远外侧入路治疗颅颈交界区腹侧病变

探讨远外侧入路在颅颈交界区腹侧病变治疗中的应用.14例患者全部采用远外侧入路显微手术治疗.11例肿瘤全切除7例,次全切除2例,大部切除2例;3例动脉瘤均顺利夹闭;行枕颈融合术3例.术后最常见的并发症是后组脑神经损伤症状;获得随访11例,恢复良好.远外侧入路是治疗颅颈交界区腹侧病变的理想入路,但治疗方案应个体化.     

累及后柱的胫骨平台骨折手术治疗体会

探讨胫骨平台骨折累及后柱的手术治疗方法。2014年1月~2015年1月笔者选取了25例胫骨平台骨折患者(后柱均受累)为研究对象,其中后内伴后外侧骨折8例,后内侧劈裂骨折11例,后外侧劈裂骨折6例。根据后柱累及部位不同采取后内侧入路、后外侧入路骨折复位固定术,观察临床治疗效果及并发症情况。结果,患者术中出血量(167.32±1.89)ml,住院时间(18.34±2.31)d,骨折愈合时间(14.22±0.60)周,完全负重时间(17.56±1.31)周,膝关节活动度(110.26±1.9)°。膝关节功能恢复优者16例(64%),良者5例(20%),优良率84%。膝关节后侧(后内侧或后外侧)入路复位及支撑钢板固定术具有复位合理、固定稳定性高、并发症少、膝关节功能快速恢复等优点,成为累及后柱的胫骨平台骨折治疗的首选手段。     

内镜下经鼻蝶入路垂体腺瘤切除术的临床研究

探讨内镜下经鼻蝶入路垂体腺瘤切除术的临床疗效及并发症的防治措施.回顾性分析我科210例行单鼻孔经鼻蝶入路垂体腺瘤切除术患者的临床资料：男106例,女104例;无功能腺瘤150例,功能性垂体腺瘤60例.存在假包膜的肿瘤行包膜外切除,术后随访3个月～32个月.结果肿瘤全切170例,次全切除5例,大部及部分切除35例.术后尿崩63例（30.0％）,激素水平低下25例（11.9％）,脑脊液鼻漏4例（1.9％）,颅内感染4例（1.9％）,鼻出血2例（0.9％）,视力下降1例（0.5％）,死亡1例（0.5％）.截止随访结束：垂体功能低下18例（8.5％）,永久性尿崩2例（0.9％）,无肿瘤复发.对鞍区解剖结构的熟悉及娴熟的内镜技术有助于安全有效的切除垂体腺瘤,减少并发症发生.     

全结肠切除加回肠造口术对特发型巨结肠性便秘的疗效分析

探讨全结肠切除加回肠造口术治疗特发型巨结肠性便秘的疗效。回顾性分析2005年1月~2013年12月在笔者医院接受手术治疗的35例特发型巨结肠性便秘患者的临床资料,其中结肠次全切除加回肠-乙状结肠侧侧吻合/升结肠-直肠端端吻合术患者13例和全结肠切除加回肠造口术患者22例,观察对比两组患者术后并发症及随访资料。在术后并发症指标观察中,发现全结肠切除术组的术后腹腔内感染率和术后炎性肠梗阻发生率明显少于结肠次全切除术组,其差异有统计学意义(P0.05)。在随访指标观察中,发现全结肠切除术组术后再手术干预率显著低于结肠次全切除术组,并全结肠切除术组无一例术后复发而再次手术的患者(P0.05)。特发型巨结肠性便秘更加适合行全结肠切除加回肠造口术。     

浅谈颈椎后纵韧带骨化症的手术治疗

摘要：颈椎后纵韧带骨化（OPLL）是一种由于后纵韧带异位骨化导致脊髓和神经根受压而产生的疾病,其病因尚未明确。手术治疗是一种有效的治疗手段,但是手术时机的选择仍充满争议。手术方法根据手术入路可分为颈前路、颈后路和前后路联合入路手术。内固定及融合方式也很多,即使同样的手术入路,也有多种不同的内固定及融合方式可供选择。不同的手术方法有不同的适应证和优缺点。本文就颈椎后纵韧带骨化症的手术治疗进行综述。     

