手术切除结合术后间质内放化疗治疗脑恶性胶质瘤

目的 探讨脑恶性胶质瘤切除术后结合间质内放疗并间质内化疗的临床疗效.方法 32例脑恶性胶质瘤均行显微神经外科手术全切除或次全切除,术中根据术前计算机三维治疗计划系统（TPS）在瘤床上植入^125 I放射性粒子行组织间持续内照射,总量为50～60 Gy,同时于瘤腔内放置Ommagy化疗囊,术后1周开始应用盐酸尼莫司汀（ACNU）行间质化疗,每周1次,连续6周.随访观察肿瘤复发率、患者生存率、中位生存期.结果 32例患者1、2年复发率分别为31.2%、68.8%,1、2、5年生存率分别为94.3%、80.6%、29.1%,中位生存期为92.3周;无明显放疗、化疗并发症.结论 在手术力争全切除肿瘤基础上结合术后间质内放疗、化疗治疗脑恶性胶质瘤,疗效较好,安全而且并发症少.     

神经胶质瘤的免疫治疗（综述）

神经胶质瘤是一种最常见的颅内肿瘤，统计资料表明其发生率约占全部颅内肿瘤的40％。虽然手术切除肿瘤、放疗、化疗治疗胶质瘤均取得了较好效果，然而恶性胶质瘤术后中位生存期仅14周［’j，手术加放疗其中位生存期也只有36周，即使手术、放疗、化疗最佳组合，其术后1年生存率也不足50％，而2年生存率则低于10％’‘’，因此促使人们去探索新的抗肿瘤模式。一、胶质瘤与宿主免疫系统的相互作用以往一直以为脑是免疫豁免区，但最近的研究表明，脑只是部分免疫豁免区，胶质瘤和宿主免疫系统之间存在着相互作用，主要表现为胶质瘤可使宿主的免…     

术后选择性化疗联合瘤内近距离放疗治疗成人恶性脑胶质瘤

目的总结41例成人恶性胶质瘤患者术后行选择性化疗联合瘤内近距离放疗的疗效及分析影响患者生存率的因素。方法回顾性分析2004年1月至2007年12月住院治疗的成人患者41例,其中首次术后病理诊断为恶性脑胶质瘤。术后接受经股动脉-颈内动脉／椎动脉介入化疗＋瘤内近距离放疗者8例,经颈总动脉选择性化疗＋瘤内近距离放疗者33例。随访至2008年7月。结果41例患者中位生存期20．75月,1年生存率78．0％,2年生存率39．0％。在影响患者术后生存率的因素中,肿瘤的切除程度、患者年龄、性别对生存率的影响有统计学意义。结论对于成人恶性胶质瘤,术后行选择性化疗联合瘤内近距离放疗的长期疗效优于目前常规术后外放疗加化疗。     

光动力辅助显微手术治疗脑胶质瘤

目的观察血啉甲醚介导光动力辅助显微手术治疗脑胶质瘤的近期疗效和随访效果。方法1999年至2001年期间,34例恶性脑胶质瘤病人给予光动力辅助手术治疗。暴露肿瘤前3h,静脉推注光敏剂,显微镜下切除肿瘤后应用光动力治疗仪对肿瘤残腔进行激光照射(200J/cm2)以杀伤残存肿瘤细胞。术后避光3d,观察近期临床表现,出院后定期随访治疗效果。结果术后近期效果满意临床症状缓解或消失,出院时Karnofsky记分升高者28例,Karnofsky记分无变化者6例,Karnofsky记分改善率82%(28/34);全部病例无皮肤光敏反应;术后1年生存率为77%(26/34);术后2年生存率为53%。结论激光光动力疗法是一种有效的脑胶质瘤辅助治疗方法近期临床效果满意,有利于提高生存率和生存质量,延长患者生命。     

脑胶质瘤树突状细胞疫苗的研究现状及进展

脑胶质瘤是最常见的中枢神经系统原发肿瘤,约占颅内肿瘤的40%.尽管目前手术切除、放疗、化疗等治疗方法已有很大进展,但是胶质瘤病人预后仍然很差,特别是恶性胶质瘤,其平均生存期不足1年.     

