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1.
以颞叶前内基底部痫灶为主引起的钩回发作称之为颞叶癫痫,它占所有癫痫病人的半数以上,是局灶性癫痫的代表。颞叶切除术和海马杏仁核切除术是治疗顽固性颞叶癫痫的一种经典而又常用的手术方式。本文主要根据近年来国内外研究领域的最新进展对颞叶及其周围组织的局部解剖结构和手术术式的选择及其优缺点、术中切除致痫灶的范围等进行阐述。  相似文献   

2.
本文对30例颞叶癫痫患者进行痫灶切除的研究。其中男性15例,女性15例。手术均在皮层脑电图监测下进行,术后总有效率为93%,重点讨论了颞叶癫痫的临床表现与痫灶定位。还根据皮层脑电图探查结果及手术切除颞叶的范围将颞叶癫痫分为五型,即:颞极型;内基底缘型;颞叶新皮层及后部型;岛叶及额叶底型;外侧及颞底型,这种分类对指导痫灶的切除有现实意义。  相似文献   

3.
难治性癫痫的外科治疗及术前评估   总被引:2,自引:2,他引:0  
癫痫是危害较大的神经系统常见病,其中约30%~40%属于难治性癫痫,近年来随着术前评估及外科手术技巧不断改进,特别是显微外科技术的应用,外科治疗尤其是对颞叶内侧癫痫的治疗疗效满意。癫痫的术前评估至关重要,手术效果与术前致痫灶定位准确与否密切相关。癫痫术前评估包括非侵袭性评估(I期)和侵袭性评估(II期),随着新的诊断技术的飞速发展,术前评估通过脑电图、脑磁图、CT、MRI、磁共振波谱、功能MRI成像、单光子发射计算机断层扫描和正电子发射计算机断层扫描等以确定病人致痫灶。癫痫手术方式主要有颞叶切除术、选择性杏仁核海马切除术、胼胝体切开术、大脑半球切除术等。本文就癫痫手术适应证、术前评估、手术方式等予以综述。  相似文献   

4.
颞叶癫痫21例手术治疗分析   总被引:1,自引:0,他引:1  
目的 探讨颞叶癫痫的外科治疗方法及效果。方法 21例颞叶癫痫患者,术前均行EEG、MRI检查,其中6例行PET检查,经定侧定位后,行手术治疗。其中13例行标准前颞叶切除术,5例行病灶切除 致痫灶切除,3例 行选择性海马杏仁核切除。术中应用皮层电极或深部电极进行监测;神经导航下海马钙化切除1例。结果 术后无明显并发症,均取得满意近期效果。结论 海马硬化是颞叶癫痫发生的主要原因;手术是治疗颞叶癫痫的重要手段,且疗效满意。  相似文献   

5.
报告1980年10月至1992年6月间,在皮质脑电描记下手术治疗颞叶癫痫55例,前颞叶切除50例.杏仁核海马切除5例。皮质脑电描记结果说明颞叶癫痫的痫灶绝大多数来源于颞叶外侧皮质和颞叶内侧结构。术中皮质脑电描记可提供痫灶的精确部位和范围。  相似文献   

6.
目的 探讨局灶性脑发育不良(FCD)的临床特征、病理学、影像学的特点及手术疗效.方法 42例外科手术切除致痫灶并经病理证实为FCD的患者中,根据Palmini病理学分型进行分类,并对其临床特征、影像学特点及手术疗效进行回顾性分析.结果 42例患者中,按致痫灶部位分类颢叶24例、额叶14例、顶叶6例及枕叶3例,其中多脑叶5例.术前影像学检查阳性率62%.组织学分型FCDⅠA型9例,FCDⅠB型21例,FCDⅡA型5例,FCDⅡB型7例,其中以FCD Ⅰ B型最为常见,多位于颞叶且常伴有海马硬化.所有患者术后至少随访1年以上,癫痫术后治愈率FCD位于颞叶67%,颞叶以外43%(EngleⅠa).结论 FCD是难治性癫痫常见的病理学改变,其病理分型与临床特征和致痫灶部位存在相关性,为制定手术方案和判定手术效果提供了依据.  相似文献   

