Spinal cord

208669 Interlaminar micro-neurosurgical discectomy in lumbar disk hermiation/Liu Hui(刘辉,Dept Neurosurgery,Gen Hosp Tianjin Med Univ,Tianjin 300052)…Chin J Neurosurg.-2008,24(7).-540～542Objective To investigate the surgical results of interlaminar microsurgical discectomy in lumbar disk herniation.Methods A study of 36 consecutive patients undergoing microsurgical lumbar discectomy was conducted.The extend of anular defi     

Biomechanical change of lumbar unilateral graded facetectomy and strategies of its microsurgical reconstruction report of 23 cases

Objective： To evaluate the lumbar stability and the primary clinical results of unilateral facetectomy, transforaminal lumbar interbody fusion （TLIF） and unilateral pedicle screw fixation by X-Tube system. Methods： Five human lumbar cadaveric functional spine units（FSU） were obtained and graded facetectomy by 0, 1/4, 1/2, 3/4 and 4/4 were performed respectively on the left articular process of them. The stability of these 5 models was evaluated at flexion, extension, lateral bending and axial rotation. After a serial of biomechanical researches, 23 patients from June 2004 to March 2006 in our department underwent unilateral facetectomy, transforaminal lumbar interbody fusion （posterior lumbar interbody fusion） and unilateral pedicle screw instrumentation by X-Tube system. After general anaesthesia, with the guide of fluoroscopy and using X-Tube system, procedures of unilateral endoscopic facetectomy, spinal nerve root decompression, autologus spongy bone transplantation, one cage oblique insertion and unilateral pedicle screw instrumentation were performed. Results： There was no significant difference in flexion, extension, lateral bending and axial rotation of lumbar motion range after unilateral graded facetectomy. The stability of left/right axial direction was greatly affected when the range of graded facetectomy exceed 1/2. According to the Nakai criteria, for the 23 patients, the clinical result was excellent in 15 （65.2%）, good in 6 （26.1%） and fair in 2 （8.7%）. The fusion rate was 95.6% in excellent and good cases. Although partial absorption of bone grafts was observed in 1 case which might indicate a unsuccessful fusion, there was no loosing and replacement of instrument and no clinical symptoms occurred. Conclusion： The lumbar stability will be affected significantly when the range of graded facetectomy exceeds 1/2. Procedures of unilateral facetectomy, transforaminal lumbar interbody fusion and unilateral pedicle screw fixation is an optional strategy for microsurgi     

Clinical study of arterial anatomic variations for transradial coronary procedure in Chinese population

Background The radial artery is currently regarded as a useful approach for coronary intervention procedures. Adequate anatomical information of the radial artery should be helpful in performing transradial coronary procedures. Few data about the Chinese population have been obtained in this field. Therefore, we tried to evaluate the incidence and clinical significance of anomalous patterns, and their influence on the intervention procedure. Methods In an estimated sample of 3000 cases, radial artery and subclavical artery angiography were performed after insertion of the sheath and coronary angiography （CA）. The evaluable data including branch anomaly, tortuosity of the radial artery and procedural characteristics were analyzed. The procedure success was defined as CA or percutaneous coronary intervention （PCI） completed with the initial radial artery approach without changing to other routes. Results In this study, 1897 cases of CA was undertaken and 1103 cases of CA combined with PCI were performed. The success rate of transradial intervention （TRI） was 96.6% （2899/3000）. The approach in 44 cases was changed to the contralateral radial artery and 57 cases were changed to the brachial artery or femoral artery due to failure with the initial radial artery approach. The angiography of the upper limb artery was performed in all cases. Anatomic variations of upper limb arteries were noted in 610 patients （20.3%）, which included tortuous configurations of the radial artery （5.0%）, hypoplasias （2.2%）, radioulnar loop （1.1%）, abnormal origin of the radial artery （7.7%）, stenosis of radial artery （1.4%）, a tortuous configuration of the brachial artery （0.9%）, a tortuous configurations of the subclavian artery （1.9%）, lusoria subclavian artery （0.1%）, and subclavian artery occlusion （0.03%）. The procedural success rate in the normal population was higher than in the variation group （97.6% vs 93.0%, P 〈0.001）. In addition, other procedural outcomes and incidence of complications except radial artery occlusion were also significantly superior to variation group. Conclusions Anatomic variations of the radial artery were common, making up an important limitation in the trans- radial approach. Selection of appropriate instruments and understanding some tips and tricks were helpful to overcome the obstacles and effectively reduce the learning curve.     

