Image features of two rare mediastinal tumors: schwannoma of intrathoracic phrenic nerve and clear cell chondrosarcoma of the rib

The current report focuses on two patients of the same age who presented similar appearances on initial anteroposterior chest images. Follow-up images showed superoanterior and superoposterior mediastinal lesions. The first patient with noninvasive cystic thymoma was suspected before surgery, while the pathologic diagnosis was intrathoracic phrenic nerve schwannoma. The second patient was with an asymmetric, dumbbell-shaped paravertebral tumor over T3 and T4 on the left side. The preoperative…     

Prevention of relapse to heroin by Han’s acupoint nerve stimulation

Background:While the official number ofdrug users in China was 901 000,the real numbermay have reached several millions,with over 80％being heroin addicts.According to the statistics,the heroin relapse rate was near 100％in a period     

Clinical features and management of Crohn’s disease in Chinese patients

Background An increasing incidence of Crohn‘s disease has been found in China in recent years.Our study has been focused on evaluating the diversity of the clinical manifestations of Crohn‘ s disease in order to improve early diagnostic accuracy and therapeutic efficacy.Methods Thirty patients with active Crohn‘s disease were enrolled and their clinical data, including diagnostic and therapeutic results, were analyzed. Endoscopy combined with histological examination of biopsy specimens provided characteristic features of the disease. Transabdominal bowel sonography (TABS) was used for detecting intestinal complications. Nutritional supportive therapy was given to 20 subjects with active cases of the disease.Results Most patients were young adults with a higher proportion of females to males ( ratio: 1.14:1 ). The disease affects any segment or a combination of segments along with the alimentary tract(from the mouth to the anus). In this study, the colon and small bowel were the major sites involved.Recurrent episodes of abdominal pain in the right lower quadrant and watery diarrhea were the most common symptoms. Granulomas were identifiable in nearly one-third (30. 8%) of all biopsy specimens. In moderate cases of the disease, remission was achieved more quickly through the use of oral prednisone therapy than with SASP or 5-ASA. Beneficial effects on the host‘ s nutritional status were observed. Immunosuppressives were used on an individual basis and showed variable therapeutic effects. Sixteen patients had surgery due to intestinal obstruction or failure to respond to drug therapies. Rapid improvement after surgery was reported.Conclusion Endoscopy (with biopsy) and TABS were both crucial procedures for diagnosis. SASP (or 5-ASA) and prednisone were effective as inductive therapies. Azathioprine has demonstrable benefits after induction therapy with prednisone. Surgery, as an alternative treatment, provided another effective choice in selected patients.     

Original article： Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy

Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation. Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the~electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed. Results Total tumor resection was achieved in 140 cases （96.6%） and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% （132/145） of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients （Grade ! and Grade ]I, 79.3%）. No patient died in this series. Preservation of nerves and vessels were as important as tumor removal during the operation. CT thinner scan could show the relationship between the posterior wall of the internal acoustic meatus and bone labyrinths, that is helpful for a safe drilling of the posterior wall of the internal acoustic meatus. Conclusions The goal of every surgery should be the preservation of function of all cranial nerves. Using the retrosigmoid approach with small craniotomy is possible even for large schwannomas. Knowing the microanatomy of the cerebellopontine angle and internal auditory meatus, intraoperating neurophysiological monitoring of the facial nerve function, and the microsurgical techniques of the surgeons are all important factors for improving total tumor removal and preserving facial nerve function.     

Surgical treatment of symptomatic Rathke’s cleft cysts: clinical features, therapy considerations and outcomes

Background  Rathke’s cleft cyst (RCC) is one of the most common incidentally discovered sellar lesions, while symptomatic cases are relatively rare. Surgical treatment is recommended for symptomatic patients to drain the cyst content and to remove the capsule safely. The aim of this study was to clarify the clinical features, surgery considerations and therapy outcomes of symptomatic RCCs.

Methods  Totally 42 patients (19 males and 23 females) were retrospectively reviewed with the diagnosis of RCCs under surgery resection at the Affiliated Hospital of Medical College, Qingdao University between January 2005 and December 2010.

Results  Patients’ age ranged from 6 to 67 years (mean of 41.6 years). The duration of symptoms ranged from 4 days to 10 years. Headache (69%), visual impairment (36%), and pituitary dysfunction (10%) were the most common presenting symptoms. The maximum diameter of cysts ranged from 6.0 to 46.7 mm (mean of 20.07 mm). Of the 42 patients, 36 underwent endonasal transsphenoidal approach and the others underwent transcranial approach. Thirty patients had a subtotal resection and decompression, while 12 patients had a total cyst resection. Cysts of 28 patients were lined by simple cubical or columnar epithelium, and cysts of 34 patients were filled by amorphous colloid material, that was the characteristic of RCCs. The majority of patients presented with a simple headache, and 93% of this group experienced a complete improvement after surgery. Twelve of 15 patients (80%) with preoperative visual deficits experienced an improvement in their vision after surgery. All of those patients with pituitary dysfunction experienced an improved endocrine status. The endocrinological complication usually was diabetes insipidus, and postoperative transient diabetes insipidus occurred in 13 (31%) patients without any permanent diabetes insipidus. The overall recurrence rate was 7% at a mean follow-up of 22 months (range 12–60 months).

