负压封闭引流术应用于糖尿病患者头皮感染及颅骨骨髓炎二例

病例1患者男,39岁,患2型糖尿病3年。头皮感染并溃疡形成半年余,见右颞顶部约8cm×8cm大小类圆形红肿,中央部见-2cm×2cm皮肤缺损溃疡,敏感抗菌药物治疗未愈,形成头皮缺损,常规换药未愈,行负压封闭引流术（vacuum sealingdrainage,VSD）治疗20余天后,皮缘肉芽生长,缺损缩小,皮肤红肿减轻。     

吡硫翁锌气雾剂联合复方氨肽素片治疗头皮银屑病疗效观察

目的观察吡硫翁锌气雾剂联合复方氨肽素片治疗头皮银屑病的疗效。方法将70例银屑病患者随机分为两组：治疗组35例患者口服复方氨肽素片,外用吡硫翁锌气雾剂;对照组35例患者口服复方氨肽素片,外用2％酮康唑洗剂外洗头皮。观察并评价两组患者治疗后第4周的临床疗效。结果治疗组痊愈21例,显效11例,总有效率为91．42％;对照组痊愈13例,显效12例,总有效率为71．42％,两组总有效率比较差异有统计学意义（P〈0．05）。结论口服复方氨肽素片联合外用吡硫翁锌气雾剂治疗寻常型银屑病,疗效好,不良反应小。     

对头皮静脉反向穿刺方法的实践

目的 降低头皮静脉穿刺处肿胀发生率，减轻患儿痛苦，提高患者家属的满意度，减少护患纠纷。方法 选择年龄在1月-3岁的住院患儿104例，分成观察组和对照组。观察组按反向静脉穿刺各52例，对照组按常规法穿刺。结果 观察组患儿头皮静脉穿刺处肿胀发生4例，少于对照组15例p〈0．01（x^2=7．792），观察组家属对穿刺护士的满意度达92.3％，对照组57．7％，p〈0．01（u=4．074）。结论 反向穿刺可降低头皮静脉穿刺处肿胀发生率，提高患者     

头针与脑梗塞后血管的早期再通

目的　观察头针对脑梗塞患者脑血管的早期再通及梗塞灶的影响。方法　采用针刺患者头皮血管舒缩区的方法 (头针组 )治疗脑梗塞患者 35例 ,并与单纯药物治疗 (对照组 )进行比较。结果　经 TCD及 CT检查显示 ,头针组在脑血管的早期再通 ,梗塞灶的收缩及临床症状的改善与对照组比有显著差异 (P<0 .0 1)。结论　脑梗塞患者早期进行头皮针治疗 ,可以提早血管的再通时间、缩小梗塞灶及改善临床症状。同时减少由于早期使用血管扩张剂而引起梗塞后出血的危险。     

头皮扩张术结合颞浅血管岛状头皮瓣转移修复不规则烧伤性秃发

在应用头皮组织扩张技术修复头皮瘢痕秃发区的基础上，我们结合颞浅血管为蒂的岛状头皮瓣移植，修复特殊的部位，如发际、鬓角及不规则的秃发区，弥补了常规头皮扩张后以局部皮瓣转移的方式进行修复的不足。同时可将片状瘢痕无发区中存留下来的一块或几块有头发的头皮，形成以颞浅血管为蒂的岛状皮瓣，充分利用，合理分配残留下来的头皮资源，结合头皮扩张来修复其它秃发区及岛状皮瓣的供区。本组病人１２ 例，均为男性，其中修复鬓角８ 例，额部发际４ 例；最大秃发面积１６５ｃｍ２ ，岛状瓣最大面积５５ｃｍ２ ；最小面积为６ｃｍ２ ，秃发区修复率达９６％ ，岛状头皮瓣成活率１００ ％ ，术后随访２～５ 年，疗效满意。     

Partitioning of deep versus superficial intracranial sources using current source densities is not valid

