Is progression in postencephalitic parkinson's disease late and age-related?

Summary Follow-up data are presented of ten patients with autopsy-proven postencephalitic Parkinson's syndrome (PEP) (mean age at death: 56.0 years) with regard to motor and psychic deterioration over a period of institutional observation between 3 and 30 years. Four patients showed deterioration of their Hoehn-Yahr score of at least one grade. These patients did not differ statistically with respect to age of occurrence of lethargic encephalitis, interval to PEP, age at start of PEP, duration of survival with PEP, and age at death. Motor deterioration in these patients seems to be attributed more to inherent disease progression, rather than to an age-related process. Clinical and pathological evidence for this conclusion is presented.     

显微手术治疗自发性基底节出血的临床研究

目的：探讨治疗自发性基底节出血的有效措施。方法：将1997年9月－2001年10月采用显微手术治疗的96例自发性脑出血患者，与1994年9月－1997年8月采用常规开颅清除血肿的88例同类患者，在术后血肿清除率，手术死亡率和致残率等方面作对比研究。结果：显微手术能显著提高血肿清除率（P＜0．05）、降低术后脑水肿反应发生率（P＜0．01），从而显著降低了手术死亡率（P＜0．05）和致残率（P＜0．05）。结论：显微手术是治疗自发性脑出血患者一种有效的手术方式。     

高压氧联合加压螺钉治疗青年股骨颈骨折临床疗效分析

目的 观察空心加压螺纹钉联合高压氧治疗青年股骨颈骨折的疗效.方法 56例青年股骨颈骨折患者,35例给予空心加压螺纹钉手术后联合高压氧治疗(高压氧组),21例仅用空心加压螺钉内固定手术,不进行高压氧治疗(手术组),对2组近、中、远期疗效和并发症进行比较.结果 2组近期疗效、并发症差异无统计学意义(P>0.05),高压氧组中、远期疗效及减少术后并发症方面优于手术组,2组差异有统计学意义(P<0.05).结论 闭合复位、小切口空心加压螺钉内固定联合高压氧治疗青年股骨颈骨折在中、远期疗效,减少股骨头坏死及髋关节疼痛等并发症方面有很好的疗效.     

大鼠神经系统发育过程中神经元特异性烯醇酶的出现和意义

用自行提纯的人脑和牛脑神经元特异性烯醇酶(NSE)分别免疫家兔,制备兔抗人和抗牛NSE血清(抗NSEh和抗NSEb)。以PAP免疫组织化学染色,系统观察3O只发育出SD大鼠的脑、脊髓与脊神经节。发现NSE最先出现于胚胎15d的脊神经节神经元,随后相继出现于三叉神经节、脊髓、嗅皮质、海马、扣带回和外侧皮质神经元。表明NSE先后出现于周围神经和中枢神经系统,由脊髓向大脑、原始皮质及新皮质发展的顺序,与神经系统发育过程中的头向发展规律相一致。     

基底节脑出血开颅手术与钻颅抽吸治疗的疗效比较（附136例报告）

目的比较基底节脑出血开颅手术治疗与钻颅抽吸治疗的有效性与安全性。方法回顾性分析我院近5年来基底节出血行外科开颅治疗和钻颅抽吸治疗的所有病例，应用统计学方法进行疗效比较。结果共136例基底节出血病例，其中30例行外科开颅清除血肿治疗，106例行钻颅抽吸治疗。两组病例在年龄、出血量、意识状态等预后影响因素方面差异无统计学意义（P〉0．05）。基底节出血开颅手术治疗有效性与安全性与钻颅抽吸治疗相比差异无统计学意义（P〉0．05）。结论基底节出血外科开颅治疗有效性与安全性并不优于钻颅抽吸治疗。     

Clinical considerations in the use of missing tissue compensators for head and neck cases

The irregular shape or contour of the patient’s surface in the treatment field can alter the dose distribution resulting in non-uniformity of dose in the treatment volume. Missing tissue compensators have been most commonly used to improve this non-uniformity, especially in head & neck, breast, lung and supraclavicular regions. Two or three dimensional compensators have been typically designed to make the dose uniform at a specific depth. This compensation shifts the dose distribution within the treatment volume so that some structures may be under or over compensated. This study will examine how various sites in head and neck cases are affected by compensators. We have also analyzed the uncertainty in compensated dose due to the daily variations in patient repositioning. Computer isodose plans using Cobalt-60 gamma rays and 6 and 18 MV x-rays were generated using coronal contours. Results show that the dose uniformity is improved for the treatment sites, especially for the thinner sites, like the larynx and the anterior cervical neck nodes. Finally, patient movement or positioning errors of ±1.0 cm will cause a change in dose distribution.     

