中风后癫痫的临床研究

本文报告３６例中风后癫痫发作的临床和ＣＴ资料。通过回顾性病历复习和随访发现，中风后癫痫的发生率占同期住院中风患者的５．２６％，以蛛网膜下腔出血和脑栓塞发生癫痫比率最高，分别为１５％和１２．５％。癫痫发作与ＣＴ所见病灶分布密切相关，皮质病灶较皮质下病灶更易发生病病。癫痫发作可发生于中风后任何时期，但早期癫痫以出血性中风多见，而迟发性癫痫则更多见于脑梗塞患者。     

Expression and distribution of vascular endothelial growth factor protein in human brain tumors

Marked neovascularization is a hallmark of many neoplasms in the nervous system. Recent reports indicate that the endothelial mitogen vascular endothelial growth factor (VEGF) may play a critical role in the regulation of vascular endothelial proliferation in malignant gliomas. Using novel monoclonal antibodies to the VEGF polypeptide we have determined the expression and cellular distribution of VEGF protein in a representative series of 171 human central nervous system (CNS) tumors by immunohistochemistry and immunoblotting. In agreement with previous in situ hybridization data, 19 out of 20 glioblastomas (95%) showed immunoreactivity for VEGF, whereas both the percentage of immunoreactive tumors and the extent of immunoreactivity for VEGF were significantly lower in astrocytomas. Of the pilocytic astrocytomas (WHO grade I) 44% were immunoreactive for VEGF, but we observed several cases with pronounced vascular proliferates in the absence of VEGF. In ependymomas, meningiomas, hemangioblastomas, and primitive neuroectodermal tumors, there was no correlation between VEGF expression, vascular endothelial proliferation and the grade of malignancy. Oligodendrogliomas and the oligodendroglial component of mixed gliomas lacked immunoreactive VEGF, indicating that endothelial growth factors other than VEGF may regulate tumor angiogenesis in these neoplasms. Western blot analysis showed a predominant VEGF protein species of 23 kDa and confirmed the immunohistochemical data in all cases. Our findings demonstrate that VEGF is expressed in a wide spectrum of brain tumors in which it may induce neovascularization. However, other angiogenic factors also appear to contribute to the vascularization of CNS neoplasms. Received: 18 April 1996 / Revised, accepted: 20 August 1996     

聚合酶链反应（PCR）对单纯疱疹病毒性脑炎的临床诊断价值

应用聚合酶链反应（ＰＣＲ）检测技术对１１８例颅内感染性疾病患者及３７例无神神经系统疾病患者脑脊液（ＣＳＦ）中的单纯疱疹病毒ＤＮＡ（ＨＳＶ－ＤＮＡ）进行了检测及分型。结果提示：“散发性脑炎”组的阳性率为３８．４６％（２０／５２），细菌、真菌性脑膜炎、其它病毒性脑炎组以及无神经系统疾病组均为阴性。作者认为：①本检测是目前单纯疹病毒性脑炎（ＨＳＥ）较为简便而准确的早期诊断方法之一；②ＨＳＶ分型检测，对病原诊断更具有全面性；③两型单纯疱疹病毒均可引起ＨＳＥ。     

Digitalis poisoning from medicinal herbs. Two different mechanisms of production]

Two cases of digitalis toxicity due to uncontrolled ingestion of medicinal herbs are presented. The first of them was caused by oleander (Nerium oleander); digoxinemia levels were very high in this patient (4.44 ng/l), who presented many brady- and tachyarrhythmias. These arrhythmias disappeared when digoxinemia returned to normal values. The second patient had atrial fibrillation with slow ventricular rate, severe hypokalemia (2.1 mEq/l) and normal digoxinemia levels. He was taking medicinal herbs for a cold, with sorbitol between its components. Sorbitol may be similar to mannitol and glycerol (osmotic diuretic drugs) when taken at high doses. Uncontrolled ingestion of medicinal herbs is not safe, and severe poisoning can occur.     

