Diagnosis and treatment of diffuse axonal injury in 169 patients

Diffuse axonal injury (DAI) following brain injuryhas acute and severe clinical manifestations andleads to a very high death rate. At presenttherapies for DAI do not have good effect. Weretrospectively analyzed 169 DAI patients treated in theSecond, Sixth…     

Combined trans-sphenoidal and simultaneous trans-ventricular-endoscopic decompression of a giant pituitary adenoma: case report

Objective  This is the first report of the simultaneous combined use of trans-sphenoidal and trans-ventricular-endoscopic route for decompression of a giant pituitary adenoma. Method  A 38 year old man presented to us with symptoms of raised intracranial pressure along with visual and hypothalamic disturbances. The CT scan revealed destruction of the sella by a large (5 × 3.5 × 2.5 cm) well defined enhancing mass in the sella and suprasellar region extending laterally up to the cavernous sinuses and both carotid arteries and superiorly into the lumen of the 3rd ventricle producing obstructive hydrocephalus. On T2WI of the non-contrast MRI scan the mass was iso-intense to grey matter suggesting the possibility of a firm nature of the adenoma. The tumour was first approached by the standard trans-sphenoidal route and as predicted from the pre-operative MRI, the tumour was found to be firm and not amenable to suction. After decompression of the intra-sellar part of the tumour, the intracranial pressure was raised in an attempt to make the remainder of the tumour descend into the sella but without success. The suprasellar part of the tumour was then simultaneously addressed via a trans-ventricular-endoscopic route but the firm tumour did not yield to endoscopic instruments viz. biopsy forceps, angiographic catheter and electrosurgical probes. It was then gently pushed down towards the sella and decompressed piecemeal by using trans-sphenoidal instruments. The sellar cavity was reconstructed using fat, fascia lata graft and a piece of septal bone. Results  Post-operatively, the patient showed a remarkable improvement of his symptoms of raised intracranial pressure, hypothalamic dysfunction and visual disturbances. Follow-up imaging at 2 months and 1 year, did not show any residual or recurrent tumour. Conclusions  This novel technique of the combined trans-sphenoidal and simultaneous trans-ventricular-endoscopic approach is a viable option for patients with giant fibrous pituitary adenoma when the tumour is not yielding to the trans-sphenoidal route alone.     

巨大消化性溃疡穿孔治疗中改良式四步法修补术的应用分析

目的 探讨及总结巨大消化性溃疡穿孔修补手术处置策略及围手术期疗效。方法 回顾性选取2014 年1 月～2020 年5 月本院采用改良式四步法修补术治疗的巨大消化性良性溃疡穿孔患者20 例作为观察组,选取同期实施小穿孔常规修补术治疗直径＜1.0 cm 的良性消化性溃疡穿孔患者20 例作为对照组。比较两组围术期相关指标、并发症发生情况及临床症状评分。结果 两组并发症发生率比较,差异无统计学意义（P＞0.05）,观察组患者术后无一例发生瘘及腹腔脓肿,均进半流质饮食后顺利出院。对照组禁食时间、胃肠减压时间、住院时间、治疗费用少于观察组,差异有统计学意义（P＜0.05）。治疗后两组患者反酸、嗳气、上腹部疼痛程度评分均明显下降,且治疗后两组患者各项症状评分比较,差异无统计学意义（P＞0.05）。结论 采用改良式四步法修补术治疗巨大消化性溃疡穿孔,临床效果满意,较直径在1.0 cm 以下的良性消化性溃疡穿孔患者仅增加禁食时间、胃肠减压时间、住院时间及治疗费用,未增加并发症发生率。     

弥漫性轴索损伤研究进展

弥漫性轴索损伤(DAI)是用于描述头部伤后以脑深部神经轴索肿胀、断裂为特征的脑损伤类型。本文就近年来对DAI研究进展包括发生机制、病理特征、临床表现、诊断及其治疗综述如下。     

虎杖免煎冲剂对糖尿病大鼠肾脏RAGE及VEGF表达的影响

目的探讨虎杖免煎冲剂对实验性糖尿病大鼠肾脏病理结构和糖基化终末产物受体(RAGE)、血管内皮生长因子(VEGF)表达的影响。方法Wistar大鼠36只,其中8只喂养普通饲料(正常组),其余28只给予高糖高脂饲料喂养,4周后注射链脲佐菌素(STZ)造成糖尿病模型,造模成功后,分别用蒸馏水(模型组)、虎杖免煎冲剂(虎杖组)、氟伐他汀(他汀组)灌胃。8周后观察各生化指标的变化;HE染色及电镜下观察肾脏病理改变;免疫组化法检测肾小球RAGE、VEGF的表达水平。结果与模型组相比,虎杖组大鼠的肾重／体重、肌酐清除率、24h尿蛋白量、肾小球平均体积均下降(P＜0.01,P＜0.05),肾脏病变程度轻,肾小球RAGE、VEGF表达下调(P＜0.05,P＜0.01)。结论虎杖免煎冲剂对糖尿病大鼠具有肾脏保护作用。其机制可能与其下调肾组织中RAGE、VEGF的表达有关。     

颞骨巨细胞瘤的诊断与治疗(附1例报告)

目的:探讨颞骨巨细胞瘤的临床表现、诊断、鉴别诊断和治疗方法。方法:分析我科收治1例颞骨巨细胞瘤患者的症状、体征、影像学、病理学特点,并复习相关文献。结果:患者为女性,发生于左侧颞骨,病理分级为Ⅱ~Ⅲ,行根治性切除,术后放疗。结论:颞骨巨细胞瘤的诊断须结合临床、影像和病理学资料进行,治疗以手术切除为主,必要时辅以术后放疗。     

