Intra-Operative Direct Electrical Stimulations of the Central Nervous System: The Salpêtrière Experience With 60 Patients

Indications of surgical treatment for lesions in the central nervous system depend on the risk of a definitive neurological deficit, related to the benefit of resection. Detection of eloquent areas is then necessary because of major individual variability. Neuro-imaging functional techniques are in development and are beginning to be efficient for cortical sensorymotor mapping, but still lack sensitivity and specificity for language mapping, and remain unable to give real-time data during surgery and to perform sub-cortical mapping. The more precise and reliable method of functional mapping is represented by the intra-operative direct electrical stimulations (DES), which allow identification and preservation of essential pathways for motricity, sensibility and language, at each level of the central nervous system (cortico-subcortical). We report our experience of DES in the surgery of tumours and vascular malformations located in supra-tentorial brain eloquent areas, with a consecutive series of 60 patients operated on under general or local anaesthesia, from November 1996 until May 1999 in our department at La Salpêtrière Hospital. Presenting symptoms in the 60 subjects (39 males, 21 females, mean age: 45 years) were seizures in 37 cases with normal clinical examination, and mild neurological deficit in 29 cases. MRI showed 60 supra-tentorial brain lesions: 30 precentral, 12 postcentral, 14 perisylvian in the dominant hemisphere, 4 deep-seated. All subjects underwent surgical resection using DES, with supratentorial cortico-subcortical mapping under general anaesthesia for motor areas detection in 43 cases and under local anaesthesia for sensori-motor and/or language tasks in 17 cases. The final histological diagnosis was 44 gliomas (31 low-grade and 13 high-grade), 9 metastasis, 3 cavernomas, 4 arteriovenous malformations (AVM). Resection was total or subtotal in 52 cases (87%) and partial in 8 cases (13%). 29 patients had no post-operative deficit, while the other 31 patients were impaired post-operatively, with in all cases, except 3, a complete recovery delayed for 15 days to 3 months (overall morbidity: 5%). The median follow up was 14 months. Intra-operative direct electrical stimulations of the central nervous system constitute a reliable, precise and safe method, allowing the realization of a functional mapping useful for all operations of lesions located in eloquent areas. This technique allows a minimization of definitive post-operative neurological deficit, and concurrently an improvement in the quality of resection.     

功能性消化不良患者胃排空的放射学检查(附48例报告)

目的 用放射学方法研究功能性消化不良患者的胃排空时间。方法 对４８例功能性消化不良患者和２０例健康者,通过服用国人日常生活中的标准膳食,以医用硫酸钡做标志物,定时透视并拍胃部照片,直至胃内容物全部排空为止,采用面积从照片中测定不同时间胃排空率。结果 患者组的胃排空率明显低于对照组,５ｈ仅排空８７．４％,而拍者５ｈ则排空１００％,统计学处理有显著差异（Ｐ〈０．００１）。结论 本法对功能性消化不良症提     

Dynamic assessment of pelvic floor function in women using the intravaginal device test

The aim of the study was to assess pelvic floor function and dysfunction using intravaginal devices (IVD test). One hundred and eighty-five patients were evaluated, 65 (35.1%) in the control group without genital prolapse and 120 (64.9%) in the study group, with prolapse. Anatomic changes were evaluated on a scale described by Halban, and functional classification based on palpation of the muscles of the pelvic floor during contraction. Additionally, weighted vaginal devices were used to assess pelvic floor function. Statistic analysis was performed with the Spearman-Pearson correlation coefficient, the ² test and the response/ operator characteristic curve. There was an acceptable correlation between the IVD test and the functional classification of 0.75. Using this classification, the IVD test showed 86.58% sensitivity, 75.72% specificity, and had a positive predictive value 73.95% and a negative predictive value of 87.64%. Significant differences between pelvic floor muscle activity in those patients with and without genital prolapse were observed (X²=58.28, P=<0.005). It was concluded that pelvic floor assessment can be done through the evaluation of active muscle strength or pelvic floor integrity using the functional classification and the IVD test.EDITORIAL COMMENT: In 1988, Peattie and Plevnick introduced the use of weighted vaginal cones to exercise the pelvic floor muscles and treat stress urinary incontinence [1]. Contreras-Ortiz and Nuñez build on this earlier work, using a similar technique to assess pelvic floor muscle function and integrity. Specifically, pelvic floor function is assessed by a combination of digital palpation of the pubococcygeus muscle at rest and during contraction; pelvic floor integrity is assessed by the patient's ability to retain a weighted cone vaginally for 1 minute. Scoring of these two parameters can then be objectively followed for therapeutic response to treatment for urinary incontinence or pelvic relaxation. Many of us forget to palpate the pubococcygeus muscle at rest and during an elicited contraction during baseline or follow-up examination. As this study indicates, simple assessment of pelvic floor function and integrity is possible, and should be used both clinically and in research.     

