31例眼睑恶性肿瘤切除后Ⅰ期修复的总结

眼睑恶性肿瘤切除术后,眼睑修复时机的选择,对保持眼睑功能和美容的效果起着十分重要的作用,术式的选择是决定手术成功关键。采用眼睑全层缺损行异体巩膜片移植,替代睑板、滑行球结膜瓣前徙替代睑结膜的眼睑再造术,对31例眼睑恶性肿瘤切除,同时进行眼睑再造术。术后无排斥反应,眼睑闭合良好,外形满意。结论认为,较大范围的眼睑恶性肿瘤切除的患者,采用异体巩膜片移植、滑行结膜瓣前徙眼睑再造术能达到保持眼睑功能和美容的效果,是理想的眼睑恶性肿瘤切除后Ⅰ期修复临床决策。     

The neural correlates of movement intentions: A pilot study comparing hypnotic and simulated paralysis

The distinct feeling of wanting to act and thereby causing our own actions is crucial to our self-perception as free human agents. Disturbances of the link between intention and action occur in several disorders. Little is known, however, about the neural correlates of wanting or intending to act. To investigate these for simple voluntary movements, we used a paradigm involving hypnotic paralysis and functional magnetic resonance imaging. Eight healthy women were instructed to sequentially perform left and right hand movements during a normal condition, as well as during simulated weakness, simulated paralysis and hypnotic paralysis of the right hand. Right frontopolar cortex was selectively hypoactivated for attempted right hand movement during simulated paralysis while it was active in all other conditions. Since simulated paralysis was the only condition lacking an intention to move, the activation in frontopolar cortex might be related to the intention or volition to move.     

The Gradual Deterioration of Syntax and Semantics in a Patient with Progressive Aphasia

FM is a progressive aphasic patient whose language comprehension we studied over a 4-year period. We developed a variety of implicit and explicit tasks to chart progressive changes in the representation of linguistic knowledge (in particular, syntax and semantics) and the automatic and controlled processes which operate on that knowledge. The representation of FM's semantic knowledge remained essentially intact over the years, but she became increasingly impaired at combining the meanings of words. She also showed progressive impairments in the processes of syntactic combination. Thus, FM's disease resulted in a progressive inability to engage in those combinatorial processes necessary for the normal comprehension of a spoken utterance. This is not a selective deficit in the traditional sense of the term, since aspects of both syntax and semantics are implicated; but it is selective in the sense that other aspects of language comprehension remain intact.     

经验医学与腰椎间盘突出症的认知史

众所周知,腰椎间盘突出症是一种脊柱退变性疾病。本病的发现历史只有70多年,但它的存在历史却至少有几千年了。本文从有记载开始的古代文明回顾了腰椎间盘突出症的存在和发现过程,特别强调经验医学在疾病认知过程中的重要作用。本文还重点提出当代保守治疗和手术治疗的进展和原则变化情况。另外,根据最近的临床研究,本文认为,脊柱力学平衡在保守治疗过程中应该引起足够的临床重视。     

Sleep paralysis and hallucinosis

Background: Sleep paralysis is one of the many conditions of which visual hallucinations can be a part but has received relatively little attention. It can be associated with other dramatic symptoms of a psychotic nature likely to cause diagnostic uncertainty. Methods and results: These points are illustrated by the case of a young man with a severe bipolar affective disorder who independently developed terrifying visual, auditory and somatic hallucinatory episodes at sleep onset, associated with a sense of evil influence and presence. The episodes were not obviously related to his psychiatric disorder. Past diagnoses included nightmares and night terrors. Review provided no convincing evidence of various other sleep disorders nor physical conditions in which hallucinatory experiences can occur. A diagnosis of predormital isolated sleep paralysis was made and appropriate treatment recommended. Conclusions: Sleep paralysis, common in the general population, can be associated with dramatic auxiliary symptoms suggestive of a psychotic state. Less common forms are either part of the narcolepsy syndrome or (rarely) they are familial in type. Interestingly, sleep paralysis (especially breathing difficulty) features prominently in the folklore of various countries.     

Ideomotor silence: the case of complete paralysis and brain–computer interfaces (BCI)

The paper presents some speculations on the loss of voluntary responses and operant learning in long-term paralysis in human patients and curarized rats. Based on a reformulation of the ideomotor thinking hypothesis already described in the 19th century, we present evidence that instrumentally learned responses and intentional cognitive processes extinguish as a consequence of long-term complete paralysis in patients with amyotrophic lateral sclerosis (ALS). Preliminary data collected with ALS patients during extended and complete paralysis suggest semantic classical conditioning of brain activity as the only remaining communication possibility in those states.     

