Objective To assess the clinical efficiency and side effects of topical mometasone furoate aqueous nasal spray for patients with naphazoline-induced rebound rhinitis. Methods A prospective, non-randomized and self-controlled study was applied. A total of 22 patients with naphazoline-induced rhinitis received two spray-puffs of 50 μg mometason furoate twice daily to each nostril in the morning for one week, followed by two spray-puffs of 50 μg mometason furoate once daily to each nostril every morning for another three weeks after withdrawn of naphazoline therapy. Nasal congestion was evaluated by visual an-alogue scale (VAS) recorded before and after treatment. Side effects like nose bleeding and perforation of the nasal septum was detected with rhinoscope. Results The statistical difference of VAS before and after treatment was significant. No adverse reac-tions as nose bleeding and perforation of the nasal septum were observed by the end of treatment. Conclusion It is safe and effective to use mometasone furoate aqueous nasal spray for treating rebound rhinitis induced by misuse of naphazoline nasal drop.

BACKGROUND: The assessment of chronic nerve root injury is mainly depend on indirect evidences of imaging results.OBJECTIVE: This study is designed to find out the relationship between the degrees of the pathological changes of nerve roots and motor evoked potential (MEP) changes due to chronic compression.DESIGN: A self-controlled trial with animals as subjects.SETTING: Spine Surgery Department of the Second Clinical Hospital of Jinan University.MATERIALS: The trial was completed in the Spinal Surgery Department of the Second Clinical Hospital of Jinan University from October 2001 to May 2003. The subjects were 30 healthy cats of either gender weighing 3 to 5 kg.INTERVENTIONS: The compression model was established by wedging a Ⅴ-shape bone flap into the right intervertebral foramens between C7, C8 and T1 vertebrae. The left foramens served as controls. The cats underwent CT examination on the 2nd, 4th, 8th and 12th postoperative week to show the foramen changes. Six randomly selected cats underwent magnetic stimulation MEP each time on the 2nd, 4th, 8th, 12th and 24th week. The injuries to the compressed nerve roots were assessed according to Mackinnon Standard and they were compared with the MEP wave.MAIN OUTCOME MEASURES: Whether the superficial magnetic stimulated MEP monitoring result was in correspondence with the pathological changes of the chronically compressed nerve roots.RESULTS: The MEP did not show any abnormal changes for Grade Ⅰ injury prolonged to 9.6- 10. 2 ms. There was almost no evoke potential at all stimulation points for grade Ⅴ nerve root injury.CONCLUSION: That the injured nerve root presents dysesthesia and normal MEP results suggests grade Ⅰ injury. Prolonged latency including prolonged F wave suggests grade Ⅱ injury. And additional amplitude decrease together with widened and unclassifiable waves implies the injury be grade Ⅲ. The prominent features of grade Ⅳ nerve injury is much more decreased amplitudes and more prolonged latency. For grade Ⅴ injury there is always disappearance of whole MEP or some potential components. The superficial magnetic stimulated MEP monitoring results are in correspondence with the pathological changes of the nerve roots due to chronic compression, which means MEP monitoring results could serve as the quantitative indication to pathological changes of nerve injury.

