To probe the treatment effects of the syringomyelia using microsurgical technique, a total of 127 patients with syringomyelia confirmed by CT or MRI in our department were analyzed retrospectively. The patients underwent occipitocervical decompression, syringostomy or syringo subarachnoid shunting (S S shunting) with microsurgery. All patients were followed up for more than 1 5 years and the treatment results were evaluated The results indicated that the collapse of the syrinx was achieved in 84 patients who underwent S S shunting or syringostomy. Decreased size of the syrinx was also noted in 43 Arnold Chiari malformation and spinal dysraphism patients who underwent occipitocervical decompression alone. The authors consider that the patients with syringomyelia should be microsurgically treated. The occipitocervical decompression, syringostomy or S S shunting may be an alternative method of surgical treatment for syringomyelia.

Objective To evaluate the diagnosis and microsurgical treatment of intraspinal abscesses. Methods The clinical manifestations, diagnosis, and microsurgical treatment of sixty-two patients with intraspinal abscess were retrospectively analyzed. Among them, 36 were male and 26 were female, with an average age of 41 years. Thirty-seven were suffering from extradural abscesses, 23 subdural abscesses and 2 intramedullary abscesses. The diagnosis was made based on the history, clinical manifestations, MRI and myelogram. Prompt decompressive laminectomy and removal of the abscesses were carried out. Results Fifty-one patients were followed up. Of them, 27 completely recovered, accounting for 52.9%; in 18 the recovery was graded as good, accounting for 35.3%; and in 6 the recovery was fair, accounting for 11.8%. Conclusion Early diagnosis and microsurgical intervention of intraspinal abscesses could result in satisfactory recovery.

Objective To sum up the experiences in microneurosurgical treatment of spinal cord cavernous hemangiomas (SCH). Methods A retrospective analysis was made of 17 cases of SCH admitted from March 1992 to December 2002. Operations were performed via a posterior midline approach under a microscope. Results Total SCH resection was done in 13 cases, and subtotal removal in 4. The postoperative neurological status was improved in 11 cases, unchanged in 4, and aggravated in 2. No postoperative death occurred. Conclusion Spinal MRI examination is a reliable diagnostic method of SCH. Skillful microneurosurgical technique can achieve a rather good result.

Objective To investigate the effects of Thomas solution in combination with nitroglycerine of different concentrations on rat cardiac preservation for 8 h. Methods Thirty Wistar rats were selected,and Langendorff heart perfusion models were established.Rats were randomly divided into Thomas solution group,Thomas solution+4?10-6 mol/L nitroglycerine group and Thomas solution+4?10-5 mol/L nitroglycerine group(n=10).After hypothermic preservation(4 ℃)for 8 h,the cardiac function of each group was determined.Tissues of left ventricular wall were obtained,and changes of myocardial ultrastructure were observed by electron microscopy. Results Compared with Thomas solution group,the cardiac function was significantly improved and the myocardial ultrastructure injury was less severe in Thomas solution+4?10-5 mol/L nitroglycerine group after hypothermic preservation(4 ℃)for 8 h,while there was no significant difference in myocardial ultrastructure injury and cardiac function between Thomas solution group and Thomas solution+4?10-6 mol/L nitroglycerine group. Conclusion Thomas solution in combination with 4?10-5 mol/L nitroglycerine can significantly improve the preservation effects for isolated hearts in rats.

Objective To explore the methods and mid-term results of interventional therapy for atherosclerotic occlusive disease of the superficial femoral artery(SFA).Methods From January 2005 to August 2008,Nineteen cases with 22 diseased lower limbs were admitted.According to Fontaine stage system,there were 6 stage Ⅱb limbs(moderate to severe intermittent claudication),8 stage Ⅲ limbs(rest pain),and 8 stage Ⅳ limbs(6 with ulcer and 2 with gangrene).The mean lesion length was 8.8 cm(5～13 cm).On the basis of the TransAtlantic Inter-Society Consensus(TASC)femoropopliteal classification,the lesions were classified as type B in 4 limbs,type C in 17,and D in 1.Follow up examinations with color duplex ultrasound and/or arteriography were carried out to determine the patency.The improvement of clinical symptoms after operation was analyzed.Results 17 limbs were revascularization successfully,2 limbs were turned to bypass operation,3 limbs were judged untreatable.The technical success rate is 77.3%,and the clinical improvement of symptoms was achieved in 100% of the 17 limbs on which the procedure was successful.The 17 limbs were followed up for a mean of 12.5 months(range 3-33 months).One patient died of cardia infarction one month postoperatively.SFA occlusion happened in 4 limbs.At one year postoperatively,the patency rate was 75%(13/17)after primary operation.Conclusions Primary endovascular treatment of SFA occlusion diseases is a safe,minimally invasive,and effective method.

