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1.
高血压脑出血不同术式治疗疗效的回顾性研究   总被引:20,自引:1,他引:19  
目的探讨高血压脑出血手术治疗方法及其适应证的选择和疗效。方法收集我院1998年1月-2003年7月采用定向引流、小骨窗开颅及骨瓣开颅三种术式治疗高血压脑出血158例,按照GCS评分和血肿量各分为3个亚组,并对各不同术式的手术适应症和疗效作一对比分析,最后得出结论。结果对高血压脑出血GCS评分较高(11~14分)、血肿量较小(20~50mL)的病人选用定向引流可降低致残率,中等量血肿(51~80mL)的病人采用小骨窗开颅能明显减少致残率,巨大血肿(〉80mL)的病人采用骨瓣开颅能明显降低死亡率。结论高血压脑出血手术治疗三种术式各有其优缺点,但小骨窗开颅具有手术创伤小,病人恢复快,并能及时有效地解除脑受压的特点,现不失为一种治疗高血压脑出血有效的治疗方法。  相似文献
2.
Early Treatment and Prognosis of Epilepsy   总被引:14,自引:14,他引:10  
E. H. Reynolds 《Epilepsia》1987,28(2):97-106
Community-based studies and our own prospective hospital-based studies suggest that the prognosis for control of epilepsy is more favorable than previously reported. Approximately three quarters of newly diagnosed patients can enter prolonged remission on currently available medication. The first 2 years of treatment are crucial in determining the subsequent course of epilepsy. The longer seizures continue, the less likely they are to be controlled. Factors that contribute to the evolution of chronic epilepsy are the presence of brain lesions, neuropsychiatric handicaps, and poor compliance. Early effective treatment may also be important in preventing the evolution of chronic epilepsy. Recent studies have not revealed any significant differences in efficacy between the major antiepileptic drugs, and the choice of drug will therefore be influenced by costs and side effects, especially cognitive and behavioral effects. The majority of patients with a single unprovoked tonic-clonic seizure go on to develop epilepsy. Studies are required to evaluate the need for and outcome of therapy in such patients. Information about the natural history of untreated epilepsy, and also the possible influence of drug therapy on the prospects for spontaneous remission, is lacking.  相似文献
3.
脊髓髓内肿瘤的手术治疗   总被引:12,自引:12,他引:84  
目的:探讨各种病理类型的脊髓髓内肿瘤临床和影像学的鉴别诊断,肿瘤囊腔及其空洞的形成机理,脊髓前动脉在病理状态下的作用及各种肿瘤的手术切除技巧。方法:系统分析了经显微手术切除的104例(116个)髓内肿瘤,包括室管膜瘤,星形细胞瘤,血管网状细胞瘤等十余种病理类型的临床资料,并进行了动物脊髓血管闭塞模型的研究。结果:全组无手术死亡率,亦无手术致残者。绝大多数病人得到满意疗效,并保证了患者良好的术后存活质量。结论:对于绝大多数髓内肿瘤,显微外科手术治疗是目前最根本的治疗方法。强调早期治疗及对不同肿瘤采取相应的微创性手术技巧。对于那些疯狂侵润性生长的恶性肿瘤,要考虑一定剂量的常规放射治疗。  相似文献
4.
Mortality and Morbidity from Serial Seizures   总被引:11,自引:11,他引:2  
5.
Epilepsy in Pakistan: A Population-Based Epidemiologic Study   总被引:11,自引:11,他引:4  
Summary: A house-to-house, cross-sectional, population study of epilepsy on 24,130 individuals of all ages from southern Pakistan indicates an age-specific prevalence rate of 9·99 in 1,000 (14·8 in 1,000 in rural and 7·4 in 1,000 in urban areas) for recurrent, non febrile "active" epilepsy in Pakistan. Mean onset of epilepsy was 13·3 years, and 74·3% epileptic persons were aged <19 years at onset of the disorder. The most common seizure type was ton-icclonic in 77% [primary generalized tonic-clonic (GTC) in 59% and secondarily generalized in 18%], simple partial (SPS) in 5%, complex partial (CPS) in 6%, generalized absence in l%, tonic in 3%, and myoclonic in 3% cases. Multiple seizure types in the same person were evident in 9·6% of only the generalized group. A putative cause could be suggested in 38·4% of cases: 32% had a positive family history of epilepsy, most common among siblings. Common perceived precipitants included fever in 29·2% and emotional disturbances in 16·6%. Only 3% of epileptic persons believed that their illness was due to supernatural causes. Treatment status was very poor, with only 2% rural and 27% urban epileptic persons receiving antiepileptic drugs (AEDs) at the time of the survey. We discuss the logistic and management problems of population-based epidemiologic studies in developing countries.  相似文献
6.
Antiepileptic Drugs and the Electroencephalogram   总被引:10,自引:10,他引:2  
John S. Duncan 《Epilepsia》1987,28(3):259-266
The usefulness of electroencephalography (EEG) as an aid to diagnosis of seizure disorders is established, but its role as a guide to monitoring treatment is much less certain. For those patients with classical absences and 3-s spike wave activity there is a very close correlation between control of clinically detected seizures and EEG events. In some, but not all, patients with other seizure disorders there is a positive correlation between numbers of seizures and amount of interictal epileptiform activity (IEA). Intravenous benzodiazepines and phenytoin result in both acute seizure control and suppression of IEA. For seizures other than absences, and antiepileptic drugs (AEDs) given in the medium and long term, there is generally not a clear relationship between control of seizures and IEA. In studies of children whose epilepsy is in remission, persistent IEA has been associated with a higher risk of seizure relapse should AEDs be discontinued, but in adults the relevance of persistent IEA appears to be much less certain. Benzodiazepines and barbiturates result in increased fast activity. All AEDs may result in slowing of the dominant rhythm and increased slow activity. Carbamazepine, in particular, is often associated with apparent deterioration of background activity, even in the face of clinical improvement. Further studies are necessary to determine the mechanisms and significance of AED-induced changes in EEG background activity.  相似文献
7.
