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Objective:To investigate the predictive value of high-sensitive C-reactive protein (hs-CRP) for early hematoma enlargement in patients with primary intracerebral hemorrhage.Methods:Patients with intracerebral hemorrhage admitted to the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from January 2014 to January 2019 were enrolled retrospectively. The patients were sent to hospital within 6 h after onset, and the diagnosis of cerebral hemorrhage was confirmed by head CT. The head CT was reexamined within 24 h after the first head CT. Hematoma enlargement was defined as hematoma volume increase >6 ml or relative volume increase >33%. Multivariate logistic regression analysis was used to investigate the independent risk factors for influencing early hematoma enlargement. Receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of hs-CRP for hematoma enlargement. Results:A total of 154 patients with intracerebral hemorrhage were included, including 99 males (64.3%), aged 58.7±11.1 years. The median baseline Glasgow Coma Scale score was 13. The time from onset to first CT scan was 2.92±1.35 h. The time from the first CT to the second one was 16.05±4.40 h. The baseline volume of hematoma was 21.82±11.08 ml. Among them, 27 patients (17.5%) had hematoma that broke into the ventricle, 40 (26.0%) had hematoma enlargement. The average hs-CRP level at admission in the enlarged hematoma group was significantly higher than that in the non-enlarged hematoma group (11.56±3.72 mg/L vs. 9.51±4.31 ml; t=-2.669, P=0.008). Multivariate logistic regression analysis showed that hs-CRP at admission (odds ratio [ OR] 1.123, 95% confidence interval [ CI] 1.017-1.241; P=0.022), irregular hematoma shape ( OR 4.160, 95% CI 1.714-10.098; P=0.002) and the time from onset to the first CT scan ( OR 0.510, 95% CI 0.323-0.803; P=0.004) were significantly correlated with hematoma enlargement. Pearson correlation analysis showed that hs-CRP was positively correlated with baseline hematoma volume ( r=0.237, P=0.003). ROC curve analysis showed that the area under the curve of hs-CRP predicting hematoma enlargement was 0.678 (95% CI 0.584-0.772). The optimal cut-off value was 10.55 mg/L. The sensitivity and specificity for predicting hematoma enlargement were 86.9% and 60.0%, respectively. Conclusion:For patients with hs-CRP ≥10.55 mg/L at admission, irregular hematoma shape, and the time from admission to the first CT scan <3 h, should be focused the management and be alert to the occurrence of early hematoma enlargement.
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Objective To explore and analyze perioperative psychological care and its effect in craniotomy patients under sober state.Methods 10 patients with cerebral tumor of functional zone undergoing craniotomy under conscious state were given pertinent psychological nursing and psychological counsehng,besides,perioperative comprehensive nursing wag given in order to reach the aim of effective psychological nursing.Results The perioperative behavioral control of patients wag better,they could cooperate with the operation as requested and reached the anticipated aim.All patients rehabilitated at discharge.Conclusions Effective psychological care plays a very important role to ensure the success of sober craniotomy and rehabilitation of patients.
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Objective To explore the surgical treatment of posttraumatic epilepsy in functional cerebral area Methods After preoperative evaluation,nineteen patients with intractable posttraumatic epilepsy of functional cerebral area underwent multiple subpial transaction under the electrocorticogram monitoring during the operation, combining with anterior corpus callosotomy, anterior temporal lobectomy and selective amygdalo-hippocampectomy. Results The follow-up results showed seizures of these patients improved considerably. According to Engel' s grading,among 19 cases,10 cases were grade Ⅰ ,7 cases were grade Ⅱ ,2 cases were grade Ⅲ ,and no cases were grade Ⅳ. Conclusions The satisfactory clinical outcome of the surgical treatment of intractable posttraumatic epilepsy in functional cerebral area could be obtained with the help of careful preoperative evaluation and multiple subpial transaction under the electrocorticogram monitoring.
