ABSTRACT
Objective To explore the surgical treatment of refractory cerebrospinal fluid rhinorrhea with recurrent bacterial meningitis.Methods The clinical data of 1 case of a 10-year-old boy who had 9 episodes of bacterial meningitis and underwent 4 surgical repair procedures for congenital cerebrospinal fluid rhinorrhea at the Children's Hospital Affiliated to Soochow University were analyzed,and the related literatures were reviewed.Results During the intervals of 9 episodes of bacterial meningitis,the patient experienced 4 neurosurgical repairs of cerebrospinal fluid rhinorrhea,including 2 endoscopic repairs via the lateral nasal cavity,a craniotomy approach repair via forehead epidural,and an endoscopic repair in combination with a ventriculo-peritoneal shunt.The first 3 surgeries were all failed,but the final surgery was successful,with no recurrence of cerebrospinal fluid rhinorrhea or bacterial meningitis in 3.5 years of follow-up.Conclusions For recurrent meningitis and refractory cerebrospinal fluid rhinorrhea,the ventriculo-peritoneal shunt can be considered in addition to conventional nasal endoscopic cerebrospinal fluid repair to eliminate the increased cerebrospinal fluid attributable to long-term chronic compensation,and effectively reduce postoperative intracranial hypertension to make the operation success.
ABSTRACT
Objective To investigate the effect of B7-H3 protein,a collaborative signal molecule,on macrophage-inflammatory protein 2 (MIP-2) mRNA level in Streptococcus pneumococcal meningitis mouse models.Methods Forty-eight healthy male BALB/C mice at the age of 1.5-2.0 months were randomly divided into 4 groups:9 g/L saline group(NS group),B7-H3 protein group(B7-H3 group),Streptococcus pneumoniae group(SP group),and Streptococcus pneumoniae plus B7-H3 protein group(combination group),12 mice in each group.Mouse models were established by intracerebral ventricular injection with 9 g/L saline,B7-H3 protein,Streptococcus pneumoniae type 3 or Streptococcus pneumoniae type 3 plus B7-H3 protein.Neurobehavior of different groups was evaluated according to loeffler rule after injection for 6 h and 24 h,then the mice were sacrificed and MIP-2 mRNA levels were tested by Real-time PCR.The results were analyzed by SPSS 18.0 software.Results Neurobehavior scoring results showed that there were no significant differences between B7-H3 group and NS group (P ＞ 0.05) after infection for 6 h and 24 h,while the score of SP group was decreased compared with that of NS group (P ＜ 0.05),and the score of combination group was significantly decreased compared with that of SP group (P ＜ 0.05).Real-time PCR results showed that,compared with the NS group,the relative MIP-2 mRNA level in SP group increased after injection for 6 hours (1.210 ±0.932 vs 1.000 ± 0.008),but the difference was not significant (P ＞ 0.05),while at 24 h post infection,the relative MIP-2mRNA expressions in SP group were significantly increased compared with that of NS group(12.880 ± 7.792 vs 1.000 ±0.091),the difference was significant (P ＜ 0.05).At 6 h post infection,SP + B7-H3 treatment enhanced the MIP-2mRNA production compared to SP infection alone,but the difference was not significant [(1.240 ± 0.804) vs (1.210 ± 0.932)] (P ＞ 0.05) ; while at 24 h post infection,the difference was significant (38.760 ± 6.601 vs 12.880 ± 7.792) (P ＜ 0.05).Conclusion Collaborative signal molecule B7-H3 protein may increase MIP-2 mRNA level in Streptococcus pneumococcal meningitis mouse model,and exaggerate the clinical disease condition.