精神分裂症首次发病患者的磁共振弥散张量显像研究

目的探讨从未用过药的精神分裂症首次发病(以下简称首发)患者的重要白质及部分灰质区的磁共振弥散张量显像(DTI)的特点。方法选取9例首发精神分裂症患者(患者组)及9名年龄、性别、受教育程度与患者组相配对的健康者,应用DTI成像技术检测脑额颞交界处、内囊等白质区和颞中回灰质、中央前回、中央后回等灰质区的各向异性(FA)、表观扩散系数(ADC)及双侧海马体积。结果患者组及对照组组内左右两侧兴趣区FA值及ADC值的差异无统计学意义(P>0.05);患者组与对照组各感兴趣区FA值差异无统计学意义(P>0.05),但患者组颞中回灰质(8.655×10-9)、中央前回(7.816×10-9)、中央后回(7.855×10-9)ADC值高于对照组(分别为7.428×10-9,6.921×10-9,7.013×10-9;P=0.049,0.009,0.005);两组内及组间双侧海马体积比较,差异均无统计学意义(P>0.05)。结论首发精神分裂症患者与健康者DTI参数之间没有明显区别。     

Analysis of the EEG dynamics of epileptic activity in gelastic seizures using decomposition in independent components.

OBJECTIVE: Gelastic seizures are a frequent and well established manifestation of the epilepsy associated with hypothalamic hamartomas. The scalp EEG recordings very seldom demonstrate clear spike activity and the information about the ictal epilepsy dynamics is limited. In this work, we try to isolate epileptic rhythms in gelastic seizures and study their generators. METHODS: We extracted rhythmic activity from EEG scalp recordings of gelastic seizures using decomposition in independent components (ICA) in three patients, two with hypothalamic hamartomas and one with no hypothalamic lesion. Time analysis of these rhythms and inverse source analysis was done to recover their foci of origin and temporal dynamics. RESULTS: In the two patients with hypothalamic hamartomas consistent ictal delta (2-3 Hz) rhythms were present, with subcortical generators in both and a superficial one in a single patient. The latter pattern was observed in the patient with no hypothalamic hamartoma visible in MRI. The deep generators activated earlier than the superficial ones, suggesting a consistent sub-cortical origin of the rhythmical activity. CONCLUSIONS: Our data is compatible with early and brief epileptic generators in deep sub-cortical regions and more superficial ones activating later. SIGNIFICANCE: Gelastic seizures express rhythms on scalp EEG compatible with epileptic activity originating in sub-cortical generators and secondarily involving cortical ones.     

术中电生理动态监护下显微手术切除椎管神经鞘瘤（附65例报告）

目的 探讨术中电生理监护对椎管神经鞘瘤显微手术中的作用及意义，提高对椎管内神经鞘瘤的治疗水平。方法 回顾性分析65例术中电生理动态监护下，显微手术切除椎管内神经鞘瘤。结果 治愈60例（占92．3％），好转5例（占7．7％），无死亡；肿瘤全切62例，次全切除3例，全切率95．4％。结论 常规动态电生理监测下显微手术切除椎管神经鞘瘤，能保全脊髓神经的功能，减少副损伤，提高手术安全性；显微手术有助于提高肿瘤全切率，可有效减少术后复发。对影响脊柱稳定性的行脊柱融合内固定。     

Wirkung und Wirkfaktoren von psychodramatischem Coaching — Eine experimentelle Evaluationsstudie

Zusammenfassung Diese Studie untersucht, wie Erfolg im Einzelcoaching entsteht und was Psychodrama dazu beitragen kann. Dabei werden zun?chst die vier Berner Wirkfaktoren dargestellt, die im Rahmen einer allgemeinen psychologischen Coachingkonzeption die vier m?glichen Erfolgsstrategien darstellen. über Videoauswertung und schriftliche Befragung aller Beteiligten wurden 35 Einzelsitzungen evaluiert. Dabei zeigten sich die vier Wirkfaktoren tats?chlich als elementar in kurz- und mittelfristig erfolgreichen Coachingprozessen. In dem experimentellen Vergleich wurde das psychodramatische Coaching zudem wesentlich besser bewertet als das Vergleichscoaching, was durch den Ressourcen- und Wachstumsfokus sowie die sehr gute Beziehungskompetenz der Psychodramatiker erkl?rt werden kann. Des Weiteren zeigen die Auswertungen, dass ein dosierter und gezielter Einsatz des psychodramatischen Methodenrepertoires fruchtbarer zu sein scheint als der zeitlich umfassende Einsatz des Psychodramas als Hauptinterventionsmethode.

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Summary The present study investigates the process of success development in one-to-one-coaching and examines how the method of psychodrama can contribute to this process. First the four change factors are presented. They represent the four success strategies in a general psychological coaching approach that can be chosen by the coach. Second 35 one-to-one-coaching sessions are evaluated by a video-based rating-system and questionnaires that were filled in by all coaches, clients and employees of the clients. In these analyses the four change factors were shown to be critical for short- and medium-term success. In an experimentally designed assessment the psychodramatic coachings had a considerably better result than the comparative coaching. This outcome could be explained by the focus on resources and growth and the high competence of the psychodramatic coaches to set up an appreciative coaching relationship. The analyses demonstrate furthermore that the well-aimed and specific use of psychodrama methods is more fruitful than its time-extensive use as the main intervention method.

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Peter Behrendt geb. 1977, Dipl. Psych., ausgebildeter Psychodrama-Therapeut und Mediator, seit 2004 freiberuflich Coaching, Moderation sowie Konzeption und Durchführung von Fortbildung und Trainings. Er konzipierte und leitete die Evaluationsstudie, die diesem Artikel zugrunde liegt.     

Fixed exanthema from systemic tobramycin.

Eye drops contain several ophthalmic medications which can produce allergic reactions. We report the case of a patient with contact dermatitis from neomycin and a probable fixed exanthema after parenteral administration of tobramycin who tolerated topical tobramycin and other aminoglycosides.