Objective To compare on therapeutic efficacy and prognosis evaluation of extended pterional approach operation with the traditional operation treatment for frontotemporal contrecoup craniocerebral injury , and provide the clinical basis for the treatment.Methods By retrospective study,112 patients with frontotemporal contrecoup craniocerebral injury were selected randomly .There was extended pterional approach operation group ( observation group,58 cases) and traditional operation treatment group (the control group,54 cases).We observed and evaluated indexes including of postoperative GOS grade assessment ,intracranial pressure measurement of 1,3,6 day preoperative and postoperative and the outcomes after operation of two groups .Results The plant survival rate of the observation group was 10.34%(6/58),lower than that of the control group 27.78%(15/54),the difference was significant (χ2 =4.58,P<0.05);The residual rate in the observation group was 29.31%(17/558),more than that of control group 16.67%(9/54),the difference was significant (χ2 =4.20,P<0.05);The severe brain edema of the observation group was 10.34%(6/58),lower than that of the control group 20.37%(11/54),the difference was significant (χ2 =4.78,P<0.05);Subdural effusion of the observation group was 12.07%(7/558),lower than that of the con-trol group 24.07%(13/54),the difference was significant(χ2 =3.96,P<0.05).The intracranial pressure of observa-tion group after 1 days and 3 days after operation were(302.18 ±17.33)mmH2O and (260.32 ±17.42)mmH2O,low-er than that of the control group was (371.24 ±18.40)mmH2O and (322.17 ±16.28)mmH2O,the difference was significant(t=7.53,5.39,all P<0.05).Conclusion Extended pterional approach could clean wound and hemato-ma fully,bleed thoroughly ,and be conducive to the protection of brain function .It is important for the clinical value to improve the quality of life of patients .

Objective To investigate the comparison of clinical improvement effect of lamotrigine and sodi-um valproate on treatment of tardive epilepsy after traumatic brain injury.Methods According to SAS randomly gen-erated random number,the 120 patients with tardive epilepsy after traumatic brain injury in our hospital were randomly divided into lamotrigine group and sodium valproate group,with 60 cases in each group.Lamotrigine group was given lamotrigine for treatment,while the sodium valproate group was given sodium valproate.The clinical improvement effect,the quality of life and the adverse reactions were compared between the two groups.Results After treatment, the total rate of clinical improvement effect in lamotrigine group was 95.00%,which was higher than that in the sodium valproate group(78.33%),and it was statistically significant(χ2 =4.123,P <0.05).The quality of life in the lam-otrigine group was (62.9 ±22.2),which was significantly higher than sodium valproate group(50.6 ±21.7),the difference was statistically significant(t =2.728,P <0.05).The rate of adverse reactions in lamotrigine group was 23.33%,significantly lower than sodium valproate group(73.33%),it was statistically significant(χ2 =4.297,P <0.05).Conclusion Comparison with sodium valproate,patients with tardive epilepsy after traumatic brain injury who were given lamotrigine can effectively improve clinical effect,safety and reduce the rates of adverse reactions.Eventually, treatment with lamotrigine can improve the life quality of patients,which is worth further clinical application.

Objective To review and summarize the experience of surgical treatment of primary cardiac tumors in children from a heart center of China.Methods The pathological studies of 11 cases of primary cardiac tumor (except myxoma) were retrospectively analyzed.Results The mean age for all patients was (23 ± 16) months,and the average weight was 3.1 ～ 15.3 (13 ± 5.7) kg at the time of the established diagnosis.The most common reason of admission was the heart murmur,and the most common pathological type of cardiac tumors was rhabdomyoma (5 cases),followed by fibrous tumor (3 cases),angiofibroma (2 cases),and fibrosarcoma (1 case).All of the patients underwent tumor resection due to the corresponding symptoms.One of them,the operation findings showed the aortic root,superior vena and sinoatrial node were involved into the tumor body,and therefore,the tumor debark resection was performed and the child died 2 years later due to the remained tumor progression.One of other children (pericardial fibrosarcoma) died 1 year late because of tumor recurrence.The others were followed-up for duration of 2 ～9 years and all kept in good condition.Conclusions The surgical resection is mandatory for children suffering with symptomatic primary cardiac tumors and the short-term and long term surgical outcomes for the majority are acceptable.

