Effect of lead trajectory on the response of essential head tremor to deep brain stimulation

BackgroundEssential tremor (ET) is one of the most common movement disorders. Normally ET affects the distal upper extremities, but it can also be accompanied by midline symptoms. Ventralis intermedius (VIM) thalamic deep brain stimulation (DBS) has been shown to be effective in reducing hand tremor, but its effects on head tremor have been inconsistent.MethodsTwenty-nine DBS patients with a diagnosis of ET met inclusion criteria. All implantations targeted VIM. The factors examined included age, gender, disease duration, presence or absence of head tremor, handedness, and the Fahn-Tolosa-Marin rating scale (TRS). This analysis specifically focused on TRS head tremor sub-scores at baseline, 6 months and 12 months post-DBS. Additionally, DBS lead entry angles were examined.ResultsTwenty-three ET patients underwent unilateral DBS and six underwent staged bilateral DBS. At both 6 and 12 months following DBS, stimulation resulted in diminished head tremor (ON vs OFF; p < 0.0001). The most important predictor of head tremor suppression was the entry angle of the DBS lead in the sagittal projection relative to the AC–PC axial plane (AC–PC angle). Head tremor reduction was greater among more vertical AC–PC angles.ConclusionA more vertical AC–PC angle of the DBS lead trajectory was associated with improved head tremor suppression. Further studies will be necessary to confirm this potentially important finding.     

幕上胶质瘤伴继发癫痫64例临床分析

目的 研究以癫痫为首发症状的胶质瘤特点,为临床癫痫治疗提供参考.方法 收集2011年1月至2012年8月北京天坛医院神经外科收治的病理确诊为胶质瘤,并以癫痫为首发症状的患者,分析癫痫发作与肿瘤部位和病理的关系.结果 收集到病理确诊的幕上胶质瘤患者171例,其中64例以癫痫为首发症状.低级别胶质瘤癫痫发生率显著高于高级别胶质瘤患者(P＜0.05),星形细胞瘤与少突星形细胞瘤癫痫发生率显著高于其他病理类型(P＜0.05).额叶与额顶叶胶质瘤癫痫发生率显著高于其他类型胶质瘤(P＜0.05).结论 胶质瘤继发癫痫与肿瘤部位和病理类型密切相关.     

下颌智齿断根移位于舌下间隙的处理

目的:探讨移位于舌下间隙的下颌智齿牙根的定位和取出方法。方法:回顾2009-07—2012-07间,6例下颌智齿拔出术中牙根移位于舌下间隙的病例,分析移位原因之后,采用双手合诊,结合影像学检查对牙根定位,行牙槽窝舌侧近远中松弛切口,翻瓣取出牙根。结果:手术成功取出移位牙根,6例牙根均移位于舌下间隙。患者术后无严重并发症。结论:牙槽窝近远中附加切口配合双手合诊,可准确定位并取出移位牙根。     

Submental perforator flap: Location and number of submental perforating vessels

The sites and numbers of submental perforator vessels were examined using a Doppler probe in 21 volunteers. The subcutaneous vascular network from each perforator was studied in three cases of dissection of upper-neck lymph nodes among the volunteers. A perforator from the submental vessels was noted in all 21 volunteers: a single perforator in 13 cases, and double perforators in eight. The main perforator, which had some subdermal branches, was located 31.8 (8.3) mm in front of the facial artery that was palpated at the mandible. Five patients who presented with skin defects on the cheek and the chin had the submental perforator flap reconstructed, excluding the platysma muscle. All flaps covered the wounds. The submental perforator flap was useful for reconstructing skin defects on the cheek and the chin, because the site of the submental perforator was stable and raising the flap was easy, and the colour and texture matches were acceptable.     

