Reduction in Internal Carotid Arterial Blood Flow Velocity in Children During Antiepileptic Drug Therapy with Clinical Dosages

Summary: We studied the effect of antiepileptic drugs (AEDs) on internal carotid artery (ICA) blood flow velocity, as an index of total cerebral blood flow (CBF). The subjects were 45 newly diagnosed children with febrile convulsion or epilepsy who were seizure-free for a period long enough not to affect the results. They had no neurologic deficit, received fixed monotherapy, and were examined by a noninvasive Doppler ultrasound method, in comparisonwith 13 age-matched normal volunteers with no AED. In 30 patients, the measurements were performed before and after AED administration [10 with phenobarbital (PB), 10 with carbamazepine (CBZ), and 10 with valproate (VPA)], and performed before and after AED discontinuation in the remaining 15 patients (all with PB). Normal volunteers underwent the two consecutive examinations with a mean interval equal to that of the entire patient group, and there was no difference in velocity values between the measurements. In patients receiving CBZ or VPA, a significant reduction was noted in blood flow velocity after drug administration. Although velocity values in the patients receiving PB did not change after drug administration, they were significantly increased after complete discontinuation. In the present study, a slight but significant reduction in CBF caused by AED administration at therapeutic doses in children was suggested.     

Delayed pain response after lumbar discography

Summary The delayed onset of symptomatic pain following lumbar discography (with no immediate pain response) is described in six patients, five with a minimum 2-year follow-up. It is usually seen in patients with nearly normal disc morphology who have incomplete or discrete annular tears that are not filled at the time of injection. Later (2–12 h in this study), dye leakage occurs through these lesions, thereby precipitating the discogenic pain This phenomenon may be missed and is probably more common than previously believed due to early discharge from the hospital, the patient expecting discomfort after the invasive study (hence no complaint is made), and the clinician being unaware of this delayed symptom, thereby not asking about it in follow-up. Close patient questioning regarding a delayed onset of symptomatic pain after discography is, therefore, an essential element in diagnostic information following this study.     

心脏搭桥术对糖尿病人降糖治疗方案的影响

目的 :通过观察 型糖尿病 (DM- )行心脏冠脉搭桥术 (CABG)术后血糖水平的升高到恢复至术前状态的过程 ,从而判断 CABG对 DM- 降糖治疗的影响。方法 :选择 36例 DM- 合并冠心病病人 ,均于体外循环 (CPB)下行心脏搭桥术 ,从术前监测血糖 ,直至术后第七天 ,于术中及术后根据血糖水平适当应用胰岛素 ,观察其对降糖治疗效果及血糖趋于稳定的过程 ,从而判断 CABG对 DM- 血糖的影响。结果 :术中及术后 1～ 3d血糖会较术前明显升高 ,需加用胰岛素助降糖 ,术后 3d血糖渐降 ,第六天趋于稳定 ,第七天恢复至接近术前水平。结论 :DM- ,病人行 CABG术 ,只要围术期有效控制血糖 ,术后血糖基本会逐渐恢复至术前状态 ,对其今后的降糖治疗不会造成严重影响     

Recurrent locking of knee joint caused by intraarticular migration of bioabsorbable tibial interference screw after arthroscopic ACL reconstruction

Two cases are reported in which, after ACL reconstruction with autologous hamstring grafts, tibial polylactide interference screws migrated into the knee joint. Clinically, both patients presented with recurrent locking of the joint. In one case, a broken 15 mm-long tip of the screw was found intra-articularly. In the other case, the whole screw had migrated into the joint cavity. The degradation process of polylactic acid, operative technique and bone quality are discussed as possible reasons for these complications.     

Skull base surgery for malignancy: when not to operate

The purpose of this paper is to detail the contraindications for surgery, with curative intent for those patients who suffer from a head and neck malignancy that invades the intracranial space. This is based on a 30-year experience of over 250 patients. The most important contraindications are anatomical. Surgery is not done if the following structures are invaded: brain stem, eloquent portions of the cerebrum, superior sagittal sinus, both internal carotid arteries, both cavernous sinuses and certain vital bridging veins. Certain tumor factors are absolute but are occasionally relative contraindications: such as distant metastatic disease especially if multiple and at multiple anatomic sites. Some tumors that behave in a particularly virulent fashion that defy complete resection but are often difficult to predict preoperatively. Lack of patient medical fitness or absence of patient commitment to the operative procedure is make-up two serious contraindications to surgery. Presented at the 77th Annual Meeting of the German Society for Oto-Rhino-Laryngology, Head and Neck Surgery, 24–28 May 2006, Mannheim, Germany.     

