Reconstruction of anterior auricular defect with postauricular island / 中华医学美学美容杂志

Objective:To investigate the clinical effect of postauricular island flap in reconstruction of anterior auricular defect.Methods:Twelve patients with auricular tumors were retrospectively analyzed in the Department of Aesthetic Plastic and Craniofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University. After the tumors were completely removed, the skin defects were repaired with retroauricular island flaps, and the clinical results of the flaps were observed.Results:All the twelve postauricular island flaps were survived postoperatively. One of the flaps had the disorder of blood supply. After puncture with the needle, the congestion was drained out and the flap survived finally. During 1 to 2 years' follow-up, all patients were well satisfied with the surgical results.Conclusions:The posterior auricular island flap in reconstruction of anterior auricular defect has the advantages of simple and easy operation, high survival rate, small scar in the donor area and good aesthetic effect, which is worthy of clinical promotion.

Application of the digital technology in the reconstruction of congenital microtia / 中华整形外科杂志

Objective@#To explore the effect of applying the digital technology in the reconstruction of congenital microtia.@*Methods@#CT data of 40 patients with congenital microtia were collected by using software (Mimics 17.01) and three-dimensional printing. And the three-dimensional reconstruction of costal cartilage and ear model was performed. The effectiveness and feasibility of the digital assisted technology in the reconstruction of congenital microtia could be established, by contrasting the pre-three-dimensional reconstruction and the morphology of the costal cartilage harvested during surgery and comparing the imaging data of the auricles before and after surgery.@*Results@#40 patients were satisfied with the appearance of the auricle after the restoration. The rib cartilage obtained during the operation was consistent with the preoperative data simulation. The trauma of the operation and the operation time were reduced. There was no statistically significant difference between both auricle length and width for the reconstructed ear and those of the normal ear, auricle length mean (62.10±6.82)mm vs (60.31±6.18)mm, auricle width mean (26.10±2.26)mm vs (25.40±2.32)mm, P>0.05, respectively.@*Conclusions@#The application of digital assisted technique in congenital microtia correction could accurately display the tissue structure of the operation area, which was helpful to preoperative design, reduce intraoperative injury and achieve satisfactory surgical result .

Clinical experience and analysis on the complications of the one-stage surgery with prolonged tissue expansion in microtia reconstruction / 中华整形外科杂志

Objective@#To explore procedure of the one-stage surgery with prolonged tissue expansion in microtia reconstruction and treatment of related complications.@*Methods@#211 patients had undergone the one-stage surgery of microtia reconstruction with prolonged tissue expansion in Department of Aesthetic Plastic and Maxillofacial Surgery, the First Affiliated Hospital of Xi′an Jiaotong University from June 2016 to June 2017. A retrospective study of these data was conducted for standardization of surgical procedure, treatment of postoperative complications, improvement of the existing technology.@*Results@#211 patients had finished the follow-up, of which 10 had complications. The complications included 4 cases of hematomas, 3 cases of expander exposures, 2 infections, and disorder on blood supply of the flap with severe headache in 1 case. We removed hematoma by washing and drainage, repositioned the exposed expander by standard debridement surgery again, controlled infection by systemic or topical application of effective antibiotics, andrelieved severe headache by reducing injection volume. After these treatments, all the patients were able to undergo the next stage surgery of ear reconstruction.@*Conclusions@#Emphasizing standardization of surgical procedure, appropriate treatment of postoperative complications and improvement of tissue expansion was beneficial for performing the next stage surgery of ear reconstruction.

Stereotactic Aspiration and Drainage on a Patient with Large Lobar Hemorrhage and Brain Herniation A Case Report / 国际脑血管病杂志

A 43-year-old man was diagnosed as massive left occipital lobe hemorrhage with the hematoma expanded into the entire ventricular system. On admission, he was in deep coma with clinical signs of brain herniation and a Glasgow Coma Scale (GCS) score of 4. Vascular malformations were highly suspected since he was young with no history of hypertension. Considering the life-threatening situation, open craniotomy and hematoma evacuation was proposed as the first therapeutic option, but this was refused by his family members for non-medical reasons. In order to save his life, stereotactic aspiration was suggested again and was accepted. UK at an aggressive dosage of 50 000 IU was administered during and after the surgical procedure for 5 days. One month later, this patient gained an excellent recovery with a Glasgow Outcome Scale (GOS) score of 5.

