OBJECTIVETo evaluate the treatment of carotid cavernous fistula with the transvenous approaches.

METHODSSeventeen patients (14 males and 3 males) with carotid cavernous fistula (CCF) were retrospectively analyzed.

RESULTSTotally 18 cavernous sinus of 17 patients were occluded. Nine operations were performed via inferior petrosal sinus approaches and 6 via the facial vein. One patient (bilateral fistula) received both two approaches. The fistula were completely occluded immediately after the procedures in 12 patients. Small shunts remained in four of other patients (2 pterygoid drainage and 2 inferior petrosal sinus, respectively). Facial vein catheterization failed because of vein vasospasm in one patient; his symptoms relieved 5 days later and angiography showed the CCF disappeared another 2 days later.

CONCLUSIONTransvenous embolization of CCF is effective, safe, and easy to perform.

Adult ; Aged ; Carotid-Cavernous Sinus Fistula ; diagnosis ; therapy ; Cerebral Angiography ; Embolization, Therapeutic ; methods ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUNDIn the past 5 years, new treatment materials and techniques offering a different concept in endovascular treatment have been described for cerebral arteriovenous malformations (CAVMs). The aim of this study was to assess the endovascular treatment of CAVMs by using a liquid embolic material, Onyx (Micro Therapeutics. Inc., Irvine, CA, USA).

METHODSFrom September 2003 to September 2004, Onyx was used to treat 22 patients with CAVMs. Ten AVMS were located in functional areas, 8 in deep cerebral areas, and 4 in the cerebellar hemisphere. The size of CAVMs was about 3 cm in diameter in 5 patients, 3-6 cm in 11, and more than 6 cm in 6.

RESULTSIn the 22 patients, Onyx embolization was successful. Nidus occlusion was complete in 3 patients, > 90% in 8, > 80% and < 90% in 6, and > 50% and < 80% in 5. Complications included transient neurological deficits in 2 patients, and adherence of microcatheter to the site of injection in 2.

CONCLUSIONSBeing non-adhesiveness, Onyx is a safe and satisfactory embolic material in the treatment of CAVMs. But its long-term efficacy awaits further follow-up.

Adolescent ; Adult ; Aged ; Child ; Dimethyl Sulfoxide ; administration & dosage ; Embolization, Therapeutic ; adverse effects ; methods ; Female ; Humans ; Intracranial Arteriovenous Malformations ; therapy ; Male ; Middle Aged

OBJECTIVETo optimize the therapeutic programs for periarthritis of shoulder treated with acupuncture, moxibustion and kinetohterapy with orthogonal design method adopted.

METHODSThe orthogonal design table of L8 (2(7)) hierarchical principle was used to randomly divide 192 patients of periarthritis of shoulder into 8 groups, 24 cases in each one. Separately, 4 factors and each different 2 levels were adopted in treatment, named acupuncture timing (factor A: A, acute stage, A2 adhesion stage), acupoint combination (factor B: B, local acupoints, B2 local acupoints and distal acupoints along meridians), filiform needling and warm needling therapy (factor C: C1 acupuncture with filiform needle, CZ acupuncture with filiform needle and warm needling therapy) and positive functional exercise (factor D: D1 without positive functional exercise, D2 with positive functional exercise). The treatment was given once a day, 10 treatments made one session and 2 sessions were required totally. The time points of observation were the point after 1 session of treatment and after 2 sessions of treatment. The short-form McGill pain questionnaire (MPQ) and shoulder joint motor disturbance score were adopted for evaluation.

RESULTSIn the orthogonal design analysis, taking the hierarchical factors into consideration, the age was considered as the main factor in the evaluation of shoulder pain and shoulder motor disturbance (P<0.01), and the shoulder function grade apparently impacted pain evaluation and the efficacy on shoulder motor disturbance (P<0.01). The best combination of 4 factors and 2 levels were A1B1CzD2 and A2BC2D2. SAS statistical analysis showed that at acute stage and adhesion stage, CZ Dz , meaning acupuncture with fifiform needling and warm needling therapy combined with positive functional exercise, is the main factor of the improvements of shoulder motor function (P<0.05).

