Volume 88  ·   Issue 45  ·  2008

Intraspinal block complications refer to the physiological reactions, toxic effects and adverse effects of technical operation caused by intraspinal injection of anesthetics and related drugs.

Objective To analyze the CT and MRI features of peripheral primitive neuroectrodermal tumor (pPNET) arising in abdomen-pelvis region,and to improve the radiological diagnostic ability of this tumor. Methods The CT and MRI appearances of thirteen abdomen-pelvis region pPNET patients proved pathologically were reviewed retrospectively. Results The age of diagnosis ranged from 2 years to 72 years (median,30 years). The tumors were located in the abdomen and pelvic cavity (nine patients),retroperitoneal tissues (two patients),fight kidney (one patient) and liver (one patient). The radiological appearances of the tumors resembled heterogeneous soft tissue masses,eight masses with cystic or necrotic areas. Masses in abdomen and pelvic cavity and kidney were well-defined;while masses in retroperitoneal tissue and liver were ill-defined. Heterogeneous enhancement with intravenous contrast agents was evident. There are speckled,patching and irregular calcifications in four patients,one of them with calcification after treatment. Five patients died,and eight patients remissd on clinical follow-up. Conclusions The radiological features of peripheral PNET are non-specific. CT and MRI are useful in delineating the extent,finding distant metastasis,predicting respectability and monitoring treatment.

Objective To analyze the cases of thyroid carcinoma with special sonographic features,so as to increase the accuracy of sonographic diagnosis for thyroid carcinoma. Methods The senographic characteristics of 9 patients with special sonographic appearance were analyzed. According to the sonographic features,they were divided into two kinds:8 cases suffered from thyroid diffuse malignant lesions,and one case showed cystic lesion sticking out of the thyroid. The senographic appearance of gray scale and color Doppler characteristics of the lesions were recorded. Result In the first kind of lesions,the dimensional ultrasound appearance of gray scale had an apparent feature,however,its color Doppler characterisfics had no apparent feature,and all of the 8 cases were diagnosed correctly by ultrasound. In the second kind of lesion,the sonographic appearance of gray scale and color Doppler had no special features,so the case was diagnosed as benign disease wrongly by ultrasound. Conclusion The first kind of lesions has apparent sonographic features,sonographic diagnosis can serve as the first choice. However,the second kind of lesion had no apparent sonographic feature.

Objective To evaluate the efficacy and complications of laparoseopic Butch colposuspension and tension-free vaginal tape (TVT) in treatment of female stress urinary incontinence (SUI). Methods Thirty patients underwent laparoscopic Burch colposuspension and 67 age,BMI,parity,and grading-matched patients underwent TVT because of moderate to severe hypermodility urodynamic SUI from 2002 to 2006. Follow-up was conducted for (9±10) months. The clinical characteristics,mean operation time,hospital stay,peri-operative complications,and late complications were compared. Results The mean operative time and the hospital stay of the TVT group was (29.57±8.23) min and (3.0±2.1) d,both significantly shorter than those of the Butch operation group [(87±23) min and (4.8±1.9) d respectively,P<0.001 and P<0.01]. The blood loss of the TVT group was (27±12) ml,significantly less than that of the Butch operation group [(59±30) ml,P<0.001]. The subjective cure rate of the Bureh operation group was 86.5%,not significantly different from that of the TVT group (95.5%,P>0.05). Short-term complications included 1 case of bladder injury and 1 case of circumflex iliac vein injuring,both occurring in the Burch colposuspension group. The postoperative urine retention rate of the Burch colposuspension group was 23.5% ,not significantly different from that of the TVT group (14.9%,P>0.05),and the postoperative fever rate of the Burch colposuspension group was 16.2%,significantly higher than that of the TVT group (4.5%,P<0.05). Three cases of erosion of sling were found in the TVT group as late complications. Conclusion Both Bureh colposuspension and TVT are effective in the treatment of female SUI. The mean operative time of Butch operation and the hospital stay thereafter are longer;however,the cost of TVT is much higher than that of the Burch operation.