儿童幕上恶性神经胶质瘤化疗与放疗之结果

脑瘤是儿童最常见的实质性肿瘤,16岁以下其发生率约为2.5/10万,占儿童全部恶性肿瘤的16%。幕上神经胶质瘤占原发性脑肿瘤的60%,且复发率高,预后差,平均生存期通常少于45周。儿童幕上肿瘤的早期治疗一般是手术切除或活检,继之以放疗,神经胶质瘤放疗后亦易复发。而化疗辅以放疗可以延长成年人恶性脑瘤的存活时间,故有人提倡用类似疗法治疗儿童幕上神经胶质瘤.作者于1975年1月至1982年6月将治27例年龄在1.2～17.9岁之间的幕上恶性神经胶质瘤,其中女17例,男10例.组织学检查诊断:4例为多形性胶     

以急性出血性脑卒中起病的脑转移瘤的诊治分析

目的探讨以急性出血性脑卒中起病的脑转移瘤的临床特点、诊断及治疗。方法回顾性分析我院收治的26例以急性出血性脑卒中起病的脑转移瘤患者的临床资料。结果全部病例均行血肿清除加转移瘤切除,其中9例行手术加放疗,8例行手术加放疗和化疗,3例行手术加化疗,6例仅行手术治疗。结论对以急性出血性脑卒中起病的脑转移瘤,在清除血肿的同时,应积极地行肿瘤切除,术后辅以放、化疗等综合治疗,以延长患者的生存期。     

努力提高脑胶质瘤的综合手术技能

脑胶质瘤是神经外科最常见的神经肿瘤,手术仍是当前临床上最主要和最基本的治疗方法。研究表明:胶质瘤手术质量不仅直接影响病人的生存质量,而且与术后肿瘤的复发及放疗、化疗和生物治疗等非手术综合治疗效果及生存期密切相关。因此,尽可能彻底切除病变组织,以最小的医疗创伤获取最大的治疗效果,一直是脑胶质瘤手术治疗中应遵循的基本原则。近年来随着神经影像学、神经导航、术中神经电生理、术中B超、荧光术等手术监测技术在临床中的应用和发展,脑胶质瘤外科治疗方法由术前及术中无法预知手术结果的经典单纯开颅肿瘤切除术,发展成可事先预…     

恶性脑膜瘤的治疗及预后影响因素分析(附34例报道)

目的探讨颅内恶性脑膜瘤的临床特点、影像学特点、治疗手段及预后影响因素。方法回顾性分析2008年4月至2018年4月开颅手术肿瘤的34例恶性脑膜瘤的临床资料。结果肿瘤全切(SimpsonⅠ～Ⅲ级)20例,非全切(SimpsonⅣ～Ⅴ)14例;术后行放疗19例,未行放疗15例。术后病理示,横纹肌样恶性脑膜瘤17例,乳头型恶性脑膜瘤6例,间变型恶性脑膜瘤11例。生存曲线分析显示,肿瘤全切病人生存期较非全切病人明显延长(P=0.002);术后放疗病人生存期较未放疗病人延长,但无统计学差异(P=0.078)。结论对恶性脑膜瘤的治疗,手术切除程度至关重要,直接影响病人生存期;术后放疗可抑制肿瘤短期内复发,但对病人长期预后无显著影响。     

