神经导航在颅脑手术的最优化选择

评价神经导航系统在颅脑手术的应用价值.充分利用神经导航系统定位精确和实时导航功能,达到颅脑手术疗效的最优化.对神经导航在颅脑手术最优化方面的几点误区进行分析,对颅脑手术"适度医疗"的问题提出一些建议.     

颅内脂肪瘤的诊断与治疗

为了分析和讨论颅内脂肪瘤的诊断和治疗,我们回顾性分析23例颅内脂肪瘤患者的临床特点、影像学资料,对17例有症状的患者行手术治疗,6例无相关症状患者行CT或MRI随访.结果显示,17例手术患者中,除1例较术前症状加重外,余16例症状缓解或明显改善.6例无症状患者随访1年～6年,CT或MRI显示脂肪瘤无明显增大.因此,无相关症状患者可行CT或MRl随访;有明显的神经表现者可行手术治疗,手术目的是充分的神经结构减压,部分切除及减压术可实现长期的症状缓解.     

超声引导和神经刺激仪定位在臂丛神经阻滞中的应用比较

臂丛神经阻滞广泛用于上肢手术,其成功的关键在于准确的解剖定位和局麻药的均匀扩散,神经刺激仪和超声技术应用于臂丛神经阻滞,改变传统方法的盲目性,更加安全有效.本文应用比较治疗学的观点,运用Meta分析方法,对两种方法辅助臂丛神经阻滞进行比较,指导科学合理的临床决策,发现超声引导更具优势,值得在临床推广.     

两种麻醉方式在门诊隆胸手术中的应用比较

为了比较瑞芬太尼-丙泊酚静脉麻醉与利多卡因硬膜外神经阻滞在门诊隆胸手术中的应用效果,选取ASA I级行门诊隆胸手术患者80例,随机等分为瑞芬太尼-丙泊酚静脉麻醉组(A组)和利多卡因硬膜外神经阻滞组(B组).观察两组患者围手术期的麻醉效果和术后2h内不良反应发生情况.结果显示,A组麻醉效果显著优于B组,且术后2h内发生的不良反应明显少于B组.     

带腓肠神经腓骨复合组织瓣移植修复前臂尺侧缺损

观察以带腓肠神经的腓骨复合组织瓣移植修复前臂尺侧缺损的临床效果.时15例前臂尺侧复合组织缺损的患者实行带腓肠神经的腓骨复合组织瓣移植修复术.结果15例组织瓣全部成活,前臂功能恢复良好.应用带腓肠神经的腓骨复合组织瓣移植修复前臂尺侧缺损,是一种治疗复合组织缺损的有效手术方法.     

显微神经外科技术治疗脑胶质瘤的效价分析

为了探讨应用显微神经外科手术技术治疗神经胶质瘤的疗效评估.将240例脑胶质瘤患者随机分为显微外科手术组和常规手术对照组各120例,比较两组患者并发症发生率、病残/死率、平均住院天数、平均住院花费以及平均恢复工作时间的差异.结果显示,应用显微神经外科手术技术治疗脑胶质瘤具有并发症少,病残率低,疗程短,住院花费少等特点,明显提高生存质量,具有显著的社会学意义.     

药物成瘾机制与手术戒毒研究进展

本文从神经束路学、神经生理学、神经化学和分子神经生物学等方面分析了药物成瘾的病理生理学机制.探讨了立体定向手术戒毒的理论依据及发展方向:通过射频毁损或脑深部电刺激,部分破坏或抑制脑内异常兴奋点,阻断药物刺激引起的病理性信息传递,进而打破药物引起的病理性平衡,通过脑功能的代偿作用和手术后适当的心理行为康复治疗使成瘾相关环路在新水平上重建相对健康的平衡,进而达到减轻药物心理依赖、降低复吸率的目的.     

甲状腺腔镜手术与开放性手术的比较

通过探讨腔镜甲状腺手术与开放甲状腺手术之间的差异,正确选择手术方式,回顾分析2008年6月至2013年2月在我院的162例行腔镜甲状腺手术患者与162例行开放甲状腺手术患者,比较住院时间、住院费用、手术时间、术中出血量、引流管引流总量、引流管拔管时间及术后并发症情况.结果162例腔镜手术均成功完成,无一例中转开放手术,腔镜手术住院时间、住院费用、手术时间、术中出血量、引流管引流总量均较开放手术多,术后1例发生短暂性喉返神经麻痹,14例胸部皮肤感觉麻木.因此,开放与腔镜甲状腺手术都是安全可靠的,腔镜手术具有确切的美容效果,但不是首选术式,不应盲目扩大腔镜手术群体,把握腔镜手术对象,以患者实际情况为出发点,以开放手术为主,节约医疗资源.     

