Objective: To introduce our experience on endoscopic endonasal transsphenoidal surgery in 46 patients with pituitary adenomas. Methods: Forty-six patients (27 females and 19 males) with a median age of 39 years (range 22-73 years) were enrolled in this study. MRI or CT images showed that the diameters of the tumor were < 1 cm in 9 patients, 1-2 cm in 11, 2-3 cm in 18 and > 3 cm in 8. Thirty-five patients had hormone-secreting adenomas and 11 had non-secreting ones. All patients received endoscopic endonasal transsphenoidal (absence of the transsphenoidal retractor) resection of the tumors and neuronavigation system was used in 3 cases. Results: Total tumor resection was achieved in 35 patients, subtotal in 6 and partial in 5. The operative time was from 1 to 3.5 hours. The postoperative hospitalization time was averagely 4.6 days (from 3 days to 10 days) and there was no operative death or optic nerve injury in our group. During follow-up (1 month to 3.3 years), 21 of the 23 patients with eyesight problems had their visual acuity improved and 24 of the 32 patients with abnormally high levels of hormones had their hormones restored to the normal levels. Two patients received γ-knife surgery after operation and 18 cases received radiation therapy 3 months after operation. Recurrence was found in 1 patient with MRI 1 year later and received neuronavigation-assisted endoscopic reoperation again. Conclusion: The method in this paper, with less operative trauma and complication, provides a satisfactory deep illumination and a panoramic operative field; moreover, it brings us more close to the operative target. All these factors contribute to the rapid recovery of patients.

Biomedical Research ; Humans ; Tai Ji

Catheter Ablation ; methods ; Humans ; Hypertension, Renal ; surgery ; Kidney ; innervation ; surgery ; Sympathectomy

OBJECTIVETo study the ischemic times of the main artery injury in the limbs and the influence on the limbs survival rate, and to analyze the reasons for the formation of the ischemia time.

METHODSFrom June 1996 to November 2012, 83 patients with completely severed limb main artery treated in our hospital were retrospectively studied. There were 77 males and 6 females, including 81 adults (ranging in age from 16 to 52 years old, with a median age of 35 years old) and 2 children (4 and 5 years old respectively). Seventy-five patients were treated with end to end anastomosis, 7 patients were treated with great saphenous vein transplantation, and 1 patient was treated with artificial blood vessel transplantation. The prior to admission ischemia time, after admission ischemia time and total ischemia time for successful and unsuccessful patients, as well as the causes of the formation of the ischemia time were studied. Limb survival rate of different ischemic time was counted. Sharpness injury or blunt injury ischemia time and amputation rate were researched statistically. All data were analyzed using SPSS statistical software.

RESULTSThere were 72 limbs survived, 11 amputated. The average ischemia time was (7.45±5.94) h for limb-salvage group and (13.73±14.00) h for amputation group. Prior to admission ischemia time between amputation and limb-salvage group had no significant difference. After admission the ischemia time in amputation group was longer than limb-salvage group. The amputation rate for ischemia time 21 to 44 h group was higher than other three groups (≤ 5 h, 6 to 10 h, 11 to 20 h) (P=0.023, 0.038, 0.044). Amputation reasons can be divided into anastomosis failure in the operation, vascular thrombosis 2 to 4 days after operation and late infection.

CONCLUSIONVascular injury limbs can tolerate longer ischemia time and the limb salvage succeed. Only too long ischemia time (> 20 h), limb amputation rate increases significantly. The main cause of long time ischemia is delayed diagnosis in the hospital. Whether limb-salvage success mainly depends on the degree of trauma and the quality of the anastomosis than ischemia time.

Adolescent ; Adult ; Amputation ; Extremities ; blood supply ; Female ; Humans ; Ischemia ; surgery ; Limb Salvage ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Vascular System Injuries ; surgery

OBJECTIVETo study the influence of actual defect length and gap width of the limbs main artery on the method selection of repairing and reconstruction.

