ABSTRACT
Objective To explore the clinical features of patients with ruptured intracranial aneurysm combined with simple intracranial hematoma. Methods A total of 410 continuous patients with ruptured intracranial aneurysms in the Neurosurgery of the Second Affiliated Hospital of University of South China from October 2012 to December 2018 was enrolled retrospectively. Eight cases of those combined with simple intracranial hematoma but without subarachnoid hemorrhage. The clinical data of these patients were collected, including cerebrovascular risk factors, Glasgow Coma Scale score, Hunt-Hess classification, Fisher classification, imaging signs, the characteristics of intracranial aneurysm, the type of surgical treatment, and the outcomes of follow-up. After 3 months of treatment, the prognosis was evaluated by modified Rankin scale (mRS) score. Results (1) The proportion of ruptured intracranial aneurysms with simple intracranial hematoma accounted for 2.0% (8/410). Five patients ignored the diagnosis of intracranial aneurysm at initial diagnosis: one case was diagnosed with acute traumatic subdural hematoma at the first time, and then diagnosed as posterior communicating artery aneurysm by CT angiography (CTA); one case was diagnosed with spontaneous basal ganglia hemorrhage at the first time, and then diagnosed as middle cerebral aneurysm by CTA; one case was diagnosed with spontaneous basal ganglia cerebral hemorrhage in the other hospital at the first time, and then diagnosed as middle cerebral artery bifurcation aneurysm during the craniotomy hematoma removal, and further diagnosed as anterior communicating artery aneurysm 2 weeks after surgery by DSA; one case was diagnosed with spontaneous frontal lobe hemorrhage due to headache in the other hospital at the first time, and then diagnosed as anterior cerebral aneurysm by CTA; one case was diagnosed with spontaneous basal ganglia hemorrhage at the first time, and then diagnosed as posterior cerebral aneurysm by CTA. (2) Imaging features: hematoma in the basal ganglia is immediately adjacent to the lateral fissure or temporal lobe, and some patients had a round-like slightly high-density shadow on the edge of the hematoma; simple lateral intraventricular hemorrhage showed that the temporal lobe hematoma invaded into the lateral ventricle temporal angle, and the subdural hematoma was without skull fracture. In addition, CTA demonstrated that the expansion direction of the aneurysm toward the brain lobe was easy to form cerebral intraparenchymal hematoma, and the direction toward the dura mater was easy to form spontaneous subdural hematoma. (3)2 cases had good prognosis (mRS score 0-2), 6 cases had poor prognosis (mRS score 3-6). Conclusions For patients who are initially diagnosed with spontaneous intracranial hematoma without subarachnoid hemorrhage, head CTA or DSA should be performed as soon as possible, especially the hematoma in the basal ganglia area near to the lateral fissure, the hematoma existing a slightly rounded high-density shadow on edge, and subdural hematoma without skull fracture. The study should pay more attention to these imaging signs to identify intracranial aneurysms.
ABSTRACT
Objective To discuss the mechanism of progesterone that soften brain water content in traumatic brain edema in rats. Methods The models of focal lobe contusion and laceration of brain were made on the male rats treated by the progesterone following injury. Immunohistochemical method was used to assess the expression of aquaporin-4 (AQP4). Evan's Blue method was used to detect the permeability of blood-brain barrier. Results Treated by the progesteron, the brain water content was significantly decreased, and the lower expression of AQP4 took place on astrocytes of the contusion and peri-contusion of the brain tissue after 24 h,72h ,and 120h . The content of EB was decreased at 6 h and 24 h post-injury. Conclusions Progesterone can soften the traumatic brain water content, which may be associated with the attenuation of AQP4 in frontal lobe contusion following traumatic brain injury ( TBI) and progesterone can protect the blood-brain barrier at early time after TBI.
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Objective To investigate the possibility of repairing the defects of fore foot by reverse medial dorsal neurocutaneous flap on foot in emergency.Methods Flap was designed along medial dorsal cutaneous nerve of foot,the axis of the medial branch was the line between lateral part of malleolar middle point and medial part of first metatarsophalangeal joint,and the axis of the lateral branch was the line between middle point of two malleolars and the tip of the great toe webspace,the pedicle located on the distant part of the foot.Based on the size of wound,the flap was cut off from the deep fascia layer,and medial dorsal cutaneous nerve of foot was anastomosed with nerve of digitales plantares proprii.All patients were operated in emergency.Results Eleven patients with defect of fore foot were perfectively recovered and all the wounds healed primarily.The appearances and functions of the foots were satisfactory,with two point sensation of 2-3 cm after 6-11 months postoperatively and without any skin fester.Conclusion Medial dorsal cutaneous nerve of foot has advantages as follows:simply procedures,avoidance of sacrificing major arteries,less harm to donor area,good recovery of sensation.So it is a good method to repair tissue defects of fore foot.
ABSTRACT
The achievements in recent research on osteogenetic induction of extracorporeal shock wave (SW) are introduced. The mechanism of osteogenesis inducted by SW and its effect of bone repairing are explained emphatically. Besides, the development prospects of SW in healing human disease are described and is indicated that SW will maybe a clinical method for osteoporosis and other disease in orthopedics according to its osteogenetic mechanism.