肾移植受者血清巨细胞病毒IgE和IgA抗体检测

采用间接ＥＬＩＳＡ检测２３名肾移植受者血清巨细胞病毒（ＣＭＶ）抗体，共检出１８名（７８％）活动性ＣＭＶ感染，其中１０名（４４％）为原发性感染。结果证实ＣＭＶ－ＩｇＥ和－ＩｇＡ具有较好的血清学诊断价值，优于ＣＭＶ－ＩｇＭ。     

Successful treatment of periungual warts using photodynamic therapy: a pilot study

AIM: The aim of this pilot study was an investigation on photodynamic therapy (PDT) whether it is a good alternative for treating periungual and subungual warts of the hands. STUDY DESIGN: Twenty patients (mean age: 30.5 years) with a total of 40 periungual and subungual warts were treated with PDT. A photosensitizer, 20%delta-aminolevulinic acid was applied on the warts. After a mean incubation time of 4.6 h (SD: 1.2), the warts were irradiated with the VersaLight for 5-30 min (15.2 +/- 4.3 min). RESULTS: After a mean of 4.5 treatments a mean clearance of 100% was achieved in 90% of the patients. One patient (5%) showed a clearance of 50% and another showed no improvement. The subungual or periungual location of the wart had no influence on the number of treatments or end result (P > 0.05). There were two recurrences during the mean follow-up period of 5.9 months (SD: 7.6). Besides mainly pain and hyperpigmentation, most treatments had no side-effects. CONCLUSION: PDT can offer a good alternative for treating periungual warts of the hands. Larger studies are indicated.     

High-flow transcranial bypass for prevention of brain ischemia

In patients in whom the internal carotid artery has to be occluded because of the presence of an intracranial giant aneurysm or an infiltrating skull base tumour and in patients with brain ischaemia, whose internal carotid artery has been occluded spontaneously on the basis of atherosclerosis, a transcranial bypass can be created. Since the beginning of the seventies 'low-flow bypasses' are made in which a branch of the superficial temporal artery is connected with a cortical branch of the middle cerebral artery. Because of the small calibre of the blood vessels involved the desired effect on the brain circulation is limited. Thanks to the nonocclusive Excimer laser-assisted anastomosing technique, developed by Tulleken et al. in the last fifteen years, it is now possible to create a high-flow bypass in a safe way. A donor vessel, e.g. the V. saphena magna, is connected at one end to the external carotid artery and at the other to the intracranial part of the internal carotid artery beyond the pathological lesion. The mean flow through the bypass was 140 ml/min in about 90 patients. For example, in three patients, a woman aged 45 with rightsided progressive ophthalmoplegia due to a giant aneurysm, a woman aged 31 years with an aneurysm in the right middle ear and a man with a chemodectoma at the base of the skull, a transcranial high-flow bypass was created nonocclusively, after which the internal carotid artery was closed without any problems.     

Relationship between anterior fontanelle pressure measurements and clinical signs in infantile hydrocephalus

The treatment of choice in progressive hydrocephalus is drainage of cerebrospinal fluid in order to reduce elevated intracranial pressure (ICP). Defining the right moment for surgical intervention, however, in a hydrocephalic infant on the basis of clinical signs alone can be a difficult task. Clinical signs of raised ICP are known to be unreliable and sometimes even misleading. In the present study, the relationship between long-term anterior fontanelle pressure (AFP) measurements and clinical signs was investigated in 37 infants with hydrocephalus. The decision as to whether to operate or not was based on clinical signs alone; AFP values were not taken into account. There was an overall difference between the non-operated group and the preoperative measurements in the operated group, and also between the preoperative and the postoperative measurements in the latter, in regard to both AFP measurements and clinical signs. Almost all preoperative AFP values were increased. The direct correlation () between most individual clinical signs and AFP levels, however, was low (=0.15–0.41). The clinical sign tense fontanelle showed the best correlation with the AFP levels (=0.75). Furthermore, using logistic regression analysis, no combination of clinical signs could be found which reliably predicted the AFP. The relationship between the AFP pressure variables and clinical signs was also examined. The pathological A-waves occurred only in the presence of raised (baseline) AFP, a situation in which considerably more frequent B-waves were observed as well. It was concluded that clinical signs of raised ICP in infantile hydrocephalus are not very reliable and AFP monitoring can therefore provide valuable information on intracranial dynamics in patients with dubious neurological manifestations of progressive hydrocephalus.     

Interhemispheric steal. An experimental study

In 21 cats the pressure in the occluded middle cerebral artery (MCA) was recorded by way of a catheter, introduced in the most proximal portion of this artery by way of the transorbital approach. The effect of temporary occlusion of the ipsilateral and contralateral common carotid artery on the pressure in the occluded MCA was studied. The results seem to prove the existence of the so-called "interhemispheric steal" syndrome.     

Changes in local cerebral blood flow,local EEG,and flow in the distal stump of the middle cerebral artery in cats with occlusion of the middle cerebral artery

Summary The local EEG, the local cerebral blood flow (1CBF), and the flow in the distal stump of the occluded middle cerebral artery were simultaneously recorded in 28 acute experiments in cats. Nembutal anaesthesia was used eleven times, and Halothane anaesthesia 17 times.The recordings were made via platinum electrodes: 12 in the ischaemic hemisphere, and 2–3 in the opposite non-ischaemic hemisphere. The flow in the occluded middle cerebral artery was recorded via a platinum electrode introduced into this artery via the transorbital approach. The changes in 1EEG, 1CBF, and middle cerebral artery flow were studied during normotension, hypertension, and hypotension. A beneficial effect of hypertension was noted in the acute phase of brain ischaemia. Hypertension counteracted also the diaschisis in the non-ischaemic part of the ischaemic hemisphere and in the opposite non-ischaemic hemisphere. A correlation between 1EEG changes and 1CBF changes was noted. In addition an interesting discrepancy was observed between the rapid H₂ clearance in the middle cerebral artery stump and the much slower H₂ clearance in the ischaemic brain area.Significant differences between experiments under Halothane and experiments under Nembutal anaesthesia were noted. In the acute phase those changes are probably the result of the different levels of blood pressure in those two groups.