翼点入路显微手术切除大型鞍区肿瘤23例临床分析

目的探讨大型鞍区肿瘤经翼点入路显微外科治疗方法。方法分析8年来经翼点入路对23例大型鞍区肿瘤运用显微手术，根据肿瘤生长的位置，从鞍区各个间隙切除肿瘤。结果23例病例全切15例，占65．2％；次全切4例，占17．4％，大部分切除2例，占8．7％；死亡2例，占8．7％。结论翼点入路对于处理大型鞍区肿瘤显露好，熟悉鞍区的解剖间隙，用显微神经外科技术充分利用该间隙是手术成功的关键。     

鼻窦镜辅助下经单鼻孔入路垂体腺瘤显微手术切除

目的总结鼻窦镜辅助下经单鼻孔入路垂体瘤显微手术切除术的经验及初步体会.方法鼻窦镜辅助下,经单侧鼻腔,严格中线入路打开蝶窦前壁,暴露鞍底.然后在神经显微镜下行垂体瘤切除,最后鼻窦镜下鞍底重建.结果 21例患者中16例一次手术全切除,3例次全切除,1例巨大生长激素(growth hormone, GH)腺瘤大部分切除,后经改良翼点入路二次手术切除,1例巨大催乳素(prolactin, PRL)腺瘤分2次经蝶肿瘤切除,术后患者症状均改善.尿崩2例,分别于术后7 d、15 d停止;脑脊液漏1例,保守治疗2周治愈.结论耳鼻喉科医师解剖熟悉,鼻窦镜下显露鞍底准确充分,神经外科医师显微镜下可克服内镜单手操作的不便,二者结合有利于减少经单鼻孔入路垂体瘤切除的创伤,提高安全性,是一种有效的方法.     

神经内镜辅助单鼻孔-蝶窦入路显微切除垂体瘤

目的探讨神经内镜技术和手术显微镜结合经单鼻孔经蝶入路切除垂体瘤的临床应用及手术技巧。方法对14例经CT扫描和MRI检查确诊为垂体瘤患者在神经内镜辅助下经单鼻孔入路,磨除蝶窦前壁,暴露鞍底,显微镜下切除垂体瘤主体后内镜下切除残余肿瘤。结果全切11例,近全切3例。术后3例出现一过性脑脊液漏,尿崩5例。7例内分泌检查正常,8例视力好转,无严重并发症发生。结论内镜辅助单鼻孔经蝶入路能良好地显示蝶窦、鞍区等结构,弥补显微镜的盲区,而手术显微镜能提供三维视野,在经鼻入路过程及切除鞍区肿瘤主体具有优势,二者结合有利于肿瘤的全切除,手术创伤小,并发症少,患者恢复快。     

超低双侧额下入路切除巨大鞍区肿瘤的研究

目的 探讨一种改良双侧额下入路切除巨大鞍区肿瘤的可行性。方法 分别采用超低双侧额下入路(超低组)及传统单侧额下入路(传统组)切除巨大鞍区肿瘤40例,将手术疗效及并发症发生情况进行对比分析。结果 超低组大型肿瘤(2cm≤直径<4cm)10例,全切除9例、次全切1例;传统组7例,全切5例,次全切2例。超低组巨型肿瘤(4cm≤直径)15例,全切4例,次全切11例;传统组8例,次全切5例,部分全切3例,无1例全切。超低组的术后症状改善、并发症发生、肿瘤复发等方面均优于传统入路组。结论 超低双侧额下入路显露充分,切除率高,并发症少,复发率低,对于适合额下入路的巨型鞍区肿瘤的治疗优于传统的单侧额下入路。     

超低双侧额下入中切除巨大鞍区肿瘤的研究

目的 探讨一种改良双侧额下入路切除巨大鞍区肿瘤的可行性。方法 分别采用超低双侧额下入路（超低组）及传统单侧额下入路（传统组0切除巨大鞍区肿瘤40例，将手术疗效及并发症发生情况进行对比分析。结果 超低组大型肿瘤（2cm≤直径＜4cm）10例，全切除9例，次全切1例；传统组7例，全切5例，次全切2例。超低组巨型肿瘤（4cm≤直径）15例，全切4例。次全切11例；传统组8例，次全切5例，部分全切3例，无1例全切。超低组的术后症状改善，并发症发生，肿瘤复发等的方面均优于传统入路组。结论 超低双侧额下入路显露充分，切除率高，并发症少，复发率低，对于适合额下入路的巨型鞍区肿瘤的治疗优于传统的单侧额下入路。     

经双额底-内侧入路切除鞍区大型肿瘤(附8例报告)

