Relief of epilepsy and headache and quality of life after microsurgical treatment of unruptured brain AVM—audit of a single-center series and comprehensive review of the literature

Although the benefit of intervention for unruptured arteriovenous malformation (AVM) with regard to stroke rates and long-term disability remains unclear, most patients present with symptoms, such as epilepsy, headache, or neurological deficits, compromising their quality of life. Detailed analysis of the long-term effects of microsurgical treatment on quality of life, epilepsy, and headache was the purpose of this audit. A series of 25 microsurgically treated patients were interviewed on average 7?±?5 years after treatment. Detailed information was obtained regarding frequency and severity of seizures and headaches. Outcome data was compared with the initial complaints and neurological findings. The Short Form (SF)-36 was used to assess health-related quality of life. On average, the SF-36 scores did not differ significantly from the age-matched German norm values. Patients suffering from chronic headache prior to treatment scored worse in most SF-36 subscales than patients without headache at the time of treatment, and the difference was significant in the SF-36 dimensions physical role functioning and emotional role functioning (P?=?0.04). In contrast, there was a trend for patients treated for incidental AVM to score somewhat better than the age norm. Twelve patients had been admitted with epilepsy. At the time of follow-up, all patients were seizure free (Engel class I), although 7 of them continued to take antiepileptic medication. Two of 13 patients without epilepsy at the time of treatment experienced seizures sometime during the post treatment course and were under medication at the time of long-term follow-up interview. At the time of the audit, 7 of 11 patients admitted with chronic headache necessitating regular use of pain medication indicated not to use pain medication any longer. Our data suggest that initial symptoms leading to diagnosis and treatment of unruptured AVM may influence long-term quality of life following treatment. Patients admitted with headache as the chief complaint appear to fare worse than patients with epileptogenic or incidental AVMs.     

Current status and perspective of diagnosis and treatment of thoracolumbar fracture in China

Since the late 20th century owing to the improvement of spinal surgery techniques, the diagnosis and treatment of thoracolumbar fracture have been perfected more and more. Although the advent of modern spinal surgery in China was late, we have gained some advanced achievements owing to     

Study of the morphology and biomechanics of sacral fracture

Objective:To observe the morphological characteristics of sacral fracture under different impact loads. Method: Ten fresh pelvic specimens were loaded in dynamic or static state. A series of mechanical parameters including the pressure strain and velocity were recorded. Morphological characteristics were observed under scanning electron microscope. Results: The form of sacral fracture was related to the impact energy. Under low-energy impact loads, ilium fracture, acetabulum fracture and crista iliaca fracture were found. Under high-energy impact loads, three types of sacral fracture occurred according to the classification of Denis: sacral ala fracture, Type I fracture; sacral foramen cataclasm fracture, Type II fracture; central vertebral canal fracture, Type III fracture. Nerve injury of one or two sides was involved in all three types of sacral fracture. The fracture mechanism of sacrum between the dynamic impact and static compression was significantly different. When the impact energy was above 25 J, sacral foramen cataclasm fracture occurred, involving nerve root injury. When it was below 20 J, ilium and sacral fracture was most likely to occur. When it was 20 - 25 J, Type I fracture would occur. While in the static test, most of the fracture belonged to ilium or acetabulum fracture. The cross section of sacrum was crackly and the bone board of Haversian system was brittle, which could lead to separation of bone boards and malposition of a few of cross bone boards. Conclusions: In dynamic state, sacrum fracture mostly belongs to Type I and Type n , and usually involves the nerve roots. Sacrum fracture is relevant to the microstructures, the distribution of the bone trabecula, the osseous lacuna and the Haversian system of sacrum. The fracture of ilium and acetabulum more frequently appears in static state, with slight wound of peripheral tissues.     

