The clinical features and efficacy of patients with geotropic direction-changing positional nystagmus / 中华耳鼻咽喉头颈外科杂志

Objective@#The purpose of this study was to observe the clinical characteristics of two types of geotropic direction-changing positional nystagmus, the transient(nystagmus time <1 min) and the persistent(nystagmus time > 1 min), and to evaluate the efficacy of the barbecue roll maneuver.@*Methods@#A total of 105 cases diagnosed by supine roll test were studied, which including 35 males and 70 females and the average age was (56.9±14.6)years. There were 70 transient geotropic DCPN and 35 persistent geotropic DCPN. The clinical characteristics and the immediate and one-week efficacy of the barbecue roll maneuver were discussed.@*Results@#The nystagmus disappeared at the null-point position and the nystagmus in supine position were opposite to the bowing (90° nose-down) position in persistent geotropic DCPN cases. While to the transient geotropic DCPN cases, there were no NP and no nystagmus in prone position. The ratio of the first onset of the two groups was 28.6% (persistent) and 72.9% (transient) respectively, and the difference was statistically significant (P<0.05). The immediate and one-week efficacy after barbecue roll maneuver were 91.4% and 80.0% in transient geotropic DCPN cases, and 0% and 42.9% in persistent geotropic DCPN cases, which were statistically significant different(P<0.05).@*Conclusions@#The light cupula hypothesis can mainly explain the clinical features of persistent geotropic DCPN cases; the barbecue roll maneuver is invalid to persistent geotropic DCPN cases which can be self-healing.

Application of craniotomy operation in aged patients with severe craniocerebral injury / 中国基层医药

Objective To explore and analyze the effect of standard large trauma improved operation ( slow decompression ) and standard large trauma conventional surgical procedures ( sudden decompression ) in the treatment of elderly patients with severe craniocerebral injury ( SCCI) .Methods 100 elderly patients with SCCI were randomly divided into the control group and the observation group ,50 cases in each group .The control group was treated with conventional methods ( standard large trauma traditional surgical treatment ) , the observation group was treated with standard large trauma surgery improved operation .The effects and postoperative complications were observed and recorded.Results 1d,3d,5d,15d after operation,the intracranial pressure of the two groups were (272.3 ±19.1)mmHg, (285.4 ±18.2) mmHg,(218.2 ±18.3) mmHg,(168.4 ±17.3) mmHg;(302.1 ±23.1) mmHg,(310.3 ± 19.2)mmHg,(221.1 ±19.2)mmHg,(148.2 ±16.4)mmHg,which were changed significantly compared with preop-eration,the intracranial pressure gradually decreased as time passed ,the decrease of intracranial pressure in the con-trol group was more obvious than the observation group .The incidence rates of epilepsy ,cerebral infarction ,hydroceph-alus in the observation group were 2.0%,6.0%,0.0%,which were significantly lower than those in the control group (30.0%,36.0 %,26.0%),the differences between the two groups were significant (χ2 =14.85,13.56,14.96,all P<0.05).The number of patients with good prognosis ,the residual in the observation group were significantly more than the control group , while the number of severely disabled and vegetative state patients in the observation group were significantly less than the control group ,(χ2 =4.88,3.93,4.33,7.44,all P<0.05).Conclusion Standard large trauma improved operation ( slow decompression ) can effectively reduce intracranial pressure in elderly patients with severe fluctuations ,reduce the incidence of complications ,improve treatment prognosis ,it should be popularized in clinical practice .

The operation timing and effect of minimally invasive surgical drill drainage in the treatment of hypertensive intracerebral hemorrhage / 中国基层医药

Objective To explore and analyze the optimal timing of surgery and clinical efficacy of minimally invasive drilling drainage in the treatment of hypertensive cerebral hemorrhage .Methods 150 patients with hyperten-sive cerebral hemorrhage ,according to a random number table method ,were randomly divided into the three groups , 50 patients in each group.Patients in group A received minimally invasive drainage drilling within 6h after the onset of disease,patients in group B received minimally invasive surgery 6-24h after the onset,patients in group C were given elective minimally invasive surgery 24-72h after the onset.Another 50 patients with hypertensive cerebral hemorrhage who received craniotomy surgery over the same period ,were selected as the control group .The clinical effects were observed and compared in four groups .Results The total effective rate of group B was 88%,which was significantly higher than the other three groups (χ2 =4.00,6.38,12.70,all P<0.05).The early cure rate of the observation group was 40%,which was significantly higher than the control group (χ2 =8.57,P<0.05).After treatment,the number of cases whose activities of daily living degree recovered to grade I in the observation group was significantly higher than the other three groups (χ2 =4.11,5.00,8.32,all P<0.05).The excellent rate of group B was 88%(44/50),which was significantly higher than the other three groups (χ2 =6.83,5.83,15.43,all P<0.05).After treatment,the incidence rate of complications in group B was significantly lower than the other three groups ,the inci-dence rate of complications in the control group was the highest (χ2 =5.32,8.58,32.97,all P<0.05).Conclusion Minimally invasive drilling drainage in the treatment of hypertension cerebral hemorrhage can obtain significant effect , the optimal timing of surgery is 6-24h,minimally invasive treatment has advantages of less invasive ,faster recovery,fe-wer complications ,and less costs ,which is worthy of widely used in clinical practice .

