伽玛刀治疗原发性三叉神经痛疗效观察

Objective To evaluate the therapeutic efficacy of gamma knife in treatment of primary trigeminal neuralgia Methods Retrospectively analysis of 120 cases with primary trigeminal neuralgia treated by gamma knife in our department From Jan. 2003 to Mar. 2008 were performed. All cases were treated with the 4 mm collimator and targeted at the proximal nerve at the root entry zone located by MRI. The target dose varied from 80 -90 Gy. Results After a follow-up of 20. 0 ±4. 5 months, complete relief of pain occurred in 69 patients (57. 5%), 50% -90% relief in 34 (28. 3%), relief less than 50% in 12(10.0%) but no relief in 5(4.2 %).The efficient rate was 95. 8% . The common complications include numbness, absence of corneal reflex. 83 patients (69. 2%) experienced temporal facial numbness and 14 patients (11. 7%) reported continuous numbness after treatment of the gamma knife. Conclusions Gamma knife radiosurgery is a minimally invasive technique for the treatment of primary trigeminal neuralgia with few complications.     

伽玛刀治疗后的垂体卒中3例

INTRODUCTIONGamma knife has become an effective method in auxiliary treatment of neural surgery with developing of therapeutic technique.But reports about pituitary apoplexy after gamma knife treatment are quite few.From August 1998 to February 2002,156 patients with pituitary adenoma were treated with gamma knife among which pituitary apoplexy occurred in 3 cases(1.9% ),the following is the report.     

Pituitary apoplexy after gamma knife treatment

INTRODUCTIONGamma knife has become an effective method in auxiliary treatment of neural surgery with developing of therapeutic technique. But reports about pituitary apoplexy after gamma knife treatment are quite few. From August 1998 to February 2002, 156 patients with pituitary adenoma were treated with gamma knife among which pituitary apoplexy occurred in 3 cases (1. 9% ), the following is the report     

Clinical analysis of 95 cases of cervical tuberculous lymphadenopathy associated with abscess formation北大核心CSCD

Objective To explore the clinical features and surgical treatment of cervical tuberculous lymphadenopathy associated with abscess formation. Methods The clinical data of 95 cases of cervical tuberculous lymphadenopathy associated with abscess formation were reviewed and analyzed retrospectively. All the patients were treated in Shenzhen Third People’s Hospital during the period from February 2012 to May 2014. Results The mean age of the 95 patients was (27.8±8.2) years. The average duration of the disease was 4.0 months. The tuberculous lymphadenopathy was most frequently found in Level IV cervical lymph nodes. Thirtyfour patients were complicated with pulmonary tuberculosis. History of surgical treatment for tuberculous cervical lymphadenopathy was reported in 26 cases. Sixty-five patients were managed with incision and drainage plus dress changing. Twenty-two patients underwent abscess rinsing, excision and primary wound closure. And 8 patients received excision of ulcers and sinuses, and lymphadenopathy cleaning. The average healing time was (2.11±1.76) months for incision and drainage. Abscess and ulcer reoccurred in 18 of the 65 patients after healing completely by incision and drainage. All the patients treated by the other two surgical modalities were cured as primary healing except 2 patients, who received local flap grafting after primary surgery. Conclusions Cervical tuberculous lymphadenopathy associated with abscess formation has special features in diagnosis and treatment. Surgical approach is usually effective if optimized for individual patients. © 2018, Editorial Department of Chinese Journal of Infection. All rights reserved.     

The life-saving emergency thoracic endovascular aorta repair management on suspected aortoesophageal foreign body injury

BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.     

