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Objective To investigate the clinical efficacy of carotid endarterectomy ( CEA) for the treatment of patients with dolichoarteriopathies of internal carotid artery combined with carotid artery severe stenosis. Methods From January 2013 to February 2018,the clinical data of 18 consecutive patients with dolichoarteriopathy of internal carotid artery combined with carotid artery severe stenosis admitted to the Department of Neurosurgery,the First Affiliated Hospital of Soochow University were analyzed retrospectively. All patients underwent color Doppler ultrasound,CT angiography (CTA),and DSA to assess the diseased vessels before operation,and blood perfusion of the cerebral hemisphere was evaluated by CT perfusion (CTP) imaging. Six patients of Metz grade Ⅱ and 4 of grade Ⅲ underwent valgus CEA +excision of the redundant internal carotid arteries;8 patients of Metz grade I were treated with standard CEA. Postoperative cervical vascular ultrasound,CTA,and CTP examinations were performed in order to understand the vascular patency of the surgery and correction of dolichoarteriopathies of internal carotid artery. The follow-up time was 6 to 72 months. The color Doppler flow imaging and CTA were used to assess the presence or absence of restenosis and MRI was used to evaluate the presence of new cerebral infarction. Results All 18 patients were successfully operated, and they had good vascular patency after operation. The Postoperative CTA showed that the distorted blood vessels had been straightened to varying degrees for ten patients who underwent valgus CEA treatment and the plaques were removed satisfactorily without stenosis for 8 patients treated with standard CEA. After operation,one patient developed sublingual nerve injury symptoms,which was improved after 3 months. One patient developed mild hyperperfusion syndrome,which was improved after 2 weeks. No patients died. Follow-up reexamination showed that all patients had no carotid artery restenosis and new stroke events. Conclusions CEA is a safe and effective treatment for patients with internal carotid artery dolichoarteriopathy combined with severe carotid stenosis. According to the characteristics of the lesions evaluated before surgery, surgical methods should be selected reasonably.
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Objective To investigate the effect of ischemic preconditioning (IPC) on expression of intracellular adhesion molecule-1 (ICAM-1) in brain tissues following traumatic brain injury (TBI) in rats.Methods Sixty male SD rats weighing 220-250 g were randomly divided into three groups (n =20 for each):sham operation group,TBI group,and IPC group.Cerebral IPC models were induced by transient occlusion of the bilateral common carotid arteries; TBI models were induced by Feeney's freefalling method; rats in sham operation group were only performed exposure of dura of the right parietal lobe.Ten rats were sacrificed respectively at 6 and 72 hours after TBI and injured brain tissues were harvested to estimate wet/dry weight (W/D) ratio for the brain,determine ICAM-1 expression by immunohistochemistry and perform microscopic examination.Results Brain W/D ratio was significantly increased in TBI group compared with sham operation group (6 h:4.2 ± 0.4 vs 2.7 ± 0.4 ; 72 h:5.0 ±0.1 vs 3.1 ± 0.2,P ＜ 0.05).ICAM-1 expression was up-regulated in TBI group compared with sham operationgroup (6h:25.4±3.5vs8.6±1.3; 72 h:36.5±5.4 vs8.4±1.6,P＜0.05).W/D ratio was significantly decreased in IPC group compared with TBI group (6 h:3.5 ±0.6 vs 4.2 ±0.4; 72 h:3.7 ± 0.4 vs 5.0 ± 0.1,P ＜ 0.05).ICAM-1 expression was down-regulated in IPC group compared with TBI group (6 h:16.5 ± 2.7 vs 25.4 ± 3.5 ; 72 h:24.3 ± 4.6 vs 36.5 ± 5.4,P ＜ 0.05).Milder injury to brain tissues was observed in IPC group than in TBI group.Conclusion IPC can attenuate TBI in rats by down-regulating the expression of ICAM-1.