CONCLUSIONFor periarthritis of shoulder at acute stage, the combined therapy of acupuncture at local acupoints, warm needling and positive functional exercise is adopted. At chronic stage, the combined therapy of acupuncture at local acupoints and distal acupoints, acupuncture with filiform needle and warm needling and positive functional exercise is the best program. Additionally, in clinical treatment, the patients' age, sex, shoulder joint function and duration of treatment should be considered comprehensively for the impacts on the efficacy.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Combined Modality Therapy ; Exercise Therapy ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Periarthritis ; therapy ; Shoulder Pain ; therapy

Objective:To observe the effect of warm joint needling plus rehabilitation techniques on the balance function and quality of life (QOL) of patients with spastic hemiplegia after ischemic cerebral stroke.Methods:Ninety patients with spastic hemiplegia after ischemic cerebral stroke were randomized into a rehabilitation group,a warm joint needling group and an observation group,with 30 cases in each group.The rehabilitation group was intervened by Bobath therapy,the warm joint needling group was treated with joint needling on the affected side plus warm needling,and the observation group was given the same rehabilitation treatment as the rehabilitation group together with the same warm joint needling as the warm joint needling group.The three groups were treated once another day,1 month as a treatment course for 6 months.Before the treatment,and respectively after 2-week,1-month,3-month,and 6-month treatment,the modified Ashworth scale (MAS) was used to measure the anti-spasm ability of the lower limb,the Berg balance scale (BBS) was adopted to evaluate the balance function,and the stroke-specific quality of life scale (SS-QOL)was employed to estimate the QOL.Results:After 3-month and 6-month treatment,the lower-limb MAS scores in the observation group were significantly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).After 1-month,3-month and 6-month treatment,the BBS scores in the observation group were significantly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).After 2-week,1-month,3-month and 6-month treatment,the SS-QOL scores in the observation group were markedly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).Conclusion:Warm joint needling plus rehabilitation can effectively improve the lower-limb spasticity state,balance function and QOL in patients with spastic hemiplegia after ischemic cerebral stroke.

BACKGROUNDUsually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization.

METHODSFrom September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months.

RESULTSAll the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus.

CONCLUSIONSTransvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.

Adult ; Aged ; Cavernous Sinus ; abnormalities ; Central Nervous System Vascular Malformations ; complications ; therapy ; Embolization, Therapeutic ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies

BACKGROUNDTreatment of cavernous dural arteriovenous fistulas (DAVF) is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach.

METHODSFrom August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins.

RESULTSAmong six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external carotid artery were embolized, and transient facial palsy was appeared after operation. The fistula was fully embolized with Onyx via the inferior petrosal sinus after two months with no complications. One bilateral cavernous sinus DAVF was embolized with Onyx via the inferior petrosal sinus by two operations, and transient abducens nerve palsy occurred after embolization.

CONCLUSIONSBecause Onyx may be injected via a transvenous approach and the microcatheter is easily withdrawn, cavernous sinus via transvenous catheterization and embolization is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulas, especially those for which operations via transarterial approaches have failed, or spontaneous cavernous dural arteriovenous fistulas.

Adult ; Aged ; Arteriovenous Fistula ; complications ; therapy ; Cavernous Sinus ; abnormalities ; Dimethyl Sulfoxide ; administration & dosage ; Dura Mater ; blood supply ; Embolization, Therapeutic ; methods ; Female ; Humans ; Male ; Middle Aged ; Polyvinyls ; administration & dosage

Adult ; Aneurysm ; surgery ; Carotid Artery Diseases ; surgery ; Humans ; Male ; Young Adult

OBJECTIVETo explore the effect of intrauterine growth retardation (IUGR) on insulin sensitivity in neonates and the relationship between insulin sensitivity and plasma adiponectin level.

METHODSEighty-two term neonates with IUGR and 90 term neonates born appropriate for gestational age (AGA) were enrolled. Weight, height, head circumference and abdomen circumference of the neonates were measured within 24 hours after birth. Fasting serum glucose (FG), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), plasma insulin and adiponectin were detected in two groups on the 7th day after birth. Homeostasis model assessment for insulin resistance (HOMA-IR) index and insulin sensitivity index (ISI) were calculated.