Summary An analytic method has recently been proposed for partitioning scalp-recorded EEG and evoked potential (EP) data into parts arising from deep (i.e., subcortical) vs. superficial (i.e., cortical) sources. The method is based on the observation that the current source density (CSD) is selectively sensitive to electrical activity arising from superficial sources, and the conjecture that the residual potential which remains after subtracting the CSD from the scalp potentials, represents activity from deep sources. We investigated the validity of this procedure by simulating scalp potential data for superficial and deep dipole sources with known locations and orientations. Our single-dipole simulations demonstrated that, when the actual location of the source was superficial, the partitioning procedure erroneously attributed a sizeable proportion of the total topographic variance to the activity of deeper sources. This produced a consistent bias in the simulations with two dipoles, when both superficial and deep sources were present. In such cases, the relative contribution of the deeper source was consistently overestimated, and the scalp topography of the deep source activity was profoundly misrepresented by the residual which results from subtracting the CSD from the scalp potential. We conclude that the proposed method for partitioning EEG and EP data into components arising from deep vs. superficial intracranial sources is not valid.Acknowledgements: This work was supported by general medical research funds from the Department of Veterans Affairs, by a VA psychiatry research training award to Dr. Turetsky and by NIDCD grant #R01 DC00328.     

Dermabrader: a different use in preparing scalp defects without periosteum for immediate skin grafting

Summary To cover a very large scalp defect, one may mobilize the remaining scalp to effect closure. However, sometimes skin grafting may be unavoidable. For this procedure, the prepared raw surface should be smooth and well vascularized. To achieve this in one case, a dermabrader has been used as an osteoabrader to remove the outer table to provide a surface with punctate bleeding. A good result was obtained with minimal hospitalization.     

Cirsoid aneurysms of the scalp

This study reviewed the surgical management of cirsoid aneurysms of the scalp, which are rarely encountered in the neurosurgical practice, and compares the results with embolization. 21 patients with cirsoid aneurysm underwent surgery. There were 1 female and 20 male patients. Trauma was present in four patients. Selective internal and external carotid artery angiograms and cranial magnetic resonance imaging studies were performed on all patients. All angiograms were staged according to published procedures. There were 15 (71.4%) Stage 1a, 4 (19.1%) Stage 1b, and 2 (9.5%) Stage 3 patients.Total excision of the lesion was achieved in 19 patients (90.5%). We operated on only one patient for a second time, because of a residual lesion, and we resected the lesion totally. Only two patients developed necrosis of the scalp (button hole). Both scalp necroses were on the frontal area. Other patients all had good cosmetic results. Surgical resection of cirsoid aneurysms seems to be the most effective treatment with good results. There may be a tendency for the occurrence of necrosis on the frontal area. Staging of the scalp aneurysms has no effect on surgical outcome.     

Seizure-induced miosis

Ictal autonomic pupillary dilation is common; however, miosis is rare. We describe a case of focal seizures secondary to cortical dysplasia presenting with bilateral pupillary miosis, rendered seizure free by resective surgery. The seizure-onset zone was localized within the left middle parietal gyrus by intracranial electrographic recording. Seizure onset was coincident with focal left centroparietal fast spike activity on electroencephalography (EEG). A large region of the left frontocentral cortical dysplasia was demonstrated on magnetic resonance imaging (MRI). Complete resection of the area of cortical dysplasia and additional cortical regions of ictal activity, identified using intracranial EEG, rendered the patient seizure free.     

21例婴幼儿头部皮肤扩张器植入术的围手术期护理

分析21例婴幼儿行皮肤扩张器植入术,修复头皮缺损组织创面的护理.术前做好患儿的皮肤准备;做好家长的防护技能训练;重视扩张器埋置期间的外置注射壶、头部扩张皮肤和注水的护理,并注意观察原发病和预防并发症.21例均顺利完成头皮扩张器植入术,并行二期病变组织切除和创面修复,扩张器取出,无皮瓣坏死,皮肤质地、色泽、弹性良好.