Interaction between verbal and gestural language in progressive aphasia: a longitudinal case study.

The objective of this longitudinal study is to investigate the on-line interaction between praxis and linguistic abilities in a progressive aphasia case. During 3 years of evolution, procedural discourse of a progressive aphasic patient was videotaped five times, allowing us to analyze the progression of both language and gestural production as well as the interaction between these two. We anticipated that, in the absence of apraxia, the patient would compensate for her speech deficit by producing progressively more and more meaningful gestures. Our compensatory hypothesis was confirmed but the compensation was not as efficient as one would expect given the absence of apraxia. With the progression of the speech deficit, the patient could not replace some verbs by pantomimes that were otherwise accompanying her discourse in the preceding testing sessions. We suggest that such a compensatory ability may constitute one important characteristic of the progressive aphasia syndrome.     

Semantic information is used by a deep dyslexic to parse compounds

We report a case study of a 48 year-old patient, J.O., who was tested 20 years after the removal of a tumor in the left temporal-parietal region. This surgery and subsequent radiation resulted in right side paralysis and numerous language problems. Tests of J.O.'s single word reading abilities indicate that she could be classified as a deep dyslexic with over 16% of her errors in word naming having a clear semantic relationship with the target word (Coltheart, 1980). We examined her ability to read compound words aloud and following Libben (1993) we provide evidence that J.O. is a second case in which there is obligatory access of morphological constituents of compound words. These data are discussed within the context of Libben's (1998) compound word processing model.     

Role of centrifugal projections to the olfactory bulb in olfactory processing

While there is evidence that feedback projections from cortical and neuromodulatory structures to the olfactory bulb are crucial for maintaining the oscillatory dynamics of olfactory bulb processing, it is not clear how changes in dynamics are related to odor perception. Using electrical lesions of the olfactory peduncle, sparing output from the olfactory bulb while decreasing feedback inputs to the olfactory bulb, we demonstrate here a role for feedback inputs to the olfactory bulb in the formation of odor-reward associations, but not for maintaining primary bulbar odor representations, as reflected by spontaneous odor discrimination.     

Progressive catatonia

We present the case of a young man with a diagnosis of a childhood-onset pervasive developmental disorder who developed a progressive neurologic deterioration with persistent catatonia and right hemiparesis. On his initial evaluation approximately three years after the onset of mutism, he manifested right hemiparesis and catalepsy. Two years later, although catalepsy had subsided, motor function had deteriorated so that he could not use his hands to feed or dress himself. Oral-facialbuccal dyskinesia manifested by blepharospasm and grimacing were present constantly during waking hours. Quantitative electroencephalography demonstrated markedly decreased amplitude, a finding associated with catatonia. Left sural nerve biopsy indicated large axon cylinder degeneration. Left deltoid biopsy demonstrated perimysial fibrosis and type II fiber predominance. Although magnetic resonance imaging of the head without contrast was normal, positron emission tomography indicated hypometabolism of the right cerebral and the right cerebellar hemispheres. The patient continues to deteriorate despite a course of 25 electroconvulsive treatments. He continues to manifest criteria for catatonia including motoric immobility, mutism, and peculiarities of voluntary movement such as prominent grimacing. We suspect an inherited neurodegenerative disorder. Since catatonia is a treatable condition frequently associated with medical and neurological diseases, examination for the features of catatonia must be included in the assessment of patients with progressive brain degeneration. This report is an attempt to clarify the traits of a serious variant of progressive brain degeneration.     

Expressive disclosure to improve well-being in patients with amyotrophic lateral sclerosis: A randomised,controlled trial

Amyotrophic lateral sclerosis (ALS) is a terminal neurological disease associated with progressive paralysis, loss of communicative ability and functional decline. Expressive disclosure may help people with ALS, particularly those who are emotionally or socially inhibited, meet psychological challenges associated with the disease. People with ALS (N?=?48) were randomised to expressive disclosure about their disease or no disclosure. Psychological well-being (affect, depression and quality of life) was assessed pre-intervention and also three and six months later. Results of multi-level models indicated that the group that disclosed thoughts and feelings about ALS had higher well-being than the control group at three months post-intervention, but not six months. Ambivalence over emotional expression (AEE) moderated three-month post-intervention well-being. Those low in AEE had higher well-being than those high in AEE regardless of condition. Those high in AEE, who disclosed, had increased well-being from pre-intervention, whereas controls had decreased well-being from pre-intervention. Expressive disclosure may be helpful for people with ALS, but only those who have difficulty expressing emotions. In addition, the intervention had only temporary effects; the dynamic challenges of ALS progression may mean that the effect of processing thoughts and feelings about the disease in one stage may not generalise to later stages.     

