Objective To investigate postoperative complications and proper treatment of craniopharyngioma after microsurgical resection. Methods The postoperative complications and treatments of 58 patients with craniopharyngioma who underwent microneurosurgical resection in our department were analyzed retrospectively. Results In the 58 cases ,45 cases received total resection, 11 cases received subtotal resection, and 2 cases received partial resection. Different levels of postoperative complications occurred in all of the cases, with diabetes insipidus in 55 cases , hypematremia and hyperchloraemia in 32 cases, hyponatremia in 25 cases, hyperpyrexia in 24 cases and hyperglycosemia acidosis in 2 cases. Forty-seven cases recovered clinically,9 cases improved,and 2 cases died. Conclusions Postoperative intensive monitor of water intake,and discharge,fluctuation of electrolyte, and actively correction of diabetes insipidus and electrolyte disturbances and maintaince of fluid balance may play an important role in postoperation treatment of craniopharyngiomas.

Objective To understand the clinical characteristics of systemic lupus erythematosus with Antiphospholipid syndrome (SLE-APS).Methods The clinical data of 39 cases of SLE-APS were collected and analyzed retrospectively. Results Thirty-one patients had 48 thrombosis episodes in total, among which the most common presenting manifestations were deep venous thrombosis and stroke. 12 of 26 married women had fetal morbidity. The prevalence of anticardio lipin antibody (aCL) and lupus anticoagulant ( LA) was 72% and 41% , respectively. 24 patients had SLE at first,on an average of 9. 5 years later they had the characteristics of APS, 12 patients had thrombosis episodes or fetal morbidities ,4. 8 years later they developed into SLE,and 3 patients had the characteristics of SLE and APS from the onset The SLEDAI was less than 5 in five cases when they had thrombosis episodes or fetal morbidities.Conclusions The incidence of thrombosis episodes or fetal morbidities increased in SLE-APS patients. APS occurred before, after or at the same time with SLE. SLE patients might have the clinical features of APS during the steady stage. It's very important to ask the medical history in detail and measure aCL in lupus patients to find the risk factor of APS and prevent the APS' occurrence.

Objective To observe the change of expressions of human leukocyte antigen-DR (HLA-DR) ,pattern recognition receptor TLR4(toll like receptor 4) of peripheral blood mononuclear cell( PBMC) with severe sepsis and its relation to clinical outcome. Methods Thirty-five patients with severe sepsis and fifteen healthy volunteers were enrolled into this study. Thirty-five patients with severe sepsis were divided into the improved group (re =25) and the death group (n = 10).The protein expression level of HLA-DR,TLR4 on PBMC was analyzed by flowcytometry. Results The quantity of monocytes(0. 39 ± 0. 30) and the expression level of HLA-DR (10. 25 ± 5. 35), TLR4 (10. 93 ± 5. 66) on PBMC were significantly lower than those in healthy volunteers ( 0. 62 ± 0.41 ) , (59. 28 ±14. 76) and (39. 86 ±8. 55) pre-treat(P<0.01or P <0. 05).Along with the clinical condition improved, the quantity of monocytes and the protein expressions of HLA-DR, TLR4 on PBMC were gradually increased at each timepoint in the improved group. In this group the quantity of monocytes (1. 03 ± 0. 78) and TLR4 expression (36. 68 ± 16. 61 ) turned to the normal range in the 5th day, which were significantly higher than pre-treat (P < 0. 05 ). However,the expression failed to return to normal range at each time point in the death groups and there were no significant difference between each time point ( P > 0.05). Conclusions The quantity of monocytes and the expression level of HLA-DR,TLR4 on PBMC show significant relevance to patients' imnmnological function and the clinical outcome.

