Clinicopathologic features of delayed radiation-induced brain injury after radiotherapy for brain tumor / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features of delayed radiation-induced brain injury after radiotherapy for brain tumor.</p><p><b>METHODS</b>The clinical, histopathologic and immunohistochemical features of 9 cases with delayed radiation-induced injury were evaluated.</p><p><b>RESULTS</b>The disease occurred from 6 months to 12 years after radiotherapy and often presented with headache and muscle weakness. Magnetic resonance imaging showed peripheral enhancing lesions with slight mass effect and surrounding edema. Microscopically, the major changes included coagulative necrosis, fibrinoid necrosis of vessels, vascular hyalinization with luminal stenosis and peripheral reactive gliosis. Immunostaining for hypoxia-inducible factors 1α was positive in reactive astrocytes.</p><p><b>CONCLUSIONS</b>Delayed radiation-induced brain injury is a relatively common complication of radiation therapy. The lesion was frequently misdiagnosed as brain tumor. Correct diagnosis relies on clinical, radiologic and pathologic correlation.</p>

Application of adjustable oblique position for microendoscopic discectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the adjustable oblique position with prone position in microendoscopic discectomy (MED) and to evaluate its advantages.</p><p><b>METHODS</b>One hundred and twenty-eight patients who underwent MED during August 2000 and August 2002 were studied. Forty-seven cases were positioned prone, 81 cases were positioned with adjustable oblique position. Operating time, blood loss and patient endurance were recorded and compared. The airway resistance of 29 lumbar disorder patients was measured when they were positioned supine, lateral and prone respectively after general anesthesia.</p><p><b>RESULTS</b>There was statistically significant difference between 2 groups in operating time, blood loss and endurance. In prone position group, when operating time lasted for more than 50 min, 75% patients felt hurt on the skin of rib arch, and 38% patients presented dizzy and nausea. And all the patients had erythema on the rib arch. In the adjustable oblique position group, 3 cases had shoulder pain after operation, and 1 case had 4 days' common poroneal nerve paralysis. The airway resistance of patients with prone position was significantly higher than those with supine and lateral positioned patients. (P < 0.05).</p><p><b>CONCLUSION</b>The adjustable oblique position in MED had the following advantages: (1) Do not limit the movement of chest and help reduce intra-abdominal pressure and epidural bleeding; (2) Give the lumbar spine the largest degree of flexion and the largest interlaminar space, which prevents injury of facet joint; (3) Increase posterior intervertebral space and make disectomy easier and exposure of nerve root and nerve root canal clearer; (4) The patients feel comfortable and can adjust the position of lumbar spine and lower extremity; (5) The monitor has the same direction with doctor, and it is easy for the doctor to operate; (6) Doctor can sit during operation.</p>