立体定向毁损术治疗男性精神分裂症患者攻击行为的护理

立体定向毁损术治疗男性精神分裂症患者冲动行为，毁损部位为脑组织的杏仁核、内侧隔区(核)等，皆为重要的脑组织结构。立体定向毁损术治疗精神分裂症患者攻击行为具有微侵袭性，术后恢复快，对躯体情况要求不高，疗效满意。1999年1月，2003年6月，我院对18例男性精神分裂症患者的攻击行为行立体定向毁损术治疗，通过对18例精     

立体定向手术治疗小儿难治性癫痫的护理

小儿难治性癫病经内科治疗无效后，临床上多采用外科手术治疗。我科自1989～1997年间，采用立体定向射频毁损杏仁核，Forel-H区及扣带回的方法治疗小儿癫病10例，均取得了满意效果，现将手术的配合与术后护理报告如下。1临床资料1．1一般资料10例患儿，男8例，女2例，年龄5～17岁，平均］2岁。其中原发性癫痫7例，继发性癫病3例（其中1例为脑炎后遗症，2例为外伤后继发癫病）。1．2症状10例患儿中每月发作3～4次至30余次不等，其中全身强直痉挛发作5例，精神运动性发作2例，失神伴强直性发作3例。10例中有5例儿童伴有不向的精神运动障碍，…     

立体定向核团毁损术治疗帕金森病的疗效观察

目的分析电极引导下立体定向核团毁损术治疗帕金森病的临床治疗效果。方法对82例接受电极引导下立体定向核团毁损术治疗的帕金森病患者进行随访和神经功能评估,手术治疗前、手术后1周、1个月、6个月、12个月、24个月不同服药状态下统一帕金森病量表(UPDRS)评分,采用Wilcoxcon检验比较手术后不同时间点UPDRS运动评分,以及与手术前的评分的差异。结果立体定向核团毁损术后6个月、12个月、24的随访显示:毁损术不仅能改善术前帕金森病患者的UPDRS评分,UPDRS评分逐渐减低,而且减轻了左旋多巴诱发的运动波动。患者术后口服抗帕金森病类药物用量较术前明显减少。核团毁损术永久性并发症的发生率约为1.2%(1/82),总体并发症发生率约为13.4%(11/82)。结论立体定向核团毁损术是中晚期帕金森病安全、有效的治疗方法,能改善帕金森病患者的UPDRS评分,减轻左旋多巴诱发的运动波动,但精确定位是手术成功的关键。     

立体定向治疗顽固性癫痫27例远期疗效随访

目的：分析立体定向治疗顽固性癫痫的远期疗效。方法：对27例行立体定向脑内单靶点或多靶点毁损。结果：27例中远期随访疗效属满意7例，占26％，显著进步7例，占26％，良好6例，占22％，较差7例，占26％。结论：立体定向手术治疗疗效是令人满意的，强调术中多靶点联合和术后综合治疗。     

CT脑立体定向开放手术切除颅内病变

目的 :探讨脑立体定向开放手术治疗颅内病变的效果。方法 :对 3 4例病变直径在 0 4～ 3 5cm的患者采用CT脑立体定向仪定位 ,显微镜下切除病灶。结果 :3 4例患者的颅内病变全部行显微手术切除 ,无手术并发症及死亡。 2 6例继发性癫痫中 ,2 1例术后停止发作 ,另 5例发作显著减少。结论 :CT脑立体定向开放手术切除颅内病灶 ,定位准确 ,安全有效     

脑囊虫病与癫痫

脑囊虫病是继发性癫痫的常见病因之一。我院15年来共收治脑囊虫病52例,其中有癫痫发作者38例,发生率为73%.本文对癫痫发作的脑囊虫病38例进行分析,着重探讨脑囊虫病与癫痫的关系。     

