Animals ; Cell Cycle ; drug effects ; Cell Proliferation ; drug effects ; Cells, Cultured ; Ceramics ; pharmacology ; Gene Expression Regulation ; drug effects ; Glass ; Humans ; Osteoblasts ; drug effects ; metabolism ; Osteogenesis ; drug effects

Objective To explore the relevant factors of prognosis of intracranial aneurysms after microsurgical treatment and risk factors of cerebral vasospasm (CVS). Methods Three hundred and twenty-two patients with intracranial aneurysms, admitted to and received surgical treatment in our hospital from June 2006 to May 2009, were chosen in our study; their clinical data were retrospectively analyzed. Logistic regression analysis was employed to analyze the influences of age, gender, blood pressure level, blood sugar level, operation time, Fisher's grade, Hunt Hess grade and infection on the prognosis of patients with intracranial aneurysms and the risk of CVS. Results Multivariate logistic analysis indicated that age, Hunt Hess grade, Fisher's grade, CVS, infection and lumber puncture times were the independent risk factors influencing the prognosis of patients with intracranial aneurysms (P< 0.05). Hunt Hess grade, Fisher's grade, number of aneurysms, endplate colostomy, lumber puncture times and infection were the independent risk factors of CVS (P<0.05). Conclusion Age, Hunt Hess grade, Fisher' s grade, CVS, lumber puncture times and infection are the independent risk factors affecting the prognosis of patients with intracranial aneurysms, among which, CVS is the most important factor. CVS is mainly affected by Hunt Hess grade, Fisher's grade, number of aneurysms, endplate colostomy, lumber puncture times and infection.

OBJECTIVETo report the modified technique and the short-term results of simultaneous pancreas-kidney transplantation (SPK) with the enteric drainage (ED) of exocrine secretions.

METHODSFrom June 2000 to August 2006, thirty-eight patients with diabetes complicated with uremia underwent SPK. The pancreas graft was placed intraperitoneally with exocrine secretions drained into the proximal jejunum without Roux-en-Y procedure. The mean cold ischemic times of pancreas and kidney were (10 +/- 2.0) h and (7 +/- 2.0) h, respectively. Quadruple immunosuppressive therapy with antilymphocyte globulin or anti-CD25 monoclonal antibody, tacrolimus, mycophenolate mofetil and steroids was adopted except one patient.

RESULTSThe 6-month survival rates of patients and grafts were both 97.4% after transplantation. All patients achieved insulin-free euglycemia at (7 +/- 6.9) d postoperative except one. For preoperative patients, mean fasting insulin and C-peptide values were (9 +/- 8.1) mU/L and (6 +/- 4.5) mU/L. After operation, fasting insulin and C-peptide values of patients were (12 +/- 5.8) mU/L and (6 +/- 4.7) mU/L, respectively, which peaked to an insulin level of (57 +/- 43.0) mU/L and a C-peptide level of (11 +/- 6.8) mU/L with stimulation. There were eight cases of delayed renal graft function. All other patients achieved immediate renal graft function. No graft losses occurred due to leakage or intra-abdominal infection. The most common surgical complications were wound infection (n = 12), enteric anastomostic hemorrhage (n = 5) and perirenal hemorrhage (n = 2). Three patients (7.9%) had been reoperated for the reasons of intra-abdominal hemorrhage and perirenal hemorrhage.

CONCLUSIONSSPK is an effective treatment option for selected patients with diabetes mellitus and approaching end-stage renal disease. Enteric exocrine drainage by direct side-to-side anastomosis (without Roux-en-Y) seems to be a simple and reliable technique.

Diabetes Mellitus ; surgery ; Drainage ; methods ; Female ; Follow-Up Studies ; Graft Rejection ; prevention & control ; Graft Survival ; Humans ; Immunosuppressive Agents ; therapeutic use ; Jejunum ; surgery ; Kidney Transplantation ; methods ; Male ; Middle Aged ; Pancreas Transplantation ; methods ; Postoperative Complications ; prevention & control ; Treatment Outcome ; Uremia ; surgery

Child ; China ; epidemiology ; Goiter, Endemic ; epidemiology ; Humans ; Iodine ; deficiency ; Students