乙肝一号和六号对原代培养鸭肝细胞DHBVDNA复制的影响

用胰蛋白酶灌流ＤＨＢＶ实验感染北京雏鸭肝脏，制备原代鸭肝细胞培养，观察了体外培养条件下乙肝一号、乙肝六号对ＤＨＢＶＤＮＡ复制的影响。     

Appropriateness of hysterectomy in Taiwan.

BACKGROUND AND PURPOSE: Hysterectomy is among the most frequently performed surgical procedures in developed countries, but few studies from the Asia-Pacific region have assessed the appropriateness of hysterectomy. The purpose of this study was to examine the rate of inappropriate hysterectomy in Taiwan and its association with patient characteristics and indications for the procedure. METHODS: A random sample of hysterectomies for which claims were submitted to the Taiwan Bureau of National Health Insurance from July 1, 1997 to June 30, 1998 was selected. A total of 658 charts were reviewed by an expert panel composed of 5 senior gynecologists. RESULTS: Overall, 74.2% of patients underwent hysterectomy for appropriate reasons, 5.6% for uncertain reasons, and 20.2% for inappropriate reasons. Inappropriate procedures were positively associated with younger age and premenopausal status. Primary indications that accounted for over 25% of inappropriate procedures were chronic pelvic pain (42.9%), abnormal uterine bleeding (37.5%), and endometriosis (27.7%). CONCLUSIONS: This study found a high rate of inappropriate hysterectomy in Taiwan. Gynecologists and physician organizations should take action to improve physician agreement on the use of hysterectomy, especially for indications associated with high rates of inappropriate procedures.     

失血性休克复苏及监测指标研究进展

创伤、失血性休克是一古老的临床研究课题。不仅在平时常见，更重要的是与战伤救治密切相关。尽管近10年来取得了一些进展，但复苏时机、复苏目标、液体种类的选择、复苏后继续生命支持以及监测技术等仍是临床以及研究人员面临的重大挑战。本文将就近年来有关上述问题的最新研究进展进行分析和讨论，以期提高对该复杂综合征的认识，为今后的研究提供帮助。     

Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial.

Patients with depression have been extensively reported to be associated with the abnormality of omega-3 polyunsaturated fatty acids (PUFAs), including significantly low eicosapentaenoic acid and docosahexaenoic acid in cell tissue contents (red blood cell membrane, plasma, etc.) and dietary intake. However, more evidence is needed to support its relation. In this study, we conducted an 8-week, double-blind, placebo-controlled trial, comparing omega-3 PUFAs (6.6 g/day) [corrected] with placebo, on the top of the usual treatment, in 28 patients with major depressive disorder. Patients in the omega-3 PUFA group had a significantly decreased score on the 21-item Hamilton Rating Scale for Depression than those in the placebo group (P < 0.001). From the preliminary findings in this study, omega-3 PUFAs could improve the short-term course of illness and were well tolerated in patients with major depressive disorder.     

异体胸腺的解剖、组织学及吻合血管移植治疗晚期恶性骨肿瘤的研究

本文对20例20～36周引产死胎胸腺进行了解剖学,组织学观察,并应用吻合血管胎儿胸腺移植治疗晚期恶性原发及继发骨肿瘤12例。结果表明,胎儿胸腺的血供主要来自胸廓内动脉,其次为甲状腺下动脉和心包膈动脉胸腺支,7～8个月胎儿胸腺静脉血管壁较厚,适合作血管吻合,胸腺细胞发育成熟,组织结构正常,已有分泌胸腺素及转化免疫细胞的功能,在解剖学,组织学,免疫学方面均具备了良好的移植条件。12例接受吻合血管胎儿胸腺移植的晚期恶性骨肿瘤患者,其临床症状、体征、X线、免疫指数均有明显改善,患者生存6个月至37个月以上。