精神分裂症立体定向脑内多靶点联合毁损术的疗效观察

【目的】观察精神分裂症立体定向脑内多靶点联合毁损术治疗的疗效，探讨该治疗方法的有效性及安全性。【方法】采用1．5T核磁共振结合立体定向规划系统定位，对32例药物难治性精神分裂症患者实施同期双侧脑内多靶点射频热凝毁损术。【结果】32例患者术后4周随访：显著进步17例，进步11例，无效4例，加重。例。有效率87．5％。远期随访（12～48个月）：恢复3例，显著进步14例，进步9例，无效4例，失访1例，加重1例，有效率81．25％。术后早期有高热，尿失禁，局灶性脑出血等一过性并发症，无远期并发症及死亡病例。【结论】对药物难治性精神分裂症立体定向脑内多靶点联合毁损术是安全，有效的治疗方法。     

立体定向多靶点毁损术改善顽固性精神分裂症患者的强迫状态和智力水平

目的 探讨伴有强迫状态的顽固性精神分裂症的手术方法,及此术式对顽固性精神分裂症的影响. 方法 对 6例伴有强迫状态的精神分裂症患者,经术前评估后,在全麻下行立体定向双侧杏仁核、双侧内囊前肢和双侧扣带回射频毁损,术后应用 BPRS量表(简明精神病评定量表)、 Yale-Brown强迫评定量表以及 WAIS智力量表进行疗效评定. 结果 患者 Yale-Brown强迫评定量表平均得分由术前的 33分降为 17 分; WAIS智力量表平均得分由术前 84分变为 87分;术后随访 6个月, 6例患者中 1例治愈, 4例显著好转, 1例好转. 1例患者术后早期出现一过性尿失禁. 结论 CT引导下立体定向多靶点毁损术能改善顽固性精神分裂症强迫状态,并提高患者的智力水平.     

立体定向治疗癫痫型脑囊虫病的观察及护理

2003年2月～2005年4月,我院行开放立体定向治疗癫痫型脑囊虫病36例,效果满意.现将体会报告如下.     

脑实质囊虫CT表现与癫痫的关系

目的:通过对147例脑实质囊虫患者的CT表现进行分析,探讨脑实质囊虫与癫痫发作的关系。方法:搜集147例经临床和脑脊液酶联免疫吸附试验(ELISA)证实脑实质囊虫患者,并对病灶的CT表现进行分期、计数及单发病灶的定位分析。结果:104例脑实质囊虫患者癫痫发作与病灶演变过程、数目及分布有关。结论:根据脑实质囊虫病CT表现能够预测癫痫发作,CT检查是一种安全、准确而又可靠的方法。     

Cerebral hydatid cysts in children.

A parasitic tapeworm, called Taneia Echinococcus, causes hydatid disease. Hydatid disease is endemic in sheep and cattle-raising areas of the world. Hydatid disease of the central nervous system constitutes 2%-3% of all reported cases of hydatid cysts. In our institution, 23 children underwent surgery for intracranial hydatid cysts between 1979 and 1995. There were 14 boys and 9 girls, aged between 3 to 16 years (mean 8.8 years). Signs and symptoms were related to the site and size of the cyst. Headache and vomiting due to increased intracranial pressure were the most common presenting symptoms. A round cystic lesion without perifocal edema and rim enhancement is the characteristic appearance on a computed tomography (CT) scan. A magnetic resonance image visualizes cyst location better than CT. Associated systemic hydatidosis in four of our patients involved kidney, liver, lung, and liver and lung, respectively. Intact cyst removal was achieved in 14 patients. In three patients with infected or inflamed hydatid disease, the ruptured cyst capsule was totally resected. Aspiration and extirpation were performed in only one patient. Eleven patients were treated with chemotherapeutic agents such as albendazole or mebendazole due to cyst rupture during surgery or associated systemic hydatid disease. Hydatid disease can also be seen in Western countries because of travel and migration. Cerebral hydatid cyst should be kept in mind for the differential diagnosis of cystic lesions.     

Latent fatality due to hydatid cyst rupture after a severe cough episode

Hydatid disease is a parasitic disease caused by Echinococcus granulosus characterised by cyst formation in various organs. The infestation mostly involves the liver. Hydatid cysts of the liver can rupture either spontaneously or due to trauma. Incidence of rupture is about 3-17% of all cases with hydatid disease. Unless treated surgically, rupture can result in death. Here, we present a case of hydatid cyst ruptured after a severe cough episode and disseminated first to the subcapsular area, then to the peritoneal space. Probably due to a decrease in parenchymal pressure in the liver after decompressive effect of rupture, the patient felt an improvement in abdominal pain, refused operation, and left the hospital on his own responsibility. This unfortunate relief resulted in a delay of 55 hours in management. The leakage of liquid materials into peritoneal space resulted in a severe inflammatory reaction and eventually death of the patient. The patient died of a late peritonitis rather than anaphylaxis, which is the most common reason for death in such patients. As a conclusion, physicians should be aware of a temporary relief in abdominal pain after cyst rupture that may cause a delay in management and in turn loss of patient due to peritonitis.     