Cast syndrome

The term cast syndrome is used to denote duodenal obstruction occurring after application of a corrective plaster cast to patients with scoliosis. We report a classical case in a 14-year-old female who required surgical intervention after conservative treatment failed. Six months later the patient had no further gastrointestinal symptoms. Clinical, radiological, and pathological details as well as the surgical treatment are described and discussed. Offprint requests to: M. E. Martín Hortigüela     

关节镜下采用四股和八股腘绳肌肌腱双束重建前十字韧带的比较研究

目的比较关节镜下采用四股和八股腘绳肌肌腱双束重建前十字韧带的临床效果。方法2001年9月至2002年8月,将76例陈旧性前十字韧带损伤患者随机分为两组进行双束重建。一组采用四股腘绳肌肌腱移植物:取同侧半腱肌肌腱,做成两个两股肌腱移植物,分别重建前十字韧带前、后束;一组采用八股腘绳肌肌腱移植物:取同侧半腱肌肌腱做成一个四股肌腱移植物重建前束,取同侧股薄肌肌腱做成另一个四股肌腱移植物重建后束。按照IKDC、Lysholm和Tegner膝关节评分标准评价疗效。结果四股肌腱移植物组有33例、八股肌腱移植物组有35例获得随访,随访时间1～3年,平均16个月。四股肌腱移植物组KT-1000检查示,双侧膝关节前向松弛度差异<3mm者25例(75.8%,25/33),3～5mm者5例(15.2%,5/33),6～10mm者3例(9.1%,3/33);轴移试验阴性28例(84.8%),阳性5例(15.2%)。八股肌腱移植物组KT-1000检查示,双侧膝关节前向松弛度差异<3mm者33例(94.3%,33/35),3～5mm者2例(5.7%,2/35);轴移试验阴性34例(97.1%),阳性1例(2.9%)。根据IKDC检查标准,四股肌腱移植物组有29例(87.9%,29/33)、八股肌腱移植物组有34例(97.1%,34/35)为正常或者接近正常,Lysholm评分分别为(90.2±2.9)分和(97.3±1.7)分,两组比较差异有统计学意义(P<0.05)。结论关节镜下采用八股腘绳肌肌腱较采用四股腘绳肌肌腱双束重建前十字韧带能够明显提高膝关节稳定性。     

Brainstem compression by basilar artery anomalies as visualized by MRI

Summary The use of MRI in the diagnosis of vascular anomalies of the basilar artery is demonstrated in two cases. The first patient had a partially thrombosed giant aneurysm of the basilar artery; the second had an atypical course of the basilar artery. MRI is indicated whenever other imaging procedures do not provide a definite diagnosis or the use of contrast medium for conventional X-ray examination or computed tomography is contraindicated.     

Percutaneous recanalization of chronic subclavian artery occlusion using optical coherence reflectometry-guided radiofrequency ablation guidewire.

Subclavian artery lesion that is associated with low complication rate could be treated by percutaneous intervention effectively. However, the success of endovascular therapy for occlusive lesion may be limited by failure to cross with a guidewire. We describe the use of a system using optical coherence reflectometry for navigation and radiofrequency ablation to enable wire passage through subclavian artery occlusion that could not be crossed by conventional guidewires.     

头胸导联、常规导联心电图诊断冠心病的比较——与冠脉造影结果对照

同步记录72例拟诊冠心病患者头胸导联(HC)及常规导联(wilson)心电图(ECG),并与冠脉造影结果对照。结果:HC与Wilson导联ECG对冠心病诊断的敏感性分别为88.9％与81.5％,特异性33.3％与27.8％,准确性75％与68.1％;二组导联对比无明显差异(P>0.05);对右心室梗塞、缺血及左心室后壁缺血.HC导联的敏感性(91.7％)及准确性(94.4％)均显著高于Wilson导联(12.5％、70.8％,P<0.01),并与冠状动脉病变程度呈高度正相关。HC导联优于Wilson导联。