Objective To evaluate the diagnostic utilities of CD64,CDllb,sICAM-1 and sE-selectin in early identification of neonatal sepsis related to bacterial infection. Methods The group of sepsis consisted of 36 newboms and the control group included 26 healthy newboms. The blood samples were collected right after being admitted to hospital and at recovery stage in the group of sepsis,as for the control the blood samples were collected only once in the study. In the sepsis group,blood samples were also taken in bacterial culture before treatment CD64 and CDllb were quantified with direct immunofluorescence staining and the whole blood cell flow cytometry analysis. sICAM-1 and sE-selectin level were determined by ELJSA assay,along with CRP. Results The expression level of CD64 in neonates with sepsis was (60. 37 22. 70) .shown in MFI,which was significantly higher than that in the group of control (23. 14 ±5. 10) MFI(P <0. 01). The expression level of CDllb in neonates with sepsis was (1645. 14 ±463. 68) MFI,which was significantly higher than that in the group of control (1041.48 ±260. 34) MFI (P < 0. 01). The concentration of blood sICAM-1 in neonates with sepsis was (240. 20 ± 83.46) μg/L, which was significantly higher than that in the group of control (100. 24 ±51.03)μg/L(P <0. 01). The concentration of blood sE-selectin in neonates with sepsis was (29. 63 ±9. 88μg/L,which was significantly higher than that in the group of control (14. 12 ±5. 33)μg/L(P <0. 01). In the sepsis group,the level of CD64,CDllb,sICAM-l and sE-selectin in the primary stage was higher than the recovery stage significantly (P <0. 01). The sensitivity of above-mentioned molecular markers were 95. 7% , 82. 6% , 81. 8% and 87. 0% , respectively, and the specificity were 95. 8% , 79. 2% ,86.9% and 79.2% . CD64 was the best one. Conclusions CD64 may serve as one of the reliable biomarkers in the early diagnosis of neonatal sepsis, and it may play important role in the treatment of neonatal sepsis.

Objective To review the diagnosis of idiopathic pulmonary hemosiderosis ( IPH),and to evaluate the efficacy of maintenance therapy with dose-adjusted 6-mercaptopurine (6MP) in IPH children. Methods The diagnosis of IPH was confirmed by in-patient examination and at least 1 year follow-up to exclude secondary causes of pulmonary hemorrhage. Fifteen children met the criteria of IPH and were enrolled. The age at diagnosis was 2-13 years ( median 7 years). Prednisone was administered at 2 mg/( kg·d) for 4 weeks in acute phase of the disease followed by taper. 6MP was also started at 60 mg/( m2·d) simultaneously and continued for 3 years. Results The diagnosis was delayed in most children, which was due to the lack of initial classical manifestation of the disease. The time between the onset of symptoms and diagnosis ranged from 2 weeks to 108 months ( median 8 months) . All the patients exhibited response to the initial treatment and prednisone was successfully tapered off. Only 1 of 8 patients with relative leucopenia (3 × 109/L -6 × 109/L) on 6MP maintenance recurred while 5 of 7 others recurred (P < 0. 05) during median 6-year (range 2. 5 - 9. 5 years) follow-up. Of the latter 5 patients who recurred,4 remained recurrence-free after adjusting the dose of 6MP upwards to keep relative leucopenia. Conclusions Diagnostic delayed is still a main problem in pediatric IPH. Most IPH children in our group tolerated maintenance treatment with 6MP and achieved long-term remission, and these suggested growth retardation on long-term steroids therapy could be avoided. Because of interindividual difference in 6MP metabolism, adjusting the dose of 6MP may be necessary for treatment of IPH children and avoid under-treatment or overtreatment in some children,and thus improve the prognosis. White blood count could be a simple and useful indicator to predict clinical response in most IPH children on 6MP.

