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Objective To explore the clinical efficacy of large M-shaped craniotomy combined with lobectomy for secondary decompression in patients following severe craniocerebral trauma.Methods The clinical data were retrospectively analyzed of the 76 patients who had undergone secondary decompression following severe craniocerebral trauma from January 2007 to January 2010.The preoperative intracranial pressure (ICP) was 30～40 mmHg in 40 cases and ＞40 mmHg in 36 ones.All the patients received regular lobectomy in primary craniotomy;for secondary decompression some received simple lobectomy and some large M-shaped craniotomy combined with lobectomy.The patients undergoing different surgical procedures were compared in terms of survival rate,changes in intracranial pressure and therapeutic efficacy by the GOS 6 months post-discharge.Results Of the patients with 30～40 mmHg ICP,22 underwent large M-shaped craniotomy combined with lobectomy and 18 simple lobectomy.The survival rate within 7 days after surgery for the former patients (72.7％) was significantly higher than that for the latter ones (38.9％) (P＜0.05).Of the patients with ＞40 mmHg ICP,19 underwent large M-shaped craniotomy combined with lobectomy and 17 simple lobectomy,but all of them died within 7 days after surgery.Of those surviving the secondary decompression,7 received simple lobectomy and 16 large M-shaped craniotomy combined with lobectomy.The ICP in the latter patients was significantly lower at postoperative one day and 3 weeks than that in the former ones (P＜0.05).Compared with those receiving simple lobectomy,the patients receiving combined procedures had significantly higher GOS and significantly better prognosis (P＜0.05).There were no significant differences between the patients receiving two different surgical procedures in such adverse events as traumatic epilepsy,cerebrospinal fluid leakage,softening brain tissue,or wound malunion (P＞0.05).Conclusion For the patients with craniocerebral trauma who still suffer severe brain swelling or infarction after primary decompression,if their ICP is below 40 mmHg,large M-shaped craniotomy combined with lobectomy for secondary decompression can obviously decrease their ICP,increase their survival rate and improve their prognosis compared with simple lobectomy.
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Objective To analyze the risk factors and characteristics of bone metastases in patients with prostate cancer. Methods Patients who were diagnosed as prostate cancer by biopsy and histopathologic analysis between June 2006 and June 2016 were included in this study. The clinical data of the patients were reviewed, and the demographic data, laboratory examination results and Gleason score were recorded. The correlations between clinical factors and bone metastasis were analyzed, and the risk factors of bone metastasis were identified. Results A total of 585 patients were recruited in this study, including 228 with bone metastasis and 357 without bone metastasis. Of the patients with bone metastasis, the incidence of pelvic metastasis was the highest, accounting for 81.58%, followed by spin (63.16%) and rib (58.33%), and the incidence of clavicle metastasis was the lowest (14.47%). Logistic regression analysis showed that age 85.5U/L, prostate-specific antigen >79.88μg/L and Gleason score >7.5 were the risk factors of bone metastasis in prostate cancer. ROC curve analysis showed that the sensitivity of diagnosing bone metastasis was 56.1%, 66.7%, 68.4% and 56.1%, and the specificity was 56.6%, 81.8%, 70.0% and 65.3%, respectively for above 4 factors. Conclusions The most common site of bone metastasis in patients with prostate cancer is pelvis. Patients' age, concentrations of plasma ALP and PSA, and Gleason score are the risk factors for bone metastasis in patients with prostate cancer.
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Objective To investigate the clinical characteristics and risk factors of intra- and post-operative reperfusion injury following surgical evacuation of epidural hematoma. Methods Clinical and radiographic data of 206 patients with cerebral herniation presented with an epidural hematoma and underwent surgical evacuation in our hospital from June 2009 to June 2015, were retrospectively analyzed; risk factors of intra- and post-operative reperfusion injury were analyzed by multi-factor and non-conditional Logistic regression analyses. Results A total of 12 patients with acute epidural hematoma and concurrent cerebral herniation developed reperfusion injury after hematoma evacuation; 7 patients (58.3%) were within 15-30 min after surgical evacuation intraoperatively and 5 patients (41.7%) were at an early stage within 6 h after operation. Local vascular cerebral edema, effusion, or even spot and patchy hemorrhage in the compressed cerebral parenchyma underneath the epidural hematoma were depicted by craniocerebral CT/MR imaging examination and further CT perfusion examination confirmed the local hyperperfusion-induced lesions. These 12 patients had an unsatisfactory clinical outcome with a high ratio of bad prognosis (58.3%, 7/12). Regression analyses indicated that the described surgical complication was significantly associated with duration of preoperative cerebral herniation (≥120 min, odds ratio [OR]=61.617, P=0.001), hematoma thickness (≥40 mm, OR=10.051, P=0.018). Conclusions Cerebral herniation longer than 120 min and hematoma thickness greater than 40 mm are high-risk factors associated with intra- and post-operative reperfusion injury. Controlled decompressive surgical strategy is helpful for a good recovery of cerebrovascular autoregulation function and thereby reduces the occurrence of reperfusion injury.
