Objective To explore surgical treatment of gliomas involving the motor eloquent area. Methods Twelve cases of gliomas involving precentral gyrus were underwent awake surgery procedures assis- ted with neuronavigation and brain functional mapping by cortical electrical stimulation.Results Eleven ca- ses acquired accurate location of both lesions and eloquent areas by neuronavigation and direct cortical stimula- tion.7 cases of motor cortices and 2 cases of motor speech centers were confirmed during the operation.Re- section,verified by postoperative MRI,was total in 8 cases (66.7%) and subtotal in 4 patients.Histological examination revealed an infiltrative glioma in all cases (8 low grade astrocytomas,2 high grade astrocytomas and 2 glioblastoma).Four patients had no postoperative deficit,while the other 8 patients were impaired, with,in all cases except one,complete recovery in 7 days to one month.Conclusion Direct cortical elec- trical stimulations and awake surgery offer a reliable,precise and safe method,allowing functional mapping es- pecially useful in case of infiltrative cerebral tumors in eloquent areas.This technique allows improvement in the quality of tumoral resection and concurrently a minimization of the risk of definitive postoperative neurologi- cal deficit.

Recent studies in western countries have reported that the mechanism pf pain are concorded with gate control opiage receptor binding sites and the release of intrinsic morphine like substances, sodium glutamate and also with bradykinin, seroconin, histamine and prostaglandin E. Otherwise the mechanism of the stimulstion producing analgesia has been reported to involve a neurophysiologic and neurohumoral inhibitory effect at the level of spinal cord, brain stem, thalamus and cortex. This has been clarified but further study should improve the chance of understanding the mechanism of pain. From the standpoint of pain management, medications used to manage pain have some unfortunate side effects. nerve blocks cause anesthesia toxicity, major neurosurgical procedures have many complications. Subarachnoidal and epidural analgesics have unknown irritation pneumonia and drug toxicity, and plexus or pituitary gland block with phenol or alcohol has uneventful complication. From January 1980 to December 1982, electrical acupuncture stimulation has been used on 210 cases at HANYANG university hospital in the pain clinic. I found it useful in relieving pain which has not responded to various conventional methods which included medications, nerve blocks, neurosurgical intervantion and neuropolytics. The results are as follows: 1) There are two kinds of treated patients: One is consultation case-12 from internal medicine, 16 from orthopedic surgery, 10 from neurosurgical and 2 from psychiatry. Another 170 cases were patients who directly to the clinic. And the age distribution shows the highset number of patients in the 3rd decade(21%) and in the 4th decade(24.8%). 2) The region of pain was 21% lumbar, 13.8% shoulder, 10% lower leg and head or face with 9.5%. 3) The duration of the pain showed 10 days 25.7%, 1~2 month 18.6%, one year 11.4% and the longest up to 20 years. 4) Patients who were able to walk into the clinic were 19.5%, moderate cases who to be accompanied were 58.6% and bedridden cases were 21.9%. 5) Treatment was conducted mainly on low frequency stimulation with various waves that included the general dynamic activity point plus reactive electro permeable point (REPP) 81.9% and REER plus head in situ needle 18.1%. 6) In 16.7% only one treatment was administered, in 46.1% 2~5 treatments were given, in 28.6% 6~10 treatments were given and in 3 cases more than 100 treatments were administered. 7) Of the 210 cases, 43.3% showed marked improvement, 41.4% were improved, 13.8% showed translent improvement and there were 3 cases of no improvement. The total confidence was 84.7%. 8) There are no serious complications except hypertensive shock case, submucosal hemorrhagic petechia 7 cases and generalized fatigue 18 cases. In conclusion, electrical acupuncture stimulation of the peripheral nervous system can be used to relieve pain replacing such conventional means as medications, nerve blocks, major neurosurgical procedures, neuroytics and physiopsychic therapy which are generally less effective.
Acupuncture ; Age Distribution ; Analgesia ; Analgesics ; Anesthesia ; Binding Sites ; Bradykinin ; Brain Stem ; Drug-Related Side Effects and Adverse Reactions ; Electric Stimulation* ; Fatigue ; Head ; Histamine ; Humans ; Internal Medicine ; Leg ; Morphine ; Needles ; Nerve Block ; Neurosurgical Procedures ; Orthopedics ; Pain Clinics ; Pain Management ; Peripheral Nerves* ; Peripheral Nervous System ; Phenol ; Pituitary Gland ; Pneumonia ; Shock ; Shoulder ; Sodium Glutamate ; Spinal Cord ; Thalamus

