Acute severe combined demyelination

We present a second case in which Guillain-Barré syndrome (GBS) and acute disseminated encephalomyelitis (ADEM) appeared simultaneously, both in acute and fulminant form. The patient, a 10-year-old girl, presented with acute onset of coma and flaccid, areflexic quadriparesis. The elevated CSF protein levels and delayed F waves fulfilled the criteria of GBS and an MRI study revealed extensive multifocal demyelination compatible with a diagnosis of ADEM. Prompt clinical response followed by complete recovery was achieved by treatment with corticosteroids. It is suggested that acute severe combined demyelination might constitute a separate entity in which the demyelinating process, involving simultaneously the central and the peripheral nervous systems, indicates immune response against a component of the myelin of one system carrying cross-antigenicity with the other.     

Local fibrinolysis for superior mesenteric artery thromboembolism

A 66-year-old man with atrial fibrillation was referred soon after developing left lower limb and abdominal pain with rectal bleeding. An immediate flush aortogram showed embolic occlusion of the left distal superficial femoral artery and superior mesenteric artery (SMA), 3 cm from its ostium. Recombinant tissue plasminogen activitor (rtPA) 40 mg was selectively in stilled in the SMA in two boluses. Abdominal symptoms resolved within 48 h, and complete recanalization of the SMA was shown on angiography. Exploratory laparotomy after 72 h showed a normal small bowel and right colon, and was completed by femoropopliteal embolectomy. Six months later, the patient remained asymptomatic.     

Gadolinium ring enhancement and mass effect in acute disseminated encephalomyelitis

A 9-year-old boy presented with a subacute history of optic neuritis followed by brainstem involvement, with fever and a lymphocytic pleocytosis in the cerebrospinal fluid. Gadolinium-enhancing ring lesions were demonstrate in the white matter of the cerebrum, brainstem and cerebellum on day 17 of the illness, all appearing simultaneously as part of a monophasic illness. A parietal lesion exerted mass effect. Needling and biopsy yielded no evidence of a pyogenic lesion, tumour or tuberculosis and showed vasculitis. There was insufficient material for myelin staining. Dexamethasone therapy lead to rapid improvement of the radiological lesions: MRI and CT on day 34 of the illness showed complete clearing of the lesions except for residual abnormality at the biopsy site.     

654─2在小儿急性脑水肿及中枢性呼吸衰竭中的应用探讨

感染性脑水肿病儿在感染得到有效控制，应用654—2（山莨菪碱）后未再用脱水剂，笔者认为．654—2具有解除脑血管痉挛及微循环障碍的作用。急性脑水肿在脱水剂应用后，用654—2有利于脑水肿液的吸收和回流。目前，治疗小儿捂热综合征（IMS）之细胞内水肿仍没有有效的方法，研究结果表明654—2能改善脑细胞供氧．其还能通过解除呼吸中枢血管痉挛而治疗中枢性呼吸衰竭。     

儿童急性荨麻疹的心电图观察

目的 了解儿童急性荨麻疹对心脏的影响。方法 对急性荨麻疹患儿593例行常规心电图检查。结果 33例(5．6％)患儿出现心电图异常改变，主要表现为I度房室传导阻滞、室性早搏、T波低平。皮损消失后心电图亦恢复正常。结论 急性荨麻疹患儿可伴有心脏的损害，临床上应予以重视。     

急性阑尾炎术中外用过氧化氢液冲洗疗效观察─—附50例报告

本文报导采用过氧化氢液在急性阑尾炎术对局部腹腔及切口进行冲洗的方法。并用５０个病例进行了对比分析。认为此法简单、可靠。对腹腔脓肿，预防切口感染有一定效果。可适用于一般基层医院。     

Clinical characteristics of severe peripheral neuropathy induced by docetaxel (Taxotere)

Background: Docetaxel, a semi-synthetic taxane may cause a usuallymild sensory neuropathy. We describe the clinical characteristics of fivepatients who developed a more severe neuropathy following treatment withdocetaxel.Patients and methods: All patients were treated in phase II studieswith 100 mg/m² docetaxel in three weekly cycles, withoutsteroid administration.Results: The clinical picture in these patients was dominated by asensory neuropathy, but in one case severe weakness was present. Anotherpatient developed Lhermitte's sign. Signs and symptoms are usually reversibleafter discontinuation of docetaxel administration, but in three patientssymptoms worsened for some time after the end of treatment before improvementoccurred.Conclusion: Severe docetaxel neuropathy may especially occurfollowing treatment with cumulative dosage over 600 mg/m²; inpatients treated with this dosage a moderate or severe neuropathy may not berare.     

六草二苓汤治疗急性黄疸型病毒性肝炎的临床研究

目的 对六草二苓汤治疗急性黄疸型病毒性肝炎的疗效进行对比临床研究,并探讨其作用机制。方法采用六草二苓汤的治疗组治疗急性黄疸型病毒性肝炎72例,并与使用肝泰乐、益肝灵、甘草甜素片的67例对照组作对比研究。结果 治疗组总有效率为93.1％,对照组总有效率为76.1％。在治疗后显效率、显效者复发率二方面,治疗组明显优于对照组(P<0.01)。在治疗前后主要症状体征变化、治疗前后肝功能变化、治疗后肝功能复常天数三方面,治疗组优于对照组(P<0.05)。结论 六草二苓汤治疗急性黄疸型病毒性肝炎,在较快地消除主要症状体征、消退黄疸、恢复肝功能、减少复发率方面有较好的疗效。     

老年急性重症胆管炎的外科治疗(附76例分析)

目的：探讨老年急性重症胆管炎(ACST)的外科治疗。方法：总结60岁以上老年ACST76例，根据病程分段统计手术后并发症率和死亡率。结果：病程在1天以内手术者，并发症率为10．0％，死亡率为0；1～3天手术者，并发症率为21．9％，死亡率为6．3％；3天以上手术者，并发症率为64.3％，死亡率为28．8％。三组之间比较有显著差异(P＜0．01)。结论：老年人ACST治疗上应早期手术，解除胆道梗阻，建立通畅的胆道引流；手术应简捷，尽量缩短手术时间。     

旁正中动脉入口部梗死82例临床分析

目的探讨急性桥脑旁正中动脉入口部梗死(branch atheromatous disease,BAD)的临床特点。方法回顾性分析1997～2003年本院神经内科收治的82例桥脑BAD的临床表现、MRI影像特点、脑干听觉诱发电位(BAEP)表现、危险因素。结果本组病例的临床特点是:平均发病年龄69.2岁,男性/女性=46/36,56/82病情呈进行性发展,75/82有构音障碍,72/82有肢体偏瘫,29/82为高度肢体瘫痪,27/82有轻度意识障碍,6/82伴有不全Homer征,49/82出现面部或(和)偏侧肢体感觉减退,25/82出现周围性面瘫,42/82有非旋转性头晕;13/82有眼球运动障碍。MRI表现有:梗死灶位于桥脑中上部、达桥脑表面,楔形,内侧位于桥脑旁正中、呈类似直线,可显示出基底动脉壁不整;危险因素方面除高血压外还与糖尿病、脂质代谢异常有关。结论根据临床特点及MRI表现正确诊断出桥脑BAD,以指导进一步的病因治疗及预防。