睡眠监测脑电图在癫痫患者中诊断价值分析

目的:研究分析睡眠监测脑电图在癫痫患者中诊断价值.方法:抽选本院收治的癫痫患者160例作为本次的观察对象,入院时间为2012年1月至2016年12月期间,将患者分为两组,对照组给予常规脑电图检查,病例组则开展睡眠监测脑电图,对比两组患者的检查结果以及癫样放电主要发生位置.结果:病例组中的异常概率明显较对照组高,P＜0.05;病例组的一侧占比、中央和中颞占比、额和前颞占比以及顶和枕部占比同对照组比较,差异均不明显,P＞0.05.结论:睡眠监测脑电图在癫痫的诊断中,可以提升异常概率.     

发作期与发作间期 SPECT显像定位癫痫灶的价值

ＳＰＥＣＴ定位癫痫灶的价值已得到肯定[1] 。有报道同一患者在发作间期和发作期进行 2次ＳＰＥＣＴ显像更能准确定位[2 ] 。为此 ,笔者分析了 130例癫痫患者的 2次ＳＰＥＣＴ显像结果 ,现报道如下。资料与方法1 临床资料。难治性癫痫患者 130例 ,男 89例 ,女 41例 ,平均年龄 2 1 5 (4～ 5 6 )岁 ,平均病程 9(1～ 39)年。癫痫的诊断和分型参照国际抗癫痫联盟的标准[3 ] 。 10 9例患者有脑炎、脑外伤、高热惊厥、窒息脑缺氧等病史 ,余病史不详。2 ＳＰＥＣＴ显像。静脉注射99Ｔｃｍ 双半胱乙酯 (ＥＣＤ ,江苏省原子医学研究所提供 ,放化纯大…     

动态脑电图在癫痫的应用

常规脑电图对癫痫的诊断受监测时间的限制,一般在发作间期只能记录到40％的爆发性放电活动。遥测脑电图又不能广泛为临床所应用。1979年8导动态盒式脑电图广泛应用于临床,尤其是对癫痫研究较多。近三年来我们对17例癫痫病人进行24—48小时脑电监测,总结如下。 资料和方法 应用英国牛津Medilog 9000型动态盒式脑电图监测仪(简称AEEG),贮存8导生理信号,同时有记录日真实的时间和事件键。有利于确定发作性放电的时间回顾和鉴别发作的真伪。电极位置符合国际10～20系统,但其放置方法略有不同,本仪电极放置前4导为左侧,后4导为右侧。按双极导联连接,具体导联设     

磁源性影像对脑软化灶伴发难治性癫痫的定位价值

目的探讨磁源性影像(MSI)对脑软化灶伴有难治性癫痫发作患者癫痫灶的定位价值。方法11例脑软化灶伴有难治性癫痫的患者进行了MSI检查，将其结果与视频脑电图(VEEG)、皮质脑电图(ECoG)结果进行比较。其中5例行伽玛刀放射治疗，6例行手术治疗。结果5例伽玛刀放射治疗后，3例疗效满意，1例显著改善，1例无效，1例癫痫灶距离软化灶后方约4cm，1例脑软化灶位于右额顶叶，但其癫痫源主要位于右侧颞叶，右额叶软化灶后方只出现少量棘波，3例癫痫灶位于脑软化灶周围。6例经手术治疗的患者中，VEEG、ECoG和MSI对癫痫灶定位完全一致3例，2例ECoG确定的棘波范围均大于VEEG及MSI，1例VEEG、MSI及ECoG定侧均不一致，该患者进行了双侧枕叶癫痫灶切除术，所有手术治疗的患者疗效满意。结论MSI对脑软化灶伴有难治性癫痫发作患者癫痫灶定位准确，具有指导临床进一步治疗的价值。     

18F-FDGPET定位致痫灶在癫痫外科治疗中的价值

目的：评价^18F-脱氧葡萄糖（FDG）PET定位致痫灶在癫痫外科治疗中的作用。方法：对30例难治性癫痫患者行EEG,MRI,PET检查,根据PET检查结果并参考EEG,MRI选择外科治疗方法（开颅手术,X刀治疗,立体定向手术）。开颅手术者,术中行皮层脑电图（ECoG）检查,术后送病理检查。所有患者均观察术后疗效。结果：致痫灶位于颞叶22例,颞叶外6例,额颞区2例,30例患者中16例。30例患者中16例行开颅手术,10例X刀治疗,4例立体定向手术。术后除2例癫痫发作无明显改善外,余28例发作明显减少或消失。结论：^18F-FDG PET检查术前定位致痫灶有助于选择手术方式,提高手术治疗效果。     