Myasthenia gravis is a disease characterized by muscle weakness upon exertion of an involved muscle group and partial return of function eithe with rest or the administration of anticholinesterase. It is generally thought that myasthenia gravis is caused by an autoimmune response associated with the thymus gland and thymectomy is considered to be the treatment of choice for countering this autoimmune process. It is a well known fact that perioerative nticholinesterase therapy, muscle relaxant administration during operation and postoperative respiratory management are in dispute. We described a case of a 42 year old male myasthenic patient with mild symptoms who needed 4 days of artificial ventilatory support following thymectomy.
Adult ; Autoimmunity ; Dissent and Disputes ; Humans ; Male ; Muscle Weakness ; Myasthenia Gravis* ; Thymectomy ; Thymus Gland

It is a well known fact that the best method of determinign need ofr transfusion is the accurate measurement of blood loss related to the patient's status and surgical maneuvers during operation. There are many complications of blood transfusion and their pathophysiologic mechanism, and theprevention and management has been discussed. Among the complications of blood transfusion, urticaria is the most common symptom. The pathophysiologic mechanism of urticaria is understood in some degree at the present time but there are many different opinions as to its prevention and management. Furthermore antihistamine has been widely used for the prevention of urticaria but there are many debatable events about the use of antihistamine. This study was undertaken to investigate the recent reports concerning the use of antihistamine for the prevent in and management of urticaria. Two hundred eighty eight transfused patients among the total of six thousand four hundred forty eight surgical cases done at the Hanyang University hospital from January 1st to December 31th 1983. were reviewed. The result are as follows: 1) The incidence of urticaria was 28 cases (9.72%) among the 288 transfused cases and there was no sex difference. 2) The age distribution was 10 cases (12%) in the 2nd decade and 9 cases(11.3%) in the 4th decade. 3) The lowest incidence of urticaria was 5 cases (5.3%) with A blood type and high of incidence with B, O and AB blood type. 4) The physical status of class 3 was seem in 10 cases(43.5%) as the most common occurrence of urticaria. 5) The highest incidence of urticaria was observed in 9(45%) of 20 obstetric cases. 6) There was no significant differnece of urticaria incidence between the groups which did and did not use antihistamine. Also in the group which received histamine 10 minutes before treansfusion there was a significant decreases 6 cases (3.41%) among the 178 transfused cases. 7) There was no significant statistical difference between blood loss and transfused blood volumes. 8) There was no significant statistical change in the mean values of hemoglobin and hematocrit which were measured preoperatively, in recovery room and 24 hours after operation. 9) In the patient's who were tranfused with more than 10 oints of whole blood, urticaria developed in 9 cases (50%) among 18. From the results of this study, I consider the most effective method for the prevention of urticaria to be the administration of histamine 10 minutes before transfusion. Further investigation of this method will be carried out.
Age Distribution ; Blood Transfusion* ; Blood Volume ; Hematocrit ; Histamine ; Humans ; Incidence ; Recovery Room ; Sex Characteristics ; Urticaria