胃癌行全胃胰体尾脾脏切除并扩大右半结肠切除术15例临床分析

探讨进展期胃体癌浸润周围脏器的联合脏器切除的适应证、手术入路、手术方法及意义.回顾性分析2009年2月至2011年10月我院15例胃癌直接浸润胰腺、脾脏和横结肠而施行全胃切除及胰体尾脾脏切除并扩大右半结肠切除术患者的临床资料.术后出现1例腹腔感染,1例切口感染,经通畅引流、局部冲洗及切口换药后均痊愈出院,无再手术及死亡病例.术后均进行随访,1例在术后14个月时出现局部复发,1年生存率100％,2年生存率38％.以右下腹肾前间隙开始的全胃切除及胰体尾脾脏切除并扩大右半结肠切除术,明显缩短手术时间,符合肿瘤的切除原则,提高了手术的安全性.     

腔镜在分化型甲状腺癌手术中的应用

作为一种新的术式,完全腔镜下甲状腺手术(TET)是不是微创手术,该选择何种入路,对甲状腺癌手术是否合适等问题仍然存在争议.本文就这些问题进行详细的阐述.完全腔镜治疗甲状腺癌手术的适应证是:有美容要求的女性或者肿瘤直接≤2cm;手术方式:腺叶全切加中央区淋巴结清扫或者加侧区清扫.手术前应该评估淋巴结转移情况,术后要严密随访.TET手术技术日趋成熟,而且是安全、可行;但要完成TET甲状腺癌根治术,术者除了具有娴熟的腔镜下手术操作技能,还要有丰富的开放甲状腺手术的经验.     

颈椎后纵韧带骨化症的临床分型及手术方式的选择

为了探讨颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床分型及其手术方式的选择,回顾性分析了2006年4月～2011年3月收治颈椎OPLL患者46例.根据患者后纵韧带骨化的范围,将OPLL分为:Ⅰ型累及下颈椎,病变范围≤2个椎体,Ⅲ型累及下颈椎,病变范围≥3个椎体,Ⅲ型累及下颈椎,狭窄率≥50％且合并发育性椎管狭窄,IV型累及上颈椎.手术方式的选择;颈后路推管减压术或后路减压内固定术.以此选择颈后路、颈前路及颈椎前后路手术方式,计算JOA改善率.经过随访后,患者从术前JOA评分平均8.72分(4分～11分)提高至13.11分(8分～15分),JOA平均改善率为53.56％.据此分型可十分明确的选择手术方式,并取得较好临床效果.此分型可为手术治疗OPLL提供一个客观的临床标准.     

成人肱骨髁间髁上骨折的手术治疗体会

观察经尺骨鹰嘴截骨入路双柱铜板治疗肱骨髁间髁上骨折临床疗效。13例肱骨髁间髁上骨折患者经尺骨鹰嘴截骨入路双柱钢板治疗,结果13例患者获9个月～14个月的随访,末次随访肱骨髁间髁上及尺骨鹰嘴骨折均获得骨性愈合;2例合并尺神经原发损伤经对症处理及神经营养治疗6个月后症状消失,1例患者出现肘关节周围骨化性肌炎,肘关节屈曲僵硬畸形Mayo肘关节功能评分优8例,良3例,可1例,差1例,优良率达84．6％。因此,在肱骨髁间髁上骨折的手术治疗中尺骨鹰嘴截骨入路对于显露骨折断端固定方便可靠,对于促进骨折愈合,肘关节的早期功能锻炼有良好的临床疗效。     

海绵窦区病变外科处理策略

为探讨海绵窦区病变的外科治疗策略,回顾性分析了58例不同性质的海绵窦病变病例的临床资料、治疗方法和治疗效果,发现根据病变的不同性质和不同的生长方式个性化地采用不同的治疗方法可在最大限度治愈病变的同时,保护颅神经的功能,获得良好的治疗效果。     