7.
目的探讨颞叶占位性病变伴癫痫患者手术治疗的疗效,分析多种致痫灶定位技术的联合应用对手术疗效的影响。方法回顾性分析31例颞叶占位性病变伴癫痫患者术前脑电图及术后随访资料,其中囊性占位7例,海绵状血管瘤6例,胶质瘤16例,其他病变2例;应用MRI、视频脑电图、脑磁图行致痫灶定位,术中应用皮质脑电图再次精确致痫灶范围后行前颞叶联合海马切除术,术后随访评估疗效。结果长程VEEG监测中,20例患者均有惯常发作和发作间期痫样放电,14例(14/20)患者发作间期痫样放电位于单侧颞叶及海马区,其中合并同侧额区放电5例。6例(6/20)患者发作间期放电位于双侧颞叶,其中合并单侧额区放电2例。8例(8/20)起源于左侧颞叶及海马区,12例(12/20)起源于右侧。MEG检查20例患者发作间歇期皆有痫样放电,检出率为100%,17例(17/20)患者单侧颞叶放电,其中合并同侧额区放电8例;3例(3/20)患者双颞放电。术后随访12~24个月:16例患者Ⅰ级,3例Ⅱ级,1例Ⅲ级,手术有效率100%,效果良好率95%。结论颞叶占位性病变伴癫痫患者的手术治疗疗效好,多种致痫灶定位技术的联合应用可提高手术疗效并有效减少术后并发症。  相似文献   

8.
目的 探讨癫痫外科中边缘系统癫痫(LE)术前定位的复杂性以及临床中的相应对策.方法 选择致痫病灶位于边缘系统的局灶性癫痫患者3例,所有患者皆在我研究所实施了局灶性切除手术,术后随访1年以上效果良好.对这3例患者术前各项评估结果,包括发作症状、头皮脑电图(EEG)及MRI进行分析比较.结果 3例患者中,1例患者致痫灶位于右侧海马及海马旁回,但头皮EEG发作期与发作间期异常放电皆出现在对侧.另一例患者致痫灶位于右侧海马旁回后部,靠近穹隆.头皮EEG与发作症状显示患者为双侧独立起源的颞叶癫痫.最后1例致痫灶部位与第2例相似,但症状及头皮发作期EEG显示为额叶起源.结论 LE不论从症状、神经电生理还是在手术决策方面都非常复杂.颞叶内侧型癫痫头皮EEG可出现定位错误;临床表现为双侧颞叶癫痫的致痫灶可能来自位于颞叶后部中线附近的单一致痫灶;LE中致痫灶位于相似部位的患者,可以因致痫灶病理性质不同而表现出非常不同的临床表现.  相似文献   

9.
目的 探讨同步EEG-功能性MRI(fMRI)对颞叶癫痫致痫灶的定位作用.方法 对17例症状性颞叶癫痫患者进行同步EEG-fMRI检查.对EEG出现痫样放电时的fMRI数据进行分析,将痫样放电导致的脑组织血氧水平依赖信号改变区域叠加在MRI图像上,确定癫痫灶的位置;并与手术中脑皮质电极和深部电极EEG确定的致痫灶位置进行比较.结果 10例患者同步EEG-fMRI与皮质电极和深部电极EEG确定的致痫灶的位置和范围完全相同;另外7例患者同步EEG-fMRI确定的致痫灶中心位置与皮质电极和深部电极EEG相同,但范围比后者显示的扩大.癫痫灶切除术后14例发作控制,3例发作频率明显降低.结论 同步EEG-fMRI对颞叶癫痫致痫灶的定位准确,无创伤性;对手术定位具有可靠的指导作用.  相似文献   

10.
痫灶切除是提高疗效的关键,本文介绍寻找痫灶的体会。指出前颞叶切除、选择性杏仁核海马切除,胼胝体前部切开合并扣带回毁损,扩展了癫痫外科治疗的范围,并收到较好疗效。  相似文献   

