Kleine-Levin and Munchausen syndromes in a patient with recurrent acromegaly

Hypothalamic disease often affects the patients' personality and this also applies to pituitary tumors with suprasellar extension. We report on a patient with a 12-year history of recurrent acromegaly, treated with three transphenoidal operations, single field radiation therapy and bromocriptine/octreotide administration. During the course of follow-up she presented with self-inflicted anemia and Kleine-Levin syndrome (hypersomnia, hyperphagia and hypersexuality). Furthermore, she developed post-radiation necrosis within the right temporal lobe. Whether her neurological and personality disorders result - at least partially - from the acromegaly or the temporal lobe necrosis remains unclear.     

五羟色胺含量在丹参改善颞叶缺血大鼠记忆障碍中的变化

目的 探讨五羟色胺(5-HT)含量在丹参改善单侧颞叶缺血性损害大鼠空间记忆障碍中的变化。方法采用立体定向光化学技术选择性地导致大鼠左侧颞叶皮层缺血,术前30min及术后第3天分别给丹参组大鼠腹腔注射丹参10g／kg体重,用Morris水迷宫及图像自动监视系统监测大鼠行为。然后取脑组织进行病理观察及5-HT免疫组化分析：结果经丹参治疗,颞叶缺血性损害大鼠的空间记忆障碍得到显改善,颞叶缺血性损害显减轻,缺血灶内5-HT表达明显减少。结论在丹参改善单侧颞叶缺血大鼠空间记忆障碍中,5-HT起一定作用。     

非痴呆型皮质下小血管性认知障碍患者的MRI、DTI表现

目的探讨常规磁共振成像(MRI)和扩散张量成像(DTI)在非痴呆型皮质下小血管性认知障碍(VCIND-SSVD)诊断中的价值。方法采用蒙特利尔认知量表(MoCA)、简易智能状态检查量表(MMSE)对26例非痴呆型血管性认知障碍和24例正常对照者的认知功能进行评价,通过常规MRI分析两组脑叶萎缩、皮质下白质疏松和腔隙性脑梗死等影像学参数的差异;通过DTI技术测量双侧额叶、顶叶、颞叶、枕叶、内囊前肢、内囊膝部及内囊后肢的分量各向异性(FA)和平均扩散率(MD)的差异;对VCIND-SSVD组患者MoCA总分及其子项评分与FA和MD进行相关分析。结果常规MRI显示脑叶萎缩、皮质下白质疏松和腔隙性脑梗死等影像学参数在两组间无明显差异,与认知功能无明显相关(均P>0.05)。VCIND-SSVD组双侧额叶FA值与对照组比较明显下降,差异有统计学意义(均P<0.01);VCIND-SSVD组双侧额叶MD值与对照组比较明显升高,差异有统计学意义(均P<0.01);两组间顶叶、颞叶、枕叶、内囊前肢、内囊膝部及内囊后肢的FA、MD值差异均无统计学意义(均P>0.05)。VCIND-SSVD组患者双侧额叶FA值下降程度与MoCA评分及注意力、语言功能、抽象概括能力、视空间与执行能力等子项评分均呈正相关,(r=0.43~0.71,P<0.05,<0.01),MD值升高程度与MoCA评分及注意力、语言功能、抽象概括能力、视空间与执行能力等子项评分均呈负相关(r=-0.43~-0.67,P<0.05,<0.01)。结论 VCIND-SSVD患者认知功能损害可能与双侧额叶白质损伤有关,DTI在VCIND早期诊断中起着重要的作用。     

Memory for object features versus memory for object location: a positron-emission tomography study of encoding and retrieval processes.