Objective To explore the clinical features of ABO hemolytic disease in newboms,red blood cell glucose-6-phosphate dehydrogenase(G-6-PD) deficiency and the combined. Methods In the study, 160 cases of ABO hemolytic disease in newborn (ABO group) ,219 cases of G-6-PD deficiency(G6PD group) ,52 cases of the combined(ABO + G6PD group). The three groups were analyzed. Results The hemoglobin in the G6PD group ( (159. 7 ± 24.9) g/L) was significantly higher than in the ABO group ((150. 2 ± 23.0) g/L) and ABO + G6PD group( (149. 2 ±22. 8) g/L) (P < 0. 01). TBIL in the G6PD group ( (419. 0 ± 152. 9)μmol/L) was significantly higher than that in the ABO group ( ( 355. 4 ± 113. 2 )μmol/L) ( P < 0. 01). The Jaundice dissipated time in the G6PD group were significantly longer than ABO group ( ( 9.4 ± 2. 3) d vs. ( 8. 2 ± 2. 2 ) d) ( P < 0. 01 ) . In the ABO + G6PD group, the Jaundice dissipated time, time of phototherapy and number of phototherapy was (12. 0 ± 2. 7)d,(43. 2±16. 0)h and (3.5 ± 1. 2) times, which was significantly longer (or more) than those of the ABO group ((8. 1 ±2.2)d,(36. 1 ±15.9)h and (2. 6 ±1. 2)times) and G6PD group( (9.4 ±2. 3)d,(37. 6 ± 17. 3)h and (2. 8 ± 1. 3) times) (P<0. 05). The incidence of the bilirubin encephalopathy, hypocalcemia rate in the G6PD group (16. 0% ,32.9% ) were significantly higher than those in the ABO group(6. 9% and 20.0% ) (P <0. 05 ) . However, the incidence of anemia (23. 3% ) in the G6PD group was significantly lower than that in the ABO group (40. 0% ) and ABO + G6PD group (51.9%) ( P < 0. 01) . Conclusions In the newborns with ABO hemolytic disease and G-6-PD deficiency,the time jaundice appear,the degree of jaundice,bilirubin encephalopathy rate were not significantly different from those in the ABO hemolytic disease and G-6-PD group, but the jaundice persisted longer,and more easily repeated. Compared to the neonatal ABO hemolytic disease, the degree of jaundice, jaundice persisted longer in the G-6-PD deficiency,bilirubin encephalopathy is more likely to occur,whereas the incidence of anemia is much lower.

Objective To analyze the change of disease constitution of complications in preterm infants in our hospital and to provide a scientific basis for the clinical prevention and treatment in the future. Methods Two hundred and sixty-eight preterm infants were admitted in NICU of our hospital from Jan. 2004 to Dec. 2009. The constitutions of complications in preterm infants were retrospectively analysed by year. Results One hundred and ninety-seven cases had complications and the incidence of complications was 73.51% ( 197/268 ). The most common complications of preterm infants in our hospital included neonatal hyperbilirubinemia (41. 62% ,82/197), neonatal hypoxic-ischemic encephalopathy (39. 59% , 78/197) and neonatal aspiration syndrome (34. 01%, 67/ 197). The change of disease constitution of the complications were as follows: the disease constitution of neonatal hyperbilirubinemia always located within the first 3 diseases ( ranged from 28. 57% to 75.76% , χ2 =13. 582, P < 0. 001) ;the occurrence of neonatal hypoxic-ischemic encephalopathy showed upward trend( increased from 10. 71% to 56. 25% ,χ2 =7. 577,P<0. 001) ,but decreased in 2008,2009;the neonatal aspiration syndrome presented with a high but fluctuant incidence among the 6 years (ranged from 15. 15% to 56. 25% ,x2=12.002,P < 0.001) ; the neonatal hypoglycemia increased in the nearly 3 years;the incidence of neonatal asphyxia was stationary;the disease constitution of neonatal respiratory distress syndrome fluctuated up and down( ranged from 3. 57% to 20.41% ,χ2 = 4. 125,P<0. 05) ;the anemia in premature infant showed upward trend,increasing from 3.03% to 18. 37% (χ2 = 4. 332,P< 0.05 ) ; the occurrence of neonatal scleredema decreased with no statistical significance; the preterm infants suffered from infectious diseases with lower rate. Conclusions The disease constitution of the hospitalized preterm infants in our hospital in the last 6 years is mainly non-infectious diseases. The neonatal asphyxia recovery technology should be further improved. The serum bilirubin concentration should be monitored early after birth of preterm infants and intervened timely. Cranial imaging studies should be performed timely for early detection of brain injury.

