Bilateral Implantation of Centromedian‐Parafascicularis Complex and GPi: A New Combination of Unconventional Targets for Deep Brain Stimulation in Severe Parkinson Disease

Objectives. Traditional deep brain stimulation (DBS) at the subthalamic nucleus (STN) has proved to be efficacious on core Parkinsonian symptoms. However, very disabling l ‐dopa–induced abnormal involuntary movements (AIMs) and axial signs are slightly affected, suggesting that we target less conventional targets. Our candidates for DBS were the globus pallidus internus (GPi) plus the intralaminar thalamic complex (Pf or CM), given its extensive functional links with basal ganglia nuclei. Materials and Methods. The routine utilization of our innovative stereotactic apparatus allows us to implant, at the same time, both the CM‐Pf complex together with the GPi in six Parkinson disease patients. Both intraoperative and postoperative neurophysiologic assessments helped us recognize functional subregions while optimizing implantation of electrodes. Unified Parkinson disease rating scale (UPDRS) motor scores, AIMs, and freezing were carefully blindly evaluated for each condition. Results. A significant amelioration of UPDRS scores was achieved by simultaneous activation of both targets. CM‐Pf activation was only slightly effective in reducing rigidity and akinesia, but more efficacious on freezing. Not surprisingly, AIMs were peculiarly decreased by the activation of the permanent electro‐catheter in the posteroventral GPi. Conclusions. These findings confirm that, in selected patients, it is conceivable to target structures other than the conventional STN in order to maximize clinical benefit.     

急性一氧化碳中毒后迟发性脑病的临床表现和影像学特点

目的探讨急性一氧化碳中毒后迟发性脑病的临床表现和影像学特点及其诊断价值。方法回顾性对23例急性一氧化碳中毒后迟发性脑病的临床表现和影像学特点进行归纳和分析。结果23例患者中智能障碍23例（100％），言语功能障碍17例（73.9％），另有共济失调精神障碍帕金森综合症及尿失禁等。头部CT和MRI主要表现为皮层下脑白质异常信号及基底节区或苍白球区异常信号，极少累及大脑皮质脑干和小脑。结论急性一氧化碳中毒后迟发性脑病的诊断主要依靠病史和临床症状，MRI比CT更有诊断价值。     

儿童肺炎支原体感染状况分析

目的 探讨儿童的肺炎支原体(MP)感染现状及早期诊断的意义。方法 检测181例就诊儿童血液标本分析MP感染的状况。结果 肺炎支原体感染率为29.8％;男性患儿MP检测阳性率(35.7％)明显高于女性患儿(16.4％)(P<0.01);5岁以下患儿阳性率超过50％,且有3例婴儿检测阳性;10-12月份支原体肺炎发病率明显增加,占全年的40.7％。结论 针对儿童支原体肺炎的发病情况,早诊断,早治疗,利于患儿尽早康复,防止肺部病变迁延及肺外并发症的发生。     

Pulmonary Lophomonas blattarum infection in patients with kidney allograft transplantation

The aim of the study was to analyse the clinical manifestation and management of pulmonary Lophomonas blattarum infection in four allograft transplantation recipients retrospectively. Four patients with pulmonary L. blattarum infection were diagnosed by using Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) examination. Their clinical manifestation and management are summarized. Four cases of pulmonary L. blattarum were found during the period from the second month to the third month after transplantation. Concurring infection by other pathogens was found in three of them. Common initial symptoms included fever (>38 degrees C) without cough and breathlessness. Lower lobe shadowing could be found on chest X-ray. Body temperature decreased to the normal range in three patients and to 37.5 degrees C in the other one, after intravenous injection of metronidazole and tapering immunosuppressant. Radiological examination confirmed improved health condition of the patients afterwards. Two patients received repeated FOB and only dead L. blattarum was found. Pulmonary L. blattarum infection in allograft transplant recipients carry relatively obscure initial symptoms. Possible L. blattarum infection needs to be screened in post-transplantation pulmonary infection patients with similar symptoms, especially in those who respond poorly to anti-infection treatment. Microscopic examination of BAL fluid can help to identify pulmonary L. blattarum infection and metronidazole is an ideal treatment choice.     

皮瓣展平法在耳廓再造时扩张皮瓣感染中的应用

目的探索耳廓再造时扩张皮瓣感染的处理方法。方法分析中国协和医科大学整形外科医院外耳冉造中心2003年1月～2005年12月耳廓再造时耳后扩张皮瓣发生感染，经皮瓣展平法处理，感染控制后进行耳再造的12例（12耳）患者的治疗情况。结果12例（12耳）患者手术顺利，术后恢复好，再造耳效果与无感染者无明显差异。结论皮瓣展平法是耳廓再造时扩张皮瓣感染较理想的处理方法。     

