Intracranial aneurysms are a severe cerebrovascular disease.Its incidences ranged from 2% to 4% in general population.With the population aging and the development of imaging technique,the prevalence of intracranial aneurysm is increasing year by year.The research of natural course of aneurysm has important significance for neurosurgeons to evaluate the validity of therapeutic measures.There are significant differences between the patients with aneurysm who have had subarachnoid hemorrhage and those who have not.The rates of ruptured intracranial aneurysms per year ranged from 0.066% to 2%.The risk factors that affect ruptured intracranial aneurysms including the size and place of aneurysm,whether it is multiple aneurysms or not,growth rate,and self-factors of patients,such as age,sex,and history of hypertension and smoking,etc.

BACKGROUND: Disoprofol has anti-apoptosis impact so that it can protect the neurons from damage caused by ischemia. However, it needs further study on the mechanism of anti-apoptosis of it. OBJECTIVE: To investigate the effects of disoprofol to cell apoptosis and expression of apoptosis-associated gene in rats during reperfusion after global ischemia.DESIGN: A randomized controlled trial.SETTING: Department of Neurosurgery of Beijing Tiantan Hospital.MATERIALS: The experiment was conducted in Beijing Neurological Surgery Research Institute of Capital University of Medical Sciences during January 2003 to January 2004. A total of 23 adult male Wistar rats were randomly divided into ischemic group( n =9), disoprofol group( n =9) and sham operation group( n = 5).INTERVENTIONS: To prepare global ischemia-reperfusion model of rats. Disoprofol was injected into vein with dose of 1.5 mL/hour after reperfusion started in disoprofol group and lasted for 30 minutes. Five rats were selected from each group to be removed brain after reperfusion for 24 hours. Apoptosis rate and necrosis rate were detected by flow cytometer. Four rats selected from ischemic and disoprofol group were detected differential expression of apoptosis associated genes by gene chip combining image analysis techniques.MAIN OUTCOME MEASURES: ① apoptosis rate and necrosis rate; ②expression of apoptosis-associated gene detected by gene chip.RESULTS: The apoptosis rate[(7.01 ±0.79)% ] and necrosis rate[ ( 12. 80 ± 0. 92) % ] of neurons of hippocampus in disoprofol group were much lower than those of ischemic group [ (10. 89 ± 0. 80)%, (16. 67 ± 1.04)% ](P ＜ 0.01) . Compared with ischemic group, the three apoptosis associated genes including apoptotic prote ase activating factor 1 (APAF1), death effector domain containing testicular molecular mRNA(DEFT) and STM-2 were down regulated.CONCLUSION: Disoprofol can protect the brain and its mechanism might be related to the down regulation of three apoptosis associated genes including APAF1, DEFT and STM-2.

Objective To study the characteristics of Ag NORs in the peripheral blood T lymphocytes (PBL) of patients with intracranial tumors. Methods Ag NORs in PBL was detected by a cell image analysis of KL 2 in 40 normal volunteers and 79 patients(intracranial benign tumor group, 27 patients;intracranial malignant tumor group, 20; other malignant tumors group, 32). Results Ag NORs in the intracranial benign tumor group was (6.42%?0.16)%, lower than (7.87%?0.10)% in the normal group that ( P

This study was made in order to esablish the method of the stature estimation of Chinese fe- males by measurement of the lumbar vertebrae.10 measurements for 37 lumbar vertebrae form Chinese fe- males of known age and stature were measured by the anthropometry.The analysis of the correlation be- tween the measurement results and the stature as well as the regression equations were made with the SPSS soft wear.The regression equations for the stature estimation of the Chinese females were as followsL1-5. L_1:Y= 592.010+0.161X_1+16.596X_2+13.922X_4+3.428X_5;r=0.751;s=45.0171.L_2:Y=641.280+19.733X_2- 0.420X_5+9.981X_6;r=0.698;s=48.2804.L_3:Y=516.200+26.079X_2+8.081X_6;r=0.758;s=43.3508.L_4:Y =1071.436+11.1133X_5;r=0.497;s=56.0890.L_5:Y=1111.890+4.17820X_5+10.335X_9;r=0.606;s= 53.3158.The regression equations can be used for the stature estimation of Chinese females.

Objective To investigate the therapeutic efficacy and side effect of regional blockade using diprospan combined with oxycodone and acetaminophen taking orally which called balanced analgesia on severe tension-type headache. Methods 32 patients diagnosed as severe tension-type headache were treated with regional blockade using diprospan mixed with 0.4% lidocaine, combined with oxycodone and acetaminophen. The severity of pain (using numeric rating scales, NRS) and the duration of headache were observed and the side effects were recorded. Results There was a significant decrease in the severity of pain and the duration of headache after treatment compared with those before (P<0.01). No serious side effects were observed. Conclusion The balanced analgesia therapy mainly including regional blockade and oxycodone and acetaminophen can be significantly effective on the severe tension-type headache.

