Lumbosacral glioblastoma and leptomeningeal gliomatosis complicating the course of a cervicothoracic astrocytoma WHO grade II

CASE REPORT: The reported female patient underwent sub-total resection of an intra-medullary cervicothoracic astrocytoma classified as WHO grade II in 1984 at the age of 18 months and received local irradiation. In 1989, a local recurrence was diagnosed and a partial resection was performed. Sixteen years later, a small recurrent cervicothoracic tumour was found and spinal seeding to the equine nerve roots and the left cerebellar cortex was apparent on MRI. The patient was implanted with a ventriculoperitoneal shunt for a pseudo-tumour cerebri producing papilloedema, which eventually lead to amaurosis. After an extended biopsy, the invasive lumbosacral tumour was classified as glioblastoma multiforme. Two months later, the patient died after rapid progression of the caudal cranial nerve dysfunction. DISCUSSION AND CONCLUSION: Anaplastic progression and dissemination of spinal astrocytomas even two decades after initial diagnosis and treatment are rare. Therapies and diagnostic follow-up strategies are discussed.     

首次CT检查阴性的颅脑损伤54例临床分析

目的分析颅脑损伤首次CT检查阴性而复查CT阳性的表现和原因。方法通过对首次CT检查阴性而复查CT阳性的54例颅脑损伤患者（研究组）的临床资料进行回顾性分析总结,并与同期收治的325例首次CT及复查CT均为阴性的颅脑损伤患者（对照组）作比较。结果研究组首次CT检查阴性而复查CT阳性表现为迟发性血肿、脑挫裂伤、脑积水、硬膜下积液、弥漫性脑肿胀、外伤性脑梗塞等,可由不同原因引起。结论熟悉本类颅脑损伤首次CT检查阴性,而复查CT阳性的表现及原因,对于指导检查及治疗,改善病人预后有重要意义。     

原发性胆囊癌的影像学诊断(附52例分析)

目的:探讨超声、CT和MRI在胆囊癌诊断中的临床应用价值。方法:回顾性分析52例经手术及病理证实的胆囊癌的超声、CT和MRI资料。结果:52例胆囊癌术前超声诊断符合率为73.1%(38/52),CT诊断符合率为75%(39/52),MRI符合率为83.3%(15/18)。其中合并慢性胆囊炎伴胆囊结石21例(40.4%)。影像表现为4种类型:胆囊壁增厚型(16例),乳头结节型(15例),混合型(壁厚和结节8例),实体型(13例)。结论:超声、CT和MRI对胆囊癌的诊断具有重要的临床价值,合理的应用能更好地指导临床治疗和术后疗效观察。     

髋臼骨折、髋关节脱位合并坐骨神经损伤的临床分析

目的探讨髋臼骨折、髋关节脱位合并坐骨神经损伤的临床特点及发病机制。方法回顾髋臼骨折、髋关节脱位及髋臼骨折合并髋关节脱位的患者155例(159侧),其中合并坐骨神经损伤35侧。分析髋臼骨折、髋关节脱位的流行病学特点及坐骨神经损伤与髋臼骨折、髋关节脱位分型的关系。结果81.3%的患者为男性,86.5%的患者年龄为20～50岁,83.9%为车祸伤所致。坐骨神经损伤总发病率为22.01%,而在髋臼骨折为17.19%,在单纯髋关节后脱位为12.90%,在髋臼骨折合并髋关节后脱位为36.36%。31侧坐骨神经损伤中48.39%为腓总神经成分损伤,51.61%为腓总神经 胫神经损伤。结论车祸伤是髋臼骨折、髋关节脱位的主要原因,多见于成年男性。坐骨神经损伤主要发生于髋臼后壁、后柱骨折合并髋关节后脱位患者,且腓总神经成分损伤多见。     