Objective To investigate the clinical value of ventricular intracranial pressure monitoring in treatment of severe craniocerebral trauma with high intracranial pressure.Methods A retrospective analysis was conducted on forty cases of severe craniocerebral trauma with GCS score of 3-5 undergone bilateral decompressive craniectomy from October 2010 to January 2012.The patients were divided into three groups:Group A (12 cases received craniotomy after the placement of ventricular intracranial pressure probe) ; Group B (15 cases had craniotomy ahead of the probe placement) ; control group (13 cases had probe placement alone).Intracranial pressure control,dose and duration of administration of dehydrator and prognosis were compared among groups.Results Groups A and B showed a better result in aspects of controlling intracranial pressure within 15 mm Hg,dose and duration of mannitol treatment,and prognosis,as compared with control group (P ＜ 0.05).Furthermore,Group A had seven cases of severe disability or in vegetable state,but only three cases in Group B (P ＜ 0.05).Conclusion Ventricular intracranial pressure monitoring can effectively reduce intracranial pressure,raise treatment success rate and decline the use of mannitol in management of severe craniocerebral trauma.

ObjectiveTo observe the effect on stress response to indwelling gastric tube assisted by bronchofiberoscope and traditional way in patients with severe craniocerebral injury in intensive care unit(ICU). Methods 126 patients admitted in Department of Surgery ICU in Lanzhou University Second Hospital were randomly divided into bronchofiberoscope assisted indwelling gastric tube group(experimental group) and the traditional way of indwelling gastric tube group(control group), 63 cases in each group. In the experimental group, the rod of mirror, Olypus BF-P60, was coated with lidocaine gel, through the nasal cavity it was sent into interior, when arrived at epiglottis, the operator adjusted the mirror head and let it go into the esophagus(about 10 cm), then put a steel wire as a guide into a hole for biopsy, and simultaneously, as the operator pulled out the rod, the wire was continuously pushed slowly further inside; after the bronchofiberoscope was completely withdrawn, valelinum liquidum was used to ensure sufficient lubrication to the external and internal walls of the indwelling gastric tube ready to be sent into the stomach, afterwards the tube was slowly pushed along the guide wire to an appropriate location and then the wire was pulled out, the operator injected air, when he or she heard the gurgling sound as the gas passing water, fixed the tube. In the control group, the traditional way of indwelling gastric tube was applied. Before and after indwelling gastric tube for 1, 3, 5 minutes, the changes of systolic pressure(SBP),diastolic pressure(DBP),heart rate(HR), end-expiratory carbon dioxide partial pressure(PETCO2) and plasma concentrations of norepinephrine(NE), adrenaline, angiotensinⅡ(AngⅡ), glucose(GLU) were examined.Results The plasma levels of SBP, DBP, HR, PETCO2, adrenaline, NE, AngⅡ and blood GLU had no statistical significant differences before operation in comparisons between both groups(allP>0.05). Compared to those before indwelling the tube, the levels of SBP, DBP, HR, PETCO2, NE, adrenaline, AngⅡ and GLU at various time points after the indwelling in experimental group were of no statisticalsignificant differences(allP>0.05), while the levels of SBP, DBP,HR, adrenaline, NE, AngⅡand GLU in control group at various time points after indwelling were higher obviously than those before operation, and the level of PETCO2 was decreased significantly compared with that before operation. The differences in the above indexes were significant between the treatment and control groups at 1 minute after indwelling〔SBP(mmHg, 1 mmHg=0.133 kPa): 125.1±15.4 vs. 135.5±13.6, DBP(mmHg): 85.6±16.1 vs. 91.1±17.2, HR(bpm): 99.4±13.8 vs. 107.9±16.5, PETCO2(mmHg): 32.5±2.8 vs. 29.8±4.1, NE(ng/L): 365.4±29.7 vs. 475.7±49.9, adrenaline(ng/L): 75.4±7.2 vs. 83.6±7.4, AngⅡ(ng/L): 65.3±6.9 vs. 73.3±9.1, GLU(mmol/L): 10.1±1.9 vs. 13.4±3.0, allP<0.05〕; the differences in the above indexes remained significant between the treatment and control groups till 5 minutes after indwelling〔SBP(mmHg): 123.7±14.8 vs. 129.7±15.1, DBP(mmHg): 84.3±14.6 vs. 88.4±14.2, HR(bpm): 97.7±13.6 vs. 31.6±3.9, PETCO2(mmHg): 33.5±3.1 vs. 31.6±3.9, NE(ng/L): 363.9±31.3 vs. 457.7±48.4, adrenaline(ng/L): 74.6±7.8 vs. 83.5±8.5, AngⅡ(ng/L): 64.3±8.4 vs. 71.9±5.9, GLU(mmol/L): 9.6±2.3 vs. 12.7±3.1, allP<0.05〕.ConclusionCompared with traditional way, the indwelling of gastric tube assisted by branchofiberoscopy can induce milder stress response.