RESUMO
Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43-93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth People's Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).
RESUMO
OBJECTIVE: To study the indications and contraindications of vaginal hysterectomy for non-prolapsed uterus. METHODS: Totally 2086 patients underwent vaginal hysterectomy during the period of June 1992-June 2003 were analysed and the surgery quality and incidence of complications among patients with different sizes of uteri, with or without history of pelvic or abdominal surgery, with history of vaginal delivery and adnexectomy were compared. RESULTS: (1) The patients with uteri > 16 weeks of gestation were associated with longer operating time [(73 +/- 25) vs (42 +/- 16) min)], more blood loss [(237 +/- 86) vs (101 +/- 58) ml] and higher rate of pelvic infection (1.69% vs 0.78%) when compared to the patients with uteri < or = 16 weeks. The differences were statistically significant (P < 0.01). (2) There was no significant difference in the operating time and intraoperative blood loss between the patients with and without history of pelvic or abdominal surgery (P > 0.05), however, the surgery group had higher side injury rate during operation. In addition, 119 patients complicated with ovarian cyst underwent vaginal ovarian cystectomy successfully. CONCLUSION: Vaginal hysterectomy for patients with uteri < or = 16 weeks of gestation is safe and feasible. The procedure is relatively difficult for uteri > 16 weeks and should be determined according to the operator's experience and the patient's condition. A history of pelvic or abdominal operation increases the side injury rate in vaginal hysterectomy. The successful rate of vaginal hysterectomy in patients with uteri < or = 16 weeks of gestation is not affected by the history of vaginal delivery. During vaginal hysterectomy, ovarian cystectomy is feasible for the ovarian cyst < or = 6 cm. Skillful operator and use of appropriate instrument expand the indication of vaginal hysterectomy.
