Electrocorticography-guided surgical treatment of solitary supratentorial cavernous malformations with secondary epilepsy / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the efficacy of electrocorticographic (ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy.</p><p><b>METHODS</b>This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years (mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated.</p><p><b>RESULTS</b>Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I (75.00%), 5 were class II (13.89%), 2 were class III (5.56%), and 2 were class IV (5.56%), thus the total effective rate (class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes (P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes (P=0.041).</p><p><b>CONCLUSIONS</b>Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes.</p>

Clinical analysis of hemolytic-uremic syndrome associated with Streptococcus pneumoniae serotype 3 infection in a child / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics of Streptococcus pneumonia-associated hemolytic uremic syndrome (SP-HUS) in children.</p><p><b>METHOD</b>Clinical and laboratory data of a pediatric case of SP-HUS were retrospectively analyzed and the key points of diagnosis and therapy were reviewed.</p><p><b>RESULT</b>An 18-month old girl was admitted with chief complaint of fever and cough for 5 days combined with mild labored breath. Breath sound was found weakened in right lung with lower lobe dullness on percussion. Laboratory tests revealed: WBC 3.7×10(9)/L, Hb 83 g/L, PLT 11×10(9)/L, C-reactive protein (CRP) > 180 mg/L. Morphological study of the RBCs showed marked anisocytosis and schistocytosis. Urinalysis showed 42.66 RBCs per high-power field, occult blood (+++), proteinura (++++). Streptococcus pneumoniae was isolated from blood, pleural fluid and sputum. Serotyping with simplified chessboard system was 3. The direct Coombs test was positive. Serum complement levels (C3 and C4) were depressed at 0.699 g/L, 0.064 g/L, respectively. Chest X-ray showed pleural effusion and infection of the right hemothorax. The computerized tomographic scan of the chest revealed pneumatoceles in the right lower lobe. The diagnosis on admission we considered was SP-HUS. Intravenous antibiotic therapy (vancomycin + cefoperazone/sulbactam) was administered. The renal replacement theraphy was administered to maintain electrolyte and fluid balances and adequate nutrition. Transfusions of washed red blood cells were administered to correct the anemia. One month after admission the patient was good with recovery. Liver and renal function recovered and the pneumonia was resolving, anemia and platelets were corrected. The direct Coombs test turned to be negative. Serum complement levels (C3 and C4) were normal. After 3-month follow-up, no clinical anomalies were detected.</p><p><b>CONCLUSION</b>SP-HUS should be suspected when the following occurs in the context of pneumococcal infections: microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure and a positive Coombs test result. Serotype 3 of SP was associated with HUS.</p>

Early one-stage ventriculo-peritoneal shunt and cranioplasty for patients with postoperative skull deficit and hydrocephalus / 中华神经医学杂志

Objective To investigate the therapic efficiency of early one-stage ventriculo-peritoneal shunt and cranioplasty on patients with skull deficit,hydrocephalus and hernia in the cerebral tissue of deficited skull after large flap decompression.Methods Thirty-eight patients with skull deficit,hydrocephalus and hernia in the cerebral tissue of deficited skull after large flap decompression,admitted to our hospital from June 2009 to December 2010,were chosen in our study;early (within two months of onset) one-stage ventriculo-peritoneal shunt and cranioplasty were performed on these patients; follow up was performed for 6-24 months.Results Postoperative CT scan 10 days after the surgery showed that hydrocephlus disappeared in 31 patients and significantly alleviated in 7; the midline located on the middle of the brain,and the titanium structure in the skull deficit was good.The follow-up of 6-24 months (mean 13 months) indicated that hydrocephlus disappeared in 30 patients,significantly alleviated in 6,and recurred in 2 patients under CT scan; recurred hydrocephalus disappeared after a new re-operation of ventriculo-peritoneal shunt.Conslusion The early one-stage ventriculo-peritoneal shunt and cranioplasty could achieve favorable outcome for patients with skull deficit,hydrocephalus and hernia in the cerebral tissue of deficited skull after large flap decompression.