Halothane was introduced in 1956. It has been used worldwidely as a relatively safe inhalation anesthetic but it is generally accepted that it can cause decrease of liver function. But the causative factor has not yet been pinpointed. Enflurane also seems to decrease liver function but the exact cause is not yet known. In order to study the effects of enflurane and halothane on liver function, we used 10 cases of spinal anesthesia as a control group, and 20 cases each of enflurane and halothane anesthesia respectively as experimental group. We then checked serum GOT, GPT, total bilirubin, alkaline phosphatase, and eosinophil count in peripheral venous blood before oeration and 6 days after operation and looked for the existence of high fever of more than 39 degrees C 3 days postoperatively. The results are as follows: 1) We found statistical significant change of serum GOT, GPT, total billirubin alkaline phosphatase and eosinophil count in spinal, enflurane, or halothane anesthesia beofre and after operation. There was no statistically significance between the control and experimental groups. 2) No patient developed high fever of more than 39 degrees C until 3 days after anesthesia in any group. 3) No significant change of mean arterial blood pressure was observed before and during anesthesia in each group. In this study no definite conclusion that enflurane and halothane might have affected the liver function.
Alkaline Phosphatase ; Anesthesia ; Anesthesia, Spinal ; Anesthetics* ; Arterial Pressure ; Bilirubin ; Enflurane* ; Eosinophils ; Fever ; Halothane* ; Humans ; Inhalation ; Liver*

OBJECTIVETo retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1).

METHODSForty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic features. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed.

RESULTSThree patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lumbar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb's angle in nondystrophic curves was 80.3 degrees and 61.7 degrees before operation, 30.7 degrees and 36.9 degrees after operation, and 32.9 degrees and 42.1 degrees at follow-up, respectively. In dystrophic thoracic curves, preoperative Cobb's angle in coronal and sagittal plane was 96.5 degrees and 79.8 degrees, postoperative 49.3 degrees and 41.7 degrees, follow-up 54.1 degrees and 45.3 degres, respectively. In thoracolumbar curves, preoperative Cobb's angle in coronal and sagittal plane was 75.0 degrees and 47.5 degrees, postoperative 31.2 degrees and 22.8 degrees, follow-up 37.5 degrees and 27.8 degrees, respectively. In lumbar curves preoperative Cobb's angle in coronal plane was 55.3 degrees, postoperative 19.3 degrees, and follow-up 32.1 degrees. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3 cases. Six patients had 7 revision procedures totally.

CONCLUSIONSPosterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; diagnostic imaging ; etiology ; surgery ; Male ; Neurofibromatosis 1 ; complications ; Radiography ; Retrospective Studies ; Scoliosis ; diagnostic imaging ; etiology ; surgery ; Spinal Fusion ; methods

OBJECTIVETo evaluate the effect of snail control through soil pasting mixed with niclosamide.

METHODSFour sites were selected in different epidemic areas in Sichuan province. Soil pasting mixed with niclosamide was carried on, and the dosage was 0 g/m2, 4 g/m2, 6 g/m2, 8 g/m2 and 10 g/m2 respectively. The mortality rate of snail and the density of snail were observed after 7, 15, 30, 90 and 180 days.

RESULTSThe mortality rate of snail was more than 43.3% in blank group after 30 days. The mortality rate of snail was from 75.3% to 100.0% at 4 g/m2 group after 30 days. The mortality rate of snail in 4 g/m2 group was significantly higher than that in the blank group (chi2 = 31.27, P < 0.05). There was no significant difference in the mortality rate of snail among all study groups (chi2 = 1.07, P > 0.05). The decrease rate of snail density was more than 90%. The mortality rate of snail was about 30% higher in Chantu group than Qutu group. The unit cost of Pasting-Mixing Drug with Soil was from 5 to 7 times of spray method, but the total cost was similar for the. two methods at the endpoint of the snail control.

CONCLUSIONThe effect of soil pasting mixed with niclosamide is good, and the dosage of 4-6 g/m2 is suggested in snail control.

Animals ; Molluscacides ; Niclosamide ; Pest Control ; Schistosomiasis ; epidemiology ; prevention & control ; Snails ; Soil

BACKGROUNDThe main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation (OLT) include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT.

METHODSThe clinical data of 25 patients diagnosed with hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement.

RESULTSAmong five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients' liver function was stable and one patient received late liver retransplantation due to ischemic bile duct lesion.