RESULTSThere were no significant differences in the levels of FG, TG, HDL and LDL between the IUGR and AGA groups (P>0.05). The plasma insulin level in the IUGR group was higher than that in the AGA group, but the plasma adiponectin level was lower than that in the AGA group (P<0.05). HOMA-IR index in the IUGR group was higher than that in the AGA group, but ISI was lower than that in the AGA group (P<0.05). Both Pearson correlation analysis and multiple linear regression analysis showed HOMA-IR index was negatively correlated with plasma adiponectin level and birth weight (P<0.05).

CONCLUSIONSThe neonates with IUGR display a higher plasma insulin level and decreased insulin sensitivity. The decreased plasma adiponectin level may be associated with the decreased insulin sensitivity.

Objective By analyzing the cases of cryptorchidism owing to dysplasia in children to explore how to apply orchidectomy in the treatment of children with cryptorchidism. Methods Two hundred and seven cryptorchi-dism patients with dysplasia who underwent surgical treatment were collected in the Department of Urology,Anhui Province Children′s Hospital Affiliated to Anhui Medical University from July 2005 to May 2016. All the patients were true cryptorchidism,aged from 0. 6 to 11. 4 years [(4. 7 ± 1. 2)years]. There were 78 cases of left cryptorchidism,104 cases of right cryptorchidism and 25 cases of bilateral cryptorchidism. All cases underwent ultrasound examination be-fore surgery,showing that there were no testis in 53 cases,testicular atrophy or dysplasia in 154 cases. All cases under-went surgical treatment,including 149 cases of inguinal incision alone,groin incision combined with laparoscopic explo-ration in 47 cases and simple laparoscopic surgery in 11 cases. Communication with the parents of all the children was conducted during operation. One hundred and sixty - seven cases of mild and moderate testicular dysplasia underwent testicular descending fixation. Forty cases of severe dysplasia or testicular atrophy,including 16 cases of intrahepatic unilateral cryptorchidism and 22 cases of unilateral cryptorchidism outside the abdomen which underwent testicular resection,while 2 cases of bilateral cryptorchidism with severe dysplasia underwent bilateral testicular descent fixation after communication with the parents of the children during operation. All the specimens were sent for pathological examination after the operation. One hundred eighty - six cases were followed up from 1 to 128 months [(53 ± 8) months],and 21 cases were lost. Ultrasound examination was performed from 3 to 6 months after the operation to observe the development of bilateral testis and whether testicular dysplasia or testicular atrophy existed. Results All the children successfully underwent the operation and discharged from hospital. The group who underwent testicular had confirmed slim blood vessels in spermatic cord and poor testicular development through operation,while another group in postoperative follow up ultrasound showed that there was no obvious testicular - like structure in 6 cases,complete atrophy in 12 cases and partial atrophy in 48 cases and no atrophy in 93 cases. No patients had testicular resection again and no canceration after the operation. The healthy sides of the testicular resection in another group all had normal development. Conclusions Mild and moderate testicular dysplasia in children can choose testicular descending fixation,while severe dysplasia or testicular atrophy should select a reasonable surgical approach after communication with families.

Five patients with synovial chondromatosis in the temporomandibular joint were treated in our hospital between August, 2011 and August, 2014. All the patients underwent preoperative imaging examinations for clinical diagnosis and determining the involvement of the lesions. Surgeries were performed and the lesions were confirmed as synovial chondromatosis by pathological diagnosis. The clinical manifestations, imaging features, diagnosis and treatment results were analyzed. All the 5 patients had pain in the joint region, 3 had limited mouth opening, and 3 had swelling in the joint region. X-ray film showed widening of the joint space in all the 5 cases and radiographic findings showed space-occupying lesions in the intra-articular space. Open joint surgeries was performed and completed successfully in all the cases. The postoperative imaging showed no residual lesions in the surgical area. As a rare clinical entity, synovial chondromatosis in the temporomandibular joint was poorly documented without specific clinical manifestations. The diagnosis of synovial chondromatosis relies on imaging, arthroscopic and pathological findings. Corpus liberum is an important feature of the disease occurring frequently in the joint cavity. Surgical intervention is the primary choice for treatment of synovial chondromatosis in the temporomandibular joint, in which the corpus liberum and the affected synovial membrane shall be removed after joint incision.