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Microsurgical treatment of ruptured intracranial aneurysms in the early and intermediate stage

Jinping LI ; Qihuang ZHAO ; Yongquan SUN ; Tong LI ; Yinglun SONG ; Xinqian YANG ; Yu WANG ; Ke TAN ; Tao LI

Clinical Medicine of China.2009;25(12):1301-1303. doi:10.3760/cma.j.issn.1008-6315.2009.12.027

Objective To explore the microsurgical method in treating ruptured aneurysms treatment and evaluating the treatment of the complication during or after the operation.Methods 36 cases of patients with intracranial aneurysm were analyzed retrospectively.All of the patients were subarachnoid hemorrhage (SAH) by CT scan on admission.The intracranial aneurysms were confirmed in 35 cases by DSA examination and A2 aneurysm was confirmed by explorative operation in 1 case.The microsurgical treatment was performed in 36 cases at the early or intermediate stage,22 cases were treated in the early stage,the other 14 cases were treated in the intermediate stage (early stage means within 3 days post SAH;intermediate stage means from 4 days to 10 days post SAH).Results After the operation,21 cases were GOS grade Ⅰ,4 cases were COS grade Ⅱ,4 cases were COS grade Ⅲ,4 cases were GOS grade Ⅳ.Of all the patients,CT scan was done after the operation,finding no intracranial bemorrhage,and cerebral infarction was disclosed in 5 cases.3 cases were dead,one suffered occipital lobe infaret after the PCoA aneurysm clipped,brain hernia occurred at last,one's Hunt Hess grade was Ⅴ,ACoA aneurysm was disclosed by DSA examination,severe brain edema occurred after the operation,the other suffered tonsillar hernia one week after the aneurysm clipping,which ruptured after endovascular treatment of ACoA aneurysm 2 years later.DSA examinations were done in 26 cases after operation,declaring 1 ACoA aneurysm was unclipped,1 PCoA aneurysm was incompletely clipped,and 1 PCoA was sacrificed.Conclusions It is a valuable method to clip the ruptured intracranial aneurysms in early and intermediate stage.The cerebral ischemia is the severe complication after clipping.Especially for the PCoA aneurysms,it is very important to protect the PCoA.Further research should be done for the treatment in the case with mother artery arteriosclerosis and thrombosis within the aneurysms.

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Analysis of pulmonary alveolar proteinosis in recent 20 years

Weiwei SHE ; Jinrong ZENG ; Changming WANG ; Yun LIN ; Feng CHEN ; Miao LUO ; Jiying WANG

Clinical Medicine of China.2009;25(12):1276-1278. doi:10.3760/cma.j.issn.1008-6315.2009.12.016

Objective To analyze the epidemiology,clinical and imageological characteristics,diagnosis,misdiagnosis,treatment and prognosis of pulmonary alveolar proteinosis (PAP) reported in China in recent 20 years,in an attempt to provide important clues for prompt and accurate diagnosis of PAP.Methods Clinical data of PAP from 1988 to 2008 in China were retrospectively analyzed and the clinical data of 126 patients with PAP which were misdiagnozed were summarized.Results There were 19 cases misdiagnozed with pneumonia,24 cases with pulmonary cancer,18 cases with bronchitis,19 cases with idiopathic pulmonary fibrosis,15 cases with pulmonary tuberculosis,10 cases with eosinophilic pneumonia,9 cases with sarcoidosis,5 cases with fungus pneumonia.The clinical manifestations of PAP had no specificity and the imageology manifestation was various.Its final diagnosis mainly depended on the examination of brochoalveolar lavage fluid and/or lung biopsy,and pathologic examination.Conclusions The diversity of clinical manifestations of PAP has resulted in higher clinical misdiagnosis rate.WhoLe lung irrigation is the safest and the most effective way to treat PAP.

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The factors relevant to the vascular calcification in ulemic patients

Yan WANG ; Jun LIU

Clinical Medicine of China.2009;25(12):1273-1275. doi:10.3760/cma.j.issn.1008-6315.2009.12.015

