Partial Motor Epilepsy with "Negative Myoclonus"

Three children had both nocturnal unilateral motor seizures and daytime ipsilateral "negative myoclonus" which occurred so frequently that it resembled asterixis. Neurophysiologic studies demonstrated lateralized spike discharges that were time-locked to postural lapse in the contralateral outstretched arm. The clinical course was characterized by good seizure control with benzodiazepines.     

Early splenectomy and polychemotherapy versus polychemotherapy alone in chronic myeloid leukemia

The effect of early splenectomy and of polychemotherapy with hydroxyurea, busulfan, and alternate bimonthly courses of arabinosyl cytosine and vincristine plus prednisone, was evaluated in 139 previously untreated patients with chronic myeloid leukemia (CML), consecutively admitted to 18 hospitals from March 1973 to October 1974. Fifty-six patients were splenectomized and 83 patients were not splenectomized. Splenectomy did not influence the duration of chronic and blastic phase, and did not prolong survival. The prognosis of high risk patients was not improved. During the chronic phase, high platelet counts were more frequent in splenectomy group, and five patients developed thrombotic or thromboembolic complications, 5 to 19 months after the operation. The median survival of the whole group was 50 months, with 32 of 139 patients (actuarial proportion 30%) remaining alive 72 months after diagnosis, but the slope of the survival curve was similar to that of historical controls. The results of this trial suggests that new strategies should be developed for the therapy of CML.     

肩胛舌骨肌瓣修复喉部分切除术后缺损

目的：探讨肩胛舌骨肌瓣修复喉部分切除术后缺损的可行性和临床疗效。方法：对24例声门上型、声门型喉癌患者切除肿瘤和受累的软骨，以肩胛舌骨肌瓣修复组织缺损、重建声门。对于一侧杓状软骨固定患者，切除杓状软骨，在取肩胛舌骨肌瓣同时连带切取一小块舌骨，将小舌骨块固定于杓状软骨缺损处，用残余黏膜覆盖之。声门上型T2、声门型T3以上患者术后接受放射治疗(50～60Gy)。结果：随访1～5年，1例声门上型(T3)患者于术后2年9个月死于局部复发，1例声门型(T3)患者于术后4年3个月死于颈部转移和骨转移。拔管率为95．8％。91．7％的患者发声近乎正常或声哑。吞咽功能全部恢复。结论：经过仔细选择病例，肩胛舌骨肌瓣修复喉部分切除术后缺损、重建声门是积极有效和切实可行的。     

鼻腔神经部分切断术及下鼻甲粘骨膜下剥离术治疗变应性鼻炎18例临床分析

目的：观察鼻腔神经部分切断术和下鼻甲粘骨膜下血管神经离断术对变应性鼻炎的疗效。方法：对18例常年性变应性鼻炎患者进行鼻腔神经部分切断术与下鼻甲粘骨膜下血管神经离断术。所有病例随访12个月，评价其临床效果。结果：10例临床症状消失，体征明显改善；7例临床症状明显缓解，体征改善；1例无效。总有效率94．4％。结论：鼻腔神经部分切断和下鼻甲粘骨膜下血管神经离断术治疗常年性变应性鼻炎效果显著。     

Splenectomy during primary and secondary cytoreductive surgery for epithelial ovarian carcinoma

Scarabelli C, Gallo A, Campagnutta E, Carbone A. Splenectomy during primary and secondary cytoreductive surgery for epithelial ovarian carcinoma. Int J Gynecol Cancer 1998; 8 : 215–221.
Splenectomy is occasionally indicated to achieve optimal cytoreduction during surgery for epithelial ovarian cancer. Between January 1989 and December 1996, 40 epithelial ovarian cancer patients underwent splenectomy: 14 patients during primary surgery and 26 during secondary cytoreductive surgery. Splenectomy was performed for tumor reduction in 34 patients (85 %) and for iatrogenic injury in six patients (15%). The spleen was removed because of parenchymal splenic metastases in nine patients (22.5 %), significant hilar and/or capsular disease in 10 patients (25 %), and perisplenic disease in 15 patients (37.5%). The histopathological diagnosis of the resected spleens showed microscopic hilar disease in four patients who had the spleen removed because of iatrogenic injury and no disease in only two patients. Splenectomy could be carried out with an acceptable morbidity. Left-sided pleural effusion was the most frequent complication. The estimated two-year survival rate for patients who underwent splenectomy during primary surgery with no residual disease and <2 cm intraperitoneal residual disease was 83% and 42%, respectively. Nine of these patients (64.3%) had recurrent disease. The median time to recurrence was 11 months (range 5–18). The estimated two-year survival rate for patients who underwent splenectomy during secondary surgery with no residual disease and <2 cm intraperitoneal residual disease was 78% and 24%, respectively. The estimated three-year survival rate was 0% for all these patients. The results of the present study show that splenectomy, if necessary to achieve optimal debulking, should be considered in previously untreated patients with no intraperitoneal residual disease and in patients with late (>1 year) recurrent disease.     