METHODSRetrospective study was carried out for 32 patients with extremity main artery injury from 1996 to 2009, including 30 males and 2 females; 30 adults with an average age of 36 years old ranging from 18 to 51 years, 2 children of 4 and 5 years old respectively. Injured body parts involved axillary artery in 4 cases,brachial artery in 7 cases,radial artery in 2 cases, femoral artery in 4 cases, popliteal artery in 13 cases, posterior tibial artery in 2 cases. Main arterial injury defect gap width of all cases were observed and the reasons were analyzed. All cases were repaired by the method of end to end anastomosis after vessels stretch.

RESULTSThe artery defect width was 3 cm to 7 cm with an average of (4.375 +/- 1.200) cm. Defect width of the upper extremity brachial artery and axillary artery group was (5.73 +/- 0.63) cm,the lower extremity femoral and popliteal artery group (3.80 +/- 0.73) cm, the posterior tibial artery group (3.25 +/- 0.35) cm, the radial artery group (3.00 +/- 0.00) cm. Defect width of upper extremity brachial artery and axillary artery group was larger than that of the other three groups (P < 0.01). End to end anastomosis was performed successfully in all cases. Blood supply recovered well. Because of the severe limb infection 2 patients had amputation in the late. All patients received follow-up. The patients without fracture were followed up to 2 weeks postoperatively, all patients with fractures were followed up to 1 year at least. Limb blood supply was good in all patients during the follow-up.

CONCLUSIONBlood vessel defect gap width is different from the actual vessel defect, but is larger than the actual vessel defect. Misjudgment of the vascular defect length will lead to more vascular transplantation. The vast majority of vascular defect can be directly repaired by the method of end to end anastomosis after the vessel free and stretch.

Adolescent ; Adult ; Arm ; blood supply ; surgery ; Axillary Artery ; injuries ; surgery ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Retrospective Studies ; Vascular Surgical Procedures ; Young Adult

Objective To study the safety and effectiveness of modified radioactive 125I seed implantation in treatment of lung cancer patients with poor lung function. Methods Thirty one lung cancer patients with poor lung function were enrolled into this study. All of them were implanted 125I seed with technology of fan-shaped distribution and coaxial puncture. Brachytherapy planning system(TPS) was used to draw up a preoperative implantation plan. Fan-shaped seed distribution system was used to simulate surgical program, and implantation pitch was 0.5 to 1.0 cm. Real-time adjustment is necessary during surgery. Dose distributions were checked by TPS immediately after implantation. Match peripheral dose(MPD),the dose of 90% tumor volume(D90)and the tumor volume covered by 90% prescription dose(D90)were calculated. Intraoperative and postoperative surgery-related complications were analyzed. All patients were followed up to 6 months, at month 2, 4 and 6 post-procedure, CT scan was performed to evaluate the local control rate of tumors. Results The technical success rate was 100% for placement of the 125I seed. MPD of the tumors was 90 to 140 Gy. D90 was 95 to 146 Gy,median dose was 118 Gy.V90 was 92%to 97%,median dose was 94%. Surgery-related complications included pulmonary hemorrhage(1 patient), pleural cavity hemorrhage (2 patients), pneumothorax(2 patients). The 2-month, 4-month and 6-monthlocal control rates were 31%(10/32), 78%(25/32) and 90%(29/32)respectively. The overall complete remission(CR) rate was18%(6/32), partial response(PR) rate was 72%(23/32), stable disease(SD)rate was6%(2/32), progression disease(PD) rate was 3%(1/32).Acute radiation pneumonitis Grade 0 in 29 patients, Grade Ⅰin 4 patients; advanced radiation pneumonitis:grade 0 in 30 patients and gradeⅠin 3 patients. Conclusions The technology of fan-shaped distribution and coaxial puncture for radioactive 125I seed implantation was safe and effective to treat lung cancer patients with poor lung function.