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Objective To evaluate the efficacy and reliability of intraoperative microvascular Doppler uhrasonography (IMDU)in urgent clipping surgery of ruptured aneurysms,and assess the impact of this method on the surgical procedure itself.Methods For 62 patients who underwent urgent clipping surgery for the treatment of ruptured aneurysms,both blood flow velocities in the aneurismal sac and in the adjacent vessels and alterations of the Doppler spectrum were determined by IMDU before and after aneurysm clipping.The findings of IMDU were analysed and compared with those of visual inspection of the surgical site and postoperative angiography. Results A relevant stenosis of an adjacent vessel induced by efip position that had escaped detection by visual inspection was identified by IMDU in 12 out of 62 patients.In addition, IMDU demonstrated a primarily incomplete clipping aneurysm in 4 out of 62 patients.The clipping aneurysm was repositioned on the basis of the IMDU findings in 16 out of 62 patients.The findings from IMDU equated with those from angiography in 38 eases.Conclusion IMDU is a safe,instantaneous,effective and reliable technique for the urgent dipping surgery of raptured aneurysms.
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This article expounds the indication,preoperative ischemic tolerance test,evaluation of collateral circulation,different surgical modes,complications and their prevention in the treatment of intracranial aneurysms during extracranial-intracranial(EC/IC)graft bypass.It is considered that EC/IC bypass graft is an effective therapeutic mode in preventing the occurrence of cerebral ischemia in the treatment of intracranial aneurysms.
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Objective To investigate surgical techniques and results of arthroscopic reduction and fixation for the treatment of avulsion fracture of the posterior cruciate ligament from the tibia through an additional posterolateral portal. Methods An additional posterolateral portal was established by using the inside-out technique under arthroscopic view.After a protective sleeve was placed through the portal and the displaced fracture was reduced,the fragment was fixed by the guide wire drilled through the sleeve temporarily.If the fluoroscopic control showed an anatomic reduction of the fragment and good placement of the wire,the self-attacked cannulated screw and washer was placed intra-articularly over the guide wire through the sleeve for the directive internal fixation of the avulsion fracture.Aggressive rehabilitation programs were recommended postoperatively.Results Except 1 case with 11 mm displacement and rotation of the fragment treated by the arthrotomy after the failure of arthroscopic reduction,the arthroscopic operation was accomplished in all the remaining 10 cases.The operative time was 63～98 min(mean,87.3 min).No injuries of popliteal vessels or nerves occurred.The postoperative X-ray firms showed an anatomic reduction of the fragment and good placement of the screw and washer.With the negative posterior drawer test confirmed by the physical examination,normal range of motion of the injured knee joint and gait were achieved in the 10 patients at 4～7 weeks after surgery.The bone union was confirmed by X-ray films at the 3 months postoperatively.The computer KT-2000 arthrometer measurements of posterior tibial displacement of both knee joints showed side-to-side difference not more than 1.2 mm in 6 patients at 5 months after surgery.Conclusions The additional posterolateral portal can be established by the arthroscopic inside-out technique safely.The displaced fragment of the avulsion fracture of the posterior cruciate ligament from the tibia can be reduced and fixed with the self-attacked cannulated screw and washer arthroscopicly.
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Objective: To study the role of inducible nitric oxide synthase (iNOS) in activated macrophages and nitric oxide (NO) in the defence against tumors. Methods: Macrophages were obtained by alveolar lavages of mice and activated through incubation with recombinant murine INF? in vitro. P815 cells were added to the culture. Culture supernates were collected to measure the activity of iNOS and NO. Tumoricidal activity of macrophages was determined in presence and absence of the specific inhibitor of NO synthase: L NMMA. Results: NO production and activity of iNOS induced by activated macrophages were positively related with concentration of INF? in macrophage P815 coculture. The addition of L NMMA to the culture suppressed NO production, the inhibitory rate of activated macrophages against P815 cells was reduced distinctly ( P
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The effects of GPA, anti-GPA IgG, ?1acid glycoprotcin (?1-AGP), ovomucoid (OM) and wheat germ agglutinin (WGA) on the invasion of erythrocytes by P. falciparum were obseryed in vitro. GPA, anti-GPA IgG and WGA at low concentrations had obviously inhibitory effects on thc invasion. There were hyperbolic relationships between the concentrations of these inhibitors and their inhibition rates. OM, ?1-AGP and non-spccific anti-serum had no obvious effect on the invasion. It is confirmed for the first time from the biological characteristics of receptor-ligand interaction that thc combination of GPA with P. falciparum merozoites has high spccificity, high affinity with a tendency to sa-turation and can produce specific biological effects.