Impact to life quality from treatment with microvascular decompression in patients with hemifacial spasm / 基础医学与临床

Objective To investigate the impact of microvascular decompression surgery on quality of life in patients with hemifacial spasm. Methods A clinical data collection of 224 adult patients with hemifacial spasm treated by the surgery was conducted from 2012 to 2017. The degree of spasm and effect of the operation was evaluated by Co-hen grading standard before and after the surgery. The quality of life was evaluated by the HFS-8 scale. The results were statistically analyzed. Results According to Cohen grading standard, symptoms were improved significantly 6 months after the surgery. The effective remission rate and the total effective rate of the surgery were 92.7% and 97.6% respectively. The score of HFS-8 scale was significantly lower than before treatment (2.71±3.25 vs 18.01± 4.57, P＜0.05) ; The scores were significantly different before and after the surgery in patients with different de-grees of remission, except for the " invalid" group ( P=0.071) ; The scores of patients with different strengths of the spasm were significantly improved ( P＜0.05) , and the Pearson correlation coefficient suggested that the HFS-8 score was significantly correlated with the severity of the spasm. Conclusions Microvascular decompression is one of the preferred treatment of hemifacial spasm, which can effectively improve the the quality of life in patients with hemifacial spasm.

Treatment of blood disease with chronic subdural hematoma / 基础医学与临床

Objective To understand the characteristics of patients with hematological illness and chronic subdural hematoma.,and the effect of blood disease on the treatment of chronic subdural hematoma. To guide the treatment of patients who both with hematological illness and chronic subdural hematoma. Methods Through a retrospective study of the cases of chronic subdural hematoma from January 1, 2000 to June 1, 2017 in Peking Union Medical College Hospital, the following items were investigated. 1).According to whether or not they were associated with blood disorders, the collected cases were divided into the blood disorders group and the non-blood disorders group. And the clinic data of the sex composition, average ages, treatment effect and mortality were compared. 2). Ac-cording to the treatment, the cases with blood disease were divided into the surgical group and the conservative group. And the treatment effect and mortality were compared. Results A total of 433 patients with chronic subdural hematoma were included in this study, including 35 patients associated with hematological illness. 1) Compared to the controls group, the patients group was younger( P＜0.01) ;the male ratio was lower ( P＜0.01) ; the treatment effect was lower( P＜0.001) and the mortality was higher( P＜0.001) . 2) Within the patients with hematological illness, the surgical group had the better treatment effect(78.9% vs 31.3%,P＜0.01) and the lower mortality (15.8% vs 50.0%,P＜0.05). Conclusions 1)The hematological illness group is younger and the male ratio is lower than the non-hematological illness group; 2) The hematological illness is a risk factor for the treatment of chronic subdural hematoma; 3) The patients who both with the hematological illness and the chronic subdural he-matoma should be treated by surgery.

Subchronic Oral Toxicity of Silica Nanoparticles and Silica Microparticles in Rats / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the subchronic oral toxicity of silica nanoparticles (NPs) and silica microparticles (MPs) in rats and to compare the difference in toxicity between two particle sizes.</p><p><b>METHODS</b>Sprague-Dawley rats were randomly divided into seven groups: the control group; the silica NPs low-, middle-, and high-dose groups; and the silica MPs low-, middle-, and high-dose groups [166.7, 500, and 1,500 mg/(kg•bw•day)]. All rats were gavaged daily for 90 days, and deionized water was administered to the control group. Clinical observations were made daily, and body weights and food consumption were determined weekly. Blood samples were collected on day 91 for measurement of hematology and clinical biochemistry. Animals were euthanized for necropsy, and selected organs were weighed and fixed for histological examination. The tissue distribution of silicon in the blood, liver, kidneys, and testis were determined.</p><p><b>RESULTS</b>There were no toxicologically significant changes in mortality, clinical signs, body weight, food consumption, necropsy findings, and organ weights. Differences between the silica groups and the control group in some hematological and clinical biochemical values and histopathological findings were not considered treatment related. The tissue distribution of silicon was comparable across all groups.</p><p><b>CONCLUSION</b>Our study demonstrated that neither silica NPs nor silica MPs induced toxicological effects after subchronic oral exposure in rats.</p>