Lumbale Radikulopathie

Back pain is a common pain syndrome in the general population. The most common cause is lumbar disc disease and only rarely bony degenerative changes of the spine. Other causes of lumbar radiculopathy include local lesions. Inflammatory changes or meningeal carcinomatosis may also lead to lumbar nerve root damage. With pronounced clinical symptoms, motor deficits of the associated muscles can occur, including weakening of muscle reflexes. In addition to thorough education of the patient about the origin, likely duration, and treatment of the disease, a combination of physical therapy and pharmacotherapy is the basis for successful treatment of lumbar radiculopathy. In cases of severe paralysis, bladder and rectal paralysis, and corresponding compression of nerves, urgent spinal surgery is inevitable.     

Electromyography diagnosis of laryngeal paralysis

The differential diagnosis of laryngeal muscle paralysis can be improved by electromyographical and neurographical analysis. The findings of 30 patients with recurrent paralysis were put forward and compared with the results among 30 test people.     

Neuroprogressive disease of post-infectious origin: a review of a resurging subacute sclerosing panencephalitis (SSPE)

Subacute sclerosing panencephalitis (SSPE) is a progressive, essentially untreatable, disease of the nervous system. When first described in the 20th Century, it was characterized more for its neuropathological features than for its pathophysiology or cause. It was not until the 1960s that a clear relationship to the measles virus was established. It is now thought that this uncommon infectious encephalopathy is caused by a "slow," altered or persistent form of the wild measles virus which has harbored in the nervous system for years. Then a "breakout" occurs and the more lytic and virulent organisms produce the progressive and spreading inflammatory and destructive lesions which are confined to the nervous system. Epidemiological study of the disease confirms its relationship to measles. In the years since the development of national measles immunization programs, there has been a dramatic decline in the incidence of measles exanthem and until recently a corresponding decline in the incidence of SSPE. In recent years there has been a mild to moderate increase in cases of SSPE as reported to the USA/International SSPE Registry. As yet, there has not been a totally effective treatment. The purpose of this paper is to give an overall review on SSPE and its relationship to measles. This review will include a prospectus of its history, considerations as to its etiology, correlation of clinicopathological features, and thoughts on the past and present epidemiology and treatment.     

19世纪帕金森病的研究历史

1817年Parkinson首先描述了震颤麻痹,此后的45年中陆续出现了一些相关报道,但并未增加有价值的临床信息。1861年以后,Charcot对此病进行了深入的研究,认识到动作缓慢是本病的核心症状之一,并将其与肌强直鉴别开。他细致地描述了面具脸等症状,认为震颤并非诊断的必要因素,在命名上建议用帕金森病来取代震颤麻痹。     

What a nostril knows: olfactory nerve-evoked AMPA responses increase while NMDA responses decrease at 24-h post-training for lateralized odor preference memory in neonate rat

Increased AMPA signaling is proposed to mediate long-term memory. Rat neonates acquire odor preferences in a single olfactory bulb if one nostril is occluded at training. Memory testing here confirmed that only trained bulbs support increased odor preference at 24 h. Olfactory nerve field potentials were tested at 24 h in slices from trained and untrained bulbs. A larger AMPA component and a smaller NMDA component characterized responses in the bulb receiving odor preference training. Field potential changes were not seen in a bulbar region separate from the lateral odor-encoding area. These results support models in which memory is mediated by increased olfactory nerve-mitral cell AMPA signaling, and memory stability is promoted by decreased NMDA-mediated signaling.     

Suicide prevention in the psychiatric hospital

It is currently impossible to distinguish between patients with depression who will make a suicide attempt and those who will not. Prevention, therefore, must be based on the assumption that any patient with more than mild symptoms of depression is at risk of suicide, and can only be effective if it is applicable to all patients with moderate to severe depression. A treatment strategy that differentiated between regressive and progressive therapeutic measures was developed for patients admitted to a psychiatric hospital. Regressive, as opposed to progressive, treatment meant that the patient was temporarily relieved of virtually all responsibilities for self and others. Progressive measures were strictly avoided for all patients with symptoms of depression, regardless of the primary diagnosis. This strategy was tested on 5,149 inpatients and day patients over a period of 6.25 years and compared with 6,891 patients over the 15.75 years prior to this period. The suicide rate was 97 (per 100,000 admissions) compared with 319 in the previous period. The treatment method appears to be able to reduce the suicide rate. Although this result was achieved with hospital patients, it suggests that a regressive treatment method could be promising if developed for outpatient treatment as well.