ABSTRACT
Late onset methylmalonic acidemia (MMA) is a rare genetic metabolic disease.This case is a 46 year old adult patient with MMA complicated with hyperhomocysteinemia.It starts with progressive limb weakness and mental abnormality, and has dysuria and respiratory failure.Neurological examination showed decreased muscle strength of limbs and pyramidal tract sign.The levels of blood homocysteine and urinary methylmalonic acid increased significantly.Head, neck, thoracolumbar magnetic resonance imaging showed abnormal signals in the spinal cord from the level of foramen magnum to the level of lumbar 1 vertebral body.Two heterozygous variants of mmachc were found by gene detection: c: 609G>A, c: 349G>A, consistent with cobalamin C deficiency.Treat with L-carnitine, vitamin B12 and betaine.The patients′ mental symptoms, limb muscle strength and respiratory failure were improved, and the level of blood homocysteine also decreased significantly.
ABSTRACT
Anesthesia modalities for endovascular treatment of acute ischemic stroke include general anesthesia and conscious sedation.Several recent studies have shown that the general anesthesia is associated with the poor outcome of endovascular treatment in patients with acute ischemic stroke.The underlying reason of causing worse outcome is unknown.It may be associated with hemodynamic instability and hypotension.Currently,it is considered that both general anesthesia and conscious sedation have their advantages and disadvantages.We must choose individualize anesthesia modalities for each patient before we obtain highquality evidence.
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Objective To evaluate the clinical effect of mandibular osteomuscular flap pedicled with temporalis and radial forearm free flap to repair palatomaxillary defects. Methods From March 2008 to March 2011,nine patients with palatomaxillary defects following malignant tumor ablation,were repaired with mandibular osteomuscular flap pedicled with temporalis and radial forearm free flap. According to Brown's classification for the maxillectomy defect,eight cases were type Ⅱ B and 1 case was type Ⅱ C. There were 6 males and 3 females with an average age of 57 years(range,34-68 years). Results All the 9 osteomuscular flaps and forearm flaps survived.The patients were followed up for 12 to 24 months with an average of 14 months. The patients acquired satisfactory appearance and complete functional restoration except 1 case of chondrosarcoma of recurrence was encountered 6 months after operation. Conclusions Palatomaxillary defects were reconstructed by mandibular osteomuscular flap pedicled with temporalis and radial forearm free flap immediately.It is easy to elevate,safe,and there were no donor site problems.This is an ideal method of repairing the palato maxillary defects.
ABSTRACT
The present new situation is calling for our advancement with the time and the development of the hospital in the spirit of the time at an unprecedented rate. To achieve this goal,the author brings forward"three musts" as follows:the spirit of the time must be entertained in following the trend of development;scientific method of adhering to self-reliance by drawing on others'strong points must be upheld;the prinlciple of making breakthroughs by proceeding from the actual situation must be maintained.
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In the new situation,party leaders and cadres should take the lead in culturing communist accomplishment,and must reinforce theory study,strengthen communist belief,culture moral quality,culture noble trait,create a positive image.
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The present paper explores how to build a stronger contingent of scientific and technical cadres in the new situation by acting on the important thought of "Three Represents".The accomplishment of this aim requires straightening out "three outlooks"(world outlook,life outlook and value outlook),professional ethics and matter of fact attitude,and putting one's talent in a right relationship to the hospital's cultivation.
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Objective To observe the relationship between cerebral border zone infarction and cerebral artery stenosis or occlusion.Methods 45 patients admitted to our hospital in 2002 were studied retrospectively.They were diagnosied as acute cerebral border zone infarction and classified into anterior border infartion,posterior border infartion and internal border infartion by diffusion weighted MR imaging(DWI). The stenosis or occlusion of cerebral arteries was evaluated by magnetic resonance angiography(MRA) or transcranial doppler(TCD) examinations.Results Cerebral artery stenosis or occlusion was founded in 32 patients(71.1%).The lesions were most located in middle cerebral artery(47.6%),next in internal carotid artery(31%), relatively seldom in anterior cerebral artery and posterior cerebral artery(11.9%). No difference of artery abnormity was found between the patients with single border infarction and the patients with mutiple border infarction.But middle cerebral artery stenosis was more frequently seen in the patients with internal border infartion( P