Objective To study the operative strategy of congenital atlantoaxial dislocation(CAAD)-induced Chiari malformation and (or) syringomyelia. Methods The operation in reported 23cases of CAAD-induced Chiari malformation and (or) syringomyelia was composed with the transoral resection of odontoid process to achieve anterior decompression at first stage and occipito-cervical bone grafting fusion at second stage. Results MRI examination revealed the tonsils ascent and (or) syrinx reduction in 19 cases after first-stage operation. Compared with their preoperative manifestations, 14cases were obviously improved and 5 improved to some extent after operation, while 4 were unchanged. Conclusions CAAD is the main cause of tonsils descent and (or) syringomyelia in the series of patients. After anterior decompression by transoral resection of odontoid process, most patients will get recovered in tonsils descent and (or) syringomyelia reduction. The main aim of posterior operation is to reconstruct the stability of craniovertebral junction.

Objective To develop a BP neural network to differentiate between ventricular fibrillation( VF) and non-VF rhythms.Methods Eighteen metrics were extracted from the ECG signals.Each of these metrics respectively characterized each aspect of the signals, such as morphology, gaussianity, spectra, variability, and complexity.These metrics were regarded as the input vector of the BP neural network.After training, a classifier used for VF and non-VF rhythm classification was obtained.Results and Conclusion The constructed BP neural network was tested with the databases of VFDB and CUDB, and the accuracy was 98.61%and 95.37%, respectively.

Death ; Hematoma, Subdural/etiology* ; Humans ; Syphilis, Congenital/complications*

Objective To explore the morphological changes of the atlantoaxial facet joint and the three-dimensional characteristics of joint dislocation in patients with atlanto-occipital assimilation accompanied by atlantoaxial dislocation. Methods Thirty-six patients with atlanto-occipital assimilation and concurrent atlantoaxial dislocation underwent spiral CT scanning of the craniovertebral junction, and the imaging data in DICOM format were transferred to the three-dimensional visualization workstation to construct the three-dimensional model of the craniovertebral junction. The characteristics of atlantoaxial dislocation in association with the bony malformation were studied in the reconstructed model. Results Multiple anomalies of the atlantoaxiai facet joint were found in these patients, including joint dislocation involving 57 sides in the 36 patients, skeletal deformity in 61 sides, and facet separation in 11 sides. Three-dimensional classification identified 3 types of atlantoaxial dislocation in these patients, namely symmetrical type (14 cases, 39%) representing the approximately symmetrical joint dislocation and/or skeletal distortion, rotational type (13 cases, 36%) representing apparently asymmetrical joint dislocation and/or skeletal deformity, and separate type (9 cases, 25%) with separation of the joint facets. Conclusion In patients with atlanto-occipital assimilation, multiple factors including developmental anomaly, secondary skeletal deformity and ligament extension and fatigue interact as the fundamental causes ofatlantoaxial dislocation. The CT-based three-dimensional model of the craniovertebrai junction allows visualization of the atlantoaxial facet joint and atlantoaxial dislocation to provide important evidence for surgical planning and decision on the internal fixation approaches.

OBJECTIVETo summarize the curative effect of surgically treated large or giant cavernous sinus hemangiomas (CSH) via epidural approach.

METHODSFrom June 1999 to June 2011, 19 cases of CSH including 15 female and 4 male patients, ranging from 26 to 70 years (mean 45.3 years) were retrospectively reviewed. Ptosis/ocular motility disorders (10 cases), headache/ophthalmalgia (7 cases), decreased visual acuity (7 cases) and facial hyperesthesia (4 cases) were the most common presenting complaints. The epidural approach was taken and the tumor dissection was performed at the interval between trochlear nerve and ophthalmic nerve and the interval between ophthalmic nerve and maxillary nerve. The curative effect was followed up regularly.

RESULTSGross total resection was attained in 13 cases, near-total resection in 4 cases, subtotal resection in 1 case and partial resection in 1 case. The follow-up period was between 6-144 months (mean 41.5 months). The results of last follow-up were as follows: among the 10 patients with ptosis/ocular motility disorders, complete remission was achieved in 5, improvement in 2, no change in 2 and lost follow-up in 1. Facial hypoesthesia symptom got complete remission in 2 patients and partial remission in the other 2 patients. The other symptoms mentioned above were all relieved. One patient got complication with impairment of vision and ocular motility disorders.