11.
Abstract. The heterogeneity of published data regarding post-stroke depression (PSD) prompted an Italian multicenter observational study (DESTRO), which took place in 2000–2003. The investigation involved 53 Italian neurology centers: of these, 50 treat acute patients and 3 provide rehabilitation care; 21 centres are in Northern Italy, 20 are in Central Italy, and 12 are in Southern Italy. The time schedule was articulated into three phases: registration of 6289 stroke patients; selection of 1817 cases and enrolment of 1074 patients; and follow-up for two years (1064 patients). Mood assessment was performed by evaluating depressive symptoms according to DSM IV and the Beck depression inventory (visual analog mood scale for aphasic patients). Depressed patients were also administered the Montgomery-Asberg depression rating scale. Scores were related to function (Barthel index, modified Rankin scale), cognition (MMSE), quality of life (SF-36), and clinical data. Data analysis will provide information on PSD prevalence, onset and evolution, correlation with ischemic clinical syndrome, impact on activities of daily living, cognitive level and quality of life. The few data available at the present time concern PSD prevalence in the first six months after stroke (33.6%). DESTRO is a longitudinal investigation of a large patient sample and is expected to provide insights into the relationship of PDS with the functional and clinical consequences of stroke.* Participants in the DESTRO study include: G. Lagalla, M.G. Manicone, M. Del Gobbo, S. Paolini, Ancona; E. Bottacchi, G. Corso, Aosta; F. Federico, D. Martino, Bari; F. Salsa, E. Turinese, Bassano Del Grappa (VI); M. Gentile, S. Bogo, Belluno; M. Crisci, T. Sacquegna, Bologna; V. Santamato, G. Pietrarossa, Carbonara (BA); G. Coppola, G. Trianni, Casarano (LE); G. Pennisi, R. Bella, Catania; S. Ricci, K. Amantini, Città Della Pieve (PG); S. Buzzelli, L. Di Francesco, Città S. Angelo (PE); B. Antonelli, G. Pelliccia, Fermo (AP); E. Paolino, E. Iezzi, Ferrara; P. Nencini, C. Sarti, Florence; W. Neri, G. Galletti, Forli; S. Pretta, M. Del Sette, Genoa; E. Giaccaglini, C. Sconocchini, Iesi (AN); A. Carolei, C. Capannolo, LAquila; F.A. De Falco, R. Santangelo, Naples; R. Musolino, S. Gangemi, G. Vita, R. Di Leo, Messina; M. Comola, S. Mammi, M.A. Zamperetti, C.A. Defanti, S. Sommacal, G. Rudelli, Milan; V. Scarano, G. Coppola, Naples; M.T. Giordana, R. Sciolla, Orbassano (TO); G. Meneghetti, M. Ottina, Padua; A. Ponari, R. Castiglia, Palermo; D. Mancia, C. Zanferrari, Parma; G. Micieli, E. Zambrelli, Pavia; G. Cardaioli, V. Gallai, Perugia; R. Badino, T. Tassinari, Pietra Ligure (SV); G. Orlandi, S. Fanucchi, Pisa; G. Ciucci, G. Padoan, Ravenna; F. Gasparini, D. Guidetti, Reggio Emilia; D. De Angelis, G.A. Amabile, G. Fiermonte Rome; C. Roberti, A. Foti, Roma; L. Cainelli, M. Chiusole, Rovereto (TN); S. Pasqualino, D. Intiso, S. Giovanni Rotondo (FG); M. Tonizzo, A. Basile, S. Vito al Tagliamento (PN); P. Viviani, SantArsenio (SA); M.L. Stromillo, A. Federico, Siena; W. Liboni, E. Pavanelli, B. Bergamasco, P. Cerrato, A. Boghi, A. Cicolin, C. Berra, Turin; M. Zorzon, M.A. Tommasi, F. Chiodo Grandi, N. Koscica, Trieste; B. Micoli, R. Lorio, Venice; P. Bovi, G. Trabucco, Verona; D. Consoli, F. Galati, Vibo Valentia; F. Bortolon, M. Morra, Vicenza; V. Crespi, M. Braga, Vimercate (MI).  相似文献   

