Applied anatomy for pituitary adenoma resection.

BACKGROUND: Pituitary adenomas are common intracranial tumors, with a rising incidence in China. Excision is a mainstay therapy for this disease, and is often carried out via transfrontal, transsphenoidal or transpterional approaches. However, few studies have systematically addressed the regional anatomy involved in these microsurgical procedures. The present study attempted to establish some key anatomic measurements relevant to pituitary adenoma resection based on cadaver and computer tomography (CT) image studies. METHODS: Head specimens from 30 randomly selected formalin-fixed adult cadavers were used for anatomical analysis. Measurements were made on the base of the skull following removal of brain structures above the pituitary gland, and on the mid-sagittal plane of the cranium. Parameters were designed by considering the 3 above-mentioned common microsurgical approaches, and obtained on each head using a sliding caliper. Multi-level CT images from 30 individuals were also used for distance measurements between landmark structures that are relevant to these surgeries. All data were subjected to statistical analysis using the SPSS 11.5 software. RESULTS: There was statistically significant difference (P < 0.05) of distance measured on cadavers relative to CT images in 3 sets of measurements related to the transfrontal surgical approach, i.e., distances from the midpoint of superciliary arch superior border to the cranial entrance of internal carotid arteries (ICAs), the opposite side entrance of ICA and to the genu of ICA. While regional anatomical analyses were carried out according to the transpterional approach, statistically significant difference was also found in 3 sets of distance measurements between cadaver and CT image data, with regard to the distances between the pterion and some landmark structures around the pituitary. CONCLUSIONS: The present study provides key anatomical and CT image measurements involving the 3 conventionally used surgical approaches for pituitary tumor resection. The data implicate that while CT scan results can provide valuable guidelines for operations, cautions and adjustments are needed during surgery for sufficient tumor excision and protection of key blood vessels and nerves in the vicinity of the pituitary gland and around the surgical pathway.

[Effects of Huoxue Tongmai Lishui method on fundus fluorescein angiography of non-ischemic retinal vein occlusion: a randomized controlled trial].

BACKGROUND: Huoxue Tongmai Lishui method, a traditional Chinese medicine treatment for eliminating water, activating and promoting blood circulation, could inhibit fundus hemorrhage on experimental retinal vein occlusion (RVO) with high obvious effective rate, and improve symptoms in traditional Chinese medicine. The action mechanism may be related to reducing plasma viscosity and non-perfusion area, and the formation of collateral circulation. OBJECTIVE: To explore the therapeutic effects of Huoxue Tongmai Lishui method (Sanxue Mingmu Tablet) on fundus fluorescent angiograph of non-ischemic retinal vein occlusion (RVO). DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: Thirty-four patients with non-ischemic RVO in Department of Ophthalmology, the First Affiliated Hospital, Hunan University of Traditional Chinese Medicine from April 2005 to April 2009 were included. All the patients were diagnosed as qi stagnation and blood stasis syndrome or hyperactivity of liver yang syndrome, and they were randomly divided into two groups, with 17 eyes of 17 patients in treatment group treated by Sanxue Mingmu Tablet combined with conventional treatment, and 18 eyes of 17 patients in control group treated by Xueshuantong Tablet combined with conventional treatment. The patients were treated for two months. MAIN OUTCOME MEASURES: Fundus colour photography, and fundus fluorescent angiograph were detected in two groups before and after the treatment. RESULTS: The curative effect of Sanxue Mingmu Tablet was better than that of Xueshuantong Tablet. Huoxue Tongmai Lishui method could significantly shorten the retinal circulation time, reduce the non-perfusion area, decrease the formation of angiogenesis and promote the formation of collateral circulation. CONCLUSION: Huoxue Tongmai Lishui method is an effective traditional Chinese medicine treatment with high obvious effective rate in reducing non-perfusion area and avoiding venous occlusion and formation of collateral circulation.

Calcitonin gene-related peptide dynamics in rat dorsal root ganglia and spinal cord following different sciatic nerve injuries.

We examined calcitonin gene-related peptide (CGRP) expression dynamics in the dorsal root ganglia (DRGs) and spinal cords of adult rats subjected to one of the following three types of unilateral sciatic nerve injury: crush (SNC), ligation (SNL), or transection combined with subsequent neurorrhaphy (SNT). Following SNC, CGRP immunoreactivity (IR) was increased in ipsilateral primary sensory neurons of L4-L5 DRGs, laminae I-II and spinal motoneurons; an area of CGRP-labeled fibers in ipsilateral laminae III-V was also increased in size following SNC. CGRP up-regulation exhibited a distinct temporospatial pattern and expression levels had returned to baseline levels by the end of the 28-day test period. Similar to SNC, SNT also resulted in an increase of CGRP-IR in these areas, though to a slightly lesser degree in the three latter areas. By contrast SNL, which is associated with complete blockade of axonal transport, induced a sustained decrease in CGRP-IR in primary sensory neurons of L4-L5 DRGs and superficial laminae (I-IIo), as well as in an ipsilateral area occupied by CGRP-labeled fibers. Interestingly, SNL did not affect CGRP-IR in spinal motoneurons, but did result in an accumulation of nerve growth factor (NGF) distal to ligature that was apparent as early as 1 day post-injury and persisted throughout the experimental period. These findings indicate that the nature of peripheral nerve injury has an impact on CGRP expression dynamics and that the response involves target tissues in vivo. Our results have important implications for elucidating the mechanisms of nerve regeneration.

