前颞叶内侧切除术治疗颞叶内侧型癫痫

目的探讨前颞叶内侧切除术治疗颞叶内侧型癫痫的治疗效果。方法21例顽固性颞叶癫痫患者,采用无框架神经导航辅助,经颞中回行前颞叶内侧切除术,切除前颞叶、杏仁核及海马。采用分级量表进行针对癫痫发作控制效果的评价。结果21例术后随访6～29个月,神经功能均改善,无严重手术并发症。16例（76%）癫痫发作完全消失（EngelⅠ级）,3例（16%）癫痫发作极少（EngelⅡ级）,2例（8%）癫痫发作减少（EngelⅢ级）。结论前颞叶内侧切除术是治疗颞叶癫痫的有效方法。神经导航辅助下手术彻底切除杏仁核及海马,避免了语言区和视放射的损伤。     

颞叶癫痫中的过度运动性发作(附2例报告)

目的过度运动性发作常见于额叶癫痫,总结我中心病例,探讨颞叶癫痫表现为过度运动性发作时的临床决策。方法回顾2007～2009年进行手术治疗的颞叶癫痫患者,对所有患者的术前评估资料包括病史、MRI、头皮视频脑电图、PET和颅内脑电记录进行回顾性分析。根据Luders的描述对过度运动性发作进行识别。结果 102例患者中有2例表现为典型的过度运动性发作,尽管症状学提示额叶起源,但是头皮脑电图均提示颞叶为发作起始区,1例进行颅内电极监测,另1例因为MRI的阳性发现而直接进行手术切除。2例患者进行了前颞叶切除术,术后2 a以上无发作。结论过度运动性发作发作偶尔可见于颞叶癫痫,如果其头皮EEG结果与影像学检查一致,则手术治疗效果比较理想。     

颞叶癫痫术前定位方法的评价

目的 探讨颞叶癫痫不同术前定位方法的效果。方法 回顾性分析58例难治性颞叶癫痫手术患者的临床资料。分别统计头皮脑电图、视频脑电监测、皮层电极、深部电极、头颅CT、MR1、PET七种检查定位方法的阳性结果,计算出准确定位率,对数据进行统计学分析。结果 CT、头皮脑电图的定位能力明显低于视频脑电监测、皮层电极、深部电极监测及MRI、PET检查,后五种评估方法的定位能力无显著差异。结论 上述术前定位方法单一应用不具有特异性．颞叶癫痫灶的准确定位需综合应用各种定位方法。     

难治性枕叶癫痫的手术治疗（附7例报告）

目的分析难治性枕叶癫痫的手术治疗效果和视觉功能保护效果。方法对7例难治性枕叶癫痫患者,行视力视野检查,致痫灶行皮层或局部病灶及周围胶质增生带切除术,对5~10 s内迅速跟随发作起始的症状产生区行低功率皮层热灼术或局部皮层切除术,疑有功能区放电或发作起始者加行脑磁图功能区定位,功能区行低功率皮层热灼术,并注意保护好其白质传导纤维。其中确定发作起始于功能区的2例行功能区皮层热灼术。根据Engel′s术后效果分级评估疗效;行视力视野检查,观察术后患者视觉功能变化。结果术后随访6-12个月,6例无癫痫发作,达到Engel′sⅠ级,1例术后存在稀少癫痫发作,达到Engel′sⅡ级。6例（包括行功能区皮层热灼术2例）术后视觉功能无明显变化,1例视觉功能障碍较术前加重。结论定位明确的难治性枕叶癫痫患者可行致痫灶皮层或局部病灶及周围胶质增生带切除术;功能区低功率皮层热灼术可有效控制癫痫发作,且不造成功能缺失。术前精确定位功能区,术中保护功能区皮质及白质传导纤维,可有效减少视觉功能损伤机会。     

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.     

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.     

Unidirectionally progressive resection of lower left lung carcinoma under video-associated thoracoscopy

General anesthesia is adopted through double-lumen endotracheal intubation, one-lung ventilation on the contralateral, and intravenous injection. The patient took a 90 degree decubitus on his contralateral side. The operative incisions: the observation port was made in the mid-axillary line of the 7^th intercostal section, a second horizontal incision of 4 cm as the main operation port at the 4^th intercostal space between the anterior axillary line and the midclavicular line, and a 3^rd incision of 1.5 cm as the secondary operation hole at the 9^th intercostal space between the axillary line and the bottom scapular line. The surgeons were on the ventral side of the patient, and operated with endoscope apparatus in front of the monitor screen.     

