Objective To investigate the therapeutical effect and mechanism of tiotropium bromide in patients with stable phase midrange and severe chronic obstructive pulmonary disease (COPD). Methods Seventy-eight patients with stable phase midrange and severe COPD were selected, and they were divided into observation group (40 cases) and control group (38 cases) according to treatment method. All patients were given conventional treatment. The patients in observation group were given tiotropium bromide, and the patients in control group were given terbutaline according to the needs for 12 weeks. The changes of dyspnea, 6 min walking distance, pulmonary function, leukotrienes C4 (LTC4), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-ɑ) before and after treatment, and drug adverse reaction were observed. Results The dyspnea score after treatment in observation group was significantly lower than that in control group:(2.9±0.5) scores vs. (3.5±0.7) scores, 6 min walking distance in observation group was significantly longer than that in control group: (427.67±70.36) m vs. (365.41±61.42) m, forced expired volume in 1 second (FEV1) and FEV1/forced vital capacity in observation group were significantly higher than those in control group:(1.76±0.89) L vs. (1.29±0.53) L and (67.43±9.52)%vs. (56.32±8.51)%, LTC4, IL-8 and TNF-αlevels in observation group were significantly lower than those in control group: (397.41± 198.57)μg/L vs. (1 181.95±207.54)μg/L, (434.81±176.05) ng/L vs. (823.37±165.43) ng/L and (0.15±0.02) ng/L vs. (0.25 ±0.02) ng/L, there were significant differences ( P<0.01). Pearson correlation analysis result showed that serum LTC4 level was negatively related to FEV 1 (r=-0.578, P=0.024);and the serum IL-8 level was negatively related to FEV1 (r=-0.542, P=0.019). There was no obvious drug adverse reaction in the two groups. Conclusions Tiotropium bromide can significantly improve the clinical manifestations in patients with COPD. Tiotropium bromide may take effects by blocking various inflammatory factors release in the stable phase of COPD.

OBJECTIVEThe purpose of the report was to investigate the causes of CSF leakage and discuss the methods for prevention and management of CSF leakage following translabyrinthine resection of acoustic neuromas.

METHODSA retrospective review of cerebrospinal fluid leakage following translabyrinthine approach for 152 acoustic neuromas patients, from January 1983 to December 2013, was performed. The cases were divided into two groups, traditional and modified closure techniques. The incidence of CSF leakage was compared between the two groups.

RESULTSThe incidence of postoperative CSF leakage by translabyrinthine approach was 5.9% (9/152), with four cases of rhinorrhea, two case of wound leakage, one case of rhinorrhea and otorrhea, one case of otorrhea, and one case of rhinorrhea and wound leakage. The CSF leakage incidence of traditional closure technique was 14.3% (5/35); the incidence of modified closure technique was 3.4% (4/117). After introducing a modified closure technique, the incidence of the CSF leakage significantly decreased.

CONCLUSIONSAs a common complication of translabyrinthine approach, the incidence of CSF leakage is closely related to the closure technique. The incidence of the CSF leakage should decrease dramatically when adopting the modified closure technique.

Adult ; Cerebrospinal Fluid Leak ; prevention & control ; Craniotomy ; Ear, Inner ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neuroma, Acoustic ; surgery ; Otologic Surgical Procedures ; adverse effects ; methods ; Postoperative Complications ; prevention & control ; Retrospective Studies