ObjectiveTo investigate the lateralization of ictal scalp EEG in different times in focal epilepsy.Methods356 surface ictal EEG of 41 patients were reviewed retrospectively in focal epilepsy arising from the mesial frontal, lateralfrontal, mesialtemporal, neocorticaltemporal, insular lobes and posterior cortex from July, 2010 to at, 2016. Each ictal scalp EEG was subdivided into ten epoches (E1-E10), then the lateralization of every epoch was analyzed. Ten epochs EEG were merged into three timesas E1-E3, E4-E6 and E7-E10. The ratio of lateralization, mislateralization and non-lateralization of each timeEEG were studied. Ictal onset zone (IOZ) were precise localized by intracranial EEG. The results of epileptogenic zone corresponded with surgical outcomes as seizure free or decreased.Results62% seizures were lateralized by surface ictal EEG in all epilepsies. Lateralized ictal scalp EEG were seen in nearly 80% of seizures in all times in temporal lobe epilepsy (TLE). The highest lateralization of 89% occurred inE4-E6 andfalse lateralization up to 30% in E1-E3 in mesial temporal lobe epilepsy (MTLE), whereas 95% lateralized seizures emerged in E1-E3 in neocortical temporal lobe epilepsy (NTLE). Apparent non-lateralization in all times were higher than lateralization in frontal lobe epilepsy (FLE), especially in mesial frontal lobe epilepsy (MFLE). Lateralization in E1-E3 was only 24% higher than other times. In addition, False lateralization never occurred in all times in lateral frontal lobe epilepsy (LFLE). There were maximum of 83%lateralized seizures in E1-E3 in LFLE and 93% in E1-E3 in posterior cortex epilepsy (PCE). Seizures arising from insular lobe epilepsy (ILE) tendedto predict less lateralization in all times.ConclusionsIctal scalp EEG of E1-E3 are valuable in the lateralization in all epilepsies particularly in LFLE, NTLE and PCE. Lateralized E4-E6 and E7-10 are very useful in MTLE.
OBJECTIVE: To investigate the effective method to treat cicatricial baldness. METHODS: From 1993 to 1998, 21 cases with multi-region or great-dimensional cicatricial baldness were treated with scalp expanding and hair autografting. Among them, there were 17 males and 4 females, aged from 14 to 49 years old. The operation was divided into two stages, stage one meaned to embed the expander under the scalp and stage two meaned to sow the autogenous hair. RESULTS: All cases, no matter what the position and area, were repaired successfully. The biggest dimension of repaired baldness was 340 cm2, one expander exposed and one failed in expanding after operation and be corrected immediately. The normal hair direction changed in two cases. CONCLUSION: Combined use of scalp expanding and hair autografting is an effective method to treat multi-region or great dimensional cicarticial baldness.
Uncovering the alterations of neural interactions within the brain during epilepsy is important for the clinical diagnosis and treatment. Previous studies have shown that the phase-amplitude coupling (PAC) can be used as a potential biomarker for locating epileptic zones and characterizing the transition of epileptic phases. However, in contrast to the θ-γ coupling widely investigated in epilepsy, few studies have paid attention to the β-γ coupling, as well as its potential applications. In the current study, we use the modulation index (MI) to calculate the scalp electroencephalography (EEG)-based β-γ coupling and investigate the corresponding changes during different epileptic phases. The results show that the β-γ coupling of each brain region changes with the evolution of epilepsy, and in several brain regions, the β-γ coupling decreases during the ictal period but increases in the post-ictal period, where the differences are statistically significant. Moreover, the alterations of β-γ coupling between different brain regions can also be observed, and the strength of β-γ coupling increases in the post-ictal period, where the differences are also significant. Taken together, these findings not only contribute to understanding neural interactions within the brain during the evolution of epilepsy, but also provide a new insight into the clinical treatment.