The functional restoration approach for chronic spinal disability

The functional restoration approach to treating chronic spinal disability consists of a medically directed, interdisciplinary team approach to physical reconditioning and a cognitive-behavioral crisis intervention procedure for dealing with related psychosocial problems. One- and two-year follow-up studies have demonstrated the clinical efficacy of this approach. The present article describes this approach and summarizes the research documenting its success in treating patients with chronic spinal disability. This article also highlights the pitfalls in misunderstanding and misrepresenting the components of the functional restoration approach when evaluating treatment efficacy.     

In vivo CT measurement of blood-brain transfer constant of iopamidol in human brain tumors

Summary We have developed an in vivo method of measuring the blood-brain transfer constant (K) of iopamidol and the cerebral plasma volume (V_p) in brain tumors using a clinical X-ray CT scanner. In patient studies, Isovue 300 (iopamidol) was injected at a dosage of 1 ml/kg patient body weight. Serial CT scans of the tumor site and arterial blood samples from a radial artery were taken up to 48 min after injection. The leakage of iopamidol into the brain through the blood-brain barrier was modelled as an exchange process between two compartments, the intravascular plasma space and the tissue interstitial space. Using this model and the concentration measurements in blood plasma and tissue, quantitative estimates of K and V_p in brain tumors were obtained. In addition, distribution of the estimated values of K and V_p in tumors were displayed as false colour functional images overlaid on the conventional CT scan.In a study of twelve patients with anaplastic astrocytoma (n = 3), glioblastoma multiforme (n = 4) or metastases (n = 5) the mean K and VP values in tumor were found to be 0.0273 ± 0.0060 ml/min/g and 0.068 ± 0.11 ml/g respectively. These values were significantly higher than those in grey or white matter in the contralateral normal hemisphere (p < 0.05). The functional images showed variations in K and V_p within the tumor which were difficult to perceive in the original contrast enhanced CT scans.     

Cortical activation during retrieval of arithmetical facts and actual calculation: a functional magnetic resonance imaging study

By using functional magnetic resonance imaging (fMRI), the neural substrates involved in mental recitation of the single-digit multiplication table and serial subtraction were studied. The former depends mostly on well-learned arithmetical facts, while the latter requires arithmetic processing. Activation during each task was compared with that in a number counting control. During the recitation of single-digit multiplication, the activated regions included the area lying along the left intraparietal sulcus, the premotor and supplementary motor areas, and the posterior portion of the left inferior frontal gyrus. The areas activated during serial subtraction included these areas as well as the bilateral prefrontal and right parietal areas. From the results obtained during retrieval of the multiplication table in this study and previous studies, it was concluded that semantic memory of the multiplication table is stored in the area lying along the intraparietal sulcus and that the frontal areas play an executive role in utilizing the semantic memory of arithmetical facts. It was assumed that the arithmetical facts requiring actual calculation are also stored in the same region. The additional activation during serial subtraction compared with the activation during retrieval of the multiplication table is probably due to the processes of actual calculation. These processes include proper alignment of digits, which may have caused the right parietal activation, and maintaining digits needed for the mental serial subtractions, which may have caused the bilateral prefrontal activation.     

功能性消化不良患者的心理测评及抗抑郁治疗

目的：探讨心理异常与功能性消化不良(FD)发病的关系，并探讨抗抑郁治疗对FD患者的疗效。方法：采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对100例FD患者及100名健康对照组进行心理测评，比较2组焦虑、抑郁的发生率；采用评分法对FD患者进行症状评分，随机将心理测评异常的FD患者分为常规组及综合组，分别给予抗消化不良药物及在此基础上加用抗抑郁药文拉法辛治疗，比较2种治疗方法的总有效率；将综合治疗有效的病例随机分成维持组及停药组，维持组继续给予文拉法辛维持量治疗，观察6mo中2组的复发率。结果：FD组患者焦虑及抑郁状态发生率明显高于健康组；综合组有效率高于常规组；文拉法辛6mo维持治疗复发率低于疗程结束后即停药者。结论：焦虑、抑郁的心理异常是FD发病的危险因素，但用抗抑郁治疗可提高FD患者常规治疗的有效率，6mo维持治疗能有效降低FD复发率。     