Objective To investigate the role of CD4+CD25+regulatory T cells in the mechanism of myasthenia gravis (MG) in children and adults. Methods Peripheral blood samples were collected from 13 MG patients,5 being aged >14 and 8 being aged ≤14,and 10 age-matched healthy persons. Peripheral blood mononuclear cells were isolated. Flow cytometry was used to examine the rate of CD4+CD25+regulatory T cells (Tregs). Fluorescence-activated cell sorter was used to detect the expression of Foxp3 and CTLA-4,2 important functional markers of CD4+CD25+Tregs. Results The percentage of CD4+CD25+Tregs of the MG children was significantly higher than that of the healthy children (P<0.05),and the percentage of CD4+CD25+Tregs of the MG adults was higher then that of the healthy adults,but not significantly (P=0.795). The expression level of Foxp3 of the MG children was significantly lower than that of the healthy children (P=0.011),and the expression level of Foxp3 of the MG adults was not significantly different from that of the healthy adult controls (P=0.084). The expression levels of CTLA-4 of beth the MG children and adults were lower than those of the healthy children and adults,but not significantly (P=0.556,P=0.767). Conclusion The CD4+CD25+Tregs in peripheral blood from MG pediatric patients are increased in number but unable functionally. The pathogenesis of MG in children may be correlated with the impairment of immunotolerance of the peripheral blood Tregs.

Objective To investigate the best concentration ratio of propofol controlled-infusion combined with sevoflurane in anesthesia for patients undergoing laparoscopy. Methods One hundred patients undergoing cholecystectomy under laparoscopy were randomly divided into 5 equal groups treated with propofol controlled plasma at the concentrations of 1,2 ,3 ,4,and 5 μg/ml respectively (Group 1-5). Bispectral index (BIS) was maintained at a range of 50±5 by adjusting sevoflurane inhalation. The end-tidal concentration of sevoflurane (ETsevo),systolic pressure,diastolic pressure,recovery time,awareness,and post-operative nausea and vomiting (PONV) within 24 h after operation were recorded. The best concentration ratio of propofol controlled-infusion combined with sevoflurane with the definition as the highest ETsevo without PONV decrease along with the increase of propofol concentration. Results ETsevo was negatively correlated with and propofol concentration. There were nit significant differences in the systolic pressure,diastolic pressure,and recovery time among different groups. No incidence of intra-operative awareness was found. The PONV rates of Group 1 and 2 were both 60%,significantly higher than those of the other 3 groups (all P<0.05) without significant differences in PONV rate among Group 3-5. The best concentration ratio of propofol controlled-infusion combined with sevoflurane was propofol controlled-infusion at the concentration of 1 μg/ml with ETsevo at the concentration as 1 minimal alveolar concentration (MAC). Conclusion Propofol controlled-infusion at the concentration of 1 μg/ml with ETsevo at the concentration as 1 MAC is the best concentration ratio with low PONV rate and a possibility to prevent intra-operative awareness.

Objective To investigate the effects of neo-adjuvant chemoradiotherapy followed by surgery in treatment of advanced esophageal carcinoma. Methods Forty-two consecutive patients with locally advanced esophageal carcinoma underwent chemotherapy and radiotherapy concurrently. The chemotherapy consisted of intravenous infusion of vinorelbine (25 mg/m2 per day) on days 1,8,22,and 29 or 5-fluorouracil (2.4g/m2) on days 1-3 and days 22-24,and cisplatin (75 mg/m2) on days 1 and 22. Radiotherapy was delivered 5 days a week for 4 weeks with the total dose of 40 Gy divided into a daily fraction of 2.0 Gy. After the completion of chemoradiotherapy,clinical restaging was performed. Esophagectomy and lymphadenectomy were performed 4-6 weeks after the chemoradiotherapy. Results Forty-one of the 42 patients finished the preoperative chemoradiotherapy. The clinical response rate of chemoradiotherapy was 83.3%. Forty cases received esophagectomy,with a radical operation rate of 97.5% and a pathological complete response rate of 23.8%. The overall 1,3,and 5-year survival rates were 66.9%,54.5%,and 44.9% respectively with a median survival time of 43.4 months. The 1,3,and 5-year disease-free survival rates were 61.1%,48.7%,and 39.5% respectively with a median disease-free survival time of 32.7 months. The toxic responses of the chemoradiotherapy,such as myelotoxicity,pulmonary toxicity,and esophagitis were at grade 1 or 2. No death occurred during chemoradiotherapy. The incidence rates of postoperative pulmonary infection and severe arrhythmia were 22.5% and 20.0% respectively. The postoperative mortality rate was 5.0%. Conclusion The neoadjuvant chemoradiotherapy followed by surgery achieves a high clinical response rate and pathologic complete tumor regression rate,significantly downstages the esophageal cancer,and improves the survival. Although the toxicity of chemoradiotherapy is mild,the side-effects cannot be ignored still.