LONG-TERM OUTCOMES OF FENESTRATED DISCECTOMY FOR LUMBAR DISC

Objective To evaluate the long-term outcomes of fenestrated discectomy for lumbar disc herniation and analyze the correlative influence factors. Methods Eighty-two cases of lumbar disc herniation, from February 1996 to May 1999, were retrospectively studied. All patients were treated with simple fenestrated discectomy. The average follow-up time was 8 years and 7 months （from 7 years tolO years and 3months）. There were 13, 38 and 31 cases at 13 - L4, L4 - L5 and L5 - S1 level, respectively. Results The average scales before operation were as following ： Japanes Orthopaedics Association （ JOA ） scale 6. 5 （ 5 - 9 ） , visual analysis scale （ VAS） of low back pain4.8 （0-8）. and VAS of sciatica 7.2 （4-10）. At the final follow-up, the above parameters were 13.2 （ 10 - 14 ）, 1.8 （0 - 10） and 1.2 （0 - 7）, respectively. The average increase ratio of JOA scale was 78. 8%. The average disc-vertebra height ratio （ Mochida method） was 80.2%. At the final follow-up, 7 cases reoccurred disc herniation. The final clinical satisfaction rate was 80% （ modified Macnab method ）. Conclusion With appropriate surgical indications, the successfid long-term outcomes could be expected with fenestrated discectomy. Discectomy improves sciatica to a greater extent than low back pain. The occurrence of low back pain is related to intervertebral disc height, segment stability, disc degeneration, and lumbar muscle disability.     

Effect of partial discectomy on the stability of the lumbar spine. A study of kinematics.

The effect on the stability of the lumbar motion segment, as affected by partial discectomy, was investigated using three-dimensional motion measurement technique. Eight functional spinal units from fresh cadaver lumbar spines were potted and clinically relevant loads applied through a special loading frame attached rigidly to the top vertebra of the specimen. Partial discectomy was performed on the right side of the specimen. The three-dimensional motions of each lumbar motion segment, before and after partial discectomy, were recorded. The results showed that partial discectomy significantly affects the stability of lumbar spinal motion segments. The clinical relevance of this finding is discussed.

     

Upper gastrointestinal burns by peroxyacetic acid in children- a review of seven cases

Objective： To study the clinical features of upper gastrointestinal burns by peroxyacetic acid （PA） in children and improve its treatment and outcome. Methods： The clinical materials of 7 cases with upper gastrointestinal burns by PA including clinical presentation, treatment and outcomes were reviewed. Results： There were six boys and one girl. The concentration of the swallowed PA was from 10% to 20% and the amount was 3-10 ml. The mainly bums were located in esophagus in one case, stomach in three cases, both esophagus and stomach in three cases. The gastrostomy and operation of dilating esophagus were performed in the cases with esophageal stricture. The pyloroplasty or gastroduodenostomy was performed in the cases with pyloric obstruction. All the cases were followed up for 12-18 months, dysfunction of esophagus or（and） cardia as well as stiffness and hypodynamia of the stomach was showed in most of the patients. Conclusion： The degree of upper gastrointestinal burns by PA varied according to different concentrations of PA which was swallowed. Correct emergent measures in the acute stage of the burns was very important, gastric tube should be inserted and go through esophagus and pylorus and must be retained for 5-8 weeks to prevent the stricture of esophagus and pylortts, otherwise the tube could act as a passage of nutriment. Prophylaxis of upper gastrointestinal bums by PA is very important because the treatment of the burns is difficulty and the outcomes are not always satisfactory.     

Cerebral tumor

<正>209224 The translamina terminalis approach for microsurgical resection of anterochiasmagic sellar tumour/Zhang Xianfeng(Dept Neurosurg,1st Hosp,Jilin Univ,Changchun 130021)…∥Chin J Neurosurg.-2009,25(3).-259~261Objective To study the operative approach and microsurgical technique of translamina terminalis approach on anterochiasmatic sellar tumour.Methods The clinical data and the follow-up result of 23 patients with anterochiasmatic sellar tumour,who were treated surgically through translamina terminalis approach,were analyzed reteospectively from February 2001 to May 2007.Results Among 23 patients,total resection was performed in 13 cases,secondary resection in 6 cases,partial resection in 4 cases.All patients had good results without operation death.Three recurred cases were found during the follow-up period of 6 months to 4 years.Conclusion The translamina terminalis approach for microsurgical resection of anterochiasmatic sellar tumour is an effective method by mastering anatomy characteristics of saddle area interspaces.Perfect microsurgical skill,protection of important structures in saddle area and treatment of     

