神经纤维瘤病Ⅱ型的MRI分析

目的探讨神经纤维瘤病Ⅱ型的MRI表现,提高对本病的认识。方法收集9例经临床及病理证实的神经纤维瘤病Ⅱ型进行分析、总结。结果双侧听神经瘤6例,其中合并多发脑膜瘤3例,多发神经鞘瘤2例,多发胶质瘤、神经纤维瘤1例;一侧听神经瘤合并侧脑室室管膜瘤及多发枕颈部皮下神经纤维瘤,合并多发脑膜瘤1例;1例脊膜瘤并侧脑室室管膜瘤。结论MRI是检查NF-II中枢神经系统病变理想的影像学检查方法,可较好的显示其多发性及多灶性病变。     

NF2基因及其编码蛋白质结构的研究进展

Ⅱ型神经纤维瘤病（neurofibromatosisⅡ，NF2）是一种常见的常染色体显性遗传性疾病。其临床表现为以双侧听神经受累为主的多种类型的肿瘤，如视神经胶质瘤、脑膜瘤、星型细胞瘤、脊膜瘤以及室管膜细胞瘤等。非常具有特征性的是，NF2中枢神经系统肿瘤多发生于包被结构，如神经鞘瘤（施万细胞瘤）和脑膜瘤。[第一段]     

神经纤维瘤病-Ⅱ型显微手术治疗策略

目的探讨神经纤维瘤病-Ⅱ型(NF-2)显微手术切除的治疗策略。方法回顾性分析2000年1月至2015年12月期间16例NF2经显微手术切除的临床资料。其中双侧听神经瘤11例,另5例为Segmental型(不完全型) NF-2。均采用乙状窦后入路切除听神经瘤,术中采用面神经、三叉神经和听性脑干反应(ABR)监测。根据肿瘤大小、听力损伤程度选择手术切除时机和侧别。结果分期分侧切除双侧听神经瘤9例,单侧听神经瘤切除7例,共切除听神经瘤25侧。肿瘤全切除22侧(22/25,88%),近全切除3侧(为唯一存在听力耳)。椎管内神经鞘瘤切除3例,颅内脑膜瘤切除1例,均获得肿瘤全切除。大部分切除的3侧肿瘤和尚未行肿瘤切除的2侧听神经瘤(尚存有效听力),以及颅内1例多发性神经鞘瘤和多发性脑膜瘤1例,术后3个月内行伽玛刀治疗。术前有残余听力的11侧耳,术后5侧耳保留不同程度听力,听力保留率为45. 5%(5/11)。23侧肿瘤术中均解剖保留面神经(23/25,92%),术后半年复查面神经功能采用House-Brackmann(H-B)评分I～Ⅲ23侧,H-BⅣ级2侧。随访11～78个月,平均随访38. 4个月,肿瘤均得到有效控制,未见肿瘤复发或增大。结论 NF-2应根据肿瘤的大小、听力水平、解除脑干压迫的必要性、肿瘤的生长速度,制定恰当的手术方案。对于伴发的脑膜瘤或脊膜瘤、椎管内和颅内其它神经鞘瘤,根据是否引起临床症状来决定是否需要切除肿瘤。     

神经鞘瘤的schwannomin/merlin表达分析

目的 分析S／M蛋白在神经鞘瘤中的表达。方法 用免疫组织化学、蛋白印迹法观察36例神经鞘瘤中S／M的表达。结果 所有神经鞘瘤无Ⅱ型多发神经纤维瘤病（NF2）（A－19）免疫活性。28例（78％）S／M表达量下降（与正常比小于70％），其中听神经瘤占81％（13／16）、非听神经瘤占75％（15／20）。13例（36％）（听神经瘤3例、非听神经瘤10例）中等度下降（与正常比下降35％－69％）；15例（42％）（听神经瘤10例、其它5例）表达重度下降（与正常比小于35％）。结论 神经鞘瘤中S／M表达下降。     

Ⅱ型神经纤维瘤病随访50年一例报告

目的提高对Ⅱ型神经纤维瘤病的病因、临床表现、诊断和治疗的认识。方法结合文献，复习收治并随访50年的1例Ⅱ型神经纤维瘤病患者的临床资料和影像学资料，总结其疾病的临床演变过程和治疗经过。结果女性患者，53岁，无家族遗传史。临床表现为先后发病的双侧前庭神经许旺细胞瘤，符合Ⅱ型神经纤维瘤病的诊断。34岁时发现右侧前庭神经许旺细胞瘤，行开颅肿瘤切除术，后因肿瘤复发而行γ-刀立体定向放射治疗；42岁时诊断为左侧前庭神经许旺细胞瘤，行γ-刀立体定向放射治疗。影像学随访至今双侧前庭神经许旺细胞瘤无复发。同时存在右侧三叉神经许旺细胞瘤、多发脑膜瘤、脊膜瘤，以及周围神经的神经纤维瘤，神经系统受累广泛。近20年来多次施行手术及γ-刀立体定向放射治疗。病理诊断为前庭神经和三叉神经许旺细胞瘤、过渡型脑膜瘤、纤维型脑膜瘤、神经纤维瘤等。现患者能够生活完全自理，右侧面部感觉减退，右侧耳聋，右侧周围性面神经麻痹，左侧肢体肌力4级。结论Ⅱ型神经纤维瘤病为常染色体显性遗传性疾病，预后差，早期诊断和治疗对保留患者听力、延长生命和提高生活质量至关重要。     

