鞍区肿瘤术后水钠代谢紊乱38例分析

目的分析鞍区肿瘤手术后,出现水钠代谢紊乱的原因及治疗。方法分析38例鞍区肿瘤术后水钠代谢紊乱的分型及治疗情况。结果术后发生水钠代谢紊乱总发生率63．3％,分为5种类型,尿崩症10例(26．33%),低钠血症24例(63．16％),脑性耗钠综合症2例(5．26％),抗利尿激素异常分泌综合征(SLADH)1例(2．63％),高钠症1例(2．63％),经治疗后37例恢复良好,1例死亡。结论鞍区肿瘤术后水钠代谢紊乱发生率较高。术中规范操作,避免损伤垂体柄和丘脑下部,注意保护穿支血管;术后注意监测水、电解质平衡并及早采取合理措施对鞍区肿瘤术后水钠紊乱的治疗有重要意义。     

鞍区肿瘤术后水钠失衡的临床因素分析

目的探讨影响鞍区肿瘤水钠失衡的临床因素。方法对55例鞍区肿瘤病例进行回顾性分析。结果35例出现一过性多尿,20例出现脑性盐耗综合症无永久性尿崩恶性肿瘤患者水钠失衡发生率为,。100%(7/7),颅咽管瘤37.5%(6/16),垂体瘤27.3%(6/22),脑膜瘤10%(1/10)。结论鞍区肿瘤术后易发生水钠失衡,术后发生率同术前是否有水钠失衡,肿瘤是否侵入第三脑室手术入路的选择及肿瘤切除程度无明显相关同肿瘤的性质及术中是否损伤下丘脑垂体柄有关。     

重型颅脑损伤和鞍区肿瘤术后脑性盐耗综合征15例

目的 探讨重型颅脑损伤和鞍区肿瘤术后病人并发脑性盐耗综合征的病因，发病机制，诊断及治疗经验。方法 回顾性分析重型颅脑损伤和鞍区肿瘤术后发生脑性盐耗综合征的15例病人，通过其临床表现及实验室指标明确诊断，确定有效的治疗方法。结果 经过治疗，15例病人低血钠症状恢复。结论 低血钠、高尿钠、低血容量及意识状态改变是脑性盐耗综合征的诊断依据，水化及补盐治疗安全有效。     

鞍区肿瘤术后低钠血症的临床研究

目的探讨鞍区肿瘤术后低钠血症的发生规律及其针对不同综合征的治疗方法。方法本组42例鞍区肿瘤患者人院后皆行鞍区肿瘤切除术，对术前及术后的血钠、尿钠、尿比重、中心静脉压等指标进行连续监测，根据诊断标准分辨出抗利尿激素分泌不当综合征（SIADH）及脑性盐耗综合征（CSWS），并根据不同诊断进行相应的治疗，其中CSWS患者分成应用及未应用氢化可的松两组，比较两种不同治疗方法的效果。结果42例患者中11例出现不同程度的低钠血症，其中垂体腺瘤9例，颅咽管瘤2例。符合CSWS的8例，SIADH的3例。SIADH一般发生在手术早期，特别是3d以内，且伴有尿量的减少和尿比重增加；而CSWS出现较晚，一般在3d以后，不伴有尿量的减少和尿比重增加。CSWS的主要处理是钠和水的补充，辅以氢化可的松治疗的效果要好于单纯补充水钠。结论鞍区肿瘤术后CSWS较常见，水钠补充辅以氢化可的松治疗效果较好。     

25例鞍区肿瘤术后低钠血症的治疗分析

目的 探讨鞍区肿瘤术后不同性质低钠血症的治疗方法. 方法对25例鞍区肿瘤手术后低钠血症按"快补-调整-诊断"的原则进行分级治疗,在治疗过程中鉴别低钠血症的不同类型. 结果术后产生一般性低钠血症4例,脑性盐耗综合征19例,抗利尿激素异常分泌综合征2例.本组低钠血症治愈24例. 结论在鞍区肿瘤术后的低钠血症中,脑性盐耗综合征占大多数,应根据低钠轻重程度采取不同的补钠方法,必要时采取限水治疗.     