Application of vestibular autorotation test in diagnosis of benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The objective of this study was to evaluate the utility of vestibular autorotation test in the diagnosis of BPPV.@*METHOD@#VAT and caloric test were performed on 41 patients with BPPV. VAT results were analyzed according to the affected semicircular canal.@*RESULT@#Results of VAT were abnormal in 34 (82.93%) patients with BPPV. Fourteen cases were found with abnormal vertical phase, 1 case with abnormal vertical gain in a total of 21 vertical semicircular canal BPPV patients. Six cases with abnormal horizontal phase lead, 5 cases with abnormal horizontal gain, 2 cases with asymmetry were found in 12 patients with horizontal semicircular canal BPPV. Phase lead was abnormal in all frequencies in 4 patients, and in 2-3 Hz in 21 patients. 24 (58.54%) patients showed abnormal canal paresis (CP) and direction preference (DP) in caloric test.@*CONCLUSION@#VAT can indicate information of vestibular function in both vertical and horizontal semicircular canal. Phase of VAT is constantly enhanced in BPPV, especially in 2-3 Hz. As the supplement of caloric test, VAT may prove helpful in assessment of semicircular canal function.

Mice lacking of voltage-gated L-type calcium channel alpha1D subunit have impaired sinoatrial node function and caused deafness / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#L-type voltage-gated calcium channel subunit alpha1D-/- mice (homozygous mutant, knockout), alpha1D+/- (heterozygous) and alpha1D+/+ (wild-type) have played role in L-type voltage-gated calcium channel alpha1D subunit in auditory function of inner ear as well as sinoatrial node function of the mice.@*METHOD@#Hearing threshold and endocochlear potential (EP) were measured in the alpha1D knockout mice, heterozygous mice and wild-type mice by auditory brainstem response(ABR), EP recordings and Electrocardiograph (ECG) respectively. To assessment of the vestibular function of the mice, the ability of Balancing was performed by a swim test and a horizontal cylinder test.@*RESULT@#The auditory function of alD+/+ mice were normal, the mean value for ABR thresholds in response to click sound stimulus was (34.8 +/- 5.7) dB SPL,EP was (105.3 +/- 3.1) mV. The mean value for ABR thresholds in response to click sound stimulus was elevated in alpha1D+/- mice was (54.4 +/- 12.4) dB SPL, relative to that observed in alpha1D+/+ mice significantly increased (P < 0.05); EP of alpha1D+/- mice was about (75.8 +/- 9.9) mV. alpha1D-/- mice were completely deaf, the ABR wave form was not observed for even 100 dB SPL sound stimuli used and EP was still remain in (48.6 +/- 19.3) mV. alpha1D knockout mice were deaf and demonstrated no vestibular defect. alpha1D+/- and alpha1D-/- mice show significant sinus bradycardia with significant prolongation of the RR interval (146 +/- 1.4 and 244 +/- 2.9, respectively) comparing to the alpha1D+/+ wild-type mice (117 +/- 0.4) in the same littermates. In addition, the homozygous alpha1D-/- show a significant prolongation of the PR interval (53 +/- 0.5) compared to that of the a1D+/+ wild-type mice (38 +/- 0.3).@*CONCLUSION@#L-type voltage-gated calcium channel alpha1D subunit plays a critical role in calcium homeostasis in the inner ear. Mice lacking of alpha1D calcium channel gene would lead to influence auditory function and sinoatrial node dysfunction subsequently.

Anterior and posterior combined operation for treatment of lumbar tuberculosis / 中国矫形外科杂志

[Objective] To determine the efficacy of one-stage posterior deformity correction with transpedicular screw system and anterior radical debridement following reconstuction with titanium mesh cage for treatment of lumbar tuberculosis. [Methods]Forty-three patients with lumbar tuberculosis were treated operatively through anterior and posterior combined approach.The postoperative neurologic status (ASIA,2000),graft fusion,deformity correction and complications were observed and analyzed respectively.[Results]Forty-one patients were followed up for a duration of 24~36 months (mean 28.3 months).A solid fusion was achived in all cases.The neurologic function was improved in all patients in different grades.The mean kyphotic angle was corrected by 21.3 degrees,the angle loss was 1?~3?,the mean vertebral height was restored by 10.2 mm,the mean height loss was 2.4 mm.There was no recurrence of the tuberculosis infection.[Conclusion]One-stage posterior deformity correction with transpedicular screw system and anterior radical debridement following reconstuction with titanium mesh cage is a safe and effective method in the surgical management of lumbar tuberculosis.