Sonographic spectrum of hydatid disease

Hydatid disease, caused by Echinococcus granulosus, is a parasitic disease that is endemic in many parts of the world. Hydatid cyst demonstrates a variety of imaging features, varying according to growth stage, associated complications, and affected tissue. The radiologic findings range from purely cystic lesions to a completely solid appearance. Ultrasound is the most important imaging modality for liver hydatid disease and clearly demonstrates the floating membranes, daughter cysts, and hydatid sand characteristically seen in purely cystic lesions. The radiologist's familiarity with the imaging findings of the disease is very important for earlier diagnosis and an appropriate treatment. There are several classification schemes for liver hydatid cysts based on their ultrasound appearances; the initial classification by Gharbi et al and the World Health Organization classification are the most commonly preferred. Computed tomography and magnetic resonance imaging play a key role in recognizing the complications such as rupture and infection of cysts associated with hydatid disease. Today, percutaneous treatment of liver hydatid cysts, a safe, easily applicable, and well-tolerated method, has become the most effective and reliable treatment procedure in most cases if the hydatid cyst is viable. In patients treated with the percutaneous treatment technique, a decrease in the dimensions of the cyst, solidification of the cyst contents, and irregularity in the walls of cysts are signs suggestive of cure. The radiologist should also be familiar with the postoperative follow-up ultrasound findings of hydatid cyst to prevent misinterpretation of the hypoechoic, anechoic, or hyperechoic appearance of posttreatment hydatid disease appearance as recurrence.     

Ruptured pulmonary hydatid cyst with anaphylactic shock and pneumothorax

Hydatid cyst is a disease caused by a parasitic tapeworm, Echinococcus granulosus, and most commonly involves liver and lung. Ruptured pulmonary hydatid cyst can present a diagnostic challenge, and radiograph can be inconclusive. Anaphylactic reaction is a rare complication of ruptured pulmonary hydatid cyst. A 22-year-old male came to our emergency department in shock with symptoms of shortness of breath and altered mental status from the previous day. Radiograph showed a thin-walled circular translucent area in the right upper lung field, which was misdiagnosed as pneumothorax, and an intercostal chest tube was inserted. After 5 days, repeat radiograph revealed a cavity with an air/fluid level. The chest tube was removed and contrast-enhanced computed tomogram showed a cavity with water-lily sign, which suggests ruptured hydatid cyst. Immunoglobin-G enzyme-linked immunosorbent assay for Echinococcus was positive. The patient responded well to treatment with crystalloid infusion, supplemental oxygen, and albendazole, and then underwent surgery. Anaphylactic reaction due to rupture of a hydatid cyst is rare, but hydatid disease should be suspected in patients from areas where Echinococcus is endemic.     

An unusual cause of chest pain: An isolated huge cardiac hydatid cyst

Hydatid disease is a human parasitic infection caused by the larval stage of Echinococcus granulosus. The most common locations for hydatid cysts are the liver and lungs. Cardiac involvement is rare, and isolated cardiac hydatid cysts are even more unusual. We report the case a 48‐year‐old female patient with an isolated huge cardiac hydatid cyst involving both the left ventricular free wall and the pericardium, and presenting with atypical chest pain. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46 :262–264, 2018     

晚发性维生素K缺乏所致颅内出血患儿的临床护理

目的探讨加强护理在提高晚发性维生素K缺乏所致患儿颅内出血救治效果中的作用。方珐回顾性分析18例晚发性维生素K缺乏所致颅内出血患儿全程护理效果。结果18例患儿中治愈17例，死亡1例，随访1年，正常14例，有后遗症者3例（16．7％），其中2例出现继发性癫痫，1例轻微智力障碍。结论早期诊断、及时救治、有效护理是提高治愈率的关键；加强乳母的营养指导、人工喂养儿以配方奶为主的合理喂养知识宣教、婴儿抚触及音乐疗法等综合康复治疗可防止脑性瘫痪，降低后遗症的发生率。     