12.
Arachnoid cysts in children: a European co-operative study   总被引:5,自引:5,他引:0  
The data on arachnoid cysts in children (0–15 years) operated upon between 1980 and 1988 were analysed in a retrospective, co-operative study. The results from 285 patients indicate a predominance of these lesions in boys (64%) more than girls (36%) and a mean age of 6 years at onset of symptoms. Focal EEG patterns corresponding to the cyst's location were encountered in 32%. About 40% of all cysts were located along the midline, the sylvian fissure representing the predominant location. Open surgery, i.e. total excision or marsurpialization (together 43.3%), emerged as the first-choice surgical procedure. The type of surgery switched somewhat to shunting procedures in cases of lesions in deeper locations (22.8%). Morphological results on follow-up revealed a reduction of the size of the cyst in a significant majority (61%); in 18% the cyst had disappeared completely on CT scans. There was an obvious correlation between postoperative morphological findings and clinical outcome.M. Colangelo, Department of Neurosurgery, Naples. Italy; L. Cristante and H.-D. Hermann, Department of Neurosurgery, Hamburg, FRG; C. Di Rocco, M. Caldarelli, and A. Ceddia, Department of Neurosurgery, Rome, Italy; J. Haase, Department of Neurosurgery, Aalborg, Denmark; A. D. Hockley, Department of Neurosurgery, Birmingham, UK; G. Kaiser, Department of Pediatrics, Bern, Switzerland; E. Kraus and H.-P. Jensen, Department of Neurosurgery, Kiel, FRG; M. Lange and R. Oeckler, Department of Neurosurgery, Munich, FRG; R. Lorenz, K. Franz, and J. Seeger, Department of Neurosurgery, Frankfurt/M., FRG; M. Marinov, Department of Neurosurgery, Sofia, Bulgaria; G. Mittermaier, Department of Pediatrics, and G. Schackert, Department of Neurosurgery, Heidelberg, FRG; M. Mühlbauer, Department of Neurosurgery, Vienna, Austria; R. W. Oberbauer and R. Pucher, Department of Neurosurgery, Graz, Austria; W. Peul and R. Braakman, Department of Neurosurgery, Rotterdam, The Netherlands; K. E. Richard, Department of Neurosurgery, Cologne, FRG; W. Serlo, Department of Paediatrics, Oulo, Finland; R. M. Villani, G. Tomei, and D. Spagnoli, Department of Neurosurgery, Milan, Italy  相似文献   

13.
Book reviews     
Norris JW, Hachinski VC, eds. Prevention of stroke.
Currier RD, Crowell RM, eds. The year book of neurology and neurosurgery 1991.
Gutin PH, Leibel SA, Sheline G, eds. Radiation injury to the nervous system.
Takeshita H, Siesjö BK, Miller JD, eds. Advances in brain resuscitation.
Freymoyer JW, Ducker TB, Hadler NM, Kostuik JP, Weinstein JN, Whitecloud HI TS, eds. The adult spine, Principles and practice.
Glasscock III ME, Cueva RA, Thedinger BA. Handbook of vertigo.
Ganten D, Pfaff D, eds. Behavioral aspects of neu-roendocrinology.
Leech RW, Brumback RA, eds. Hydrocephalus.
Yanagihara T, Petersen RC, eds. Memory disorders.
Eggermont JJ. The correlative brain.  相似文献   

14.
Books Received     
Mc. Alpine, D., C. E. Lumsden, E. D. Acheson , A re-appraisal.
Smith, B. H. , Principles of Clinical Neurology
M. Mumenthaler, H. Schliack, Torben Fog , Läsionen periphärer Nerven
E. Ettlinger , Functions of the Corpus Callosum
J. C. Scotto , L'hyperostose frontale interne
D. Ingvar, N. Lassen , Regional Cerebral Blood Flow
Michaelis, L. , Orthopaedic surgery of the limbs in paraplegia
Adolf Juba , Pathologie des Ballismus
I. Taylor , The neurological mechanisms of hearing and speech in Children
F. Mellerio , L'electroencéphalographie dans les intoxications aigués
T. W. Farmer , Pediatric Neurology
P. Bourret, R. Louis , Anatomie du systéme nerveux central
M. Brazier , Brain Function. Vol. II. RNA and brain function; memory and learning
E. Gutmann, P. Hnik , The effect of use and disuse on neuromuscular functions
R. G. Siekert, J. P. Whisnant , Cerebral Vascular Disease
Excerpta Medica Foundation , Third International Congress of Neurological Surgery, Copenhagen, August 1965
H. W. Delank , Das Eiweissbild des Liquor cerebrospinalis und seine klinische Bedeutung
Schadé, J. P., D. H. Ford , Basic Neurology
C. Bernhard, E. Bohm , Local Anaesthetics as Anticonvulsants
M. Singer, J. Schadé , Degeneration Patterns in the Nervous System
K. Akert, C. Bally, J. Schadé, H. Pakkenberg , Sleep Mechanisms  相似文献   

