Application of neurosurgical microscopic technology training in medical undergraduate teaching / 中华医学教育探索杂志

There are still many existing problems in the training of medical undergraduates and microsurgery talents in China, such as lack of scientific research ability and scientific literacy of medical undergraduates, insufficient practical ability, short of scientific research opportunities for medical undergraduates, and inadequate talent reserve in microsurgery. In view of the above shortcomings, Wannan Medical College has established a training course on microneurosurgery technology for medical undergraduates, and made a preliminary exploration to solve the above problems. Through the training, undergraduates not only improve their practical ability, but also stimulate their interest in microsurgery, which will help them adapt to clinical and scientific research work at an early stage. Neurosurgical microscopic technology training with emphasis on extracurricular expansion as main content, plays an important role in the cultivation of undergraduate microscopic skills, the establishment of basic theories of neurosurgery, the improvement of scientific research accomplishment and the expansion of extracurricular vision.

Endoscopic anatomy of infraorbital/maxillary nerves in endoscopic transmaxillary approach / 中国神经精神疾病杂志

Objective To explore the localization and guidance value of infraorbital/maxillary nerve in endoscopic transmaxillary approach, and to provide anatomical data for clinical operation. Methods The eight adult cadaver heads were dissected by means of the endoscopic transmaxillary approach to expose the infraorbital/maxillary nerve, and relevant data were collected. Results In 8 cases, 16 maxillary nerves arose from the trigeminal ganglion of the trigeminal nerve and emerged from the foramen rotundum, transited to the infraorbital nerve at the infraorbital fissure, then traveled in the infraorbital canal and out of the infraorbital foramen. The infraorbital/maxillary nerve could be divided into four segments according to the foramen rotundum, infraorbital groove and infraorbital foramen: the terminal segment, the infraorbital nerve and its terminal branches to the face, distal to the infraorbital foramen; the orbitomaxillary segment and the orbitomaxillary segment of the infraorbital nerve within the infraorbital canal from the infraorbital foramen along the infraorbital groove (length 11.7 ±2.5 mm ), which was readily identified in the roof of the maxillary sinus in all specimens. The pterygopalatine segment, the pterygopalatine segment within the pterygopalatine fossa, which started at the infraorbital groove to the foramen rotundum (length 13.4±2.1 mm); The intracranial segment, the intracranial segment from the foramen rotundum to the trigeminal ganglion(length 15.2±3.9 mm). Conclusion The infraorbital nerve can serve as a anatomical landmark for endoscopic transmaxillary approach to get access to infratemporal fossa, pterygopalatine fossa, trigeminal ganglion and lateral wall of the cavernous sinus.

Imaging features and pathological analysis of calvarial cavernous hemangioma / 中国神经精神疾病杂志

Objective To investigate the imaging features of the calvarial cavernous hemangioma and the surgical efficacy to improve diagnosis and treatment of the calvarial cavernous hemangioma.Methods The clinical information,imaging materials and surgical efficacy from ten cases of calvarial cavernous hemangioma confirmed by pathology and the related literature was reviewed.Results The lesion was located in frontal bone in eight cases,in parietal bone in one case and in occipital bone in one case.The lesions were round-shape hypodensity with clear margin in X-ray.The lesions were hyperdensity or slightly hyperdensity on CT scan,and were osteolytic lesions with a characteristic honeycomb or starburst pattern on bone window.The MRI features were complicated and variable.The lesions were heterogenous and unevenly enhanced signal intensity.Nine patients underwent radical resections and reconstructed immediately by titanium mesh.The patient with tumor in occipital bone underwent radical resection only.Macroscopically,the pathologic bone was a huge purple-red blush mass protruding from the skull surface.Histological examination revealed the diploe with large,thin-walled,dilated blood-filled spaces lined by flattened endothelial cells without evidence of malignancy.No recurrence was noted in any case during a follow-up period from 3 to 24 months.All the patients survived well without recurrence.Conclusions The imaging features of calvarial cavernous hemangioma have a high value in the diagnosis and may provide guidance for the treatment.The radical resection and immediate reconstruction treatment for calvarial cavernous hemangioma is satisfied.

Diagnostic value of double contrast-enhanced ultrasound in obstructive jaundice / 中华超声影像学杂志

Objective To evaluate the preoperative value of dual contrast-enhanced ultrasound (DCEUS) on obstructive jaundice.Methods Seventy-nine patients with obstructive jaundice were included.DCEUS (percutaneous transhepatic contrast-enhanced cholangio-ultrasonography combined with intravenous contrast-enhanced ultrasound) was performed preoperatively.The biliary obstruction plane,degree and cause were observed.After surgery,the diagnostic accuracy of DCEUS was compared with final pathologic results respectively.Results The overall accuracy of DCEUS in determining the flat,degree and cause of biliary obstruction was 98.7％,98.7％ and 93.7％,respectively.The DCEUS and golden standard were both almost perfect for assessing biliary obstruction with Kappa values of 0.979,0.837 and 0.975(P =0.000).The overall diagnostic accuracy of obstruction combined with obstruction plane,the extent and cause was 92.4％.Conclusions DCEUS could be considered a feasible,reliable,and exhaustive method for preoperative evaluation of obstructive jaundice.