Adult ; Female ; Humans ; Male ; Middle Aged ; Palatine Tonsil ; pathology ; Sleep Apnea, Obstructive ; pathology ; surgery ; Tongue ; pathology

Adenocarcinoma, Mucinous ; pathology ; Breast Neoplasms ; pathology ; Carcinoma, Ductal, Breast ; pathology ; Carcinoma, Renal Cell ; pathology ; Carcinoma, Squamous Cell ; pathology ; Cystadenocarcinoma, Mucinous ; pathology ; Cystadenoma, Mucinous ; pathology ; Female ; Giant Cells ; pathology ; Humans ; Osteoclasts ; pathology ; Ovarian Neoplasms ; pathology ; Pancreatic Neoplasms ; pathology ; Thyroid Carcinoma, Anaplastic ; Thyroid Neoplasms ; pathology ; Tongue Neoplasms ; pathology ; Urologic Neoplasms ; pathology

Objective To assess the feasibility for the automated treatment planning verification system Mobius3D (M3D) to perform an independent 3D dose calculation in intensity-modulated radiotherapy (IMRT) for cervical cancer.Methods Twenty patients with cervical cancer were randomly selected.With treatment planning systems (Pinnacle,Version 9.2;Eclipse,Version 13.5),all IMRT plans were divided into 7 fields to meet the dosimetric goals.The optimized plans were exported to the M3D server.The percentage differences in the volume of region of interest (ROI) and the dose calculation of target volume and organ at risk (OAR) were evaluated for the two treatment planning systems,and theγ passing rate was used to assess the accuracy of M3D calculation.Results The difference in the volume of ROI for Pinnacle 9.2 to M3D was less than that for Eclipse 13.5 to M3D,with maximum differences of 0.22％±0.69％ and 3.5％±1.89％ for Pinnacle 9.2 and Eclipse 13.5,respectively.The differences in the dose calculation of target volume and OAR for the two treatment planning systems to M3D were within ± 1％.After recalculating by M3D,the dose difference between Pinnacle 9.2 and M3D was smaller than that between Eclipse 13.5 and M3D,but the mean differences were all within ±3％.The γ passing rates for target volume and OAR were more than 95％ on average.Conclusions The method of utilizing the automated treatment planning verification system to validate the accuracy of plans is convenient.It can be used as a secondary check tool to improve accuracy in IMRT dose calculation.

AlM: To explore the judgment of pattern reversal visual evoked potential on visual function and injured part of children with spastic cerebral palsy.METHODS: There were two groups in this study. 30 children with spastic cerebral palsy ( quadriplegia: 15, diplegia:15) were selected as observation group, while 30 normal children were selected as control group with randomized controlled trial. The changes of half-view and full- view incubation period and amplitude were observed by pattern reversal visual evoked potential.RESULTS: Full-view pattern reversal visual evoked potential: the P100 incubation period of the observation group was 113. 55 ± 8. 14ms, and the P100 amplitude was 23. 08±15. 41μV. The P100 incubation period of the control group was 105. 05 ± 5. 58ms, and the P100 amplitude was 31. 65±7. 37μV. From the comparison on P100 incubation and P100 amplitude between two groups, the difference was statistically significant ( P<0. 05 ) . P100 incubation period of the spastic diplegia of full-view pattern reversal visual evoked potential was 112. 73±7. 22ms, and the P100 amplitude was 21. 03±12. 17μV. P100 incubation period of the spastic quadriplegia was 114. 37 ± 9. 02ms, and the P100 amplitude was 25. 14 ± 18. 06μV. From the comparison on P100 incubation and P100 amplitude between two groups, the difference had no statistically significance (P>0. 05). Compared to the control group, each eye and each view latency of observation group were higher, the difference was statistically significant ( P<0. 05). The change of the incubation period of the full-view and half - view pattern reversal visual evoked potential took place in the lesion of the visual pathway:including optic neuropathy, some optic nerve lesion, lesion after optic chiasma, and optic chiasma lesion. Among them, the lesion after the optic chiasma was the most common.CONCLUSlON:Pattern reversal visual evoked potential can help people to understand the visual impairment and injury of children with spastic cerebral palsy in order to identify the abnormal children and early intervention.