神经纤维瘤病Ⅱ型4例报告

神经纤维瘤病Ⅱ型(NF-Ⅱ)临床少见,我院从82年以来共收治四例患者,经手术及病检证实为神经纤维瘤病Ⅱ型。现报告如下。1病例报告例1及例2女,31岁、51岁。因多发皮下包块,左、右侧耳鸣、听力减退9年余、10年余入院。查体:多发皮下包块,患侧听力减退。CT示患侧桥小脑角区高密度肿块,大小约2.75cm×4.2cm、3.25cm×4.3cm。皮下包块病检为神经纤维瘤。显微手术切除肿瘤。肿瘤全切、面神经保留完整。术后病检为听神经鞘瘤。分别随访6年和2年,患侧轻度面瘫、听力丧失,肿瘤无复发。例3女,30岁。因头痛、双侧耳鸣14年,听力减退9年,多发皮下包块4年…     

神经纤维瘤病Ⅱ型听神经瘤:手术原则和时机选择与听力保护

正神经纤维瘤病Ⅱ(NF2)型听神经瘤的生物学特性、临床特点、治疗方法不同于散发性听神经瘤,肿瘤形成的时间、类型、体积、数量及部位等因素均存在差异,治疗方案的制定、手术时机的选择和具体的适应证还有些争议。双侧听神经瘤体积的大小、两侧听力受损的程度等诸多因素,均影响手术时机的选择、侧别的选择和听力的保留。选择合适的手术     

神经鞘瘤中NF2基因外显子2突变及意义

目的 :研究神经鞘瘤中 型多发神经纤维瘤病基因 (NF2 )外显子 2的突变及其意义。方法 :用 PCR- SS-CP、 DNA测序检测 36例神经鞘瘤 (听神经瘤 16例 ,其它 2 0例 )中 NF2基因外显子 2的突变。结果 :我们共发现 4例突变 ,均为听神经瘤 ,其中移码突变 2例、反义突变 2例。结论 :NF2基因外显子 2的突变可能是听神经瘤发生中的关键因素。     

立体定向伽玛刀放射外科治疗继发于II型神经纤维瘤病的前庭神经鞘瘤的临床经验

目标评估立体定向放射外科对继发于II型神经纤维瘤病的前庭神经鞘瘤的治疗效果。方法回顾性分析连续治疗的96例(122个)继发于Ⅱ型神经纤维瘤病的前庭神经鞘瘤。通过以下三种方式评估肿瘤的控制情况:需行外科手术的情况,系列放射影像学检查和计算相对生长率(以对侧未经治疗的肿瘤为内部对照,共29例)。依据Gardner-Robertson计分表和平均纯音听力图来评估听力。详细记录并发症。结果应用目前的技术,在放射外科治疗8年后约有20%的病人需行外科手术治疗,50%的病人在影像学上肿瘤得到了有效控制,而30%的病人肿瘤控制不够满意,但仍可以继续保守…     

听神经鞘瘤切除术术中体位与术后并发症相关性分析（附90例报告）

目的探讨听神经鞘瘤经枕下乙状窦后入路肿瘤切除术中体位与术后并发症的相关性。方法对2004年至2007年收治的90例听神经鞘瘤病人，应用显微外科技术在显微镜下行枕下乙状窦后入路肿瘤切除术，术中病人体位取坐位58例，侧卧位32例，回顾性分析术后一系列并发症的发生与术中体位的关系。结果术后出现颅内血肿5例，其中术中采取坐位者4例（6．90％），侧卧位者1例（3．12％）；术后出现颅内积气47例，其中坐位者38例（65．52％），侧卧位者9例（28．12％），经统计学分析，采取两种不同体位手术的病人颅内积气发生率差异显著（P〈0.05）。结论侧卧位下较坐位下行枕下乙状窦后入路听神经鞘瘤切除术能更有效降低听神经鞘瘤术后颅内积气的发生率。     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Micro-affirmations and Recovery for Persons with Mental Health and Alcohol and Drug Problems: User and Professional Experience-Based Practice and Knowledge

Recurrent factors contributing to a recovery process from co-occurring mental health and addiction problems mentioned by users and professionals have been analyzed as part of working alliances and helpful relationships. Still, we lack knowledge about how helpful relationships are developed in daily practice. In this article, we focus on the concrete construction of professional helpful relationships. Forty persons in recovery and fifteen professionals were interviewed. The interviews were analyzed according to thematic analysis, resulting in three themes presented as paradoxes (1) My own decision, but with the help of others; (2) The need for structures and going beyond them; and (3) Small trivial things of great importance. Micro-affirmations have a central role in creating helpful relationships by confirming the individuals involved as more than solely users or professionals. More attention and appreciation should be paid to practices involving micro-affirmations.

     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.