2015年 · 第95卷第41期

On the occasion of the 100th anniversary of the founding of the Chinese Medical Association and the 100th anniversary of the founding of the Chinese Medical Journal, we are inspired to look back on the 80-year history of neurosurgery in China, and we are full of confidence to look forward to the future.

In recent years, with the rapid increase of various vehicles, the occurrence of lower cervical dislocation has been increasing year by year^[1,2]。 At present, the commonly used treatment for lower cervical dislocation is preoperative heavy-weight traction. If the reduction is successful, anterior cervical surgery should be performed. If the reduction fails, posterior surgery or combined posterior-anterior surgery should be performed^[3,4,5,6]。 In this study, the patients with lower cervical dislocation were treated with first-stage anterior cervical decompression and then reduction in emergency department, and good results were achieved.

Craniopharyngioma is a common intracranial lesion, which originates from the embryonic residual cells in the nodule of the pituitary stem. Therefore, it is often adjacent or adherent to important structures such as the surrounding optic nerve, pituitary stem and hypothalamus, so there are many postoperative complications and severe patient reactions. Therefore, this study summarized and analyzed the clinical data of 58 cases in the Department of Neurosurgery of Beijing Tiantan Hospital from October 2012 to October 2013, and made a preliminary discussion on the management of postoperative complications of adult craniopharyngioma.

The 43-year-old female was admitted to the Department of Obstetrics and Gynecology, Beijing Military Region General Hospital of the People's Liberation Army due to dysmenorrhea for 33 years and aggravation for 3 years. Usually, menstruation was regular, 5~6/33 days, with moderate amount and severe dysmenorrhea. The patient developed dysmenorrhea after menarche, which was unbearable, and intermittently took oral analgesics. It improved before and after giving birth in 1997, and the symptoms of dysmenorrhea worsened in 2005. A mass appeared at the scar of cesarean section consciously, and the menstrual period became larger, harder and tender. The lower abdominal pain accompanied by lumbosacral soreness from 1 d before menstruation to 2 or 3 d after menstruation required oral analgesics, and the pain symptoms gradually decreased after menstruation. In 2010, I experienced anal distension and severe feeling after tenesmus, enlarged mass at the scar, and aggravated menstrual pain. I went to a local hospital, considered abdominal wall incision endometriosis, and recommended surgery. I did not follow the doctor's advice, and then the symptoms progressively aggravated, seriously affecting the quality of life, so I was hospitalized on October 21, 2013. The patient's past history was not special, and there was no history of hormone treatment. Married at the age of 25, with 4 deliveries and 1 delivery, 1 medical abortion and 2 induced abortions. In 1997, she gave birth to a full-term live girl by cesarean section, and she was healthy. Physical examination: body temperature 36.5℃, heart rate 80 beats/min, breathing 18 beats/min, blood pressure 110/70 mmHg (1 mmHg =0.133 kPa), normal development, clear consciousness, cooperative physical examination, no abnormalities in cardiopulmonary auscultation, soft abdomen, a transverse old surgical incision scar about 10 cm long can be seen 3 cm above the pubic symphysis, and a mass about 4.0 cm ×2.5 cm in size can be seen on the left side of the incision scar, with clear boundaries, located subcutaneously, and no obvious tenderness. Gynecological examination: vulva is married, vagina is unobstructed, cervix is smooth, uterus is horizontal, such as the size of 8 weeks of pregnancy, hard in texture, no tenderness, and the double adnexal area is not palpable with obvious abnormalities.

