Nonconvulsive Status Epilepticus: High Incidence of Complex Partial Status

Nonconvulsive status epilepticus may be subdivided into generalized (absence) status and complex partial status. The latter is regarded as a rarity, whereas the former constitutes the dominant part of the hitherto reported cases. We report 10 consecutive cases of adult patients with nonconvulsive status epilepticus, all documented by ictal electroencephalographic (EEG) recordings. Five had a complex partial status; the origin of the complex partial status appeared to be frontal in four of these patients. Three had recurrent complex partial seizures with incomplete recovery between seizures, and two had more continuous symptoms. One of the latter exhibited neither motor phenomena nor automatisms. The effect of diazepam or clonazepam was immediate in all 10 cases though transient in eight. A lasting control of the status was not achieved in six patients until i.v. phenytoin was added. The difficulties in the differentiation between complex partial status and absence status despite ictal EEG recordings are discussed, illustrated by a case with seizure discharges of a focal onset which rapidly generalized. The study indicates that complex partial status may be more common and the clinical expressions of absence status more variable than hitherto recognized.     

^125I放射微粒微创植入治疗前列腺癌

目的观察^125I放射微粒植入对前列腺癌的治疗效果。方法对26例临床确诊为前列腺癌患者经皮穿刺在癌组织植入^125I放射微粒，每例平均36粒，术后复查肛诊、B超、影像学及血生化指标。结果患者植入治疗经过顺利，2例少量出血，留置导尿后愈合，3个月后经肛诊、直肠B超示结节缩小，前列腺特异性抗原（PSA）降低，多普勒超声显示结节内动脉收缩期最大血流速度（VS）、阻力指数（RI）及动脉搏动指数（PI）均明显下降。结论^125I放射微粒植入对前列腺癌的治疗安全性好、效果可靠。     

Chloroquine blood concentrations and malaria prophylaxis in Tanzanian women during the second and third trimesters of pregnancy

Objective: Routine malaria prophylaxis with chloroquine (CQ) is recommended to pregnant semi-immune women in several countries in Africa. The dosage is empirically based. We investigated whether blood CQ concentrations and apparent oral blood clearance (CL/F) change during the course of pregnancy. We also studied whether malaria parasites could be detected together with low CQ blood levels. Methods: Forty nine semi-immune Tanzanian women were recruited in the 16th week of pregnancy. They were given 310 mg oral CQ base once per week as prophylaxis during the whole pregnancy. Capillary blood samples were taken for analysis of CQ before treatment and at weeks 26 and 36. Blood samples were dried on filter paper and analysed by HPLC. Blood was also drawn to detect occurrence of malaria parasites. Results: A total of 25 women fulfilled the sampling schedule. CL/F increased significantly from 160 ml ·  min⁻¹ at week 26 to 180 ml · min⁻¹ at week 36. In 7 of 25 women, CL/F increased >20%. Trough blood CQ concentrations, determined on four occasions at week 26 and at week 36 varied between 200 and 900 nmol · l⁻¹. No statistically significant differences between occasions were seen. Malaria parasites were seen in two individuals early in pregnancy. Conclusion: Blood CQ CL/F showed a small increase during the course of pregnancy. The estimated mean blood CL/F values of 160 and 180 ml · min⁻¹ (week 26 and 36, respectively) were higher than the mean CL/F of 125 ml · min⁻¹ in non-pregnant individuals, published previously. Efficacy of higher dosages of CQ in malaria prophylaxis in pregnant women could, therefore, be evaluated in controlled trials in high-risk malaria areas. Received: 3 July 1996 / Accepted in revised form: 5 November 1996     

Morphological and functional changes in spinal ganglion neurons after epidural clopheline administration

The aim of this chronic experimental study performed in 16 dogs was to determine the effect of epidural infusion of 0.01% clopheline solution on the morphological and histoenzymological characteristics of spinal ganglion neurons. Daily infusions of clopheline at the dose of 15 mg/kg for 14 days caused a decrease in capillary permeability in the spinal ganglia at the injection site and its increase in the intact areas. This finding suggests the changes in the activity of the microcirculatory bed with a disturbed interaction in capillary-neuron system. Analysis of morphometric parameters has demonstrated the presence of some functional and reversible dystrophic changes in spinal ganglion neurons, which were associated with epidural infusion of both clopheline and isotonic solution of sodium chloride. Determination of the activity of oxidation-reduction enzymes, which reflect the course of aerobic and anaerobic processes in spinal ganglion neurons, has shown no significant differences between the groups of animals infused with or isotonic solution of sodium chloride. In conditions of chronic experiment no significant variations were found in RNA content in ganglionic cells at and outside the sites of infusion of clopheline and of isotonic solution of sodium chloride.     

Do children take the same number of steps every day?

The purpose of this study was to examine the day-to-day variability in pedometer-assessed physical activity (steps/day). A total of 1,443 children aged 6-12 years from the United States (195 boys, 254 girls), Sweden (257 boys, 252 girls), and Australia (229 boys, 256 girls) wore a pedometer for 4 consecutive weekdays. Repeated measures analysis of variance was used to examine daily differences in steps/day and the coefficient of variation (CV) was calculated for each individual to describe the day-to-day variability. Overall, mean steps/day were higher among boys (14,698 +/- 3,373 steps/day) than girls (12,086 +/- 2,929 steps/day). Significant differences were found between the 4 monitoring days for the entire sample; however, the absolute mean differences were small (55-958 steps) with an overall effect size of 0.01. This trend was apparent regardless of age, gender, and country. Individual CVs ranged from approximately 2 to 88% and the overall mean CV approximated 22%. An age-related increase in the mean CV was observed between 6- and 12-year-old children. The age x gender x country interaction was not significant (P > 0.05). These findings have implications toward the proper design, analysis, and interpretation of studies regarding physical activity among children. Beyond this aspect, our results lend insight into potential age-related biological mechanisms that may also influence daily levels and patterns of physical activity.     

MILITANCY TRAUMA : MAXILLOFACIAL INJURY,ANAESTHESIA AND CRITICAL CARE

Eighty four out of 2151 militancy trauma patients sustained severe maxillofacial injury from Jan 1990 to March 1993. The resuscitation, stabilisation and intensive care of these patients was based on management priorities of primary resuscitation, care of airway, management of haemodynamics, oxygenation and monitoring. Anaesthesia was administered in a situation when the airway was likely to be compromised and the patients were critically sick. Initial ventilation and oxygenation was the most difficult and could be achieved with satisfactory seal around the face mask by applying water-soaked guaze pieces around the mouth and nose to “fill-in” the defects. Tracheal intubation could be accomplished with intravenous sedation by an experienced anaesthesiologist. Dental occlusion and wiring necessiated the placement of nasotracheal tube for 48-72 hours after surgery.KEY WORDS: Trauma, Maxillofacial injury, Trauma anesthesia, Anaesthesia and critical care