立体定向射频多靶点联合毁损治疗顽固性精神病

目的：探讨立体定向射频多靶点联合毁损术治疗顽固性精神病的作用．方法：对30例顽固性精神病患者行CT和MRI引导下立体定向双侧杏仁核和内囊前肢联合毁损，症状不缓解病人加行双侧扣带回及双侧尾状核下束毁损术。结果：术后随访3个月～4年，有效率为70％，无效率为30％。结论：立体定向射频多靶点联合毁损术，治疗顽固性精神病是一种较安全、有效的方法。     

立体定向射频多靶点联合毁损治疗顽固性精神病

目的：探讨立体定向射频多靶点联合毁损治疗顽固性精神病的作用。方法：对18例顽固性精神病患行CT和MRI引导立体定向射频双侧杏仁核和内囊前肢联合毁损，症状不缓解病人行双侧扣带回及双侧尾状核下束切开毁损术。结果：术后随访3个月－3年，有效率为69％，无效率为31％。结论：立体定向射频多靶点联合毁损治疗顽固性精神病是一种较安全、有效的方法。     

立体定向手术对精神分裂症患者顽固性幻觉妄想症状的疗效评定

目的 探讨立体定向手术能否有效消除难治性精神分裂症患者存在的顽固性幻觉妄想症状.方法 对523例存在顽固性幻觉妄想的难治性精神分裂症患者,采用CT定位立体定向双侧杏仁核、内囊前肢、隔区、扣带回等多靶点组合毁损治疗.术后1年由精神科医生对治疗效果进行评定.结果 术前存在顽固性幻觉的患者479例,术后症状完全消除430例、偶发31例,治疗有效率为96.2%.术前存在顽固性妄想的患者491例,术后症状完全消除454例、偶发12例,治疗有效率为94.9%.结论 立体定向脑内多靶点组合毁损治疗可有效消除难治性精神分裂症患者存在的顽固性幻觉妄想症状.     

立体定向手术治疗精神病初步报告(附11例报告)

我们自1988年12月至1989年12月用立体定向技术治疗11例精神病人,获得较满意效果。其中精神分裂症9例,脑发育迟滞并发作性精神障碍1例,神经症1例。病例与靶点选择:精神分裂症靶点选择:扣带回(双侧)1例;双侧扣带回+1侧杏仁核5例;双侧扣带回+双侧杏仁核2例;双侧扣带回+双侧内囊前支1例。脑发育迟滞并发作性精神障碍第一次手术毁损双侧杏仁核,效果欠佳,于20天后二次手术毁损双侧扣带回+双侧内囊前支。神经症:双侧扣带回+双侧内囊前支。疗效评价精神分裂症:9例病人于手术后,由2～3位精神病科医师采用BPRS精神量表评分,近期     

立体定向术治疗难治性精神病的近期疗效观察

目的探讨立体定向手术治疗难治性精神病的临床疗效。方法对140例难治性精神病患者,采用CT定位立体定向双侧杏仁核、内囊前肢、扣带回等多靶点组合毁损治疗。术中用电阻值和微电极电生理验证靶点。术后6个月由精神科医生对治疗效果进行评定。结果140例患者中,恢复12例、显著进步107例、进步17例、无变化4例,总有效率为97％。无严重并发症和后遗症发生。结论CT导向立体定向多靶点毁损术定位精确、安全、显效,是难治性精神病的有效治疗方法之一。     

立体定向手术治疗87例顽固性癫痫的远期疗效观察

目的探讨立体定向手术治疗顽固性癫痫的远期疗效.方法男64例,女23例,年龄7～54岁(平均24.8岁),病程3～37年(平均12.7年).其中全身性发作65例,部分性发作22例.手术除6例儿童采用全麻外,均在局麻下进行,33例行一侧杏仁核加Forel-H毁损,24例行双侧杏仁核加一侧Forel-H毁损,15例行双侧杏仁核毁损,6例行双侧杏仁核加扣带回毁损,5例行一侧杏仁核毁损,3例一侧Forel-H毁损,1例行双侧扣带回加内囊前肢毁损.另外有6例患者进行了两次手术.结果通过3～13年(平均6.8年)的随访,发现18例病人(20.7%)癫痫发作完成消失;32例患者(36.8%)癫痫发作减少90%以上;12例患者(13.8%)术后癫痫发作减少50%以上;手术效果不理想者有25例(28.7%),其中1例患者(1.1%)术后因并发颅内感染而死亡.总有效率71.3%,优良率为57.5%.结论立体定向手术是治疗顽固性癫痫的一种有效方法,但手术前应准确定位致痫灶,并选择适当的手术靶点.     