Regional cerebral blood flow was measured with positron-emission tomography during two encoding and two retrieval tasks that were designed to compare memory for object features with memory for object locations. Bilateral increases in regional cerebral blood flow were observed in both anterior and posterior regions of inferior temporal cortex and in ventral regions of prestriate cortex, when the condition that required retrieval of object locations was subtracted from the condition that required retrieval of object features. During encoding, these changes were less pronounced and were restricted to the left inferior temporal cortex and right ventral prestriate cortex. In contrast, both encoding and retrieval of object location were associated with bilateral changes in dorsal prestriate and posterior parietal cortex. Finally, the two encoding conditions activated left frontal lobe regions preferentially, whereas the two retrieval conditions activated right frontal lobe regions. These findings confirm that, in human subjects, memory for object features is mediated by a distributed system that includes ventral prestriate cortex and both anterior and posterior regions of the inferior temporal gyrus. In contrast, memory for the locations of objects appears to be mediated by an anatomically distinct system that includes more dorsal regions of prestriate cortex and posterior regions of the parietal lobe.     

Unilateral cirrhosis

Summary The patient presented had a diaphragm-like stricture in the right hepatic duct, portal fibrosis of the right lobe, atresia of the left hepatic duct, and unilateral cirrhosis of the left hepatic lobe, with portal hypertension and gastrointestinal hemorrhage from varices. He was treated with the selective distal splenorenal (Warren) shunt and endoscopic transduodenal lysis of the right hepatic diaphragm.     

A case of broncholiths derived from calcification of peripheral tuberculous lesions subsequently infected by Actinomyces

A 72-year-old woman who had been treated for coxotuberculosis was examined because of persistent hemoptysis. Chest X-ray films and CT scans revealed atelectasis of the right middle lobe and bronchial calcification. Bronchoscopy showed a yellow broncholith with pus 1 cm from the orifice of the right B4 bronchus. Actinomyces israelii was isolated by anaerobic culture of bronchial lavage fluid. Since the broncholith occluded the right middle lobe bronchus and had caused repeated episodes of infection the right middle lobe was resected by video-assisted thoracoscopic surgery. Histological examination revealed broncholiths due to calcification of peripheral caseating nodules of tuberculosis, which is a rarely finding.     

手术治疗顽固性颞叶癫痫(附23例报告)

目的探讨颞叶癫痫手术适应证与术式选择。方法根据发作类型和表现、发作间期EEG及头颅MRI扫描，选择顽固性颞叶癫痫综合征23例进行手术治疗，其中单侧海马硬化16例。行前颞叶切除术7例，经颞中回侧脑室入路与经侧裂侧脑室入路选择性杏仁核海马切除术分别4、5例；蛛网膜囊肿2例仅行囊肿壁切除术；颞中回后部胶质瘤1例先行病灶切除术，术后因癫痫仍发作于术后第5天再次行前颞叶切除术；颞叶内侧肿瘤4例行肿瘤切除术加前颞叶切除术。术后随访3～22月。结果16例海马硬化中，2例术后1周内分别出现1次和2次强直阵挛发作．服卡马西平后未再发作，3例术后6～8个月的随访期内共发作1、3、3次，余11例未发作。蛛网膜囊肿者术后发作次数减少90％，颞叶肿瘤除1例术后第6天出现强直阵挛发作1次外未出现发作。结论在筛选颞叶癫痫手术适应证时，应注意癫痫发作形式和MRI表现，根椐病因选择术式。     

血管性痴呆的扩散张量成像研究

目的应用扩散张量成像(DTI)技术,探讨皮质下缺血性血管性痴呆(SIVD)患者脑白质变化的特点及不同脑区DTI参数改变与认知的关系。方法对34例SIVD患者(SIVD组)及26例健康老年人(对照组)行DTI扫描,测量双侧前额叶、额叶深部、眶额内侧、下额叶、颞叶、顶叶、枕叶白质及T_2WI高信号区、T_2WI高信号周围正常白质区的分量各向异性(FA)、主各向异性(PA)及表观弥散系数(ADC)值。结果对照组左侧前额叶白质PA值大于右侧,ADC值小于右侧。SIVD组双侧前额叶、双侧额叶深部、下额叶、眶额内侧的FA值及PA值明显下降,平均ADC值升高;双侧顶叶的FA值下降,平均ADC值升高;双侧颞叶、枕叶平均ADC值升高;左侧下额叶、眶额内侧白质的FA与PA值较右侧小;左侧下额叶ADC值较右侧大。病变区及病变周围区的FA和PA值小于正常区,ADC值大于正常区。前额叶FA与简易智能状态检查表评分呈正相关。结论 SIVD患者脑白质FA、PA和ADC改变具有区域选择性,前部及左侧脑区损伤明显,后部及右侧相对保留白质的完整性。DTI是研究SIVD脑白质损伤的一种理想的方法。     

