Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome / Epilepsia do lobo temporal com esclerose mesial temporal: o padrão da perda neuronal hipocampal como preditor do prognóstico cirúrgico

OBJECTIVE: To analyze retrospectively a series of patients with temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS), and the association of patterns of hippocampal sclerosis with clinical data and surgical prognosis. METHOD: Sixty-six patients with medically refractory TLE with unilateral MTS after anterior temporal lobectomy were included. Quantitative neuropathological evaluation was performed on NeuN-stained hippocampal sections. Patient's clinical data and surgical outcome were reviewed. RESULTS: Occurrence of initial precipitating insult (IPI), as well as better postoperative seizure control (i.e. Engel class 1), were associated with classical and severe patterns of hippocampal sclerosis (MTS type 1a and 1b, respectively). CONCLUSION: Quantitative evaluation of hippocampal neuronal loss patterns predicts surgical outcome in patients with TLE-MTS.

OBJETIVO: Analisar retrospectivamente uma série de pacientes com epilepsia do lobo temporal (ELT) e esclerose mesial temporal (EMT), bem como correlacionar os padrões de esclerose hipocampal com os dados clínicos e o prognóstico cirúrgico. MÉTODOS: Foram incluídos neste estudo 66 pacientes com ELT refratária a tratamento medicamentoso e com EMT unilateral submetidos à lobectomia temporal anterior. A análise neuropatológica quantitativa foi realizada em seções hipocampais imunomarcadas com NeuN. Dados clínicos e resultados do acompanhamento pós-cirúrgico foram revisados. RESULTADOS: Ocorrência de evento precipitante inicial e melhor controle de crises após a cirurgia (i.e. classe 1 de Engel) foram associados aos padrões clássico (EMT tipo 1a) e severo (EMT tipo 1b) de esclerose hipocampal. CONCLUSÃO: A análise quantitativa do padrão de perda neuronal do hipocampo é capaz de predizer o prognóstico cirúrgico em pacientes com ELT-EMT.

Prognostic risk factors for surgery in patients with cirrhotic portal hypertension / 中华肝胆外科杂志

Objective To investigate the prognostic risk factors for surgery in patients with cirrhotic portal hypertension.Methods One hundred and sixty one patients with cirrhotic portal hypertension who received surgery in our hospital in the past 10 years were studied.The data were entered into a pre-designed form.24 predictors including patients′ age,sex,degree of liver atrophy,ChildPugh classification,coagulation profile,splenic size,renal function,blood pH,base excess (BE),operative time,volume of ascites,and intraoperative and postoperative hemorrhage were recorded and analyzed.For each of the predictors,2-3 subgroups were compared.Results Seven predictors were clearly related to surgical prognosis:postoperative bleeding within 30h (B0.356,P＜0.001) and a bleeding volume ＞2 L were awarded 3 points; liver volume (B-0.160,P＜0.001) and severe liver atrophy (antero-posterior diameter of the left liver lobe ≤55 mm,oblique diameter of the right lobe ≤110 mm) were awarded three points; blood pH (B0.141,P＜0.001),pH＜7.35 was awarded 2 points; BE (B-0.123,P＜0.001),BE＜-3 (mmol/L) was awarded 2 points; decrease in PLT (B0.065,P =0.015),PLT＜ 3 (T/L) was awarded 2 points; intraoperative bleeding (B0.062,P=0.014),bleeding volume ＞2 L was awarded 2 points; decrease in RBC (B0.053,P=0.024),＜3(G/L) was awarded 1 point.Of the 147 patients who recovered from surgery,all had ≤3 points,except one who had 4 points.Of the 14 patients who died,all had ≥5 points except one who had 4 points.Conclusions Postoperative bleeding (＞2 L),severe liver atrophy (antero-posterior diameter of the left live lobe ≤55 mm,oblique diameter of the right lobe ≤110 mm),blood PH＜7.35,BE ＜-3 (mmol/L),PLT＜30 000(T/L),intraoperative major bleeding (＞2 L) and RBC＜3 (G/L) were significant prognostic risk factors for surgery.For patients who had a score of 5-6 points; death was likely following surgery.A score ≥8 points should be considered as a contraindication to surgery.To reduce operative mortality,active treatment should be given before surgery to keep the score to be 4 points or less.