Effect of percentage of enteral nutrition in the total energy and nutrition support for patients with traumatic brain injury / 肠外与肠内营养

Objective: This study was conducted to determine the proper percentage of EN in the total energy and nutrition support for critically ill patients with traumatic brain injury (TBIs). Methods: 94 cases were randomly divided into 3 groups according to the percentage of EN in the total energy: 100％ EN group in which patients received 100％ calories from EN; 75％ EN group in which patients received 75％ calories from EN, 25％ from PN; 50％ EN group in which patients received 50％ calories fromm EN, 50％ from PN. At baseline and follow-up on day 4, 7, 10, nutrition parameters, complete blood count and electrolytes as well as metabolic parameters including tests of liver and renal function were measured. Complications during treatment were recorded and the prognosis was finally judged. Results: Total protein and albumin were significantly higher in the 50％ EN and 75％ EN group on day 7 than in TEN group (P＜ 0. 05). There was significance difference found in complications between 75％EN and 50％EN group. A reduction in the length of stay in the hospital and expenses in the ICU for 10 days in the 75％ EN group (P ＜ 0. 05) was also observed. Conclusion: 75％ calories from EN in the total energy and nutrition support appeared to have great impact on management of critically ill patients with traumatic brain injury.

An improved method for stereotactic location of the supraoptic nucleus with oblique stereotactic puncture in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish an improved method for stereotactic location of the supraoptic nucleus in rats.</p><p><b>METHODS</b>Twenty-four SD rats were randomly divided into experimental group (12 rats) and control group (12 rats) for oblique (20° to the left) stereotactic puncture (OSP group) and vertical stereotactic puncture (VSP group), respectively, both targeting the supraoptic nucleus (SON). The surgical data and postoperative (within 24) mortality of the rats were compared between the two groups.</p><p><b>RESULTS</b>The nucleus locating time was longer in OSP group than in VSP group (59.55∓3.64s vs 27.44∓2.18 s, P=0.000), and the postoperative mortality rate of the rats did not differ significantly between the groups (0 vs 44.4%, P=0.082). In OSP group, compared with VSP group, the procedure was associated with a lowered rupture rate of the superior sagittal sinus (11.1% vs 88.9%, P=0.003), a shortened hemostatic time after craniotomy (52.89∓24.05 s vs 157.445 ime a s, P=0.000) and after puncture (24.33 reas 45 s vs 133.89∓28.81 s, P=0.000), and also a shortened operation time (178.89 on tims vs 362.44 timees, P=0.000).</p><p><b>CONCLUSION</b>The improved method for locating supraoptic nucleus in rats is convenient, stable and reproducible, and helps to avoid important blood vessels and specific nuclei according to the needs of different experiments and allows the operators to choose different surgical paths.</p>

Pathological features and origin of primary pineal mixed germ cell tumors / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the origin of mixed germ cell tumors in the pineal region based on the image data, surgical findings and pathological examination of the tumor.</p><p><b>METHODS</b>The preoperative CT and magnetic resonance imaging (MRI) findings and tumor specimens were retrospectively analyzed in 15 cases of pineal mixed germ cell tumors confirmed by postoperative histological examination between January 2000 and September 2010.</p><p><b>RESULTS</b>Radiographic examination of the tumor revealed calcification in 12 cases, cystic changes in 10 cases, and the presence of lipid in 5 cases. On the anteroposterior images, the tumors appeared round or elliptic with smooth edge in 6 cases, and showed irregular shape with multiple processes on the edge in 9 cases. Surgical exploration found all the tumors located in the the suprapineal recess enclosed by the arachnoidal envelope of the Galen vein. Pathologically, 13 specimens contained germinoma component, 9 contained teratoma component, 4 had embryonic carcinoma component, 3 had choriocarcinoma component, 7 showed yolk sac tumor component, and 3 showed rhabdomyoma component. Germinoma components were found on the tumor margin in 7 specimens, and intermingled germinoma and other components were found in 10 specimens.</p><p><b>CONCLUSION</b>Pineal mixed germ cell tumor originates from the residue germ cells around the pineal gland, and most likely evolves from single primordial germ cells.</p>