轻度认知损害患者冲突信息处理的事件相关电位研究

目的采用事件相关电位(event-related potential,ERP)及低分辨率电磁断层成像(low resolution brain electromag-netic tomography,LORETA)技术,研究轻度认知损害患者冲突信息处理系统的损害机制及敏感指标。方法研究对象为15例轻度认知损害(AMCI)患者(AMCI组)和15例年龄、性别、受教育年限匹配的正常老年(正常老年组)作为对照。成对的简单平面图形先后呈现,受试者比较刺激对是否相同,同时记录32导脑电、正确反应率及反应时间。结果刺激匹配状态下两组的P300波形分布均以顶部为著,潜伏期及波幅无显著差异。刺激冲突状态下N270主要分布在前头部,AMCI组N270潜伏期较正常老年组明显延长(F1,28=25.3264,P=0.000),波幅差异不显著。LORETA电流密度分析显示冲突状态下正常老年组前头中央部、左右前额背外侧及右颞叶激活,AMCI组右前额背外侧及右颞叶区域激活增强,前头中央部无明显激活。脑电地形图分析与上述结果相一致。结论前头部ERP成分N270峰潜伏期延长反映了轻度认知损害患者信息加工处理速度减慢,患者对冲突状态信息加工处理的损害较匹配状态信息加工处理的损害更为明显。     

电子支气管镜下联合取材病理诊断肺癌120例分析

目的探讨电子支气管镜在肺癌诊断中的作用。方法对我院收治的120例肺癌患者行电子支气管镜检查,通过电子支气管镜活检、刷检、术后痰涂片行细胞学检查或病理进行分析。结果病变部位以左肺上叶多见,其次为右肺上叶,左肺下叶、右肺下叶次之。确诊的多为中央型肺癌,肺癌病理类型以鳞癌为主,其次为腺癌,小细胞癌最少。结论经电子支气管镜下联合取材病理诊断肺癌中央型肺癌居多,鳞癌比例最高;肺癌病变部位好发于左右肺上叶;电子支气管镜下联合取材病理诊断肺癌,对提高肺癌诊断率有一定的帮助。     

Symptomatic postictal cardiac asystole in a young patient with partial seizures.

This report describes a patient with complex partial seizures arising from the right temporal lobe who developed symptomatic sinus arrest following the end of his seizure activity. A ventricular pacemaker was implanted and was documented to function appropriately, preventing development of bradycardia associated symptoms during subsequent seizures. Possibly relevant cerebral structures are briefly discussed.     

Postoperative management for donor safety in living related donor liver transplantation

