Application of myelography in diagnosis and therapy of spontaneous intracranial hypotension / 中华神经科杂志

Objective To investigate the application of myelography including digital subtraction angiography myelogram (DSM) and computed tomography myelogram (CTM) in patients with spontaneous intracranial hypotension.Methods The myelography results including DSM and CTM of 10 patients with spontaneous intracranial hypotension form Guangzhou First People's Hospital between January 2013 and June 2018 were retrospectively analyzed.Some patients were treated with targeted epidural blood patch on the basis of myelography.Results Myelography (including DSM and CTM) showed cerebrospinal fluid leakages in all the 10 patients.There were one to 16 leak sites with an average of nine sites (totally 90 leak sites).Forty-two sites (47％) were located in cervical vertebra,19 sites (21％) in thoracic vertebra,22 sites (24％) in lumbar vertebra,and seven sites (8％) in sacral vertebra.On DSM and CTM,cerebrospinal fluid leakage was characterized by the diffusion of contrast agent along one side or the bilateral sides of nerve root,enlargement of the nerve sleeves and paraspinal collections of hyper-demity contrast medium.Two patients whose cerebrospinal fluid leakage occurred in long sections showed more cerebrospinal fluid leakage on CTM than on DSM.Two patients responded well to targeted epidural blood patch on the basis of myelography.The cerebrospinal fluid leakage was completely settled on myelography after the treatment of epidural blood patches.Conclusions Myelography has been shown to assist the diagnosis of spontaneous intracranial hypotension and accurately define the location and extent of cerebrospinal fluid leakages.Myelography can be used to guide targeted epidural blood patch and applied in the reexamination of cerebrospinal fluid leakages after treatment.More cerebrospinal fluid leakages are detected by CTM than by DSM.

MRI analysis of pleomorphic xanthoastrocytoma / 实用放射学杂志

Objective To investigate the MRI features of pleomorphic xanthoastrocytoma (PXA).Methods 1 5 pathologically confirmed PXA cases were analyzed retrospectively.Clinical history and imaging features including location,size,shape,signal intensi-ty,enhancement and surrounding changes of those lesions were analyzed.Results All 1 5 cases were supratentorial and solitary le-sions,of which 9 lesions located in temporal lobe(60%).14 lesions contacted with the leptomeninges,and 1 lesion contacted with lat-eral ventricle wall.All lesions were solid-cystic,with different proportion of solid/cystic components.8 large lesions were predomi-nantly cystic(53.3%),3 small lesions were predominantly solid(20%),and 4 lesions had roughly equal cystic and solid proportions (26.7%).Solid components showed iso-intense or mild hypo-intense on T1 WI,iso-intense or mild hyper-intense on T2 WI,and signif-icant enhancement with contrast.Cyst fluid showed slightly hyper-intense in some cases.Cyst wall or septa enhancement was seen in 7 cases,and leptomeningeal enhancement was seen in 8 cases.Conclusion The MRI features of PXA are the characteristic of suprat-entorial solid-cystic lesions commonly seen in temporal lobe and contacting with leptomeninges.The typical features include “cyst with mural nodule”and “multiple cysts with irregular eccentric nodule”with significant enhancement of solid component and some cyst wall.MRI features of PXA is valuable in diagnosis and differential diagnosis of PXA.

Morphology of normal and degenerative nucleus pulposus cells and quantitative analysis of collagen type II protein / 中国组织工程研究

BACKGROUND:The narrowing of intervertebral space induced by the intervertebral disc degeneration is mainly characterized by the expression of proteoglycan in nucleus pulposus cells and the reduction of col agen type II. OBJECTIVE:To quantitatively observe col agen type II protein in adult normal and degenerative intervertebral disc nucleus pulposus cells by immunofluorescence staining and safranin O staining. METHODS:The nucleus pulposus specimens were col ected from adult scoliosis patients and patients with intervertebral disc protrusion, who were al volunteers. After culture, 26 cells in each patient were measured. There were 78 cells in both normal group and degeneration group. The normal and degenerative intervertebral disc nucleus pulposus cells were subjected to safranin“O”staining, and gray values were determined;intracellular col agen type II was detected by immunofluorescence staining. RESULTS AND CONCLUSION:Immunofluorescence staining revealed that, degenerative intervertebral disc nucleus pulposus cells were only mildly stained, with the fuzzy staining, the shape was round, spindle, fusiform and irregular. There were a very smal amount of fluorescent particles within cells. The expression of col agen type II was decreased significantly compared with normal cells (P0.05). The degenerative intervertebral disc nucleus pulposus cells have a smal quantity and partial y become apoptotic, the content of col egen type II protein is decreased significantly compared with normal nucleus pulposus cells.

Total proctocolectomy with SMA & V severance and ileal pouch-anal anastomosis for familial polyposis coli / 中华普通外科杂志

Objective To investigate the clinical value of a newly designed surgical therapy for familial polyposis coli by severing the superior mesenteric artery&vein in order to make a complete lysis of the mesentery and an ileum pouch and the anal anastomosis within the entire muscular sheath of the rectum.Methods Six patients with familial polyposis coli(5 males and 1 female,aged 24-36 years)were admitted and underwent the procedure which was consisted of:(1)An incision was made in the left middle and lower parts of the rectus abdominis;(2)The greater omentum was retained and the large intestine was removed;(3)At the juncture of the sigmoid colon and the rectum,the muscular sheath was dissociated 0.5cm,the mucous membrane of the rectum was stripped in a revolving manner,the nourishing artery and vein in the membrane were exposed,and clamped and cut in sequence up to the anocutaneoue line;(4)The rectal mucous membrane was completely removed;(5)Under the right colonic artery,the superior mesenteric artery and vein were severed;(6)An N-,J-or W-shaped pouch was made in the ileum accordingly:(7)An anastomosis of the ileum pouch and the anal canal was made within the entire muscular sheath of the rectum,and a drainage was placed;(8)The mesostenium was fixed on the fight posterior abdomen,the small intestines were spread out to the right side,and the mesostenium was covered on the coarse surface of the colon bed:(9)A tube was placed in the left lower abdomen for a vacuum aspiration for 2 days after operation,combined with the suction drainage,to eliminate the pelvic effusions;and(10)The abdomen was closed.Results Patients were able to discriminate stools and flatus 3-7 days after operation.and the formed stools occurred 7-10 days after operation.Five patients were followed-up for 3-17 years,with averagely one defecation a day,with no night defecation and seepage.Urination was normal;In another one patient who underwent the procedure 4 months ago the defecation was twice a day,with no night defecation.All the 6 patients had normal autonomic nerve function and sexual function as well as normal defecation and urination,with no recurrence of polyposis coli or infection.The small bowel functions well with no ischemia related symptoms.Conclusion Cutting the superior mesenteric artery and vein and then making anastomosis of the ileum pouch and the anal canal within the muscular sheath of the rectum is a new surgical approach to familial polyposis coli.It is safe and significantly improves the patients' life quality.