15.
Risk of cancer in patients with Guillain-Barré syndrome (GBS)   总被引:1,自引:0,他引:1  
Abstract. The possible relationship between Guillain-Barré syndrome (GBS) and cancer is still controversial and the existence of a paraneoplastic GBS remains unconfirmed. To better define whether there is a relationship between GBS and malignancy, we compared the observed and the expected number of patients with tumours in a population-based cohort of subjects with GBS. Clinical differences between GBS patients with or without malignancies were analysed. Data were obtained from the Piemonte and Valle dAosta Register for GBS (PARGBS) (years 1990–1998). GBS was diagnosed according to NINCDS criteria. The number of expected cases of malignancy in the PARGBS population was calculated using the incidence rate of all types of cancer (ICD codes 140–208) in Piemonte [1985–1987], and in the most important town of this region, that is Turin (years 1993–1997). In the nine-year period, 435 incident patients with GBS were found. Nine of them developed cancer in the six months preceding or following GBS; in seven of them, the diagnosis of cancer and GBS was concomitant. The expected number of malignant tumours was 3.7 (using the incidence in Piemonte) and 3.8 (using the incidence in Turin); therefore, the odds ratios were 2.43 (95 % CI, 1.11–4.62) and 2.37 (95% CI, 1.09–4.50), respectively (p < 0.01). Although the cases with malignancies were clinically similar to the other cases of GBS observed through the Register, the mortality in GBS patients with cancer was higher and was the final cause of death in two patients affected by severe cancer. These results suggest a possible correlation between some cases of GBS and cancer. However, GBS in cancer patients does not meet all the criteria for paraneoplastic diseases.* Piemonte and Valle dAosta Register for GBS (PARGBS): Coordinating center: 2nd Division of Neurology, Department of Neuroscience, University of Torino, Italy. Project coordinator: A. Chiò, MD. Study monitors: A. Calvo, MD, N. Di Vito, MD, M. Vercellino, MD. Scientific Committee: A. Bertolotto, MD, E. Bottacchi, MD, A. Chiò, MD, D. Cocito, MD, M. T. Giordana, MD, M. Leone, MD, L. Mazzini, MD, G. Mora, MD. Collaborating centers: A. Chiò, MD, A. A. Terreni, MD, D. Schiffer, MD, R. Mutani, MD, D. Cocito, MD, B. Bergamasco, MD, I. Rainero, MD (Department of Neuroscience, Section of Neurology, University of Torino, and Azienda Ospedaliera San Giovanni Battista, Torino), A. Bertolotto, MD, A. Tribolo, MD, R. Sciolla, MD, F. Mondino, MD, M. T. Giordana, MD (Department of Neuroscience, Section of Neurology, University of Torino, and Azienda Ospedaliera San Luigi Gonzaga, Orbassano), M. Leone, MD, P. Gaviani, MD, F. Monaco, MD (Department of Neurology, Amedeo Avogadro University, Novara), M. De Mattei, MD, E. Morgando, MD (Department of Neurology, Azienda Ospedaliera San Giovanni, Torino), L. Sosso, MD, M. Gionco, MD (Department of Neurology, Ospedale Mauriziano, Torino), U. Morino, MD, M. Nobili, MD (Department of Neurology, Ospedale Martini, Torino), L. Appendino, MD (Department of Neurology, Ospedale Maria Vittoria, Torino), D. Piazza, MD (Department of Neurology, Ospedale S. Giovanni Bosco, Torino), E. Oddenino, MD, W. Liboni, MD (Department of Neurology, Ospedale Gradenigo, Torino), G. Vaula, MD, G. Ferrari, MD (Department of Neurology, Ivrea), M. Favero, MD, C. Doriguzzi Bozzo, MD (Department of Neurology, Pinerolo), P. Santamaria, MD (Department of Neurology, Vercelli), U. Massazza, MD, E. Bollani, MD (Department of Neurology, Biella), A. Villani, MD, R. Conti, MD (Department of Neurology, Domodossola), G. Mora, MD, C. Balzarini, MD (Department of Neurological Rehabilitation, Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Scientific Institute of Veruno), M. Palermo, MD (Department of Neurology, Alessandria), F. Vergnano, MD (Department of Neurology, Casale Monferrato), S. Cordera, MD, C. Buffa, MD (Department of Neurology, Novi Ligure), M. T. Penza, MD (Department of Neurology, Tortona), F. Fassio, MD (Department of Neurology, Asti), P. Meineri, MD (Department of Neurology, Azienda Ospedaliera Santa Croce e Carle, Cuneo), A. Cognazzo, MD, C. Mocellini, MD, A. Dutto, MD, A. Cucatto, MD (Department of Neurology, Savigliano), C. Cavestro, MD, W. Troni, MD (Department of Neurology, Alba), G. Corso, MD, E. Bottacchi, MD (Department of Neurology, Aosta).  相似文献   