Objective To study the etiologic genes of generalized epilepsy with febrile seizure plus (GEFS+). Methods Peripheral blood samples were collected from 25 persons of 2 families, including 2 probands. DNA was extracted from the peripheral blood leukocytes using phenol-chloroform method. Ten microsatellite markers spanning the critical regions of SCN1B, SCN1A, SCN2A, and GABRG2 genes were genotyped for linkage analysis by the software LINKAGE v5.1. The two-point linkage relation was determined by LOD score definiing the approximate position of etiologic genes of the 2 GEFS+families. Mutation analysis of the candidate etiologic genes in all members of these 2 families was performed. Results No sharing allele was discovered among the several microsatellite markers flanking SCN1A, SCN2A, and SCN1B genes, and the involvement of these genes in these 2 families could be excluded. In the family named Tian, sharing alleles were discovered among the markers D5S820, D5S422, and D5S1403 flanking GABRG2 gene. The two-point LOD scores at θ=0 were 0.67,1.0, and 0.79 for the marker D5S820, D5S422, and D5S1403, thus indicating possible linkage. In the family named Di, sharing allele was discovered only in the marker D5S1403 flanking the GABRG2 gene. Sequence analysis was performed for nine exons of the GABRG2 gene in these 2 families. Three single nucleotide variations were discovered on the exon 5 (c.588 C>T) , exon 3 (c.604 C>T) , and noncoding region of the exon 7. No mutation change of the GABRG2 gene was observed in these 2 families. Conclusion No evidence supports the causal relation between the SCN1B, SCN1A, SCN2A, and GABRG2 mutation and the etiologic genes in the two families with GEFS+. It is still not clear what is the common etiologic genes of GEFS+.

Objective To investigate the interaction between the cystathionine synthase gene (CBS)/hydrogen sulfide (H2S) and beme oxygenase-1 (HO-1)/carbon oxide (CO) systems during myocardial ischemia-repeffusion. Methods Twenty-four SD rats were randomly divided into 4 equal groups:ischemia-reperfusion (I/R) group undergoing intraperitoneal injection of normal saline (NS) and then 30 min later undergoing ligation of the left coronary artery (LCA) for 30 min,ischemia-reperfusion +zinc protoporphyrin (I/R+Z) group undergoing intraperitoneal injection of 45 μmol/kg zinc protoporphyrin,a HO-1 inhibitor,30 min before the ligation of LCA,ischemia-reperfusion + hydroxylamine (I/R+H) group,undergoing intraperitoneal injection of 5 mmol/L hydroxylamine,a CBS inhibitor,30 min before the ligation of LCA,and ischemia-reperfusion + zinc protoporphyrin + hydroxylamine (I/R+Z+H) group undergoing intraperitoneal injection of zinc protoporphyrin and hydroxylamine 30 min before the ligation of LCA. Another 6 rats underwent sham operation and intraperitoneal injection of NS 30 min before the operation and were used as control (C) group. The rats were killed 2 h after the reperfusion with their hearts taken out. Electron microscope was used to observe the mitochondrial structure. Homogenate of myocardium was prepared to examine the concentrations of H2S,CO,glutathione (GSH) ,malonyldialdehyde (MDA),activity of superoxide dismutase (SOD),and expression level of CBS-mRNA and HO-1-mRNA. Result The concentration of CO,H2S,GSH,and MDA increased,SOD activity decreased,and HO-1-mRNA and CBS-mRNA expression levels increased in Group I/R as compared with Group C (all P<0.01). In Group I/R+Z the CO level decreased,H2S and GSH levels increased,and HO-1-mRNA expression level decreased,but CBS-mRNA expression level increased as compared with Group I/R (all P<0.05). In Group I/R+H the H2S and GSH levels decreased,CO level increased,and HO-1-mRNA expression level increased and CBS-mRNA expression level decreased as compared with Group I/R (all P<0.05). In Group I/R+Z+H the H2S,CO,GSH,and SOD levels decreased,MDA level increased,and HO-1-mRNA and CBS-mRNA expression levels decreased as compared with Group I/R (all P <0.05). Electron microscopy found that mitochondrial structure was destroyed in the Groups I/R,I/R+Z,I/R+H,and most seriously in Group I/R+Z+H. Conclusion Both CBS/H2S and HO-1/CO systems play a protective role in myocardial ischemia-reperfusion and they interact on each other.