PRIMARY STUDY OF REPAIRING PERIPHERAL NERVE GAP WITH PORCINE SMALL INTESTINAL SUBMUCOSA

Objective To investigate the role of porcine small intestinal submucosa （SIS） conduit in axonal regeneration of rat sciatic nerve with a 10 mm gap. Methods Forty-eight rats were randomly divided into three groups （n=16）. Following a 10 mm gap was made in one side of the sciatic nerve of each rat; previously prepared SIS and auto-nerve graft were interposed into the gap to reconnect the proximal and distal ends of the nerve, respectively. In the control group, the nerve gap remained unconnected. The samples of the SIS, graft, and distal nerve in group 1 and group 2 were harvested at 6 weeks and 10 weeks after operation, respectively. Axonal regeneration was evaluated by histology, electrophysiology, and quantitated by using computer-analyzed image.Results Regenerative nerve fibers were evident which contained much myelinated axons and grew over the gap in the SIS conduits at 10 weeks. Electrophysiological examination and computer-analyzed image showed that axonal regeneration in the SIS group was similar to that in the auto-nerve grafting group at 10 weeks. Conclusion SIS as a conduit possesses the ability for axonal regeneration of the peripheral nerve, thereby having a potential to be an alternative bio-material instead of the autograft to repair the peripheral nerve gap.     

不同氧浓度复苏对创伤性轴索损伤合并低氧血症后大鼠脑组织的影响

目的 在创伤性轴索损伤（traumatic axonal injury,TAI）合并低氧血症性二次脑损伤（secondary brain injury,SBI）大鼠模型基础上进一步探讨不同氧浓度复苏对大鼠脑组织病理学的影响.方法 应用自制TAI致伤装置,大鼠伤后给予10％浓度氧吸入30min制成低氧血症性SBI模型,随后给予大鼠不同氧浓度混合气体1h,复苏后不同时间点（24h、1周）进行免疫组化染色.结果 脑干ROI的β-APP免疫组化染色显示,24h时TAI合并缺氧组的阳性染色明显强于各复苏组,50％氧浓度时的阳性染色最弱;各组阳性染色随时间而减弱,1周时各组阳性染色明显弱于24h,此时TAI合并缺氧组的阳性染色仍明显强于各复苏组,50％氧浓度时的阳性染色最弱.染色阳性的神经轴索半定量分析显示,24h时TAI合并缺氧组明显高于各复苏组,50％氧浓度时的值最低;各组数值随时间而降低,1周时各组值明显低于24h,此时TAI合并缺氧组的值仍高于各复苏组,50％氧浓度的值仍为最低.结论 给氧治疗可以显著减低轴索损伤,起到神经保护作用;对于当前的TAI合并缺氧动物模型的最佳复苏氧浓度为50％.     

Diffuse Axonal Injury after severe head trauma

Summary Diffuse Axonal Injury (DAI) is a well known entity that affects many patients with severe head trauma. Classically DAI has been considered the pathological substrate of those cases rendered unconscious at the moment of impact and in which the CT scan does not show mass lesions. Diffuse axonal damage is almost always related to mechanisms of injury in which the rotational acceleration produces shear and tensile strains of high magnitude. In this paper we present a group of 24 patients with a severe head injury in whom the postmortem examination demonstrated unequivocal signs of DAI.Widespread axonal retraction balls, located preferentially in the centrum semiovale and internal capsule were the most constant histological finding. We divided the entire series into two subgroups. One group (15 cases), included all the patients in whom the CT scan did not demonstrate mass lesions. In the second group (9 patients) we considered patients with a diffuse axonal injury in whom the CT scan additionally demonstrated a mass lesion (6 acute subdural haematomas, 2 intracerebral and 1 extradural haematoma). The mean age of the entire group was 26 years.Twenty two patients were injured in a road traffic accident, the remaining two fell from a considerable height. All were rendered immediately unconscious on impact. Diffuse brain damage is a common finding in patients with a severe head injury and immediate coma in whom the CT scan does not show mass lesions. Diffuse axonal injury can also appear in connection with a wide spectrum of focal lesions (acute subdural haematoma, basal ganglia haematoma etc.). Associated shear injuries of the brain in this latter group, could justify the poor outcome that certain groups of patients had in spite of the rapid surgical treatment and aggressive control of intracranial pressure.     

颈部巨淋巴结增生临床分析

目的 提高对颈部巨淋巴结增生(Castleman病)的诊断水平.方法 回顾性分析曾经误诊的10例巨淋巴结增生的临床资料,分析临床诊断和鉴别诊断的经验和教训.结果 10例颈部巨淋巴结增生患者,男3例,女7例;按Frizzera分类标准分为局灶性8例(其中透明血管型6例,混合型2例),多中心性2例(其中浆细胞型1例,混合型1例).临床以无痛性颈淋巴结肿大为特征,多中心性2例伴有全身症状和(或)多脏器受累等特征.10例患者均为误诊后接受淋巴结切除术后病理检查确诊.随访4～17年10例患者均健康生存,其中1例多中心性浆细胞型患者术后2年复发,再次接受淋巴结手术切除术和化疗后4年未再复发.结论 颈部巨淋巴结增生临床少见,易于误诊,应采用淋巴结切除活检术病理检查确定诊断,注意与颈淋巴结结核、颈淋巴结炎、结节病、肉芽肿等鉴别.如无系统功能严重受累,首选手术切除.