Unidirectionally progressive resection of left upper pulmonary lobe under video-assisted thoracoscopy

The case is a nodule in the upper left lobe, and intraoperative frozen section pathological diagnosis on the removed nodule confirmed well differentiated mucinous adenocarcinoma. Unidirectionally progressive resection of the left upper pulmonary lobe under video-assisted thoracoscopy is selected as the surgical method. Right below the operation hole, surgeons gradually advanced in one direction, and dissociated and divided in such order: the upper left pulmonary vein, the upper left lobe bronchus, the upper left pulmonary arterial branches and the fissures. Endoscopic linear cutters and hem-o-lok clip applicator were used to deal with the blood vessels, bronchus, and under-differentiated fissures. At last, the removed upper left lobe was put into a size eight sterile glove and taken out through the main operation hole. General anesthesia with double-lumen endotracheal intubation is used. The patient took a 90 degree decubitus on his contralateral side. The surgeons were on the ventral side of the patient, and operated with endoscope apparatus under the monitor.     

颞叶癫痫大鼠学习记忆障碍与海马病理变化的相关性研究

目的 探讨大鼠颞叶癫痫发作后不同时问学习、记忆障碍程度与海马病理变化的相关性。方法 采用立体定向技术在大鼠右侧海马注射红藻氨酸诱发颡叶癫痫发作,观察其行为学表现、脑电图变化,Morris水迷宫评价不同时间段学习、记忆障碍程度,以及海马、皮质病理变化。结果 注射红藻氨酸大鼠出现颞叶癫痫发作,随发作时间延长出现不同程度学习、记忆障碍,定位航行实验示逃避潜伏期延长,空间搜索实验示原平台象限内游泳时问百分比下降,与对照组比较均有显著性差异（P〈0．05）,发作后2个月达到高峰。右侧海马锥体细胞逐渐出现变性、坏死,由CA3区向CA4、CA2、CA1区扩展,2个月达到高峰;对侧海马锥体细胞也出现变性、坏死。但程度明显低于注射侧。结论 大鼠颡叶癫痫发作后,其学习、记忆障碍程度与海马变性、坏死程度具有一定相关性。     

Human single-neuron responses at the threshold of conscious recognition

We studied the responses of single neurons in the human medial temporal lobe while subjects viewed familiar faces, animals, and landmarks. By progressively shortening the duration of stimulus presentation, coupled with backward masking, we show two striking properties of these neurons. (i) Their responses are not statistically different for the 33-ms, 66-ms, and 132-ms stimulus durations, and only for the 264-ms presentations there is a significantly higher firing. (ii) These responses follow conscious perception, as indicated by the subjects' recognition report. Remarkably, when recognized, a single snapshot as brief as 33 ms was sufficient to trigger strong single-unit responses far outlasting stimulus presentation. These results suggest that neurons in the medial temporal lobe can reflect conscious recognition by "all-or-none" responses.     

