Objective To establish an experimental subarachnoid hemorrhage(SAH)model with endo- cerebrovascular peroration.Method The right external carotid artery of SD rats were isolated,leaving a stump of approximately 3 to 4 mm.A-3-O monofilament nylon suture was inserted up through the stump of external carotid artery to the internal carotid artery for about 18～19 mm.A small resistance was usually felt,and the suture was then advanced 2 mm further and the suture was immediately withdrawn.Two hours or two days after SAH induction,SAH extension was observed.Two days after SAH induction,the diameter of the basilar artery was measured.Results SAH extends from the ipsilateral artery to the eontralateral artery after SAH induction.The diameters of basilar arteries in SAH animals were smaller than those of control rats,indicating the present of cerebrovascular spasm in SAH animals.Conclusions The endo-cerebrovascular perforation technique for establishing a non-craniotomy SAH model is reliable.

Cell Proliferation ; Colony-Forming Units Assay ; Glioma ; pathology ; Hematopoietic Stem Cells ; pathology ; Humans ; Stem Cells ; cytology ; metabolism

OBJECTIVETo investigate the anti-tumor effect of dendritic cells (DC) pulsed with G422 glioblastomas RNA in mice bearing intracranially G422 glioblastomas.

METHODSDCs were pulsed in vitro with glioblastomas G422 cell RNA. The tumor-bearing mice were injected intratumorally or subcutaneously with pulsed DCs, PBS, non-pulsed DCs. The survival duration of mice was recorded. Serum levels of cytokine IFN-gamma, IL-2, IL-10, IL-4 were detected. Pathological examination was performed.

RESULTSThe survival duration of mice with DC-based vaccine increased significantly(P<0.01). The serum IFN-gamma level was increased (P<0.01) and IL-10 level was decreased (P<0.05) after treatment. Pathological examination showed necrotic tumor in the treatment mice.

CONCLUSIONDC vaccination can significantly increase survival duration of mice with intratumoral or subcutaneous administration of vaccines.

Animals ; Brain Neoplasms ; immunology ; therapy ; Cancer Vaccines ; immunology ; Dendritic Cells ; immunology ; transplantation ; Glioblastoma ; immunology ; therapy ; Immunotherapy ; methods ; Mice ; RNA, Neoplasm ; immunology ; Random Allocation ; T-Lymphocytes, Cytotoxic ; immunology

PURPOSE: To describe the therapeutic effect and possibility of the ultra-early surgery for poor-grade aneurysmal subarachnoid hemorrhage (Hunt-Hess grades IV - V). MATERIALS AND METHODS: Nine cases with intracranial aneurysms, demonstrated by computed tomographic angiography (CTA), were treated by ultra-early surgery under general anesthesia within 24 hours from subarachnoid hemorrhage (SAH), 5 cases were treated within 6 hours and 4 cases in 6 - 24 hours. Preoperative Hunt-Hess grade: 6 cases were IV and 3 cases were V. The clinical outcome was evaluated by Glasgow Outcome Scores (GOS). RESULTS: In operation, difficult dissection occurred in 5 cases (55.6%), and rupture of aneurysm occurred and temporary obstructions were performed in 4 cases (44.4%). After clipping of aneurysm, 2 cases underwent V-P shunt because of hydrocephalus, pulmonary infection occurred in 3 cases, hypothalamus reaction accompanied with upper gastrointestinal hemorrhage in 2 cases. The clinical outcome were favorable (GOS 4 - 5) in 4 cases (44.4%), dissatisfied (GOS 2 - 3) in 3 cases (33.3%), and dead (GOS 1) in 2 cases (22.2%) when patients departed from our hospital. CONCLUSION: The ultra-early surgery can avoid early rebleeding of intracranial aneurysm, therefore, should be considered in the treatment of Hunt-Hess grade IV-V intracranial aneurysms. The appliance of CTA can make it possible to use of ultra-early surgery and improve the therapeutic effect.
Adult ; Aged ; Cerebral Angiography ; Female ; Humans ; Intracranial Aneurysm/pathology/*surgery ; Male ; Middle Aged ; Subarachnoid Hemorrhage/pathology/*surgery

OBJECTIVETo investigate the role of large decompressive craniectomy (LDC) in the management of severe and very severe traumatic brain injury (TBI) and compare it with routine decompressive craniectomy (RDC).