Effect of bisphenol A and co-administration of bisphenol A and vitamin C on epididymis of adult rats： A histological and biochemical study

Aim: To study the effect of bisphenol A on the epididymis and epididymal sperm of rats and the possible amelioration action of co-administration with vitamin C. Methods: Male Wistar rats were orally administered bisphenol A (0.2 μg·kg-1·day-1, 2 μg·kg-1·day-1 and 20 μg·kg-1·day-1) and 0.2 μg, 2μg and 20 μg bisphenol A + 40 mg vitamin C·kg-1·day-1 for 60 days. On day 61, rats were killed with anesthetic ether and sperm collected from epididymis were used for assessment of sperm count, motility and viability and biochemical studies. A 1 % homogenate of epididymis was prepared and used for biochemical estimations. Caput, corpus and cauda epididymis were fixed in Bouin's fixative for histological studies. Results: Administration of bisphenol A caused a reduction in the epididymal sperm motility and count and the sperm viability remained unchanged. The activities of superoxide dismutase and glu-tathione peroxidase decreased, while the levels of lipid peroxidation increased in epididymal sperm an     

Diagnosis and treatment of traumatic hematoma of posterior fossa

Traumatic hematoma of posterior fossa(THPF) is a special kind of craniocerebral injury with its own characteristics in clinical manifestations, diagnosis and treatment.In general, the prognosis of THPF is poor.Without early diagnosis and prompt treatment, the outcome would be very poor, with high occurrence of morbidity and mortality.Since the availability and mortality.Since the availability of computed tomography(CT)in 1983,we have received and successfully treated 44 patients with THPF until November 2000.     

Diagnostic and therapeutic management of lumbar and thoracic spondylodiscitis – an evaluation of 59 cases

Fifty-nine patients with spondylodiscitis (SD) of the thoracic and/or lumbar spine were followed-up clinically and radiologically [X-ray, computed tomography (CT), magnetic resonance imaging (MRI)] over a mean time of 2.2 years (1–6.5 years). All patients without abscess formation (n = 35) were treated conservatively. Out of the group with abscess formation (n = 24) 6 patients were also treated conservatively, 11 were drained under CT control and 7 were operated. At time of diagnosis, “signs of florid inflammation” were seen in 60% of the roentgenograms, in 93% of the CTs and in all of the MRIs. The sensitivity to differentiate between SD with and without abscess formation was 85% by MRI and 69% by CT. “Signs of regressive inflammation” and “signs of increasing osseous consolidation”, essential facts for starting remobilization, could first be seen using CT 6 weeks after onset of therapy. Using MRI these signs were seen with a considerable delay at 12 weeks. Clinically, only 3 of the 59 analyzed patients developed recurrent SD. In conclusion, MRI is the radiological method of choice for establishing the diagnosis of SD, in particular with regard to differentiating between cases with and without abscess formations. In contrast, CT is superior for performing success control after treatment. Therapeutically, conservative, minimal-invasive and operative procedures are not rival but rather complementary. Received: 9 May 1999     

Diagnosis and treatment of pancreatic trauma

Pdasenisvcterinereactt iiacvbe dt rsoaymumminpaatol mis isn a.ju Brryeult as tioitvm heealytsim caeo hmsig pwhlii ctihantoceuiddte aannncdeyof morbidity and complications.The mortality rate canbe as high as12%-20%.1Essential points inmanagement of pancrea…     

Intraductal papillary-mucinous tumor of the pancreas: difficulties and mistakes of diagnostics and treatment

15 patients with intraductal papillary-mucinous tumors (IPMT) of the pancreas were observed. Clinical manifestation corresponded with chronic pancreatitis. Ultrasound study, including endosonography, contrast-enhanced computer and magnetic resonance tomography were used in complex observation of the patients. Dilation of main or lateral pancreatic ducts, connection of tumor with pancreatic duct system and absence of septal calcinosis are typical signs in radiodiagnostics of IPMT. Visualization of parietal papillary proliferations and their contrast enhancement are undeniable signs f or neoplastic character of pancreatic duct dilation. Sensitivity of CT, MRТ and endoUS amounted accordingly 66, 83 and 88%. All patients were operated. Extent of operation was determined by morphological character, localization and size of the tumor (pylorus-preserving pancreaticoduodenal resection was carried out to 6 patients, distal resection including robot-assisted - to 7 patients, midline resection - to 1 patient, duodenum-preserving resection of head and body of pancreas - to 1 patient). Intraoperative urgent histologic study of pancreatic section was carried out by all means. Tumors with borderline degree of malignancy were detected in 4 cases.     