Cytotoxic Activities of Total Saponins from Plena Clematis on Human Tumor Cell Lines In Vitro / 中国结合医学杂志

OBJECTIVE@#To investigate the anti-proliferative effects of saponins prepared from Plena Clematis (PC) cultured in Fujian Province, China on 4 human tumor cell lines and its possible anti-tumor mechanism.@*METHODS@#The growth inhibition assays of saponins on human esophageal squamous carcinoma cell line (EC9706), human hepatoma cell line (HepG-2), human oral cancer cell line (KB) and human gastric cancer cell line (BGC-823) were evaluated in vitro by thiazolyl blue (MTT) method. The inhibitory effects on EC9706 treated with different concentrations of saponins (15.62, 31.25, 62.50, 125, 250 and 500 μg/mL) were performed in vitro by MTT method. The morphology and nuclear staining with acridine orange/ethidium bromide of EC9706 cells treated with saponins were illustrated under an inverted phase fluorescence microscope. The apoptotic effects of saponins were further evaluated by annexin-V/propidium iodide dual staining experiment to examine the occurrence of phosphatidylserine externalization onto the cell surface by a flflow cytometer.@*RESULTS@#MTT assay showed that the saponins could inhibit the proliferation of 4 tumor cell lines. Among them, the maximum inhibition rate of 73.1% was detected in EC9706 cells at the saponins concentration of 250 μg/mL for 24 h. Further investigation indicated that the saponins induced EC9706 cells apoposis. The EC9706 cells presented apoptotic characteristics when treated with saponins, including that the morphologies of EC9706 cells were appeared round-shaped with higher refraction, and the cell nuclear stained orange with EB after 250 μg/mL saponins exposure. The flow cytometry analysis results showed that the induction of cell cycle arrest in apoptotic system may participate in the anti-proliferative activity of saponins on EC9706 cells.@*CONCLUSION@#The saponins from PC exhibited significant cytotoxicity against human EC9706, KB, BGC-823, and HepG-2 cells and might be beneficial to development of ethnic pharmaceutical plant for potential anti-tumor drugs.

Research advances in the application of methylprednisolone in the treatment of acute spinal cord injury / 中国医学科学院学报

Acute spinal cord injury(ASCI),mainly caused by traffic accidents and fall injuries,is a catastrophic event that can profoundly affect the trajectory of a patient's life. Debate continues over the medical management of ASCI,in particular the usefulness,dosage,and potential risks of methylprednisolone(MP). Although the results of American National Acute Spinal Cord Injury Study 2 and 3 trials led to the wide adoption of a high-dose MP regimen for ASCI patients,the reliabilities of their study methods and data were still questionable. Based on the currently available literature,we conclude that high-dose MP is no longer a recommended therapy for ASCI;however,due to the lack of effective treatment,it remains a useful option for this condition.