BACKGROUND: Many clinical cases have proved that the satisfactory reposition, fusion and internal fixation in the internal fixation for inferior lumbar spondylolisthesis are not consistent with the postoperative symptoms and physical signs, and functional restoration.OBJECTIVE: To investigate the application of somatosensory evoked potential(SEP) in the monitoring during internal fixation for inferior lumbar spondylolisthesis, and the effects of SEP monitoring on the improvement of postoperative symptoms and the spinal functions as well.DESIGN: A randomized controlled trial.SETTING: Inpatient department of spinal surgery, an affiliated hospital of a university. PARTICIPANTS: Fifty-two patients with inferior lumbar spomlylolisthesis including 23 male and 29 female cases aged between 18 and 68 years old were admitted by the Department of Spinal Surgery, Second Affiliated Hospital(Shenzhen People's Hospital) of Jinan University, from June 2000 to December 2003. All cases were randomly divided into control group(n = 20) and monitor group ( n = 32).METHODS: SEP induced by segmental stimulation in cutaneous nerve was used in the control group for preoperative and intraoperative monitoring, and postoperative follow up. The intraoperative potential changes in patients with excellent and good improvement in postoperative functions had been retrospectively investigated to confirm the effective indices for intraoperative monitoring, which thereby provided references for intraoperative monitoring in patients of monitor group.MAIN OUTCOME MEASURES: ① Evaluation of postoperative spinal function; ② SEP latency and amplitude.RESULTS: SEP values after postoperative anesthesia were set as basis.The manifestations of intraoperative potential alterations: ① If the latency reduced 10% -15% or the amplitude increases more than 40% after fixation, it suggested favorable prognosis; ② The potential indices were stable during monitoring, or the reduction of latency was less than 10%,or the increase of amplitude was less than 30%, the fixation could be continued, and partial functions of nerve root and symptoms could be improved after surgery; ③ During the surgery, if potential indices had transient lluctuation, which could be recovered to basic potential within 15 to 20 minutes, fixation should be stopped during the fluctuation. Still partial functions of nerve root and symptoms could be improved after surgery; ④If the intraoperative latency prolonged more than 5%, or amplitude reduced more than 10%, or part of the components disappeared, or the wave shape dispersed, it might suggest postoperative aggravation of pain and dyskinesia. So intraoperative adjustment was necessary. The coincident rate of the improvement of the indices of intraoperative monitoring and the improvement of postoperative spinal function reached 93.75%.CONCLUSION: SEP induced by segrmental stimulation in cutaneous nerve is an objective and effective method in the monitoring and instruction of decompression, reposition, fixation of internal fixation for inferior lumbar spondylolisthesis, which has important merits in the improvement of the function of nerve root and the restoration of spinal function.

OBJECTIVE: To review endonasal endoscopic surgeries aided by Fusion image guided system, and to explore the application value of Fusion image guided system in endonasal endoscopic surgeries. METHOD: Retrospective research. Sixty cases of endonasal endoscopic surgeries aided by Fusion image guided system were analysed including chronic rhinosinusitis with polyp (n = 10), fungus sinusitis (n = 5), endoscopic optic nerve decompression (n = 16), inverted papilloma of the paranasal sinus (n = 9), ossifying fibroma of sphenoid bone (n = 1), malignance of the paranasal sinus (n = 9), cerebrospinal fluid leak (n = 5), hemangioma of orbital apex (n = 2) and orbital reconstruction (n = 3). RESULT: Sixty cases of endonasal endoscopic surgeries completed successfully without any complications. Fusion image guided system can help to identify the ostium of paranasal sinus, lamina papyracea and skull base. Fused CT-CTA images, or fused MR-MRA images can help to localize the optic nerve or internal carotid arteiy . Fused CT-MR images can help to detect the range of the tumor. It spent (7.13 ± 1.358) minutes for image guided system to do preoperative preparation and the surgical navigation accuracy reached less than 1mm after proficient. There was no device localization problem because of block or head set loosed. CONCLUSION Fusion image guided system make endonasal endoscopic surgery to be a true microinvasive and exact surgery. It spends less preoperative preparation time, has high surgical navigation accuracy, improves the surgical safety and reduces the surgical complications.
Cerebrospinal Fluid Leak ; surgery ; Endoscopy ; instrumentation ; Fibroma, Ossifying ; surgery ; Humans ; Nasal Surgical Procedures ; methods ; Neurosurgical Procedures ; Nose ; pathology ; Papilloma, Inverted ; surgery ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Sinusitis ; surgery ; Sphenoid Bone ; pathology ; Surgery, Computer-Assisted ; methods