Evaluation of the combination of multiple subpial transection and other techniques for treatment of intractable epilepsy / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Multiple subpial transection (MST) is one approach to the surgical treatment of intractable epilepsy with epileptogenic lesion located in functional areas. To verify the effect of MST, an experimental study was performed first, followed by clinical application.</p><p><b>METHODS</b>On the basis of the experimental study, MST was performed in 200 intractable epileptic patients from 1991 to 2000. Of them, 80 cases underwent MST only while 120 others underwent MST combined with other techniques, such as corpus callosotomy, temporal lobectomy and focus resection. A series of modifications of the surgical techniques were made.</p><p><b>RESULTS</b>The results of the experimental study indicated that MST could inhibit the formation and spreading of epileptic discharge and limit the damage to neurons in a minimal area on the epileptogenic agent injected cortex. MST does not impair major functions of the cortex. After the clinical application and modifications, 160 patients were followed up for 1 to 8 years. Complete control of seizure was obtained in 100 cases (62.5%), significant reduction (more than 75%) in 32, reduction (more than 50%) in 20 and no change in 8. The total rate of effectiveness was 95.0%, and the significant rate of effectiveness was 82.5%. No functional defects were found in any patients.</p><p><b>CONCLUSIONS</b>The results indicate that MST is an effective approach to the surgical treatment of intractable epilepsy. MST can be combined with other approaches. The outcome of the subdivision of the MST only group indicates that MST on local epileptogenic lesion without structural changes is as effective as that of the combined operation group. To evade hemispheric disturbance, MST should be done first to avoid severe complications. Hemispherectomy should be performed only on poor effected cases of MST.</p>

HISTOLOGICAL CHANGES IN NORMAL RAT BRAIN AFTER GAMMA IRRADIATION / 解放军医学杂志

To study time and dose related changes after gamma knife radiosurgery (GKR) in rat brain, right caudate nucleuses of rats were irradiated by OUR XGD gamma units. The maximum dosages of 20,50,75 and 160Gy were given using a 4 mm collimator. HE, Nissl, Luxol fast blue staining and immunohistochemistry were utilized to observe histological changes.Histological changes in the right caudate nucleuses such as microvessel injury, which appeared as telangiectasia, vasodilatation, vessel wall thickening and edema, and astrocyte changes, which appeared as hypertrophy and proliferation, were observed at various time points after GKR. These findings demonstrate time dependent and dosage dependent changes are found in normal cerebral tissue after GKR. These results provide an explanation of the process taking place during the latent period before delayed radiation necrosis develops.

Comparison inhibitory effect of bleomycin and carmustine on craniopharyngiomas cultured in vitro / 第二军医大学学报

Objective: To compare the inhibitory effect of carmustine(BCNU) and bleomycin on craniopharyngiomas in vitro. Methods: Cells were successfully cultured in vitro from the fresh specimens, then the culture medium with bleomycin or BCNU at different concentration was added. The tumor inhibitory curve-line was drawn based on the cell number at different time points. After cultured for 144 h, ATP-luminescence assay was applied to test the antitumor effect. Results: The cell number decreased rapidly when the medium was added. The decreasing speed was faster in BCNU medium than that in bleomycin medium at the same concentration. The bleomycin medium showed no significant inhibitory effect except for the one at 1.00 g/L. However, regardless of the concentration, BCNU medium inhibited the cells effectively. Conclusion: BCNU has stronger inhibitory effect on craniopharyngiomas cells than bleomycin, it can be used to treat this tumor

Clinical application of rotating gamma system radiosurgery in neurosurgery: 2381 cases report / 解放军医学杂志

Objective To evaluate the safety and efficacy of OUR Rotating Gamma System in neurosurgical clinical application. Methods Based on the results of animal experiments, 2381 patients with intracranial disease were treated using OUR Rotating Gamma System in Aohai Gamma Knife Center of Navy General Hospital of PLA betwean December 1996 and November 2002. There were 1288 males and 1093 females and their age ranged from 3 to 84 years (mean 45.8 years). 1020 patients had benign intracranial tumors, and of them 446 suffered from pituitary tumors, 254 meningioma, 148 craniopharyngioma and 103 vestibular schwannomas. Malignant tumors were diagnosed in 796 patients, among them glioma was found in 360 and metastasis in 360. 374 patients had cerebral arteriovenous malformations (AVMs) and 191 functional neurological disorders. Treatment technique of Gamma Knife Stereotactic Radiosurgery, dose prescription and precise orientation performed in intracranial tumor or foci were analyzed, and the preliminary outcome of treatment was evaluated in this study. In addition, the management of the possible complication and adverse reaction was studied. Results Gamma Knife Stereotactic Radiosurgery alone, or combined with other treatment procedures, could cure some of selected patients with benign brain lesions including pituitary neoplasms, meningioma, vestibular schwannomas, AVMs, and craniopharyngioma etc. And this treatment was also beneficial to some patients with malignant tumors. The incidence of radiation edema was 0.75%. Conclusions The clinical results suggest that Gamma Knife Stereotactic Radiosurgery is a very effective, accurate and relatively safe neurosurgical tool used either as a primary or adjuvant procedure for treatment of intracranical pathologic processes. However, it might lead to some severe or fatal complications if used inappropriately. Thus, optimal result would not be obtained unless a careful and precise Gamma treatment based on the operative rules and the effective management for postoperative complications are well planned.