BACKGROUND/AIMS: Living related donor liver transplantation must hold on in absolute donor safety. Nevertheless, the risks to the donors are increased because of the use of right lobe for size mismatch. Therefore the intensive management for donor operation can hardly be overestimated. In this study, we investigated the utility of prostaglandin E1, methylprednisolone and C-tube in the postoperative management for donor operation based on our understanding of the mechanisms of liver injury after massive hepatectomy. METHODOLOGY: Outcome of the thirteen donors, whose right lobe was removed (right lobe group: 7 cases) or the left lobe only (3 cases) and left lobe plus caudate lobe (3 cases) (left lobe group: 6 cases) from 1999 March to 2000 August, for living related liver transplantation were evaluated. Indication for right lobe living related liver transplantation was basically defined as an estimated left lobe volume/recipient body weight ratio (GVBW ratio) of < 0.8% (range: 0.65-1.4, right lobe group: 1.05 +/- 0.18, left lobe group: 0.89 +/- 0.16). RESULTS: The donors recovered from the operation without the differentiation between right and left lobe group. There were no significant differences in the operative time, the operative hemorrhage, the hospital stays and the postoperative liver function in the two groups. They had no bile leakage and no serious complications. We experienced the left lobe donor who suffered from a cholangitis without any infection and he recovered by the administration of prostaglandin E1 and steroid. They improved bile secretion and bilirubinemia. Eleven recipients (84.6%) were successfully treated. The two causes of death were the sepsis (right lobe) and brain hemorrhage (left lobe). CONCLUSIONS: The current series of right lobe donation was able to show successful results as well as left lobe donation by the postoperative management with steroid, prostaglandin E1 and C-tube drainage based on our understanding of liver injury after massive hepatectomy in the adult-to-adult living donor liver transplantation.     

Psychomotor seizures

A 30-year-old woman presented to the emergency department after an episode of "dizziness" that caused her to lose control of her car. During the preceding 12-month period she had had recurrent "dizzy" spells and abdominal pains for which she was evaluated by several physicians in various emergency departments. Physical and general neurological examination on presentation was within normal limits. Outpatient CT scan was normal, and an EEG revealed a right temporal lobe spike with slow wave pattern suggestive of temporal lobe focus. Since begun on therapeutic doses (300 mg per day of phenytoin), the patient has not experienced further spells or abdominal pains. This report emphasizes the need to be cognizant of an underlying seizure disorder as a possible etiologic agent responsible for a traumatic incident.     

磁共振动脉自旋标记技术对阿尔茨海默病脑血流量的初步研究

目的 探讨磁共振动脉自旋标记(arterialspinlabeling,ASL)技术对显示阿尔茨海默病(AD)患者脑血流异常的临床应用价值.方法 22例AD患者和20例年龄相匹配的健康对照者进行头颅ASL灌注成像和磁共振形态学检查,其中16例AD患者及11例健康对照者完成了脑单光子发射计算机断层扫描(singlephotonemissioncomputedtomography,SPECT)检查.ASL灌注的原始数据经处理后得到脑血流图,测量双侧额叶、颞叶、颞顶交界区、顶叶和枕叶皮质和海马区的脑血流量,并比较AD患者脑血流量与健康对照者的差异.结果 22例AD患者ASL脑灌注图像均可见局部皮质灌注减低区,主要为颞叶72.7%(16例)、颞顶交界54.5%(12例)和顶叶45.5%(10例),且与SPECT表现一致.AD患者双侧额叶、颞叶、颞顶交界区、顶叶皮质及海马区的脑血流量较健康对照者显著下降(均P<0.05).AD患者右额叶、左顶叶及左颞顶交界皮质的脑血流量与简短精神状态量表(mini-mentalstateexamination,MMSE)评分呈正相关(r分别为0.49、0.54和0.64,均P<0.05).结论 ASL不仅可以清晰显示AD患者局部脑血流减低区,而且表现与SPECT一致,提示ASL技术是一种评价AD患者脑血流下降的有效工具.     