Changes of circadian blood pressure patterns and cardiovascular parameters indicate lateralization of sympathetic activation following hemispheric brain infarction

The effects of left- and right-sided hemispheric brain infarction on variability in circadian blood pressure and cardiovascular measures were investigated in 35 patients to test for asymmetry of the sympathetic consequences of stroke. No significant differences regarding age, size of infarction or extent and frequency of damage to the insular cortex could be detected between the two groups. Patients with right-sided infarction showed a significantly reduced circadian blood pressure variability [diastolic: -1% (95% CI -4 to 1) vs -6% (-9 to -2);P < 0.05] and a higher frequency of nocturnal blood pressure increase (47% vs 35%;P < 0.05) as compared with patients with left-sided infarction. Right-sided infarction was also associated with higher serum noradrenaline concentrations [546 pg/ml (95% CI 415–677) vs 405 pg/ml (266–544);P < 0.05], and ECG more frequently showed QT prolongation (53% vs 35%;P < 0.05) and cardiac arrhythmias (67% vs 20%;P < 0.005). However, irrespective of the hemisphere damaged, patients with insular infarction showed the most pronounced changes of these parameters. In addition, two patients with right-sided strokes (13%) involving the insula, but none with a left-sided infarction, developed myocardial infarction. These findings suggest lateralization of sympathetic activation with right-sided dominance for sympathetic effects following hemispheric stroke.Supported by the Friedrich-Schiedel-Stiftung     

THE CASE AGAINST OPEN NECK BIOPSY

Many patients present with lateral neck lumps due to benign or malignant conditions, and they may be difficult to differentiate clinically. It is detrimental to perform an open neck biopsy on a patient with a cancer originating from the head and neck region (upper aerodigestive tract or skin) prior to definitive treatment. The biopsy interferes with the assessment and management of the neck, increasing morbidity. It may also decrease curability and perhaps induce fungation. A protocol to avoid the need for an open biopsy, using fine needle aspiration cytology and a thorough examination of the upper aerodigestive tract is recommended. The authors also recommend combined radical radiotherapy and surgery for the patient who has had an open biopsy. A thoughtless biopsy is both needless and harmful.     

GABAergic elements in the neuronal circuits of the monkey neostriatum: a light and electron microscopic immunocytochemical study

An antibody raised in rabbits against a GABA-BSA conjugate was used together with the PAP technique to label elements in the neostriatum of three Old World monkeys. Light microscopy revealed numerous immunoreactive medium-size neurons of various staining intensities, some of which had indented nuclei, as well as an occasional large cell. The neuropil showed a plexus of fine processes with frequent puncta. Ultrastructurally, the medium-size GABA-positive neurons were of two types: one with smooth nuclei and scanty cytoplasm, similar to spiny I cells, the other with invaginated nuclear envelopes and more abundant perikaryon, resembling the aspiny type. Correspondingly, labeled dendrites were either spiny or varicose. Some stained axons were myelinated, and the boutons had either large and ovoid, or small and pleomorphic vesicles. All of these boutons formed symmetric synapses, the former type with GABA-positive dendritic shafts but also with unlabeled dendrites; the latter type usually with GABA-negative elements, either dendrites, dendritic spines, or somata. Synapses were also observed between unreactive boutons and immunostained dendrites. Terminals with densely packed, small round vesicles that established asymmetric synapses with spines were always GABA-negative. Glial elements were consistently unlabeled, save for some astroglial endfeet. These findings provide positive evidence for the existence of two classes of GABAergic striatal neurons corresponding to a long-axoned spiny I type and an aspiny interneuron. Furthermore, the simultaneous labeling of GABA-immunoreactive presynaptic and postsynaptic profiles offers possible morphologic bases for the various kinds of intrastriatal inhibitory processes, including the feedforward, feedback, and "autaptic" types.