Hospitalized patients with novel influenza A (H1N1) virus infection: Shanghai, June–July 2009

Background From late May 2009, sporadic imported cases of novel influenza A （HIN1） were continuously confirmed in Shanghai, but there were few reports on its clinical presentation in China. The aim of the study was to investigate the demographic and clinical features of the laboratory-confirmed cases and the treatment with oseltamivir. Method We performed a retrospective study in the Shanghai Public Health Clinical Center （SHAPHC）, reviewing the medical records of the laboratory-confirmed patients derived from June 10 to July 20, 2009. Results A total of 156 cases were enrolled, of whom 152 had a history of recent travel. The mean age was 22.6 years and 89 cases （57.1%） were males. The most common symptoms were fever, cough, and sore throat, with children more likely to run a temperature above 38.5℃ than adults. The mean leucocyte count was 5.4×10^9/L, the mean neutrophil count 3.2×10^9/L and the mean lymphocyte count 1.4×10^9/L. Other findings included a normal range or elevated level of C-reactive protein （CRP） and glutamic-pyruvic transaminase and a normal or decreased level of prealbumin; the levels of prealbumin and CRP were significantly lower in the children than in the adults. Fifty-two patients had abnormal chest CT results, with small unilateral or bilateral pulmonary infiltrates, axillary and mediastinal lymphadenopathy and local pleural thickening, while no cases showed symptoms of hypoxia. All the patients received oseltamivir and recovered without complications, but the duration of fever and virus shedding were significantly longer in the children than in the adults. Conclusions Travel-related circulation may be an important reason for the H1N1 epidemic in the non-epidemic areas, and the virus caused mild respiratory symptoms. The infection in children was more severe in terms of prealbumin levels, temperature, the duration of fever and virus shedding. Oseltamivir was effective for H1N1, but more effective in the adults than in the children.     

Efficacy of the Dynamic Interspinous Assisted Motion system in clinical treatment of degenerative lumbar disease

Background The Dynamic Interspinous Assisted Motion （DIAM） system was designed to stabilize degenerative spinal segments without fusion surgery, maintain segment motion and prevent adjacent segment degeneration. The aim of thisstudy was to investigate clinical efficacy of the DIAM system in treatment of degenerative lumbar disease in China.Methods Eight cases of lumbar vertebral instability were treated with the DIAM system at Peking Union MedicalCollege Hospital from June 2006 to January 2008. There were 6 female and 2 male subjects with a mean age of 46.9years and a range of 40-52 years. Radiographs and scores on outcome measures included the visual analogue scale （VAS） for pain and the Oswestry disability index （ODI）. These scores were recorded before surgery and after surgery at intervals of 3-month, 6-month, 1-year and the final follow-up visit.Results The follow-up time ranged from 12-31 months, with an average of 20.6 months. There were significant differences between preoperative and postoperative scores at each follow-up evaluation （P 〈0.05）. However, there was no significant difference between each postoperative follow-up score （P 〉0.05）. There were significant differences between preoperative and postoperative L4-5 segment activity at each time interval （P 〈0.05）, but no obvious difference was found within each postoperative follow-up evaluation （P 〉0.05）. The ODI and VAS score improvements were directly correlated with segment activity （r 〉0.7, P 〈0.05）.Conclusions The DIAM system appears to be a useful and effective treatment in the surgical management of degenerative lumbar disease in certain patients. However, long-term follow-up is needed to evaluate the clinical outcomes of the device.     

Hemi-semi laminectomy approach for the microsurgical treatment of spinal schwannomas

Objective To evaluate the safety and efficiency of hemi-semi laminectomy approach for the microsurgical treatment of spinal schwannomas.Methods A total of 22 patients underwent hemi-semi laminectomy for the microsurgical removal of spinal schwannomas during a period of 2009 and 2011 in Affiliated Hospital of Nantong University.We retrospectively analyzed the clinical outcomes of these patients.Results Of them,5 cases were diagnosed with cervical schwannomas,9 with thoracic schwannomas,and 8 with lumbar schwannomas.All the tumors including two dumbbell schwannomas were totally removed without major complications.Postoperatively,all patients were followed up from 6 to 36 months.The symptoms and signs were obviously improved,and no tumor recurrence or spinal deformity occurred.Conclusion Hemi-semi laminectomy is a safe and effective method for resection of spinal schwannomas.     