Clinical study of pineal region tumors: experience with 132 patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To review the clinical manifestations, imaging, tumor markers, treatment methods, pathology results and clinical curative effects of pineal region tumors and to evaluate the characteristics and intervention strategies for those tumors.</p><p><b>METHODS</b>The clinicopathological data of 132 patients with pineal region tumor treated in our department between January 2000 and May 2008 were retrospectively studied.</p><p><b>RESULTS</b>A moderate predominance in males was presented. The clinical manifestations of the disease included increased intracranial pressure and ocular movement impairment. There were some features but no regularity and specific appearance on imaging including CT and MRI. 88.6% of patients associated with hydrocephalus. A high serum level of alpha-fetoprotein (AFP) was presented in 14 cases and high HCG in 9 cases. Eighteen cases received direct radiation therapy and 7 had radiotherapy post biopsy. 107 cases were treated surgically and 63 cases received postoperative adjuvant treatment. 114 cases had pathology results including 56 germ cell tumors. The patients were followed up for 12 approximately 132 months. Recurrence developed in 23 cases and 12 cases died. The 5-year survival rate was 89.3%.</p><p><b>CONCLUSION</b>Pineal region tumors are often associated with hydrocephalus and this makes preoperative diagnosis difficult. Imaging examination may help diagnosis but less specific. Germ cell tumors may diagnosed by some tumor markers. Radiation therapy is the choice of treatment for pure germinomas. Other types of pineal region tumors should receive surgical treatment. Postoperative adjuvant treatment based on pathology can provide a good prognosis in pineal region tumor.</p>

Dynamic changes of serum interleukin-6 and interleukin-8 in patients with acute traumatic brain injury and the clinical significance / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the dynamic changes of serum interleukin-6 (IL-6) and IL-8 in acute traumatic brain injury (TBI) and their correlations to the severity of brain injury and the condition of the patients.</p><p><b>METHODS</b>Thirty-four patients with acute TBI were divided into two groups according to the Glasgow Coma Scale (GCS) score, clinical manifestations and the imaging data, namely patients with GCS score < or = 8 and those with GCS score between 9 and 12. Radioimmunoassay was employed to determine the serum levels of IL-6 and IL-8 at 6 different time points within 15 days after the injury in the two groups.</p><p><b>RESULTS</b>The serum IL-6 reached the peak level on the second day after the injury in patients with GCS score < or = 8 and on the 7th day in patients with GCS score of 9-12, showing significant differences in IL-6 variations between the two groups (P=0.046). The peak serum level of IL-8 occurred on the 7th day in patients with GCS score < or = 8 and on the 3rd day in patients with GCS score of 9-12, also showing significant differences (P=0.045). The peak level of IL-6 on the second day after the injury was significantly higher than the peak level of IL-8 that occurred on the 7th day, demonstrating significant differences in the variations of IL-6 and IL-8 after the injury (P=0.000).</p><p><b>CONCLUSION</b>The changes of serum IL-6 and IL-8 levels show positive correlations to the severity of the condition of the patients sustaining TBI. IL-6 variation is more obvious than that of IL-8 without intimate correlations between them. Clinically, serum IL-6 level can be more informative than serum IL-8 level in evaluating the changes of the condition of the TBI patients in early stage following the injury.</p>