Triangulation of the neurocomputational architecture underpinning reading aloud

The goal of cognitive neuroscience is to integrate cognitive models with knowledge about underlying neural machinery. This significant challenge was explored in relation to word reading, where sophisticated computational-cognitive models exist but have made limited contact with neural data. Using distortion-corrected functional MRI and dynamic causal modeling, we investigated the interactions between brain regions dedicated to orthographic, semantic, and phonological processing while participants read words aloud. We found that the lateral anterior temporal lobe exhibited increased activation when participants read words with irregular spellings. This area is implicated in semantic processing but has not previously been considered part of the reading network. We also found meaningful individual differences in the activation of this region: Activity was predicted by an independent measure of the degree to which participants use semantic knowledge to read. These characteristics are predicted by the connectionist Triangle Model of reading and indicate a key role for semantic knowledge in reading aloud. Premotor regions associated with phonological processing displayed the reverse characteristics. Changes in the functional connectivity of the reading network during irregular word reading also were consistent with semantic recruitment. These data support the view that reading aloud is underpinned by the joint operation of two neural pathways. They reveal that (i) the ATL is an important element of the ventral semantic pathway and (ii) the division of labor between the two routes varies according to both the properties of the words being read and individual differences in the degree to which participants rely on each route.Cognitive neuroscience offers the exciting prospect of understanding the neural basis of cognitive behaviors, a goal which requires integration of sophisticated cognitive models with knowledge about the underlying neural machinery. As a key cognitive skill, reading provides an advanced test case. Computationally implemented theories present detailed accounts of how reading is accomplished at a cognitive level (1–4). To achieve a full understanding of reading and its impairment in neurological disorders, these cognitive theories must be integrated with information about the neural basis of the reading system. However, although various studies have explored the neural basis of reading (5), the level of integration between cognitive and neural models remains limited. In the present study, we used an improved functional MRI (fMRI) protocol to test the specific predictions of an influential computational model of word reading: the connectionist “Triangle Model” (2). We were able to map specific elements of this cognitive model onto different cortical regions, thereby providing a direct link between cognitive theorizing and neural implementation. Specifically, we provide insights into the division of labor between semantic and phonological processes in supporting reading aloud, which has been a long-standing source of controversy among cognitive models (6, 7). Moreover, we demonstrate that this division of labor is jointly influenced by variation in the properties of words being read and by individual differences in the neurocognitive architecture across participants and that these individual differences can be predicted using an independent behavioral measure of reading style.Cognitive and neural models of single-word reading agree that multiple pathways contribute to reading aloud (1, 2, 8–10). These pathways consist of a route that maps directly from orthographic forms to phonological representations (allowing us, for example, to pronounce novel letter strings such as “flumpt”) and an indirect route mediated by word-level lexical or semantic knowledge. The exact function of these pathways remains a source of active debate, much of it focused on the role of semantic (word meaning) knowledge in reading aloud. Dual-route models hold that all words can be read either via grapheme-to-phoneme rules or through access to orthographic and phonological lexica that are distinct from knowledge of word meaning (1, 10). In contrast, the Triangle Model proposes that semantic knowledge plays an integral part in pronouncing words correctly (2, 6, 11). The cornerstone of this second approach is the view that, because reading is, in evolutionary terms, a recently developed skill, it is unlikely to be served by a dedicated neural architecture. Instead, it is underpinned by the phylogenetically more mature primary systems of vision, phonology, and semantics (9). This idea has been instantiated in several connectionist computational models known as Triangle Models because they comprise a direct pathway from visual (or orthographic) to phonological representations (here termed the “O→P pathway”) and an indirect pathway in which the translation from orthography to phonology is mediated through access to semantic knowledge (2–4, 12). In such models, the direct O→P pathway becomes sensitive to the statistical regularities in the mapping from spelling to sound. It therefore is efficient in computing the pronunciations of words with typical spelling-to-sound mappings (e.g., “mint”) but is less successful for words with exceptional spelling-to-sound correspondences, such as “pint” (2, 13). The indirect, semantically mediated pathway (O→S→P) provides additional support for reading, which is especially important for exception words that are poorly served by the O→P pathway.The Triangle Model assumes that each of the primary systems of vision, phonology, and semantics makes distinct contributions to reading. This position is supported by neuropsychological investigations of patients with acquired dyslexias, in which damage to visual, phonological, and semantic systems are associated with distinct patterns of reading deficit. The visually based reading deficit sometimes termed “pure alexia” is associated with damage to the left ventral occipitotemporal cortex (14, 15), an area that is ubiquitously activated for tasks involving orthographic processing (8, 16). Critically, such patients also have visual deficits for nonorthographic stimuli such as checkerboards and faces (15, 17, 18), supporting the primary systems view that this brain region is a more general visual-processing area. In a similar vein, patients with phonological dyslexia have concomitant phonological deficits in tasks that do not involve written words (19–21). Lesion–symptom mapping studies indicate that these patients’ reading deficits are associated with damage to frontal and temporal perisylvian cortex (22). The involvement of premotor cortex in such patients is of particular interest, because this region is robustly activated when healthy individuals read aloud in the scanner (23). This area is strongly associated with phonological processing and in the computation of phonological output representations (24, 25). These findings reinforce the notion that reading aloud draws on a core phonological system that also is recruited by nonreading tasks.Involvement of the semantic system in reading aloud has proved the most controversial element of the Triangle Model. Semantic involvement is supported by the study of surface dyslexia, a reading disorder characterized by poor reading of exception words. This pattern is strongly associated with semantic dementia (SD), a disorder in which patients suffer from a progressive, selective deterioration in semantic knowledge (26). Both reading deficits and semantic deficits in this group have been linked to atrophy centered on the left anterior temporal lobe (22, 27, 28), suggesting that this area makes a critical contribution both to semantic knowledge and to the reading of exception words. However, although these studies provide persuasive evidence