颅内肿瘤切除术后颅内感染危险因素分析

目的 探讨颅内肿瘤切除术后颅内感染的危险因素和预防措施。方法 回顾性分析442例颅内肿瘤切除术患者的临床资料。结果 442例颅内肿瘤切除术患者发生颅内感染33例，感染率为7．47％。非脑膜瘤手术颅内感染率为10．04％，高于脑膜瘤术后颅内感染率3．83％（P〈0．05）；手术时间≥4h者颅内感染率为9．87％，高于手术时间〈4h者颅内感染率4．78％（P〈0．05）；有脑脊液漏者颅内感染率为15．00％，高于无脑脊液漏者颅内感染率6．28％（P〈0．05）；引流管留置≥24h者颅内感染率为11．58％，高于未留置或留置〈24h者颅内感染率5．03％（P〈0．05）。结论 手术时间≥4h、引流管留置时间≥24h、存在脑脊液漏是颅内肿瘤切除术后发生颅内感染的危险因素。     

Pulsatile Perfusion Reduces the Incidence of Delayed Graft Function in Expanded Criteria Donor Kidney Transplantation

The use of expanded criteria donors (ECD) has been proposed to help combat the discrepancy between organ availability and need. ECD kidneys are associated with delayed graft function (DGF) and worse long-term survival. The aim of this study is to evaluate the impact of pulsatile perfusion (PP) on DGF and graft survival in transplanted ECD kidneys. From January 2000 to December 2003, 4618 ECD kidney-alone transplants were reported to the United Network for Organ Sharing. PP was performed on 912 renal allografts. The prognostic factors of DGF were analyzed using multivariate logistic regression analysis. Risk factors for reduced allograft viability were greater in donors and recipients of PP kidneys. Three-year graft survival of ECD kidneys preserved with PP was similar to cold storage (CS) kidneys. The incidence of DGF in PP kidneys was significantly lower than CS kidneys (26% vs. 36%, p < 0.001). Despite having a greater number of risk factors for reduced graft viability, the ECD-PP kidneys had similar graft survival compared to ECD-CS kidneys. The use of PP, by decreasing the incidence of DGF, may possibly lead to lower overall costs and increased utilization of donor kidneys.     

Impact of ceftazidime restriction on gram-negative bacterial resistance in an intensive care unit

The present study included three periods: (1) a 12-month prerestriction and control period in 2001; (2) a 12-month restriction period with reduced ceftazidime prescribing in favor of piperacillin-tazobactam (2002); (3) and a 24 month postrestriction period (2003–2004). Note that, for results, P represents the difference between 2002 and 2001; P′, the difference between 2003 and 2001; and P″, the difference between 2004 and 2001. No changes in hygiene practices were observed during these three periods. The purpose of this study was to assess the effect of reducing ceftazidime use in an intensive care unit (ICU) upon Gram-negative bacterial resistance, particularly as regards Pseudomonas aeruginosa. During the three periods of the study, patients were similar concerning age, Simplified Acute Physiology Score (SAPSII), the site of nosocomial infection, and the requirements for mechanical ventilation (75% in 2001, 76% in 2002, 74% in 2003, and 85% in 2004). The most commonly isolated pathogens were P. aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae. The use of ceftazidime decreased significantly from 12.6% in 2001 to 9% in 2002, to 3% in 2003 (P′ = 0.0009), and 2.6% in 2004 (P″ = 0.0001) in favor of piperacillin-tazobactam (0% 2001 to 3.7% in 2003; P′ = 0.002; and 5% in 2004; P″ = 0.0001). Simultaneously, we observed a significant decrease in isolates of P. aeruginosa resistant to piperacillin-tazobactam (P = 0.03; P′ = 0.004; P″ = 0.009), and those resistant to imipenem in 2003 (P′ = 0.008). We also noted a significant decrease in A. baumannii isolates resistant to ceftazidime (P′ = 0.01; P″ = 0.0004) and those resistant to imipenem in both 2002 and 2004 (P = 0.03; P″ = 0.04), and a considerable decrease in isolates of Klebsiella pneumoniae producing expanded spectrum betalactamase (ESBL) in 2003 and 2004 (P′ = 0.04; P″ = 6.10⁻⁵). In contrast, we noted an increase in penicillinase-producing isolates of K. pneumoniae, from 6% in 2001 to 16% in 2002 (p = 0.01), 20% in 2003 (P′ = 0.001), and 32% in 2004 (P″ = 10⁻⁶). We concluded that restriction of ceftazidime use was demonstrated to be efficient in reducing antimicrobial resistance, especially to K. pneumoniae ESBL.     

早产患者血清粒细胞集落刺激因子的检测及其意义

目的探讨粒细胞集落刺激因子(G-CSF)与自发性早产的关系及其对预测早产的可能意义。方法采用ELISA-双抗体夹心法分别对28-34周、34-37周不同孕龄组早产妇女及正常妊娠妇女的血清G-CSF进行检测。结果孕28-34周早产妇女血清G-CSF水平较正常对照组妇女升高(P<0.05)。结论高水平的血清G-CSF与妊娠<34周发生的早产有关,检测妊娠妇女血清G-CSF水平对预测妊娠34周之前发生的早产有重要意义。