Intracerebroventricular opiate infusion for refractory head and facial pain

AIM: To study the risks and benefits of intracerebroventricular(ICV) opiate pumps for the management of benign head and face pain.METHODS: SSix patients with refractory trigeminal neuralgia and/or cluster headaches were evaluated for implantation of an ICV opiate infusion pump using either ICV injections through an Ommaya reservoir or external ventricular drain. Four patients received morphine ICV pumps and two patient S received a hydromorphone pump. Of the Four patients with morphine ICV pumps, one patient had the medication changed to hydromorphone. Preoperative and post-operative visual analog scores(VAS) were obtained. Patients were evaluated post-operatively for a minimum of 3 mo and the pump dosage was adjusted at each outpatient clinic visit according to the patient's pain level.RESULTS: All 6 patients had an intracerebroventricular opiate injection trial period, using either an Ommaya reservoir or an external ventricular drain. There was an average VAS improvement of 75.8%. During the trial period, no complications were observed. Pump implantation was performed an average of 3.7 wk(range 1-7) after the trial injections. After implantation, an average of 20.7 ± 8.3 dose adjustments were made over 3-56 mo after surgery to achieve maximal pain relief. At the most recent follow-up(26.2 mo, range 3-56), VAS scores significantly improved from an average of 7.8 ± 0.5(range 6-10) to 2.8 ± 0.7(range 0-5) at the final dose(mean improvement 5.0 ± 1.0, P 0.001). All patients required a stepwise increase in opiate infusion rates to achieve maximal benefit. The most common complications were nausea and drowsiness, both of which resolved with pump adjustments. On average, infusion pumps were replaced every 4-5 years.CONCLUSION: These results suggest that ICV delivery of opiates may potentially be a viable treatment option for patients with intractable pain from trigeminal neuralgia or cluster headache.     

经后路椎间盘镜手术患者的综合康复护理探讨

Objective To study the clinical effect of comprehensive rehabilitation nursing of postopera-tive patients treated by micrecndoscopic discectomy through posterior approach. Methods Fifty - four patients with Inmhar disc herniation were performed to remove nucleus pulposus with microendoscopic discectomy. A retro-spective analysis of 51 patients was made, and the therapeutic effect of the comprehensive rehabilitation nursing was evaluated. Results After operation, the patients could walk in 2±1 days, resumed their daily activities in 11±5 days and went back to work in 28±9 days. Excellent results were achieved in cases 44 (86.3% ), good in cases 3 (5.9%) and improved in cases 4 (7. 8% ) according to the Nakni scale. The excellent and good results were 92.2%. Conclusions Comprehensive rehabilitation nursing is effective in the postoperative patients treated by micrcendoscopic discectomy through posterior approach.     

经后路椎间盘镜手术患者的综合康复护理探讨

Objective To study the clinical effect of comprehensive rehabilitation nursing of postopera-tive patients treated by micrecndoscopic discectomy through posterior approach. Methods Fifty - four patients with Inmhar disc herniation were performed to remove nucleus pulposus with microendoscopic discectomy. A retro-spective analysis of 51 patients was made, and the therapeutic effect of the comprehensive rehabilitation nursing was evaluated. Results After operation, the patients could walk in 2±1 days, resumed their daily activities in 11±5 days and went back to work in 28±9 days. Excellent results were achieved in cases 44 (86.3% ), good in cases 3 (5.9%) and improved in cases 4 (7. 8% ) according to the Nakni scale. The excellent and good results were 92.2%. Conclusions Comprehensive rehabilitation nursing is effective in the postoperative patients treated by micrcendoscopic discectomy through posterior approach.     

经后路椎间盘镜手术患者的综合康复护理探讨

Objective To study the clinical effect of comprehensive rehabilitation nursing of postopera-tive patients treated by micrecndoscopic discectomy through posterior approach. Methods Fifty - four patients with Inmhar disc herniation were performed to remove nucleus pulposus with microendoscopic discectomy. A retro-spective analysis of 51 patients was made, and the therapeutic effect of the comprehensive rehabilitation nursing was evaluated. Results After operation, the patients could walk in 2±1 days, resumed their daily activities in 11±5 days and went back to work in 28±9 days. Excellent results were achieved in cases 44 (86.3% ), good in cases 3 (5.9%) and improved in cases 4 (7. 8% ) according to the Nakni scale. The excellent and good results were 92.2%. Conclusions Comprehensive rehabilitation nursing is effective in the postoperative patients treated by micrcendoscopic discectomy through posterior approach.     

经后路椎间盘镜手术患者的综合康复护理探讨

Objective To study the clinical effect of comprehensive rehabilitation nursing of postopera-tive patients treated by micrecndoscopic discectomy through posterior approach. Methods Fifty - four patients with Inmhar disc herniation were performed to remove nucleus pulposus with microendoscopic discectomy. A retro-spective analysis of 51 patients was made, and the therapeutic effect of the comprehensive rehabilitation nursing was evaluated. Results After operation, the patients could walk in 2±1 days, resumed their daily activities in 11±5 days and went back to work in 28±9 days. Excellent results were achieved in cases 44 (86.3% ), good in cases 3 (5.9%) and improved in cases 4 (7. 8% ) according to the Nakni scale. The excellent and good results were 92.2%. Conclusions Comprehensive rehabilitation nursing is effective in the postoperative patients treated by micrcendoscopic discectomy through posterior approach.