Ulnar impaction syndrome misdiagnosed by soft tissue injury in wrist / 中国矫形外科杂志

[Objective]To explore the reason of ulnar impaction syndrome misdiagnosed by tissue injury in wrist.[Method]From December 1998 to December 2005,216 cases who were diagnosed for soft tissue injury in ulnar wrist were checked and discriminated according to X-ray and MRI of the injured wrist,and 48 cases were re-diagnosed for ulnar impaction syndrome.The misdiagnosis rate was 22.2%.[Result]Most cases of ulnar impaction syndrome had positive lunar variance(68.8%).Carpal avascular necrosis were found in about 27.1% of cases through X-ray of wrist and 100% through MRI.Different degree changes of abnormal signal intensity were found in soft tissue,triangular fibro cartilage(TFC) and carpal bones by MRI which displayed swelling of soft tissue in carpal joint,strip-shape high signal intensity or mixed signal intensity at ligament around wrist and enhanced signal intensity at TFC area extending to ulnar carpal articular facet.The appearance of MRI in carpal bones showed local abnormal signal,articular cartilage thickening and hydropsia in bone below cartilage and marrow.[Conclusion]The misdiagnosis can be reduced through elevating acquaintance level of ulnar impaction syndrome basing on clinical symptoms,making the most use of imaging,especially MRI.

Comparison of caloric test findings in benign paroxysmal positional vertigo / 中国耳鼻咽喉头颈外科

OBJECTIVE To analyze the caloric test findings of the unilateral primary horizontal and posterior semicircular canal benign paroxysmal positional vertigo(HSC-BPPV and PSC-BPPV).METHODS Caloric test were tested in 152 PSC-BPPV patients and 25 HSC-BPPV patients after Dix-Hallpike test and Roll test.RESULTS Of 152 PSC-BPPV patients 64 canal paresis(CP)were found in the abnormal side and 44 in the normal side;Of 25 HSC-BPPV patients 16 canal paresis were found in the abnormal side and 9 in the normal side.The incidence of CP in PSC-BPPV is 30.3% and the incidence of CP in HSC-BPPV is 52%.13 Patients with PSC-BPPV were found abnormal Directional Preponderance(DP)and 10 Patients with PSC-BPPV were found abnormal Directional Preponderance.CONCLUSION The incidence of CP in the abnormal side of HSC-BPPV and PSC-BPPV is more than that of the normal side.The incidence of CP in abnormal side of the HSC-BPPV is more than that of PSC-BPPV.The incidence of abnormal DP in HSC-BPPV is more than that of PSC-BPPV.

Retrograde replantation method for amputated hallux / 临床外科杂志

Objective To investigate the characteristics and the effect of severed hallux replantation.Methods Eighteen completely severed halluces had been replanted since 1991.Injuried foot were kept in extending at 90?-120? position.The sequence of hallux replantation was opposed to the classical order and was so called"the retrograde replantating means(RRM)".The order of RRM was defined as follows: skin of toe abdomen→subcutaneous vein of toe abdomen→inhered toe nerve→inhered toe artery→flexor toe tendon→toe fixation by a single K-needle→extendor toe tendon→artery in the back of toe→subcutaneous vein of toe back→skin of bilateral and back.Results Sixteen of eighteen halluces survived replantation(89.9%).The total flexion degree in replanted halluces was 25?～70?.The appearance of amputated toes restored well.The two-point discrimination was 10～16 mm.Eleven cases walked as entirely usually in gait, and seven cases had basic normal gait.Conclusions Replantation of severed halluces could alleviate wound and remnant greatly.The recovery of foot function and aspect of replanted toes was satisfactory.The RRM gradation showed a distinctive advantage that there was no requiring for injuried foot be moved during operation.