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Objective To observe the preventive effects of electroacupuncture therapy on glenohumeral subluxation(GHS)in patients of cerebral stroke of super-early period. Methods A total of 160 cases with cerebral stroke were randomly recruited into a control group of 80 cases and a treatment group of 80 cases. The control group was treated with conventional medicine and rehabilitation training, while the treatment group was given electro-acupuncture therapy based on conventional medicine and rehabilitation training. All treatments were performed once in each day, and one treatment course lasted for ten days. The preventive effect was evaluated after the successive three courses. Results 4 cases in treatment group and 2 cases in control group quitted in therapeutic process. The GHS incidence rate in the third course of treatment group was significantly lower than control group (P<0.05). The severe GHS incidence rate of treatment group was significantly lower than control group in the second course (P<0.05)and the third course (P<0.01). The GHS scale of the treatment group showed no significant difference in all three courses (P>0.05), while the control group showed significant difference in one course of all three(P<0.05). Conclusion Electro-acupuncture therapy can significantly decrease GHS incidence rate, relieve pathogenetic condition, control its progress, and so thus prevent GHS of stroke patients in super-early period.
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Objective To study the feasibility of semi-laminectomy procedures for the management of intradural extramedullary tumors of the spinal cord.Method Retrospective analysis of 19 cases of in-tradural extramedullary tumors of the spinal cord were treated by the approach of semi-laminectomy.including 11 cases of neurilemmoma and 8 cases of meningioma.Results Seventeen cases of extraspinal tumors were totally resection,2 of dumbbell neurilemmomas underwent subtotal resection.No new neurologi-cal disfunetions as well as recurrence or comphcations were found in all cases after the operation.Conclu-sion Semi-laminectomy procedures for the management of intradural extramedullary tumors of the spinal cord is a mini-invasive procedure,and is beneficial to the stability of spine,with the advantages of short hos-pitalization time,slight postoperative reactions and less complications.
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Objective To discuss the methods of treatment of sellar region tumors by microsurgery via modified transpterional approach.Methods The clinical data of 326 patients with sellar region tumors were retrospectively analyzed. All of the patients(of them 158 patients with pituitary adenomas, 89 patients with craniopharyngiomas and 79 patients with meningiomas)were treated by microsurgery via modified transpterional in our hospital in recent 4 years. The most important part of preoperative arrangement was giving glucocorticoid and anti-epilepsy drugs. Modified transpterional craniotomy was performed, and the tumors were removed by employing microsurgical techniques via the 5 anatomy interspaces in sellar region after the subarachnoid cisterns were dissected carefully under surgical microscope. Consciousness, urine volume and serum electrolyte of the patients were observed strictly after surgery, and the complications such as diabetes insipidus, serum electrolyte disorder and epilepsy were remedied in time.Results The rate of intact frontal branch of facial nerve was 92.18% and that of intact supraorbital nerve was 95.72%. Atrophy of temporal muscle occurred in none of the patients. Total and/or subtotal resection of tumors was achieved in 95.26% patients and the rate of intact pituitary stalk was 62.44%. The major postoperative complications included diabetes insipidus and serum electrolyte disorder. Although the incidence of complications was high to 61.42%, complete restore was achieved in 97.12% of the patients with the complications within 1 month.Conclusion The modified transpterional approach for sellar region tumors may give a lower incidence of damage to frontal branch of facial nerve, super-orbital nerve and temporal muscle, and it can achieve higher total resection rate and a less postoperative complications by employing modified transpterional approach and the microsurgical techniques, combined with the active treatments of postoperative complications, therefore it is deserved to be spread to use in clinical works.
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Objective To investigate the methods of total resection of craniopharyngioma and treatment of postoperative complications. Methods The abscission of CPG was performed in 24 patients with craniopharyngioma (CPG) which situated at sellar region after giving glucocorticoid and anti-epilepsy drug. The tumors were removed via the 4 anatomy spaces in sellar region by employing microsurgical technique. Consciousness, urine, and serum electrolyte of patients were observed strictly after surgery, and complications such as diabetes insipidus, serum electrolyte disorders and epilepsy were remedied in time. Results Total removal of tumors were achieved in 22 cases, and minor portion of tumors was left in 2 cases. All of the patients were sober after surgery. Diabetes insipidus, serum electrolyte disorder and body temperature disorder took place in 16 cases,12 cases, and 6 cases respectively. After treatment, serum electrolyte disorder and body temperature disorder were rectified in all cases, but diabetes insipidus was rectified in 13 of 16 cases. Conclusion Choosing the best operation approach according to the scope which tumor invades and being familiar with the 4 sellar anatomy spaces so as to be used correctly in operation are the keys to remove the CPG completely. Giving glucocorticoid before operation and active treatment of complications such as diabetes insipidus, serum electrolyte disorder can decrease mortality observably.