Objective To explore suppression of allograft vaseulopathy (AV) by transfer of the calcitonin gene-related peptide (CGRP). Methods The descending thoracic aortas from 39 Lewis rats were grafted to the abdominal aortas of 39 F344 rats,and then the recipient rats were randomized into 3 groups:Group A transfected with Ad5-CGRP-EGFP,a gene construct containing sequences from the adenoviral oncoprotein,CGRP,and enhanced green fluorescent protein ,Group B,transfected with Ad5-EGFP containing sequences from the adenoviral oncoprotein and enhanced green fluorescent protein,and Group C without transfection. Four and 8 weeks later the abdominal aortas of 6 recipient rats from each were collected respectively. The degree of vascular obstruction was observed by microscopy. Frozen tissue sections were made and the inverted phase contrast fluorescence microscopy was used to observe the green fluorescence showing the expression of CGRP and enhanced green fluorescent protein (EGFP). RT-PCR was used to detect the expression of CGRP. Immunohistochemistry was used to examine the expression of inducible nitric oxide synthase (iNOS) and vascular cell adhesion molecule-1 (VCAM-1). The apoptosis index (AI) was detected by TUNEL method. Results CGRP expression was positive in both Group A and B 4 weeks later and negative in both groups 8 weeks later. Group A is approximately normal in pathological morphology 4 weeks later. The vascular luminal occlusion score of Group A was lower than Groups B and C 4 weeks later,and significantly higher than that Ⅰ the same group (P<0.05),however,still lower than those of Groups B and C 8 weeks later. The AI 4 weeks later of Group A was significantly lower than those of Groups B and group C,however,there was no significance in AI among the 3 groups. Four weeks later the VCAM-1 expression levels in the tunicae intima,media,and adventita of Group A were all significantly lower than those of Group B C 4 weeks later,however,the iNOS expression level of Group A was only significantly lower than those of Groups B and C in the tunica intima 4 weeks later. Conclusion The expression of CGRP effectively suppresses the development of AV 4 weeks after the operation.