Objective To explore the therapeutic effect and application value of retroperitoneal laparoscopic combined with resectoscopic radical nephroureterectomy for upper tract urothelial carcinoma Methods From Jan.2006 to Jul.2009,fifteen upper tract urothelial carcinoma patients underwent excision of bladder cuff with resectoscope at first,and then retroperitoneal laparoscopic radical nephroureterectomy.All tumors were confirmed to be localized,stage T1-T3.Clinical outcomes of the patients were retrospectively analyzed.Results Mean operative time was 150 (range:120-180) minutes and blood loss volume was 200 (range:100-400)ml.The function of intestinal canal recovered after 24-48 hours,the drainage tube could be removed after 3-4 days.Catheter was kept for 7-10 days.During the follow up for 1-40 months,all the 15 patients survived with one retroperitoneal lymphatic metastasis.There were no severe complications in perioperative and postoperative period.Conclusions Retroperitoneal laparoscopic combined with resectoscopic radical nephroureterectomy may be a practical surgical procedure for upper tract urothelial carcinoma patients with less intraoperative blood loss and early recovery.

BACKGROUND:Idiopathic interstitial pneumonia is of poor response to treatment. Glucocorticoids are the first medicine for the treatment, however there is only 30% of the patients who are responded. Traditional Chinese drugs (TCD) have been researched hot point for prevention and treatment of pulmonary fibrosis. Many TCD have been used clinically, and with a certain therapeutic effect. Transforming growth factor-β1 and tumor necrosis factor-α are the considerable cytokines to cause pulmonary fibrosis, inhibition of their expression, therefore, may be effective to pulmonary fibrosis.OBJECTIVE: To investigate the interventional effect of qidan granule on pulmonary fibrosis in rats induced by bleomycin A5 and the influence on the expressions of transforming growth factor-β1 and tumor necrosis factorα, and also to compare with those of hydrocortisone.DESIGN:A randomized and interval grouping design.SETTING:Department of Respiratory Medicine, Shandong Provincial Hospital, Shandong University.MATERIALS:The experiment was conducted from May 2003 to March 2004 at Pathological Laboratory of Shandong Provincial Academy of Medical Science. Totally 105 SD male rats, were at random divided into 4groups: normal control group (n= 15 ), model group, qidan group and hydrocortisone group, with 30 rats in each group. Each group was subdivided as7-day, 14-day and 28-day group, with 5 rats in each normal group, and 10in each other groups.METHODS: [1] Model establishment: A perfusion was intrabronchially performed, of 0.25 mL normal saline for rats in normal control group, and of bleomycin A5 0.25 mL ( 5 mg/kg,4 g/L) for rats in other 3 groups, to set up the models of pulmonary fibrosis. [2]Administration: Next day to the beginning of modeling qidan granule (consisting of Radix Astragali seu Hedysari, Radix Salviae Miltiorrhizae, Rhizoma Ligustici Chuanxiong and so on, 3 125 mg/kg) was intragastrically given per day for rats in qidan group, hydrocortisone (25 mg/kg) was intraperitoneally given per day for rats in hydrocortisone group, and normal saline (2 mL/rat) was intragastrically given per day for rats in normal and model groups.[3] Observation indexes: The rats in each group were on the day 7, day 14 and day 28 put to death under the anesthesia, then the lung tissue was taken, stained with hematoxyline-eosin stain for pathological observation of lung tissue. The expressions of transforming growth factor-β1 and tumor necrosis factor-α were detected by immunohistochemistry.MAIN OUTCOME MEASURES:Pathological observation of lung tissue,and the expressions of transforming growth factor-β1 and tumor necrosis factor-α at different time points of rats in each group.RESULTS:Totally 100 rats entered the final result analysis.[1]Pathological observation of lung tissue: In the normal group the structure was normal, in the model group there were alveolitis on the day 7, deterioration of alveolitis on the day 14, and extensive fibrosis on the day 28; the degrees of alveolitis and fibrosis in the qidan group were slighter than those in the model group, and there was normal structure of alveoli; and in the hydrocortisone group the alveolitis on the day 7 and 14 was slighter than that in the model group, but there was no significant difference of fibrosis compared with the model group.[2] Expression of transforming growth factor-β1:In the model group the expression was highest on the day 28 and obviously higher than that in the normal group (3.6±0.4,1.2±0.4,P ＜ 0.01 ); the expression in the qidan group and hydrocortisone group was obviously lower than that in the model group(1.7±0.5,2.5±0.4,P ＜ 0.01), and the expression in the qidan group was lower than that in the hydrocortisone group (P＜ 0.01 ). [3]Expression of tumor necrosis factor-α: In the model group at different time points the expression was continuously increased, the expression in the qidan group and hydrocortisone group was obviously lower than that in the model group(P ＜ 0.05 or P ＜ 0.01), and the expression in the qidan group was lower than that in the hydrocortisone group ( P ＜ 0.01).CONCLUSION: Qidan granule can obviously reduce the extent of pulmonary fibrosis in rats induced by bleomycin A5, lower the expressions of transforming growth factor-β1 and tumor necrosis factor-α, and the effect was better than that of hydrocortisone.