Clinical Features and Treatment of Bronchogenic Cyst in Adults

Objective To investigate the clinical features and management of bronchogenic cyst in the adults. Methods We retrospectively reviewed 50 patients admitted to our hospital with histopathologically proved bronchogenic cyst from January 1983 to December 2007. Of all the patients, 28 were male and 22 were female, with an average age of 36.9 （range, 18 to 64） years. The symptoms, location of the cysts, imaging evaluation, surgical treatment manner, and outcome of these patients were analyzed. Results Symptoms were present in 33 of the 50 patients, and cough was the most common symptom. Thirteen patients presented with complications： hemoptysis, infected cyst, dysphagia, paralysis, and hoarseness. The locations of the cysts included the mediastinum （28 cases）, pulmonary parenchyma （12 cases）, hilar area （3 cases）, visceral pleura （1 case）, and some rare locations including the intestinal mesentery （1 case）, retroperitoneum （1 case）, adrenal gland （1 case）, neck （2 cases）, and dura matter of the cervical verte-brae （1 case）. Chest X-ray was performed in 36 patients and computed tomography （CT） was performed in 41 patients. The bronchogenic cyst in CT was characterized as a round, well circumscribed, unilocular mass, with density ranging from that of water to high density （0-50 Hu）. As for treatment, complete resection of the bronchogenic cyst was performed in 47 （94%） patients, subtotal resection was performed in 3 （6%） pa- tients. Open surgery was performed in 45 （90%） patients, and thoracoscopy （video-assisted thoracic surgery） was performed in 5 （10%） paitients. Of the 12 patients with intrapulmonary cyst, 11 patients underwent lobectomy and 1 patient underwent wedge resection. Postoperative sequelae occurred in 2 patients, 1 with persistent air leakage and 1 with hoarseness. All patients were proved with bronchogenic cyst pathologically. The average follow-up period was 6.5 years （range, 4 months to 10 years）, and no late sequelae or recur-rence of the cyst occurred. Conclusions The clinical and imaging presentations of bronchogenic cyst in adults are variable. Surgical resection is the best way for diagnosis and treatment. Both open surgery and thoracoscopy are appropriate for the selected candidates.     

Dynesys dynamic stabilization system for the lumbar degenerative disease: a preliminary report from China

Background Dynesys dynamic stabilization system in 2007. Therefore, it was a new technique for Ch about Dynesys in China. The objective of this study degenerative disease in China. was first implanted in patients in 1994, and introduced to China nese orthopedics and hence necessary to collect clinical data was to report the preliminary results of Dynesys for the lumbar Methods Twenty-seven patients were treated with the Dynesys between July 2007 and January 2009. The diagnosis included degenerative spondylolisthesis （12 cases）, degenerative spinal stenosis （nine cases）, and lumbar intervertebral disc herniation （six cases）. Back pain and leg pain were evaluated using 100-mm visual analog scales （VAS）. The Oswestry Disability Index （ODI） was used to evaluate the patients＇ function. The intervertebral disc height and range of motion at the operative level were taken on radiographs. Results All the patients were followed-up, with an average of （22.40±4.23） months （range 15±32 months）. VAS of back pain and leg pain were improved significantly （P 〈0.05） at foUow-up. The ODI scores were reduced from （62.58±12.01）% preoperatively to （15.01±5.71）% at follow-up （P 〈0.05）. The preoperative mean height of the intervertebral disc was （11.21±1.58） mm （range 8.5±13.8 mm） and mean was （10.10±1.78） mm （range 7.0±13.4 mm） at follow-up （P 〈0.05）. The mean range of motion of the implanted segment was （6.00±1.79）° （range 2.5-9.3°） preoperatively and （5.47±1.27）° （range 2.9±7.8°） at follow-up （P=0.11）. Conclusions The preliminary results of Dynesys for the lumbar degenerative disease in China are similar to the published results of other countries. It can significantly improve the clinic symptoms and preserved motion at the level of implantation. However, the long-term follow-up data need to be collected.     