CONCLUSIONSCombined with skilled skull base techniques, surgical treatment of large or giant CSH via epidural approach is an effective method and the preservation of cranial nerves could be attained to an acceptable level.

Adult ; Aged ; Cavernous Sinus ; pathology ; Female ; Follow-Up Studies ; Hemangioma ; surgery ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Treatment Outcome

OBJECTIVESTo analyze the clinical characteristics of the atlantoaxial dislocation (AAD) in craniovertebral junction (CVJ) abnormalities and to study the setup of its surgery strategy.

METHODSFrom April 2009 to November 2011, 56 patients of AAD and CVJ abnormalities including 22 male and 34 female patients who had received surgery were analyzed. There were 2 cases of reducible AAD and 54 cases of irreducible AAD. The age of the patients ranged from 9 to 56 years (mean 34 years). Among them, 14 cases achieved reduction/partial reduction via direct posterior fixation, 41 cases had transoral anterior deconpression and occipito-cervical/C₁-C₂ fusion and 1 case had the posterior odontoidectomy and spinal fusion.

RESULTSFifty-three cases had a follow-up between 6 months and 36 months (mean 20 months) and 3 cases lost follow-up (had improvement at discharge). Seven cases had complications as follows: 1 case had irreversible spinal cord injury and muscle weakness of extremities, 2 cases had cerebrospinal leak, 2 cases had pulmonary infection, 1 case had local granuloma hyperplasia and 1 case had delayed healing of the incision. The later 6 cases all got recovery after reasonable treatments. The grades of Nurick at last follow-up were as follows: 6 cases (11.3%) improved by 3 grades, 30 cases (56.6%) improved by 2 grades, 13 cases (24.5%) improved by 1 grade, 3 cases (5.7%) without change, 1 case (1.9%) get worse.

CONCLUSIONSReducible AAD could achieve direct reduction and fixation via posterior pathways. Irreducible AAD needs individualized treatment. To choose the direct reduction and fixation or transoral odontoidectomy and posterior fixation and fusion should consider the pathogenetic condition, the image data and personal clinical experience.

Adolescent ; Adult ; Atlanto-Axial Joint ; surgery ; Child ; Decompression, Surgical ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Spinal Fusion ; methods ; Young Adult

BACKGROUNDPhotodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) is an emerging technique for the treatment of genital human papillomavirus (HPV)-induced benign and premalignant lesions. We report here in a case series of condyloma acuminata (CA) in pregnancy successfully treated with ALA-PDT.

METHODSFive pregnant patients with CA received three to four times treatment respectively. Patients were followed up for 6 - 23 months after treatment.

RESULTSThe clearance rate of genital warts was 100%. No recurrence was found during the follow-up period. Major adverse events reported were mild erosion, pain, and local edema. All pregnancies resulted in healthy live births without delivery complications.

CONCLUSIONSPDT with topical ALA seems to be safe and effective in the treatment of CA in pregnancy. It demonstrated high clearance rate of warts, was well-tolerated by patients, and showed no adverse effects on mothers or fetuses. ALA-PDT may be an ideal strategy of treatment for pregnant women with CA.

Adult ; Aminolevulinic Acid ; therapeutic use ; Condylomata Acuminata ; drug therapy ; Female ; Humans ; Photochemotherapy ; methods ; Pregnancy

OBJECTIVESTo study the revascularization techniques in the treatment of intracranial complex aneurysms and occlusive reasons of bypass vessel.

METHODSThe 20 complex intracranial aneurysms who underwent saphenous bypass treatment from November 2006 to November 2008 were retrospectively analyzed and the occlusive reasons were studied. Of the 20 patients, 12 were female and 8 were male, mean age was 54.5 years (ranged 27 - 65 years). The distribution of the lesions included 13 cavernous sinus aneurysms, 4 para-clinoid aneurysms, 2 supraclinoid aneurysms, and 1 basilar trunk aneurysm. Four aneurysms were giant (diameter > 25 mm), 12 aneurysms were large (15 - 25 mm), and 4 aneurysms were medium (10 - 15 mm) size.

