[Epilepsy surgery in a reference centre]. / Cirugía de la epilepsia en un centro de referencia.

INTRODUCTION: Patients with drug resistant epilepsy are potential candidates for surgery. The pre surgical study of these patients involves a multidisciplinary approach. PATIENTS AND METHODS: We included patients who had been submitted to EEG video monitoring in our centre (a tertiary university hospital) between April 1995 and May 2000. The evaluation protocol included magnetic resonance (MR) brain scan (according to a specific protocol), neuropsychological and psychiatric evaluation, and ictal/interictal SPECT, when possible. Patients who underwent surgery were followed up at regular intervals until at least two years after surgery. RESULTS: Of the 299 patients with EEG video monitoring, 87 had been submitted to surgery up to June 2000. Nine of these patients required invasive subdural studies or studies of the foramen ovale using electrodes. Of the patients who underwent surgery, 44.8% had sclerosis of the hippocampus in the MR and in 10% it was found to be normal. The results of pathological anatomy revealed: 49.3% with sclerosis of the hippocampus, 15.1% with benign tumours, 13.7% with gliosis, 4.1% heterotopias and 4.1% cavernomas. Just one patient has been submitted to surgery again because of badly controlled seizures. Eight patients have presented post surgical complications (four with permanent morbidity). Of the 73 patients who were followed up for at least a year, 83.6% are in Engel class I, 9.6% in class II, 2.7% in class III and 4.1% in class IV. Among patients who underwent a temporal resection, 88.7% were in class I and 0% in class IV. CONCLUSIONS: Epilepsy surgery, in selected patients, has a very low morbidity/mortality rate and the chances that seizures will disappear or greatly improve are high.

Neuroendocrine tumors of the nasal cavity: an ultrastructural and morphometric study of 24 cases.

A series of 24 small cell nasal tumors with neuroendocrine differentiation was studied by electron microscopy, and the numbers of secretory granules and cell junctions were assessed. To investigate the relationship between the extent of dendrite formation and the behavior of the tumors, the size of the tumor cells and the area occupied by dendritic processes were determined for each tumor by morphometric analysis performed on low-magnification electron micrographs. A positive correlation was demonstrated between the dendritic area index and the survival of the patients (P = 0.017). Neither the number of secretory granules nor the frequency of cell junctions was prognostically significant.

[The behavior of a striated muscle implant in contact with the intestinal wall. An experimental study]. / Comportamiento de un implante de musculo estriado en contacto con la pared intestinal. Estudio experimental.

Based on the experiences of Thompson and Hakelius, we wanted to study the behaviour of a previously denervated skeletal muscle, in close contact with the intestinal wall, as a possible high pressure mechanism. We used 60 Sprague-Dawley rats. Two surgical procedures were performed: sciatic nerve section and a plantaris muscle transplant at the ileum, the interval between these two procedures was zero, two and four weeks. The implant area was studied by histochemical and histological techniques at different posttransplant times. Live muscle fibers were seen in all implants. The best results were seen in those implants that has been denervated 4 weeks prior to the seconds procedure. During the first phase, there was considerable postimplant inflammation. In the later phases, healthy muscle fiber remained, but with partial fibrous substitution. An implant of skeletal muscle, prior denervated, in contact with the intestinal wall, survive the posttransplant ischemia. The implant showed live muscle fibers with structural capacity for contraction. This experimental model, that is described for the first time, allows for the functional study of pre- and postimplant behaviour.