Identification of Frontal Lobe Epileptic Foci in Children Using Positron Emission Tomography

Summary: Purpose: Presurgical evaluation for intractable frontal lobe epilepsy (FLE) is difficult and invasive, partly because anatomic neuroimaging studies with computed tomography (CT) and magnetic resonance imaging (MRI) typically do not show a discrete lesion. In adult patients with FLE, functional neuroimaging of glucose metabolism with positron emission tomography (PET) is less sensitive in detecting focal metabolic abnormalities than in temporal lobe epilepsy (TLE). Comparable data on children with FLE are not available. Methods: We used high-resolution PET scanning of glucose metabolism to evaluate 13 children (age 17 months to 17 years; mean age 9.5 years) with intractable FLE being considered for surgical treatment. Only children with normal CT and MRI scans were included. Results: Hypometabolism including the frontal lobe was evident in 12 of the 13 children, was unilateral in 11 of 13, and was restricted to the frontal lobe in 8 of 13. One child showed bilateral frontal cortex hypometabolism and another had anictal PET scan demonstrating unilateral frontal cortex hyper-metabolism surrounded by hypometabolism. Additional hypo–metabolic areas outside the frontal cortex were observed in 5 children in parietal and/or temporal cortex. Localization of seizure onset on scalp EEG was available in 10 children and corresponded to the location of frontal lobe PET abnormality in 8. However, in 4 of the 10 children, the extent of hypometabolism exceeded the epileptogenic region indicated by ictal EEG. In 2 of the 13 children, the abnormality evident on EEG was more extensive than that evident on PET. In the remaining 3 children for whom only interictal EEG data were available, the PET foci did not correspond in location to the interictal EEG abnormalities. In 11 of the 13 children, the presumed region of seizure onset in the frontal lobe, as based on analysis of seizure semiology, corresponded to the locations of frontal lobe glucose metabolism abnormalities. Conclusions: Although high-resolution PET appears to be very sensitive in localizing frontal lobe glucose metabolic abnormalities in children with intractable FLE and normal CT/ MRI scans, the significance of extrafrontal metabolic disturbances requires further study; these may represent additional epileptogenic areas, effects of diaschisis, seizure propagation sites, or secondary epileptogenic foci.     

海绵窦区硬脑膜动静脉瘘的栓塞治疗

目的　探讨海绵窦区硬脑膜动静脉瘘的治疗方法。方法　海绵窦区硬脑膜动静脉瘘共 12例 ,经颈外动脉以微粒栓塞 3例 ;以正丁基氰基丙烯酸异丁酯 (NBCA)栓塞 2例 ;经颈外动脉插入海绵窦以NBCA栓塞1例 ;经岩下窦以机械可脱性弹簧圈 (MDS)栓塞 1例 ;经眼上静脉以MDS栓塞 5例。结果　瘘口完全消失 8例 ;瘘口残留 4例 ,其中 2例瘘口残留患者 3个月后症状好转。结论　根据不同的类型 ,经静脉栓塞和经动脉栓塞均可作为海绵窦区硬脑膜动静脉瘘的有效治疗方法     

上颌窦内提升同期或延期牙种植临床研究

目的:探讨上颌窦底内提升术同期或延期在上颌后牙区牙种植的临床效果.方法:2007年5月～2011年5月共完成67例、105枚种植体的上颌窦内提升同期或延期种植,术后6个月行种植义齿修复.随访观察18～72个月.检查方法为临床检查和X线检查及口腔CT扫描.结果:患者观察期内102枚种植体成功种植,7例发生上颌窦黏骨膜破裂,但术后观察未发生上颌窦感染等并发症;3枚因感染拔除.种植体总累计留存率为97.1％,同期种植、延期种植累计留存率分别为96.4％、97.8％,两者之间无显著性差异(P＞0.05).结论:上颌窦内提升同期或延期种植修复技术对于上颌后牙区牙槽骨高度严重不足病例能够减少创伤,缩短修复时间.掌握好上颌窦底内提升植骨术同期或延期牙种植的适应证,二者均可取得较好的临床效果.可在上颌后牙区种植修复病例中选用.     

