Objective To assess the clinical efficiency and side effects of topical mometasone furoate aqueous nasal spray for patients with naphazoline-induced rebound rhinitis. Methods A prospective, non-randomized and self-controlled study was applied. A total of 22 patients with naphazoline-induced rhinitis received two spray-puffs of 50 μg mometason furoate twice daily to each nostril in the morning for one week, followed by two spray-puffs of 50 μg mometason furoate once daily to each nostril every morning for another three weeks after withdrawn of naphazoline therapy. Nasal congestion was evaluated by visual an-alogue scale (VAS) recorded before and after treatment. Side effects like nose bleeding and perforation of the nasal septum was detected with rhinoscope. Results The statistical difference of VAS before and after treatment was significant. No adverse reac-tions as nose bleeding and perforation of the nasal septum were observed by the end of treatment. Conclusion It is safe and effective to use mometasone furoate aqueous nasal spray for treating rebound rhinitis induced by misuse of naphazoline nasal drop.

BACKGROUND: The assessment of chronic nerve root injury is mainly depend on indirect evidences of imaging results.OBJECTIVE: This study is designed to find out the relationship between the degrees of the pathological changes of nerve roots and motor evoked potential (MEP) changes due to chronic compression.DESIGN: A self-controlled trial with animals as subjects.SETTING: Spine Surgery Department of the Second Clinical Hospital of Jinan University.MATERIALS: The trial was completed in the Spinal Surgery Department of the Second Clinical Hospital of Jinan University from October 2001 to May 2003. The subjects were 30 healthy cats of either gender weighing 3 to 5 kg.INTERVENTIONS: The compression model was established by wedging a Ⅴ-shape bone flap into the right intervertebral foramens between C7, C8 and T1 vertebrae. The left foramens served as controls. The cats underwent CT examination on the 2nd, 4th, 8th and 12th postoperative week to show the foramen changes. Six randomly selected cats underwent magnetic stimulation MEP each time on the 2nd, 4th, 8th, 12th and 24th week. The injuries to the compressed nerve roots were assessed according to Mackinnon Standard and they were compared with the MEP wave.MAIN OUTCOME MEASURES: Whether the superficial magnetic stimulated MEP monitoring result was in correspondence with the pathological changes of the chronically compressed nerve roots.RESULTS: The MEP did not show any abnormal changes for Grade Ⅰ injury prolonged to 9.6- 10. 2 ms. There was almost no evoke potential at all stimulation points for grade Ⅴ nerve root injury.CONCLUSION: That the injured nerve root presents dysesthesia and normal MEP results suggests grade Ⅰ injury. Prolonged latency including prolonged F wave suggests grade Ⅱ injury. And additional amplitude decrease together with widened and unclassifiable waves implies the injury be grade Ⅲ. The prominent features of grade Ⅳ nerve injury is much more decreased amplitudes and more prolonged latency. For grade Ⅴ injury there is always disappearance of whole MEP or some potential components. The superficial magnetic stimulated MEP monitoring results are in correspondence with the pathological changes of the nerve roots due to chronic compression, which means MEP monitoring results could serve as the quantitative indication to pathological changes of nerve injury.