目的探讨切除鞍区大型肿瘤的手术方法。方法采用经双额叶底－内侧入路治疗８例鞍区不同病理性质肿瘤，手术要点：①作全冠状皮肤切口，形成跨中线额低骨瓣，结扎前矢状窦、剪断大脑镰。②自双额底游离嗅神经至嗅三角。③自底内向外上牵开双额叶，暴露肿瘤，必要时截断前交通动脉。结果本组８例中肿瘤全切除５例，次全切除３例，术后症状不同程度改善。结论本入路由于手术视野明显扩大，适用于鞍区大型肿瘤的手术治疗。     

显微手术治疗垂体腺瘤(附57例分析)

目的总结经不同手术入路显微切除垂体腺瘤的临床经验。方法回顾性分析57例垂体腺瘤的临床资料。本组病人经不同手术入路切除垂体腺瘤。结果经额下入路全切12例,次全切3例,部分切除1例。经翼点入路全切8例,次全切2例。经单鼻孔-蝶窦入路全切23例,次全切6例,部分切除2例。经颅手术全切率为76.9%,经单鼻孔-蝶窦入路全切率为74%。结论微腺瘤与中、小型腺瘤及肿瘤向鞍上垂直生长,无海绵窦浸润及颈内动脉包裹的大腺瘤,经单鼻孔-蝶窦是首选术式。明显向鞍上生长的大腺瘤,若肿瘤明显偏向侧方侵犯海绵窦、颈内动脉、额叶底及鞍背后方者应采用经颅手术,且以翼点入路为佳。     

扩大经额入路显微手术切除大型鞍结节脑膜瘤

目的介绍扩大经额入路显微手术切除大型鞍结节脑膜瘤的手术入路,探讨其手术切除方法和疗效。方法回顾性分析我院自1994年6月至2002年8月采用扩大经额入路手术切除的15例大型鞍结节脑膜瘤患者的临床资料。结果本组15例中,肿瘤全切12例(SimpsonⅠ、Ⅱ级),次全切3例(SimpsonⅢ级);视力改善10例(66.7%),无严重手术并发症,无手术死亡病例。结论采用扩大经额入路切除大型鞍结节脑膜瘤,可提供良好的手术空间和视野;熟练掌握显微外科技术,仔细操作,能获得良好疗效。     

经颅显微外科手术治疗鞍区肿瘤（附20例报告）

目的探讨经颅单侧额下入路和翼点入路显微手术切除鞍区肿瘤的疗效。方法对15例位于鞍内、鞍上主要在轴线上的鞍区肿瘤采用一侧额下入路，5例偏轴线生长或巨大型向鞍旁、鞍后侵袭的肿瘤采用经翼点入路手术切除。结果肿瘤全切除10例，次全切除7例，大部分切除3例。术后14例发生短暂尿崩，10例出现低钠血症，1例出现高钠血症，无手术死亡病例。结论经颅额下和翼点入路切除鞍区肿瘤具有操作直观、显露良好、损伤小的优点，结合显微操作技术，可获得满意疗效。     

经颅切除鞍区大型肿瘤手术入路探讨

目的探讨经颅切除鞍区大型肿瘤的手术入路。方法对13例位于鞍内-鞍上轴线上的大型肿瘤采用一侧额下经眶入路手术；11例鞍上巨大型肿瘤和侵袭至鞍区周邻部位的肿瘤经眶-翼点入路切除。结果肿瘤全切除9例，次全切除9例，大部分切除6例。术后死亡1例，余无严重并发症，恢复良好。结论该两种手术入路具有操作简便、显露良好、脑牵拉轻和并发症少等优点，适于鞍区大型肿瘤的经颅手术切除。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

利培酮对精神分裂症患者生活质量的影响

目的：比较利培酮与氟哌啶醇对精神分裂症患者生活质量的影响。方法：对门诊72例服用氟哌啶醇及74例服用利培酮的精神分裂症患者用生活质量综合评定问卷（GQOLI）、阳性与阴性症状量表（PANSS）、副反应量表（TESS）进行评定。结果：利培酮组患者治疗后生活质量有所提高,而氟哌啶醇组患者生活质量有所下降。结论：利培酮治疗有利于患者提高生活质量。     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

Effect of high simple dose of cisplatinum and of radiation on the brain of rabbit

Abstract

In former studies of intracarotid and intravenous administration of cisplatinum, separate and combined with brain irradiation, we found no cerebral damage. In this study! gradually increasing high doses (above the therapeutic ones) of cisplatinum were administered intravenously to one series of rabbits arid increasing high amounts of irradiation (above the therapeutic amounts) were given to another series. Although the rabbits that received highest doses of irradiation developed areas of alopecia and skin ulcers on the head! the general clinical and histopathologic examination of the rabbits brains in both series was normal. The purpose of this study was to establish the effects of high doses of intravenous cisplatinum and irradiation on the rabbits brains. [Neural Res 1997; 19: 216–218]