Microsurgical resection of ventral foramen magnum meningiomas via a far-lateral suboccipital approach

BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial. OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treated via a far lateral suboccipital approach. DESIGN: Retrospectively clinic case investigation. SETTING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm, mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three. METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned. Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up. MAIN OUTCOME MEASURES: Operative effect. RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2 patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2 patients still had lower cranial nerve deficit and others recovered from their illness. No tumor relapse or increment was found in CT or MRI scans. CONCLUSION: Most of VFMMs could be totally removed via a far lateral suboccipital approach with or without resection of the occipital condyle according to the tumor size, allowing most of these patients to achieve a good outcome in a 3 months follow-up.     

小肝细胞癌的螺旋CT诊断

目的探讨小肝细胞癌的CT影像表现。方法回顾我院2001年2月-2005年2月经病理证实的12例小肝细胞癌的CT表现。结果通过平扫、动脉期、门脉期及部分延迟扫描均可对小肝细胞癌作出定性诊断。结论螺旋CT作为非创伤性容积扫描技术对小肝细胞癌的早期检出、定位、定性诊断具有十分重要的临床价值。     

岛状皮瓣静脉淤血再通后对大鼠全身情况的影响

目的：探讨岛状皮瓣静脉淤血再通后对全身多脏器的影响。方法：按静脉淤血时间的不同将大鼠分为4组。观察耳部微循环的改变，测量术后肿瘤坏死因子α(TNFα），白细胞介素10（IL－10）的动态变化，观察心，肺，肝，肾，小肠及耳部血管等组织结构及中性粒细胞浸润数目。结果：皮瓣原位缝合组及静脉淤血2h组，耳部微循环、TNFα、IL-10浓度基本保持不变，各脏器结构改变较轻，中性粒细胞浸润数目少。静脉淤血6、10h组，微循环，肺，小肠，血管则有明显组织学改变，大量中性粒细胞浸润其中，但心，肝，肾组织学改变较轻。TNFα浓度再灌注1h达到高峰，其后逐渐下降，IL－10浓度3h达到最低，然后逐渐上升。结论：皮瓣静脉淤血再通后可造成肺、小肠及血管器官损伤，静脉淤血时间越长，再通后则损伤程度越重。全身微循环的改变，中性粒细胞在肺、小肠中的浸润，与血管内皮细胞的粘附及细胞因子TNFα与IL－10的浓度失衡是重要的操作原因。     

布-加氏综合症介入放射学治疗

目的　探讨布 -加氏综合征不同类型的介入放射学治疗效果。方法　 1例患者经下腔静脉造影后采用球囊成形术 ,其余 3例均造影后行球囊成形 支架置入术。结果　 1例膜型梗阻经球囊成形术后治愈 ,2例节段型梗阻患者经球囊成形术后分别置入“Z型支架 ,1例肝静脉型置入wallstent支架治愈。结论　介入放射学在诊治布 -加氏综合征方面是一种独特、有效的方法。     

视场角设置对虚拟环境中目标判断的影响

目的探讨不同视场角参数对虚拟环境中目标判断的影响规律 ,找出最佳视场角参数。方法利用自行研制基于PC平台的虚拟现实 (VR)实验系统 ,选定 45名年龄在 2 3～ 5 8岁被试者并完成大小与角度判断的实验设计。首先进行 30 0人次的预实验 ,确定引起虚拟环境中目标判断差错的视场角及相应观察任务的差别等级 ,然后开始单因素、4水平的完全随机正式实验。结果方差分析表明 ,不同的虚拟环境视场角对目标判断的真实性有显著性影响 ,当视场角为 60°时 ,目标判断的正确率最大。结论利用VR技术进行载人航天器工效设计、操作训练或其它任务的研究时 ,应考虑视场角的作用 ,适合目标大小判断的视场角参数值宜取 60°,以便获得最大的工效     

创伤性睾丸脱位5例报告

目的 探讨创伤性睾丸脱位的诊断和治疗。方法 对所收治的5例患的诊治情况进行分析研究，并结合复习有关献。结果 1例手法复位成功，4例行手术复位．1例发生睾丸萎缩后切除患睾。结论 创伤性睾丸脱位临床少见，漏误诊率较高。对骨盆部、会阴部、阴囊部外伤患应警惕本病；详细检查阴囊及睾丸．确诊后尽早行手法或手术复位固定．定期随访。     