Clinical and laboratory survey of 65 Chinese patients with Leigh syndrome

Background Leigh syndrome is an inherited neurodegenerative disease that emerges in infancy and childhood and presents with a clinically heterogeneous variety of neuromuscular and non-neuromuscular disorders. It can result from the inheritance of mutations in either nuclear or mitochondrial DNA. In the current study, we performed a retrospective study in 65 patients in order to investigate the clinical and genetic characteristics of Leigh syndrome in Chinese patients. Methods Sixty-five unrelated cases （35 men and 30 women） who were hospitalized in the past 12 years were reviewed. Diagnosis was based on both the clinical presentation and the characteristic neuropathologic findings of bilateral symmetric necrotizing lesions in the basal ganglia and brain stem as detected using cranial computed tomography （CT） scan or magnetic resonance imaging （MRI）. The differential diagnosis of organic acidurias and fatty acid IS-oxidation defects were performed. Specific point mutations and deletions in mitochondrial DNA （T8993G, T8993C, T9176C, A8344G, A3243G） were screened by PCR-restriction analysis and Southern blot. The SURF1 gene was sequenced. Skeletal muscle biopsies were performed in 17 （26.2%） of the patients. The diagnosis was confirmed by autopsy in 6 （9.2%） patients. Results The patients had various forms of metabolic encephalomyopathy. Filly-nine （90.8%） of the patients had the typical neuroradiological features of Leigh syndrome, including symmetrical necrotizing lesions scattered within the basal ganglia, thalamus and brain stem. Twenty （30.8%） patients were confirmed by genetic, biochemical analysis and autopsy. Specific point mutations in mitochondrial DNA were found in 5 cases （7.7%）. Of these, the A8344G mutation was detected in 2 patients. The T8993G T8993C, and A3243G point mutations were identified in 3 other patients, respectively. SURF1 mutations associated with cytochrome c oxidase deficiency were identified in 8 （12.3%） families by DNA sequencing. A G604C mutation was identified in 6 （9.2%） patients. The genotypes of 52 patients remained unknown. Conclusions Leigh syndrome presents as a diverse array of clinical features and can result from specific mutations in nuclear or mitochondrial DNA. In this study, SURF1 mutations associated with cytochrome c oxidase deficiency were identified in 8 （12.3%） out of 65 patients with Leigh syndrome. It indicates that SURF1 mutations might be a common cause of Leigh syndrome in China. The etiology of Leigh syndrome in Chinese patients represents a persistent challenge to clinicians.     

Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes

Background The purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and instrumented posterior lumbar interbody fusion （iPLIF） in patients with lumbar disc herniation and Modic endplate changes.Our hypothesis was that iPLIF could provide better outcome for patients with refractory lumbar disc herniation and Modic changes （LDH-MC）.Methods Ninety-one patients with single-segment LDH-MC were recruited.All patients experienced low back pain as well as radicular leg pain,and low back pain was more severe than leg pain.Forty-seven patients were treated with discectomy and 44 were treated with iPLIE The outcomes of both low back pain and radicular leg pain using visual analogue scale （VAS） as well as the clinical outcome related to low back pain using Japanese Orthopaedic Association （JOA） score were assessed before and 18 months after surgery,respectively.Results Both low back and leg pain were significantly improved 18 months after simple discectomy and iPLIE Compared to patients undergoing simple discectomy,low back pain was significantly reduced in patients undergoing iPLIE but there was no significant difference in leg pain between two groups.Solid fusion was achieved in all patients who underwent iPLIF.Conclusions In patients with LDH-MC,iPLIF can yield significantly superior outcome on the relief of low back pain compared to simple discectomy.Simple discectomy can relieve radicular leg pain as efficient as iPLIE Accordingly,iPLIF seems to be a reliable treatment for patients with LDH-MC and predominant low back pain.     

