the degree of embolism; [2] the degree of speaking fluency, the sense of limbs and the strength of the muscles of the limbs.RESULTS: Totally 56 cases entered the final analysis without any loss. [1]Degree of embolism: Among 56 cases, 100% focus was eliminated for 77% in 43 cases, 90% was eliminated for 12% in 7 cases and 60%-80% was eliminated for 11% in 6 cases. [2] Fluency of language: Before the treatment of rehabilitation, they suffered different degree impediment of speaking in 14 cases, improvement in 14 cases and obvious improvement in 11 cases. [3] Sense of limb:The sense of limbs was improved in 23 cases and 18 of them improved obviously. [4] Strength of muscles: The strength of muscles in 0 to 1 grade in 3 cases, 1 to 2 grade in 11 cases, 2 to 3 grade in 15 cases. But after the treatment of rehabilitation, speaking ability was improved in 14 cases, and 11 of them improved obviously. The strength of muscles was. resumed to 2 or 3 grade from 0or 1 grade in 2 cases, and to 4 grade in 21 cases and 5 grade in 6 cases.CONCLUSION: Endovascular embolization is a minimal traumatic, the rehabilitative therapy which is secure and effective method for treatment of high risk cerebral AVM, can promote motion function, language function and ability of activity of daily living, and quality of life of patients with cerebral arteriovenous malformation after embolism.

Objective To discuss the image characters and the technical manipulation of endovascular embolization for cerebral AVM with bleeding. Methods The cerebral AVMs with bleeding in 56 cases were confirmed by CT, MRI, and whole cerebral DSA. Depended on the nidus of AVM, the superselective endovascular embolization with NBCA or embolization combined with radiological surgery was chosen. Results The nidus was eliminated for 100% in 36 cases after embolization for 1 to 3 processes. The rebleeding was found in 2 cases with new growth and survival aneurysm in nidus during the follow-up period and treatment with X-knife, and was cured by the second embolization. Conclusion The main causes of AVM bleeding included aneurysm and aneurysm-like dilation beside and located at the nidus, fine draining veins, and growth in the ventricles. To prevent the brain from bleeding, it is favourable to eliminate the aneurysm in AVM during embolization.