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

Objective To investigate the predictors of long-term remission of type 2 diabetes induced by short-term intensive insulin treatment.Methods Fifty-four cases of diabetes mellitus with the duration of illness less than 5 years received an intensive insulin treatment for 2 weeks.The standard meal test and intravenous glucose tolerance test were performed at the baseline and 24 h after treatment completion respectively.Long-term remission meant that the diabetic patients should maintain the target glyeaemic control without any hypoglyeaemie agent within one year.Results The remission rate was 57.4% (31/54) overall,and even reached to 80.6% (29/36) in patients with the duration of illness less than 6 months,whereas,the remission rate was only 11.1% (2/18) in those with the duration of illness more than 12 months.In another view,the remission rate was significantly higher in the patients with fasting plasma glucose (FPG) level of less than 7 mmol/L (78.8%,26/ 33) 24 h after intensive treatment than those with FPG level of more than 7 mmol/L (23.8%,5/21,P

OBJECTIVETo evaluate the indication, time and strategy of surgery for patients with bilateral carotid atherosclerotic stenosis.

METHODSSeventy-four patients with bilateral carotid atherosclecrotic stenosis were admitted to our hospital from February 1987 to December 2007. In 34 patients who presented with unilateral symptoms and underwent ipsilateral carotid endarterectomy (CEA), contralateral CEA or carotid artery stenting (CAS) was performed in 8 because of severe stenosis (> 70%) or unstable plaque. Thirty-eight patients presented with bilateral symptoms. Among them, 15 underwent CEA on both sides, 3 were performed CEA on one side and CAS on the other side, while 20 underwent unilateral CEA only. In 2 asymptomatic patients, CEA was also performed.

RESULTSNinety-three cases of CEA were performed in 74 patients. Sixty-eight patients were uneventful after operation. Neurological deficits deteriorated in 2 patients. Four patients developed cardiac ischemia, cerebral hemorrhage and hoarseness respectively. Sixty-seven patients were followed-up for 4.9 years. No cerebral ischemia relevant to operated carotid artery developed in 63 patients.

CONCLUSIONSIf the indication is obvious, CEA should be performed no matter how contralateral carotid artery is. The strategy of therapy is individual. Whether using shunt depends on intra-operative monitoring.

Adult ; Aged ; Atherosclerosis ; complications ; Carotid Stenosis ; etiology ; surgery ; Endarterectomy, Carotid ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Stents

OBJECTIVETo study the expression and significance of GCS gene in human pancreatic cancer cell line SW1990 and its drug-resistant sublines.

METHODSSW1990 and its drug-resistant sublines, SW1990/FU, SW1990/ADM and SW1990/GEM were cultured in vitro. CCK-8 (Cell Counting kit-8) was used to detect the drug resistance of the sublines. Relative quantitation of GCS mRNA expression was evaluated by real-time PCR and Western blot was adopted to evaluate the expression of GCS protein.

RESULTSThe drug resistance indexes of SW1990/FU, SW1990/ADM and SW1990/GEM were 339.7, 11.9 and 56.6, respectively. The GCS mRNA and protein were expressed in all SW1990 and its drug-resistant sublines. There was a higher expression of GCS mRNA in all the sublines and a significant difference of GCS protein expression was detected in SW1990/ADM and SW1990/GEM compared with SW1990.

CONCLUSIONSGCS gene is expressed in SW1990 and its drug-resistance sublines. The high expression of GCS protein in SW1990/ADM and SW1990/GEM might be one reason of resistance to ADM and GEM in the sublines.

Cell Line, Tumor ; Drug Resistance, Neoplasm ; genetics ; Gene Expression ; Glucosyltransferases ; biosynthesis ; genetics ; Humans ; Immunoblotting ; Pancreatic Neoplasms ; enzymology ; genetics ; pathology ; RNA, Messenger ; genetics ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVETo explore the specialty of diagnosis and surgery of tight carotid stenosis.

METHODFrom January 2000 to December 2009, 53 patients with tight carotid stenosis (> 95%) were operated on. All 53 patients had tight carotid stenosis more than 95% on one side in whom 28 had contralateral carotid stenosis or occlusion. The clinical and imaging data as well as surgical outcomes of the patients were retrospectively analyzed.

RESULTSForty-five patients had postoperatively done well without any complications. There were 3 cases of hemodynamic instability and one case of cardiac ischemia which resolved in one to two days. One patient developed mild hoarseness. One complicated with bacteremia due to deep vein catheter insertion. Two patients experienced brain hemorrhage. None of this series occurred perioperative brain ischemia.

CONCLUSIONSTight carotid stenosis indicates a need for expeditious carotid endarterectomy with very low rates of brain ischemia. Intraoperative shunting is seldom necessary. Postoperative hyperperfusion syndrome and brain hemorrhage should be worried. Micro-endarterectomy can effectively prevent from restenosis.

Adult ; Aged ; Carotid Stenosis ; diagnosis ; surgery ; Endarterectomy, Carotid ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents

OBJECTIVETo investigate the techniques and effect of extradural approach for the resection of trigeminal schwannomas involving the cavernous sinus.

METHODSTwenty-three patients (range 26-63 years, mean age 46.2 years) with trigeminal schwannomas involving the cavernous sinus treated by middle fossa extradural approach were retrospectively analyzed. Frontotemporal orbitozygomatic extradural approach was performed in 2 patients. Frontotemporal zygomatic extradural approach was carried out in 21 patients. The first follow-up visit was on the 3rd month after surgery, and if residual was observed on enhanced MRI, then the patient was followed up every 6 months; otherwise, the patient was followed up every 8-12 months.

RESULTSThe length of hospital stay after surgery was 7-13 days (mean 8.5 days). Two tumors originated from the ophthalmic branch, 2 from the maxillary branch, 5 from the mandibular branch and 14 from the gasserian ganglion. Total resection was achieved in 21 of the 23 patients (91.3%) and subtotal resection in the other 2 patients. All the patients were followed up from 3 months to 4 years. Median follow-up time was 19 months. The most common symptom was facial hypoesthesia, occurring in 18 patients. This symptom improved in 10 patients and worsened in 8 patients after surgery. New postoperative facial hypoesthesia was observed in 2 patients. Facial pain was observed in 3 patients and subsided after surgery. Two patients had loss of hearing, this symptom improved in 1 patient and worsened in 1 patient after surgery. Diplopia was observed in 6 patients. In 1 of these 6 patients, diplopia resulted from palsy of the oculomotor nerve. In the other 5 patients, diplopia resulted from palsy of the abducens nerve. This symptom improved postoperatively in all these 6 patients. New postoperative atrophy of the temporalis muscle was observed in 3 patients. There was no operation-related mortality. Tumor recurrence was only found in 1 patient after 24 months and was treated by Gamma knife.

CONCLUSIONSThe middle fossa extradural approach may be an ideal option for the resection of trigeminal schwannomas involving the cavernous sinus. This approach produces no further impairment, less complication, and is less likely to injured the trigeminal nerve, abducens nerve, trochlear nerve and internal carotid artery.

Adult ; Cranial Nerve Neoplasms ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neurilemmoma ; surgery ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Trigeminal Nerve Diseases ; surgery