BACKGROUND: As a novel procedure in minimally invasive spine surgery (MISS), percutaneous laser disc decompression(PLDD) has been applied widely in the recent development in clinical practices.OBJECTIVE: This study was designed to evaluate the influences of PLDD on the stability in cervical spinal constructs.DESIGN: A before-after comparison trail based on patients.SETTING: The experiment was performed at the spine surgery department of a hospital affiliated to a university.PARTICIPANTS: Twenty-eight patients who were diagnosed as lateral cervical disc herniation at the Spine Surgery Department of Shenzhen People' s Hospital, Second Hospital Affiliated to Jinan University were involved from October 2001 to April 2003. Of all of the patients, 17 were male and 11 were female. They have 29 cervical disc protrusions altogether.INTERVENTIONS: Monitored by X-ray, a 400 μm fixed optical fiber was introduced into the injured intervertebral disc via a 9-gauge flexible trocar through an anterior cervical approach. An Nd-YAG laser system,with a 1 060 nm wavelength and an output power of 15W, was employed to ablate or decompress the inner disc tissue. The disc tissue was exposedto 500- 950 J laser powers.MAIN OUTCOME MMEASURES: Before and 6 months after the PLDD, the deviation of adjacent vertebra displacements was observed and changings of the wedge angles of the intervertebral discs were calculated respectively.RESULTS: The deviation of adjacent vertebra displacements showed no significant difference between before and after operation, when the patients were examined with a more flexed-position or a more extended-position(t=0.811 7-0.827 2, P＞ 0.05), and no significant changes in the wedge angles of the intervertebral discs could be observed either(t=0.768 7-0.827 1,P ＞ 0.05).CONCLUSION: Applying percutaneous laser disc decompression to lateral cervical disc herniation has many advantages, such as simplicity of operation, minimal invasion and having no impact on the stability in cervical spinal constructs.

Objective To discuss the feasibility, efficacy and complications of CT-guided 125I seed implantation for the treatment of lymph node metastasis nearby the iliac vessels.Methods The clinical data of twelve patients with para-iliac vessel lymph node metastasis, who had been treated with CT-guided 125I seed implantation, were retrospectively analyzed. A total of 12 lesions were detected; the diameter ≤6 cm was seen in seven lesions, and the diameter >6 cm was seen in five lesions. Using computer treatment planning system, the source distribution was calculated. Under CT guidance 125I seeds with the activity of 0.4-0.7 mci were implanted into the metastatic lymph nodes with a seed interval of 0.5-1.0 cm. CT scan was performed immediately after implantation to check the distribution of seeds as well as the possible complications. After the treatment, D90 (90%prescription dose received by target volume) was ≥75 Gy in 6 patients and <75 Gy in other 6 patients. Two months after the treatment CT reexamination was employed, and imaging evaluation was conducted according to WHO Response Evaluation Criteria in Solid Tumors. Results CT-guided 125I seed implantation was successfully accomplished in all 12 patients. Two months after the treatment, the evaluation of the therapeutic effect showed that complete remission (CR) was obtained in 0 patient, partial remission (PR) in 8 patients, stable disease in 3 patients and progress disease in one patient;and the total effect rate(CR+PR) was 66.7%. The local control rate was 91.7%. In eight patients the pain that was caused by metastatic lymph nodes was significantly relieved within 1-14 days after 125I implantation treatment. Before the treatment three patients had lower limb edema, and in two of them the lower limb edema was obviously relieved within 1-14 days after the treatment. All patients were followed up for 3-39 months, and the median follow-up time was 11 months. One-year survival rate was 41.7%. No severe complications such as massive hemorrhage, infection, myelosuppression or seed displacement occurred. Conclusion For the treatment of para-iliac vessel lymph node metastasis, CT-guided 125I seed implantation is safe and feasible. Better curative effect may be achieved when the diameter of the metastatic lymph node is<6 cm and the peripheral radiation dose is>75 Gy.

