ABSTRACT
Objective Few studies are reported on the influence of perivascular space enlargement (PVSE) on the prognosis of cerebral infarction. This study was to investigate the clinical correlation of EPVS in the basal ganglia and central semiovale with the prognosis of the first acute cerebral infarction (ACI) with anterior circulation mild small-artery occlusion (SAO).Methods We treated 137 cases of the first ACI with anterior circulation mild SAO in Tangshan Gongren Hospital from August 2015 to October 2016. According to the scores on PVSE in the basal ganglia and central semiovale, we divided the patients into a mild PVSE (score: 0-1) and a severe PVSE group (score: 2-4). Based on the National Institutes of Health Stroke Scale (NHISS) and the modified Rankin Scale (MRS) scores, we classified the outcome of neurological function recovery as good (MRS≥2) and poor (MRS<2) and analyzed the risk factors for the poor prognosis of ACI by logistic regression analysis.Results There were 60 cases of severe and 77 cases of mild PVSE in the in the basal ganglia as compared with 57 cases of severe and 80 cases of mild PVSE in the in the central semiovale. Good prognosis was achieved in 97 cases while poor prognosis observed in 40. Multivariate logistic regression analysis showed that the risk factors for the poor prognosis of ACI included NHISS at the onset (OR=5.393, 95% CI: 1.858-15.654), hypertension (OR=3.729, 95% CI: 1.310-10.610), and the severity of PVSE in the basal ganglia (OR=3.137, 95% CI: 1.343-7.325).Conclusion For the first acute cerebral infarction with anterior circulation mild small-artery occlusion, the severity of PVSE in the basal ganglia is an important factor affecting the recovery of neurological function.
ABSTRACT
ObjectiveTo probe into the clinical efficiency of reconstruction to person who had composite tissue defect of the floor of mouth and the lower part of face with the free forearm flap and free iliac bone in the same term.MethodsBefore the surgery, the surgeon should carefully evaluate the scope and shape of defects in 11 cases who had the composite tissue defects of the floor of mouth and the lower part of face, to design the individual forearm flap, so that it matches with the defect region. During surgery, the first resumption of defects using titanium plates forming the basic shape of mandible and the occlusal relationship,then used to re-sawing to take modeling of the iliac bone,transplanted free iliac bone and fixed after the inside of the titanium plate, thereby restoring the continuity of mandible missing.ResultsFree forearm flap and free iliac bone all survived in 11 cases, the success rate of 100％. The patients were followed up for 6 to 12 months, although the shape of restoration areas were different levels of fat, but eating, swallowing and other oral function had been well improved, 7/11 could enter normal diet, 4/11 to enter liquid diet, At the same time, the patients in social activities can communicate in a language daily, sensory function of skin flap and facial appearance has been satisfactory recovery.ConclusionConformal free forearm flap and free iliac bone is an ideal way to reconstruct the composite tissue defects of the floor of mouth and the lower part of face in the same period, not only safe, practical prognostic effect, and also can significantly improve the patients quality of life, which is worthy of reference and use.