Immunotoxicologic assessment of genetically modified drought-resistant wheat T349 with GmDREB1 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To assess the immunotoxicologic effects of genetically modified drought resistant wheat T349 with GmDREB1 gene.</p><p><b>METHODS</b>A total of 250 female BALB/c mice (6-8 week-old, weight 18-22 g) were divided into five large groups (50 mice for each large group) by body weight randomly. In each large group, the mice were divided into five groups (10 mice for each group) by body weight randomly, which were set as negative control group, common wheat group, parental wheat group, genetically modified wheat group and cyclophosphamide positive control group, respectively. Mice in negative control and positive control group were fed with feedstuff AIN-93G, mice in common wheat group, non-genetically modified parental wheat group and genetically modified wheat group were fed with feedstuffs added corresponding wheat (proportion up to 76%) for 30 days, then body weight, organ coefficient of spleen and thymus, peripheral blood lymphocytes phenotyping, serum cytokine, serum immunoglobulin, antibody plaque-forming cell (PFC), serum 50% hemolytic value (HC50), mitogen-induced splenocyte proliferation, delayed-type hypersensitivity (DTH) reaction and phagocytic activities of phagocytes were detected respectively.</p><p><b>RESULTS</b>After 30 days raise, among negative control group, common wheat group, non-genetically modified parental wheat group, genetically modified wheat group and cyclophosphamide positive control group, mice body weight were (21.0±0.3), (20.4±0.7), (21.1±1.0), (21.1±1.0), (19.4±1.0) g, respectively (F=7.47, P<0.01); organ coefficient of spleen were (0.407±0.047)%, (0.390±0.028)%, (0.402±0.042)%, (0.421±0.041)%, (0.304±0.048)%, respectively (F=12.41, P<0.01); organ coefficient of thymus were (0.234±0.032)%, (0.246±0.028)%, (0.249±0.040)%, (0.234±0.034)%, (0.185±0.039)%, respectively (F=5.58, P<0.01); the percentage of T cell in peripheral blood were (70.43±4.44)%, (68.33±5.37)%, (73.04±2.68)%, (74.42±2.86)%, (90.42±1.66)%, respectively (F=57.51, P<0.01); the percentage of B cell were (13.89±3.19)%, (15.34±4.84)%, (13.06±4.22)%, (12.93±2.36)%, (3.01±0.96)%, respectively (F=12.79, P<0.01); the percentage of Th cell were (55.87±3.80)%, (55.24±4.60)%, (57.92±3.70)%, (59.57±2.54)%, (77.37±2.31)%, respectively (F=68.58, P<0.01);the Th/Ts ratio were 4.16±0.29, 4.73±0.96, 4.19±0.78, 4.52±0.40, 6.34±0.73, respectively (F=17.57, P<0.01);the serum IgG were (1046.38±210.67), (1065.49±297.22), (1517.73±299.52), (1576.67±241.92), (1155.88±167.05) µg/ml, respectively (F=10.53, P<0.01); the serum IgM were (333.83±18.97), (327.73±27.72), (367.47±27.18), (363.42±46.14), (278.71±24.42) µg/ml, respectively (F=12.11, P<0.01); the serum IgA were (51.69±10.10), (42.40 ± 8.35), (32.11±4.22), (37.12±4.90), (41.45±8.89) µg/ml, respectively (F=8.25, P<0.01); the PFC were (29.2±14.6), (28.0±20.0), (34.8±30.9), (33.2±25.1), (4.8±5.3) per 10(6) splenocyte, respectively (F=3.33, P<0.05); the HC50 were 82.3±6.5, 79.7±4.6, 75.8±4.1, 74.9±3.6, 70.8±2.1, respectively (F=9.99, P<0.01);the LPS-induced splenocyte proliferation were 0.21±0.10, 0.21±0.14, 0.26±0.12, 0.25±0.14, 0.07±0.06, respectively (F=4.18, P<0.05).</p><p><b>CONCLUSION</b>The genetically modified drought-resistant wheat T349 was substantially equivalent to parental wheat in the effects on immune organs and immunologic functions of mice, and it didn't show immunotoxicity.</p>

Thyroid-stimulating hormone pituitary adenomas: clinical characteristics, diagnosis and treatment / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics, diagnosis and surgical effects of thyroid-stimulating hormone pituitary adenomas (TSH-omas).</p><p><b>METHODS</b>The clinical data of 19 patients (14 female and 5 male) with TSH-omas were analyzed retrospectively in this study from January 2001 to December 2008. The patients ranged from 20 to 70 years old (average 40.5 years old) and had disease histories from 1 to 228 months (average 55 months). Among these patients, 15 of them complained of thyrotoxicosis symptoms, while the other 4 patients' symptoms were associated with headache and/or visual disturbance caused by the tumor mass effect. Initially, 12 of the 15 patients with thyrotoxicosis symptoms were misdiagnosed with Grave's disease. As a result 2 of them received (131) Iodine, and one received subtotal thyroidectomy. All of these patients underwent transsphenoidal microsurgery.</p><p><b>RESULTS</b>Average follow-up period was 3.6 years (6 months-7 years). Pathological analysis of the surgical specimen showed pituitary adenoma in all patients, immunohistochemistry were positive for TSH in 17 cases, negative for TSH in 2, positive for growth hormone in 2, positive for prolactin in 1, and positive for adrenocorticotrophic hormone in 1. Postoperative MRI revealed that the tumors in 15 patients were removed totally, though 4 patients still had residual tumors. The thyroid hormone level tests suggested that 13 patients could be considered normal 3 months after their tumors were removed, though 2 of patients with normal postoperative MRI and thyroid hormones showed increased levels of TSH. For these 2 patients, tumors did not recur and their thyroid hormone levels returned to normal after pituitary radiotherapy. The cure rate was 11/19 after surgery and 13/19 after surgery plus pituitary radiotherapy.</p><p><b>CONCLUSIONS</b>The screening test for hyperthyroidism patients with high TSH levels is a key point to improve the accuracy rate in early diagnoses of TSH-omas. The transsphenoidal microsurgery is first choice to treat TSH-omas, while pituitary radiotherapy and somatostatin analogs are beneficially adjunctive therapies.</p>