Comparative study of GDNF and methyl prednisolone on intracellular free calcium and containing water capacity after spinal cord injury in rats / 医学研究生学报

Objectives:To compare the effect of glial cell line-derived neurotrophic factor(GDNF) and methylprednisolone(MP) on intracellular free calcium(［Ca2+］i) and capacity of containing water(CCW) after spinal cord injury(SCI).　Methods:Forty-two SD rats were divided into four groups： control, GDNF,MP and GDNF+MP.GDNF and MP were supplied through subarachnoid cavity, tail vein and both of the above after T12 segments spinal cord injury by modified Allen crush method. Animals were executed and specimens were collected at 24 h, 72 h and 168 h after SCI.［Ca2+］i and CCW were measured using Fura-2 method.　Results:Both ［Ca2+］i and CCW of injured spinal cord in GDNF,MP, and GDNF+MP groups were lower than that of the control group at 24 h and 72 h after SCI(P<0.01).Levels of ［Ca2+］i and CCW in GDNF group was much higher than that of MP and MP+GDNF groups(P<0.01),but there was no difference between MP group and MP+GDNF group(P>0.05) 24 hours after SCI. Seventy-two hours after SCI,［Ca2+］i in GDNF group was higher than that in MP group, MP group was higher than MP+GDNF group(P<0.05).CCW of GDNF group exceeded that of MP and MP+GDNF group(P<0.01).［Ca2+］i in GDNF group was higher than that in MP group, and MP group was higher than MP+GDNF group(P<0.01) 7 days postoperatively, but for CCW, there were no differences among GDNF,MP and MP+GDNF groups(P>0.05).　Conclusions: Both GDNF,MP and GDNF + MP groups might reduce ［Ca2+］i and CCW of injured spinal cord. The curative effect of MP for SCI preponderate over that of GDNF, the effect of MP could be enhanced by adding GDNF.

Analysis of GDNF mRNA gene expression on both severed sections of the sciatic nerve in rats / 中华骨科杂志

Objective To investigate the gene expression of GDNF mRNA on both ends of the severed sections of sciatic nerve in rats. Methods The specimen of sciatic nerve proximal and distal to the cut off site was taken respectively before and after sciatic nerve severance. The level of GDNF mRNA on both cutting sections was observed and compared by using of semi quantitative RT-PCR method with ? Actin as a inner consult before nad after sciatic nerve cut off. Results A minimum expression of GDNF mRNA was found on sciatic nerve before the operation, however, there was an increase of 20% at 24 hours in the distal section after sciatic nerve cut off, 60% at 7th day, 85% at 14th day and 90% at 28th day. While it decreased by 10%, 38%, 45% and 52% at 1st day, 7th day, 14th day and 28th day in the proximal section respectively. Conclusion The decreasing and increasing of GDNF mRNA level at the proximal and distal sciatic nerve section is the result of the disruption of “neuron axon target”axis after sciatic nerve cut off. This may provide a theory basis in treatment of SCI by use of the foreign GDNF.

Clinical observation of the influence of cigarette smoking on digit replantation / 中华骨科杂志

Objective To analyze the effect of cigarette smoking on replantation of amputed digit, investigate the pathologic mechanism of vascular crisis(VC) caused by smoking. Methods 1)The replantation risk factor such as smoking to VC and blood insufficiency of replanted digit was reviewed in 1 685 cases of digit replantation. 2)The complications after digit replantation in short and long terms among patients smoking were compared with those not smoking after operation. The results of management and time of appearance VC was assayed. 3)The possible pathologic mechanism of VC caused by smoking was analyzed. Results 1)A significant correlation between the ratio of VC, blood insufficiency of replanted digit and smoking index(SI, the number of cigarette in a day multiplies the years of smoking) was found. 2)The rate of VC, wound infection and unhealing in short term and the feeling of pain, numbness and cool in the long term in patients smoking after operation (92.6%,55.6%,48.1% and 71.6%) was obviously more than that in non smoking patients(17.8%,9.3%,2.0% and 3.0%,P

Changes of GDNF mRNA expression in proximal end and corresponding spinal cord after sciatic nerve sever in rats / 第二军医大学学报

Objective:To investigate the expression of GDNF mRNA on proximal end of sciatic nerve and T 12 L 1 spinal cord after sciatic nerve was cut in rats. Methods:The sciatic nerve of proximal end and spinal cord paralleling T 12 L 1 nerve root was taken respectively before and after sciatic nerve were severed. The level of GDNF mRNA on proximal end of sciatic nerve and spinal cord was observed and compared before and after sciatic nerve cut. Semi quantitative RT PCR method with ? actin as an inner consult was used to detect the expression of GDNF mRNA. Results:GDNF mRNA expression decreased by 10% 24 h after sciatic nerve was cut, 38% 7 d later, 45% 14 d and 52% 28 d in proximal end, while it decreased by 20%, 68%,80% and 85% on 1, 7, 14 and 28 d respectively in the spinal cord. Conclusion:The reduction of GDNF mRNA level on proximal end and homologous segmental spinal cord may be caused by losing the support of GDNF mRNA from the target tissue after sciatic nerve cut. This study provides a foundation for foreign GDNF to be used in treating SCI.