Preliminary results of cord blood mononuclear cell therapy for multiple system atrophy: a report of three cases

This study was designed to evaluate the effects of cord blood mononuclear cell transplantation in multiple system atrophy [MSA]. Cord blood mononuclear cells [1-2 × 10 8 cells/6 ml] were injected into the subarachnoid space using lumbar puncture in patients 1 and 2 and cisterna magna puncture in patient 3 in the 3 patients with MSA. The cord blood mononuclear cell transplantation was repeated 30 days after the first treatment in patients 1 and 2; it was repeated twice in patient 3. The clinical outcomes of treatment were used to assess the Unified Multiple System Atrophy Rating Scale [UMSARS] before, 90 and 180 days after the cell transplantation. There were no clinically noticeable side effects from the cord blood mononuclear cells. The UMSARS scores improved after 90 days of the cord blood mononuclear cell therapy in all 3 patients, the most significant improvement being that in urinary incontinence and ability to walk. Cord blood mononuclear cell transplantation was safe and potentially effective in the treatment of MSA in the 3 patients

Changes and prognostic value of serum vascular endothelial growth factor in patients with differentiated thyroid cancer

To evaluate the changes and the prognostic value of serum vascular endothelial growth factor [VEGF] in patients with differentiated thyroid cancer [DTC] . A total of 79 patients with DTC and 30 healthy individuals were divided into four groups: [1] a healthy control group [n = 30]; [2] DTC without recurrence [n = 35; 23 papillary, 12 follicular] ; [3] DTC with local recurrence [n = 24; 15 papillary, 9 follicular], and [4] DTC with lung metastasis [n = 20; 13 papillary, 7 follicular] . Serum VEGF and thyroglobulin levels were measured in all patients. Serum levels of VEGF were significantly higher in the lung metastasis group than in the other three groups [p < 0.05]. Serum thyroglobulin concentration positively correlated with VEGF expression [r = 0.8678, p < 0.001] in patients with thyroid cancer recurrence. Multivariate Cox regression analysis showed that clinical staging [OR = 1.851, 95% Cl 1.04-3.47; p = 0.038], non-compliance with postoperative thyroxin replacement therapy [OR = 1.935,95% Cl 1.03-3.65; p = 0.042] and postoperative levels of thyroglobulin [OR = 1.892, 95% Cl 1.01-3.56, p =0.032] were independent predictors for thyroid cancer recurrence. Every additional 100 ng/l of serum VEGF levels increased the risk of thyroid cancer recurrence by 20.3%; but this did not reach statistical significance [OR = 1.203, 95% Cl 0.95-1.52; p = 0.125] . Serum VEGF increased in patients with recurrent thyroid cancer following surgical therapies. The predictive value of serum VEGF requires further investigation

Relations between plasma von willebrand factor or endothelin-1 and restenosis following carotid artery stenting

This study was designed to investigate the relation between plasma von Willebrand factor [VWF] or endothelin-1 [ET-1] and post-carotid artery stenting [CAS] restenosis. Plasma levels of VWF and ET-1 were measured in 61 patients [36 males, mean age 64.4 +/- 6.8 years] before and after CAS. The mean follow-up time was 13.8 +/- 1.7 months [range, 6-63]. In-stent restenosis was defined as a >10% narrowing of the vascular lumen with or without ischemic symptoms following CAS. In-stent restenosis was identified in 14 [23%] patients, including 3 with >50% restenosis. In the restenosis group, mean VWF and ET-1 levels at 2 weeks, 1 and 6 months after CAS were higher than the baseline levels [p < 0.05 or p < 0.01]. Mean levels of VWF and ET-1 in the restenosis group were higher than in the non-restenosis group within 6 months after CAS [p < 0.05 or p < 0.01]. Persistent elevation in plasma VWF and ET-1 within the first 6 months of CAS was found in patients with in-stent restenosis