for the co-occurrence of semantic impairment and exception word reading deficits, they provide limited data regarding the exact neuroanatomical locus of such effects. A number of recent neuroimaging studies have highlighted the involvement of the ventral anterior temporal lobe (ATL), i.e., the inferior temporal and fusiform gyri, in semantic processing of verbal and nonverbal stimuli (29–31) in an area that coincides with the peak neural correlate of semantic impairment in patients with SD (32). The ATL is rarely activated in studies of word reading. One intriguing exception is a study in which participants were trained to associate pseudowords with particular meanings (33). Following this training, activation in the lateral ATL was observed when participants read the pseudowords aloud, suggesting that linking of novel pseudowords with meanings triggered engagement of the ATL. In general, however, there is scant neuroimaging evidence for the involvement of the ATL in the reading of familiar words, as various authors have noted (8, 34–36). As a consequence, the ATL is rarely included in models of the neural basis of reading (5, 36).There are two possible interpretations of these results. The first is that the ATL and, by extension, the semantic representations supported by this region, are not involved in the process of converting print to sound. Indeed, some have claimed that exception-word reading deficits in patients with SD are caused instead by mild atrophy in the posterior temporal lobe (7, 37). [There are, however, cases of surface dyslexia in SD without evidence of disruption to posterior temporal regions; see Woollams et al. (38).] The alternative argument, which we propose and test in this paper, is that the ATL does make a critical contribution to reading aloud and that the paucity of neuroimaging evidence for this contribution is the result of a number of technical and methodological factors. When these factors are addressed, we demonstrate that ATL activation is present and that it conforms to the predictions of the Triangle Model.It is well known that various methodological factors can reduce the probability of ATL activations being observed in neuroimaging studies. These include use of a restricted field of view that excludes the inferior parts of the temporal lobe from image acquisition and the use of low-level baselines that do not adequately control for automatic activation of the semantic system during passive conditions (39). In addition, gradient-echo fMRI is susceptible to magnetic field inhomogeneities that cause signal dropout and distortion in the orbitofrontal and ventral temporal cortices, including the ATL (40). One technique that combats this problem involves spin-echo (SE) imaging combined with processing that corrects for the spatial distortion incurred in problem areas (41). A number of studies using this distortion-corrected fMRI have found activation in the ventral and lateral ATLs for semantic decisions made in response to written and spoken words, pictures, and environmental sounds (29, 30, 42). To our knowledge, the present study is the first to use this technique to investigate reading aloud.In addition to general challenges in imaging the ATL, there are two issues that are specific to reading studies. The first is that it is not straightforward to predict which words should elicit the greatest activation in regions dedicated to semantic processing. Based on the Triangle Model and the poor exception word reading of patients with SD, one might expect the semantically mediated reading route to be more active when participants read exception words (6). In contrast, other authors have argued that reading any word elicits automatic activation of its meaning and that this activation occurs independently of any functional role in accessing the appropriate phonological form (36). This view predicts similar levels of activation for regular and exception words, with activation influenced instead by psycholinguistic variables such as frequency and imageability that index the strength of semantic representation.The second issue concerns individual differences in the degree to which people require semantic activation to compute the pronunciations of exception words. It has been observed that similar levels of semantic impairment in SD can result in varying degrees of impairment in exception word reading (6). In a few cases, patients even may present initially with normal exception word reading despite having measurable semantic impairment. Based on these findings, it has been proposed that individuals vary in their reliance on the semantic pathway, with Triangle Model simulations used to demonstrate that this variation in semantic reliance theoretically could account for the variability observed in SD (4, 6, 11). Individuals with an efficient and flexible direct pathway need little semantic support, whereas those with a less efficient direct pathway will need to fall back on semantic activation for harder words with atypical spelling–sound correspondences. The Triangle Model therefore predicts that the size of an individual’s consistency effect (i.e., the difference in reading performance between words with consistent versus inconsistent mappings) indexes the degree to which they use semantic knowledge when reading aloud. We refer to this quantity as a reader’s level of semantic reliance (SR). One important prediction arising from this research is that the level of ATL activation during reading varies systematically across individuals as a function of the individual’s SR. This between-subject variability may be an additional factor contributing to the failure to find ATL activations in previous studies. In this study, we used a behavioral measure of SR to model this variation explicitly, for the first time to our knowledge.In summary, the Triangle Model predicts that reading aloud should engage regions of the ATL involved in semantic processing but the existing neuroimaging literature provides little support for this claim, hampering efforts to integrate the cognitive model with neural data. Importantly, the absence of evidence for ATL involvement in word reading may be a result of (i) factors in imaging protocols that reduce the likelihood of observing activation in the ATL and (ii) failure to take into account the degree to which ATL activation in reading may be modulated by both word-level and subject-level variability. To maximize sensitivity to ATL activation in the present study, we used a distortion-corrected SE fMRI protocol with full brain field-of-view and an active baseline (see Fig. S1 for signal-to-noise map). We also tested for the effects of word-level factors as well as subject-level variation in SR. Although word-level variation is commonly investigated in reading studies, this is the first study to our knowledge to test for changes in activation relating to individual differences in SR. Our investigation proceeded in two stages. First, we investigated the effects of frequency and spelling-to-sound regularity on activation in regions involved in orthographic, phonological, and semantic processing. Dynamic causal modeling was used to explore the interactions between these areas. In the second part of the study, we tested the hypothesis that individual differences in SR could explain variation in ATL activation. We adopted a triangulation technique for identifying areas involved in the semantic reading pathway. The Triangle Model predicts that activation associated with semantically mediated reading is influenced by the type of word being read (exception > regular) and by the degree to which individual participants make use of this pathway (high SR > low SR). We therefore sought regions that exhibited a conjunction of these independent word-based and subject-based effects.Open in a separate windowFig. S1.Temporal signal-to-noise map, averaged across all participants.     