Objective Moyamoya disease is a progressive cerebrovascular occlusive disease. The etiology of the disease is unknown. most think that Moyamoya usually presents with cerebral ischemia in children and intracranial hemorrhage in adults. But we have some adults present with cerebral ischemia .This article will help us know better about moyamoya disease in adults present with cerebral ischemia. And will let us know better about treatment and prognosis of this disease.Methods We reviewed our experience 88 adults angiographically diagnosed patients with moyamoya. There are 49 patients with moyamoya disease initially present with cerebral ischemia. We report their clinical presentation, radiological findings, management, and clinical outcomes. Results The incidence of moyamoya disease presents with cerebral ischemia is 55.7% in adults .The mean age of patients at symptom onset was 32 years (range, 18~64 years). Ischemic strokes or transient ischemic attacks were the predominant initial presentations.7 cases present intracranial haemorrhage in follow-up period. There was no difference in clinical representation, image and cerebral infarction in this 7 case.Conclusions Moyamoya usually presents with cerebral ischemia in adults higher than we think. diagnosis and treatment of moyamoya disease in adults is essential to minimize residual mental and physiologic deficits. If we find patients 30-40 years old ,with cerebral infarction that can’t explain in conventional mode, we should pursuit these patients, in order to exclude Moyamoya disease .Structured multicenter randomized clinical trials are needed to further assess the best treatment modalities for patients with moyamoya.

BACKGROUND: Cerebral vascular spasm is the main complication of intracranial aneurysm during perioperative period. Anesthesia of clamp operation of intracranial aneurysm not only meet the basic requirement of anesthesia, but also prevent cerebral vascular spasm and protect cerebral function possibly.OBJECTIVE: To observe the changes of angiotensin Ⅱ and endothelins of paitents with intracranial aneurysm under the anesthesia of desflurane during the clamp operation so as to discuss the effect of desflurane on cerebral protection.DESIGN: Case analysis.SETTING: Department of Neurosurgery and Department of Anesthesiology of Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences.PARTICIPANTS: Totally 64 patients, 30 males and 34 females, who were prepared for clamp operation of intracranial aneurysm, were selected from Department of Neurosurgery of Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences between October 2002 and June 2004.METHODS: After anesthesia induction, tracheal cannula was used to control respiration and desflurane was used to maintain the anesthesia. Totally 4 mL arterial blood were collected at the four time points: before anesthesia induction, cutting dura mater, clamp aneurysm and 30 minutes after clamp aneurysm. Levels of angiotensin Ⅱ and endothelins in plasma were assayed with radioimmunoassay.MAIN OUTCOME MEASURES: Levels of angiotensin Ⅱ and endothelins at the four time points: before anesthesia induction, cutting dura mater,clamp aneurysm and 30 minutes after clamp aneurysm.RESULTS: Aneurysm of two patients was disrupted during the operation of angiotensin Ⅱ was ranged normally before operation, and that at the other three time points during the anesthesia of desflurane did not changed endothelins: Level of endothelins at the three time points of cutting dura mater, clamp aneurysm and 30-minutes after clamp aneurysm was lower than that at the time point of pre-an esthesia induction [(40.4±10.3),(40.0±9.6), (40.7±12.3), (49.3±12.7) ng/L, (P=0.002, 0.001, 0.009)].CONCLUSION: Levels of angiotensin Ⅱ and endothelins which anesthetizes by desflurane are not increased during the whole clamp operation of intracranial aneurysm. However, level of endothelins is obviously lower than that at the time point of pre-anesthesia induction, and there is not significantly different from that at various time points of the operation. This suggests that anesthesia of desflurane can avoid the onset of acute cerebral vascular spasm induced by the increasing liberation of angiotensin Ⅱ and endothelins and decrease the onset of secondary cerebral ischemic injury so as to protect brain.