脑电图与动态脑电图对癫痫诊断的对比分析

癫痫是一种常见的疾病,以往诊断除临床症状外还依赖于脑电图的检查,癫痫是脑部神经元过度异常放电的发作性疾病,对癫痫的诊断及与其他发作性疾病的鉴别主要依据患者的临床表现和发作,发作间歇期脑电图痫样放电波,但常规脑电图阳性率仅40%左右[1],24 h动态脑电图可在自然环境中(动、静、睡)进行描记,同时检测时间长,从而大大提高了痫样放电的阳性率。本文对临床已拟诊为癫痫患者的50例脑电图和同一时期(1周内)的动态脑电图进行了监测和对比分析,以提高临床诊断疾病的可信性和癫痫的准确率,现报告如下。1资料与方法1.1一般资料:本组50例中男性28例,女性22例,年龄5~14岁,平均10.5岁,病程1~5年,头颅CT扫描45例,异常2例(一侧脑室小1例,限局性脑软化灶1例)。1.2方法:本组使用丹麦雅迪公司生产的PL-270型16导数字化无纸脑电图机,常规作单导和双导,光刺激和呼吸诱发试验,以冯应琨脑电图分析为标准。动态脑电图应用丹麦雅迪公司生产的(M ed ilog D igital Rep lac ing and Analysis Sys-tem),按国际10/20系统安置盘状电板,以火棉胶固定,16导联记录,记录期间患...     

机器人无框架立体定向仪在顽固性癫痫定位和 治疗方面的应用

目的探讨机器人辅助无框架立体定向系统置入深部电极和射频热凝毁损的方法及效果。方法对7例额、颞发作间期存在痫样放电的顽固性癫痫患者,采用机器人辅助无框架立体定向系统经额向双侧颞叶内侧置入深部电极,记录深部电极脑电图。深部电极脑电图记录到颞叶内侧为临床发作或电发作起源灶者,遂行机器人立体定向系统经额入路射频热凝颞叶深部结构;并对6例同意进行神经干细胞移植者移植干细胞。结果术后24～52个月,7例随访按照Engel分级系统Ⅰ级4例(其中Ⅰa级3例、Ⅰd级1例),Ⅳa级2例、Ⅳc级1例。未有术后神经功能明显下降。结论机器人辅助立体定向系统置入深部电极、射频热凝毁损和移植神经干细胞安全、有效、方便、快捷,部分额、颞叶顽固性癫痫患者对立体定向射频热凝和神经干细胞移植治疗反应良好。     

机器人无框架立体定向仪在顽固性癫痫定位和治疗方面的应用

目的探讨机器人辅助无框架立体定向系统置入深部电极和射频热凝毁损的方法及效果。方法对7例额、颞发作间期存在痫样放电的顽固性癫痫患者,采用机器人辅助无框架立体定向系统经额向双侧颞叶内侧置入深部电极,记录深部电极脑电图。深部电极脑电图记录到颞叶内侧为临床发作或电发作起源灶者,遂行机器人立体定向系统经额入路射频热凝颞叶深部结构;并对6例同意进行神经干细胞移植者移植干细胞。结果术后24～52个月,7例随访按照Engel分级系统Ⅰ级4例(其中Ⅰa级3例、Ⅰd级1例),Ⅳa级2例、Ⅳc级1例。未有术后神经功能明显下降。结论机器人辅助立体定向系统置入深部电极、射频热凝毁损和移植神经干细胞安全、有效、方便、快捷,部分额、颞叶顽固性癫痫患者对立体定向射频热凝和神经干细胞移植治疗反应良好。     

发作间期SPECT脑灌注显像在癫痫手术定位中的价值

癫痫是神经系统难治性疾病,由于药物治疗难获根治效果,随着病情发展患者出现     

Device for facilitating lesion localization in breast biopsies

To allow easier radiographic localization and pathologic correlation of occult lesions in breast biopsies, a specimen holder composed of two Plexiglas plates was devised. The specimen is compressed between the plates and radiographed. The lesion can be localized by inserting a 22-gauge needle through the appropriate hole in the bottom plate. Holes are centered within alpha numerically labeled squares on a grid created by grooves on the plates. The grooves allow the pathologist to excise only the tissue with the lesion.     

Gallium-67 localization in herpetic skin lesion

Previous cases of gallium localization in various cutaneous lesions have been reported, including sporotrichosis, acne vulgaris, sarcoid, lymphoma, and exfoliative erythroderma. This is a report of a case of gallium localization in cutaneous lesions of herpes zoster.     

Retractable-barb needle for breast lesion localization: use in 60 cases

A needle system with a retractable barb was developed for localization of nonpalpable breast lesions. The system can be repositioned without major adjustments and strongly anchors to breast tissue, eliminating failure due to dislodgment or transection of the localizing wire. Its use may necessitate fewer confirmatory radiographs, resulting in decreased radiation exposure. In addition, the needle can be retracted during surgery, to ease extraction of the specimen.     