Objective To investigate the factors relevant to the vascular calcification in uiemic patients.Methods Eighty-five uiemic patients were enrolled in this study.The levels of fetuin-A,serum calcium,serum phosphorus,C-reactive protein and other parameters related to calcification were examined.B-ultrasound was used to detect carotid plaques.Results The Fetuin-A levels in patients with vascular calcification were significantly lower than those with non-vascular calcification[(2.34±0.95) μg/L vs (3.79±1.19) μg/L,t=5.94,P＜0.01],but serum calcium,serum phosphorus and C-reactive protein were higher than those non-vascular calcification [serum phosphorus (1.97±0.23) mmol/L vs (1.80±0.33) mmol/L,t=2.05,P＜0.05;calcium and phosphorus product (50.04±6.61) mg~2/dl~2 vs (44.84±9.75) mg~2/dl~2,t=2.05,P＜0.05;C-reactive protein (33.45±25.11)mmol/L vs (20.65±13.43) mmol/L,t=2.03,P＜0.05].Linear correlation analysis indicated that low fetuin-A level was correlated with C-reactive protein (r=-0.43,P＜0.01),calcium-phosphorus product (r=-0.32,P＜0.01),serum albumin concentration (r=0.37,P＜0.05) and phosphorus level (r=-0.36,P＜0.05).Conclusions The risk factors relevant to the vascular calcification are high serum phosphorus,calcium and phosphorus product and the micro-inflammatory status in uiemic patients.Vascular calcification is also correlated with low fetuinA level,adding exogenous Fetuin-A may become an effective means in preventing vascular calcification.

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Random flap experimental study of dynamic changes of blood flow

Hongbo SHAO ; Yueming YAO ; Qingfu ZHANG ; Jianke FENG ; Yongqiang BAI ; Chejiang WANG

Clinical Medicine of China.2009;25(12):1236-1238. doi:10.3760/cma.j.issn.1008-6315.2009.12.002

Objective To know the establishment of the flap pedicle blood supply and the right moment of the cutting off of pedicle by means of laser Doppler blood perfusion imaging instrument on the random flap blood flow changes.Methods 20 adult healthy rabbits were divided in to four groups and each 5 have unilateral flaps.1,3,5,7,9,12,14,18 days after operation,the pedicle blood perfusion values (PU) measurement of the distal pedicle on the flap and midpoint of both ends of the pedicle were performed,and PU values were analyzed.Results Pedicle of the PU values at the different time points changed little (P＞0.05).The PU value in the distal flap reached the minimum 1 day after operation and then increased gradually [3 d (1.24±0.07),5 d (1.57±0.15),7 d (1.79±0.08),9 d(1.89±0.13),12 d(2.01±0.16),14 d(2.18±0.09) and 18 d(2.40±0.18),P＜0.05].When distal PU values/pedicle PU value≥1.2,the flap survival rate reached 99%.Conclusions The establishment of random skin flap blood circulation,as well as the ratio of PU values of distal to the pedicle flap pedicle can be used as the timing of an important indicators.

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Microsurgical management of supra- and infra-tentorial meningioma of the posterior petrous bone

Sumin GENG ; Junting ZHANG ; Zhen WU ; Jie TANG ; Xinru XIAO

Clinical Medicine of China.2009;25(12):1297-1298. doi:10.3760/cma.j.issn.1008-6315.2009.12.025

Objective To explore the microsurgical experience of supra- and infra-tentorial meningioma of the posterior petrous bone.Methods Clinical data of 21 patients who had undergone microsurgical treatment were retrospectively reviewed.Results All patients underwent surgical treatment via a suboccipital retrosigmoid approach,and hyperostosis of the petrous bone and infiltrated cerebellar tentorium were resected intraoperatively.Tumor resection was categorized as Grade Ⅰ in 16 patients,Grade Ⅱ in 5 patients,according to the Simpson classification system.The main postoperative complications included slight facial paresis and hearing function deterioration.The mean follow-up time was 3.2 years.All patients resumed normal daily activity and no tumor recurrence happened.Conclusions Total resection for supra- and infra-tentorial meningioma of the posterior petrous bone can be achieved with an excellent prognosis by use of microsurgical technique.

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Influence of intensive lipid lowering with atorvastatin on carotid intima-media thickness and vascular endothelia function in patients with geriatric carotid plaque

Yongxue YANG ; Lin ZHANG ; Jianguo LEI ; Yan SHEN ; Daxing YANG ; Yuandong HUANG ; Xiaoping ZHAO ; Xiaoli DU

Clinical Medicine of China.2009;25(12):1246-1250. doi:10.3760/cma.j.issn.1008-6315.2009.12.006