Objective To quantitatively evaluate the hemodynamic status in animal models of steroid-induced avascular osteonecmsis of femoral head (SANFH) by multislice CT (MSCT) perfusion imaging,and estimate the therapeutic efficacy on early intervention of hyperbaric oxygen (HBO) to improve the region blood flow (rBF) of ischemic femoral head. Methods Forty-eight New Zealand male rabbits were injected with Escherichia coli endotoxin and methyl-prednisolon to establish SANFH models and then divided into 3 subgroups to undergo MSCT to measure the rBF,regional blood volume (rBV),and mean transit time (MTT) to obtain perfusion maps at the femoral head epiphysis,metaphysic,and neck of femur,and then were killed to undergo histological examination of the bilateral femoral heads 2,4,and 6 weeks later respectively (Groups M2,M4,and M6). Twenty-four rabbits underwent HOB treatment after the second injection of E. c. endotoxin for 1-3 courses respectively ( Groups H1,H2,and H3),and then underwent MSCT and pathological examination as described above. Eight rabbits were used as controls (Group N). Results (1) The rBF values of Groups M2,M4,and M6 were all significantly lower than that of Group N (P<0.001,<0.001,and <0.002). The rBF value of femoral head epiphysis of Group M2 was remarkably lower than that of Group N,decreased to the lowest in Group M4,and re-increased in Group M6. The rBV value demonstrated similar change pattern in femoral head epiphysis. The MTT values of Groups M2 and M4 were longer than that of Group N,and then re-decreased in Group M6. (2) It did differ significantly between the perfusion data of different femoral head anatomic regions in Groups M2,M4,M6 and N (rBF:F=52.190,P<0.001;rBV:F=42.677,P<0.001;MTr:F=3.09,P=0.048). The changes of the perfusion data in femoral head epiphysis were more significant than those in other anatomic regions. (3) There were no statistically significant differences in the rBF value of the femoral head epiphysis and metaphysis (F=2.081,P=0.115;F=1.142,P=0.341),,in the rBV value of the femoral metaphysis and neck of femur (F=2.642,P=0.059;F=1.568,P=0.209) ,and the MTT value of all the anatomic regions (F=1.111,P=0.347) among Groups H1,H2,H3,and N. The rBF values of Groups H1 ,H2,and H3 were statistically higher than those of the corresponding phase model groups (all P<0.05). Conclusions Able to detect hemodynamic status of femoral head,MSCT perfusion imaging technique may be used in the early detection of SANFH. Early intervention of HBO therapy can improve the blood perfusion of femoral head.

Objective To explore the postsynaptic density (PSD) proteins related with the development of temporal lobe epilepsy (TLE). Methods Five SD rats were injected intra-peritoneally with lithium chloride and then pilocarpine twice to establish epilepsy models. At last 24 rats developed TLE,and 12 developed non-TLE. Then rats underwent intraperitoneal injection of normal saline (Norm group). Thirty days after the appearance of epilepticism the rats were decapitated with their brains taken out. The PSD proteins were extracted and purified by using sucrose gradient centrifugation and membrane sequence extraction,isolated by using two-dimensional gel electrophoresis. PDQuest software was used to screen the specifically and differentially expressed protein spots. Partial differentially expressed PSD protein spots were selected and identified by MALDI-TOF-MS. Several identified proteins were detected in the PSD fraction by Western blotting. Results Compared with the non-TLE and Norm groups,there were 40 ifferential protein spots in the TLE group. The expression levels of heat shock protein-27 (HSP-27),fructose-bisphosphate aldolase A (FBA),creatine kinase (CK),thyroid receptor-interacting protein 6 (TRIP6),myelin basic protein S (MBP) ,and LIM domain were up-regulated,but the expression levels of tubulin,actin,interoexin-alpha,peptidyl-prolyl cis-trans isomerase (PPIase) ,sorting nexin 3 (SNX3) ,aconitate hydratase (ACO) ,glyceradehydea-3-phosphate ehydrogenase (GADPH),and succinate-coenzyme A ligase (SCOAL) were down-regulated in the TLE group. The HSP27,tubulin-alpha,and SNX3 were in the PSD gels were immunostaining positive in the 3 groups. Conclusion The differential expression of PSD proteins in TLE may be due to injury induced neural plasticity. But the degree thereof may contribute to the development of TLE. These identified proteins can be regarded as important candidates for or against the development of TLE.

Objective To develop a new method to promote the differentiation of mesenchymal stem cells derived from human placenta (pMSC) to uterus smooth muscle cells (uSMC) in simulated uterus microenvironment. Methods MSCs were isolated from human placenta,cultivated,and analyzed for their phenotype by flow cytometry. The muhipotential differentiation of the pMSC was examined by chondrogenic,adipogenic,and osteogenetic induction,uSMC were isolated from uteri resected during operation and co-cultivated with the pMSC in a Transwell chamber simulating Two,4,and 8 days later RT-PCR and Western blotting were used to detect the mRNA and protein expression of α-actin,calmodulin,and myosin heavy chains (MHC),the markers of smooth muscle differentiation at the early,middle,and late stages. On clay 8 RT-PCR was used to detect the expression of estrogen receptor in these 2 groups of cells,then estrogen was used to stimulate these cells and the protein kinase C (PKC) activity was examined. Results The pMSC could be induced into adipocytes,osteocytes,and chondrocytes respectively. After co-culture with uSMC,the morphology of the pMSC changed closely into that of the uSMC,and MHC was expressed in the pMSC. Estrogen receptor was positive in both groups of cells. The PKC activity increased,especially in the cell membrane,after stimulation of estrogen. Conclusion The postpartum human placenta can be used as an important and novel source of muhipotent stem cells for tissue engineering and genetic engineering. Placental MSC have the potential to differentiate into smooth muscle cells under the simulated uterus microenvironment in vitro.