双侧杏仁核、扣带回多靶点毁损治疗精神病3例报告

双侧杏仁核、扣带回多靶点毁损治疗精神病３例报告邓厚才周曹朱晓梅李亚飞邓先佑黄功华陈晓兵我院在几年中，采用脑立体定向术（双侧杏仁核、扣带回多靶点毁损）治疗３例慢性、难治性精神分裂症，全部获得成功，分别通过６年，５年和近期追踪观察，２例显效，１例进步。我...     

难治性精神分裂症的立体定向手术治疗——术后一年随访结果

目的探讨立体定向手术治疗难治性精神分裂症的临床疗效。方法对251例难治性精神分裂症患者,采用CT定位立体定向双侧杏仁核、内囊前肢、扣带回等多靶点组合毁损治疗,术中用电阻值和微电极电生理验证靶点,其中17例患者因首次手术后3~6个月疗效不佳而接受二次手术。术后1年由精神科医生对治疗效果进行评定。结果251例患者中,恢复13例、显著进步200例、进步29例、无变化9例,无严重并发症发生。结论CT导向立体定向多靶点组合毁损术安全,是难治性精神分裂症的有效治疗方法之一。     

选择性多靶点联合毁损治疗难治性精神障碍

目的 探索以正电子发射断层扫描(positron emission tomography,PET)为主要依据进行选择性立体定向多靶点毁损治疗药物难治性精神障碍.方法 本组符合药物难治性精神障碍共46例,其中精神分裂症34例,精神发育迟滞伴攻击行为10例,强迫症2例.所有患者在术前均行PET扫描.根据患者PET结果,对目前常用的治疗精神障碍靶点进行调整,拟定个性化毁损靶点.立体定向多靶点毁损后对患者疗效进行评估.结果 PET显示本组87%患者存在不同程度的脑代谢异常,额叶代谢降低为63.1%,颞叶代谢减低21.8%,双侧扣带回区代谢增高26.1%.根据以上结果,颞叶代谢降低则同侧杏仁核不做毁损,扣带回代谢增高给予扩大毁损范围.术后经量化评估,疗效满意,没有出现严重并发症.结论 PET是目前唯一反应精神异常患者脑内代谢情况的影像学检查,其结果对制定个性化手术方案有重要参考价值.     

立体定向核团毁损术治疗难治性强迫症27例分析

目的：探讨立体定向核团毁损术治疗难治性强迫症的临床疗效。方法对27例难治性强迫症病人,采用C T导向立体定向手术对双侧扣带回、内囊前肢实施多靶点毁损治疗。术前在256层螺旋C T 扫描下定出双侧扣带回、内囊前肢拟毁损的靶点,术中用电阻抗监测验证靶点,70℃射频毁损60～75 s。术前及术后6个月及1 a由精神病专科医师独立进行Yale-Brown强迫症量表、Hamilton抑郁量表、Hamilton焦虑量表的评定比较。结果本组27例手术病人中强迫症状完全消失13例,显效8例,有效3例,无效3例。7例病人在术后出现记忆力下降和定向障碍,6例术后2周恢复;5例出现尿失禁,在1周后缓解;1例出现一侧肢体轻偏瘫,复查头颅CT 未见出血,经扩血管及高压氧等治疗3周后肌力恢复。结论螺旋CT导向立体定向双侧扣带回、内囊前肢毁损术对顽固性强迫症病人疗效明显,可有效提高患者的生活质量,恢复社会功能。     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -