A single-blinded pilot study assessing neurovascular contact by using high-resolution MR imaging in patients with trigeminal neuralgia

Objective

To assess the feasibility and utility of high-resolution three-dimensional magnetic resonance angiography (3D MRA) and contrast-enhanced 3D spoiled gradient-recalled imaging (3D SPGRI) for the purpose of visualization of neurovascular contact in trigeminal neuralgia (TN) patients.

Methods

Forty-five patients (25 males, 20 females; age range, 23–82 years; and mean age, 55.67 ± 18.23 years) with unilateral typical TN and 36 control subjects (21 males, 15 females; age range, 25–85 years; mean age, 57.53 ± 19.25 years) underwent high-resolution 3D MRA and contrast-enhanced 3D SPGRI assessment. The images were reviewed by two experienced neuroradiologists who were blinded to the clinical details. The imaging results were compared with the operative findings in all the patients; additionally, the degree of neurovascular contact was compared between the two groups based on MR imaging.

Results

In 45 patients with unilateral typical TN, the use of 3D MRA in conjunction with the contrast-enhanced 3D SPGRI identified neurovascular contact in 40 of the 42 symptomatic nerves; the contact was verified surgically. Based on the surgical findings, the sensitivity and specificity of MR imaging were 95.20% and 100%, respectively. Based on MRI, the compressing vessel (artery, vein) was correctly identified in 32 of the 39 cases verified by microvascular decompression. There was good agreement (K = 0.77; 95% confidence interval, 0.54–0.99) between the position (medial, lateral, superior, and inferior) of the compressing vessel relative to the trigeminal nerve as defined by MR imaging and the surgical findings. The rates of vascular contact with the trigeminal nerve as observed on MRI were 31.94%, 48.89%, and 88.9% in the control subjects, asymptomatic, and symptomatic side of patients, respectively.

Conclusion

The combined use of high-resolution 3D MRA and contrast-enhanced 3D SPGRI is an extremely sensitive and specific technique for demonstrating vascular contact with the trigeminal nerve in TN patients.     

A treatment algorithm for managing giant mandibular ameloblastoma: 5-year experiences in a Paris university hospital

Aims

To review our experiences with giant mandibular ameloblastoma (GMA) over a 5-year period, and to formulate a treatment algorithm for managing this tumour.

Methods

We retrospectively reviewed all GMA patients who underwent segmental mandibulectomy and immediate free fibular osteoseptocutaneous flap reconstruction (SM-IFFOFR) by a single reconstructive team from 2002 to 2006. All treatment methods and outcomes were analysed.

Findings

Forty-four ameloblastoma patients were operated upon during this study period. Sixteen cases had GMA, of which 9 patients were included in this series (mean age: 35 years). The defects in the mandible ranged from 7 to 16 cm in length (mean: 12 cm). The average length of the harvested fibula was 11 cm, and the number of osteotomies ranged from 1 to 2. The mean ischemic time was 137 min (range: 90–180 min). Neck recipient vessels were used for flap perfusion in all cases. All but one flaps were viable without any complications, whilst partial skin-island necrosis occurred in 2 patients. Hospital stay was 2 weeks in most of the patients. No tumour recurrence was found during the follow-up period (range: 26–73 months). Dental implants were placed in 2 patients.

Conclusions

Despite several limitations of this study, we suggest that a radical approach with the SM-IFFOFR is an effective treatment for GMA. Further well-designed, larger series with longer follow-up periods are still encouraged.     