Objective To observe the changes of carotid intima-media thickness(CIMT) and vascular endothelia function in patients with geriatric carotid plaque before and after intensive lipid lowering was performed.Methods 102 patients diagnosed with carotid plaque were ramdomly divided into common group (atorvastatin 10 mg/d,n=48) and intensive lipid lowering group (atorvastatin 20 mg/d,n=54).After one year of treatment,the fasting venous blood total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),high density lipeprotein cholesterol (HDL-C) and triglyceride (TG) were assayed,and the thickest and thinnest CIMT and brachial arterial.endothelium dependent diastolic function (FMD) and carotid artery plaque index(PI) were measured by ultrasound.Results Two groups in the thickest CIMT and PI had no significant difference before and after treatment (P＞0.05).The levels of FMD,TC,LDL-C,TG and the thinnest CIMT had significant difference before and after therapy [common group:GIMT(0.85±0.20)mm,(0.83±0.22) mm,FMD(3.85±1.41)%,(7.91±1.05)%,TC(6.46±1.05) mmol/L,(4.82±1.26) mmol/L,LDL-C (4.71±1.00) mmol/L,(3.16±1.00) mmol/L,TG (1.55±0.45) mmol/L,(1.49±0.44) mmol/L;intensive lipid lowering group:CIMT(0.84±0.20) mm,(0.63±0.17) mm,FMD (3.74±1.38) %,(0.25±1.58)%,TC (6.36±1.06) mmol/L,(4.10±1.00) mmol/L,LDL-C (4.73±1.01) mmol/L、(2.28±1.26) mmol/L,TG (1.56±0.53) mmol/L,(1.50±0.49) mmol/L,P＜0.05].After one year's therapy,the difference in intensive lipid lowering group was more obvious than in common group (P＜0.05).Conclusions Intensive lipid lowering therapy is more effective to decrease TC,LDL-C and CIMT and to improve the vascular endothelia function.Atorvastatin is effective to stabilize the plaque and to retard the atheroscleresis development.

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Clinical study of 36 cases with severe pre-eclampsia complicated with ascites

Xiaomin FU ; Yanli ZHANG ; Zhuangyan ZHU

Clinical Medicine of China.2009;25(12):1317-1319. doi:10.3760/cma.j.issn.1008-6315.2009.12.034

Objective To analyse clinical characteristics and preventive methods of pregnancy-induced hypertensive severe pre-eclampsia with ascites.Methods 184 cases of patients with severe pre-eclampsia complicated with ascite were divided into two groups and the clinical characteristics were compared(severe pre-eclampsia complicated with ascite group,n=36;Severe pre-eclampsia group,n=148 cases).Results The average time of the termination of pregnancy was (34±4) weeks in severe pre-eclampsia complicated with ascites group,and (36±3) weeks in severe pre-eclampsia group (t=2.71,P＜0.01).There were 6 cases of intrauterine stillborn (16.67%),14 cases of neonatal mortality (38.89%);22 cases of premature labor (61.11%) in severe pre-eclampsia complicated with aacites group;There were 4 cases of intrauterine stillborn (2.7%);16 cases of neonatal mortality (10.81%);and 35 cases of premature labor (23.65%) in severe pre-eclampsia group (X~2=10.99,16.73,19.01,P＜0.001).There were differences in the total protein,albumin,white/ball ratio,lactic acid dehydregenase,serum creatinine,24-hour urinary protein between the two groups [total protein:(51.68±6.08) g/L vs (59.34±8.28)g/L,albumin:(24.32±4.06) g/L vs (32.16±5.63) g/L,white/ball ratio:(0.92±0.26) vs (1.16±0.26),lactic acid dehydrogenase:(495.87±312.56) U/L vs (323.81±185.00) U /L,serum creatinine:(131.62±95.34) μmol/L vs (91.52±86.83) μmol/L,24 h urinary protein(4.21±3.51)g/24 h vs (2.38±2.57)g/24h,t=6.17,8.77,5.50,4.79,2.72,3.98,P＜0.05 or ＜0.01].Conclusion Tbe condition of severe pre-eclampsia with ascites is extremely serious,so pregnancy should be timely terminated.The aacites can be dissipated after delivery.Early,systematic and regular prenatal care can prevent severe pre-eclampsia and complications in time.

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Expression of nerve growth factors and its receptors in granulosa cells and human ovarian follicle development in polycystic ovarian syndrome

Bingjin CHEN ; Linan CHENG ; Yongwei WANG ; Linte SHI ; Junling CHEN ; Lu LI ; Xiaoxi SUN

Clinical Medicine of China.2009;25(12):1314-1316. doi:10.3760/cma.j.issn.1008-6315.2009.12.033

Objective To investigate the possible role of nerve growth factors (NGF) and its receptors in ovarian follicle development,and detect the difference between polycystic ovarian symdrome (PCOS) and normal control.Methods Immunohistochemisty was applied to detect the expression of NGF,p75NTR,TrkA in ovarian follicle granulosa cells.Results In 54 cases (including 9 cases of IVM-PCOS,16 cases of IVF-PCOS and 29 cases of IVF-Normal),49 cases showed NGF protein positive in granulose cells with significance difference between groups (P＜0.05),and especially NGF was the strongest expressed factor in IVF-PCOS group but there was no remarkable difference between the other two groups in the expression of NGF.41 were TrkA protein positive,almost all IVF cases were TrkA protein positive while only 2 in IVM and there was no remarkable difference in expression of TrkA between IVF PCOS and IVF Normal(P＞0.05).The cases with stronger expression of NGF or TrkA had higher estradiol level than that of lower expression group (P＜0.05).51 cases had positive expression of p75 NTR protein but there was no significant difference between groups (P＞0.05).Conclusions TrkA is expressed in mature ovarian follicle,and the interaction of NGF-TrkA may be involved in ovarian follicle development,and overexpression of NGF may be associated with PCOS development.