18F-FDG PET/CT在黑色素瘤中的应用价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在黑色素瘤诊断、临床分期及监测治疗后肿瘤复发与转移灶中的应用价值.方法 黑色素瘤患者61例,均进行18F-FDG PET/CT全身显像.所有PET、CT及PET/CT融合图像均通过融合软件进行帧对帧对比分析.肿瘤病灶根据病理学检查、多种影像学检查及临床随访结果诊断.结果 18F-FDG PET/CT显像对黑色素瘤病灶检出的灵敏度、特异性和准确性分别为90.9%(40/44)、88.2%(15/17)和90.2%(55/61).其中12例治疗前患者中,18F-FDG PET/CT显像诊断的灵敏度为83.3%(10/12).在黑色素瘤病灶局部切除、尚未进行其他治疗的9例患者中,5例残余病灶18F-FDG PET/CT显像检出3例;4例远处转移灶患者全被检出,提高了临床分期,改变了治疗方案.首先发现转移性黑色素瘤病灶并且手术切除后,寻找原发灶的7例患者中,18F-FDG PET/CT检出原发灶2例,4例其他转移灶全被检出.黑色素瘤患者根治术后监测肿瘤复发或转移患者33例,18F-FDG PET/CT显像灵敏度、特异性和准确性分别为100.0%(19/19)、85.7%(12/14)和93.9%(31/33).与同期临床其他影像学检查比较,18F-FDG PET/CT显像发现更多,33例患者中,16例(48.5%)病灶提高临床分期;7例(21.2%)排除可疑病灶,降低临床分期;10例(30.3%)检出病灶与临床一致.结论 18F-FDG PET/CT显像对于黑色素瘤的诊断,残余病灶、复发病灶及转移灶的检出,临床分期的明确具有重要价值.     

阿片受体对体外循环缺血再灌注损伤心肌的保护作用

目的 通过建立猪体外循环(CPB)心肌缺血再灌注(MI/R)模型对δ阿片受体激动剂脑腓肽(DADLE)介导的CPB MI/R损伤早期时相和后时相的心肌保护作用进行探讨,以期为临床心肌保护提供理论和实验依据.方法 将24只成年家猪随机分为对照组、早期时相和后时相组,每组8只常规建立CPB模型,主动脉阻断同时灌注改良St.Thomas停搏液.每组于CPB前、主动脉开放时、CPB结束时、停机后1、2 h检测冠状静脉窦血肌钙蛋白(TnT)含量,相应时间点监测左室舒张末期压(LVEDP)和左室内压最大变化速率(±ap/dt<,max>),于停机后2h取左心室心肌,进行心肌组织Gia蛋白的表达、PKC的表达和ATP含量的测定.并应用透射电镜观察心肌再灌注损伤超微结构的变化.结果 (1)和早期时相和后时相组相比,对照组心功能指标明显下降.(2)对照组的TnT较早期时相和后时相组明显升高,ATP含量明显降低.(3)和对照组相比,早期时相和后时相组Gin蛋白和PKC的表达更为明显.(4)透射电镜下早期时相和后时相组的心肌超微结构损伤均较对照组明显轻微.结论 (1)和CPB前1 h应用一次DADLE而产生的早期时相心肌保护作用相比,CPB前48 h和24 h两次应用DADLE引发的后时相心肌保护作用更为显著.(2)Gi蛋白-PKC途径可能是δ阿片受体介导的猪CPB NI/R损伤心肌保护中一条重要的信号传导途径.     

TNF-α在沙漠干热环境下猪腹部肠管火器伤后肝组织中的表达

目的探讨沙漠干热环境下猪腹部肠管火器伤后肝脏组织TNF-α的表达和肝功能的变化。方法沙漠干热环境组和常温环境组健康长白仔猪各42头随机等分为对照组和伤后1、2、4、8、12 h和24 h组,实验组建立腹部火器伤肠管穿透模型后,用免疫组化及图像分析法测定各组肝脏组织内TNF-α的表达,同时测定血清中AST水平。结果伤后各组肝组织TNF-α表达明显高于对照组,沙漠干热环境组于伤后2 h和8 h出现2个高峰;常温环境组于伤后2 h和12 h出现2个高峰。血清AST水平于伤后显著增高,并于伤后2 h出现第1个高峰,沙漠干热环境组和常温环境组分别于伤后8 h和12 h出现第2个高峰。结论沙漠干热环境下腹部肠管火器伤后肝脏TNF-α的表达增加并与AST的变化趋势一致,而且峰值较常温组提前出现,提示TNF-α在腹部肠管火器伤后肝损伤过程中可能起重要作用。     

Wnt pathway in the formation of ischemic brain injury*★ Interventional pathway of basic fibroblast growth factor