16.
IIIrd International Symposium On Neural Transplantation from Molecular Bases to Clinical Application(6th - 11th August 1989, Cambridge, U.K.)International Organising Committee: A. Aguayo, A. Bj?rklund, S.B. Dunnett, WJ. Freed, F.H. Gage, D.M. Gash, S.D. Iversen, R.D. Lund, C.D. Marsden, L. Olson, J. Sladek, C. Sotelo.Local Organising Committee: L.E. Annett, DJ. Clarke, S.B. Dunnett, P.C. Emson, B.J. Everitt, O. Isacson, S.D. Iversen, S.-J. Richards, J.D. Rowell, D.J.S. Sirinathsinghji.  相似文献   

17.
In September 1996, during a carpal tunnel syndrome (CTS) symposium, the Italian CTS Study Group was funded. The group designed a strict clinical and neurophysiological protocol for performing a wide multicentre study on idiopathic CTS in hands. In addition to the traditional evaluations, the group also adopted a validated patient-oriented measurement in order to obtain comprehensive and reliable data for the clinical picture. The study was designed to: (1) better assess the clinical picture of the CTS population, especially using new measurement tools (patient-oriented); (2) evaluate the sensitivity of an electrodiagnostic protocol; (3) re-evaluate the validity of a neurophysiological classification; and (4) evaluate the influence of social status and quantify some of the aspects regarding economic and social costs. The study design is described.Participating members of the Italian CTS Study Group: L. Bertin, Padova; T. Carboni, Neurology, Civil Hospital S. Benedetto del Tronto (AP); P.G. Di Pasqua, Neurology, Paediatric Hospital Bambin Gesù, Palidoro (RM); R. Eleopra, Neurology Division, Arcispedale S. Anna, Ferrara; F. Giannini, Institute for Nervous and Mental Diseases, University of Siena; P. Girlanda, Institute of Neurological and Neurosurgical Sciences, University of Messina; M. Giunchedi, Neurophysiology Laboratory, Hospital of Lavagna (GE); A. Grippo, Neurophysiopathology, Civil Hospital, Viareggio (LU); A. Insola, Neurophysiopathology, Orthopaedic Trauma Centre, Rome; R. Liguori, Neurology, University of Bologna; S. Lori, Neurophysiopathology, ASL 10, Florence; R. Lucchetti, Department of Orthopaedics, Traumatology & Hand Surgery, State Hospital, San Marino (RSM); E. Mariani, Neurophysiopathology, Clinical Institute for Specialization, Milano; D. Murasecco, Neurology, University of Perugia; L. Padua, Neurology, Catholic University, Rome; F. Pisano, Neurophysiopathology, S. Maugeri Foundation IRCCS, Veruno (NO); M. Romano, Neurophysiopathology, Villa Sofia CTO, Palermo; C. Speranzini, Neurology, Hospital A. Murri, Fermo (AP); E Tironi, Neurophysiopathology, Ospedali Riuniti, Bergamo; A. Uncini, Regional Centre for Neuromuscular Diseases, Hospital SS Annunziata, Chieti  相似文献   