Midbrain-hypothalamic interrelationships in the control of aggressive behavior

Previous studies have suggested an involvement of the midbrain ventral tegmental area in the biting attack upon a rat elicited by electrical stimulation of the lateral hypothalamus in cats. In order assess further the relationship between these two regions, 12 cats were implanted with attack-eliciting electrodes in both the lateral hypothalamus and the midbrain ventral tegmental area. Following a lesion of the midbrain attack site, attack previously elicited from hypothalamic electrodes ipsilateral to the lesion was eliminated or significantly reduced in frequency. The attack elicited from electrodes in the hypothalamus contralateral to the lesion was unaffected. Midbrain lesions made at sites from which attack was never elicited had no effect on hypothalamically elicited attack. The midbrain lesion in some cases eliminated only certain components of the total attack pattern; for example, the approach of a cat to the rat frequently remained present while the bite was absent. Additionally, it was found that the attack elicited from rostral hypothalamic electrodes was disrupted to a greater degree by a single midbrain lesion than the attack elicited from more caudal hypothalamic electrodes. These finding are discussed in terms of the neural system mediating this form of aggressive behavior in cats.     

Differential contributions of dorsal vs. ventral hippocampus to auditory trace fear conditioning

The effect of excitotoxic lesions of dorsal vs. ventral hippocampus on the acquisition and expression of auditory trace fear conditioning was examined in two studies. In Experiment 1, animals received excitotoxic lesions of either the dorsal or ventral hippocampus or sham surgeries one week prior to conditioning, and were tested 24 h later. In Experiment 2, animals received excitotoxic lesions of either the dorsal or ventral hippocampus or sham surgeries 24 h after training, and were tested one week after surgery. Both pre- and post-training lesions of ventral hippocampus impaired the acquisition and expression, respectively, of auditory trace fear conditioning. Pre-training lesions of dorsal hippocampus had no effect on the acquisition of trace fear conditioning, while post-training lesions of dorsal hippocampus dramatically impaired expression during subsequent testing. Although in some cases animals with lesions of ventral hippocampus exhibited locomotor hyperactivity, it is unlikely that the pattern of observed deficits can be attributed to this effect. Collectively these data suggest that the dorsal and ventral hippocampus may contribute differentially to the mnemonic processes underlying fear trace conditioning.     

Dissociations across the dorsal-ventral axis of CA3 and CA1 for encoding and retrieval of contextual and auditory-cued fear

The present study was designed to dissociate the roles of dorsal CA3, dorsal CA1, ventral CA3, and ventral CA1 in contextual and auditory-cued classical fear conditioning. Rats received excitotoxic lesions of dorsal CA3, dorsal CA1, ventral CA3, or ventral CA3 prior to acquisition of classical fear conditioning. Dorsal CA3 and dorsal CA1, but not ventral CA3 or ventral CA1, lesions caused a deficit for the acquisition of contextual fear. Dorsal CA1, ventral CA3, and ventral CA1, but not dorsal CA3, lesions caused deficits for the retrieval/expression of contextual fear when tested either 24 or 48h after encoding. Ventral CA3, but not dorsal CA3, dorsal CA1, or ventral CA1, lesions caused a deficit for retrieval of auditory-cued fear when tested either 24 or 48h after encoding. The data suggest that dorsal CA3 mediates encoding of contextual fear, whereas ventral CA3 mediates retrieval of contextual fear. The data also suggest that dorsal CA1 mediates encoding and retrieval of contextual fear, whereas ventral CA1 mediates only the retrieval of contextual fear.     

Response Channel Activation and the Temporoparietal Junction

When we learn to make one motor response to one visual stimulus and a different motor response to another, representations of these stimulus–response associations must be maintained to efficiently transduce perception into action. When an irrelevant distractor is presented adjacent to a target stimulus, interference is observed when the two stimuli are associated with conflicting responses, presumably due to response channel activation by the incompatible information. We have explored the neural bases of these interference effects. In a previous study, patients with hemispatial neglect showed normal interference from contralesional flankers. In another study, patients with lesions of the lateral prefrontal cortex were found not to show interference from distractors presented in the contralesional hemifield. The current study provided a more anatomically detailed investigation of the effects of posterior association cortex lesions on flanker interference. Patients with chronic, unilateral lesions involving the temporoparietal junction (TPJ), two of whom had hemispatial neglect, were compared with patients with lesions of the posterior association cortex not involving the TPJ. All patients performed a color discrimination task at fixation while a congruent or incongruent colored flanker was briefly presented (16.7 ms) in the adjacent contralesional or ipsilesional hemifield. Patients with TPJ lesions showed no interference effects from the contralesional flankers. These results suggest that the TPJ, in combination with the dorsolateral prefrontal cortex, is involved in transducing perception into action.     