Cortical electrocorticography monitoring in surgical management of secondary epilepsy / 中华神经医学杂志

Objective To investigate the therapeutic effect of surgical management on patients with secondary epilepsy under the monitoring of cortical electrocorticography (ECoG). Methods Eighty-four patients with secondary epilepsy, admitted to our hospital from September 2004 to January 2008, were chosen; intraoperative ECoG monitoring was performed to locate the epileptic foci before the resection of the primary lesion. After the resection of primary lesion, resection of epileptic foci, enlarged resection of epileptic foci, cortical thermocoagulation, anterior temporal lobectomy,amygdalohippocampectomy and anterior callosotomy were performed, respectively, in different patients according to the clinical manifestations of seizures, and the locations of lesions and epileptic waveform discharges detected by intraoperative ECoG monitoring. Results The epileptic waveform discharges in 84 patients were noted before the resection of primary lesion. The epileptic waves were found in 80patients at the peripheral areas of the primary nidus under immediately postoperative ECoG monitoring,with a relevance ratio reaching 95.24%; after the resection of residual cortical zone with epileptic wave discharges, epileptic wave disappeared on immediately postoperative ECoG in 13 patients whose lesion located in nonfunctional area; normal signals were noted in 60 of the 67 patients performed cortical thermocoagulation whose cortical zone with epileptic wave discharges were located or neighbored in functional area, and good outcomes under the immediately postoperative ECoG monitoring were noted in the other 7 patients performed thermocoagulation combined with anterior callosotomy and/or amygdalohippocampectomy. The follow-up studies for 10 months to 4 years showed that grade Ⅰ in 56patients (66.67%), grade Ⅱ in 21 (25.00%), grade Ⅲ in 4 (4.76%) and grade Ⅳ in 3 (3.57%) according to the Engle standard of curative effect were achieved; the total effective rate was 96. 42%. Conclusion ECoG monitoring can significantly improve the efficiency of surgical management of secondary epilepsy.

Microsurgical treatment of the third ventricular lesions / 中华神经医学杂志

Objective To study the surgical treatment and effects of the lesions in the third ventricle. Methods The data of 15 patients with third ventricular lesion, accepted surgical treatment were retrospectively analyzed. The lesions were removed through transcallosal approach in 11 patients, frontal trans-cortical approach in 2 and trans-terminalis approach in 2,respectively. Postoperative radiotherapy was performed in 5 and chemotherapy in 2. VP shunt was performed in 1. Results The lesions were total-resected in 8 (53.3%), subtotal-resected in 5 (33.3%) and partial-resected in 2 (13.3%) with 1 postoperative death. The hydrocephalus were resolved in all cases. With a follow-up of 3 to 12 months, all the 14 patients recovered without obvious neurological deficits. Conclusion Proper microsurgical approach and perfect surgical skills are the keys to high resection and good prognosis. And postoperative radiotherapy or chemotherapy may be helpful in improving the outcome

Contents of serum albumin after surgical operation in children with acute intussusception / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the changes of serum albumin contents after operation and investigate whether post-operational serum albumin contents are correlated with the disease severity in children with acute intussusception.</p><p><b>METHODS</b>Serum albumin contents were measured using the automatic biochemistry analyzer in 32 children with mild acute intussusception and 21 children with severe acute intussusception 1 day after surgical operation. After 5 days combined treatment, serum albumin contents were re-examined. Thirty healthy children severed as the control group. The correlation between post-operational serum albumin contents and critical illness scores was evaluated.</p><p><b>RESULTS</b>Serum albumin contents in the mild (34.2+/-6.5 g/L; P<0.05) and the severe intussusception groups (25.8+/-7.5 g/L; P<0.01) 1 day after operation were significantly lower than those in the control group (37.1+/-4.1 g/L). There were significant differences in serum albumin contents between the mild and the severe intussusception groups (P<0.05). Five days after operation, serum albumin contents in the mild intussusception group significantly increased (37.1+/-11.4 g/L; P<0.05), while serum albumin contents in the severe intussusception group did not differ from those 1 day after operation. There was a positive correlation between serum albumin contents on the 1st day after operation and the critical illness scores (r=0.879, P<0.01).</p><p><b>CONCLUSIONS</b>Serum albumin contents decreased on the 1st day after operation and were correlated with the disease severity in children with acute intussusception. Hypoalbuminemia lasted for a longer period in severe cases. The post-operational measurement of serum albumin contents may be useful in the evaluation of the severity for children with acute intussusception.</p>

Influence of Continuous Renal Replacement Therapy on Serum Levels of Cytokines and Endotoxin in Children with Severe Sepsis / 实用儿科临床杂志

0.05),while the level of IL-8,TNF-? and endotoxin changed significantly during CRRT(Pa