强化降糖和降压对2型糖尿病患者微血管病变的影响

目的 观察强化降糖和降压对2型糖尿患者底微血管病变的影响.方法 将入选的107例2型糖尿病患者随机分入强化组和标准组,强化组给予低剂量培哚普利-蚓哒帕胺联合降压和以格利齐特缓释片为基础的强化降糖治疗,标准组接受常规治疗或安慰剂治疗.定期检查患者尿微量白蛋白、尿肌苷水平,并通过直接眼底镜检查眼底和眼底七个视野彩色立体照相,比较5年后患者尿微量白蛋白/尿肌苷指数(UMA/UCR)、视力及眼底变化情况.结果 强化组基线与5年UMA/UCR比较无差异,而标准组则有上升(P=0.00).两组患者基线时视力分布无统计学差异;治疗5年后强化组视力保持稳定,而标准组视力有所下降(P=0.04).基线时两组眼底糖尿病病变无差异,治疗5年后强化组眼底病变无发展趋势,而标准组糖尿病视网膜病变有所加重(P=0.0006),并有1例患者新发生视网膜静脉分支阻塞.结论 强化降糖和降压治疗能有效控制糖尿病患者微血管病变的发展,并能保持糖尿病患者视力稳定.     

Angioarchitectural form, functional distributive pattern and classification of the fungiform papillae on the crossbred Japanese cat tongue anterodorsal surface in scanning electron microscopic specimens

The purpose of this study was to undertake a three-dimensional comparative observation of the angioarchitectural form, functional distributive pattern, and to classify the fungiform papillae (FuP) found sporadically and geometrically on the oblique lines of the filiform papillae (FiP) on the entire dorsal surface of the crossbred Japanese cat foretongue in microvascular cast specimens (MVCS). By means of the corrosive resin casting technique, the MVCS of the FuP of the cat tongue were prepared and examined in detail under the scanning electron microscope (SEM). With regard to the arrangement of FiPs and FuPs on the frontal half of the antero-dorsal surface of the cat foretongue, FiP types I-V and FuP types I-IV are arranged a A form with the point in the direction of the apex and in an oblique line running from the antero-central portion to both postero-peripheral portions. In the rear half of the antero-dorsal surface of the foretongue, FiP types I-V and types FuP I-IV are arranged in a V form with the point in the direction of the radix and in an oblique line running from both antero-peripheral portions to the postero-median portion or towards the pharynx on the anterior centro-dorsal surface of the cat foretongue. With the FuP arranged in the medial zone (M) and peripheral zone (P) running from the central to the apical parts, both the peripheral parts and the pharyngeal can be classified into four types (FuP types I-IV) according to the shape and size of the main process (MP), the number of the accessory processes (AP) and the regional position of the lozenge arrangement. FuP Types I-III consisted of a MP containing a large half oval, network-like process, and the AP contained a bundle of spine-like processes arranged radially in a circle at the anterior basal margin of the MP. The FuP Type IV was made up of only one MP. In the central zone (C) of a lozenge part arranged in the A and V forms, there was no FuP as a taste organ. It was assumed that in the lozenge arrangement of the A and V forms, except for the C zone, FuPs could be classified into four types (FuP types I-IV) from the frontal portion of the antero-dorsal surface toward the pharynx on the foretongue, and would play an assistant functional role in receiving the sense of taste of foods and liquids.     

心肌微血管内皮细胞培养及生物学特性的初步观察

目的 :建立一种新的心肌微血管内皮细胞培养方法 ,并初步观察其生物学特性。方法 :采用组织块干涸翻转法培养心肌微血管内皮细胞 ,Ⅷ因子相关抗原免疫组织化学鉴定 ,细胞计数法测定其生长曲线 ,3 H TdR掺入法及放射免疫法观察牵张刺激对其增殖能力和内皮素释放的影响。结果 :Ⅷ因子相关抗原鉴定表明心肌组织块培养的微血管内皮细胞纯度达 96 % ,其生长特点是潜伏期较心肌成纤维细胞长 ,达 72h ,在不加内皮细胞生长支持物时 ,传代 3～ 5次后 ,其生长速度逐渐降低。牵张刺激可显著诱导其增殖和释放内皮素。结论 :心肌微血管内皮细胞组织块培养法简便易行 ;其生长潜伏期较长 ,长期培养时需要内皮细胞生长因子 ;机械刺激可促进其生长和内分泌活化。     

Comparative angioarchitectural formation seen in microvascular cast specimens of the fungiform papillae in the weaning period and adult rat tongue