Clinical features and management outcomes of severe hand, foot and mouth disease

This study was designed to describe the clinical features and management outcomes of severe hand, foot and mouth disease [HFMD]. Data on 147 severe HFMD patients during an outbreak in 2009 were analyzed. Most patients were under 3 years of age; 102 [69.4%] were boys. All had skin rashes and fever of ?38°C. All [n = 147, 100%] showed signs of central nervous system involvement, such as lethargy [n = 124, 84.4%], myoclonic jerks [n = 76, 51.7%], or drowsiness [n = 34, 23.1%]. Respiratory symptoms were mainly tachypnea [n = 112, 76.2%] or bradypnea [n = 21, 14.3%]. Common cardiovascular symptoms included tachycardia [n = 134, 91.2%] and hypertension [n = 23, 15.5%]. Chest X-ray showed increased markings in 76 [51.7%] or consolidation in 44 [29.9%]. Hyperglycemia and elevated blood lactic acid levels were found in 127 [86.4%] and 130 [88.4%], respectively. Positive enterovirus EV71-PCR was found in 113 [76.9%]. All patients were treated with mechanical ventilation for 61.2 +/- 12.8 h [range, 40-96 h], as well as mannitol, dexamethasone, gamma globulin and ribavirin. Dopamine, dobutamine or amrinone was administered in 58.5, 51.0 and 21.8%, respectively. Three patients [2%] died during hospitalization. All others had a full recovery and were discharged after 14.2 +/- 1.6 days [range, 12-17 days]. Central nervous and cardiorespiratory systems were involved in the patients with severe HFMD. Fasting blood glucose and lactic acid levels increased in the majority of patients. Mechanical ventilation and supportive pharmacotherapy were associated with a good clinical outcome in these patients

Feasibility and safety of early removal of incisional dressings following thoracic surgery

To investigate the feasibility and safety of early dressing removal of clean wounds following thoracotomy. A total of 230 patients [127 males, mean age 55.6 +/- 16.7 years] were randomly divided into study and control groups. In the study group the cotton gauze dressing was removed 48 h after the surgery, whereas in the control group the dressing was kept on for 7-8 days until the removal of skin sutures. The infection and healing of the wounds were examined, and patients were followed up for 30 days. There was no statistically significant difference in age, sex, smoking rates, concurrent illnesses and operational characteristics between the study and control groups [p > 0.05]. The wound infection rate in the study and control groups was 6 [5.2%] and 7 patients [6.1%], respectively [p = 0.775]. Two patients [1.7%] from the study group and 1 [0.9%, p = 0.561] from the control group had partial wound approximation by day 7. Surrounding skin integrity was normal in 106 [92.2%] of the study group and 107 [93.0%] of the control group patients by postoperative day 7 [p = 0.801]. Removal of wound dressing 48 h after thoracic surgery was not associated with an increased risk of surgical site infection. Hence the early removal of wound dressing did not appear to have an adverse impact on wound healing

Value of high frequency ultrasonography in diagnosis and surgical repair of traumatic finger tendon ruptures

To investigate the value of high frequency ultrasonography in the diagnosis of zone 2 flexor tendon injuries. Subjects and Methods: Ninety-two patients [49 males and 43 females, mean age 32.6 +/- 11.2 years] with zone 2 flexor tendon injuries in one or more digits were randomly divided into a study [n = 46, 95 digits] and a control group [n = 46,90 digits]. In the study group, preoperative ultrasound was performed and surgical repair was conducted based on ultrasonographic findings. Diagnosis and surgical repair of the control group was based on history of trauma and physical examination. Types of ruptures [complete or partial] and the location of the distal end of the ruptured tendon diagnosed by preoperative ultrasonography were consistent with surgical findings in all cases [95/95, 100%] of the study group, whereas the concordance rate between clinically diagnosed ruptures and surgical findings was only 34.4% [31/90] in the control group [p = 0.02]. Preoperative high frequency ultrasound examination yielded excellent diagnostic accuracy for zone 2 flexor tendon injuries