METHODSThe clinical data of 263 patients with severe TBI (GCS < or = 8) treated by either LDC or RDC in our department were studied retrospectively in this article. One hundred and thirty-five patients with severe TBI, including 54 patients with very severe TBI (GCS < or = 5), underwent LDC (LDC group). The other 128 patients with severe TBI, including 49 patients with very severe TBI, underwent RDC (RDC group). The treatment outcome and postoperative complications of the two treatment methods were compared and analyzed in a 6-month follow-up period.

RESULTSNinety-six patients (71.7 %) obtained satisfactory treatment outcome in the LDC group, while only 75 cases (58.6 %) obtained satisfactory outcome in the RDC group (P < 0.05). Moreover, the efficacy of LDC in treating very severe TBI was higher than that of RDC (63.0 % vs. 36.7 %, P < 0.01). The chance of reoperation due to refractory intracranial pressure (ICP) in the LDC group was significantly lower than that of the RDC group (P < 0.05), while the incidences of delayed intracranial hematoma and subdural effusion were significantly higher than those of the RDC group ( P < 0.05).

CONCLUSIONSLDC is superior to RDC in improving the treatment outcome of severe TBI, especially the very severe ones. LDC can also efficiently reduce the chances of reoperation due to refractory ICP. However, it increases the incidences of delayed intracranial hematoma and contralateral subdural effusion.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Injuries ; surgery ; Child ; Child, Preschool ; Craniotomy ; adverse effects ; Decompression, Surgical ; adverse effects ; Female ; Humans ; Infant ; Intracranial Pressure ; Male ; Middle Aged

OBJECTIVETo evaluate the clinical characteristics and present the experience in the treatment of patients with penetrating craniocerebral injury (PCCI).

METHODSThe data of 7 cases with PCCI by foreign body were retrospectively studied and compared with associated literatures. The strategies of diagnosis and treatment of PCCI were analyzed. In this series, 3 cases underwent emergency debridements and 4 cases underwent craniotomies. All patients received surgical intervention within 3 hours after admission.

RESULTSOutcomes were good in 3 cases, moderate disability was in 2 cases, severe disability in 1 case and persistent vegetative state in 1 case. One case developed wound and intracranial infection, but made good recovery after treatment. During the follow-up period, one patient died one month after discharge and other six patients (range from 8 months to 3 years) recovered well and no epilepsy, leakage of cerebrospinal fluid (CSF), or traumatic vascular disease occurred.

CONCLUSIONSEarly diagnosis and prompt debridement are the fundamental factors affecting the outcome of PCCI. CT scans are the mainstay in evaluating PCCI and three dimensional (3D) images reconstructed from spiral CT scans provide more information. Efficient debridement should be performed as early as possible. Minimizing the degree of surgical management of PCCI is preferred when there is no indication for aggressive operation. It is important to stress the rapid and effective management of CSF leakage in early stage of PCCI. Use of prophylactic broad-spectrum antibiotics is recommended for patients with PCCI. Traumatic vascular injury should be paid attention to after PCCI.

Adolescent ; Adult ; Anti-Bacterial Agents ; Child ; China ; Combined Modality Therapy ; Craniotomy ; methods ; Drug Therapy, Combination ; therapeutic use ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Head Injuries, Penetrating ; diagnosis ; therapy ; Humans ; Injury Severity Score ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Risk Assessment ; Sampling Studies ; Tomography, X-Ray Computed ; Treatment Outcome

Bias ; Confounding Factors (Epidemiology) ; Epidemiologic Methods ; Humans

OBJECTIVETo investigate the relationship between the expression of endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF) and angiogenesis in primary astrocytoma.