Objective To investigate the surrounding and central dosimetric distribution difference of the same activity, same number of 125I seeds. Methods 3D treatment planning system (3D-TPS) was used to separately sketch out 7 cubes with side length of 2 cm, 2.5 cm, 3 cm, 3.5 cm, 4 cm, 4.5 cm and 5 cm;simulations of different tumor sizes were established, into which 125I seeds with activity of 0.5 mCi were respectively loaded. All seeds were distributed at the periphery of the tumor (peripheral group) with the prescribed dose of 145 Gy. The dose volume histogram (DVH) was printed and the 90% of target volume absorbed dose (D90), 90% of prescription dose coverage target volume percentage (V90), the maximum dose and mean dose were determined. Then the seeds in every cube were distributed into the center (central group) and the above parameters were calculated by using the same method. Results The mean D90 of the peripheral and central group was (147.29 ±0.58) Gy and (106.08 ±9.40) Gy respectively, the difference between the two groups was statistically significant (t=-4.292, P=0.005). The mean V90 of the peripheral and central group was (95.46±0.44)% and (79.07±4.19)% respectively, the difference between the two groups was statistically significant (t=-3.831, P=0.009). The mean maximum dose of the peripheral and central group was (1 224.65 ±12.7) Gy and (1 532.48 ±48.54) Gy respectively, the difference between the two groups was statistically significant (t=6.823, P=0.000). The mean value of average dose of the peripheral and central group was (192.14 ±2.89) Gy and (179.81 ±5.40) Gy respectively, the difference between the two groups was statistically significant (t=-2.847, P=0.029). Conclusion The dose distribution is directly influenced by the distribution pattern of the 125I seeds. When the number and activity of the 125I seeds are the same, the peripheral seeds implantation has a better dose distribution.

OBJECTIVE:To study the purification technology of 4 active components from Tripterygium wilfordii by macropo-rous resin. METHODS:The purification abilities of nine macroporous resins(ADS-5,ADS-8,HPD100,HPD300,HPD400, HPD450,HPD700,HPD722 and HPD750) were studied with the adsorption and desorption rates of triptolide,wilforlide,trip-tonide and tripterine as the index by static adsorption and desorption experiments for 4 active components from T. wilfordii,so as to screen optimal macroporous resins. Using transfer rate of active component as index,single factor test was used to investigate the effects of different sampling method,ratio of mixing sample to total resin quantity,ratio of resin to medicinal material,cleaning so-lution(type,amount and cleaning flow rate),diameter- height ratio of resins,eluant(volume,flow rate)on adsorption,so as to determine the optimal elution technology;validation test was also conducted. RESULTS:HPD722 macroporous resin was chosen as adsorption resin;ratio of diameter to height was 1∶10,resin-medicinal material ratio was 1∶2,and ratio of mixing sample to to-tal resin quantity was 1∶10;wet column installing and mixing resin for sample loading were adopted. The macroporous resin was washed with 12 BV 20%ethanol at the rate of 12 BV/h,and then eluted with 12 BV 95%ethanol at the rate of 6 BV/h. The verifi-cation test results showed that the total transfer rate of 4 active components from T. wilfordii was more than 90%(RSD=0.99%, n=3). CONCLUSIONS:The optimized technology is stable and feasible,and suitable for the purification of 4 active components from T. wilfordii.