Cluster Headache and Intercalated Seizures in a Young Man: Therapeutic Effectiveness of Flunarizine

A young man suffering from both cluster headache and epilepsy is reported. Since the age of 37 he had recurrent generalized tonic-clonic seizures; one year later cluster headache attacks began. Neurological examination, standard laboratory tests and CT-scan were normal. The EEG showed medium-voltage sharp waves, not blocking upon eye opening, over the right parieto-temporal region. Flunarizine was added to his phenytoin therapy; it controlled both paroxysmal disorders. After six months, flunarizine was discontinued and during a one year follow-up the patient remained symptom-free. This calcium channel blocker can be regarded as an ideal drug in patients suffering from both cluster headache and epilepsy; it controls this headache syndrome and is a useful add-on to standard anti-convulsant therapy.     

The role of endoscopic retrograde cholangiopancreatography in the management of hepatic hydatid disease.

BACKGROUND AND STUDY AIMS: Hydatid disease of the liver, and its complications, causes serious morbidity and mortality. We evaluated the role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatic hydatid disease. PATIENTS AND METHODS: This retrospective analysis includes 28 patients with hepatic hydatid disease who underwent ERCP. ERCP was performed preoperatively in 11 patients, for acute cholangitis (n =7), acute pancreatitis (n = 1) and right upper quadrant pain (n = 3), and in eight asymptomatic cases to search for fistulae between the cyst and the biliary tree. In a further nine patients ERCP was performed for early (< 30 days; n = 7) and late (n = 2) postoperative biliopancreatic problems. RESULTS: In all seven patients with cholangitis preoperative ERCP with EST and ductal clearance of daughter cysts and debris led to substantial clinical improvement, including four acutely ill elderly patients who stabilized and were later able to undergo surgery. EST in two of the three patients with pain who had papillary stenosis led to resolution of the abdominal pain. Six of the seven postoperative fistulae could be successfully treated endoscopically using EST. CONCLUSIONS: This study demonstrates the usefulness of ERCP in symptomatic patients with hepatic hydatid cysts; EST enables clearance of the common bile duct and allows healing of postoperative fistulae in the majority of patients. We do not, however, recommend performing routine preoperative ERCP in asymptomatic patients with the disease.     

输尿管囊肿的三维超声和彩色多普勒诊断

目的 :评估三维超声、彩色多普勒超声对输尿管囊肿的应用价值。方法 :用三维、彩色多普勒血流观察了 10例输尿管囊肿的立体形态及喷尿情况。结果 :三维超声立体感强 ,形态逼真 ,定位准确。彩色多普勒显像示喷尿的尿流束由囊肿内向膀胱喷射时较为明显 ,表现为细而色艳的彩色流束 ,而由输尿管向囊肿内喷射时流束则呈粗而色暗。结论 :三维超声和彩色多普勒超声能提高诊断输尿管囊肿的准确率 ,为临床提供更准确的诊疗信息     

MRI of abdominal hydatid disease

Seventy hydatid cysts in 30 patients were studied with magnetic resonance imaging (MRI) and computed tomography (CT); all cases were confirmed surgically. MRI detected all cysts when confined to solid organs, whereas small-sized cysts (2 cm) may be missed when located in the peritoneal cavity. Hydatid cysts of less than 3 cm (noncomplicated) present no specific findings of hydatid disease. MRI findings suggesting hydatid disease demonstrate a relatively thick hydatid cyst wall, daughter cysts, and germinal membrane detachment. T2-weighted images proved to be superior to T1 or PD-weighted images in demonstrating hydatid cyst wall thickness, germinal membrane detachment, and daughter cysts. In all spin-echo sequences, the maternal cystic content presented much higher signal intensities than that of daughter cysts. This difference in signal intensity is more obvious in T2 weighted images, except in complicated, infected cases. CT proved to be superior to MRI in demonstrating wall calcifications.