Surgical treatment of a case of early infantile epileptic encephalopathy with suppression-bursts associated with focal cortical dysplasia

We report a surgically treated case of early infantile epileptic encephalopathy (EIEE) with suppression-bursts associated with focal cortical dysplasia. Tonic-clonic seizures followed by a series of spasms occurred about a hundred times a day at a few days of age. Interictal electroencephalogram (EEG) revealed a suppression-burst pattern that was predominant in the left hemisphere. Magnetic resonance imaging (MRI) suggested focal cortical dysplasia in the left prefrontal area. Combination therapies with antiepileptic treatments showed only partial efficacy. The patient underwent lesionectomy at age 4 months, after which he gradually showed psychomotor development and a decrease of spasms to 0-2 series daily. In cases of EIEE with focal cortical dysplasia, surgical treatment may have beneficial effects on both psychomotor development and seizure control.     

An angiographically occult arteriovenous malformation in the medial parietal lobe presenting as seizures of medial temporal lobe origin

We present an unusual case of a patient who was diagnosed with temporal lobe epilepsy and whose seizures were reduced markedly after excision of an angiographically occult arteriovenous malformation (AVM) located in the left medial parietal lobe. A 38-year-old man had complex partial seizures characterized by motionless staring with oroalimentary and behavioral automatisms since the age of 15 years. Magnetic resonance imaging (MRI) demonstrated a small lesion extending from the left posterior cingulate gyrus to the precuneus. There was no MRI evidence of mesial temporal sclerosis. Intracranial EEG recordings showed ictal onset from the left medial parietal lobe propagating to the medial temporal lobes. Clinical signs appeared when these discharges reached the temporal lobes. After excision of the lesion (which was histologically confirmed as an AVM), together with the marginal cortex, seizures were reduced significantly. Careful diagnostic evaluation of lesions such as the this one may reveal an epileptogenic lesion (zone) far from the region where scalp ictal discharges seem to arise. In our case, we hypothesize that false localization was due to propagation of ictal discharges from the parietal focus through the limbic system.     

内窥镜辅助下显微神经血管减压术治疗 特发性偏侧面肌痉挛

目的为进一步提高神经血管减压术治疗特发性偏侧面肌痉挛的疗效。方法经乙状窦后小骨窗开颅加用内窥镜辅助显微血管减压术治疗特发性偏侧面肌痉挛３５例。结果术后３４例症状消失,１例症状减轻,３５例随访６个月至３年半,术后面肌抽搐消失者３３例,１例症状减轻,１例１年后复发。结论内窥镜可弥补手术显微镜的不足之处,减少组织损伤和判断错误,提高治疗效果。     

Postoperative MRI appearance after transsphenoidal pituitary tumor resection

BACKGROUNDKnowledge of the magnetic resonance imaging (MRI) appearance of the pituitary fossa following transsphenoidal resection of a pituitary adenoma, in the early and late postoperative period, is important for detecting complications and for assessing extent of tumor excision. Few prospective studies have addressed this issue.METHODSFourteen patients with pituitary macroadenomas were prospectively studied with MRI. Maximal tumor resection was accomplished in each patient, and the postoperative histological diagnoses included non-secreting adenoma in 11 patients, prolactinoma in 2 and necrosis in one. Early postoperative scans were obtained within 14 days after surgery, and late studies between 3 and 4 months, in all patients. Four patients also had delayed scans between 8 months and a year. The maximum coronal dimension (MCTD) of the sellar and suprasellar contents was measured on T1-weighted contrast enhanced scans.RESULTSAll patients had normal or improved visual examinations and normal or improved hormonal function postoperatively. The preoperative MCTD ranged from 11 mm to 59 mm in height (mean 30.3 mm). There was little change in MCTD on the early postoperative MRI scans (range 7–49 mm, mean 23.5 mm). However, in all patients the MCTD decreased in height by 4 months (range 2–35 mm, mean 12.7 mm). This change represented a 58% mean reduction in size compared to the preoperative measurements.CONCLUSIONSWe conclude that the appearance of the sellar contents on early postoperative MRI may appear remarkably similar to that seen before surgery, even after technically adequate resection. The postoperative mass may represent a combination of residual tumor, edema, postoperative hemorrhage and hemostatic material. Routine follow-up MRI after transsphenoidal resection of pituitary tumors may be delayed until at least 4 months after surgery in patients who are clinically stable.     

Nitric oxide inhalation as a chemical assist for circulation in patients after cardiovascular surgery