Child ; Endoscopy ; Humans ; Male ; Paraganglioma ; surgery ; Urinary Bladder Neoplasms ; surgery

Bridged-Ring Compounds ; poisoning ; Humans ; Male ; Middle Aged ; Poisoning ; therapy ; Treatment Outcome

Objective To analyze and summarize the experiences in diagnosis and treatment of patients with severe traumatic brain injury (sTBI) so as to increase the cure rate and survival rate. Methods A retrospective study was made on the diagnoses and treatment of 4 462 cases of sTBI inclu-ding 3 298 males (73.9%) and 1 164 females (26.1%). The most frequent cause for injury was traffic accident, accounting for 35.5% (1 583/4 462). Closed bead injury ocurred in 3 654 cases (81.9%) and open head injury in 808 (18.1%). The most commen clinical manifestations included unconscious-ness, changes of pupils and life signs. Of all, 1 158 cases (26.0%) were found with combined injury and 1 356 (30.4%) with complications. Treatment measures included first aid, surgery or conventional treatment. Emphasis was put on the treatment of secondary insults. Results Surgery was performed in 3 023 cases (67.7%) including craniotomy for hematoma clearance in 856 cases and hematoma clearance plus decompression in 2 167, with mortality rate of 17.9%. Conventional treatment was carried out in 1 439 cases (32.3%), with mortality rate of 23.7%. There were 2 462 eases (55.2%) with fair recov-ery, 508 (11.4%) with mild disability, 339 (7.6%) with severe disability, 272 (6.1%) under vege-tative state and 881 (19.7%) deaths on discharge according to the Glasgow Outcome Scale. Conelu-sions Active diagnoses and treatment, strict medication rules and prevention and treatment of secondary insults may be key to higher eure rate as well as lower morbidity and mortality of sTBI.

OBJECTIVETo observe whether there was difference between the head-chest leads electrocardiogram (HCECGs) and routine lead electrocardiogram (RLECGs) in the manifest accessory pathways in patients with Wolff-Parkinson-White syndrome.

METHODSHCECGs and RLECGs were recorded simultaneously in patients with Wolff-Parkinson-White syndrome, whose manifest accessory pathways had been confirmed by radiofrequency catheter ablation and intra-cardiac electrophysiology according to the same standard set beforehand. The diagnosis of pathways location was made by analysis of each HCECG and RLECG by two senior physicians in clinical electrophysiology. The diagnostic accuracy of the HCECGs and RLECGs was evaluated by the comparison with that of the intra-cardiac electrophysiology. The delta wave size was also compared between HCECGs and RLECGs.

RESULTSThe diagnostic accuracy in the manifest accessory pathways was 86.2% (50/58) in RLECGs, and 84.4% (49/58) in HCECGs in the 58 patients with Wolff-Parkinson-White syndrome, showing no significant difference between them (P > 0.05), but each delta wave in HCECG was more evident than that in RLECG.

CONCLUSIONHCECG and RLECG both have high diagnostic accuracy in the manifest accessory pathways in patients with Wolff-Parkinson-White syndrome.

Body Surface Potential Mapping ; Electrocardiography ; Humans ; Wolff-Parkinson-White Syndrome ; diagnosis ; physiopathology

OBJECTIVETo explore the effect of reference point on the potential distribution of normal cardioeleclric field of healthy individuals.

METHODSTwo different reference points including central terminal and right forehead were applied to record electrocardiogram simultaneously from 15 testing points (V(1)-V(6), V(7)-V(9), V(3R)-V(8R)) of Wilson lead (RL) and the same testing points (HV(1)-HV(9), HV(3R)-HV(8R)) of head-chest (HC) lead around the torso of healthy individuals. Chi-square test was performed to observe statistical difference between the HCECGs and RLECGs according to different shapes of QRS and T waves.

RESULTSAmong 120 healthy individuals, deformed ECGs appeared in V(1) and HV(3R)-HV(8R) leads, with 20% (24/120) inverted T wave in V(1) lead, 100% (120/120) in V(3R)-V(8R) leads, wide or deep Q wave 100% (120/120) in V(4R)-V(8R) leads. However, in the corresponding HC-lead system, T waves were all positive, and QRS waves were upright as the pattern of rs, RS or qRs. There was statistical difference in the form of ECG between V(1), V(3R)-V(8R) of Wilson lead and the corresponding HC-lead (P<0.05). The distribution of normal cardioeleclric field related to QRS-T wave was of all-round outward shape by HC-lead, and of roughly bipolar shape by Wilson lead for inverted QRS-T wave on the right thoracic surface.

CONCLUSIONThe normal distribution of electrocardial field is determined by the potential of the reference point. The forehead of HC-lead seems to be better than the central terminal as the reference point of the lead system.

Adolescent ; Adult ; Body Surface Potential Mapping ; methods ; standards ; Chi-Square Distribution ; Female ; Heart ; physiology ; Humans ; Male ; Middle Aged ; Reference Values ; Young Adult