Clinical diagnostic approach to severe acute respiratory syndrome: an institution’s experience

Objective To analyze diagnostic approach to severe acute respiratory syndrome (SARS) according to the diagnostic criteria issued by the Ministry of Health of China (MHC). Methods The clinical data and the diagnostic results of 108 cases of SARS were retrospectively reviewed according to the MHC criteria. Results There were 55 men and 53 women, with a median age of 34.5 years (range, 12-78 years). The interval between their first visit and clinical diagnosis was 3 days (range, 0-14 days). The diagnosis was made at the first visit in 7 (6.5%, 7/108) cases with a history of exposure to SARS patients and infiltrates on chest radiograph. Eighty-nine (82.4%) and 12 (11.1%) patients were categorized as probable cases and suspected cases respectively at their first visit and a clinical diagnosis of SARS was made subsequently. The interval between first visit and reaching the final diagnosis was 1-3 days in 72 (66.7%) cases and 4 days in 29 (26.9%) cases. The final diagnosis was made in 0-14 days (median, 2 days) for those (n=59, 54.6%) with a history of close contact with SARS patients and 2-8 days (median, 3 days) for those (n=49, 45.4%) living in Beijing but without such a history (P=0.03). The chest radiograph was interpreted as unremarkable in 26 (24.1%) cases at their first visit, and the diagnosis was made in 4 days (range 2-8 days), which was significantly longer compared with other cases (P&lt;0.001). In patients without a history of close contact with SARS patients, all the five criteria were met after combination antibiotic therapy had failed. Conclusions A chest radiograph without infiltrates at the early stage of SARS is an important factor responsible for delayed diagnosis. In patients without a history of close contact with SARS cases, antibiotic effect was a major factor influencing doctors’ diagnosis.     

Computer-assisted minimally invasive spine surgery for resection of ossification of the ligamentum flavum in the thoracic spine

Background Ossification of the ligamentum flavum （OLF） has been widely recognized as one of the main causes of thoracic spinal canal stenosis and thoracic myelopathy.Decompression is the only effective strategy for treating thoracic myelopathy caused by OLF.The purpose of this study was to describe the clinical outcomes of computer-assisted minimally invasive spine surgery （CAMISS） for posterior decompression in patients with thoracic myelopathy caused by OLF.Methods In all cases,the surgical procedure was performed with the assistance of an intraoperative three-dimensional navigation system.Decompression of the spinal cord was performed with a high-speed drill; the supraspinal ligaments and spinous process were partially preserved.The outcomes were evaluated by a modified Japanese Orthopedic Association （JOA） scoring system and recovery rates.Results The mean duration of follow-up for the 14 cases was 3.9 years.All patients experienced neurological recovery,the mean JOA score improving from 6.1 points preoperatively to 8.6 points at final follow-up and the mean rate of recovery being 52.7% （excellent in two cases,good in eight,fair in three,and unchanged in one）.Conclusion CAMISS is a safe and effective procedure for resection of the OLF in the thoracic spine.     

直肠神经内分泌肿瘤的临床病理特点分析

Objective To analyze the clinicopathological characteristics of rectal neuroendocrine tumors (NETs) so as to improve their understanding and diagnosis. Methods The data of 62 rectal NETs patients were retrospectively analyzed to summarize their clinical characteristics. They were categorized into 3 types based on the level of histological differentiation. And the relationship of tumor size, histological type and metastases was examined. Results The clinical presentations of rectal NETs were atypical. The main clinical presentation was change in bowel habit (n = 43, 69.4%); Ten cases (16.1%) were asymptomatic. Nine cases were found during routine digital rectal examination. In 57 cases (91.9% ), the distance was within 8cm from anorectal line. All patients had single lesion without the presence of carcinoid syndrome. 25.8% ( 16/62 ) had colonic polyps while 16. 1% ( 10/62 ) synchronous colorectal adenocarcinomas. Except for synchronous colorectal adenocarcinomas (n = 10) , among 52 cases, there were 39 cases with tumor diameter ＜ 1 cm, the main type was type Ⅰ; 7 cases with tumor diameter ＞2 cm, the main types were types Ⅱ and Ⅲ. The metastatic rates in three groups with tumor diameter ＜ 1 cm, 1-2 cm and ＞2 cm were 0, 33.3% and 71.4% respectively. Conclusion The clinical presentations of rectal NETs are non-specific. Most cases are often single lesion without the presence of carcinoid syndrome. The clinical process and prognosis of rectal NETs are closely related to tumor size, histological type, the presence of lymph node metastases and liver metastases. The routine digital rectal examination is the simplest and most effectively way of diagnosing rectal NETs. Colonoscopy is important in diagnosing the synchronous cancers and conducting a follow-up.     