The use of cysto-peritoneal shunt to treat intracranial temporal arachnoid cysts in children / 中国医师杂志

Objective To summarize the clinical experience of the temporal arachnoid cysts in children with cysto-peritoneal shunt.Methods The clinical data of 16 patients from June 2009 to August 2012 of children with the temporal arachnoid cysts taken by cysto-peritoneal shunt were analyzed retrospectively .The surgical procedure and prognosis were also analyzed .Results Sixteen ca-ses of follow-up from 2 to 30 months after surgery showed 5 cases of preoperative symptoms disappeared .After surgery of 6 months, the head computed tomography (CT) showed 4 cysts disappeared (25.0%), 12 cysts shrink (75.0%), reduced >50%in 9 cases, and reduced 50%in 4 cases, and reduced <50%in 1 cases.1 case after surgery of 2 months with head CT showed the cysts shrink and had left frontal subdural effusion;Two years later the cranial CT scan showed the cysts disappeared and the left frontal subdural effusion absorption . No serious complications and infections were observed .Conclusions Cysto-peritoneal shunt might be a safe and effective method to treat intracranial temporal arachnoid cysts in children and had good prognosis .

Occlusion of ruptured vertebral artery dissecting aneurysms via bilateral vertebral artery approach an efficacy analysis / 中国脑血管病杂志

Objective To investigate the effect of endovascular treatment of intracranial ruptured vertebral artery dissecting aneurysms via bilateral vertebral artery approach. Methods The symptoms and imaging results of 5 patients with ruptured vertebral artery dissecting aneurysms were analyzed retrospectively. They were all treated with coil embolization via bilateral vertebral artery approach. The two ends of dissection aneurysms were packed densely,the middle segments were packed loosely,and the arteries were isolated from the blood circulation. Results Of the 5 patients after treated,the clinical symptoms were improved rapidly in 4 patients no abnormal limbs activity and mental disorders. After treatment,the modified Rankin scale (mRS)was 0 in four cases after six-month follow-up. One patient turned clear consciousness after 4 weeks, and their mRS was 3 at 6-month follow-up. Before treatment,DSA showed vertebral artery dilation and stenosis. The mean length of involvement in vertebral arteries was 9. 3 ± 1. 5 mm;after treatment,the dissecting aneurysms of 5 patients did not develop completely,no further bleeding occurred,and no new infarcts were observed. No recurrence of the aneurysms and parent artery recanalization were found at the follow-up after 6 months. Conclusion The occlusion of ruptured vertebral artery dissecting aneurysms via bilateral vertebral artery approach is technically feasible. It may be an effective treatment to prevent rebleeding.

Effects of glutamine and growth hormone on nutritional status,immunity and inflammatory responses in postoperative patients with portal hypertension / 国际外科学杂志

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.

Long-term curative effects of suture plus proximal gastric vagotomy or triad-therapy for duodenal ulcer with acute perforation / 中华外科杂志

<p><b>OBJECTIVE</b>To study the long-term curative effects of suture plus proximal gastric vagotomy (PGV) and suture plus triad-therapy (omeprazole, amoxycillin and flagyl taken orally) for the treatment of duodenal ulcer with acute perforation.</p><p><b>METHODS</b>Three hundred and twenty-nine patients with duodenal ulcer and acute perforation were treated with 2 different methods, respectively. Method A was suture plus PGV (group A, 153 cases), and method B was suture plus triad-therapy (group B, 176 cases). Follow-up was made by means of correspondence, outpatient reexamination and cooperation with local hospitals in 5 to 8 years after operation. The contents of follow-up included symptom acquisition (such as upper abdominal pain or distention, pyrosis, belch, acid regurgitation, vomiting, diarrhea and conditions of living or working), gastroscopy and Helicobacter pylori (HP) detection. The curative effects were evaluated by the Visick scale.</p><p><b>RESULTS</b>Three hundred and one patients were followed up (group A 142 and group B 159). According to the Visick scale, 97 (68.3%), 19 (13.4%), 13 (9.15%) and 13 (9.15%) patients in group A, and 31 (19.5%), 28 (17.6%), 24 (15.1%) and 76 (47.8%) in group B were classified as Visick I, II, III and IV respectively (Z = -9.818, P < 0.01). As for HP detection, there were 130 (91.5%) patients in group A and 94 (59.1%) in group B (chi(2) = 41.438, P < 0.01).</p><p><b>CONCLUSIONS</b>The long-term curative effects of suture plus PGV were superior to those of suture plus triad-therapy for duodenal ulcer with acute perforation although HP positive rate was higher in group A than in group B. HP infection is one of the etiological factors of duodenal ulcer. The increased excitability of the vagus nerve remains to play an important role in duodenal ulcer.</p>