右美托咪定辅助硝酸甘油控制性降压在鼻内镜手术中的应用效果

目的：观察右美托咪定辅助硝酸甘油控制性降压在鼻内镜手术中的应用效果。方法2012年4月~2013年2月,选择择期行鼻内镜手术的患者60例,ASAⅠ~Ⅱ级,随机分为硝酸甘油组(N组)和右美托咪定复合硝酸甘油组(DN组),每组30例。记录麻醉前(T0)、手术开始前(T1)、降压15 min(T2)、降压30 min(T3)、和停止降压20 min(T4)各时点的MAP、HR、血乳酸(Lac)浓度及NT值,评估术野质量,并记录苏醒期躁动发生率等。结果与T0时比较,N组MAP于T2、T3时降低(P<0.05),HR于T2~T4时加快(P<0.05),DN组MAP于T1~T3时降低(P<0.05),HR于T1时减慢(P<0.05);与N组比较,DN组MAP及HR于T1~T4时降低(P<0.05)。与T0时比较,N组及DN组血乳酸于T2、T3时升高(P<0.05);DN组术野质量评分低于N组(P<0.05),苏醒期躁动发生率低于N组(P<0.05)。结论右美托咪定辅助硝酸甘油控制性降压,术野理想,为鼻内镜手术一种较适宜的控制性降压方法。     

Sympathetic nerve stimulation influences mucociliary activity in the rabbit maxillary sinus

The effect of preganglionic sympathetic nerve stimulation on mucociliary activity in the rabbit maxillary sinus was investigated in vivo. Response to nerve stimulation was recorded photoelectrically and expressed as a percentage of the basal mucociliary activity prior to stimulation. Nerve stimulation (15 V, 5 ms) for 60 s at 2, 10 and 20 Hz stimulated mucociliary activity, the maximum increase being 21.1 ±1.3% at 20 Hz, an increase that pretreatment with the cholinergic antagonist atropine reduced to 14.5±2.4%, suggesting that part of the response involves cholinergic mechanisms. Nerve stimulation (10 Hz) of animals pretreated with the β-adrenoceptor antagonist propranolol reversed the mucociliary response from an increase to a decrease (-10.6± 1.6%), indicating the involvement of β-receptors in the nerve-evoked increase. Pretreatment with the α-adrenoceptor antagonist phentolamine had no effect on response to nerve stimulation. Rabbits given a combined atropine, propranolol and phentolamine blockade manifested decreased mucociliary activity in response to nerve stimulation (- 10.6± 2.1 %). Guanethidine pretreatment blocked the effect of nerve stimulation on mucociliary activity, including the observed decrease after combined blockade, indicating the effect to be mediated via sympathetic nerve fibres. The decrease in mucociliary activity in response to nerve stimulation after combined cholinergic-, β-, and α-adrenoceptor blockade suggests the presence of a nonadrenergic, non-cholinergic inhibitory mechanism. It is possible that this effect is mediated by release of neuropeptide Y, as intraarterial injections of neuropeptide Y reduce mucociliary activity in the rabbit maxillary sinus, and as neuropeptide Y is released in the upper airways upon sympathetic nerve stimulation.     

口腔上颌窦瘘即刻修补21例

[背景 ]探讨几年来口腔科拔牙导致上颌窦瘘的原因及修补方法 ,旨在防止口腔上颌窦瘘的发生及提高疗效 .[病例报告 ]采用回顾性分析方法 ,对口腔科拔牙过程中发生的 2 1例上颌窦瘘的临床资料进行了分析 .2 1例上颌窦瘘中 ,拔上颌第一磨牙腭侧根时发生者 14例 ,拔上颌第一磨牙远中颊侧根时发生者 3例 ,拔上颌第二磨牙腭侧根时发生者 2例 ,拔上颌第二磨牙远中颊侧根时发生者及拔上颌第二前磨牙时发生者各 1例 .对 13例患者用颊侧粘骨膜滑行瓣修补 ,6例用隔间牙槽切开术修补 ,2例用带蒂腭侧粘骨膜瓣修补 .[讨论 ]口腔上颌窦瘘是拔上颌后牙时常见的并发症 ,所以拔上颌后牙时应注意控制用力的大小和方向 ,才能降低瘘的发生 ,若一旦发生 ,可以根据瘘孔大小及周围组织情况 ,选择适当的方法进行修补 ,以利于日后的义齿修复 .     

