X—刀治疗的质量控制及相关物理参数的测量

本文介绍了我院在安装调试和使用Ｂｒａｉｎ－ＳＣＡＮ Ｘ刀治疗系统过程中相关物理参数的测量方法及质量控制的技术要求。主要包括：（１）Ｓｔ、ＴＭＲ、ＯＡＲ的测量，（２）直线加速器机械稳定性及等中心点的校准，（３）人体不均头模检验治疗计划与实际治疗中剂量分布的差异，（４）对每一例治疗计划中数据验证及检查。经过双方论证，相关物理参数的测量值和机械性能均达到Ｘ刀治疗的质量控制要求。Ｘ刀已成为可部分替代神经外     

X-刀临床意义初步探讨──附144例治疗报告

Ｘ－刀临床意义初步探讨──附１４４例治疗报告胡威夷，曾力，匡永勤，严利春，袁忠勋，张国才，骆建华，刘焕义我院１９９５年８月至１９９６年１０月Ｘ－刀（Ｒａｄｉｏｎｉｃｓ／ＲＳＡ放射外科系统及Ｖａｒｉａｎ２１００Ｃ直线加速器）治疗颅内肿瘤及ＡＶＭ共１４４...     

X-刀立体定向放射外科治疗颅内转移瘤

Ｘ－刀立体定向放射外科治疗颅内转移瘤王立根郭艳章翔易声禹宋少军魏丽春我院于１９９６年引进美国Ｒａｄｉｏｎｉｃｓ公司产ＲＳＡ第三代Ｘ－刀设备和技术，已用于临床实践，本文报导到目前为止使用Ｘ－刀治疗颅内转移瘤２１例的结果及体会。材料与方法一、一般资料２１...     

大鼠蛛网膜下腔出血后脑组织P53基因表达与细胞损伤

目的　探索防治蛛网膜下腔出血（ Ｓ Ａ Ｈ）引起的脑血管痉挛（ Ｃ Ｖ Ｓ）的新途径。方法　利用大鼠 Ｓ Ａ Ｈ 模型，设立对照组、 Ｓ Ａ Ｈ 组、放线菌素酮治疗组（ Ｃ Ｈ Ｘ 组）。经 Ｄ Ｉ Ｇ Ｒ Ｔ Ｐ Ｃ Ｒ 对不同时间大鼠脑组织 Ｐ５３基因进行检测。结果　对照组、 Ｃ Ｈ Ｘ 组 Ｐ５３基因表达相近， Ｓ Ａ Ｈ 组 Ｐ５３基因表达增高。显微镜下见 Ｃ Ｈ Ｘ 组病理形态学变化近似正常， Ｓ Ａ Ｈ 组神经细胞损伤严重。结论　大鼠 Ｓ Ａ Ｈ 后 Ｃ Ｖ Ｓ所致的脑缺血，脑组织 Ｐ５３基因表达明显增高。大鼠 Ｓ Ａ Ｈ 模型 Ｐ５３基因表达与脑神经元细胞损伤明显相关。放线菌素酮通过抑制 Ｐ５３基因表达从而抑制其诱导的损伤。     

头颅X-刀治疗185例临床报告

头颅Ｘ－刀治疗１８５例临床报告柏秀松，王刚，刘均，范湘，于丽萍我们在１９９６年一年中对１８５例颅内神经外科疾病应用Ｘ－刀治疗效果，与传统手术治疗方法进行比较和分析，对不同部位、不同性质病变所使用的治疗剂量和方法。我们使用ＲＳＡＸ－ｋｎｉｆｅ－３治疗系...     

X-刀治疗颅内疾病的护理配合与观察

Ｘ－刀治疗颅内疾病的护理配合与观察徐丽夏燕我院１９９６年３月引进了美国ＲＳＡ公司的Ｘ－刀和美国瓦里安公司的直线加速器，１９９６年３～９月，对４２例颅内疾患病人施行Ｘ－刀治疗，就护理配合和观察报告如下。本组４２例中男２５例，女１７例，年龄７～７１岁，平...     

关于X-刀治疗的照射剂量

关于Ｘ－刀治疗的照射剂量王所亭张纪陈国雄自立体定向放射外科（ＳＲＳ）技术（Ｘ，γ刀）问世以来，由于它使用了与常规放疗根本不同的单次特大剂量，那么“究竟该用多大剂量”一直受人关注。由于对此涉及到的因素很多，不能一概而论，但也并非无规律可循。本文拟通过国...     

X-刀立体定向放射神经外科治疗颅内转移瘤

Ｘ－刀立体定向放射神经外科治疗颅内转移瘤王立根，郭艳，章翔，易声禹，宋少军，魏丽春我院于１９９６年引进美国Ｒａｄｉｏｎｉｃｓ公司产ＲＳＡ第三代Ｘ－刀设备和技术，已用于临床实践。本文报导使用Ｘ－刀治疗颅内转移瘤２１例，男性１３例，女性８例；年龄３３～７...     

X-刀治疗深部脑肿瘤围手术期的护理

Ｘ－刀治疗深部脑肿瘤围手术期的护理张永琴郭艳王立根崔红丽蔡雁丽Ｘ－刀放射外科是目前较先进的颅内肿瘤非手术治疗方法之一。我院于１９９６年引进美国Ｒａｄｉｏｎｉｃｓ公司产ＲＳＡ第三代Ｘ－刀设备和技术，已用于临床实践，１９９６年６月～１９９７年１月为５４例...     

肠溶阿斯匹林剂量和血阿斯匹林及水杨酸盐浓度与药效关系探讨

本文探讨了ＡＳＡ剂量与药效的关系及血ＡＳＡ、ＳＡ药物浓度监测的临床意义，结果表明：（１）ＡＳＡ剂量与６－ｋｅｔｏ－ＰＧＦ_（１α）抑制率呈正相关（Ｐ＜０．０１），而与ＴＸＢ_２及ＰＡｇＲ抑制率无相关性（Ｐ＞０．１）；（２）本文采用ＨＰＬＣ内标法同时测定血ＡＳＡ和ＳＡ浓度，结果准确，方法简便；（３）当口服小剂量ＡＳＡ防治ＣＩ时，监测血ＡＳＡ和ＳＡ以调整ＡＳＡ用药剂量的临床价值并非十分重要。     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.