84例鞍区肿瘤术后水钠失衡的临床分析

目的 探讨鞍区肿瘤术后水钠平衡紊乱的临床特点及治疗方法。方法 对84例鞍区肿瘤术后水钠平衡紊乱患者的临床资料进行回顾性分析。结果 本组84例均有尿崩症状，其中74例(88．10％)合并血钠紊乱，单纯性低钠60例，单纯性高钠10例，交替性血钠异常4例：经处理后均获临床控制。结论 鞍区肿瘤术后水钠平衡紊乱有其特殊的临床特征及不同治疗方法。     

鞍区肿瘤术后低钠血症的治疗方法(附51例分析)

目的探讨鞍区肿瘤术后不同性质低钠血症的治疗方法。方法对鞍区肿瘤手术后51例低钠血症按“决补-调整-诊断”的原则进行分级治疗,在治疗过程中鉴别低钠血症的不同类型。结果术后产生一般性低钠血症8例,脑性盐耗综合征（CSWS）39例,抗利尿激素异常分泌综合征（SIADH）4例。本组低钠血症治愈49例。结论在鞍区肿瘤术后的低钠血症中,CSWS占大多数。应根据低钠轻重程度采取不同的补钠方法,必要时采取限水治疗。血浆和白蛋白在低血钠综合征的治疗中起重要作用。     

鞍区肿瘤术后低钠血症的探讨

目的 探讨鞍区肿瘤手术后并发低钠血症的病因、发病机制、诊断和治疗方法.方法 回顾性分析我科2004年1月至2008年12月诊治的21例鞍区肿瘤手术后并发低钠血症的临床资料.结果 19例患者诊断为脑性盐耗综合征（CSWS）,2例诊断为抗利尿激素不适当分泌综合征（SIADH）.经相应治疗后,全部患者低钠血症纠正.结论 鞍区肿瘤手术后易发生低钠血症,包括脑性盐耗综合征和抗利尿激素不适当分泌综合征,前者主要是补钠和补充血容量,后者却需限水治疗.中心静脉压监测对其诊治有指导意义.     

鞍区肿瘤术后低钠血症的治疗(附39例报告)

目的探讨鞍区肿瘤术后低钠血症有效合理的治疗方法。方法对39例鞍区肿瘤手术后低钠血症的治疗进行回顾性分析。结果39例低钠血症中,一般性低钠血症7例;脑耗盐综合征(CSWS)29例;抗利尿激素异常分泌综合征(SIADH)3例,经合理治疗后均治愈。结论鞍区肿瘤术后易发生低钠血症,以CSWS占绝大多数,治疗策略是根据低钠程度轻重采取不同的补钠方法,必要时采取限水治疗。     

鞍区肿瘤患者手术前后血中抗利尿激素的变化

目的 探讨鞍区肿瘤患者手术前后血中抗利尿激素变化及其与水钠代谢紊乱的关系.方法 在行鞍区肿瘤切除术的37例患者之中选取心肾功能正常的30例,对其手术前后抗利尿激素水平进行监测.根据研究对象的水钠代谢紊乱类型,将研究对象分为5组.结果 术后无水钠代谢紊乱者(Normal)8例,手术前后抗利尿激素水平无统计学意义.尿崩症者(DI)15例,采血前注射垂体后叶素者(DIA)7例,术后抗利尿激素水平明显高于术前,有统计学意义;采血前未注射垂体后叶素者(DIB)8例,术后抗利尿激素水平明显低于术前,有统计学意义.脑性盐耗综合征者(CSWS)5例,手术前后抗利尿激素水平无统计学意义.抗利尿激素分泌不当综合征者(SIADH)2例,术后抗利尿激素水平明显高于术前,有统计学意义.结论 水钠代谢紊乱是鞍区肿瘤患者最常见的并发症之一,其与患者手术前后血中抗利尿激素的变化有密切联系.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

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.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

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.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

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.