涟波振荡与大鼠颞叶癫癎发作关系的研究

目的探讨脑电中的涟波振荡与大鼠颞叶癫癎发作的关系。方法10只SD大鼠,在双侧齿状回和海马分别置入深部电极,用氯化锂-毛果芸香碱腹腔注射诱发大鼠颞叶癫癎,记录癫癎发作前后的深部脑电(采样频率10KHz,低通为5000Hz)。用小波变换提取脑电中的涟波和快速涟波成分,并用能量法对癫癎发作前后的涟波成分进行分析。结果涟波和快速涟波的能量变化与癫癎发作的状态十分符合。癫癎发作时,快速涟波和涟波的能量都有明显增加,累积速率大。给予地西泮后,两者的能量都有所减小,累积速率趋于稳定,但快速涟波的能量累积速度降低得更快。结论脑电中的涟波振荡成分对癫癎发作有指示性作用。     

褪黑素对匹罗卡品致癫癎大鼠海马神经发生和突触重建的影响

目的探讨褪黑素(Mel)在匹罗卡品(PILO)致癫癎犬鼠模型中的抗癫癎作用机制。方法将45只Wistar大鼠按癫癎持续状态(SE)后6 h,14、28天分为PILO组(1 5只),PILO+Mel组(15只)和对照组(15只),采用PILO诱导大鼠慢性颞叶癫癎模型,用5溴-2-脱氧尿嘧啶核苷标记增殖细胞,Timms染色评价苔藓纤维发芽(MFS)等技术,动态观察MeI对癫癎大鼠海马神经发生和MFS的影响及其与反复自发性癫癎发作(SRS)发生的关系。结果与对照组比较,PILO组大鼠SE后6 h,14、28天细胞数明显增加,差异有统计学意义(P<0.01);与PILO组比较,PILO+Mel组大鼠在SE后6 h,14、28天,细胞数量明显减少(P<0.05),28天SRS数量明显减少,差异有统计学意义(P<0.05)。与PILO+Mel组比较,PILO组大鼠SE后14天,Timms染色密度开始增强,28天密度明显增强,差异有统计学意义(P<0.05)。结论Mel对SRS的预防作用可能与其对癫癎诱导的神经发生和MFS的抑制作用有关。     