neurofibromatosis type 2 (NF2) is an autosomal dominant disease, localized at 22q11-q13.1. It is mainly manifested as bilateral acoustic neuroma, which may be accompanied by neurofibroma, meningioma, ependymoma and astrocytoma in the cranial and spinal canal. Four cases of NF2 complicated by cervical spinal ependymoma were collected in this group and reported as follows.

Objective To investigate the effect of a new technique of navigated percutaneous placement of iliosacral screws using intra-operative three-dimensional (3D) imaging. Methods Sixteen patients with hip fracture were placed in supine position. After the reference marker was fixed on the iliac crest,a 3-D C-arm navigation system was used intra-operatively to obtain 3D images that were transferred to the navigation system by an automatic. Registration process to calculate the length of screw and direction to insert it. A navigated pointer defined the entry point,while navigated percutaneous drilling was done accordingly with a navigated drillbit in combination with a navigated drill sleeve under permanent dynamic control on the navigation screen without further intra-operative fluoroscopic imaging. A control intra-operative 3D scan was used to observe the position of the screws,while for didactic reasons another postoperative CT scan was done. Results Twenty screws were successfully inserted into the first sacral vertebral bodies of the 16 patients. No additional intra-operative and postoperative complications occurred. The average operation time was 80 minutes and the average intra-operative radiation time was 1.13 minutes. Four patients underwent bilateral iliosacral fixation with longer operation time (152 minutes) and radiation time (1.56 minutes). The post-operative 3D scanning showed good results. No screws penetrated into the sacral canal or foramen. The reduction of fracture or dislocation and the position of iliosacral screws were all judged satisfactory. Conclusion Compared with the conventional fluoroscopy method,navigated percutaneous placement of iliosacral screws under intra-operative 3D imaging reduces the radiation time and improves the accuracy. It is feasible and useful though there are some disadvantages such as the inferior image quality compared to CT scan,prolonged operation time and higher overall cost.

A 24-year-old woman was admitted to the Department of Immunology, Peking Union Medical College Hospital on 23 January 2007 due to fever, rash and polyarthralgia for one month. On 9 December 2006, she had fever without obvious inducement, and the fever type was irregular, with several peaks a day, the highest being 38.5℃, accompanied by chills, chills, sore throat, bilateral hip, knee and wrist pain, swelling of both wrists, and no morning stiffness.

A 24-year-old female patient was treated in a foreign hospital in November 2006 due to headache, dizziness, numbness of left limb and unfavorable movement. CT of the skull showed mixed high-density shadows of the right parietal lobe (Figure 1A), and MRI of the skull showed irregular sheet shadows of the right parietal lobe (Figure 1B, C), with circular shadows of the long T1 and short T2 signal around it. Arteriovenous malformation was suspected. Whole brain angiography (DSA) was not performed for personal reasons, and she was discharged after conservative treatment.

Systemic lupus erythematosus (SLE) is a chronic and inflammatory autoimmune disease, which can affect many organs from skin to internal organs. It is characterized by the formation of autoantibodies such as antinuclear antibodies and autoimmune complexes.

A 25-year-old male was admitted to the hospital due to "left ankle pain gradually worsening for half a year". Physical examination revealed local swelling and tenderness. The lateral and axial X-ray films of the calcaneus showed osteolytic lesions of the left calcaneus with clear boundaries and sclerosis, slight swelling and thinning of the bone cortex, multiple partitions of different sizes, and no obvious soft tissue mass.