Conclusions  Surgical treatment is to drain the contents of the cyst and to remove the capsule as much as possible under the precondition that does not increase the complications. Biopsy and decompression procedures are recommended for most cases.

     

Volumetric magnetic resonance imaging classification for Alzheimer’s disease based on kernel density estimation of local features

Background The classification of Alzheimer's disease (AD) from magnetic resonance imaging (MRI) has been challenged by lack of effective and reliable biomarkers due to inter-subject variability.This ar...     

Transfer of a branch of the anterior interosseous nerve to the motor branch of the median nerve and ulnar nerve

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Acupuncture Treatment of Parkinson’s Disease

It can be concluded that acupuncture possesses definite therapeutic effectiveness for Parkinson's disease, which is mainly represented by improvement in the clinical symptoms and signs, delaying of the disease's progression, decrease in the dosage of anti-parkinsonian drug, and expectant treatment of the complications and symptoms induced by the drug side-effects.     

Molecular diagnosis of Down’s syndrome

Objective To establish a new diagnostic method for Down’s syndrome using polymerase chain reaction (PCR).Methods DNA extracted from five healthy individuals and five Down’s syndrome patients was amplified in six specific tetranucleotide repeat loci on chromosome 21 using PCR. An accurate diagnosis was made by analyzing allelic distribution at each locus. Results All Down’s syndrome patients were identified as having at least two loci with three alleles, while none of the healthy individuals had three alleles. In addition, when two alleles were identified for a particular locus in the Down’s syndrome samples, it was more likely that the intensity ratio between the two alleles was close to 2∶1. Conclusion The molecular method can provide a fast, accurate, and economical alternation for the traditional cytogenetic diagnostic method for Down’s syndrome.     

Microsurgical treatment of Nelson’s syndrome

Objective To discuss the etiology, diagnostic criteria and treatment of Nelson’s syndrome.Methods Twenty-three patients with Nelson’s syndrome who were treated in our department over the last 19 years were analyzed retrospectively.Removal of adenoma by the transsphenoidal approach was done in 21 patients and by transfrontal craniotomy in 2.The follow-up period ranged from six months to nine years.Results The incidence of Nelson’s syndrome was 7.7% in a series of 300 patients with Cushing’s disease treated by microsurgery in the same period.Hyperpigmentation was relieved and adrenocorticotropic hormone (ACTH) levels decreased in all patients after tumor excision.Eight patients with visual disturbance improved after surgery.The curative and remission rates were 56.5% and 26.1%, respectively.Conclusions Transsphenoidal microsurgical removal of pituitary ACTH adenoma is the first choice in the prevention and treatment of Nelson’s syndrome.Regular follow-up examinations should be performed over a long time.     

Transfer of a branch of the anterior interosseus nerve to the motor branch of the median nerve and ulnar nerve.

OBJECTIVE To explore the applied microsurgical anatomy of the intrinsic hand muscles and related nerves after nerve injuries in the wrist region and to report the results of new technique for the restoration of motor functions of the injured nerves.

METHODS Seven fresh forearm amputation specimens were employed for studying the anatomical and microsurgical characteristics of the relevant tissues. Transfer of the pronator quadratus branch of the anterior interosseous nerve (PBAN) to the recurrent branch of the median nerve (RBMN) and the deep branch of the ulnar nerve (DBUN) to restore the functions of the intrinsic hand muscles was performed on 20 patients from April 1979 to January 1994. Fourteen patients were followed up for 3-9 years with an average of 5 years and 8 months.

RESULTS The RBMN, DBUN and PBAN had approximately the same lengths of diameter and similar amounts of fascicles and nerve fibers so that after nerve transfer, the possibilities of misdirected connections were greatly reduced. In the latest follow-up, normal muscle strength was regained in 3 patients, grade VI strength in 6, grade III strength in 3 and grade II strength in 2.

CONCLUSIONS This new technique is able to restore the intrinsic hand muscular functions after median or ulnar nerve injuries in the wrist region or distal forearm.

     

Telediagnosis of Parkinson’s Disease Using Measurements of Dysphonia

Parkinson’s disease (PD) is a neurological illness which impairs motor skills, speech, and other functions such as mood, behavior, thinking, and sensation. It causes vocal impairment for approximately 90% of the patients. As the symptoms of PD occur gradually and mostly targeting the elderly people for whom physical visits to the clinic are inconvenient and costly, telemonitoring of the disease using measurements of dysphonia (vocal features) has a vital role in its early diagnosis. Such dysphonia features extracted from the voice come in variety and most of them are interrelated. The purpose of this study is twofold: (1) to select a minimal subset of features with maximal joint relevance to the PD-score, a binary score indicating whether or not the sample belongs to a person with PD; and (2) to build a predictive model with minimal bias (i.e. to maximize the generalization of the predictions so as to perform well with unseen test examples). For these tasks, we apply the mutual information measure with the permutation test for assessing the relevance and the statistical significance of the relations between the features and the PD-score, rank the features according to the maximum-relevance-minimum-redundancy (mRMR) criterion, use a Support Vector Machine (SVM) for building a classification model and test it with a more suitable cross-validation scheme that we called leave-one-individual-out that fits with the dataset in hand better than the conventional bootstrapping or leave-one-out validation methods.