BDNF modulates GABAA receptors microtransplanted from the human epileptic brain to Xenopus oocytes

Cell membranes isolated from brain tissues, obtained surgically from six patients afflicted with drug-resistant temporal lobe epilepsy and from one nonepileptic patient afflicted with a cerebral oligodendroglioma, were injected into frog oocytes. By using this approach, the oocytes acquire human GABAA receptors, and we have shown previously that the "epileptic receptors" (receptors transplanted from epileptic brains) display a marked run-down during repetitive applications of GABA. It was found that exposure to the neurotrophin BDNF increased the amplitude of the "GABA currents" (currents elicited by GABA) generated by the epileptic receptors and decreased their run-down; both events being blocked by K252A, a neurotrophin tyrosine kinase receptor B inhibitor. These effects of BDNF were not mimicked by nerve growth factor. In contrast, the GABAA receptors transplanted from the nonepileptic human hippocampal uncus (obtained during surgical resection as part of the nontumoral tissue from the oligodendroglioma margins) or receptors expressed by injecting rat recombinant alpha1beta2gamma2 GABAA receptor subunit cDNAs generated GABA currents whose time-course and run-down were not altered by BDNF. Loading the oocytes with the Ca2+ chelator 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetate-acetoxymethyl ester (BAPTA-AM), or treating them with Rp-8-Br-cAMP, an inhibitor of the cAMP-dependent PKA, did not alter the GABA currents. However, staurosporine (a broad spectrum PK inhibitor), bisindolylmaleimide I (a PKC inhibitor), and U73122 (a phospholipase C inhibitor) blocked the BDNF-induced effects on the epileptic GABA currents. Our results indicate that BDNF potentiates the epileptic GABAA currents and antagonizes their use-dependent run-down, thus strengthening GABAergic inhibition, probably by means of activation of tyrosine kinase receptor B receptors and of both PLC and PKC.     

Middle lobe syndrome: a nationwide study on clinicopathological features and surgical treatment

Introduction: Middle lobe syndrome (MLS) is a relatively uncommon lung disease that is characterized by damage to the middle lobe and often needs surgical intervention. Objective: To study clinical, radiological and histological features of all patients who underwent surgical resection for MLS in Iceland over a 13‐year period, including evaluation of surgical outcome. Methods: Information on patients who underwent surgery of the right middle lobe in Iceland from 1984 to 2006 was obtained from a centralized diagnosis and pathology registry. Clinical data were collected retrospectively from clinical records from hospitals and from private offices. All pathology specimens were reviewed. Results: We studied 18 patients, 3 males and 15 females between the ages 2 and 86 years (mean 55). The most common clinical features were recurrent infection (n = 15), chronic cough with productive sputum (n = 9), chest pain (n = 8) or dyspnea (n = 7). The most common findings on chest radiographs and on computerized tomography of the chest were atelectasis, consolidation and bronchiectasis. One patient had a foreign body. The most common major histological finding was bronchiectasis in nine patients, and two had foreign body reaction. Minor findings included bronchiolitis, organizing pneumonia and peribronchial inflammation. All patients survived surgery with minor peri‐ and postoperative complications. Conclusion: MLS is more common in females, and recurrent infections, chronic productive cough and dyspnea were the most common symptoms. Bronchiectasis is the most common histological finding. MLS can be treated effectively with lobectomy with low mortality and rate of complications. Please cite this paper as: Einarsson JT, Einarsson JG, Isaksson H, Gudbjartsson T and Gudmundsson G. Middle lobe syndrome: a nationwide study on clinicopathological features and surgical treatment. The Clinical Respiratory Journal 2009; 3: 77–81.