Clinical application of neuronavigation in transsphenoidal microsurgery of pituitary adenomas / 中华外科杂志

<p><b>OBJECTIVES</b>To summarize the experiences in clinical application of neuronavigation in transsphenoidal microsurgery of specific pituitary adenomas, and to discuss its indications.</p><p><b>METHODS</b>From January 2006 to December 2010, 138 cases of transsphenoidal microsurgery for specific pituitary adenomas under neuronavigation were reviewed. The indications for neuronavigation in transsphenoidal microsurgery includes: recurrent or regrowth of residual pituitary adenomas after former transsphenoidal surgery in 36 cases, invasive pituitary adenomas in 45 cases, extremely laterally or deeply situated microadenomas in 45 cases, poor pneumatization of the sphenoid in 4 cases, skull base anomalies due to osteodysplasia fibrosa in 3 cases, narrow space between bilateral internal carotid arteries in 4 cases, distortion of nasal septum in 1 case.</p><p><b>RESULTS</b>In the recurrence group, 12 were totally removed, 9 subtotally removed; postoperative complications included hematoma within the tumor cavity in 2 cases, cerebrospinal fluid (CSF) leakage in 4 cases among which 3 developed intracranial infection and 2 communicating hydrocephalus, oculomotor paralysis in 1 case and hypopituitarism in 3 cases; 9 were cured and 8 remission. In the invasive group, 5 were totally removed, 27 subtotally removed; postoperative complications included hematoma within the tumor cavity in 1 case, CSF leakage and intracranial infection in 1 case; 2 were cured and 22 remission. None of the 30 invasive hormone-secreting adenomas were cured or remission. The 45 cases of hormone-secreting microadenomas were all totally removed, among which 38 were cured. Among the poor sphenoid pneumatization group, total and subtotal tumor removal were achieved in 2 cases respectively with only one cured. In the skull base anomaly group, 2 were totally removed and 1 subtotally removed, with only one cured. For the cases with narrow space between bilateral internal carotid arteries and distortion of nasal septum, all were totally removed and cured.</p><p><b>CONCLUSIONS</b>Transsphenoidal microsurgery under neuronavigation can be applied for pituitary adenomas in above specific indications. It is an accurate, safe and effective approach for specific pituitary adenomas, which can not only expand the indication of transsphenoidal microsurgery for pituitary adenomas, but also reduce the harmful exposure of X-rays for the operating staff.</p>

Neural endoscopic assisted micro-invasive management of Chiari I malformation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In order to make posterior fossa decompression for the management of Chiari I malformation simple and less invasive while using direct visualization, a novel solely endoscopic procedure has been employed for the decompression of Chiari malformation type I. The objective of this study was to present neural endoscopic posterior fossa decompression and atlas laminectomy for Chiari type I patients.</p><p><b>METHODS</b>Twenty-one patients with Chiari type I underwent neural endoscopic posterior fossa decompression and atlas laminectomy. We described the procedure for neural endoscopic posterior fossa decompression and atlas laminectomy. All patients in this series demonstrated cerebellar tonsil herniation below the foramen magnum in addition to syringomyelia. All patients in the reviewed study underwent preoperative MRI as well as 3-month postoperative MRI. Additional follow-up MRI varied but was usually repeated 12 months to 18 months after surgery. Postoperative MRI studies were retrospectively reviewed and compared with preoperative studies.</p><p><b>RESULTS</b>All patients showed clinical improvements, and none had any complications. Patients with syringomyelia had symptoms entirely disappear. Eleven patients (52.4%) experienced radiographic improvement in syringomyelia (decreased size or resolution) during the follow-up period. Nine patients (42.8%) demonstrated decreased syrinx size and four (19%) demonstrated resolved syrinx. Of the 15 patients with symptomatic syringomyelia, 11 (73.3%) experienced symptomatic improvement. The median time to symptom improvement was four months after surgery. Post surgical MRI examinations indicated complete and sufficient decompression of foramen magnum region.</p><p><b>CONCLUSIONS</b>Endoscope atlanto-occipital decompression surgery is an innovative, safe and effective surgical procedure. It has similar results compared to traditional surgery, however with the added advantages of being minimal invasive, having fewer complications, decreased influence on stability of occipital bony structure, and a faster recovery as well as reduced hospital stay and expenses.</p>