Objective To explore an improved method of reconstructing the scalp soft tissue defect with the expanded skin soft tissue and treating and preventing the related complication. Methods From October 2002 toJune 2005, 32 patients (20 males and 12 females, aged 5-48 years) underwent reconstruction of the scalp soft tissue defects with the expanded scalp soft tissue in thetwo-stage operation. In the first stage, a tissue expander (cylindrical form, 50-250 ml) was inplanted into the skin to achieve a skin soft tissue expansion. After a sufficient skin expansion (8 cm×5 cm to 25 cm×23 cm) was made by the routine water affusion for 6-16 weeks, a properly-designed skin flap was taken and transferred to reconstruct the scalp soft tissue defect in the second-stage of the operation. All the scalp defects were left after the resections of the scalp lesions, which ranged in size from 7 cm×5 cm to 20 cm×20 cm.Results After operation, all the 32 patients had their scalp defects repaired and reconstructed well.The expanded skin flaps of all the 32 patients survived except 1 patient who had a necrosis of the distal epidermis of the flap, which healed after the dressings of the wound. The hair grew well and the scars were hidden with a satisfactory appearance. Four patients developed complications (necrosis of the distal flapin 1 patient, hematoma in 1, expander exposure in 1, and wound rupture in 1).Conclusion Reconstruction of the scalp soft tissue defect with the skin soft tissue expansion is an ideal method.
ObjectiveTo systematically review the effectiveness of scalp acupuncture for treating ischemic stroke. MethodWe searched databases including PubMed, EMbase, MEDLINE, The Cochrane Library, CBM, CNKI, VIP and WanFang Data from inception to December 30th 2014 for randomized controlled trials (RCTs) on scalp acupuncture in the treatment of ischemic stroke. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 27 studies involving 2 741 patients were included. The results of meta-analysis showed that:a) As for the improvement of nervous functional deficiency, the scalp acupuncture plus drug group was superior to the drug alone group (MD=-5.33, 95%CI -6.71 to -3.96, P<0.000 01), and the scalp acupuncture plus conventional therapy group was superior to the conventional therapy alone group (MD=-2.11, 95%CI -3.31 to -0.91, P=0.0006). b) As for the effective rate, the scalp acupuncture group was superior to the body acupuncture group (OR=0.28, 95%CI 0.15 to 0.53, P<0.000 01), the scalp acupuncture plus drug group was superior to the drug alone group (OR=0.20, 95%CI 0.14 to 0.29, P<0.000 01), and the scalp acupuncture plus conventional therapy group was superior to the conventional therapy alone group (OR=0.12, 95% CI 0.02 to 0.56, P=0.008). However, there was no significant difference between the scalp acupuncture group and the drug alone group (OR=0.16, 95%CI 0.03 to 0.97, P=0.05). ConclusionScalp acupuncture appears to be an effective adjuvant therapy method for ischemic stroke, and can significantly improve the nervous functional deficiency when combined with other treatment. However, the strength of evidence is low due to high risk of bias of the included studies. More rigorous studies are needed to verify the above conclusion.
ObjectiveTo find out the most appropriate way to fix scalp electrodes for long-range video electroencephalogram on female patients. MethodsA total of 50 female patients with epilepsy who underment video electroencephalogram between May 2011 and May 2013 were divided into tonsure group, collodion group, and improvement group, with 40 patients in each group. Differences among three methods of fixation were observed and a questionnaire survey on satisfaction of patients and medical staff was conducted. ResultsWe found that the modified-method cost less time, caused less pain during electrode removal, required fewer procedures for nurses and was more acceptable by patients. ConclusionWe recommend the modified-method for female patients unless they are limited by some special conditions.