颅内高度恶性非生殖细胞瘤性生殖细胞肿瘤

目的探讨颅内高度恶性非生殖细胞瘤性生殖细胞肿瘤（non-germinomatous malignant germ cell tumors,NGMGCTs）的临床特点、治疗和预后.方法回顾性分析了19例高度恶性NGMGCTs患者的临床特点、血清肿瘤标记物监测、治疗方法以及预后.其中胚胎癌2例,卵黄囊瘤4例,绒毛膜上皮癌7例,混合性生殖细胞肿瘤6例.有7例术前肿瘤标记物监测均异常,所有患者均行手术切除肿瘤,全切除7例,近全切除10例,大部分切除2例.所有患者均行放疗,有11例行术后化疗.结果共随访到17例患者,平均随访3.5年,1年生存率为29.4%,3年生存率为5.9%.其中卵黄囊瘤1年生存率为25.0%;混合性生殖细胞肿瘤3年生存率为20.0%,胚胎癌和绒毛膜上皮癌患者皆于1年内死亡.结论高度恶性NGMGCTs预后很差.根据临床表现、影像学资料和肿瘤标记物甲胎蛋白（AFP）和（或）β-绒毛膜促性腺激素（β-HCG）增高,多数患者在术前可确诊为高度恶性NGMGCTs.治疗应先采用化疗后放疗,对治疗后肿瘤标记物水平降至正常而影像学上肿瘤仍未完全消失者,可考虑手术切除,术后再行化疗和（或）放疗.治疗结束后注意随诊,如肿瘤标记物再次升高,经影像学证实肿瘤复发,可再行化疗和手术治疗.这样会延长高度恶性NGMGCTs患者的生存期.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Clobazam for Treatment of Intractable Epilepsy: A Critical Assessment

Summary: Clobazam (CLB), a 1,5-benzodiazepine, is a remarkably effective add-on drug for individual patients with refractory partial epilepsy. CLB has an excellent safety record. As with all benzodiazepines used for treating epilepsy, sedation and withdrawal effects, together with the development of tolerance, limit its usefulness. Recent efforts to prevent or reverse tolerance with intermittent administration of CLB or periodic injection of a benzodiazepine antagonist, flumazenil, are encouraging and justify further investigations.     

La passion de Torquemada et le terrorisme islamique : quelques points de comparaison

This original research compares the doctrinal, psychopathological and operational standpoints of the 15th century Spanish Inquisition (Torquemada) with those of radical Islamism from 1988 to 2005 (Al-Qaeda). The following are reviewed: (a) the main texts codifying the procedure for conducting the criminal investigation of a Holy Office trial (Directorium inquisitorum); (b) the life and work of the grand inquisitor Tomás de Torquemada (1420–1498); (c) the psychopathological relations between passion (passionate psychoses, passionate idealism, paranoid personality) and fanaticism; (d) “the madmen, the enlightened and the criminals” of Islamic terrorism; (e) the cognitive and emotional motives for engagement in the jihadist radicalization of young people; (f) the common principles of monotheistic fanaticism (Inquisition, Al-Qaeda) and the particular dogmas of Islamic terrorism in our time; (g) the operating modes of the Inquisition and the Jihadist holy war. The author concludes that the rigour and seriousness of the inquisitorial judicial procedure, which was precise, individual and personalized, contrasts with the revolutionary pamphlets of Al-Qaeda, which only provide broad guidelines for the modus operandi of the fight against infidels, who are usually random victims.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Neurological soft signs and schizophrenia: a review of current knowledge

Schizophrenia is a frequent and disabling disorder emerging during adolescence or early adulthood. The identification of underlying processes has been hampered by the complex clinical expression and the probable etiological heterogeneity. The frequency of neurological soft signs (NSS) in patients with schizophrenia and their presence early in life (during the first two years) in high risk subjects support the hypothesis that schizophrenia is a "brain disease" reflecting pre- or perinatal insults during development. The growing interest for NSS has lead to multiple studies that are often difficult to compare. The objective of this review is to summarize the current knowledge on NSS, methodological issues and the future perspectives.     

Lacan, lecteur de Minkowski : l'approche structurale

The notion of structure occupies a predominant place in the theory of Lacan. He indicates that was developed from the work of Minkowski. In fact, through his phenomeno-structural approach, Minkowski does not limit himself to purely observable phenomena, but attempts to determine the underlying structure. He refers to the comprehensive phenomenology and psychopathology, and this method provides him with clinical finesse and another means of determining a diagnosis. Thus Lacan has used this as a basis for his approach to structure to develop a theory regarding the individual. This implies that the structure of the individual is based on his relation to language. From this concept, he then develops the clinical structures of neurosis, psychosis, and perversion. These structural landmarks also have an effect on the course of treatment.