A magnetic resonance imaging study of regional cortical volumes following stereotactic anterior cingulotomy

The purpose of this study was to test the hypothesis that orbitofrontal cortical volume would be reduced following anterior cingulotomy for obsessive-compulsive disorder (OCD). Whole brain cortical parcellation was performed on magnetic resonance imaging (MRI) data from nine patients, before and 9 (+/-6) months following anterior cingulotomy. No significant volumetric reductions were found in the orbitofrontal cortex. Exploratory findings of reduced volume in ventral temporo-fusiform and posterior cingulate regions were consistent with chance differences, in the face of multiple comparisons. Therefore, though the circumscribed lesions of anterior cingulotomy have recently been associated with corresponding volumetric reductions in the caudate nucleus, no comparable volumetric reductions are evident in cortical territories. Taken together, these results are most consistent with a model of cingulo-striatal perturbation as a putative mechanism for the efficacy of this procedure. While limitations in sensitivity may have also contributed to these negative findings, the methods employed have previously proven sufficient to detect cortical volumetric abnormalities in OCD. The current results may reflect a relatively diffuse pattern of cortico-cortical connections involving the neurons at the site of cingulotomy lesions. Future functional neuroimaging studies are warranted to assess possible cortical or subcortical metabolic changes associated with anterior cingulotomy, as well as predictors of treatment response.     

A Simon effect for depth in three-dimensional displays

We investigated whether the Simon effect occurs for the depth dimension in a 3-dimensional display. In Experiment 1, participants executed discriminative responses to 2 stimuli, a cross and a sphere, both 3-dimensional, which were perceived to be located near or far with respect to the participant's body. The response keys were located near and far along the participant's midline. Apparent stimulus spatial location (near or far) was irrelevant to the task. Results showed a depth Simon effect, attributable to the apparent stimulus spatial location. Experiment 2 replicated Experiment 1 with a different procedure. The 2 stimuli, a triangle and a rectangle, were 2-dimensional and were perceived as being located near or far from the participant's midline; the response keys were located near and far along the participant's midline. Results showed again the depth Simon effect. Experiment 3 was a control condition in which the 2 stimuli, drawings of a lamp and of a chair, had the same size, regardless of whether they appeared to be near or far. The depth Simon effect was replicated. A distribution analysis on data of Experiment 3 showed that the Simon effect increased as reaction times became longer. In Experiment 4, the position of the 2 stimuli, a circle and a cross, varied on the horizontal (right or left) dimension, whereas the position of the 2 responses varied along the depth (near or far) dimension. No Simon effect was found.     

Does focus of attention alter craniocervical flexion test motor learning? A randomized controlled trial

ObjectiveTo evaluate the effects of three different foci of attention (internal, external and mixed) on motor learning using craniocervical flexion test in inexperienced participants.MethodsNinety healthy young adults, with no experience in the task, practiced the craniocervical flexion test under three different focus of attention: a) Mixed Focus (internal plus external), b) Internal Focus, and c) External Focus. We assessed immediate, post-training, and retention (one week after the last training session) aspects of motor learning by quantifying (i) the activity of the superficial cervical flexors muscles, (ii) craniocervical range of motion, and (iii) the performance on the craniocervical flexion test.ResultsNone of the groups showed any significant immediate, post-training, or retention effects on superficial neck flexors activity and craniocervical range of motion progression. At immediate assessment, mixed focus had greater craniocervical flexion performance than external (MD 0.9, 95%CI 0.2 to 1.5), and internal foci (MD 1.4, 95%CI 0.8 to 2.1). At post-training, mixed focus led to better craniocervical performance compared to external (MD 1.6, 95%CI 0.8 to 2.4) and internal foci (MD 2.7, 95%CI 1.9 to 3.5). External focus had better scores on the craniocervical flexion test performance than internal focus (MD 1.1, 95%CI 0.3 to 1.9). Results remained similar at retention, with mixed focus being superior to internal (MD 2.3, 95%CI 1.7 to 3) and external foci (MD 1.5, 95%CI 0.9 to 2.1) on craniocervical flexion test performance. Similarly, the performance on the craniocervical flexion test performance remained similar at retention between external and internal foci (MD 0.9, 95%CI 0.2 to 1.5).ConclusionIn inexperienced asymptomatic participants, different foci of attention were not able to change cervical muscle activity and craniocervical range of motion during the craniocervical flexion test. Mixed focus was better than external and internal focus on the craniocervical flexion test. These findings were retained after one week.     