CONCLUSIONSIndividualized therapeutic regimens should be adopted in treating hepatic artery complications after OLT, according to postoperative periods, types and whether ischemic bile duct lesion exists or not. Liver retransplantation is the best treatment for patients with hepatic artery thrombosis. Interventional treatments of late HAS without irreversible liver failure or bile duct ischemia are appropriate, whereas retransplantation is recommended for early HAS.

Adult ; Aged ; Constriction, Pathologic ; Female ; Hepatic Artery ; pathology ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Reoperation ; Retrospective Studies ; Thrombosis ; therapy

OBJECTIVETo evaluate the safety of recombinant human interferon alpha-2b for nasal spray for the prevention of SARS and other upper respiratory viral infections.

METHODSField epidemiologic evaluation was conducted, the design was randomized and had a synchronously parallel control group. In the study, the drugs were given for five days and all subjects were followed up for ten days.

RESULTSDuring the period of using interferon, body temperature of the experimental group was normal compared to the control group. Experimental group had more influenza-like symptoms than the control group (P < 0.05), such as headache (4.83%-7.09%), dizziness (7.17%-11.63%), lassitude (8.55%-15.06%), muscular soreness (4.43%-7.09%), pharynx dryness (12.10%-17.85%), angina (6.25%-8.72%), abdominal pain (2.30%-5.50%) and diarrhea (2.45%-5.66%). Most of side effects reached their peak with in the first 3 days. Except for pharynx dryness, the incidences of all other side effects declined after completion of the use of the trial drug, and incidences of some symptoms in experimental group were lower than those of the control group. There were no significant differences in the symptoms of cough and expectoration between the experimental group and the control group. The incidence of exanthem in the control group was significantly higher than that in the experimental group. The side effect of bloody nasal mucus was not observed in experimental group, which had been reported by other authors in several volunteer studies.

CONCLUSIONUsing recombinant human interferon alpha-2b for nasal spray could lead to some influenza-like symptoms, however, all those symptoms were mild , reversible, and relieved after completion of the use of the trial drug. No serious side effects were found during the period of following up. The authors conclude that the drug is safe.

Abdominal Pain ; chemically induced ; Adolescent ; Adult ; Antiviral Agents ; administration & dosage ; adverse effects ; therapeutic use ; Dizziness ; chemically induced ; Female ; Follow-Up Studies ; Headache ; chemically induced ; Humans ; Interferon-alpha ; administration & dosage ; adverse effects ; therapeutic use ; Male ; Recombinant Proteins ; SARS Virus ; drug effects ; Severe Acute Respiratory Syndrome ; prevention & control ; virology ; Treatment Outcome ; Young Adult

Objective To analyze the status of quality indicators(QI) on specimen acceptability and establish preliminary qual ity specification.Methods Web based External Quality Assessment system was used to collect data of laboratories partici pated in "Medical quality control indicators in clinical laboratory" from 2015 to 2017,including once in 2015 and 2017 and twice in 2016.Rate and sigma scales were used to evaluate incorrect sample type,incorrect sample container,incorrect fill level and anticoagulant sample clotted.The 25th percentile (P25) and 75th percentile (P75) of the distribution of each QI were employed to establish the high,medium and low specification.Results 5 346,7 593,5 950 and 6 874 laboratories sub mitted the survey results respectively.The P50 of biochemistry (except incorrect fill level),immunology and microbiology reach to 6σ.The P50 of clinical laboratory is 4 to 6σ except for incorrect sample container.There is no significant change of the continuous survey results.Based on results in 2017 to establish the quality specification,the P25 and P75 of the four QIs is 0 and 0.084 4 ％,0 and 0.047 6 ％,0 and 0.114 2 ％,0 and 0.078 4 ％,respectively.Conclusion According to the results of the survey,most laboratories had a faire performance in biochemistry,immunology and microbiology,and clinical laboratory needs to be strengthened.Laboratories should strengthen the laboratory information system construction to ensure the actual and reliable data collection,and make a long time monitoring to achieve a better quality.