Management of pulmonary thromboembolism in post-operative neurosurgical patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize the diagnosis and treatment of pulmonary thromboembolism (PTE) in post-operative neurosurgical patients.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 7 patients who experienced pulmonary thromboembolism after neurosurgical operations in our department from October 2009 to March 2010.</p><p><b>RESULTS</b>Of these 7 patients, 6 were confirmed with computed tomographic pulmonary angiography (CTPA) and 1 was diagnosed according to the clinical manifestations and other diagnostic examinations. All the patients were treated initially with low-dose heparin or low-molecular-weight heparin and then with warfarin. Two patients were implanted with permanent inferior vena cava filters before anticoagulation. One received anticoagulant therapy and died of respiratory failure due to pulmonary embolism on the fourth post-operative day. Six patients were discharged after significant improvement.</p><p><b>CONCLUSIONS</b>Many risk factors may cause PTE peri-operatively. Post-operative CTPA may be indicated. Anticoagulation and other management strategies may be applied to improve the outcome.</p>

The preliminary study of using neuro-endoscope assisted atlanto occipital decompression to treat Chiari type I malformation with syringomyelia / 中华外科杂志

<p><b>OBJECTIVE</b>To explore and evaluate the methodology of neuro-endoscope assisted atlanto occipital decompression in Chiari type I malformation with syringomyelia.</p><p><b>METHODS</b>Between January 2007 to January 2008, 8 patients underwent neuro-endoscope assisted atlanto occipital decompression, including 2 male patients and 6 female patients (aged 13 to 52 years). During the operations, the surgical fields were lightened by the illuminator of endoscope. All the manipulations were done outside the sheath of neuroendoscope. The decompression bone window was about 2.0 cm × 2.0 cm. After the atlanto occipital fascia was cleared thoroughly, dura were opened in 6 cases and intact in 2 cases.</p><p><b>RESULTS</b>There were no complications observed in this study. Seven patients were determined as excellent in recovery according to the Tator criteria because of apparent improvements in superficial sensation. Five of the seven patients had improvements in muscle strength. One patient was assessed as good because of stable symptom without deterioration.</p><p><b>CONCLUSION</b>Neuro-endoscope assisted atlanto occipital decompression is a potential technique worthy of employing in the mini-invasive neurosurgical technology.</p>

Construction of cholecystokinin transgenic mouse and its effects on food intake / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cholecystokinin (CCK) is one of the richest neuropeptides in the mammalian brain, which is mainly distributed in the cerebral cortex, hippocampus, thalamus and caudate-putamen. CCK is implicated in a variety of behavioral functions such as food intake, learning, memory, anxiety, pain and neuroprotection. The current research results for CCK are obtained mainly through injection of CCK peptide into the body. The key issues of whether CCK can regulate diet by a central pathway and whether there are long-term regulation effects on diet are still unresolved. In this study, the effects of CCK on food intake in transgenic mice were investigated.</p><p><b>METHODS</b>Transgenic mice were created by microinjection of the PDGF-CCK construct into male pronucleus of the zygotes. The genomic phonetype of transgenic mice were identified by PCR. The expression of PDGF-CCK was analyzed by Western blotting. Body weight, plasma glucose, cholesterol and triglycerides were assayed and analyzed.</p><p><b>RESULTS</b>Two PDGF-CCK transgenic independent lines were established and exhibited a high-levels brain-specific transgene expression compared with that of nontransgenic littermate controls. The food intake of male CCK transgenic mice was decreased by 5% - 10% with the same levels of water consumed compared with wild type mice. The food intake in female mice was not obviously changed. In the transgenic mice the bodyweight was lower and plasma glucose was higher compared with the nontransgenic littermate controls.</p><p><b>CONCLUSIONS</b>The high expression of the CCK gene in the brain can decrease body weight and increase plasma glucose. The differences in food intake between the males and females require further study.</p>