Sinistral portal hypertension: clinical features and surgical treatment of chronic splenic vein occlusion

Sinistral, or left-sided, portal hypertension [SPH] is a rare cause of upper gastrointestinal hemorrhage. This retrospective analysis summarizes the clinical features of SPH and the results of surgical treatment. Between 2000 and 2009, patients from our hospital diagnosed with SPH were identified. Diagnosis of SPH was based on evidence of isolated splenic vein thrombosis, splenomegaly, gastroesophageal varices and exclusion of other causes of portal hypertension. Eight males and 5 females were included in the study, with a mean age of 43.5 +/- 6.4 years [range: 31-68 years]. Liver function was normal in all patients. Causes of SPH were chronic pancreatitis [n=7], pancreatic cancer [n=3], pancreatic cysts [n=2] and neuroendocrine tumor [n=1]. The main clinical manifestations were gastrointestinal hemorrhage in 7 cases [53.8%], upper abdominal pain in 10 [76.9%] and hypersplenism in 12 [92.3%]. All patients had splenomegaly and gastroesophageal varices. Twelve patients underwent splenectomy and 1 received surgical removal of a pancreatic cyst. No major gastrointestinal tract rebleed occurred after a mean follow-up of 46 months [ +/- 7 months]. Two patients died of pancreatic cancer and 1 of acute myocardial infarction during follow-up. SPH should be suspected in patients with upper gastrointestinal varices as well as unexplained splenomegaly with normal liver function. Surgical intervention such as splenectomy offers a good long-term outcome in symptomatic patients

Value of three-dimensional optical coherence tomography and fundus photochromy in correlating the fluorescein leaking sites of acute central serous chorioretinopathy

This study was designed to investigate the value of 3-D optical coherence tomography [3-D OCT] combined with fundus photochromy in the diagnosis of acute central serous chorioretinopathy [CSCR]. 3-D OCT and fundus photochromy were performed on 30 patients [36 eyes] with acute CSCR. Fluorescein angiography [FA] was also performed to confirm the diagnosis and to obtain the fluorescein leakage sites. 22 eyes presented neurosensory retinal detachment determined by 3-D OCT [28 leakage spots], 1 eye showed retinal pigment epithelium [RPE] detachment [2 leakage spots], and 13 eyes showed both neurosensory and RPE detachment [17 leakage spots]. 3-D OCT showed significant changes in the RPE in 36 of 47 leakage spots [76.6%]. Fundus photochromy showed white-gray changes in 22 of the 47 leakage spots [59.6%]. 47 leakage spots were identified by FA in 36 eyes. The combination of 3-D OCT and fundus photochromy identified 42 of the 47 leakage spots [89.4%] spotted by FA. A combination of 3-D OCT and fundus photochromy offered a high identification rate of the leakage spots. The combination of the two noninvasive techniques may be used as an alternative diagnostic or evaluation tool for acute CSCR

Percutaneous endoscopic gastrostomy/jejunostomy combined with percutaneous transhepatic biliary drainage in treating malignant biliary obstruction

To investigate the safety and efficacy of percutaneous endoscopic gastrostomy/jejunostomy [PEG/PEJ] combined with percutaneous transhepatic biliary drainage [PTCD] in treating malignant biliary obstruction. Nine patients [6 males and 3 females, average age 71.3 +/- 5.5 years] with complete obstruction of the biliary tract were treated with PEG/PEJ after PTCD. The PEG/PEJ and PTCD tubes were linked outside of the abdominal wall to direct the externally drained bile back to the jejunum through the PEG/PEJ intestinal tube. Clinical symptoms and liver function were assessed following the treatment. The operations were successfully completed in the 9 patients within 40 min [average 35 +/- 2.9 min]. Clinical symptoms such as jaundice, abdominal distension, stomachache and diarrhea appeared but improved within 7 days of the operation. Serum levels of bilirubin, aspartate aminotransferase and alanine aminotransferase were reduced [p < 0.01] 4 weeks following the treatment. There were no procedural complications. Combined PEG/PEJ and PTCD appeared to be safe and effective in the management of malignant biliary obstruction. Further, larger-scale studies will be needed to verify findings of this report