Optimal microsurgical treatment of dorsum sellae meningioma

Background There are few reports of microsurgical treatment of dorsum sellae meningiomas--which, because of location, size, and differences in growth direction, clinical presentations, degree of surgical difficulty, have varied posttreatment sequelae. In pursuit of an optimal microsurgical treatment option for dorsum sellae meningioma patients, we performed a retrospective analysis of eight microsurgery-treated patients in our set up. Methods Clinical data of eight microsurgery-treated dorsum sellae meningioma patients were analyzed. Dorsum sellae meningiomas were classified into 2 types based on tumor location, size, and direction of growth. Type Ⅰ tumors （dorsum sellae-inferior third ventricle type, four cases） were resected by craniotomy via the frontotemporal or orbitozygomatic approach. Type Ⅱ tumors （dorsum sellae-third ventricle type, 4 cases） were resected by frontal craniotomy via the transcallosal-interforniceal approach. Results Complete tumor resection was achieved in all the eight patients. In Type Ⅰ tumor patients, the only postoperative complication was oculomotor nerve palsy. In Type Ⅱ tumor patients, the postoperative complications included hyperthermia, electrolyte imbalances, endocrinologic disturbances, and hydrocephalus. The mean follow-up was 2.1 years. Four patients returned to normal life and found a job, two were able to live independently, one required assistance, while one died. Conclusions Dorsum sellae meningioma surgery is challenging, and resection of Type Ⅱ tumors is more difficult than Type Ⅰ tumors. The selection of a suitable microsurgical approach based on tumor type, and the active treatment of postoperative complications are important means of increasing therapeutic efficacy.     

CONGENITAL CHOLEDOCHAL CYST——REPORT OF 56 CASES

Objective. The aim of this paper is to describe the mechanism, clinical manifestation, diagnosis and surgical management of congenital choledochal cyst. Methods. From 1984 to 1997, 56 cases of congenital choledochal cyst were reviewed. Among them, 8 patients were male, 48 patients were female, the age ranges from 12 to 50 years old with an average of 26.3. Results. The main clinical manifestation includes jaundice, abdominal pain and abdominal mass. All of them were confirmed by ultrasonography, while 39 cases were performed ERCP and PTC with the same diagnosis. Fifty-one patients were performed cystectomy and hepatojejunostomy, two cases were per-formed cystjejunostomy because of diffused angioma and severe hemorrhage respectively, external drainage was performed in one case with emergent cholangitis, the other two cases were reported malignancy through biopsy and operation was abandoned. Conclusions. Ultrasound diagnostics is essential to accurately diagnose the cyst, preoperative ERCP is helpful for differentiating pancreatic duct from bile duct, while MRCP is a reliable method ; cystectomy and cholangiojejunostomy is recommended, laparoscopic procedure is becoming more and more accepted.     

直肠神经内分泌肿瘤的临床病理特点分析

Objective To analyze the clinicopathological characteristics of rectal neuroendocrine tumors (NETs) so as to improve their understanding and diagnosis. Methods The data of 62 rectal NETs patients were retrospectively analyzed to summarize their clinical characteristics. They were categorized into 3 types based on the level of histological differentiation. And the relationship of tumor size, histological type and metastases was examined. Results The clinical presentations of rectal NETs were atypical. The main clinical presentation was change in bowel habit (n = 43, 69.4%); Ten cases (16.1%) were asymptomatic. Nine cases were found during routine digital rectal examination. In 57 cases (91.9% ), the distance was within 8cm from anorectal line. All patients had single lesion without the presence of carcinoid syndrome. 25.8% ( 16/62 ) had colonic polyps while 16. 1% ( 10/62 ) synchronous colorectal adenocarcinomas. Except for synchronous colorectal adenocarcinomas (n = 10) , among 52 cases, there were 39 cases with tumor diameter ＜ 1 cm, the main type was type Ⅰ; 7 cases with tumor diameter ＞2 cm, the main types were types Ⅱ and Ⅲ. The metastatic rates in three groups with tumor diameter ＜ 1 cm, 1-2 cm and ＞2 cm were 0, 33.3% and 71.4% respectively. Conclusion The clinical presentations of rectal NETs are non-specific. Most cases are often single lesion without the presence of carcinoid syndrome. The clinical process and prognosis of rectal NETs are closely related to tumor size, histological type, the presence of lymph node metastases and liver metastases. The routine digital rectal examination is the simplest and most effectively way of diagnosing rectal NETs. Colonoscopy is important in diagnosing the synchronous cancers and conducting a follow-up.