Objective To assess the clinical effect of tumor-type prosthesis replacement for treatment of giant cell tumors of bone near the joints. Methods Thirty-seven patients with giant cell tumors of bone near the joints from January 1998 to January 2008 were reviewed. 18 were males and 19 were females. The ages ranged from 19 to 64 and the median age was 32 years old. The anatomic site of the lesions spreaded at distal femur(23 cases) , proximal tibia(10 cases),proximal humerus(3 cases) and proximal femur(1 case). According to Companacci's staging system: 9 patients were classified as grade II and 28 as grade Ⅲ. All patients had been treated with block excision and reconstruction with prosthesis. The functional outcomes were evaluated by MSTS 93 score. Results According to the follow-up for 2 -9 years,1 patient (4. 3% ) had local recurrence and underwent amputation of the diseased limb. As for the complications, periprosthesis infection occurred in 1 patient, prosthesis loosening in 2 patients. The average MSTS 93 score was 22. 49 ±5. 16 in 3 years after surgery. The evaluated functional result revealed excellent or good performance in 89. 2% of the patients. Conclusions Tumor-type prosthesis replacement is an effective procedure to reduce the local recurrence,and to restore joint function.

Objective To investigate the clinic features of extra-intestinal manifestations ( EM ) of ulcerative colitis (UC) in Chinese patients in Liao ning Province. Methods Two hundred and five UC cases in the First Hospital of China Medical University from Jan. 2002 to Feb. 2007 were reviewed retrospectively. Chi-square test was used to test the difference between groups. Results Skeletal and mouth manifestation were the most frequent extra-intestinal manifestations (6. 83% ). The incidence of parenteral performance in patients less than 40 years old was significantly higher than that in patients more than 40 years old (P <0. 01). There was no significant difference between male and female ( P > 0. 05). Our data showed that the extensive colitis had the highest incidence of extra-intestinal manifestations than of the other two types, LUC and DUC. Most extra-intestinal manifestations presented in UC active period ( P < 0. 05 ). The incidence of extra-intestinal manifestations in severe cases was significantly higher than that in mild cases(P <0. 05). There was a trend of increasing frequency from mild to moderate to severe type cases ( P < 0. 05 ). The occurrence of extra-intestinal manifestations was significantly higher in the group with disease course more than five years than that with less than five years group ( P < 0. 05). Conclusions Extra-intestinal manifestations had a high incidence in UC. The most frequently involved organs were joints, mouth, hepatobiliary, skin and eyes system. The patient could have multiple extra-intestinal manifestations and there was a tendency that EM was more likely occurred among patients in the higher age, active phase, longer course, severity degree of the disease.

Objective To compare the efficiency of repairing perimembranous ventricular septal defect (VSD) with continuous stitching to that with interrupted stitching. Methods Of the 158 patients with perimembranous VSD ( 54% males) ,102 ( 65% ) patients underwent the repairing of continuous stitching (continuous group) ,and 56 patients underwent interrupted stitching (interrupted group). All the surgeries were performed under hypothermic cardiopulmonary bypass. Results The cardiopulmonary bypass time and aortic cross-clamp times were (31 ±14) mins and (18 ±12) mins in the continuous group, which was significantly less that those of (42 ± 16) mins and (25 ±11) mins in the interrupted group (t =4.49 and 3. 61 .respectively ,P <0. 05) . No case was died. The main complications involved temporary M atrioventricular block (AVB) of two cases (1 case in each group),which disappeared after 1 week. There were two remnants remaining leak (n =2) which was less than 3 mm and automatically cured after 3-6 months. Complete right bundle branch block(CRBBB) occurred in 3 cases in the continuous group and 6 cases in the interrupted group,of which 3 disappeared after 1 month and 2 disappeared after 12 months. The outcome was good in all cases after 1-3 years follow up. Conclusions Continuous stitching showed a shorter cardiopulmonary bypass and aortic cross-clamp times, and reduced the CRBBB.