Transsphenoidal microsurgical results of non-invasive prolactinomas / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the transsphenoidal microsurgical results of non-invasive prolactinomas, in order to provide reference for their treatment choice.</p><p><b>METHODS</b>To review the transsphenoidal microsurgical results of 234 non-invasive prolactinomas treated in our department in recent 10 years, and to analyze the prognostic factors. There were 18 males and 216 females, aged between 13 and 58 years, averaged (31.1 +/- 8.5) years. The course ranged from half a month to 20 years, averaged (47.3 +/- 44.9) months. The preoperative serum PRL level ranged between 41 and 8406 ng/ml, averaged (400.5 +/- 888.0) ng/ml, with a median of 164.1 ng/ml. The primary symptoms were amenorrhea, galactorrhea and/or infertility in 211 cases. The tumor size was small (< 1 cm) in 100, large (> or = 1 cm) in 116 and giant (> or = 3 cm) in 18 cases. All the patients received transsphenoidal microsurgery and were followed-up for 12 to 132 months, averaged (43.8 +/- 35.0) months.</p><p><b>RESULTS</b>There was no mortality. One hundred and twenty-seven (54.3%) cases had transient postoperative imbalance of water and electrolytes. One hundred and eighty-eight cases (80.3%) were cured, 12 (5.1%) experienced clinical remission, 20 (8.5%) were improved, and 14 (6.0%) were ineffective. The male patient, the giant prolactinomas and those with higher preoperative serum PRL level had a relative poor postoperative prognosis. While the other factors had no influence on prognosis, including the course, preoperative bromocriptine intake, tumor texture, tumor apoplexy and intraoperative descending extent of the diaphragm of sella. The overall operative expense for transsphenoidal microsurgery ranged from 8323.8 to 22898.5 yuan, averaged (12912.0 +/- 2361.2) yuan.</p><p><b>CONCLUSIONS</b>Transsphenoidal microsurgery may be chosen as the primary therapy for non-invasive prolactinomas, with the purposes of therapeutical efficacy, facilitating the patients, re-establishing the patients' self-confidence and reducing the overall expense.</p>

Effects of adrenalectomy on the treatment of Cushing disease / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the effects of adrenalectomy (ADX) on the treatment of Cushing's disease(CD).</p><p><b>METHODS</b>Clinical data of 15 cases of CD between January 1980 and December 2005 were analyzed to evaluate operative indications, complications and the changes of hypercortisolism and hormone levels pre- and post- adrenalectomy.</p><p><b>RESULTS</b>All the patients involved underwent transsphenoidal pituitary surgery previously. Repeated transsphenoidal surgery was performed in 4 cases. Pituitary radiotherapy was done in 4 cases. The average time from original transsphenoidal operation to ADX was 25.7 months. Pre- and post- adrenalectomy serum cortisol median level were 1156.4 nmol/L and 99.4 nmol/L, the 24 h urinary-free cortisol median level were 315.0 and 5.4 microg, respectively. Hormone replacement therapy was needed in all cases. Average follow-up period was 47 months (9-120 months). Nelson syndrome (NS) appeared in 5 cases (33.3%), while 10 cases showed no NS.</p><p><b>CONCLUSIONS</b>ADX is an effective and symptomatic treatment to relieve hypercortisolism caused by CD but with the risk of NS. Longtime hormone replacement therapy and follow up are needed after ADX.</p>