Predisposing factors for postoperative epilepsy in patients with gliomas / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the predisposing factors for postoperative epilepsy in patients with gliomas.</p><p><b>METHODS</b>A total of 258 glioma patients with complete clinical data receiving cranial surgeries were analyzed retrospectively. With gender, age, predominant symptoms, positive signs, history of preoperative epilepsy, time of epilepsy onset, tumor location, surgical approaches, cortical injury, arterial and venous injury, scope of tumor resection, postoperative edema, tumor pathology, tumor recurrence, number of operation, radiation therapy as the independent variables, the occurrence of postoperative epilepsy was analyzed as the dependent variable using logistic regression to identify the risk factors for postoperative epilepsy.</p><p><b>RESULTS</b>History of preoperative epilepsy, surgical approaches, postoperative edema, tumor pathology and tumor recurrence were identified as the risk factors for postoperative epilepsy in glioma patients.</p><p><b>CONCLUSIONS</b>Postoperative epilepsy severely affected the quality of life of glioma patients, and rigorous treatment targeting the risk factors may decrease the occurrence of postoperative epilepsy.</p>

Combined modality therapy for primary choriocarcinoma in the pineal region: report of two cases / 南方医科大学学报

We report two rare cases of primary choriocarcinoma in the pineal region verified histologically. In both cases, the pre-operative serum level of human chorionic gonadotropin (HCG) was significantly elevated to 128-/+935.7 and 9 -/+088.9 mIU/ml, respectively, and serum alpha-fetoprotein (AFP) was negative. The tumors were microsurgically removed, and postoperative hydrocephalus were treated by endoscopic third ventriculostomy. Both patients underwent chemotherapy and radiotherapy. After adjunctive treatment, the serum HCG decreased within normal range. During the two-year-long follow-up, no radiological (MRI) evidence was found to suggest recurrence in MR imaging, and the serum HCG was normal in one patient, but mildly elevated in the other. HCG measurement can be crucial to the diagnosis and post-treatment monitoring of choriocarcinoma, and radical surgical tumor removal and combined modality therapy including chemotherapy and radiotherapy may ensure good results.

Treatment of recurrent malignant brain gliomas by surgical excision combined with biodegradable polymers of interstitial chemotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the effectiveness of treatment of recurrent malignant brain gliomas by surgical excision combined with biodegradable polymers of interstitial chemotherapy.</p><p><b>METHODS</b>In 30 patients with recurrent malignant brain gliomas, the tumor was surgically removed and Vp-16 biodegradable polymers were implanted during operation in the tumor bed at a dose of 100 - 150 mg. The patients were followed up for 3 - 24 months, and the results were compared with 46 cases with the recurrent malignant brain gliomas who received operation only.</p><p><b>RESULTS</b>At 3, 6, 12, 24 months after treatment, the recurrent rate was 16.7%, 30%, 50% and 83.3%, respectively; the mortality rate was 6.67%, 20%, 40% and 70%, respectively. All the patients had no apparent side-effects of chemotherapy.</p><p><b>CONCLUSION</b>Surgical treatment combined with interstitial chemotherapy with biodegradable Vp-16 polymers improves the treatment result of recurrent malignant brain gliomas compared to surgery alone.</p>

Surgical treatment of 516 cases with acute traumatic brain injury / 中华创伤杂志

Objective To summarize the experience and lesson of surgical treatment of acute traumatic brain injury.Methods A total of 516 cases with acute traumatic brain injury treated surgi- cally from January 2001 to December 2004 in our hospital were analyzed retrospectively.Of all,there were 56 cases with simple comminuted depressed fractures,138 with brain contusion and laceration and/ or intracerebral hematoma,122 with epidural hematoma,126 with suhdural hematoma,48 with diffuse brain swelling,18 with open brain injuries and eight with other kind of injury,all of whom were treated with standard large eraniectomy under general anaesthesia.The treatment results were evaluated by Glas- cow Outcome Scale(GOS).Results Of all,standard large craniectomy was performed in 194 cases, of which 304 cases(58.9%)were with good recovery,66(12.8%)with moderate deficit,72(13.9%) with severe deficit,12(2.3%)under persistent vegetative status and 62(12.0%)died 3-6 months after surgery.Conclusions More attention should be paid to surgery for traumatic brain injury.Individual surgical treatment should be performed under surgical principles.