超声引导下骶管阻滞麻醉在肛肠手术中的应用

 目的 探讨超声引导下骶管阻滞麻醉在肛肠手术中应用效果。方法 选取2017-01至2018-03医院行肛肠手术患者208例,随机分为超声组和对照组,每组104例。 超声组予以超声引导定位骶管阻滞麻醉,对照组以传统解剖定位骶管阻滞麻醉。分别记录两组患者的穿刺情况(穿刺时间、穿刺针调整次数、麻醉起效时间和痛觉消失时间)、麻醉成功率及患者满意度和麻醉后并发症情况。结果 超声组穿剌针调整(2.50±0.50)次,明显少于对照组的(5.00±1.00)次,差异有统计学意义(P<0.05);麻醉起效时间(2.85±1.30)min,明显短于对照组的(4.88±0.92)min;痛觉消失时间(4.85±1.24)min,明显短于对照组的(7.86±2.12)min,差异均有统计学意义(P<0.05);超声组麻醉Ⅰ级比率及麻醉成功率均明显高于对照组(P<0.05)。超声组麻醉Ⅲ级比率明显低于对照组,差异有统计学意义(P<0.05)。超声组出现血肿、出血和神经损伤相关并发症明显少于对照组,差异均有统计学意义(P<0.05)。结论 超声引导下骶管阻滞麻醉在肛肠手术中可准确定位,提高阻滞麻醉成功率,减少并发症,提高患者满意度。     

子宫动脉开口摄影角度分析

目的 探讨子宫动脉开口在DSA图像上的“最易显示角度区间”.方法 对12例患者子宫动脉开口部CTA三维容积重建(VR)、最大密度投影(MIP)成像进行标准正位和旋转观察,在正位分析出子宫动脉开口与其附着动脉的内外关系,在左右斜位获得能清晰显示子宫动脉开口的小角度区间.对27例患者子宫动脉开口部用同样方法于DSA造影过程中验证这个区间的准确性.结果 41支子宫动脉开口位于附着动脉外侧,向对侧倾斜10°～40°可显示清晰;13支开口位于附着动脉内侧,向同侧倾斜30°～50°显示清晰;24支开口位于附着动脉前方,大角度倾斜40°～60°显示清晰.结论 “最易显示角度区间”能很轻易、清晰显示子宫动脉开口.     

踝间线足背动脉在全膝关节置换术髓外定位中的临床应用

目的探讨踝关节力学中心体表标志点,为全膝关节置换术(TKA)下肢力线的准确定位提供依据。方法对64例膝骨关节炎(OA)终末期患者实施初次TKA治疗,股骨侧采用髓内定位,胫骨侧采用髓外定位,实验组(34例)踝关节力学中心位于踝间线足背动脉处,对照组(30例)定位则按传统方法进行。术后测量患者胫骨假体胫骨角及后倾角。结果患者均获得随访,时间4~6年。胫骨假体胫骨角平均度数:实验组为(2.1±0.2)°,对照组为(2.6±0.1)°,差异有统计学意义(P0.05);胫骨假体后倾角:实验组为(3.1±0.2)°,对照组为(3.3±0.1)°,差异无统计学意义(P0.05)。实验组胫骨假体力线优于对照组。结论踝间线足背动脉定位可靠,其标示简单易行,能提高胫骨假体力线的精确度,不失为TKA术中踝关节力学中心定位的理想参考。     

范永升教授“利湿清热法”治疗白塞综合征经验拾零

[目的] 总结全国名中医范永升教授治疗白塞综合征的临床经验。[方法] 通过跟师临证、整理医案及相关文献等,总结范永升教授治疗白塞综合征的主要思想和处方用药,并举临床验案两则加以佐证。[结果] 范永升教授认为白塞综合征的基本病机为湿热内壅,治疗时应以利湿清热为大法,并需进一步分清湿热所在的位置。根据湿热所犯部位不同,可分为脾胃湿热上犯、肝胆湿热化火及下焦湿热流连三种类型,灵活应用甘草泻心汤、龙胆泻肝汤、四妙丸等方药,疗效显著。两则医案患者均表现出湿热内壅的症状,分别属于脾胃湿热上犯证、肝胆湿热化火证,以甘草泻心汤及龙胆泻肝汤为主方治疗,均取得较满意的疗效。[结论] 范永升教授把握白塞综合征湿热内壅的基本病机,灵活选用利湿清热方药,分病位治之,疗效显著,其经验可供参考借鉴。