肝动脉栓塞加部分脾栓塞治疗原发性肝癌伴脾亢的临床研究

对原发性肝癌伴肝硬化脾亢患者行肝动脉化疗栓塞加部分脾栓塞与单纯肝动脉化疗栓塞对照研究。结果显示，肝动脉化疗栓塞加部分脾栓塞疗效满意。动态观察血常规、肝功能及各项免疫指标，发现该组血细胞下降较单纯肝动脉化疗栓塞组明显减少，两组比较有显著差异（Ｐ＜０．０１），再次治疗的间隔时间缩短。长期观察发现，肝动脉化疗栓塞加部分脾栓塞组治疗前后肝功改善也较单纯肝动脉化疗栓塞组明显。提示肝动脉化疗栓塞加部分脾栓塞是治疗原发性肝癌伴肝硬化脾亢患者的有效方法之一     

针刺对备用根猫背根节神经元IGF-Ⅰ表达的影响

目的观察胰岛素样生长因子-I（IGF—I）在正常猫、部分去背根猫及针刺部分去背根猫的L6手术侧背根节（DRG）表达的时空变化，以了解IGF—I与针刺促进脊髓可塑性的关系。方法25只成年健康雄猫随机分为5组：即正常组、备用根术后7d组与14d组（动物行单侧部分去背根手术，即切除一侧L1～L5、L7～S2背根节，保留L6为备用根）、针刺备用根术后7d组与14d组（动物行单侧部分去背根术后针刺L6脊神经外周支配区内的两组穴位）。动物于术后7d、14d分别处死，取各组（手术侧）L。背根节，-20℃恒冷箱切片，片厚20μm，用兔抗IGF—I（1：200）抗体行免疫组化ABC法染色。观察、计数并比较各组背根节IGF—I阳性神经元的分布、含量及时空变化。结果针刺备用根7d组，DRGIGF—I阳性神经元数较术后7d组明显增加（P〈0．05），但仍低于正常水平；针刺14d，DRG阳性神经元比术后14d亦增多（P〈0．01），且恢复至正常水平。与针刺7d组比较，DRGIGF—I阳性神经元在针刺14d时明显增多（P〈0．05）。结论针刺可增加针刺侧DRG内IGF—I阳性中小神经元数。提示针刺后IGF—I在背根节的表达变化可能与针刺促进脊髓可塑性有关。     

断流术治疗肝硬化门静脉高压症的疗效观察

目的探讨断流术治疗肝硬化门静脉高压症并发食道、胃底静脉曲张破裂出血(EVB)的临床疗效。方法断流术治疗EVB 56例,观察其近期临床疗效,并随访0.5-5年,了解远期疗效及预后。结果56例患者近期治愈52例,治愈率92.86%,近期死亡4例(7.14%)。52例患者随访最短半年,最长5年。曲张的食道、胃底静脉消失者37例(71%)、好转12例(23%),再出血3例(6%)。结论断流术治疗EVB即时止血率高,近期及远期疗效满意,有一定的远期再出血率。     

TURBT术治疗T1T2期膀胱癌91例

目的:分析两种手术方法对T1T2期膀胱癌的治疗效果。方法:根据病史、体格检查、B超、3D-CT、膀胱镜活组织检查确诊的T1T2期膀胱癌152例,采用TURBT术(经尿道膀胱肿瘤切除术)91例,膀胱局部切除术61例,分析比较治疗效果。结果:两种手术方法疗效无显著特异性,患者生存率与肿瘤病理分期有直接相关性。结论:T1T2期膀胱癌采用TURBT术与采用膀胱局部切除术疗效相当,但TURBT费用低,创伤少,便于再次手术,有推广意义。