ANTERIOR CALLOSOTOMY FOR 50 CASES OF INTRACTABLE EPILEPSY / 解放军医学杂志

Fifty patients with intractable epilepsy were treated in the years from 1984-1986. Anterior callo-sotomy was performed on all the patients, and cingulectomy was added in 19 patients with psychorea-ction. There was no mortality or any serious operative complication. The effective rate was 88%. In this paper the mechanism of the operative procedure and indication are briefly discussed. In conclusion, it may be stated that the operative results are satisfactory.

GAMMA KNIFE COMBINED WITH STEREOTAXIC TECHNIQUE FOR BRAIN LESIONS / 解放军医学杂志

Fifty-five patients with brain lesions were treated with gamma knife combined with stereotaxic technique. There were 33 males and 22 females, and their age ranged from 12 to 72, averaged 41 years. The lesions were located in the sellar area in 21 patients, in the deep cerebrum in 10,in the basal ganglion in 9, in the cerebellum in 5, in the brain stem in 4. Intracranial multiple lesions were found in 6 patients. Twenty-four patients were treated with gamma knife combined with stereotaxic biopsy, 21 with gamma knife combined with stereotaxic aspiration for the cyst and 8 with gamma knife combined with stereotaxic biopsy and aspiration. In the other 2 cases, conservative therapy was used because their pathogenesis was parasite and abscess. Of the 47 biopsies, glioms were diagnosed pathologically in 15 cases, metastasis in 9, craniopharyngioma in 7, pituitary adenoma in 4, germinoma in 3, other tumor in 4, parasite in 1 and abscess in 1. The biopsy positive rate was 93.6%. Aspirated cytic fluid ranged from 1 to 30ml, and the symptoms improved dramatically after aspiration. There were no severe complications and deaths related to stereotaxic procedures. It suggested that gamma knife combined stereotaxic technique is a useful and safe procedure for neuropathological diagnosis and an appropriate management for certain brain lesions.

Early blood-brain barrier disruption after gamma irradiation in rats / 第二军医大学学报

Objective: To study the effect of gamma irradiation on the permeability of the blood brain barrier(BBB) in rat brains. Methods:The right caudate nucleuses of Sprague Dawley rats were irradiated by OUR XGD gamma units.Maximum dosages of 20,50,75 and 160 Gy were given using a 4 mm collimator.Immunohistochemistry with antibody of serum albumin was used for detecting the extravasation of endogenous serum components.Ultrastructural changes of BBB were observed through injection of lanthanum nitrate into blood vessels. Results: Extravasation of albumin and BBB opening in the right caudate nucleuses were detected as early as 12 h after irradiation at 50,75 and 160 Gy,and were detected 1 d after irradiation at 20 Gy.Immunoreactivity and emematous water reached their maximum after 3 d, gradually decreased during the following few days,and disappeared by day 7(20,50 Gy) or day 14(75 Gy).Irradiation at 160 Gy elicited persistent extravasation of albumin and BBB opening for 14 d. Conclusion: These are transient impairments to BBB after irradiation at 20,50,75 Gy,and persistent impairments after irradiaton at 160 Gy.

CLINICAL AND PATHOLOGICAL RESEARCH OF RESECTION OF TEMPORAL EPILEPTOGENIC FOCUS / 解放军医学杂志

This article reports the experience of treatment of 30 cases of temporal epilepsy with surgery. There were 15 male patients and 15 female. The duration of the disease ranged from 5 to 37 years with an average of 13.6 years. 12 patients suffered from grand and petite mal, 8 Jacksonian accompanied by psychomotor epilepsy, and 10 grand mal. Before the operation, the focus with sporadic spikes was found in the temporal lobe with electroencephalogram. Operation: the temporal pole and the medi-basal region were removed in 9 cases, anterior portion of the temporal nesiolobe in 10 cases, temporal neocortical of the temporal lobe in 6 cases, dorsolateral and laterobasal parts in 5 cases. Organic pathological changes were confirmed in all cases by pathological examination. Clinical result of all cases was satisfactory, with an effective rate of 93%. The clinical and pathological changes of epilepsy and efficacy of the treatment are discussed. It is stressed that the localization of the focus of epilepsy depe nds mainly on electroencephalogram. It is very important to look for sporadic spikes using cortical electrode during operation, and complete eradication of the focus is the key to achieve a good treatment effect.