Surgical Revascularization of Symptomatic Kinking of the Internal Carotid Artery.

OBJECTIVE: To evaluate the safety and outcomes of surgical revascularization for patients with symptomatic kinking of the internal carotid artery (ICA). METHODS: Twenty-five consecutive patients presented with symptomatic kinking of the ICA and a history of transient ischemic attack (TIA) or stroke were prospectively enrolled in this study. All patients were treated with ICA transection and end-to-side reimplantation at the level of the carotid bulb. Patients were followed up for a median of 32 months. RESULTS: There were no deaths or strokes within the 30 days of the treatment. No postprocedural thrombosis or narrowing of the ipsilateral ICA was observed. One (4%) patient had temporary recurrent nerve palsy, which was completely recovered at 4-week follow-up. One (4%) patient had a myocardial ischemic event. At the end of the 32-month follow-up, 1 (4%) patient developed ipsilateral minor stroke. No recurrent stenosis was detected by Doppler ultrasound. CONCLUSION: Surgical treatment for isolated, symptomatic kinking of the ICA and a history of TIA or stroke is safe, and the outcomes are acceptable.

Antisense-mediated depletion of GMPase gene expression in tobacco decreases plant tolerance to temperature stresses and alters plant development.

In our previous work [1] we investigated the role of tomato GDP-mannose pyrophosphorylase (EC 2.7.7.22) in plants by overexpressing its gene in tobacco leaves and showed its function in AsA metabolism and detoxification of reactive oxygen species under temperature stresses. In this study, we use the antisense technique to block the endogenous GMPase gene expression in tobacco in order to further investigate its function. Northern and western blot analysis confirmed that the expression of endogenous tobacco GMPase mRNA and protein was inhibited by this antisense expression. Consequently, the activity of GMPase and the content of AsA in the leaves of antisense transgenic plants were markedly decreased. This was also the case for the activities of both chloroplastic SOD (superoxide dismutase EC 1.15.1.1), APX (ascorbate peroxidase EC 1.11.1.7) and the content of AsA in leaves of the transgenic plants. On the contrary, the contents of H(2)O(2) and O(2) (-•) were increased. Meanwhile, the net photosynthetic rate (Pn) and the maximal photochemical efficiency of PSII (Fv/Fm) also declined in the leaves of antisense plants. Under high or low temperature stresses, the seed germination rate of the antisense transgenic plants was significantly decreased in comparison with that of the wild-type tobacco. Interestingly, the antisense plants had smaller leaves and an earlier onset of flowering. In conclusion, the depletion of GMPase decreased the content of AsA, resulting in the plants susceptible to the oxidative damage caused by temperature stresses and subjected to developmental alternations.

[Reconstructive vascular operation for kinking of internal carotid artery].

OBJECTIVE: To evaluate and summarize the possibility and experience of reconstructive vascular operation for kinking of internal carotid artery. METHODS: Reconstructive vascular operation was performed on 5 patients with symptomatic kinking of internal carotid artery between July 2008 and June 2009. There were 2 male and 3 female patients, age ranged from 53 to 68 years (mean 62 years). Cutting the internal carotid artery at the bifurcation, mobilizing and stretching the internal carotid artery, then anastomosing the internal and common carotid artery. Two of them underwent endarterectomy simultaneously. RESULTS: For the 5 patients, postoperative recovery went smoothly and symptoms were well improved. Except that mild high perfusion syndrome happened in 1 patient, no other obvious complications. Kinking of internal carotid artery had been stretched in the postoperative CT angiography. In the 5-16-month follow-up, no transient ischemic attack or cerebral infarction happened, and no restenosis appeared. CONCLUSIONS: Reconstructive vascular operation is an effective surgical approach to kinking and coiling of the internal carotid artery. For some risk exists, all-round evaluation should be performed before operation, and operative indication should be strictly controlled.

Microsurgical treatment of cerebrospinal fluid rhinorrhea in sphenoidal sinus.

OBJECTIVE: To explore the clinical manifestation, diagnosis and surgical treatment of cerebrospinal fluid rhinorrhea in sphenoidal sinus. METHODS: Nine cases of cerebrospinal fluid rhinorrhea in sphenoidal sinus from 2007 to 2009 were retrospectively analyzed consisting of their possible etiological factors, clinical manifestations, localization of the leakage site and treatment methods. Among them, there were 3 cases of traumatic rhinorrhea, 4 postoperative rhinorrhea and 2 spontaneous rhinorrhea. All 9 patients underwent 3-dimensional CT scan in sellar region including all para-nasal sinus. Leakage site was identified and repairing procedure was performed through trans-sphenoidal approach. RESULTS: All cases were cured with the trans-sphenoidal microsurgical procedure. They were followed up for 9 months to 2 years. No recurrence, no infection and epilepsy complications were observed. CONCLUSION: For the cerebrospinal fluid rhinorrhea at sphenoidal sinus, it is critical to identify the leakage site accurately and the trans-sphenoidal approach is a microinvasive and effective way to repair the leakage, which is worthy to be advocated.

Remifentanil combined with low-dose ketamine for postoperative analgesia of lower limb fracture: a double-blind, controlled study.

OBJECTIVE: To investigate the adjuvant effect of intraoperative and postoperative low-dose ketamine administration to remifentanil consumption in patient-controlled analgesia (PCA) for lower limb fracture. METHODS: A total of 200 patients with lower limb fracture receiving the surgery were randomly divided into 4 groups. In Groups A, B and C, patients received 0.5 mg/kg ketamine infusion under general anesthesia, and ketamine in a dose of 0.1 mg/ kg, 0.05 mg/kg, 0.01 mg/kg per hour continuously for 24 hours after surgery, respectively. The control group (Group D) received an equivalent volume of normal saline only. With 20 microgram/ml remifentanil in normal saline, postoperative PCA was administered with a background infusion at 2 ml/h following 2 ml as a loading dose and 1ml demand dose with a 3-minute lockout period. Remifentanil consumption, 11-point visual analog scale (VAS) scores, global satisfaction score (GSS), and side effects were also recorded by the acute pain service. RESULTS: Cumulative PCA remifentanil consumption in Groups A and B were (1378+/-77) microgram and (1531+/-402) microgram, significantly lower than (1807+/-510) microgram and (1838+/-523) microgram in Groups C and D (P<0.01). VAS scores in Groups A and B were significantly lower than those in Groups C and D (P<0.01). In the first 12 hours after operation, GSS was improved (P<0.01). No respiratory depression was observed. No significant difference in side effects was observed among groups. CONCLUSION: Low-dose ketamine can relieve postoperative pain and moderately decrease remifentanil consumption for PCA, with no obvious side effects of ketamine.