OBJECTIVE To analyze the clinical manifestations, neuroimaging and pathological characteristics of primary central nervous system lymphoma （PCNSL） with a normal immunity, and to explore the methods of treatment and diagnosis. METHODS The clinical, laboratory, imaging data and pathological findings and therapeutic efficacy of 31 cases with pathologically proved PCNSL, during a period from July 1995 to June 2006, were analyzed retrospectively. The method of surgery, used in combination with chemotherapy and radiotherapy, was evaluated in 18 cases versus a simple surgical procedure used in 5. Among the total cases, a CHOP regimen was employed in 11 and Teniposide （VM26） plus Semustine （me-CCUN） was used in 7 cases. RESULTS PCNSL had a variety of clinical features, so that its misdiagnosis rate was high. The main clinical findings of PCNSL included intracranial hypertension and （focal） neurologic impairment. No positive result was found in the CSF cellular examination. All of the 31 cases were B-cell lymphoma. Twenty-four of the 31 cases were followed-up, with a follow-up period from 6 to 98 months. The median period of survival of the group who underwent surgery in combination with chemotherapy and radiotherapy was 20 months, while the group with simple surgical therapy was 10 months. CONCLUSION Specific clinical manifestations were usually absent in the patients with PCNSL, giving an uncertain preoperative diagnosis and a poor prognosis. Pathological examination is the only reliable method for a final diagnosis of the disease. The main objective of surgical therapy is to relieve the intracranial hypertension caused by the tumor. Recurrence may occur in a short period following the simple operation. Therefore combined therapy, i.e. surgery plus additional radiotherapy and chemotherapy, should be adopted. This is the key point for extending survival time and improving the quality of life.
目的观察依达拉奉联合磷酸肌酸钠对颅内动脉瘤术后脑血管痉挛的临床效果。方法选取颅内动脉瘤破裂出血术后患者60例,随机分为观察组和对照组各30例。对照组采用尼莫地平等常规治疗,观察组在对照组治疗的基础上联合应用依达拉奉及磷酸肌酸钠治疗。治疗前和治疗后2周,经颅多谱勒超声(transcraninal Doppler sonography,TCD)分别测定大脑中动脉的血流速度评价血管痉挛程度,同时采用美国国立卫生院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)对比2组的临床疗效,并比较2组不良反应的发生情况。结果治疗2周后,2组血管痉挛情况均较治疗前明显改善(P<0.01)。观察组大脑中动脉平均血流速度较对照组显著降低(P<0.01),NIHSS较对照组明显降低(P<0.01)。2组脑梗死发生率、病死率及不良反应发生率比较差异均无统计学意义(P>0.05)。结论依达拉奉联合磷酸肌酸钠治疗颅内动脉瘤术后脑血管痉挛引起的脑缺血效果确切,能明显改善患者预后。