The purpose of this study was an attempt to identify the functional and comparative angioarchitectural differences between the sexes, and the developmental processes seen in microvascular cast specimens (MVCS) of the formation of the fungiform papillae (FuP) geometrically and regularly distributed on the anterodorsal surface in the weaning period and in the adult rat tongue. The basic microvascular structure seen in the MVCS of FuP of both the weaning and adult rat tongue consisted of several ascending (As. b) and descending branches (Ds. b) and a loop structure (L. st), and the cylindrical network structure of the L. st made up of the open-hole formation of the C form of the upper and lower microvascular structures. In the lateral view, the MVCS of FuP has a bamboo basket-like shape, and by means of the three-dimensional expansion of the surface area, effectively plays an assistant functional role in receiving the taste of foods and liquids. There were obviously no sex and morphological differences in the developmental process as to shape, but there was some difference between the weaning period and the adult rat in size in the MVCS of FuP.     

应用医用胶和可溶性小血管支架粘接小动脉的实验研究

常规间断缝合法吻合小血管难度大,需时长。我们应用国产医用胶和可溶性小血管支架法粘接兔小动脉的实验研究,只需在12点、6点处缝合两针,置入小血管支架,将两断端严密对齐,吻合口处涂布医用胶,待胶固化后,吻合便告完成,操作简便,省时。远期通畅率、吻合口的修复过程与间断缝合法相比较,基本一致。     

吻合血管的阔筋膜瓣移植术

目的：探讨吻合血管的阔筋膜瓣移植联合游离植皮的临床效果。方法：应用该方法修复软组织缺损２４例，切取阔筋膜瓣的面积为３ｃｍ×８ｃｍ～１０ｃｍ×１６ｃｍ。结果：２３例完全成功，１例失败。结论：阔筋膜瓣以旋股外侧动脉降支为血供，血管解剖位置恒定，血管蒂长，切取容易，而且较薄，适宜修复手和足部的软组织缺损     

膀胱移行细胞癌微血管密度与其复发的关系

目的:探讨肿瘤微血管形成能力与膀胱移行细胞癌复发的关系及机制。方法:采用免疫组化的方法对42例膀胱移行细胞癌组织中的第Ⅷ因子相关抗原,碱性成纤维细胞生长因子(bFGF)及血管内皮细胞生长因子(VEGF)分别进行特异染色,记数肿瘤内微血管密度(MVD),并观察bFGF、VEGF的表达。结果:VEGF和bFGF的阳性表达率分别为:59.5%和40.5%,MVD阳性表达组显著高于阴性表达组(P<0.05),术后复发组显著高于未复发组(P<0.05),且高MVD组复发率高于低MVD组(P<0.05)。结论:MVD与膀胱移行细胞癌复发有关,而且血管形成因子的异常表达是其微血管形成能力增高的重要因素。     

微血管减压术辅以异常肌反应电生理监测治疗面肌痉挛

目的 探讨显微血管减压手术中,辅以异常肌反应电生理监测治疗面肌痉挛的临床应用价值.方法 北京协和医院于2009至2010年对47例原发性面肌痉挛患者均采用显微血管减压手术,手术过程中间断电刺激患侧面神经颧支,记录同侧口轮匝肌肌电位的变化情况.手术后随诊5～22个月.结果 47例患者在手术开始时,均可在痉挛侧记录到异常肌反应信号.在手术过程中的不同阶段里,42例患者痉挛侧异常肌反应信号消失(其中4、9及29例患者的异常肌反应信号分别于剪开硬膜时、分离蛛网膜时、垫开责任血管时消失);全部42例患者术后未再发作面肌痉挛.5例患者异常肌反应波形在手术结束时仍未消失;随访中发现其中2例患者的面肌痉挛症状完全消失,3例患者痉挛程度较术前明显缓解.结论 显微血管减压手术中辅以异常肌反应电生理监测,可帮助判定责任血管,提高手术的疗效.