Laparoscopic splenectomy is rapidly becoming a common treatment modality in the surgical management of hematological processes involving the spleen. Hereditary spherocytosis is the most common red blood cell membrane disorder, and its diagnosis is often associated with hemolytic crisis and premature cholelithiasis. This condition has not been successfully treated laparoscopically until recently, and to our knowledge, the technique of concomitant laparoscopic splenectomy and cholecystectomy described here is the first reported in U.S. literature. Our patients, a 16-year-old 5-foot 3-inch-tall 90 pound emaciated albino, presented with cholelithiasis, splenomegaly, and anemia. Because of persistent anemia and gastrointestinal symptoms, the patient underwent laparoscopic cholecystectomy and splenectomy. The cholecystectomy was performed in a standard laparoscopic fashion. An additional 12-mm trocar was utilized for takedown of the spleen. The umbilical incision was extended to 4.5 cm, and the spleen was extracted manually. Total operative time was 12 hours. Examination demonstrated a 15 x 10 x 5-cm spleen, which weighed 350 grams. The gallbladder microscopically showed cholecystitis and had several stones. In conclusion, we present a combined laparoscopic cholecystectomy and splenectomy for hereditary spherocytosis associated with splenomegaly, cholelithiasis, and cholecystitis.
Summary: We report the fourth case of partial status epilepticus (SE) in benign epilepsy of childhood with rolandic spikes (BECRS). The child suffered long‐lasting attacks involving the mouth and pharynx, clinically manifest as speech arrest, sialorrhea, and drooling. Both clinical and electroencephalogram (EEG) data were compatible with the diagnosis of BECRS. Only during SE was the clinical picture similar to that observed in the operculum or Foix‐Chavany‐Marie syndrome. SE remission was obtained with the usual antiepileptic drug therapy (diazepam, clobazam, valproate). EEG records showed additional patterns of continuous spike‐waves during slow sleep and specific inhibition and blocking of interic‐tal centrotemporal spikes by mouth and/or tongue voluntary movements. RÉSUMÉ Les auteurs rapportent une observation de manifestations paroxystiques de longue durée, bucco‐linguo‐pharyngées avec anarthrie, sialorrhée et émission de salive. Ľétude clinique et électroencéphalographique (EEC) a permis de préciser qu'il s'agissait ďun état de mal épileptique partiel, avec des décharges critiques bilatérales, rolando‐temporales. Le tableau clinique pendant les états de mal était celui ďun syndrome operculaire antérieur, ou syndrome de Foix‐Chavany‐Marie. Ľensemble des élements cliniques et EEG était compatible avec le diagnostic ďépilepsie partielle bénigne de ľenfant avec paroxysmes rolandiques (centrotemporaux). Ľarrêt des états de mal fut obtenu avec les antiépileptiques habituels (diazepam, clobazam, valproate). Ľétude EEG nous a permis en outre de mettre en evidence des pointe‐ondes continues pendant le sommeil lent, sans traduction clinique, et àľétat de veille une inhibition nette des paroxysmes intercritiques, lors des mouvements volontaires de la bouche ou de la langue. Il s'agit du quatrième cas publiéďétat de mal partiel dans une épilepsie partielle bénigne de ľenfanl avec paroxysmes rolandiques. RESUMEN Los autores presentan una observación de manifestaciones paroxísticas de larga duratión, oro‐linguo‐faringeas con anartria, sialorrea y babeo. El estudio clínico y electroencefalográfico (EEG) ha permitido precisar que se trata de un estate epilepticus parcial con una descarga crítica bilateral rolando‐temporal. Solamente durante el estatus epilepticus se haevidenciado un síndrome opercular anterior (o síndrome de Foix‐Chavany‐Marie). Las caracteristicas ch'nicas y EEG conjuntas son compatibles con el diagnóstico de epilepsia parcial benigna de la infancia con paroxísmos rolándicos o centrotemporales (EPBIPR). Nuestra observación presenta una notable fármaco‐sensibilidad al tratamiento anticomicial convencional (diacepam, clobazam, valproato). El estudio EEG nos ha permitido demos‐trar en nuestro caso, la presencia de un estado de puntas‐ondas continuas durante el sueño lento, infraclínico, y una clara inhibitión de las anomalías intercríticas en vigilia moviendo voluntariamente los músculos de la boca o de la lengua. Se trata del cuarto caso de estado de mal parcial en una EPBIPR.
In this study it has been valued the differences between T.C. and "scialography" in the parotid gland cystic lesions. Between 1986 and 1987 we examined 100 patients affected by parotid gland diseases utilizing the two different techniques. In 7 patients we diagnosed cystic lesions of parotid gland. Afterwards we compared the results obtained by T.C. and by scialography.