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Objective To develop and validate a novel preoperative risk evaluating system for surgical decision on decompressive craniectomy for patients with massive cerebral infarction (MCI) secondary to acute epidural hematoma (EDH) and concurrent cerebral herniation.Methods Clinical data of a retrospective patient cohort (from January 2006 to January 2012,n=151) were analyzed by multivariate Logistic regression analysis for the risk factors correlated with postoperative MCI so as to establish a preoperative risk scoring system,whose clinical accuracy of surgical decision-making were validated in another prospective patient cohort (from February 2012 to December 2014,n=97).Results Incidences of secondary cerebral infarction were 19.2％ (29/151) and 18.6％ (18/97) in the retrospective and prospective patient cohorts,respectively.Regression analyses indicated that 6 clinical factors were identified to be independently correlated with postoperative MCI,including temporal hematoma (P=0.005),preoperative hemorrhagic shock (P=0.003),hematoma volume greater than 100 mL (P=0.003),bilateral mydriasis (P=0.015),duration of cerebral herniation longer than 90 min (P=0.001),and Glasgow Coma Scale (GCS) scores ≤ 5 (P=0.070).A novel preoperative risk scoring system was established by totting-up the standardized partial regression coefficients of each identified risk factor (EDH-MCI scale,with total scores of 0-18).Results suggested that the incidence and mean volume of cerebral infarction increased along with risk scores in a stair-stepping manner.Therefore,three intervals were divided into low (0-9),borderline (10-12),and high risk intervals (13-18) according to the EDH-MCI scores.Clinical reliability of surgical decision-making guided by novel EDH-MCI scale was validated by a prospective clinical study.As compared with traditional empirical surgical strategy,EDH-MCI scale-guided prospective surgical strategy exhibited remarkable superiority that it significantly increased the accuracy of surgical decision (low risk interval,100.00％ vs.91.92％,P=0.046;borderline risk interval,77.78％ vs.46.67％,P=0.034;high risk interval,100.00％ vs.68.18％,P=0.023;overall accuracy,95.88％ vs.79.47％,P=0.000).Conclusion The established preoperative risk scoring system can make a precise judgment on the clinical risks of postoperative massive cerebral infarction secondary to cerebral herniation from isolated acute epidural hernatoma and thereby provide a reliable reference on the surgical decision of decompressive craniectomy.
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Objective To investigate the safety and feasibility of fast track surgery (FTS)in patients with vaginal hysterectomy for non -prolapsed uterus.Methods 1 1 0 cases of vaginal hysterectomy for non -prolapsed ute-rus with benign uterine disease were randomly divided into two groups:fast track group (n =55)and conventional group (n =55).The operative time,intraoperative blood loss,postoperative nausea and vomiting,anal exhaust time, postoperative hospital stay,medical cost and perioperative complications were compared between the two groups. Results In FTS group,the incidence rate of postoperative nausea and vomiting,the postoperative anal exhaust time, hospital stay,cost of hospitalization were 1 6.4%,(1 3.73 ±2.41 )h and (4.38 ±1 .08 )d,(7 541 .00 ± 253.1 7)yuan,respectively,which in the control group were 36.4%,(1 8.56 ±1 .54 )h,(4.89 ±1 .26 )d, (8 1 55.1 5 ±495.89)yuan,the differences were statistically significant between the two groups (χ2 =5.67,t =-1 2.53,-2.28,-8.1 7,all P 0.05).Conclusion FTS has good security.It can short the hospitalization time,reduce medical costs and improve the quality of life in patients who underwent vaginal hysterectomy for non -prolapsed uterus with benign uterine disease.
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Objective To study the effects of vagus nerve stimulation (VNS) on brain tissue tumor necrosis factor-α (TNF-o),interleukin-1β (IL-1β) and IL-10 levels in serum and brain tissues after blast brain injury in rabbits.Methods Twenty New Zealand white male rabbits were randomly divided into sham-operated group (n=6),traumatic brain injury (TBI) group (n=10),TBI+VNS group (n=8).Rabbit brain blast injury models of TBI group and TBI+VNS group were established; and the right cervical vagus nerves of the rabbits in TBI+VNS group were stimulated (10 V,5 HZ,5 ms,20 min).The TNF-α,IL-1β and IL-10 changes in the serum (6 h after injury) and brain tissues (24 h after injury) and the water content in the injured brain tissues were observed and recorded.Results The TNF-α and IL-1β levels in the serum and brain tissues,the water content in the brain tissues of the TBI group were significantly higher than those in the sham-operated group and TBI+VNS group (P＜0.05); the IL-10 level in the TBI+VNS group was significantly higher than that in the sham-operated group and TBI group (P＜0.05).Conclusion VNS can reduce the brain edema degree by increasing the IL-10 level and decreasing the TNF-α and IL-1 β levels,which plays a key role in brain protection effect after brain blast injury in rabbits.
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Objective To evaluate the diagnostic value of dual-source CT angiography (DSCTA) for intracranial aneurysms.Methods The data of DSCTA and digital subtraction angiography (DSA) were collected from 95 patients with subarachnoid hemorrhage (SAH).The efficacies of detection and description of morphologic features of intracranial aneurysms were analyzed retrospectively.Results A total of 117 aneurysms in 88 patients were detected with DSCTA.Two patients were suspected of having aneurysms,and no aneurysrms were detected in 5 patients.These patients were reexamined with DSA,4 were diagnosed as having aneurysm,and the aneurysms were not detected in 3 patients.DSA results were considered as gold standard,the specificity,sensitivity and accuracy of DSCTA for the detection of intracranial aneurysms were 100％,96.7％and 96.8％,respectively.The larger volume of intracranial aneurysm was,the higher the sensitivity of DSCTA diagnosis would be.Even for small aneurysms,the sensitivity of DSCTA diagnose was more than 90％.In addition,tmeasurement results of the maximum diameter and neck width of aneurysms measured by DSCTA were almost consistent with DSA.Condclusions SCTA is a non-invasive,quick,reliable,and effective method,and can provide accurate imaging information for surgery.The specificity and sensitivity of the diagnosis of aneurysms with DSCTA are almost the same with DSA.It has more advantages than DSA in the emergency operation of intracranial aneurysms.