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Objective To observe the therapeutic effect of electroacupuncture plus laser intravenous irradiation therapy on dysfunction caused by craniocerebral injury. Methods One hundred and seventy cases of craniocerebral injury were randomly and equally divided into a treatment group and a control group. The control group was managed with routine treatment, while the treatment group with the electroacupuncture plus the laser intravenous irradiation on the basis of the routine treatment. Results After the treatment, there were significant differences between the two groups in terms of Glasgow Outcome Scale(GOS), Dyscinesia Scale(DS) and Karnofsky Performance Scale(KPS) evaluations. Conclusion The therapeutic effect and clinical outcome of electroacupuncture plus intravenous laser irradiation is significantly better than that in control group, indicating that electroacupuncture plus intravenous laser irradiation is a better therapeutic option for improvement of motor functions.
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Objective To explore the efficacy of large dose of magnesium sulfate used to treat patients with brain trauma. Methods According to standards 32 patients were chosen and divided into experimental group and control group at random. Sixteen patients in experimental group received 16 mmol magnesium sulfate intravenously over 15 minutes, followed by 65 mmol over 24 hours; while 16 patients in control group received nothing. Serum NSE, GCS and GOS of all the patients were measured after 3 days, 2 weeks and 6 months, respectively and the data were analyzed statistically. Results The serum NSE, GCS and GOS in experimental group were (24.8±19.2) μg/L, 12.3±3.3 and 3.6±1.4, respectively; while the serum NSE, GCS and GOS in control group were (49.7±23.1) μg/L, 9.8±2.8 and 3.1±1.6, respectively. Between the two groups the serum NSE and GCS were different significantly (P<0.01, P<0.05, respectively) while the GOS was not (P>0.05). Conclusions Large dose of magnesium sulfate is effective to treat patients with brain injury at least within a short term.
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Objective To investigate the method of total resection of craniopharyngioma and prevention and treatment of post-operative complications. Methods Pterion craniotomy was performed in 24 patients with craniopharyngioma which was situated in sellar region after giving glucocorticoid and anti-epilepsy drug. The tumors were removed via the 4 anatomy spaces in sellar region by employing microsurgical technique. Consciousness, urine volume, and serum electrolyte of patients were observed strictly after surgery, and complications such as diabetes insipidus, serum electrolyte disorders and epilepsy were treated in time. Results Total removal of tumors were achieved in 22 cases, and minor portion of tumors was left in 2 cases. There was not obvious deficit of nervous system function in all of the patients after surgery. Diabetes insipidus, serum electrolyte disorder and body temperature disorder occurred in 16 cases, 12 case, and 6 cases respectively. After treatment, serum electrolyte disorder and body temperature disorder were rectified in all cases, and diabetes insipidus was rectified in 13 of 16 cases. Conclusion Choosing the best operation approach according to the scope of tumor invasion and being familiar with the 4 sellar anatomy spaces were the keys to remove craniopharyngioma completely. Giving glucocorticoid before operation and active treatment of complications such as diabetes insipidus and serum electrolyte disorder could effectively decrease mortality.
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Objective To investigate the expression of human telomerase reverse transcriptase(hTRT) in meningiomas,the correlation with malignancy grade and the prognostic significance of hTRT activity.Methods The expression of hTRT and proliferating cell nuclear antigen(PCNA) in 43 meningiomas was examined by immunohistochemical technique.Postive rates of hTRT between histopathologically different grades were analyzed,and so did between initial detected case group and recurrent case group.The labelling indexes of PCNA between hTRT-positive group and hTRT-negative group were also analysed.Results Of 43 meningiomas examined,19(44%) demonstrated the expression of hTRT.hTRT was present in 3 of 26 benign meningiomas(11 5%),10 of 11 atypical meningiomas(90%) and 6 of 6 malignant meningiomas(100%),respectively(P