六昧安消胶囊治疗功能性消化不良的临床研究

目的 :评价六味安消胶囊治疗功能性消化不良的疗效及安全性。方法 :30例功能性消化不良患者随机分为两组 ,给以治疗组六味安消胶囊 3粒 ,1日 3次 ,对照组莫沙比利 5mg ,1日 3次 ,疗程均为 2wk。治疗前存在胃排空延迟者 ,治疗后用小钡条法复查固体食物胃排空。结果 :两组治疗 2wk后均可明显改善功能性消化不良患者上腹胀、早饱、腹痛、食欲不振及嗳气等症状 ,与治疗前相比 ,有显著性差异 (P <0 0 5 ) ;治疗组治疗前症状总积分为 19 7± 5 1,治疗后为 3 9± 3 3,有显著性差异 (P <0 0 5 ) ;治疗组上腹胀、早饱、腹痛、食欲不振及嗳气等症状的有效率分别为 6 1 2 7% ,6 7 2 4 % ,5 6 84 % ,6 5 % ,5 8 2 6 % ,对照组治疗前症状总积分为 2 0 4± 9 5 ,治疗后为 5 3± 3 7,有显著性差异 (P <0 0 5 ) ;对照组上腹胀、早饱、腹痛、食欲不振及嗳气等症状的有效率分别为 6 3 15 % ,6 0 33% ,6 8 2 5 % ,5 5 7% ,5 3 6 %。两组治疗前后的症状总积分及症状有效率比较 ,均无显著性差异 (P >0 0 5 )。两组均可改善胃排空延迟患者的胃排空率 ,均无显著性差异 (P >0 0 5 )。两组患者治疗后均未发现严重不良反应。结论 :六味安消胶囊治疗功能性消化不良安全、有效     

Renal functional reserve in insulin dependent diabetic children

Abstract Background: Microalbuminuria has been shown to be predictive for clinical diabetic nephropathy. Renal functional reserve (RFR), as a response to protein loading in a short period of time, is a parameter to assess the ability of kidneys to increase the glomerular filtration rate (GFR). The aim of this study was to predict the early phase of diabetic nephropathy by measuring urinary albumin level and RFR capacity in patients with insulin-dependent diabetes mellitus (IDDM).
Methods: Twenty-two patients with IDDM were studied: 11 with a disease duration of less than 5 years (group 1) and 11 with a disease duration of more than 5 years (group 2). As the control group, 15 healthy children (group 3) were included in the study. At the beginning of the study, glucose was measured and the urinary albumin/creatinine ratio was calculated. Average glycosylated hemoglobin (HbA₁c) over 1 year was determined. After protein loading (red meat containing 2 g/kg of protein), the creatinine clearance was calculated at each hour for a duration of 4 h. The RFR was accepted as the peak percentage increase in GFR over the baseline value.
Results: Although metabolic control in group 2 was better, the RFR in group 2 was significantly lower than in group 1 (P < 0.05). Urinary microalbumin levels between the groups did not differ (P < 0.05). In two patients in whom microalbuminuria was detected, the RFR was much lower.
Conclusions: Detecting lower RFR levels in patients with normal urinary albumin excretion, as well as in patients with microalbuminuria, may support the idea that the RFR capacity is more sensitive than microalbuminuria in assessing the early phase of diabetic nephropathy.     

儿童功能性消化不良与幽门螺杆菌感染的关系

目的探讨儿童功能性消化不良与幽门螺杆菌（HP）感染的关系。方法用ELISA法和胃液尿素酶试验检测163例功能性消化不良和54例健康儿童的HP感染情况。结果血清HP-IgG阳性申功能性消化不良组高于对照组（43．6％:14.8％，X2＝14．7，ｐ＜0.01），尿素酶试验阳性率功能性消化不良组也高于对照组（15．3％:3．7％，x2＝5．07，p＜o．05）。内镜检查15例患儿中，慢性胃炎12例（占80％）。经抗HP治疗功能性消化不良症状消失。结论儿童功能性消化不良与HP感染相关，HP是该疾病的主要病因之一。