RESUMO
Objective:To investigate the clinical manifestations, pathogenesis,diagnosis and treatment of negative pressure hydrocephalus (NPH).Methods:A retrospective analysis was performed on the 5 patients with NPH admitted to the Department of Neurosurgery, Tianjin Huanhu Hospital from January 2019 to December 2021. All of the patients underwent lumbar puncture and ventricular puncture to test the pressure. Three patients underwent endoscopic third ventriculostomy (ETV), the outcome of the patients was observed.Results:The pressure of subarachnoid was not equal to intraventricular, and the pressure of intraventricular was negative. Cisternography showed cerebrospinal fluid circulation obstruction in all 5 cases. The symptoms of 1 patient were improved after external negative pressure drainage, 3 patients were improved after further ETV and 1 patient had pulmonary infection without further surgical treatment.Conclusion:With the obstruction of cerebrospinal fluid circulation, the pressure of lateral ventricle and subarachnoid is different, when the pressure of brain or subarachnoid drop, the ventricular expansion under the effect of pressure gradient, intraventricular pressure drop even for the negative pressure. CT cisternography provides strong evidence for the diagnosis of this disease. External ventricular drainage with negative pressure and ETV are effective treatment methods.
RESUMO
Objective:To analyze the application value of metagenomic next-generation sequencing (mNGS) in the detection of pathogenic bacteria in brain abscesses.Methods:The data of patients with brain abscess in Tianjin Huanhu Hospital from January 2019 to December 2021 were retrospectively analyzed. All patients underwent stereotaxic abscess puncture and drainage. According to the different methods of pathogen detection, they were divided into bacterial culture group (bacterial culture only) and mNGS group (bacterial culture with mNGS). The clinical symptoms, abscess site, bacterial culture and mNGS results, antibiotic application protocol and prognosis of the patients were analyzed. The bacterial detection results of the two groups were analyzed, and the antibiotic application and prognosis were compared. χ 2 test, exact probability method and Mann Whitney test were used to compare the difference between the two groups. Results:A total of 43 patients with brain abscess were enrolled, including 21 cases in bacterial culture group and 22 cases in mNGS group. The positive rate of bacteria culture group was 42.9% (9/21), the positive rate of bacteria culture group was 45.5% (10/22), and the positive rate of mNGS detection was 100% (22/22). Only 3 cases in the bacterial culture group could have a clear bacterial source, while 17 cases in the mNGS group could have a clear bacterial source according to the bacterial results, showing a significant statistical difference between the two groups (χ 2=19.69, P<0.001). The return time of bacterial culture was 7.0 (4.0,7.0) days, and the average return time of mNGS was 1.5 (1.5,1.5) days, the difference of bacterial return time between the two groups was statistically significant ( Z=0.00, P<0.001). The cost of antibiotic use in bacterial culture group was 24.00 (5.60,31.00) thousands yuan, and the cost of antibiotic use in mNGS group was 12.00 (2.10, 20.00) thousands yuan, and there was significant statistical difference between them ( Z=5.22, P=0.026). Conclusions:MNGS can quickly and accurately identify the types and sources of brain abscess pathogens, guide the clinical application of antibiotics more targeted, reduce the cost of antibiotic use, and is an effective method for the detection of brain abscess pathogenic bacteria.
RESUMO
Objective To explore the facial nerve functional recovery law after resection of acoustic neuroma,and the influence of tumor size on postoperative facial nerve function. Methods According to the House-Brackman (HB) facial nerve function classification method, 89 patients with acoustic neuroma were performed microsurgical resection with the ret?rosigmoid approach and facial nerve preservation. The HB classification method was used to evaluate the facial nerve func?tion at operation, 15 d, 45 d, 3 m, 6 m, 12 m and more than 12 m after surgery. The recovery pattern of neurological function after operation was analyzed. al. According to the tumor size, patients were divided into three groups: diameter < 30 mm group (n=23), 30-40 mm group (n=31) and≥40 mm group (n=35). The facial nerve function was compared between different groups with early postoperative (within 15 days) and long-term (more than 12 months). Results The facial nerve function was the worst in 15 days after operation (excellence rate was 52.81%), but the function was returned to normal in postopera?tive 3 months (excellent rate reached 80.90%). After postoperative 12 months, almost all patients returned to normal func?tion (excellent rate was 91.01%), and the facial nerve recovery was more smoothly (excellent rate was 92.13%). Tumor size had remarkable effect on facial nerve function in the early postoperative period (χ2=23.34, P<0.05), and long-term period (χ2=14.46, P<0.05). And tumor size was positively correlated with classification of facial nerve function in the early stage (r=0.476, P<0.05) and long-term stage (r=0.379, P<0.05). The excellent rates of postoperative facial nerve function were decreased with the increased diameters of tumor size. Conclusion The facial nerve function may appear deterioration in early postoperative period (within 15 days) in patients with acoustic neuroma, which can return to the normal level in 12 months. The diameter of tumor is one of important factors influencing the early and long-term prognosis of postoperative fa?cial nerve function.
RESUMO
Objective To investigate effect of mild hypothermia on changes of somatosensory evoked potential (SEP) and synaptophysin mRNA level after traumatic brain injury (TBI) and determine hypothermia-induced neuroprotection.Methods Forty-five SD rats were allocated into mild hypothermia group,TBI group and sham operation group with 15 rats per group according to the random number table.Left-side fluid percussion impact was performed to induce models of TBI.Rats were exposed to hypothermia environment (32-35℃) for 6 hours in mild hypothermia group after TBI.Rats in sham operation group were treated by only drilling on left side of the head,rather than hitting.To evaluate function outcome,modified neurological severity score (mNSS),SEP and synaptophysin mRNA level were measured at 6 hours,24 hours and 7 days postinjury.Results The mNSS in mild hypothermia group lowered compared with TBI group,especially at 24 hours and 7 days (P ＜ 0.05).SEP in mild hypothermia group was significantly shortened at 6 and 24 hours compared with TBI group (P ＜ 0.05),but SEP revealed no significant difference among the 3 groups at 7 days (P ＞ 0.05).Level of synaptophysin mRNA in mild hypothermia group increased at 6 hours postinjury compared with TBI group [(0.08 ± 0.02) vs (0.12 ±0.04)],with further increase at 7 days postinjury[(0.06 ± 0.01) vs (0.33 ± 0.10)] (P ＜0.05).Conclusion The shortage of nerve conduction time of the injured side and promotion of nerve regeneration suggest the neuroprotective role of mild hypothermia following TBI.
RESUMO
<p><b>OBJECTIVE</b>To evaluate the clinical significance of AFP-L3 in patients with hepatocellular carcinoma.</p><p><b>METHODS</b>Serum AFP-L3 variants were separated by micro centrifugal column, and detected by chemiluminescence.</p><p><b>RESULTS</b>AFP and AFP-L3 levels were higher in patients with hepatocellular carcinoma than those in patients with chronic hepatitis (P<0.001); as a diagnostic target, the sensitivity and specificity of AFP-L3 were 72.3 percent and 97.2 percent, respectively. Eight patients with hepatitis have higher AFP-L3, but none of them were found with carcinoma by CT three months later.</p><p><b>CONCLUSION</b>AFP-L3 is very useful in the diagnosis of patients with hepatocellular carcinoma.</p>