BACKGROUND: Many clinical cases have proved that the satisfactory reposition, fusion and internal fixation in the internal fixation for inferior lumbar spondylolisthesis are not consistent with the postoperative symptoms and physical signs, and functional restoration.OBJECTIVE: To investigate the application of somatosensory evoked potential(SEP) in the monitoring during internal fixation for inferior lumbar spondylolisthesis, and the effects of SEP monitoring on the improvement of postoperative symptoms and the spinal functions as well.DESIGN: A randomized controlled trial.SETTING: Inpatient department of spinal surgery, an affiliated hospital of a university. PARTICIPANTS: Fifty-two patients with inferior lumbar spomlylolisthesis including 23 male and 29 female cases aged between 18 and 68 years old were admitted by the Department of Spinal Surgery, Second Affiliated Hospital(Shenzhen People's Hospital) of Jinan University, from June 2000 to December 2003. All cases were randomly divided into control group(n = 20) and monitor group ( n = 32).METHODS: SEP induced by segmental stimulation in cutaneous nerve was used in the control group for preoperative and intraoperative monitoring, and postoperative follow up. The intraoperative potential changes in patients with excellent and good improvement in postoperative functions had been retrospectively investigated to confirm the effective indices for intraoperative monitoring, which thereby provided references for intraoperative monitoring in patients of monitor group.MAIN OUTCOME MEASURES: ① Evaluation of postoperative spinal function; ② SEP latency and amplitude.RESULTS: SEP values after postoperative anesthesia were set as basis.The manifestations of intraoperative potential alterations: ① If the latency reduced 10% -15% or the amplitude increases more than 40% after fixation, it suggested favorable prognosis; ② The potential indices were stable during monitoring, or the reduction of latency was less than 10%,or the increase of amplitude was less than 30%, the fixation could be continued, and partial functions of nerve root and symptoms could be improved after surgery; ③ During the surgery, if potential indices had transient lluctuation, which could be recovered to basic potential within 15 to 20 minutes, fixation should be stopped during the fluctuation. Still partial functions of nerve root and symptoms could be improved after surgery; ④If the intraoperative latency prolonged more than 5%, or amplitude reduced more than 10%, or part of the components disappeared, or the wave shape dispersed, it might suggest postoperative aggravation of pain and dyskinesia. So intraoperative adjustment was necessary. The coincident rate of the improvement of the indices of intraoperative monitoring and the improvement of postoperative spinal function reached 93.75%.CONCLUSION: SEP induced by segrmental stimulation in cutaneous nerve is an objective and effective method in the monitoring and instruction of decompression, reposition, fixation of internal fixation for inferior lumbar spondylolisthesis, which has important merits in the improvement of the function of nerve root and the restoration of spinal function.

OBJECTIVE: To review endonasal endoscopic surgeries aided by Fusion image guided system, and to explore the application value of Fusion image guided system in endonasal endoscopic surgeries. METHOD: Retrospective research. Sixty cases of endonasal endoscopic surgeries aided by Fusion image guided system were analysed including chronic rhinosinusitis with polyp (n = 10), fungus sinusitis (n = 5), endoscopic optic nerve decompression (n = 16), inverted papilloma of the paranasal sinus (n = 9), ossifying fibroma of sphenoid bone (n = 1), malignance of the paranasal sinus (n = 9), cerebrospinal fluid leak (n = 5), hemangioma of orbital apex (n = 2) and orbital reconstruction (n = 3). RESULT: Sixty cases of endonasal endoscopic surgeries completed successfully without any complications. Fusion image guided system can help to identify the ostium of paranasal sinus, lamina papyracea and skull base. Fused CT-CTA images, or fused MR-MRA images can help to localize the optic nerve or internal carotid arteiy . Fused CT-MR images can help to detect the range of the tumor. It spent (7.13 ± 1.358) minutes for image guided system to do preoperative preparation and the surgical navigation accuracy reached less than 1mm after proficient. There was no device localization problem because of block or head set loosed. CONCLUSION Fusion image guided system make endonasal endoscopic surgery to be a true microinvasive and exact surgery. It spends less preoperative preparation time, has high surgical navigation accuracy, improves the surgical safety and reduces the surgical complications.
Cerebrospinal Fluid Leak ; surgery ; Endoscopy ; instrumentation ; Fibroma, Ossifying ; surgery ; Humans ; Nasal Surgical Procedures ; methods ; Neurosurgical Procedures ; Nose ; pathology ; Papilloma, Inverted ; surgery ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Sinusitis ; surgery ; Sphenoid Bone ; pathology ; Surgery, Computer-Assisted ; methods

Objective To investigate the surrounding and central dosimetric distribution difference of the same activity, same number of 125I seeds. Methods 3D treatment planning system (3D-TPS) was used to separately sketch out 7 cubes with side length of 2 cm, 2.5 cm, 3 cm, 3.5 cm, 4 cm, 4.5 cm and 5 cm;simulations of different tumor sizes were established, into which 125I seeds with activity of 0.5 mCi were respectively loaded. All seeds were distributed at the periphery of the tumor (peripheral group) with the prescribed dose of 145 Gy. The dose volume histogram (DVH) was printed and the 90% of target volume absorbed dose (D90), 90% of prescription dose coverage target volume percentage (V90), the maximum dose and mean dose were determined. Then the seeds in every cube were distributed into the center (central group) and the above parameters were calculated by using the same method. Results The mean D90 of the peripheral and central group was (147.29 ±0.58) Gy and (106.08 ±9.40) Gy respectively, the difference between the two groups was statistically significant (t=-4.292, P=0.005). The mean V90 of the peripheral and central group was (95.46±0.44)% and (79.07±4.19)% respectively, the difference between the two groups was statistically significant (t=-3.831, P=0.009). The mean maximum dose of the peripheral and central group was (1 224.65 ±12.7) Gy and (1 532.48 ±48.54) Gy respectively, the difference between the two groups was statistically significant (t=6.823, P=0.000). The mean value of average dose of the peripheral and central group was (192.14 ±2.89) Gy and (179.81 ±5.40) Gy respectively, the difference between the two groups was statistically significant (t=-2.847, P=0.029). Conclusion The dose distribution is directly influenced by the distribution pattern of the 125I seeds. When the number and activity of the 125I seeds are the same, the peripheral seeds implantation has a better dose distribution.

