ABSTRACT
Objective@#To summarize the clinical presentations and imaging features of cerebral venous sinus thrombosis (CVST) in 5 newborns.@*Methods@#The clinical data of 5 newborns with CVST admitted to Department of Neonatology of Maternal and Children Hospital of Hubei Province from February 2017 to April 2018 were analyzed retrospectively. The risk factors, clinical presentations, imaging manifestations and treatment of CVST were investigated.@*Results@#Of the 5 full term neonates, 4 were males and 1 female, with 4 aged less than 7 days and 1 more than 7 days; one with the history of maternal gestational diabetes mellitus, one with maternal gestational hypertension. The clinical presentations included seizures (3 cases), fever (3 cases), dehydration (1 cases), lethargy (2 cases), hypoglycemia (2 cases), thrombocytopenia (2 cases). Electroencephalogram (EEG) showed electrical seizures in 3 cases. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) showed 4 cases of intracranial hemorrhage, 3 cases of cerebral parenchymal infarction. For the sites of the thrombi, 4 were in the superior sagittal sinus, 3 in straight sinus, 2 in transverse sinus and 1 in sinus confluence. CT showed intracranial hemorrhage in 2 cases and venous sinus dilatation in 2 cases. Doppler ultrasound showed 2 cases of intraventricular hemorrhage and 2 cases of changes of venous sinus blood flow. Three neonates were treated with anticoagulant and thrombolytic therapy, followed by recanalization of the veins and discontinuing of seizures.@*Conclusions@#Seizure is the main clinical presentation of CVST. The main radiologic manifestations are cerebral infarction and hemorrhage. Timely brain MRI and MRV are helpful in the early diagnosis and treatment of CVST.
ABSTRACT
Objective To investigate the effects of preoperative biliary drainage ( PBD ) on the morbidity and mortality of pancreaticoduodenectomy in patients with malignant obstructive jaundice in the lower bile duct. Methods Clinical data of 74 cases undergoing pancreaticoduodenectomy from Jan. 2000 to Dec. 2005 with preoperative total bilirubin level over 85 μmol/L were collected and retrospectively analyzed. Comparison was performed between patients receiving PBD and those not. Before surgery. The parameters sincluding perioperative situation, in-hospital death rate, post-operative complications and were calculated to evaluate the influence of pre-operative biliary drainage on the outcomes. Univariate analysis and Logistic analysis were used to identify the risk factors for post-operative complications. Results Forty (40/74) cases received PTCD procedure. The total bilirubin was significantly reduced from (338. 10±88. 38 )μwnol/L to ( 228. 50±82.24) μ,mol/L in PTCD population and was significantly lower than ( 328. 60±93. 02) μmol/L of the non-PTCD group. There was no significance between the two groups in terms of total complications and individual complication Logistic regression analysis showed that preoperative TB over 340 μmol/L and blood loss over 600 ml were important risk factors for post-operative complications. Conclusion High pre-operative total bilirubin over 340 μmol/L increases the risk of post-operative complications in the patients with malignant jaundice. Preoperative biliary drainage is useful to reduce the total bilirubin and improve the hepatic function of the patients. Prolonged pre-operative biliary drainage could be considered in the patients with high preoperative bilirubin,poor nutritional condition and impaired coagulation to enhance the tolerance of surgery.