[Applied anatomy of inferior epigastric artery in coronary artery bypass grafting].

OBJECTIVE: To measure the inferior epigastric artery(IEA),coronary artery and arterial bridge to supply the anatomic and hemodynamic data of IEA in coronary artery bypass grafting for clinicians. METHODS: Anatomic method was adopted to measure the length of IEA, arterial bridge, the outer diameter of IEA and coronary arteries. Colour doppler ultrasound instrument was adopted to measure the caliber and the blood flow rate of IEA and coronary artery. RESULTS: In the anatomic method, the length of IEA was (13.00+/-2.58)cm and the caliber of original IEA was (2.95+/-0.21)mm, the caliber of IEA intersecting with abdomen rectus was (2.51+/-0.32)mm, and (1.60+/-0.26)mm at 1.0 cm below the umbilicus. In color doppler ultrasound method, the caliber of original IEA was (2.98+/-0.37)mm, and at 5 cm from the original spot was (2.60+/-0.27)mm. The blood flow rate was (57.00+/-6.78)cm/s. The main stem caliber of the left coronary artery was (4.90+/-0.76)mm, and that of the right coronary artery was (3.58+/-0.63)mm; the blood flow rate was (48.50+/-7.72)cm/s. The length of the arterial bridge was (10.95+/-1.35) approximately (15.30+/-2.82)cm. CONCLUSION: IEA can bridge the aorta and the coronary artery branches including the left anterior descending branch, the left circumflex branch and the right main coronary artery in free grafting. Its caliber and blood flow rate can match with those of the coronary artery. Before the operation of applying color doppler ultrasound instrument, the safety of IEA in the coronary artery bypass grafting can be evaluated to provide a new safe method in clinical follow-up.

[Effects of transforming growth factor-beta 1 on the peripheral nerve regeneration of rats].

OBJECTIVE: To explore the effects of exogenous transforming growth factor-beta 1 (TGFbeta1) on peripheral nerve regeneration after the peripheral nerve injury and if TGFbeta1 regulates the expression of basic fibroblast growth factor (bFGF) in the anterior horn motoneurons of spinal cord during regeneration. METHODS: Forty-eight rats were crushed on the right sciatic nerve and then randomly divided into 2 groups: TGFbeta1 group and NS group. In TGFbeta1 group, TGFbeta1 50 microL (0.1 microg/mL) was injected into the proximal nerve near to the crushed nerve and after the operation the injured leg was injected with equal TGFbeta1 whereas the NS was replaced in the NS group. The rats of each group survived for 3, 7, 14 and 21 days after the lesion. The bFGF expression in the anterior horn motoneurons of spinal cord was detected by immunohistochemistry (IHC). Semi-thin section and Fast Blue retrograde tracing were also performed with the rats surviving for 21 days to observe the regeneration of distal end in the injured right sciatic nerve. RESULTS: The number of bFGF immunoreactive positive motoneurons in TGFbeta1 group was obviously higher than that of the NS group (P < 0.05). In the distal sciatic nerve of the rats treated with TGFbeta1, the number and diameter of regenerating myelinated axons and the thickness of myelinated sheath were more than those of the NS group (P < 0.05). The number of motoneurons in spinal cord and neurons in dorsol root ganglia (DRG) labelled with Fast Blue in the NS group was obviously lower than in the TGFbeta1 group (P < 0.01). CONCLUSION: Exogenous TGFbeta1 plays an important role in promoting the peripheral nerve regeneration; TGFbeta1 up-regulates the bFGF expression in the anterior horn motoneurons of spinal cord during the peripheral nerve regeneration.

[Bridging rat sciatic nerve defects with the composite nerve-muscle autografts wrapped with human amnion matrix membrane].

OBJECTIVE: To explore the possibility of bridging the sciatic nerve defects with the composite nerve-muscle (NM) autografts wrapped with human amnion matrix membrane (HAMM) in rats. METHODS: Fifty-four Wistar rats were divided randomly into 3 groups (n = 18), and about 10 mm of right sciatic nerve defects were bridged with the composite NM autografts, the nerve autografts and the denatured skeletal muscle autografts respectively (Group A, B, and C), and all grafts were wrapped with HAMM. After the operation, the regenerated nerves were assessed by Fast blue retrograde tracing, neurofilament (NF) immnohistochemical staining, regenerated axons counting, measuring the diameter and myelin thickness of the regenerated axons, and quantifying the wet weight of tibialis anterior muscle. RESULTS: In Group A and B, there were more fluorescent-labeled cells in dorsal root ganglion and spinal cord than in Group C. The regenerated NFs were sparse and disordered in Group C, but dense and regular in Group A and B. Group A and Group B showed results superior to Group C as to other histologic and morphologic characters (P < 0.05), whereas there was no significant difference between Group A and B (P > 0.05). CONCLUSION: The composite NM autografts wrapped with HAMM in this study can well bridge and repair sciatic nerve defects in rats.