Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

Objectives

Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2–4 years) of this treatment from a single-center.

Methods

From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case).The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10 mm) in 32 cases (82%), large (11–25 mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated.

Results

Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one).The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year.Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and time of complete occlusion were not correlated with the aneurysm size. MCA aneurysms mainly showed partial occlusion (2/3 cases). Besides, large-neck aneurysms and those with a vessel arising from the sac mainly showed late (>6 months) or partial occlusion.

Conclusion

FDD are a safe and efficacious treatment of intracranial aneurysms, resulting in high occlusion rate and low incidence of complications. It should be the treatment of choice for the large-neck aneurysm of the ICA.     

腹腔引流管的标识化管理及体会

腹部外科病种多,患者病情复杂,留置腹腔引流管是腹部外科手术后患者常见的治疗措施。由于每个患者术中置人引流管的种类、数量各不相同,护士易对留置管道作出错误的判断,导致护理差错的发生,延误患者的治疗与康复。为此,自2005年起,我科尝试实行腹腔引流管的标识化管理,在临床护理工作中采用了各种护理标识,避免因无标识而出现的护理差错,效果良好,现报道如下。     

The 10-day mark is a good way to diagnose not only acute rhinosinusitis but also adenoiditis, as confirmed by endoscopy

OBJECTIVE: Acute rhinosinusitis (ARS) usually presents with respiratory complaints that persist for more than 10 days with no sign of improvement. This 10-day mark is considered to separate simple upper viral respiratory infection from ARS. Thus, the aim of the study was to evaluate a group of children with suspected ARS by performing nasal endoscopy. METHODS: This cross-sectional study evaluated 287 consecutive children (152 males and 135 females, aged between 2 and 15 years), in whom ARS was suspected. A detailed clinical history was recorded for each patient and a thorough physical examination was carried out by an allergist-paediatrician. Patients were also evaluated by an ENT specialist who performed nasal endoscopy. RESULTS: Endoscopy confirmed the clinical diagnosis of rhinosinusitis in 256 patients (89.2%). Isolated rhinosinusitis was diagnosed in 80.85% of cases (207 patients), whereas it was associated with adenoiditis in 49 (19.15%) children. Twenty patients had adenoiditis alone (7%). The distribution of the isolated and combined diagnoses differed significantly between age groups (p=0.015), particularly between the youngest and oldest group (post hoc test p=0.005). CONCLUSIONS: This study suggests that the endoscopy is a valuable tool in diagnosing children with suspected ARS and with adenoiditis too. Moreover, the age influences the diseases' pattern.     

A new method to geometrically represent bite marks in human skin for comparison with the suspected dentition

The aim of this study was to develop new software to describe tooth marks from photographs of human bites. Using these images, BitePrint software approximates each tooth mark as an ellipse and the dental arch as a semi-circle. The expert marks the mesiodistal length and the bucco-lingual width of each tooth mark and the software automatically fits an ellipse. The dental arch is calculated by adjusting the circumference with a minimum of three non-aligned ellipses. The software can also calculate the inter-canine distance, rotation, eccentricity, angular position and distance to the arch of each tooth mark. BitePrint can also operate with biting edges obtained from 3D dental casts. Thus, the software represents the bite mark as a set of geometric coefficients that can be used to compare with the biting edges of the dental cast. BitePrint software offers a semiautomatic quantitative approach to bite mark identification.     

AFP,CA19—9联检在原发性肝癌和肝硬化鉴别诊断中的临床意义

为提高原发性肝癌的诊断率和与肝硬化，其他慢性肝病的鉴别诊断，本文采用放射免疫分析法和免疫放射分析法。对５０例健康体检者、４８例原发性肝癌、３９例肝硬化，３６例其他一肝病患者，分别检验其血清中甲胎蛋白，糖类抗原１９－９肿瘤标志物的含量，结果进行比较。     

血清唾液酸与鼻咽癌相关性研究

为探讨血清ＳＡ含量变化对ＮＰＣ诊断、临床分期、疗效评价、预后判断的价值，地ＨＮＰＣ裕诊未治３５例、ＮＰＣ治疗后３１例、ＮＰＣ治疗后复发２５例的血清ＳＡ进行检测，结果发现：ＮＰＣ初诊未治组血清含量升高，ＮＰＣ治疗后且水平下降，ＮＰＣ治疗后复发组血清ＳＡ水平又再回升，提示血清ＳＡ民ＮＰＣ的的消长有一定的相关性，这对判断ＮＰＣ治疗效果，病程转归有一定帮助。ＮＰＣ初诊未治组血清ＳＡ明显高于非肿瘤组与对照组     

Pipeline血流导向装置用于治疗大型椎基底动脉瘤

目的 观察Pipeline血流导向装置(PED)用于治疗大型椎基底动脉瘤(LVBA)的价值。方法 纳入接受PED治疗的30例单发未破裂LVBA患者,动脉瘤最大径(16.1±6.9)mm,21例位于椎动脉V4段、9例位于基底动脉;观察围手术期并发症、术后改良Rankin量表(mRS)评分及O''Kelly Marotta(OKM)分级,评估PED用于治疗LVBA的价值。结果 对30例均成功完成治疗。共植入34枚PED,27例植入1枚、2例2枚、1例植入3枚,均未联合弹簧圈栓塞。3例出现围手术期并发症(3/30,10.00%),均为缺血性事件。出院时改良Rankin量表(mRS)评分0分26例,1分2例,2分1例,4分1例。随访2~33个月,未见动脉瘤复发。末次随访时mRS评分0分26例,1分1例,6分3例;其中24例接受数字减影血管造影(DSA),O''Kelly Marotta(OKM)分级分别为B级1例、C级6例及D级17例。3例死亡,死因分别为急性脑梗死、蛛网膜下腔出血及呼吸衰竭。结论 PED用于治疗LVBA具有一定价值。     

不同时期新生儿重度窒息临床分析

目的 :寻找预防新生儿重度窒息和改善预后的办法。方法 :分析了 1990年和 1998～ 2 0 0 0年两个时期新生儿重度窒息发生的有关因素和结局。结果 :农村产妇及 1990年羊水 ～ 度胎粪污染者新生儿重度窒息发生率较高 ,P<0 .0 1。后一时期新生儿重度窒息发生率较 1990年低 ,P<0 .0 1。各分娩方式与新生儿重度窒息无直接关系 ,后一时期重度窒息新生儿经气管插管抢救 ,提高了 5分钟 Apgar评分 ,无初期新生儿死亡。结论 :努力提高孕期保健和产科质量 ,可以预防和减少新生儿重度窒息的发生率。熟练掌握气管插管技术 ,能迅速抢救重度窒息新生儿 ,改善重度窒息新生儿的预后     

Study on apoptosis of human acute T-lymphocyte leukemia cell line induced by allicin

Gallicisakindofthedailyfoodstuffsofhumanbeings,andmuchimportanceisattachedtoitsvalueinmedication.Allicin,amonomerextractedfromgallic,wasusedatfirstintreatingmycoticinfection.Studiesinrecentyearshaveshowedthatithastherapeuticeffectoncardiovasculardiseasesanddiabetesmellitus,particularattentionwaspaidonitspreventiveandcurativeeffectont..o.(l--3).ThisarticlereportsthestudyofmechanismofapoptosisinducingeffectofallicinonhumanacuteT-lymphocyteleukemiacellline(6T--CEM).METHODSReagents6T--CEMwa…