BACKGROUND: Basic fibroblast growth factor (bFGF) can reduce neuronal apoptosis following ischemia/reperfusion (I/R) injury. Mechanism of the phenomenon should be elucidated. OBJECTIVE: The goal of this study was to observe the effect of bFGF on the expressions of Dickkopf-1(DKK-1) and β-catenin in the Wnt pathway in hippocampal tissue of rats following brain I/R injury, in order to investigate the role of Wnt pathway in the formation of ischemic brain injury. DESIGN: Randomized controlled experiment. SETTING: Shenyang Medical College. MATERIALS: Thirty healthy 3 months old male Wistar rats, weighing 300–350 g, were provided by the Experimental Animal Center of Shenyang Medical College. Thirty rats were randomized into sham-operation group, model group and treatment group. Goat anti-rat monoclonal antibody β-catenin was purchased from SANTA CRUZ Company. BFGF was developed by Beijing SL Pharmaceutical Co., Ltd. METHODS: This experiment was carried out in the Shenyang Medical College between November 2005 and May 2006. ①Focal brain I/R by suture-occluded method was modeled in rats in the treatment group and model group. Their middle cerebral artery was occluded 1 hour and reperfused for 24 hours. While in the sham-operation group, only the right common carotid artery and external carotid artery of rats were occluded for 90 minutes. ② The rats in the treatment group were intraperitoneally injected with 10 μg/kg bFGF, and those in the other groups were intraperitoneally injected with the same amount of saline. MAIN OUTCOME MEASURES: Following I/R 48 hours, the expressions of β-catenin and Dickkopf-1 mRNA in the neurons of hippocampal CA1 region by immunohistochemical SABC and RT-PCR. RESULTS: Following I/R 48 hours, the expressions of β-catenin and Dickkopf-1 mRNA in the neurons of hippocampal CA1 region was evaluated by means of immunohistochemical SABC and RT-PCR. ① Expression of DKK-1 mRNA in the sham-operation group was at low level, it was significantly higher in the model group compared to the sham-operation group; Expression of DKK-1 mRNA in the treatment group was significantly lower than that in the model group. ② Expression of β-catenin in the cerebral cortex and hippocampal cytoplasm of rats: The mean gray scale of β-catenin of model group was significantly lower than that of sham-operation group (74.27±2.65 vs. 111.36±5.39，P < 0.05); The mean gray scale of β-catenin of treatment group was significantly higher than that of model group (86.18±7.41 vs. 74.27±2.65, P < 0.05). CONCLUSION: bFGF may influence Wnt pathway by participating in the regulation of DKK-1 mRNA and β-catenin expressions, and thereby protect neurons.     

A preliminary investigation into the long-term injury consequences reported by retired baseball players

Seventy-five retired baseball players participated in a survey (37.8% response rate) in order to establish the long-term consequences of injuries sustained during their playing careers. Respondents had a mean age of 55.8 (+/-11.4) years with a mean age of 41.3 (+/-11.4) years at retirement from play. The mean overall rate of injury suffered per player/playing career was 5.6 (+/-7.1). 54.7% of respondents experienced a major injury (i.e. injury resulting in 5 or more consecutive weeks absence from training and play) with a mean major injury per player/playing career of 1.5 (+/-2.2). The rate for significant injuries (i.e. injury resulting in more than 1 week but less than 5 weeks absence from training and play) was 4.1 (+/-6.5) per player/playing career. Catchers had significantly less injuries than all other positions (p=0.027). 18.7% of all respondents reported suffering from arthritis, 24% from restricted joint mobility and 4% from chronically stiff fingers; all of these conditions were associated with their participation in baseball based on medical examination by their GP or medical specialist. 29.3% of respondents indicated that they had incurred additional medical costs and 12% reported significant loss of income associated with their injuries. Some injuries were severe enough that they resulted in extended stays in hospital producing costs carried by the health care system.     

椎弓根固定及椎间植骨融合治疗腰椎退行性椎管狭窄症

腰椎退变性椎管狭窄症多见于中老年患者,一旦出现明显的神经压迫或间歇跛行症状,多需要手术治疗。以往采用只减压不Ⅰ期融合的方法治疗,具有简单、有效、费用低廉等优点,是一种公认的技术。但随着相关研究的深入,经过较长时间的随访发现,部分患者效果不理想,随访5年以上的优良率为50·0%~70·8%,说明了恢复腰椎稳定性对腰椎手术远期疗效的重要性。2001年2月-2004年10月,采用腰椎管减压、椎间Cage植骨融合、椎弓根内固定术式治疗36例腰椎退变性椎管狭窄症患者取得了满意的疗效。1临床资料本组36例,男16例,女20例;年龄32~69岁,平均为50·3岁…