Langerhans’ cell density and degree of keratinization in foreskins of Chinese preschool boys and adults

Background  

Recent epidemiological studies have proposed that male circumcision reduces the relative risk of acquiring HIV-1. Here, we evaluated the density of Langerhans’ cell and degree of keratinization in the foreskins of Chinese preschool boys and adults.     

Prevention and treatment of the complications of progressive renal insufficiency

There is now clear evidence that all these pathophysiological changes that develop during the progressivley worsening course of chronic renal insufficiency can be prevented, or at least attemated, by a number of therapeutical interventions. Morever, evidence is accumulating that:     

Diagnosis and treatment of 34 cases of blunt duodenal injuries

Objective： To summarize the experience on diagnosis and treatment of blunt duodenal injuries, and thus to improve the therapeutic skills. Methods ： Clinical data of 34 cases of blunt duodenal injuries admitted to our hospital from 1990 to 2006 were retrospectively analyzed. Results ： Among them, 28 cases were cured, 20 cases presented with complications, and 6 cases died. The causes of death were： duodenal or pancreatic fistula in 2 cases, intra- and retroperitoneal infection complicating septicopyemia in 2, disseminated intravascular coagulation in 1 and multiple organ failure in 1. Conclusions： Misdiagnosis and missed diagnosis predispose to happen for blunt duodenal injuries. Early recognition and surgical intervention are critical to a successful rescue.     

Lipid and protein histochemistry of enamel — Effects of fluoride

Summary Staining reactions for a number of histochemical procedures for lipophilic staining and protein were studied in the enamel matrix along the length of rat incisors. Sudan Black gave a positive stain across the whole thickness of very early enamel (up to 30 m) but this staining only continued as a narrow band close to the ameloblasts as the enamel matured. A variety of tests for protein produced almost identical staining patterns in enamel matrix up to 100 m thick. Since the pattern of lipid staining persisted, after using a number of procedures which could normally be expected to remove lipid, it is suggested that Sudan Black positive staining may be due to lipophilic protein rather than lipid itself. Fluoride did not significantly alter the staining reactions for lipid and protein but did proceduce matrix which was much more effectively stained by cross-linking agents FFDNB and FF sulphene.     

NSAID Exposure and Risk of Nonunion: A Meta-Analysis of Case–Control and Cohort Studies

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for postoperative pain control. However, concerns regarding the potential deleterious effects of NSAIDs on bone healing have compelled many physicians to avoid NSAIDs in patients with healing fractures, osteotomies, and fusions. We systematically reviewed and analyzed the best clinical evidence regarding the effects of NSAID exposure on bone healing. Medline, Embase, and Cochrane electronic databases were searched for prospective and retrospective clinical studies of fracture, osteotomy, and fusion studies of patients with NSAID exposure and nonunion as an outcome. Study quality was assessed using the Newcastle–Ottawa Scale. Data on study design, patient characteristics, and risk estimates were extracted. Pooled effect estimates were calculated. Subanalyses were performed by bone type and by NSAID dose, duration, and route of administration. In the initial analysis of 11 cohort and case-control studies, the pooled odds ratio for nonunion with NSAID exposure was 3.0 (95% confidence interval 1.6–5.6). A significant association between lower-quality studies and higher reported odds ratios for nonunion was observed. When only higher-quality studies were considered, seven spine fusion studies were analyzed, and no statistically significant association between NSAID exposure and nonunion was identified (odds ratio = 2.2, 95% confidence interval 0.8–6.3). There was no increased risk of nonunion with NSAID exposure when only the highest-quality studies were assessed. Randomized controlled trials assessing NSAID exposure in fracture, fusion, and osteotomy populations are warranted to confirm or refute the findings of this meta-analysis of observational studies.