Temporal lobectomy for refractory epilepsy in the U.S. military

OBJECTIVES: To determine the characteristics, seizure outcomes, and quality-of-life outcomes for military beneficiaries undergoing partial temporal lobectomy for refractory epilepsy at the only U.S. military medical center with a comprehensive epilepsy surgery program. METHODS: The records of all 84 patients treated with partial temporal lobectomy between 1986 and 2000 at Walter Reed Army Medical Center were retrospectively reviewed. Outcome measures included seizure frequency according to the Engel classification system, driving, employment, anticonvulsant use, and military service. RESULTS: The study cohort consisted of 72 military dependents, 10 active duty military members, and 2 military retirees. Two years after surgery, 65 (92%) of 71 patients had seizure improvement (Engel classes I-III) and 46 (66%) of 71 had seizure remission (Engel class I). Driving and employment rates increased after surgery, whereas anticonvulsant use decreased. Five (50%) of 10 active duty patients achieved seizure remission postoperatively and continued to serve in the Armed Forces. Active duty patients had a later age of seizure onset, shorter duration of epilepsy, and greater proportion of lesional epilepsy, compared with nonactive duty patients. CONCLUSIONS: Epilepsy surgery outcomes in the U.S. military are similar to those reported from nonmilitary centers, with the majority of patients experiencing seizure remission and improvements in quality-of-life measures. Complete seizure remission after successful anterior temporal lobectomy enables some active duty military members to continue service in the U.S. Armed Forces.     

分期手术治疗难愈性创面效果评价

 目的 观察和评价采用先行创面清创、全封闭负压吸引装置安置术后,再行肌皮瓣、筋膜皮瓣或全厚皮移植修复难愈性创面等分期手术的治疗效果.方法 选择22例各种难愈性创面病例,随机分成2组,进行比较分析.结果 两组22例均痊愈出院,治疗组创面修复手术均一期愈合,对照组延期愈合6例.治疗组创周红肿消退时间、平均住院天数、住院花费均少于对照组.结论 采用创面清创、全封闭负压吸引装置安置术后行肌皮瓣、筋膜皮瓣或全厚皮移植修复难愈性创面,分期手术缩短住院时间,减轻患者的经济负担,提高了手术的一期愈合率.     

原发性甲状旁腺机能亢进影像诊断的评价

目的比较Ｂ超、ＣＴ、９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）对于高功能甲状旁腺病灶定位诊断的价值。方法经临床诊断为原发性甲状旁腺机能亢进（简称原发甲旁亢）的２３例患者均做了Ｂ超检查，２０例做了ＣＴ扫描，２１例进行了９９ｍＴｃＭＩＢＩ核素显像。结果２３例患者共摘除２３枚腺瘤和２枚增生腺体，均经病理诊断证实。Ｂ超、ＣＴ、９９ｍＴｃＭＩＢＩ的灵敏度分别为６０％、６８％和９１％，特异性为９７％、９７％和１００％，准确性为８９％、９１％和９８％。Ｂ超与ＣＴ无明显差异，９９ｍＴｃＭＩＢＩ在灵敏度和准确性方面优于Ｂ超和ＣＴ，但特异性三者近似。结论９９ｍＴｃＭＩＢＩ双时相法对于甲状旁腺腺瘤的定位诊断很有帮助，原发甲旁亢患者首次探查术前进行无创影像定位检查是必要的     

Presurgical evaluation of refractory temporal lobe epilepsy: Comparison of MR imaging,PET and ictal SPECT in localization of the epileptogenic substrate

Purpose

To compare the sensitivities of MRI, FDG-PET and ictal/SPECT in localization of the epileptogenic substrate in patients with refractory temporal lobe epilepsy.

Patients and methods

This study included 137 patients who received surgical treatment for intractable epilepsy. MRI, FDGPET and ictal ^99mTc-HMPAO SPECT were retrospectively reviewed regarding their sensitivity in lateralization of the epileptogenic zone compared to video/EEG, pathological results and surgical outcome.

Results

104 MR-positive and 33 MR-negative patients were enrolled. In the MR-positive group, MRI, PET and ictal/SPECT were concordant to video/EEG in 72%, 83% and 73%, respectively. When compared to pathological diagnosis, they correctly lateralized the epileptogenic zone in 70%, 87%, and 73%, respectively. In patients with good surgical outcome, they correctly localized the epileptogenic zone in 79%, 88%, and 78%, respectively. In the MR-negative group, PET and ictal/SPECT were concordant with video/EEG in 82% and 58%, respectively and matching with pathological diagnosis in 85% and 56%, respectively.

Conclusion

PET is the most sensitive method in lateralization of the epileptogenic substrate. The use of MRI, PET and ictal/SPECT as a multimodality approach improves lateralization of the affected zone particularly in cases with negative MR findings and distinguishes patients who will benefit from surgery.