BACKGROUND: Cerebral ischemia and reperfusion affects not only cellular necrosis at acute stage, but also delayed neuronal apoptosis in central neural system.OBJECTIVE: To observe apoptosis rate, necrosis rate and expression of Bcl-2 and Bax apoptpsis-regulating proteins in hippocampal neurons at various reperfusion stages of complete cerebral ischemia in rats so as to probe into the regulation of injury induced by complete cerebral ischemia and reperfusion.DESIGN: Randomized control experiment.SETTING: Department of Neurosurgery and Department of Anesthesiology in Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences.MATERIALS: The experiment was performed in Beijing Institute of Neurosurgery Affiliated to Capital University of Medical Sciences from January 2003 to January 2004. Totally 33 healthy adult male Wistar rats of clean grade were employed, randomized in 5 groups, named ischemia +reperfusion 24 hours group (24 hours group) (7 rats), ischemia + reperfusion 48 hours group (48 hours group) (7 rats), ischemia + reperfusion 72hours group (72 hours group) (7 rats), ischemia + reperfusion 7 days group (7 days group) (7 rats) and sham-operation control (control) (5 rats).INTERVENTIONS: Model of complete cerebral ischemia and reperfusion was prepared in rat. Cerebral hippocampal tissues were collected in 24, 48,72 hours and 7 days after reperfusion successively. The flow cytometer was used to determine cellular apoptosis rate and necrosis rate and expression of Bcl-2 and Bax proteins in cerebral hippocampal neurons in rats.percentages of Bcl-2 and Bax proteins.hippocampal neurons in 7 days group was the highest [(24.59±0.97) %].The peak value of necrosis rate presented in 24 hours group [(16.67±1.04)%], which was remarkably higher than the control [(1.28±0.50)%,low [(1.07±0.27)%], but high expression of Bax presented [(46.09±5.37)%].and reperfusion [(14.41±0.67)%] and the peak value of Bax protein presented in 72 hours after ischemia and reperfusion [(77.38±1.52)%].CONCLUSION: Hippocampal neuronal apoptosis rate is increased gradually and expression of Bcl-2 and Bax apoptosis-regulating genes was increased abnormally after injury induced by complete cerebral ischemia and reperfusion, which suggests that Bcl-1 and Bax proteins are involved in apoptosis regulation in the injury induced by complete cerebral ischemia and reperfusion.

BACKGROUND: Quiet a number of researches has reported the morphological changes of global ischemic reperfusion model. However, there are few reports on the ultrastructural changes of cortex in early reperfusion, especially the change of blood brain barrier.OBJECTIVE: To explore the changes of brain cortex neurons, glial cells and blood brain barrier in order to provide reliable evidence for clinical treatment.DESIGN: A randomized and controlled trial.SETTING: Department of Neurosurgery, Departnent of Anesthesia and Electron Microscope Room of Beijing Tiantan Hospital.MATERIALS: The experiment was conducted to 6 Wistar rats in Beijing Neurological Surgery Research Institute of Capital University of Medical Sciences during February 2003 to February 2004. The rats were randomly divided into two groups with one of ischemia-reperfusion group and sham operation group with 3 rats in each group.INTERVENTIONS: To prepare global ischemic reperfusion model of rats. Brain was removed from ischemic group in one hour of reperfusion and from sham operation group one hour after the operation. Electronic microscope technique was used to observe the ultrastructural changes of cortex.MAIN OUTCOME MEASURES: Ultrastructural changes of cortex.RESULTS: The neurons of cortex shrank to certain degree in the early stage of ischemic reperfusion(1 hour) . The glial cells were swollen with dissolved chromosome in nucleus and unclear nuclear membrane. The foot protrusions around blood vessel slightly swelled and separated from basement membrane. Mircro-tubes were partially dissolved.CONCLUSION: In early stage of reperfusion injury, the cortex neurons, glial cells, cellular framework and blood brain barrier already changed which suggested that the protective treatment such as reducing brain edema, protecting blood brain barrier should start as early as possible.

OBJECTIVE To determine the distribution and antibiotic resistance of bacteria isolated from cerebral spinal fluid in neurosurgical patients. METHODS Bacterial isolates from cerebral spinal fluid specimens in Department of Neurosurgery,Beijing Tiantan Hospital were collected from Jan 2000 to Dec 2004.Distribution and antibiotic resistance of pathogens were analyzed retrospectively. RESULTS Of 438 isolates,Gram positive cocci and Gram negative bacilli accounted for 72.1%(316 isolates) and 27.9%(122 isolates),respectively.The most frequently isolated pathogen was coagulasenegative staphylococci(53.7%) followed by Staphylococcus aureus(10.5%),Enterobacter spp(6.2%),Acinetobacter spp(6.2%),and Pseudomonas aeruginosa(3.7%).The most active compounds against Gram-negative bacilli were imipenem(87% susceptibility),piperacillin/tazobactam(77%),amikacin(68%),cefepime(64%) and ceftazidime(63% susceptibility).Imipenem,cefepime,ceftazidime,and piperacillin/tazobactam demonstrated excellent activity against most of Gram negative bacilli.In S.aureus and coagulase-negative staphylococci,oxacillin resistance strains accounted for 76% and 100%,respectively. CONCLUSIONS Prevailing pathogens are Gram positive cocci in intracranial infection after neurosurgical operation,especially coagulase-negative staphylococci and S.aureus.Data collected in present study will provide valuable information for prophylactic and empirical antibiotic use in post-operative intracranial infection.