The time required for hippocampal seizure activity to propagate to the contralateral hippocampal formation was evaluated in 57 patients with complex partial seizures and related to histological findings following temporal lobectomy. Interhemispheric propagation times were found to be significantly longer (greater than 20 s) in those patients diagnosed as having hippocampal sclerosis than in those patients without hippocampal sclerosis. Quantitative analysis of cell densities was made in 28 patients. Dentate fascia granule densities and hippocampal pyramidal cell densities were found to be lower in those patients with longer interhemispheric propagation times. However, this relationship was not observed when only patients with hippocampal sclerosis were considered. Thus, a tendency for hippocampal seizures to exhibit interhemispheric propagation times greater than 20 s is suggestive of underlying hippocampal sclerosis. However, information about interhemispheric propagation time does not appear useful for estimating the actual degree of cell loss within the sclerotic hippocampus. The association of longer interhemispheric propagation times with hippocampal sclerosis supports the hypothesis that direct commissural connections between the hippocampal formations in humans are either unimportant or missing.  相似文献
8.
Summary: Purpose: To determine the incidence of psychiatric disorders before and after surgical treatment for partial epilepsy and to document the effectiveness of their treatment.
Methods: Fifty consecutive patients treated surgically for focal epilepsy (44 temporal and six frontal) were evaluated by established neuropsychiatric methods before surgery and over a mean period of 2 years after surgery. The patients with interictal dysphoric disorders, with or without psychotic episodes, were treated with tricyclic antidepressant medication alone or combined with serotonin selective reuptake inhibitors and, if necessary, with the addition of risperidone.
Results: Before surgery, 25 (57%) of the 44 patients with temporal lobe epilepsy had dysphoric disorders. After surgery, 17 (39%) of the 44 patients experienced either de novo psychiatric complications (six psychotic episodes, six dysphoric disorders, and two depressive episodes) or exacerbation of preoperative dysphoric disorder (three patients). Eight previously intact patients of the 19 (42%) developed dysphoric disorders after surgery that were significantly related to recurrence of seizures. All psychiatric complications occurred in the first 2 months after surgery, except for the six patients intact before surgery, who had a recurrence of seizures. A significant predictor of ultimate excellent psychiatric outcome was complete absence of seizures after surgery. All postoperative psychiatric complications remitted on treatment with psychotropic medication in the compliant patients.
Conclusions: An exceptional psychiatric morbidity is associated with the months after temporal lobectomy. Possible pathogenetic mechanisms are discussed. Antidepressant drugs are very effective in treating the psychiatric disorders of chronic epilepsy; their use in conjunction with the surgical treatment of epilepsy appears to be crucial for the overall positive outcome of a significant number of patients.  相似文献
9.
中国七城市卒中患者急诊溶栓情况分析   总被引:9,自引:2,他引:7  
目的超早期重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)溶栓治疗是缺血性卒中有效的治疗方法,但目前缺血性卒中救治过程中存在溶栓率偏低的问题,本调查的目的在于了解实际溶栓状况及未溶栓原因。方法本调查在中国的7个城市51家中心展开前瞻性调查,调查采用标准的登记数据,内容包括患者的一般人口学信息、院前卒中急救信息、院前院内关键延误时间、溶栓信息等。结果在研究期间,共有1091例患者确诊符合入选标准,其中754例(69.6%)急性缺血性卒中患者中共有20例(2.7%)患者溶栓,其中静脉rt-PA15例、动脉rt-PA2例、静脉尿激酶(Urokinase,UK)5例。在静脉rt—PA中,93.5%(14/15)存在方案违背。大部分病例(17/20)在2呐就到达了医院,院前延迟平均中位时间为1.17h。急诊接诊到获得检查(CT或磁共振)平均中位时间为0.67h。未进行溶栓的主要原因除年龄(〉80岁或〈18岁)(28.9%)、卒中症状太轻(24.0%)、病情迅速恢复(16.5%)、CT影像已有病灶(15.7%)、时间〉5h(15.7%)、卒中症状太重(7.4%)等因素外,患者/家属主观拒绝仍占了18.2%。结论急性缺血性卒中溶栓比例偏低,溶栓药物使用不规范且存在方案违背,存在院前延迟问题,亟待整合院前急救中心与医院间医疗资源,规范院前转运途径,缩短延误时间,提高溶栓率。  相似文献
10.
中枢神经细胞瘤的诊断和治疗   总被引:9,自引:0,他引:9  
目的深入认识中枢神经细胞瘤,以期提高本病的诊疗水平。方法回顾性总结我科22例中枢神经细胞瘤的临床表现、影像学检查、诊断及治疗效果。结果所有22例均手术治疗,术后11例全切除病例中4例联合放射治疗,8例次全切除病例中3例联合放射治疗、1例化疗,3例部分切除病例中1例联合放射治疗、1例化疗。死亡7例,失访6例,其余9例随访2个月至35年,均未见肿瘤复发或再长。结论脑室内中枢神经细胞瘤手术风险较大,死亡率较高;运用显微神经外科及术中导航技术切除肿瘤可有效降低致残率和死亡率;联合术后放疗可减少本病复发;化疗的疗效有待评价。  相似文献
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