Objective To discuss the feasibility, efficacy and complications of CT-guided 125I seed implantation for the treatment of lymph node metastasis nearby the iliac vessels.Methods The clinical data of twelve patients with para-iliac vessel lymph node metastasis, who had been treated with CT-guided 125I seed implantation, were retrospectively analyzed. A total of 12 lesions were detected; the diameter ≤6 cm was seen in seven lesions, and the diameter >6 cm was seen in five lesions. Using computer treatment planning system, the source distribution was calculated. Under CT guidance 125I seeds with the activity of 0.4-0.7 mci were implanted into the metastatic lymph nodes with a seed interval of 0.5-1.0 cm. CT scan was performed immediately after implantation to check the distribution of seeds as well as the possible complications. After the treatment, D90 (90%prescription dose received by target volume) was ≥75 Gy in 6 patients and <75 Gy in other 6 patients. Two months after the treatment CT reexamination was employed, and imaging evaluation was conducted according to WHO Response Evaluation Criteria in Solid Tumors. Results CT-guided 125I seed implantation was successfully accomplished in all 12 patients. Two months after the treatment, the evaluation of the therapeutic effect showed that complete remission (CR) was obtained in 0 patient, partial remission (PR) in 8 patients, stable disease in 3 patients and progress disease in one patient;and the total effect rate(CR+PR) was 66.7%. The local control rate was 91.7%. In eight patients the pain that was caused by metastatic lymph nodes was significantly relieved within 1-14 days after 125I implantation treatment. Before the treatment three patients had lower limb edema, and in two of them the lower limb edema was obviously relieved within 1-14 days after the treatment. All patients were followed up for 3-39 months, and the median follow-up time was 11 months. One-year survival rate was 41.7%. No severe complications such as massive hemorrhage, infection, myelosuppression or seed displacement occurred. Conclusion For the treatment of para-iliac vessel lymph node metastasis, CT-guided 125I seed implantation is safe and feasible. Better curative effect may be achieved when the diameter of the metastatic lymph node is<6 cm and the peripheral radiation dose is>75 Gy.

Objective To investigate the dose distribution of esophageal stents carrying different diameters of radioactive 125I seeds in tumor target area. Methods A laser scanner was used to scan a piece of blank paper on which circles of 12 mm, 14 mm and 16 mm diameter and a 5 cm scale were drawn. The data were stored in JPEF format on the computer desktop. According to the circular diameter, simulations of the corresponding esophageal stents were established, which were divided into group A, group B and group C. By using image conversion program, 17 images with 5 mm slice-distance were created for each group; the images were transmitted to the computer treatment planning system (TPS) to simulate the 8 cm long esophageal stents of different diameters. TPS was used to sketch the gross tumor volume (GTV) in order to simulate the esophageal stent border that was used as the inner boundary of GTV, which was expanded 0.5 cm outward to be used as the external boundary of GTV. Beginning from the fifth level, the 4 cm-long GTV was drawn with circles. Setting the same prescription dose, from the fifth level to the thirteenth level the 125I seeds with 0.3, 0.4, 0.5, 0.6, 0.7, 0.8 and 0.9 mCi were successively loaded on the simulation of the esophageal stents. The distance between 125I seed layers was 1 cm; the average number of seeds distributed on each layer was 4 particles. The dose volume histogram (DVH) was obtained. The D90 (the dose received by 90% of the target) and V90 (the percentage of the GTV volume receiving 90% the prescription dose) were recorded.Result s The arithmetic mean D90 of group A, B and C was (77.24 ±19.92) Gy, (69.56 ±25.27) Gy and (56.38±20.08) Gy respectively, and no statistically significant differences existed between each other among the three groups (F=0.84,P=0.44). The V90 of group A, B and C was (77.76±30.73)%,(76.79±25.92)%and (64.10 ±32.49)% respectively, and no statistically significant differences existed between each other among the three groups (F=0.46,P=0.64). Conclusion When the diameter of radioactive esophageal stent is 12 mm, the activity of 125I seed of 0.6 mCi is recommended. When the diameter of radioactive esophageal stent is 14 mm or 16 mm, the activity of 125I seed of 0.7 mCi is recommended. Nevertheless, when the diameter of radioactive esophageal stent is 16 mm, distribution of every five 125I seeds on each layer is strongly recommended. These three kinds of esophageal stent diameter have no significant effect on the dosimetric parameters.

