ABSTRACT
With the development of modern medical standards,autoimmune diseases and their associ-ated successive osteoporosis have received increasing attention in recent years.Patients with autoimmune diseases,due to the characteristics of the disease and the prolonged use of glucocorticoid hormone thera-py,may affect the bone formation and bone absorption of the patient,followed by severe successive osteo-porosis,thereby increasing the risk of osteoporotic vertebral fractures.Vertebral compression fractures of the spine are common fracture types in patients with osteoporotic fractures.Osteoporosis is a common complication after glucocorticoid therapy in patients with autoimmune diseases.Percutaneous vertebro-plasty(PVP)and percutaneous kyphoplasty(PKP)are minimally invasive operation and are commonly used surgical methods for the treatment of osteoporotic vertebral compression fractures.However,due to the operation of spinal puncture during the operation,there are serious surgical risks such as bone cement leakage,spinal epidural hemorrhage,subdural hemorrhage,and subarachnoid hemorrhage in both PVP and PKP.As a result,it is necessary to evaluate the patient's body before surgery carefully,especially in the case of blood coagulation.This article reports a case of autoimmune disease patient admitted to Peking University People's Hospital due to lumbar 4 vertebral compression fracture combined with Sj?gren's syn-drome.The patient's preoperative examination showed that the activated partial thromboplastin time(APTT)was significantly prolonged.After completing the APTT extended screening experiment and lu-pus anticoagulant factor testing,the multi-disciplinary team(MDT)of Peking University People's Hospi-tal jointly discussed the conclusion that the patient's test results were caused by an abnormal self-immuni-ty anti-copulant lupus(LAC).Based on the results of the laboratory examination,the patient was con-sidered to be diagnosed with combined antiphospholipid syndrome(APS).For such patients,compared with the patient's tendency to bleed,we should pay more attention to the risk of high blood clotting in the lower limbs of the patient,pulmonary clots and so on.With timely anti-coagulation treatment,the patient safely passed the peripheral period and was successfully discharged from the hospital.Therefore,for pa-tients with autoimmune diseases with prolonged APTT in the perioperative period,doctors need to careful-ly identify the actual cause and carry out targeted treatment in order to minimize the risk of surgical and perioperative complications and bring satisfactory treatment results to the patients.
ABSTRACT
Objective To analyze the correlative factors of hypopituitarism in patients with intracranial non-sellar tumors.Methods Eighty-three patients with intracranial non-sellar tumors,admitted to our hospital from May 2014 to April 2015,were included in our study;their clinical data were retrospectively analyzed.The status of pituitary function was assessed according to the level of preoperative serum hormone.Univariate and multivariate Logistic regression analyses were employed to analyze the correlations of preoperative hypopituitarism with age,gender,hypertension,epilepsy history,course of disease,mass effect of tumor,tumor location,intracranial pressure (ICP),and composition of cerebrospinal fluid.Results Before surgery,30 showed hypopituitarism,accounting for 36.14％:23 had deficiency in one pituitary axe and 7 had multi-axial deficiency.Univariate analysis showed that high ICP (ICP＞200 mmH2O),acute or sub-acute course (≤ 3 months) and presence of mass effect by non-sellar brain tumor were the risk factors of hypopituitarism (P＜0.05).Multivariate Logistic regression analysis revealed that intracranial mass effect in patients with non-sellar brain tumor was an independent risk factor (OR=3.197,95％CI=1.085-9.423,P=0.035).Conclusion Hypopituitarism has high morbidity in patients with non-sellar brain tumor;intracranial mass effect is an independent risk factor for hypopituitarism.
ABSTRACT
Objective To investigate the accuracy of volumetric measurements (Dotian formula and platform-like volume calculation formula [PLVCA]) in pituitary adenomas and their practicabilities.Methods Forty-five large and giant pituitary adenomas patients,admitted to our hospital from May 2013 to May 2014,were collected.According to the imaging finds of pituitary adenomas,the patients were divided into regular type group and irregular type group;the volume of these tumors were calculated by PLVCA method,Dotian formula and virtual reality (VR) reconstruction method,respectively.The results of VR method were used as the standards to investigate the accuracy of Dotian formula and PLVCA method on pituitary adenomas.Results In 45 pituitary adenomas,17 (37.78％) were regular;the result of tumor volume using VR method was (6.54±11.27) cm3,that using PLVCA method was (5.50±9.40) cm3 and that using Dotian formula was (4.32±9.00) cm3;significant differences were noted between the results of VR method and PLVCA method and the results of VR method and Dotian formula (P＜0.05);there was no significant difference between the results of PLVCA method and Dotian formula (P＞0.05).Another 28 (62.22％) were irregular;the result of volume using VR method was (11.65±16.60) cm3,that using PLVCA method was (11.50±16.18) cm3,there was no significant difference between the two results (P＞0.05);that using Dorian formula was (10.04±19.45) cm3,and there was significant difference between the VR method and Dotan formula (P＜0.05),which was also found between PLVCA method and Tada formula (P＜0.05).Conclusion PLVCA method has a higher accuracy in volume measurement of pituitary adenomas than Dotian formula,especially in irregular adenomas.
ABSTRACT
Objective To investigate the early clinical and imaging features,treatment strategies of subarachnoid hemorrhage secondary to cerebral venous sinus thrombosis.Methods The clinical data of 3 patients with subarachnoid hemorrhage secondary to cerebral venous sinus thrombosis,admitted to our hospital from October 2013 to March 2015,were retrospectively analyzed.One patient underwent anticoagulant therapy singly,and two underwent anticoagulation and thrombolytic therapy.Results One patient was admitted to hospital in gestation period,two patients had unknown etiology.All patients complained of headache;among them,two presented with epilepsy.Two patients with early diagnosis and treatment of anticoagnlation and thrombolysis had favorable prognosis,one patient with secondary intracranial hemorrhage had good outcome after active treatment.Conclusions For those patients with onset of non-aortogenic subarachnoid hemorrhage,we must keep an eye out for underlying cerebral venous sinus thrombosis.Anticoagulant and thrombolytic therapy are the first-line treatment.It is suggested that the appropriate dosage at the appropriate time to prevent cerebral hemorrhage from occurring is necessary.