Velasco F, Velasco M, Rodríguez Cuevas H, Jurado J, Olvera J, Jiménez F
Oncology Unit, Hospital General de Mexico, National Medical Center, IMSS.
Stereotact Funct Neurosurg. 1991;57(4):195-212. doi: 10.1159/000099579.
Ten patients with advanced Parkinson's disease, presenting with tremor, rigidity and akinesia had autologous adrenal medullary transplantation taken from the left adrenal gland to the head of the right caudate nucleus. Particular attention was taken to avoid prolonged exposure of the adrenal tissue before transplantation and to separate the medullary from the cortical adrenal tissues. Postoperative CT scans confirmed the correct position of the transplants. Differences between pre- and 1-year postoperative clinical conditions were statistically evaluated, with patients under medical (L-dopa) treatment and after the medication was temporarily discontinued. Performance of motor tasks was tested to differentiate slowness of movements imposed by excessive muscular tension (rigidity) from that secondary to delayed reaction time to sensory demands (akinesia). Two deaths occurred 35 and 69 day after surgery for causes not related to the surgical procedures. One of those patients had remained stable neurologically and the other had deteriorated to progressive dementia and catatonia. At autopsy, no lesions in the CNS other than those expected from the surgical procedure were evident, and histological examination failed to reveal chromaffin cells in the head of the right caudate nucleus. Evaluation of the 8 cases that survived for 1 year revealed no significant improvement in their clinical or motor task performance, when considered as a group. However, cases with mild akinesia did better than cases with moderate to advanced akinesia, suggesting that transplantation is indicated in cases with rigidity, but not in cases with 'negative' symptoms of Parkinson's disease. All cases required postoperative medication.
10例晚期帕金森病患者，表现为震颤、强直和运动不能，接受了自体肾上腺髓质移植，将取自左肾上腺的组织移植到右侧尾状核头部。特别注意避免移植前肾上腺组织长时间暴露，并将肾上腺髓质与皮质组织分离。术后CT扫描证实了移植组织的正确位置。对术前和术后1年的临床状况差异进行了统计学评估，患者接受药物（左旋多巴）治疗并暂时停药。测试运动任务的执行情况，以区分由过度肌肉紧张（强直）导致的运动迟缓与继发于对感觉需求反应时间延迟（运动不能）的运动迟缓。术后35天和69天发生2例死亡，死因与手术操作无关。其中1例患者神经功能保持稳定，另1例恶化为进行性痴呆和紧张症。尸检时，除手术操作预期的病变外，中枢神经系统未见其他明显病变，组织学检查未能在右侧尾状核头部发现嗜铬细胞。对存活1年的8例患者进行评估，作为一个整体来看，其临床或运动任务表现无显著改善。然而，轻度运动不能的患者比中度至重度运动不能的患者效果更好，这表明移植适用于有强直症状的患者，但不适用于帕金森病有“阴性”症状的患者。所有病例术后均需药物治疗。