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The differential diagnosis of 135 cases with pleural effusion

Zheng ZHU ; Qing CHENG ; Qixing ZHOU

Clinical Medicine of China.2009;25(12):1281-1283. doi:10.3760/cma.j.issn.1008-6315.2009.12.018

Objective To evaluate the differential diagnostic values of combined detection of adenosine de aminase (ADA),carcinoembryonic antigen (CEA),carbohydrate antigen 153 (CA153),neuron-specific enolase (NSE) and carbohydrate antigen 199 (CA199) in patients with pleural effusion.Methods Serum and hydrothorax fluid of CEA,CA153,NSE and CA199 in patients with plearal effusion were measured by electrochemiluminescence assay(ECLA),ADA from pleural effusions were measured by enzyme rate assay,and the clinical value of combined detection in the differential diagnosis of pleural effusion was evaluated.Results The levels of ADA(65.89±19.81 U/L) in hydrothorax fluid group with tuberculous pleural effusion were beth higher than those in the groups with inflammatory pleural effusion (17.33±16.58) U/L and malignant pleural effusion(27.44±22.64) U/L (q=12.19 and 10.72,P＜0.01).The positive rate of A DA was 82.88% (29/135) in hydrothorax fluid group with tuberculous pleural effusion,13.41% (11/135) in malignant pleural effusion and 11.11% (2/135) in inflammatory pleural effusion (X~2=59.07,P＜0.01).The levels and positive rate of CEA,CA153,NSE,and CA199 in serum and hydrothorax fluid group with malignant pleural effusion were both higher than those in the group with tuberculous pleural effusion (P＜0.05).Compared with the group with malignant pleural effusion,the levels of CA153 and CA199 in serum and the levels and the positive rate of NSE in serum and hydrothorax fluid were not statistically different in inflammatory pleural effusion group.In the 82 cases with malignant pleural effusion,the positive rate of the four kinds of serum tumor markers including CEA,CA153,NSE and CA199 was 74.39% (61/82) and the positive rate of those hydrothorax fluid tumor markers was 82.93% (68/82).Conclusions Combined detection of ADA,CEA,CA153,NSE and CA199 is of some significance to the differential diagnosis of pleural effusion.

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The effect of insulin glargine plus metformin on inflammatory factors in the treatment of patients with newly diagnosed type 2 diabetes

Chenglan SU ; Yanmei LIU

Clinical Medicine of China.2009;25(12):1266-1268. doi:10.3760/cma.j.issn.1008-6315.2009.12.012

Objective To observe the effect of insulin glargine plus mefformin on inflammatory factors(IF) in the treatment of patients with newly diagnosed type 2 diabetes(T2DM).Methods 110 patients with newly diagnosed T2DM were given insulin glargine(beginning dose:10 U/d) and mefformin(0.5 g,tid) for 12 weeks;while 100 cases selected for the same period from the normal healthy population were taken as control group.Baseline fasting blood glucose(FPG),2 h postprandial blood glucose(2 hPG),glycosylated hemoglobin (HbA_1c),C-reactive protein(CRP),TNF-α and IL-6 were observed.Results Before treatment,FPG,2 hPG,HbA_1c and IF in T2DM group were obviously higher than those in control group(P＜0.05),but there was no difference in other clinical data (P＞0.05).After 12 weeks treatment,in T2DM group there was a significant improvement in blood glucose targets [FPG from (14.8±3.9) mmol/L to (6.6±2.1) mmoL/L;2 hPG from (17.6±3.3) mmol/L to (8.3±1.2)mmol/L;HbA1c from (9.6±2.7)% to (6.5±0.8)%,t=7.40,8.37,3.98,P＜0.05],and the level of IF also decreased significantly [CRP from (8.8±2.5) mg/L to (5.5±1.4) mg/L;TNFα from (2.9±0.6) ng/L to (1.6±0.2) ng/L;IL-6 from(170.3±22.2) pg/L to (105.9±14.6) pg/L,t=4.61,3.52,5.68,P＜0.05].Conclusions Insulin glargine and mefformin combined therapy can improve glucose metabolism in patients with newly diagnosed T2DM,and decrease the levels of IF.

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