RESULTSOne saphenous vein was occluded intraoperatively and one saphenous vein was occluded postoperatively. At discharge, 18 out of the 20 patients had Glasgow Outcome Scale (GOS) score of 4 or 5, 2 patients had score of 3, and 1 patient had score of 1. At 6 months follow up, 18 of 19 survivors had GOS score of 4 or 5 and 1 patient had score of 3.

CONCLUSIONSExtracranial-intracranial revascularization technique is a safe and effective method in the treatment of complex aneurysms. Mechanical and hemodynamic factors are two leading reasons for occlusion of bypass vessels. Long-term bypass vessels patent rate still needs further observation.

Adult ; Aged ; Cerebral Revascularization ; methods ; Female ; Follow-Up Studies ; Graft Occlusion, Vascular ; etiology ; prevention & control ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Saphenous Vein ; surgery ; Treatment Outcome

BACKGROUNDRecent studies suggest that bone marrow adipose tissue might play a role in the pathogenesis of osteoporosis. There are inconsistent findings on the relationship among marrow fat content, bone mineral density and apparent diffusion coefficient (ADC). This study aimed to prospectively explore the efficacy of MR spectroscopy (MRS) and diffusion-weighted MR imaging (DWI) in detecting vertebral marrow changes in postmenopausal women with varying bone densities.

METHODSBoth MRS and DWI of the lumber spine were performed in 102 postmenopausal women (mean age, (67.3 +/- 6.5) years; range, 55 - 83 years), who underwent dual X-ray absorptiometry. Marrow fat content and ADC were compared and correlated among three groups: 24 with normal bone density, 31 with osteopenia and 47 with osteoporosis.

RESULTSVertebral marrow fat content was significantly increased in the osteoporotic group ((65.60 +/- 7.68)%, P < 0.001) and the osteopenic group ((57.68 +/- 6.45)%, P < 0.001), when compared with the normal bone density group ((51.67 +/- 3.27)%). ADC values were significantly decreased in the osteoporotic group ((0.39 +/- 0.03) x 10(-3)mm(2)/s, P < 0.001) and in the osteopenic group ((0.42 +/- 0.02) x 10(-3)mm(2)/s, P < 0.001), when compared with the normal bone density group ((0.47 +/- 0.03) x 10(-3)mm(2)/s). The marrow fat content negatively correlated with both bone density (r = -0.731, P < 0.001) and marrow ADC (r = -0.572, P < 0.001). The bone density positively correlated with the ADC values (r = 0.802, P < 0.001).

CONCLUSIONSPostmenopausal women experience a corresponding increase in vertebral marrow fat content as the bone density decreases. Marrow fat content and ADC correlate to the bone density. MRS and DWI may indirectly assess the early bone marrow changes in postmenopausal women.

Aged ; Aged, 80 and over ; Bone Density ; physiology ; Bone Marrow ; metabolism ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Humans ; Magnetic Resonance Spectroscopy ; methods ; Middle Aged ; Postmenopause ; metabolism

OBJECTIVE: To compare the pathomorphologic changes between the pancreas in acute necrotizing pancreatitis (ANP) and that in acute deaths of rats (within 48 hours) so as to find the distinctions. METHODS: The animal models of ANP and other acute deaths (electroshock, mechanic asphyxia/strangle, and acute poisoning with tetramine) were established according to the criteria. Half-quantitative grading and image quantitative analysis methods were employed to observe the gross and microscopic changes of the pancreases. RESULTS: Three features including inflammation infiltrate, fat necrosis and calcium deposit in the ANP group were considerably different from that in other acutely died rat group (P<0.05). CONCLUSION Inflammation infiltrate, fat necrosis and calcium deposit are the most important pathologic features found in ANP by common light microscope, distinguishing ANP from postmortem pancreatic autolysis.
Animals ; Autolysis ; Female ; Forensic Pathology ; Male ; Pancreas/pathology* ; Pancreatitis, Acute Necrotizing/pathology* ; Poisoning/pathology* ; Postmortem Changes ; Rats ; Rats, Sprague-Dawley