外周型原始神经外胚层肿瘤1例

原始神经外胚叶肿瘤是一种罕见的、起源于原始神经上皮的恶性小圆形细胞肿瘤,具有多方向分化能力,可发展为神经元性的、胶质细胞性的、甚至间叶组织性质的肿瘤.根据发病部位将其分为中枢型和外周型两种,中枢型多发于脑和脊髓,外周型多见于胸壁、四肢,发生于脊柱者少见.本文就外周型原始神经外胚层肿瘤1例做病例报道,总结该类肿瘤的特点,肿瘤密度/信号不均匀,轻至中度强化,预后差,临床治疗手段主要为外科手术辅以放化疗,术前行增强CT对手术可切除性评估非常有价值.     

理清思路,预防喉返神经损伤

喉返神经损伤是甲状腺手术常见而严重的并发症.阐述了喉返神经的局部解剖及一些重要的解剖变异,分析了导致喉返神经损伤的一些常见原因,并运用唯物辩证法的观点提出了预防喉返神经损伤的一系列措施.     

From Freud to Gehrig to Rapaport to DiMaggio

Lacking the size, talent, and speed to play shortstop for the New York Yankees, I chose instead to become a psychologist/psychoanalyst. Yet, baseball and psychoanalysis share much in common. Each is played in the inner diamonds of one's mind, values the past and what is passing, and requires a strong work ethic. Both are timeless and involve an almost boring leisureliness between occasional moments of crisis. Then too, each calls for an attitude of consistency and patience and a responsibility to do one's best. From my parents and brother to my wife and son and his family, from my teachers and supervisors to my colleagues, and from Menninger to the Society for Personality Assessment (SPA), I feel deeply grateful for the partners and teammates I have and have had.     

From Biology to Consciousness to Morality

Abstract. Social animals are provisioned with prosocial orientations that operate to transcend self‐interest. Morality, as used here, describes human versions of such orientations. We explore the evolutionary antecedents of morality in the context of emergentism, giving considerable attention to the biological traits that undergird awareness and our emergent human forms of mind. We suggest that our moral frames of mind emerge from our primate prosocial capacities, transfigured and valenced by our symbolic languages, cultures, and religions.     

How Not to Apply to College

Samples of letters written by college students are excerpted to demonstrate the deterioration of students' writing skills. The relative unimportance many college students and graduates attach to the art of writing letters of inquiry is emphasized. A checklist is provided to assist students in preparing letters requesting information from colleges and universities.     

From object to image to object

Images are mental representations accommodated by grammatical structures. These structures order sensori-input of information as well as provide for articulated ways of expressing motor sequences associated with images. The psychological process of perception is reflected in the development of paradigmatic structures. The psychological process of action (behavior and its mental representations) is reflected in the development of syntagmatic structures. Forming and expressing imagery requires both paradigmatic and syntagmatic structuring. The former relates to logical issues of identity of objects and to the formation of concepts. The latter relates to the solution of psycho-logical questions of causality through articulation of grammatical roles in sentences. Two issues affecting the formation of a model to account for imagery are examined: (1) The tendency to explain imagery as a result of motor sequences and to utilize performance grammar. (2) The impact of ontogenesis on social processes affecting the logical and psycho-logical concerns facing the person at different stages of development. The grammar of imagery is seen as broader than one of performance. The epistemology of imagemaking does not reflect a linear ontogenetic development which precludes attention to problems of creating the logical structures of an object.     

Minors' competence to consent to abortion

In the light of legal restrictions in some states, the psychological evidence for whether adolescents are competent to give informed consent to abortion is reviewed. It would be important to know whether competence to decide on pregnancy outcome reflects maturity to be a parent; further, whether degrees of maturity can be traced throughout adolescence. Research shows that parents, not peers, are major sources of advice for minors' abortion decisions. Younger and less competent minors are more likely to consult parents than older, mature minors. There is no evidence that adolescent issues or developmental tasks influence pregnancy decisions. Decision making competence does not differ from that of adults, except as affected by the living situation of the adolescent. Decision performance does differ: minors are more likely to consider their present family's opinion, and not consider future risks, than are adults. The sparse research available on this problem provides no basis for restricting minors' decision making on the ground of competence alone.