Septal damage in infant and adult rats: Effects on activity,emotionality, and muricide

Septal lesions produced signs of increased emotionality in the adult rat, the septal syndrome (hyperresponsiveness to handling; in the open field: decreased rearing and ambulation activity, increased defecation, deficient habituation) being more or less complete and more or less marked depending on the age at which the lesion was performed (7 days or 3 months), the extent of the lesion (restricted to the septum or extending to more ventrally located structures) and the environmental conditions in which the animals were reared (in groups or in isolation). All septal lesions provoked a similar and significant increase in the probability of occurrence of mouse-killing behavior, irrespective of age of operation, extent of lesion and kind of rearing environment. In a 24-hour actography starting at 11:30 a.m., the rats septalectomized at adult age were less active than controls during the initial period, while all septals were markedly more active than controls during the night period. Early septal lesions only transiently disrupted weight gain. The results obtained point to complex interactions between the effects of early brain damage and environmental conditions.     

Infant pattern vision: A new approach based on the contrast sensitivity function

Current approaches to the study of infant pattern vision have yielded interesting findings but have not yielded a set of data or principles from which general predictions can be drawn. We propose an alternative approach based on measurements of the contrast sensitivity function (CSF). This approach has been successfully applied to the study of adult vision. In principle, the approach allows one to predict the detectability of a wide variety of two-dimensional patterns if one knows the observer's CSF. Two experiments were conducted. In Experiment 1, CSFs of 1-, 2-, and 3-month infants were measured using a fixation preference paradigm. The results indicated noteworthy development between 1 and 3 months particularly in sensitivity to high spatial frequencies (fine stripes). The low-frequency attenuation characteristic of adult vision is observed at 2 and 3 months but not always at 1. In Experiment 2, CSFs of 2-month infants were measured at a lower luminance level. The results indicated that low-frequency attenuation became less pronounced as would be predicted if it were a manifestation of lateral inhibitory processing. The manner in which the CSF can be used to make general predictions is described. The CSFs of Experiment 1 are then used to successfully predict infants' detection of patterns used in two frequently cited experiments. We also propose a simple model of infant pattern preference and show that the model accurately predicts the results of a number of well-known experiments.     

Reactivity and aggression in the rat: induction by alpha-adrenergic blocking agents injected ventral to anterior septum but not into lateral septum.

Intracranial injections were made bilaterally through permanently implanted cannulas ending in the lateral septum or in the region ventral to the anterior septum. The rats were first screened with injections of a local anesthetic, lidocaine, which blocks both synaptic and axonal conduction. Those animals that showed an increase in reactivity and aggression were then injected with a synaptic transmitter blocking agent. The results showed that transmitter blocking agents reproduced the effect of the local anesthetic only in the region ventral to the anterior septum and that alpha-adrenergic (phentolamine, tolazoline), but not beta-adrenergic (propranolol, hydralazine), cholinergic (atropine, hyocine), or dopaminergic (haloperidol) blocking agents were effective. These results suggest that synapses in the forebrain system controlling reactivity and aggression are alpha-asrenergic and are located in the region ventral to the anterior septum just lateral to the diagonal band of Broca. The septum itself may be involved only to the extent that it is traversed by fibers of passage.