Objective To investigate the safety and feasibility of different puncturing approaches in the performance of CT-guided 125I seed implantation for the treatment of retroperitoneal malignant tumors. Methods The clinical data of twenty-five patients with retroperitoneal malignant tumors, who had underwent CT-guided 125I seed implantation, were retrospectively analyzed. The puncturing approaches included trans-hepatic route, trans-gastric route, trans-duodenal route, and through mesentery and through thoracolumbar iliocostalis. The malignant tumors included retroperitoneal lymph node metastases (n=21) and pancreatic cancer (n=4). Preoperative full bowel preparation was carried out in all patients, and treatment planning was formulated by using treatment planning system (TPS) before the procedure. Under CT guidance, proper puncturing approach was selected according to lesion's location. One to 3 needles were used to implant 125I seeds. Immediately after 125I seed implantation, CT scanning was performed to check the distribution of 125I seeds. Results CT-guided 125I seed implantation was successfully completed in all patients. The puncturing approaches used in this series included trans-hepatic route (n=21), trans-gastric route (n=9), trans-duodenal route (n=2), through mesentery (n=2) and through thoracolumbar iliocostalis (n=5). After the operation, no procedure-related complications such as bleeding, peritonitis, hematemesis or melena occurred in all patients. The postoperative 125I particle number, total activity and peripheral dose (D90) were not significantly different from the preoperative data. Conclusion The use of the five puncturing approaches mentioned above is clinically safe and feasible. Strict perioperative management measures should be carefully executed when through cavity organ implantation is employed.

Objective To explore the dosimetric effects of the same number and activity of radioactive 125I seeds in different plane arrangements. Methods Simulated 9 distribution modes using 9 125I seeds were designed by three- dimensional treatment planning system (3D- TPS), and the isodose curves of 60 Gy, 80Gy, 130 Gy, 145 Gy and 200 Gy were obtained. The areas enclosed by the isodose curves, the longer and shorter radius of these isodose curves and the medical cost per unit area were calculated with the professional image analysis software. Results Obvious differences in areas enclosed by the isodose curves, the longer and shorter radius of these isodose curves and the medical cost per unit area existed between each other among the nine different distribution modes of 9 125I seeds. The distribution modes that had the maximum areas enclosed by 60 Gy, 80 Gy, 130 Gy, 145 Gy and 200 Gy isodose curves were x1.5y1.5, x1y1.5, x1y1, x1y1 and x0.5y1, respectively, with the corresponding areas of 1 583.86 mm2, 1 146.03 mm2, 768.30 mm2, 621.85 mm2 and 480.97 mm2, respectively. Conclusion The peripheral dose and the therapeutic efficacy are significantly influenced by the arrangement of 125I seeds when the same number and activity of the seeds are used. The dose distributions are more homogeneous when the maximum areas enclosed by the isodose curves are obtained.

Objective To study the causes of reoperation after biliary duct operation, in order to decreasing the rate of biliary tract reoperation. Methods The clinical data of 828 patients who underwent reoperation of biliary duct diseases in Nankai hospital between 1990-1999 were evalated, and the causes of biliary duct reoperation were classified and analysed.Results The most common cause for reoperation was recurrent or retained bile stone(65.10% ), bile stone companied by stenosis of the sphincter of oddi (33.82%), simple stenosis of sphincter of Oddi ( 9.54%), traumatic stricture of bile duct and stricture of bilioenteric anastomosis( 10.39%), bile duct obstruction due to tumor (6.52%), and other less important factors. Conclusions Recurrent or retained bile duct stone was the main cause for biliary reoperation,and stenosis of the sphincter of Oddi was the next important factor for reoperations.Thoroughness of the initial operation and rationality of operative procedure are the chief factors to decrease bile duct reoperations.