Relationship between plasma cortisol levels and stress ulcer following acute and severe head injury

This study was designed to investigate the relationship between plasma cortisol levels and stress ulcer following acute severe head injury. The plasma cortisol levels were prospectively measured by radioimmunoassay in 68 patients following acute head injury. The diagnosis of stress ulcer was based on clinical evidence and was confirmed by endoscopic examination. Patients with stress ulcer and gastrointestinal bleeding [n = 30, 44.1%] were older than those without stress ulcer [38.2 +/- 7.9 vs. 28.3 +/- 9.7 years, P< 0.01]. The combined rate of poor recovery and death in the stress ulcer patients [70.0%] was significantly higher than in the nonulcer patients [42.1%, p = 0.02]. On each of the first 3 days following the head injury, the average plasma cortisol levels in the stress ulcer patients were higher than in the nonulcer patients [p< 0.01]. Univariate analysis showed a positive relationship between plasma cortisol on admission and stress ulcer [r= 0.329, p = 0.01]. Logistic regression analysis revealed that plasma cortisol levels on admission [OR = 2.326, 95% Cl = 1.982-2.466] and age [OR = 1.064, 95% Cl = 0.861-1.219] were independent predictors of stress ulcer. The data showed that acute severe head injury was associated with a significant increase in plasma cortisol. Plasma levels of cortisol and age were independent predictors of stress ulcer following acute head injury

Value of radiographic esophageal imaging in determining an optimal atrial septal puncture site for percutaneous balloon mitral valvuloplasty

To investigate the value of radiographic esophageal imaging in facilitating transseptal catheterization in patients undergoing percutaneous balloon mitral valvuloplasty. A total of 468 patients were randomized into either the study group [n = 234], in which radiographic esophageal imaging by the oral administration of a contrast media took place, or the control group [n = 234], in which the Ross technique was used. Of the 468 patients, 203 were males and 265 were females. The average ages of the study and control groups were 53 +/- 16 and 51 +/- 17 years, respectively. The patients had severe left atrial enlargement as measured using 2-dimensional echocardiography. In the study group, the left atrial impression on the esophagus was clearly seen, and was used to identify the puncture site on the right atrial side for the passage of the transseptal catheter. In the control group, the left atrial silhouette was not clearly shown by fluoroscopy in 112 patients [47.5%]. The success rate of transseptal catheterization in the study group was higher than in the control group [99.6 vs. 45.7%, p = 0.0001]. There were no complications in the study group, but pericardial tamponade occurred in 1 patient in the control group. Radiographic esophageal imaging facilitates the identification of an optimal atrial transseptal puncture site, and improves the success rate of transseptal catheterization in patients undergoing percutaneous balloon mitral valvuloplasty

Video-assisted thoracoscopic left sympathectomy for the treatment of congenital long QT syndrome / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the feasibility, safety and effectiveness of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of congenital long QT syndrome.</p><p><b>METHODS</b>Under general anaesthesia, pleural cavity was entered via two or three small incisions in the left intercostal space. The left thoracic sympathetic chain was identified and resected from T2 approximately T5. The lower one at the third of the left stellate ganglion was also resected.</p><p><b>RESULTS</b>VATS resulted in a significant shortening in corrected QT intervals in three patients. The average QT interval of the four patients was 537.5 ms before VATS and 512.5 ms after VATS. The heart rate of the patients remained unchanged. There were no major peri-operative complications apart from mild ptosis of the left upper eyelid in one patient who recovered in the following days. The syndrome recurred in one patient in syncopal events in four months after VATS.</p><p><b>CONCLUSION</b>VATS is a safe as well as an effective technique for the treatment of congenital long QT syndromes.</p>