18.
Background Although residential facilities (RFs) have largely replaced mental hospitals (MHs) in most developed countries for the long-term residential care of severely impaired patients, the process of care in RFs has not been well studied. The aim of this paper is to investigate the process of care in 265 RFs, representing 19.3% of all RFs in Italy, and to devise a classification of RFs based on process characteristics.Methods Structured interviews were conducted with the manager and staff of each RF. Residents were evaluated using standardized rating instruments.Results Most RFs had specific admission criteria, with one third having a waiting list that averaged about 3 months. There was no formal limitation to the length of stay in three quarters of RFs, and turnover rates were very low. Although a homelike atmosphere was found in many RFs, most facilities had restrictive rules on patients’ daily lives and behaviours. RFs carried out several external activities targeted at integrating patients within the local community. Standardized assessment instruments and written treatment plans were rarely used. A cluster analysis based on the levels of restrictiveness and the standardization of the process of care classified RFs into five groups that differed with respect to daily staff coverage, size, geographical distribution and proportion of former MH residents. No significant intercluster differences were associated with the current clinical and psychosocial characteristics of residents, or with several other outcome variables.Conclusions This study provides naturalistic evidence of the heterogeneity of the process of residential care on a large scale. Future efforts should focus on developing an empirical classification of RFs, as well as on national and international standards of care and staffing to address patients’ needs.The PROGRES Group includes: National Coordinators: G. de Girolamo, A. Picardi, P. Morosini (National Mental Health Project, National Institute of Health); Biostatistician: R. Micciolo (University of Trento); Regional Coordinators: P. Argentino, M. Casacchia, P. Ciliberti, G. Civenti, A. Colotto, G. Dell’Acqua, W. Di Munzio, G. Fagnano, A. Fioritti, N. Longhin, M. Miceli, M. Nicotera, M. Pisetta, R. Putzolu, E. Rossi, M. E. Rotunno, G. Borsetti, D. Semisa, R. Tomasi, P. Tulli, E. Zanalda; Researchers: C. Barbini, F. Basile, G. Bazzacco, R. Bracco, A. Calvarese, G. Canuso, E. Caroppo, L. Caserta, M. Colangione, S. Damiani, T. De Donatis, F. Di Donato, V. Di Michele, R. Esposito, M. Facchini, S. Ferraro, P. Fracchiolla, P. Gabriele, D. Gallicchio, G. Giardina, A. Greco, F. Grilletti, S. Guzzo, A. M. Lerario, M. R. Marinelli, C. Marino, E. Monzani, F. Picoco, L. Pinciaroli, C. A. Rossetti, P. Rubatta, G. Santone, F. Scorpiniti, V. Scrofani, M. Stefani, A. Svettini, A. Zaffarano, M. Cellini, A. Galli, K. Pesaresi, G. Pitzalis, L. Tarantino; Scientific Consultants: F. Amaddeo, I. Falloon  相似文献   

19.
Organotypic brain slice cultures have been used in a variety of studies on neurodegenerative processes [K.M. Abdel-Hamid, M. Tymianski, Mechanisms and effects of intracellular calcium buffering on neuronal survival in organotypic hippocampal cultures exposed to anoxia/aglycemia or to excitotoxins, J. Neurosci. 17, 1997, pp. 3538-3553; D.W. Newell, A. Barth, V. Papermaster, A.T. Malouf, Glutamate and non-glutamate receptor mediated toxicity caused by oxygen and glucose deprivation in organotypic hippocampal cultures, J. Neurosci. 15, 1995, pp. 7702-7711; J.L. Perez Velazquez, M.V. Frantseva, P.L. Carlen, In vitro ischemia promotes glutamate mediated free radical generation and intracellular calcium accumulation in pyramidal neurons of cultured hippocampal slices, J. Neurosci. 23, 1997, pp. 9085-9094; L. Stoppini, L.A. Buchs, D. Muller, A simple method for organotypic cultures of nervous tissue, J. Neurosci. Methods 37, 1991, pp. 173-182; R.C. Tasker, J.T. Coyle, J.J. Vornov, The regional vulnerability to hypoglycemia induced neurotoxicity in organotypic hippocampal culture: protection by early tetrodotoxin or delayed MK 801, J. Neurosci. 12, 1992, pp. 4298-4308.]. We describe two methods to induce traumatic cell damage in hippocampal organotypic cultures. Primary trauma injury was achieved by rolling a stainless steel cylinder (0.9 g) on the organotypic slices. Secondary injury was followed after dropping a weight (0.137 g) on a localised area of the organotypic slice, from a height of 2 mm. The time course and extent of cell death were determined by measuring the fluorescence of the viability indicator propidium iodide (PI) at several time points after the injury. The initial localised impact damage spread 24 and 67 h after injury, cell death being 25% and 54%, respectively, when slices were kept at 37 degrees C. To validate these methods as models to assess neuroprotective strategies, similar insults were applied to slices at relatively low temperatures (30 degrees C), which is known to be neuroprotective [F.C. Barone, G.Z. Feuerstein, R.F. White, Brain cooling during transient focal ischaemia provides complete neuroprotection, Neurosci. Biobehav. Rev. 1, 1997, pp. 31-44; V.M. Bruno, M.P. Goldberg, L.L. Dugan, R.G. Giffard, D.W. Choi, Neuroprotective effect of hypothermia in cortical cultures exposed to oxygen glucose deprivation or excitatory aminoacids, J. Neurochem. 4, 1994, pp. 387-392; G.C. Newman, H. Qi, F.E. Hospod, K. Grundhmann, Preservation of hippocampal brain slices with in vivo or in vitro hypothermia, Brain Res. 1, 1992, pp. 159-163; J.Y. Yager, J. Asseline, Effect of mild hypothermia on cerebral energy metabolism during the evolution of hypoxic ischaemic brain damage in the immature rat, Stroke, 5, 1996, pp. 919-925.]. Low temperature incubation significantly reduced cell death, now being 9% at 24 h and 14% at 67 h. Our results show that these models of moderate mechanical trauma using organotypic slice cultures can be used to study neurodegeneration and neuroprotective strategies.  相似文献   