鼻内镜治疗鼻窦炎合并鼻息肉的疗效及其对患者嗅觉的影响

目的探讨鼻内镜下微创手术治疗鼻窦炎合并鼻息肉的疗效,并观察其对患者嗅觉功能的影响。方法将2012年6月~2014年6月笔者所在医院收治的134例鼻窦炎合并鼻息肉患者按照随机数字表法均分两组,各67例,对照组施行传统Wigand式开放手术治疗,研究组施行鼻内镜手术治疗,对两组患者术后疗效及嗅觉功能改善情况进行综合比较。结果术后28 d对两组患者治疗效果进行综合评价,研究组患者治疗总有效率(97.01%)高于对照组(88.06%)(P<0.05);两组患者术后12周时嗅觉功能CCCRC评分较术前均有明显改善(P<0.05),但研究组改善幅度较对照组更为显著(P<0.05)。结论鼻内镜下微创手术治疗鼻窦炎合并鼻息肉效果显著,能够明显改善患者嗅觉功能,值得临床推广应用。     

核因子-κB在上颌窦鳞状细胞癌中的表达

目的探讨核因子-κB(NF-κB)在上颌窦鳞状细胞癌中的表达及其与主要临床指标间的关系.方法采用免疫组化SP法检测42例上颌窦鳞状细胞癌和20例正常上颌窦粘膜组织中NF-κB的表达情况.结果 20例正常上颌窦粘膜组织中NF-κB表达全部为阴性,42例上颌窦鳞状细胞癌中28例NF-κB表达上调.NF-κB的表达与肿瘤分期、淋巴结转移之间无明显相关性,而与组织分化程度显著相关,低分化上颌窦鳞状细胞癌NF-κB的表达较中、高度分化上颌窦鳞状细胞癌明显增高(P＜0.05).结论 NF-κB的表达在上颌窦鳞状细胞癌的发生发展中起一定作用,NF-κB可能成为上颌窦鳞状细胞癌治疗的新靶点.     

Lateral hypothalamic and peripheral cardiovascular afferent inputs to ventrolateral medullary neurons

Experiments were done in chloralose anesthetized, paralyzed and artificially ventilated cats to identify single units in ventrolateral medulla (VLM) projecting directly to the intermediate gray (IG) region of the upper thoracic cord and responding to inputs from pressor sites in the anterior lateral hypothalamus (Hla) and carotid sinus (CSN) and aortic depressor (ADN) nerves. Forty-eight units were antidromically activated in VLM to stimulation of the IG at the level of T2. Of these 48 units, 15 (31%) were orthodromically excited by stimulation of the Hla with a mean latency of 15.8 +/- 2.1 ms. In addition, 8 of the 15 units responding to Hla stimulation were also excited orthodromically by stimulation of either the CSN or ADN or both. Of the remaining 33 units, 15 responded to stimulation of only the buffer nerves and 18 were unresponsive to the tested inputs. These results provide electrophysiological evidence for the existence of neurons in VLM which receive hypothalamic and buffer nerve inputs and suggest that the VLM plays a role in integrating and relaying cardiovascular afferent information from peripheral baroreceptors and chemoreceptors and from supramedullary centers to provide effector signals to spinal autonomic neurons involved in the control of the circulation.     

Role of Mitomycin-C in Prevention of Post Operative Adhesions After Endoscopic Sinus Surgery––A Prospective Study

To evaluate the role of Mitomycin-C in preventing synaechiae formation and ostial stenosis following endoscopic sinus surgery. This prospective study was conducted in VMMC and Safdarjung hospital from November 2007 to August 2008. 30 subjects aged between 16 and 60 of either sex in two groups were included in the study. All these patients with bilateral nasal polyposis underwent endoscopic sinus surgery with topical application of Mitomycin-C and were subjectively and objectively assessed for improvement of symptoms and post operative synaechiae formation. Patients showed improvement in subjective symptoms mainly nasal obstruction and hyposmia as well as decreased incidence of synaechiae formation and ostial stenosis post surgery following Mitomycin-C application. After doing this study we could conclude that Mitomycin–C applied topically following endoscopic sinus surgery was helpful in improvement of symptoms like nasal obstruction and hyposmia as well as decreased adhesion rate and middle meatal antrostomy closure rate. Topical application of Motomycin-C was safe in a dose of 0.4–0.8 mg/ml applied over 5 min and offered significant improvement both subjectively and objectively.