The objective of this study was to investigate whether nitric oxide (NO) inhalation might be an alternative strategy as a chemical assist for the circulation in patients showing a deterioration in oxygen delivery. Twelve adult patients whose oxygen delivery indices (DO2I) were less than 400 ml/min/m2 after cardiovascular surgery were included in this study. NO was administered via a premixing system or a side stream system at doses between 1 and 10 (5.1+/-2.4) ppm. Data obtained before and during a 120 min NO inhalation were compared using the paired Student's t-test. The increase in PaO2/FiO2 resulting from NO inhalation was significant (from 162 to 251 mm Hg). DO2I increased significantly from 326 to 417 ml/min/m2 concomitantly with significant increases in both arterial oxygen content (CaO2) and cardiac index (CI) (from 14.1 to 15.4 vol% and from 2.31 to 2.71 L/min/m2 , respectively). The increase in SvO2 during NO inhalation was significant (from 55.2 to 62.6%). Among the other hemodynamic parameters, both total pulmonary resistance and systolic pulmonary arterial pressure (SPAP) showed significant decreases during NO inhalation, but right atrial pressure did not change significantly. There was a close relationship between the baseline SPAP level (bSPAP) and the decrease in SPAP during NO inhalation (dSPAP) (r = -0.88). However, negative correlations were observed between bSPAP and percentage increase in CI (%CI) (r = -0.61) and between bSPAP and percentage increase in DO2I (%DO2I) (r = -0.48). Moreover, positive relationships were observed between dSPAP and %CI (r = 0.62) and between dSPAP and %DO2I (r = 0.45). Hemoglobin (Hb) increased significantly from 11.0 to 11.4 g/dl. There were no significant changes in Fio2, pH, PacO2, or base excess (BE) during NO inhalation. The level of methemoglobin measured during the study period remained within the normal range (0.86+/-0.23%). In conclusion, NO inhalation could be an efficient and alternative assist for the circulation in patients whose oxygen delivery deteriorates after cardiovascular surgery.     

Sphenoidal sinus mucocele after transsphenoidal surgery for acromegaly

This report concerns one case of a sphenoid sinus mucocele occurring 17 years after transsphenoidal surgery for acromegaly. In 1979, a 51-year-old man was successfully operated by the transnasal transsphenoidal approach for a growth hormone (GH) adenoma 1 cm in diameter. In 1996, the patient was hospitalized for headaches and diplopia. He presented a loss of right visual acuity with paralysis of the right oculomotor nerve. The basal GH level was normal with a satisfactory decrease after oral glucose ingestion. Pituitary sellar radiography showed a disappearance of the posterior clinoid while magnetic resonance imaging revealed the existence of a bilocular, circular, homogeneous lesion of the sphenoid sinus 3 cm in diameter with a posterior and lateral extension. The diagnosis of mucocele was confirmed by surgical treatment, allowing drainage of the mucocele through a transsphenoidal approach. The drained material was composed of sinus epithelium containing many polynuclear and resorptive cells. Postoperatively, the symptoms decreased dramatically, leading to full recovery of visual function and disappearance of the headaches. Apart from the tumor recurrence, the mucocele of the sphenoid sinus can be evoked as a possible long term complication of transsphenoidal sugery for pituitary adenoma. Received: 2 June 1998 / Accepted: 23 February 1999     

Aesthetic Male Facial Skeletal Surgery

Craniofacial surgery concepts developed originally for reconstruction may also be applied to aesthetic surgery. The facial skeleton is an important component of appearance and may be modified using common craniofacial surgery techniques. Three representative male patients are presented, who each desired an improvement in his appearance. The techniques used were different and combined orthognathic and remodeling procedures. Aesthetic male facial skeletal surgery was beneficial in these selected cases. The results were well received and without complications. Surprisingly, we have found that male skeletal aesthetic patients did not have unrealistic expectations and were pleasant to manage pre- and postoperatively.     

窥镜下激光治疗前列腺增生症

目的 评价经尿道激光前列腺切除术（ＴＵＬＰ）的疗效及其与前列腺大小的关系。方法 回顾分析了１９８８年至１９９８年１０年,采用ＴＵＬＰ治疗的４６９例前列腺增生症患者对手术技术、手术前后的症关改善情况进行比较,并对２３３例符合条件的患者ＴＵＬＰ手术效果与前列腺大小的相关性进行了研究。结果 ４６９例患者前列腺症状评分（ＩＰＳＳ）平均值由术前的２６．７降到术后的１４．２;最大尿流率平均值由６．２ｍｌ／ｓ上     

三维立体定位开窗术治疗腰椎间盘突出症疗效分析

为评价开窗术治疗腰推间盘突出症的疗效 ,总结 1991年以来应用三维立体定位开窗术治疗腰椎间盘突出症 5 3例的疗效情况。结果 :经 2个月～ 7年随访 ,以Greenough评价标准分析 ,治疗后达到优 48例 ,良3例 ,可 2例 ,差 0例 ,优良率 96% ,无 1例出现并发症。结论 :①依据电子计算机体层摄影 (CT)、磁共振成像 (MRI)对腰椎间盘突出做出精确的三维立体定位是手术成功关键 ;②开窗法摘除腰椎间盘 ,组织损伤少 ,康复时间短 ,不影响后期脊椎稳定性 ,远期疗效满意     

冠脉搭桥术：8例经验体会

目的　总结冠脉搭桥术（ Ｃ Ａ Ｂ Ｇ） 的临床经验和体会、寻找最佳的围术期处理方法。方法　分析８ 例 Ｃ Ａ Ｂ Ｇ 患者完整的临床资料。心绞痛７ 例,陈旧性心肌梗塞伴左室室壁瘤形成及发作性心绞痛１ 例。并发高血压病者６ 例,糖尿病３ 例。 Ｎ Ｙ Ｈ Ａ 心功能Ⅱ级１ 例,Ⅲ级４ 例,Ⅳ级３ 例。内乳动脉替代７ 例,共用大隐静脉桥１５ 支。结果　１ 例,术后因对角支静脉桥出血,行第２ 次开胸修补止血。次２ 日又因胸骨裂开,第３ 次开胸行胸骨再固定术。全组无手术死亡病例,出院时心绞痛症状完全缓解。结论　 Ｃ Ａ Ｂ Ｇ 成功的关键除病变部位的准确诊断外,桥的获取及良好的心肌保护至关重要。