20.
Abstract. Background: This review traces the 12-year history of an international collaboration of researchers—the WHOQOL Group—who were brought together by the World Health Organisation to develop and produce a cross-cultural measure of quality of life for use in health and health care. Discussion: The theoretical and philosophical basis of the WHOQOL instrument is outlined as it evolved throughout the design and adjustment of a reflexive methodology that places an assessment of the users views at the centre of health care. The stages of research are further expanded and explained in recounting the scientific experience of this unique collaboration. The WHOQOL is available in 40 countries and most majority languages. Adaptations exist for assessing particular conditions, e. g. spirituality, religion and personal beliefs.1 The paper is based on data and experience obtained as part of the WHO study to develop a QoL measure (WHOQOL). The collaborators in this study have been at WHO Geneva: Dr. Norman Sartorius, Dr. J. Orley, Dr. Willem Kuyken and Dr. Mick Power. In the Field Research Centres collaborating investigators are Prof. Helen Herrman, Dr. H. Schofield and Ms B. Murphy, Univ. of Melbourne, Australia, Prof. Z. Metelko, Prof. S. Szabo and Mrs. M. Pibernik-Okanovic, Institute of Diabetes, Endocrinology and Metabolic Diseases and Dept. of Psychology, Faculty of Philosophy, Univ. of Zagreb, Croatia, Dr. N. Quemada and Dr. A. Caria, INSERM, Paris, France, Dr. S. Rajkumar and Mrs. Shuba Kumar, Madras Medical College, India, Dr. S. Saxena, All India Institute of Medical Sciences, Delhi, India, Dr. D. Baron and Dr. M. Amir, Ben Gurion Univ., Beer Sheeva Israel, Dr. Miyako Tazaki, Dept. of Science, Science Univ. of Tokyo, Japan and Dr. Ariko Noji, Dept. of Community Health Nursing, St. Lukes College of Nursing, Japan, Dr. G. van Heck and Mrs. J. de Vries, Tilburg Univ., The Netherlands, Prof. J. Arroyo-Sucre and Prof. Pichard-Ami, Univ. of Panama, Panama, Prof. M. Kabanov, Dr. A. Lomachenkov, and Dr. G. Burkovsky, Bekhterev Psychoneurological Institute, St. Petersburg, Russia, Dr. R. Lucas Carrasco, Barcelona, Spain, Dr. Yooth Bodharamik and Mr. Kitikorn Meesapya, Institute of Mental Health, Bangkok, Thailand, Dr. S. Skevington, Dept. of Psychology, Univ. of Bath, Bath, UK, Dr. D. Patrick, Ms M. Martin and Ms D. Wild, Univ. of Washington, Seattle, USA and Prof.W. Acuda and Dr. J. Mutambirwa, Univ. of Zimbabwe, Harare,Zimbabwe. An international panel of consultants includes: Dr. N. K. Aaronson, Dr. P. Bech, Dr. M. Bullinger, Dr. He-Nian Chen, Dr. J. Fox-Rushby, Dr. C. Moinpur and Dr. R. Rosser. Consultants who have advised WHO at various stages of the development of the project have included: Dr. D. Buesching, Dr. D. Bucquet, Dr. L. W. Chambers, Dr. B. Jambon, Dr. C. D. Jenkinson, Dr. D. De Leo, Dr. L. Fallowfield, Dr. P. Gerin, Dr. P. Graham, Dr. O. Gureje, Dr. K. Kalumba, Dr. Kerr-Corea, Dr. C. Mercier, Mr. J. Oliver, Dr. Y. H. Poortinga, Dr. R. Trotter and Dr. F. van Dam  相似文献   

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