磁共振动脉自旋标记技术对阿尔茨海默病脑血流量的初步研究

目的 探讨磁共振动脉自旋标记(arterialspinlabeling,ASL)技术对显示阿尔茨海默病(AD)患者脑血流异常的临床应用价值.方法 22例AD患者和20例年龄相匹配的健康对照者进行头颅ASL灌注成像和磁共振形态学检查,其中16例AD患者及11例健康对照者完成了脑单光子发射计算机断层扫描(singlephotonemissioncomputedtomography,SPECT)检查.ASL灌注的原始数据经处理后得到脑血流图,测量双侧额叶、颞叶、颞顶交界区、顶叶和枕叶皮质和海马区的脑血流量,并比较AD患者脑血流量与健康对照者的差异.结果 22例AD患者ASL脑灌注图像均可见局部皮质灌注减低区,主要为颞叶72.7%(16例)、颞顶交界54.5%(12例)和顶叶45.5%(10例),且与SPECT表现一致.AD患者双侧额叶、颞叶、颞顶交界区、顶叶皮质及海马区的脑血流量较健康对照者显著下降(均P<0.05).AD患者右额叶、左顶叶及左颞顶交界皮质的脑血流量与简短精神状态量表(mini-mentalstateexamination,MMSE)评分呈正相关(r分别为0.49、0.54和0.64,均P<0.05).结论 ASL不仅可以清晰显示AD患者局部脑血流减低区,而且表现与SPECT一致,提示ASL技术是一种评价AD患者脑血流下降的有效工具.     

Pulmonary vein thrombosis following bilobectomy

Acute thrombosis of the pulmonary vein following lobectomy or bilobectomy is a rare complication with no standard guideline for diagnosis or management. In this report, we present a case of right upper lobe vein thrombosis following a middle and lower lobectomy. Diagnosis was confirmed by ventilation-perfusion lung scan, pulmonary angiogram, and bronchoscopy. The patient was treated conservatively with no further complications and had a partial recovery of the circulation to the right upper lobe. A review of the literature is also presented along with the experimental data demonstrating the mechanisms of recovery.     

Relapsing herpes simplex encephalitis resulting in Kluver-Bucy syndrome

Relapsing herpes simplex encephalitis (HSE) rarely occurs after acyclovir treatment. We treated a patient with relapsing HSE of the contralateral temporal lobe, resulting in Klüver-Bucy syndrome, after a full-dose acyclovir treatment. This case suggests that physicians should consider sudden behavioral and emotional changes after HSE treatment as a possible indication of relapsing HSE, as well as possible temporal lobe epilepsy, and the need to administer longer acyclovir treatment for select patients.     

Coccidioidomycosis presenting as liver abscess.

A 26-year-old man presented with pain in the right upper abdomen. Ultrasonography revealed a large solitary right lobe liver abscess, which was treated by aspiration and antiamebic treatment. The patient continued to be symptomatic with the abscess increasing in size. Repeat aspiration revealed a pure growth of coccidioidomycosis, which was confirmed on culture. He was treated with amphotericin-B; the abscess resolved completely and the patient has remained asymptomatic at one-year follow up.     

Chyloptysis with right middle lobe syndrome complicated postoperatively by chylothorax: An unusual cause of right middle lobe syndrome

Chyloptysis, in the context of middle lobe syndrome, and chylothorax are rare clinical entities. They are reported in the medical literature mostly as case reports, but never together in the same patient. The present report describes the case of a 34-year-old woman who presented with chyloptysis associated with recurrent right middle lobe syndrome since she was 20 years of age, and eventually underwent right middle lobectomy. A few weeks postoperatively, she developed a right-sided chylothorax, which was refractory to medical therapy, and was successfully treated with thoracic duct ligation. She has been symptom-free for two years postsurgery.     

A case of simple type Caroli's disease confined to right lobe of the liver]

Caroli's disease is a rare congenital hepatobiliary disease characterized by multifocal segmental dilatation of intrahepatic bile ducts affecting all or parts of the liver. Two forms of Caroli's disease are described, the pure form and that associated with periportal fibrosis. The disease may diffusely affect the liver or be localized to one lobe or segment. Less than 20% of all reported cases of Caroli's disease are monolobar type. We report a case of simple type Caroli's disease confined to right lobe of the liver in a 22 year old man. He was admitted due to right upper abdominal pain and diagnosed by magnetic resonance cholangiopancreatography. He was treated with right hepatic lobectomy and recovered completely.