ABSTRACT
Objective To investigate the clinical safety and efficacy of mechanical thrombectomy(MT) with Solitaire stent compared with the selective intra-arterial thrombolysis (IAT) in the treatment of acute cerebral infarction.Methods Totally 82 cases patients with severe acute ischemic stroke caused by middle cerebral artery stenosis from January 2014 to May 2016 in the stroke treatment center of the first people's Hospital in ZunYi city who were applied with the mechanical thrombectomy or the selective intra-arterial thrombolysis was included,and a comparative analysis was conducted on the mTICI rating to assess the interventional recanalization,the NIHSS score after the treatment,bleeding rate,and conditions of neurological functional recovery 90 days after operation.Results There were 42 cases applied with the mechanical thrombectomy (MT group),40 cases applied with the intra-arterial thrombolysis (IAT group).The total effective rate reached 85.70％ in the MT group and 62.50％ in the IAT group,the difference was significant (P ＜ 0.05).Compared with NIHSS score before operation,the score after the treatment showed a decreased trend.And the NIHSS score of MT group was better than that of the IAT group in a week after the treatment (P ＜ 0.05).The bleeding rate was lower in the MT group with statistically significant difference (P ＜ 0.05).Conclusion Compared to IAT,MT can provide broader time window,higher recanalization rate and better outcome in patients with severe acute ischemic stroke.
ABSTRACT
Objective To investigate the best injection position and curative effect of ultrasound-guided thrombin injection (UGTI)on femoral pseudoaneurysm (FPA).Methods Review the data of FPA cases in the neurology department of southwest hospital from January 2010 to June 2015.Detailed clinical information of the patients,including the curative effect of local compression therapy,the position,meth-od,dosage and curative effect of ultrasound-guided thrombin injection were collected and analyzed.Results From January 2010 to June 2015,43 cases (1.20%)of FPA were diagnosed in 3573 patients undergoing cerebrovascular interventional operation.Local compression therapy was effective in 11 of 43 FPA patients.The remaining 32 patients who had no response to local compression therapy were treated by UGTI,and the average dosage of thrombin was (30 ±12)IU.All FPA were blocked successfully within 1 minute and without any distal em-bolism events after the first UGTI attempt.No relapse and complications occurred during the follow-up of 5 to 70 months,averagely (38.69 ± 20.79)months.Conclusion UGTI is effective for treatment of FPA who had no response to local compression therapy.Thrombin injection at position far away from the blood flow direction of pseudoaneurysm neck crevasse with ultrasound-guided could bring about highe success rate, less amount of thrombin,and less complications.
ABSTRACT
Objective To investigate the diagnostic value of three-dimensional magnetic resonance imaging (MRV ) and digital subtraction arteriography (DSA ) in cerebral venous sinus thrombosis (CVST). Methods Twenty-nine patients with CVST admitted to the First Affiliated Hospital of the Third Military Medical University (Southwest Hospital)from January 2008 to February 2014 were enrolled retrospectively. Eleven of them were males and 18 were females. Their course of disease ranged from 3 days to 3 months. Nine patients were in the acute phase (2 weeks). All the patients were underwent magnetic resonance (MR)(T1 or T2 weighted image ),three-dimensional MRV,and DSA examinations. Results DSA detected 29 and MRV detected 24 patients. MRI revealed 12 patients had cerebral infarction and 7 had cerebral infarct and hemorrhage. On T2-weighted sequences,16 patients showed the flow void effect of venous sinus disappeared,and thromboses with different signals in the sinuses. MRV showed part development of the veins in 14 cases and no development in 10 cases,including 4 with collateral circulation. Compared with DSA,the positive detection rate of MRV was 82. 8%. The lesion sites of 3 patients involving the transverse sinus and 2 involving the sagittal sinus were not detected on MRV. Conclusion Compared with DSA,the MRV has a certain percentage of missed diagnosis rate for CVST. In clinical work,if MRV diagnosis is negative,it can not exclude the diagnosis of CVST,and further DSA examination is needed.
ABSTRACT
Objective: To identify the mutation points of Cu/Zn superoxide dismutase(SOD1) gene in an amyotrophic lateral sclerosis(ALS) family with a unique phenotype,and to compare the value of single strand conformation polymorphism(SSCP) and denaturing high performance liquid chromatography(DHPLC). Methods: Five exons of SOD1 gene were amplified by PCR. The difference of these products were analyzed by PCR-SSCP and DHPLC.DNA sequencing was used to examine the mutation. Results: ①Mutations were found in exons 2 and 5 in several family members.DNA sequencing revealed that a base pair insertion occurred in the codon area of exon 2 and in the non-codon area of exon 5.②The results of DHPLC tests proved double peaks in one member with ALS symptoms(Ⅲ1),which indicated the possibility of mutation in SOD1 exon 4.DNA sequencing revealed that there was a heterozygote,with a mutation of GAA to GGA in exon 4 in the member with double peak. Conclusion: ①The mutations in exons 2,4,5 were proved.Insertion of exon 2 may be responsible for the disease of the ALS family in Chongqing.②Compared with PCR-SSCP,DHPLC technique has been proven to be a rapid and reliable method for screening mutation site in large samples.
ABSTRACT
Objective To investigate the effectiveness,safety of the percutaneous transluminal angioplasty and stenting(PTAS) in the management of the vertebrobasilar stenosis.Methods From April 2003 to June 2004,the PTAS was performed in 28 patients with the vertebrobasilar stenosis.Results Among the 28 patients,the unilateral significant stenosis of the dominant vertebral artery was found in 18 patients,the bilateral stenosis of the vertebral artery in 4 patients,the tandem stenosis of the vertebral artery in 1 patient,the stenosis of the basilar artery in 2 patients.According to Mori's division,the type A occurred in 24 patients,the type B in 3 patients,the type C in 1 patient.The successful rate of stent implantation was 100% without any serious complication.Twenty-eight patients underwent PTAS with a mean pre-procedural vertebrobasilar stenosis of 81.3% and the residual stenosis was less than 10%.Over a mean 6-month follow-up in 17 patients,according to Malek's scale,the scale 1 was in 15 patients,the scale 2 in 2 patients.No restenosis was in 3 patients by the cerebral angiography.Conclusion PTAS in the management of the vertebrobasilar stenosis is a safe and effective method.Meanwhile,PTAS may alleviate the vertebrobasilar ischemia and prevent stroke of the vertebrobasilar system.
ABSTRACT
Objective To identify the point mutation of Cu/Zn superoxide dismutase(SOD1) gene in an amyotrophic lateral sclerosis(ALS) family and observe the value of denaturing high performance liquid chromatography(DHPLC). Methods DHPLC and DNA sequencing were used to examine SOD1 gene of the ALS family which had not been found mutation by PCR-SSCP. Results DHPLC tests proved double peaks in one member(Ⅲ_1), Which indicated the possibility of mutation in SOD1 exon 4. DNA sequencing revealed that there was a heterozygote,with mutation of GAA to GGA in exon 4, and with a substitution of glutacid by glycine. Conclusion As compared with PCR-SSCP, DHPLC technique has proved to be a rapid and reliable method for screening mutation site in large samples.