A 68-year-old male was diagnosed with primary Parkinson's disease in the First Affiliated Hospital of Dalian Medical University 10 years ago, and had a history of hypertension and diabetes for 10 years. At present, in the H-Y stage 3, oral administration of dopaserazide tablets, carbazolidopa controlled-release tablets, entacapone, pramipexole and selegiline, the symptom control is poor, and there is an "on-off" phenomenon. The opening period is about 1 h, accompanied by involuntary movement, posture instability, restlessness, stiffness of limbs, difficulty walking, and sweating all over the body. The UPDRS scores in the on and off periods were 63 and 74. Admission for deep brain electrical stimulation (DBS). The target was the bilateral subthalamic nucleus (STN), and microelectrode recording was performed 10 mm from the target. The temporary irritation symptoms improved satisfactorily, and a permanent electrode (L301, Tsinghua Pinchi) was implanted. Under general anesthesia, a left anterior subcutaneous pulse generator (G102R, Tsinghua Pinchi) was implanted. On the night after surgery, the patient was sleepy and lazy, and could be awakened with reasonable questions and answers. On the first day after surgery, he woke up from general anesthesia and took the same medication as before surgery. The "on-off" phenomenon was significantly reduced, the opening period was prolonged, and the abnormal movement of the opening period disappeared. The UPDRS scores were 38 and 59 in the on and off periods. On the second day after surgery, the patient was somnolent again, accompanied by new symptoms such as hallucinations, unreasonable questions and answers, and groping with both hands. Re-examination of the head CT showed patchy low-density shadows in the cortex around the left electrode and subcortical white matter (Figure 1), MRI undercooperation. On the 4th postoperative day, symptoms returned to baseline levels, with reasonable questions and answers and no groping movements. On the 6th postoperative day, head MRI revealed T₂High signal around the left electrode of WI, with a maximum diameter of about 3.52 cm (Figure 2)。 Dexamethasone 10 mg, once a day, intravenous drip for 3 days; Continue prednisone 30 mg, once a day, orally for 4 days. Retrospective head MRI at 20 days after surgery showed T₂WI hyperintensity resolved significantly (Figure 3)。

Coronary heart disease is the result of the interaction of immune mechanisms with metabolic risk factors. In the early stage of atherosclerotic lesions, immune cells occupy a dominant position, and their effector molecules can accelerate the progression of the lesions, while the activation of inflammatory response can trigger acute coronary syndrome. The study found that the root cause of acute myocardial infarction in the vast majority of cases is thrombosis on the basis of atherosclerotic plaques. 60% ~70% of patients with acute myocardial infarction develop thrombosis secondary to plaque rupture. Plaque rupture is typically located in the weak areas and incomplete parts of the fibrous cap. Immune cells are abundant in this location, which produce a large number of inflammatory molecules and proteolytic enzymes, which in turn lead to the progression of stable plaque to vulnerable plaque. Once the plaque ruptures, the contents of the plaque (phospholipids, tissue factors, platelet adhesion molecules, etc.) can be exposed to the blood, accelerating thrombosis, blocking blood vessels, and causing acute myocardial infarction. It can be said that acute myocardial infarction is a process of thrombosis and inflammation^[1]。

Pelvic organ prolapse (POP) is a common disease in multiparous women at all ages, with a prevalence of up to 37%^[1]The pathogenesis of POP is complex and involves many factors^[2]Such as postpartum or multipartum, menopause, advanced age, history of previous pelvic floor surgery, connective tissue disease, low estrogen level, smoking, chronic obstructive pulmonary disease, obesity, long-term increase in abdominal pressure, etc., but damage to pelvic floor supporting tissues such as uterosacral ligament (USL) and main uterine ligament (CL) is an important anatomical cause of its pathogenesis. In recent years, with the continuous exploration of the anatomy of DeLancey's first level, that is, the main ligament-uterosacral ligament complex, and the rapid development of imaging technology, especially studies have shown that the preoperative use of dynamic or functional magnetic resonance imaging (MRI) to evaluate pelvic floor dysfunction can change the initial surgical planning of 67% patients^[3]Therefore, MRI provides a useful tool for evaluating the complex pelvic floor condition of pelvic floor dysfunction, studying the mechanism of POP, achieving precise diagnosis and individualized surgical selection. The anatomical histology and MRI characteristics and clinical application of the principal sacral ligament of the uterus are summarized as follows.

Combination of clopidogrel and aspirin as standard antiplatelet therapy after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). 2003 Müller et al.^[1]Platelet aggregation inhibition was found in 4.7% of PCI patients taking clopidogrel<10%, and is associated with an increased risk of clinical thrombotic events. Studies have found that the antiplatelet effect of clopidogrel is heterogeneous, and 4% ~30% of patients have "clopidogrel resistance" or "platelet hyperreactivity"^[2]。 For this reason, in 2010, the US FDA issued a "black alert", recommending that patients with poor response to clopidogrel may consider drug genetic testing. Individualized treatment of clopidogrel based on laboratory testing has received extensive attention in clinical research and clinical practice, mainly including platelet function testing and drug gene polymorphism testing. This article reviews the research on individual responsiveness differences and individualized treatment of clopidogrel.