【Abstract】 Objective To investigate the effects of different surgical methods in treating scalp mal ignanttumors. Methods From January 1995 to September 2004, 70 patients with scalp mal ignant tumor were treated with different surgical methods. There were 41 males and 29 females with an average age of 50.3 years (30-85 years). The course of disease ranged from 2 weeks to 3 years(mean 3.5 months). There were 31 cases of basal cell carcinoma, 24 cases of squamous carcinoma, 8 cases of melanocarcinoma, 4 cases of fibrous sarcoma, 2 cases of l iposarcoma, and 1 case of vasculosarcoma. Leision size ranged from 1.0 cm × 0.5 cm to 10.0 cm × 8.0 cm. Scalp defect ranged from 3 cm × 3 cm to 12 cm × 11 cm after clearing up the tumors. Defect was repaired with free skin transplantation in 51 cases, scalp flap in 12 cases, cervico-shoulder flap in 2 cases, trapizius myocutaneous flap in 3 cases, and radial artery retro-island flap in 2 cases. The flap sizes ranged from 5 cm × 4 cm to 18 cm × 12 cm. Results Of 70 cases, 67 skin flaps survived and incision healed by first intention; 2 flaps necrosed at distal part(lt; 1 cm) and healed by second intention after dressing change; 1 flap infected and was treated with symptomatic medication.All the donor sites healed by first intention. Fifty-five patients were followed up for 1 to 5 years and 5 cases had tumor recurrence. In patients receiving skin transplantation, 1 case of squamous carcinoma and 1 case of fibrous sarcoma relapsed after 1 year and 2.5 years respectively and were given radical resection and skin flap grafting; in patients receiving skin flap grafting, 1 case of vasculosarcoma and 1 case of squamous carcinoma relapsed after 6 months and 3 months respectively, and gave up treatment; 1 case of fibrous sarcoma relapsed after 2 years and was given radical resection and skin flap grafting. The other cases survived and had no tumor recurrence. Conclusion Scalp mal ignant tumors should be diagnosised and treated as early as possible. Clearing up completely by surgery is an effective method.
efect of the eyebrow is a common facialdefect. It was resulted from a variety of causes,but the most common was burn. The operationby using free postauricular scalp graft to repairthe defect of eyebrow was intreduced. The var-ious metheds of eyebrow reconstruction werecompared. The treatment of 79 patients with thedefect of eyebrow was summarized. It was notedthat it had the following advantages , such as theoperation being simple and easy, a naturallooking, appropriate density and r...
ObjectiveTo investigate the effectiveness of different free flaps in the repair of large defects after resection of scalp malignant tumors. MethodBetween March 2012 and January 2015, 18 patients with large defect after resection of scalp malignant tumors were treated with different free flaps. There were 13 males and 5 females with an average age of 49 years (range, 18-72 years). There were 17 cases of squamous carcinoma and 1 case of dermato-fibril sarcoma protuberans. The defect size ranged from 15 cm×12 cm to 22 cm×17 cm after resection of tumors. Defects were repaired with anterolateral thigh flap in 5 cases, latissimus dorsi myocutaneous flap in 6 cases, thoracodorsal artery perforator flap in 3 cases, and latissimusdorsi muscle flap plus intermediate split thickness skin graft in 4 cases. The flap size was 17 cm×14 cm to 24 cm×19 cm. The donor sites of the skin flap were covered with skin graft, while the donor sites of the muscle flap were directly sutured. ResultsOf 14 skin flaps, the other 13 flaps survived except 1 flap necrosis; all muscle flaps survived. The patients were followed up 5-33 months (mean, 20 months). Three patients died because of intracranial metastasis at 5, 7, and 13 months after operation, respectively. Two patients had local recurrence and underwent secondary operation. The results of both appearance and function were satisfactory; secondary operation of thinning the flaps was performed in 4 cases of bulky flaps. The flaps had good wear resistance, without ulceration during follow-up. No obvious impairment was observed after harvesting latissimus dorsi myocutaneous flap. ConclusionsLarge scalp defects after malignant tumor resection can be effectively repaired by proper application of different free flaps.
Objective To compare the mean operative time and complications between the LigaSure device and Harmonic Scalpel during video-assisted endoscopic approaches thyroidectomy. Methods The clinical data of 684 cases performed Miccoli thyroidectomy by the same operation team from January 2007 to December 2011 in the department of general surgery，Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University were analyzed. Three hundred and forty-nine patients were used Harmonic Scalpel，335 patients were used LigaSure device. The mean operative time and complications （such as hematoma，transient hoarseness，permanent recurrent laryngeal nerve injury，and hypocalcemia） were compared between two groups. Results A total of 684 patients were included in the study，of whom 263 underwent total thyroidectomy and 421 underwent lobectomy. There were not significant differences of the operative time and the complications in both thyroidectomy and lobectomy between the LigaSure device and Harmonic Scalpel（P＞0.05）. Conclusions The uses of the LigaSure device and Harmonic Scalpel in thyroid surgery are safe and reliable，surgeons may choose surgical instruments by habits and medical equipments.