METHODSThirty-seven primary astrocytomas and 4 astrocytic hyperplasia samples were collected and divided into three groups according to histological grade. The expression of eNOS, VEGF and factor VIII related antigen (FVIIIRAg) were assayed by immunohistochemistry. Microvascular density was assessed by FVIIIRAg immunoreactivity. The intensity of immunoreactivity was graded according to the percentage of positive tumor cells.

RESULTSNo eNOS and VEGF were expressed in the astrocytes and vascular endothelium in astrocytic hyperplasia. The expression of eNOS or VEGF was light in low-grade astrocytoma and strong in glioblastoma. eNOS expression in astrocytoma was very positively correlated with VEGF. eNOS and VEGF expression in anaplastic astrocytoma was median in contrast to the low grade astrocytoma and glioblastoma. Lower microvascular density was found in low grade astrocytoma than that in higher grade malignant ones. The expressions of eNOS and VEGF were correlated with microvascular density and tumor malignancy.

CONCLUSIONThis finding suggests that eNOS and VEGF may have cooperative effect in tumor angiogenesis and play an important role in the pathogenesis of primary astrocytoma.

Adolescent ; Adult ; Aged ; Astrocytoma ; blood supply ; metabolism ; Biomarkers, Tumor ; metabolism ; Child ; Child, Preschool ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Male ; Middle Aged ; Neovascularization, Pathologic ; metabolism ; pathology ; Vascular Endothelial Growth Factor A ; metabolism

Uterine leiomyosarcoma is an uncommon malignant neoplasm of smooth muscle origination and is associated with a poor prognosis. We report two cases of uterine leiomyosarcoma that presented with pulmonary metastases. 2-deoxy-2-(¹⁸F)fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) was performed to identify the primary carcinoma and found the focus located in the uterus. The follow-up magnetic resonance imaging (MRI) confirmed the diagnosis was uterine leiomyosarcoma.
Adult ; Female ; Fluorodeoxyglucose F18 ; Humans ; Leiomyosarcoma ; diagnosis ; Magnetic Resonance Imaging ; methods ; Middle Aged ; Positron-Emission Tomography ; methods ; Tomography, X-Ray Computed ; methods ; Uterine Neoplasms ; diagnosis

OBJECTIVETo evaluate the response rate and adverse reactions of exemestane (a new aromatase inactivator) in the treatment of postmenopausal women with advanced breast cancer.

METHODSOne hundred and seventy-three patients with advanced breast cancer entered this study with two patients excluded because of postmenopausal time being less than one year. Therefore, 173 patients could be evaluated for adverse events and 171 patients could be evaluated for efficacy. Exemestane, 25 mg orally daily for 4 weeks as one cycle was given.

RESULTSIn the 171 patients evaluated for efficacy, 4 (2.3%) experienced a complete response (CR) and 40 (23.4%) a partial response (PR), with the overall response rate of 25.7%. Ninety patients (52.6%) had stable disease (SD), with 25 having SD for at least 24 weeks. The clinical benefit (CR + PR + SD > or = 24 weeks) was shown in 69 (40.4%) patients. Progressive disease (PD) was shown in 37 (21.6%) patients. The untreated patients had a higher objective response rate (33.8%) than the retreated ones (18.1%) with significant difference (P = 0.019 7). The response rates for soft-tissue, bone involvement and visceral metastasis were 32.8%, 23.9%, and 12.4% (P = 0.002). There was no significant difference in different ages, time of menopause, disease-free interval or receptor status (P > 0.05). Drug-related adverse events were gastric discomfort (17.9%), malaise (17.9%), nausea (13.9%), hot flushes (11.0%) and dysphoria (5.8%). Other side reactions and abnormal laboratory parameters were observed occasionally which were irrelevant.

CONCLUSIONExemestane can be used to treat postmenopausal women with advanced breast cancer giving only mild adverse reactions which are well tolerated.

Adult ; Aged ; Androstadienes ; adverse effects ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Aromatase Inhibitors ; Breast Neoplasms ; drug therapy ; Enzyme Inhibitors ; therapeutic use ; Female ; Humans ; Middle Aged ; Postmenopause