Poly-L-Lysine玻片在寡核苷酸芯片制备中的改进

目的 为了制得适合固定未修饰寡核苷酸的芯片，提高检测灵敏性，对Patrick Brown实验室的多聚左旋赖氨酸包被玻片的方法进行改进。方法 玻片经清洗后用缩水甘油-丙氧基三甲氧基硅烷进行硅烷化，然后应用Poly-L-Lysine在玻片表面形成聚合物涂层，经次亚苯基二异硫氰酸盐表面活化后可使寡核苷酸共价连接在芯片表面。设计了各种实验考察方法改进前后芯片表面的性能，并将改进后的玻片初步应用于SARS冠状病毒寡核苷酸芯片检测中。结果 方法改进后芯片表面性能优良：固定效率高、点的同一性好、杂交效率和热稳定性好、寡核苷酸结合牢固、芯片可以重复利用。结论 利用共价连接，方法改进后的芯片表面适合固定未修饰的寡核苷酸，解决了寡核苷酸与玻片之间物理结合不稳定、易剥离的缺陷，提高了芯片检测的灵敏性。     

准分子激光屈光性角膜切削术治疗近视及近视散光临床分析

目的评价准分子激光屈光性角膜切削术治疗近视及近视散光的临床效果。方法应用准分子激光（NIDEKEC—5000型）治疗24D以下．伴或不件5D以内散光的近视眼。214只治疗眼随诊6个月以上。结果随诊1年以上的病例显示术后3个月屈光度及视力基本稳定。术后6个月时，在等值球镜度低于6D的治疗眼中，裸眼视力≥1．0者占92．04％，≥0．5为100％，80．53％的裸眼视力≥术前最佳矫正视力，99．12％的眼屈光度在预定矫正度数的±1．00D以内。低于10D的高度近视眼也有近似的疗效。214只治疗眼中操眼视力≥1．0者占78．97％，≥0．5为90．65％，72．43％的裸眼视力≥术前最佳矫正视力，88．32％的眼屈光度在预定矫正度数的±1．00D以内。6只眼（2．80％）最佳矫正视力减少2行以上，有Ⅱ级以上Haze的有7眼间（3．27％）。结论准分子激光屈光性角膜切削术治疗近视及近视散光具有很高程度的精确性和安全性，在＜10D的近视眼中更显示了良好的预测性和稳定性。     

Kinetics and enzyme involvement in the metabolism of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in microsomes of rat lung and nasal mucosa.

The rat lung and nasal cavity are two target organs for carcinogenesis by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). In order to characterize further the enzymes involved in the bioactivation of NNK, detailed kinetic and inhibitory studies were conducted with rat lung and nasal mucosa microsomes, and the results were compared with previous studies. The enzymes in rat lung microsomes catalyzed the alpha-hydroxylation, pyridine N-oxidation and carbonyl reduction of NNK. The apparent Km for the formation of the NNK-derived keto aldehyde, NNK-N-oxide, the NNK-derived keto alcohol and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol were 28.8, 10.4, 7.0 and 178.1 microM respectively. In rat nasal microsomes, alpha-hydroxylation was the predominant pathway and the rate was approximately 200 times higher than that in lung microsomes. The apparent Kms for keto aldehyde and keto alcohol formation in rat nasal microsomes were 9.6 and 10.1 microM respectively. The cytochrome P450 inhibitors metyrapone and carbon monoxide markedly inhibited the metabolism of NNK in both rat lung and nasal microsomes. In rat lung microsomes, alpha-naphthoflavone and monospecific antibodies against P450s 1A2, 2A1 and 2B1 inhibited the formation of keto aldehyde by 39, 46, 64 and 23% respectively. In rat nasal microsomes, alpha-naphthoflavone and antibodies against P450s 1A2, 2A1 and 3A inhibited the metabolism of NNK by 80, 35, 20 and 14% respectively. The results indicate that cytochromes P450 play a major role in the metabolic activation of NNK in rat lung and nasal microsomes, and that there are tissue-related differences in NNK metabolism.     

STUDIES ON NUTRITION AND PRECANCEROUS LESIONS OF THE ESOPHAGUS IN THE ADOLESCENTS

This paper reports the prevalence of chronic esophagitis and nutritional status among 538 young persons aged 15 to 26 years from the high risk area for esophageal cancer. Of these subjects, 166 were from households with history of esophageal cancer and 372 were from households without history of esophageal cancer. The Incidences of chronic esophagltis among male and female adolescents were 37. 6% and 36% respectively, which was significantly higher than those in the low risk area (17%). The frequency of chronic esophagltis in the adolescents in the households with history of esophageal cancer was aiso higher than in those In the households without history of esophageal cancer. The deficiencies of vitamins, especially of riboflavin and ascorbate, are prevalent and severe among these adolescents. Ascorbate deficiency Is correlated with the severity of the chronic esophagltis. These results indicate that chronic esophagltis may be involved in the natural history of esophageal carclnogenesis. Nutrient defic