Magnetic resonance imaging characteristics and surgical results of adrenocorticotropin-secreting pituitary adenomas / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate magnetic resonance imaging (MRI) characteristics and surgical results of adrenocorticotropin (ACTH)-secreting pituitary adenomas.</p><p><b>METHODS</b>MRI characteristics and relationship between MRI positive rate and surgical results of 266 patients with pathologically confirmed Cushing's disease were analyzed retrospectively. All patients underwent thin-section sagittal and coronal scans of the pituitary gland before and after administration of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) on a 1.5 Tesla MRI scanner, and dynamic enhanced MRI was performed in 39 patients. All patients underwent transsphenoidal adenomectomy. Endocrinological examinations and assessments were performed.</p><p><b>RESULTS</b>Preoperative MRI revealed normal results in 41 (15.4%) cases, microadenoma in 179 (67.3%), macroadenoma in 42 (15.8%), and huge adenoma in 4 (1.5%). Pituitary apoplexy was found in 13 (4.9%) cases. Positive rate of ACTH-secreting adenomas was 84.6% (225/266) on MRI scans, and that of small microadenomas was 87.2% (34/39) on dynamic enhanced MRI scans. Preoperative endocrinological tests of 199 cases supported the diagnosis of typical Cushing's disease, while the other 67 cases had atypical endocrinological results. The endocrinological cure rate, remission rate, and inefficacy rate were 85.7%, 7.9%, and 6.4%, respectively. There was no difference in the initial endocrinological cure rate between the patients with positive and normal MRI results (90% vs. 87.8%, P = 0.904).</p><p><b>CONCLUSIONS</b>Enhanced coronal pituitary MRI is helpful for preoperative localization of ACTH-secreting pituitary microadenoma. Dynamic enhanced MRI may improve detection rate of microadenoma. There is no marked difference in the surgical results for patients with preoperative MRI results indicating presence or absence of microadenoma.</p>

Endoscopic foramen magnum decompression of Chiari malformation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the effectiveness and safety to treat Chiari malformation with the surgical decompression of the foramen magnum under endoscope.</p><p><b>METHODS</b>In 1 patient with Chiari malformation with syringomyelia, we made a 2.5 cm incision under the endoscope for the surgical decompression of the foramen magnum.</p><p><b>RESULTS</b>All the symptoms and signs were remarkably relieved, and the patient could walk the next day and was discharged 3 days after the operation.</p><p><b>CONCLUSION</b>The endoscope-assisted decompression of the foramen magnum is a safe and effective surgical method to treat Chiari malformation.</p>

Factors influencing the recurrence of Cushing's disease treated by transsphenoidal surgery / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore factors influencing the recurrence of patients with Cushing's disease after transsphenoidal surgery.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 182 patients treated by transsphenoidal surgery with Cushing's disease in our department in PUMC Hospital from 1992 to 2002.</p><p><b>RESULTS</b>The recurrence rates were significantly different when patients had different radiological findings (P = 0.001), operative methods (P = 0.001), histological findings (P = 0.04), and postoperative cortisol levels (P = 0.02); however, such difference was not found in term of tumor size (P = 0.43).</p><p><b>CONCLUSION</b>Radiological findings, operative methods, histological findings, and postoperative cortisol estimates may be the factors influencing the recurrence of patients treated by transsphenoidal surgery.</p>

Relationship between invasive pituitary adenomas and cavernus sinus and cariod artery and surgical outcomes / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the relationship between invasive pituitary adenomas and cavernus sinus and cariod artery and to predict their surgical outcomes.</p><p><b>METHODS</b>Totally 270 patients with pituitary tumors were investigated in this retrospective study, including 113 men and 157 women, with a mean age of 40.8 years. The mean disease history was 3.6 years. Pituitary microadenomas were diagnosed in 56 cases, macroadenomas in 118 cases, and hugeadenomas in 96 cases. Adrenocorticotropic hormone-releasing adenomas (Cushing's diseases) were diagnosed in 40 cases, growth hormone-releasing adenomas in 58 cases, prolactinomas in 57 cases, and non-functional pituitary adenomas in 115 cases. Transsphenoidal microsurgery were performed on 260 patients, while transcranial microsurgery on 6 patients.</p><p><b>RESULTS</b>The percentage of invasive pituitary adenomas was about 3.6% in microadenomas, 20.4% in macroadenomas, and 61.4% in hugeadenomas. Rate of total removal was 94.1% in non-invasive pituitary adenomas, and was 58.8% in invasive pituitary adenomas.</p><p><b>CONCLUSIONS</b>It is important to analyze the grade of invasive pituitary adenomas to improve the removal of pituitary adenomas, avoid injuring cariod artery, and increase the rate of total removal.</p>