Volume 90  ·   Issue 43  ·  2010

In recent years, the incidence of trigeminal neuralgia tends to be aging, and most of the elderly patients are accompanied by cardiovascular and cerebrovascular diseases, diabetes, etc., and craniotomy has a great risk and a certain mortality rate. In order to explore the suitable treatment method for trigeminal neuralgia in the elderly, we summarized the data of CT-guided percutaneous semilunar ganglion radiofrequency thermocoagulation in elderly patients with trigeminal neuralgia in Xuanwu Hospital of Capital Medical University in recent 5 years, and reported as follows.

Objective To investigate the effects of endostar, a recombined humanized endostatin,on the growth, lymphangiogenesis and lymphatic metastasis of Lewis lung carcinoma xenograft in mice. Methods Lewis lung carcinoma (LLC) xenograft were established in C57 mice by intravenious transplantation of 1 × 106 cells. Then tumor-bearing mice were assigned into two groups: control group received caudal vein injections of 0. 2 ml of 0. 9% sodium chloride for 15 days, and treatment group received 500 μg endostar daily. Six weeks after LLC cell injection mice were sacrificed, and then tumor numbers and size were recorded. The expression of vascular endothelial growth factor-c (VEGF-C) and microlymphatic vessel density( MLVD)were observed by immunohistochemical staining. Results Tumor number and size of control group were significantly higher than those of treatment group. The microlymphatic vessel density (MLVD) was 5.7 ± 1.6 in the treatment group, which was markedly lower than in the control mice (7. 8 ±1.6). Two lymph node metastases were observed in treatment group, and eight in control group. Lymphatic metastases were more frequent in control group than in treatment group. Expression of VEGF-C in control group was significantly higher than that in treatment group. Conclusion Endostar significantly inhibits the growth, lymphangiogenesis and lymphatic metastasis of Lewis lung carcinoma xenografts, and the inhibitory effect is due to its ability to regulate the expression of VEGF-C of tumors in part.

Objective To study the biochemistry of blood and feature of pathology of an animal model in rabbits with the early primary hyperparathyroidism (PHPT). Methods 60 rabbits were divided 1-, 2- or 3-month intervals. Compared with the control animals, serum PTH levels, serum calcium levels and serum phosphorus levels were determined. The parathyroid and kidneys of all animals were performed by the histologic examination. Results Compared with the control animals, serum parathyroid hormone(PTH)levels were elevated at 1-, 2-,3-month intervals in experimental group( t = -7. 665, t= -16. 033, t =12. 877 respective, P ＜ 0. 05 ), whereas serum calcium levels were decreased at all three time intervals(t =6. 184,t = 9. 329, t = 13. 842, respective, P ＜ 0. 05 ), but serum phosphorus levels did not change ( t =0. 611 ,t = 1. 041 ,t = 1. 941, respective, P ＞ 0. 05 ). Parathyroid histopathologic studies demonstrated no change at 1 month whereas six of ten experimental animals showed mild hyperplasia at 2 months and nine of ten showed mild to moderate hyperplasia with gland enlargement at 3 months compared with control animals.Histopathologic examination of the kidneys showed no change at 1 month but focal parenchymal inflammation with calcium deposition at 2- and 3-month in the experimental groups. Conclusion The high-phosphate diet successfully induced an animal model in rabbits with the early primary hyperparathyroidism, which has a better stability and reproducibility.

Objective To analyze the clinical significance of a novel operating approach of cutting the core of uterus to perform freezing section histological examination intra-operatively for the patients with endometrial hyperplasia (EH). Methods The patients ready to undergo total hysterectomy with a histological diagnosis of EH were selected. In the cutting core group ( n = 39 ), the core of uterus was resected firstly according to the freezing histological diagnosis. Thirty cases received hysteroscopy with directed biopsies while the control group had 57 cases. Their differences of missed diagnosis rate of endometrial cancer and operative approaches were compared. And the clinic significance of cutting firstly the core of uterus intra-operatively was discussed. Results In the cutting core, hysteroscopy with directed biopsies and control groups, the missed diagnosis rate was 2. 6%, 3.3% and 14. 0% respectively. The missed diagnosis rate of first two groups had significant difference as compared with the controls (χ2 =4. 78,P ＜ 0. 05 ;χ2 = 4. 73, P ＜ 0. 05 ). Conclusion The novel operating approach can effectively prevent the missed diagnosis of endometrial cancer. It helps a surgeon to choose suitable operative extent for the patients with endometrial hyperplasia.

Objective To compare the success rate, radiation dose, image quality and diagnosis of prospective electrocardiogram (ECG)-gated 320-detector computed tomography coronary angiography (CTCA) versus retrospective ECG-gated CTCA. Methods Patients suspected coronary artery disease were divided into two groups which underwent 320-detector CTCA with prospective ECG-gated and retrospective ECG-gated scanning ( n = 240 each, HR ＜ 65 bpm ). Curved-planar reconstruction ( CPR ), maximum intensity projection (MIP) and volume rendering (VR) were performed to demonstrate the coronary arteries. The image quality was defined as excellent,good and poor by motion and stair-step artifacts. Effective radiation exposure dose was estimated from the dose-length product. Effective radiation dose, image quality and diagnosis were evaluated. Results The success rate of examination was 100% in prospective ECG-gated group and retrospective ECG-gated group. The mean effective radiation dose of prospective ECG-gated CTCA [( 3.3 ± 1.3) mSv] was significantly lower than that of retrospective ECG-gated CTCA [( 13.0 ± 1.6) mSv,P ＜ 0. 01]. Segments of diagnostic image quality ( 95.42%, 3435/3600 ) and non-diagnostic coronary segments (4. 58%, 165/3600) in prospective ECG-gated group were similar as those of retrospective ECG-gated group (95.81%,3449/3600 and 4. 19%, 151/3600, all P ＞0.05). Compared with CAG, the sensitivity, specificity, false positive and false negative value in prospective ECG-gated group (93. 22%,99. 21%, 91.64%, 99.05% ) and retrospective ECG-gated group ( 94. 55%, 98. 80%, 95. 86%,98.54% ) were not significantly different. Conclusion Though the effective radiation dose is significantly lower, the success rate, image quality and diagnosis of prospective ECG-gated 320-detector CTCA is comparable with that of retrospective ECG-gated 320-detector CTCA on patients with stable heart rates less than 65 bpm.

Objective To analyze the efficacy of surgical treatment for cavernous sinushemangiomas (CSH). Methods The data from 29 surgical CSH patients, 7 males and 22 females, aged 52 ± 9 years old, at our department were collected from 2003 to 2009 and analyzed retrospectively. The main presenting symptoms included headache ( n = 15 ), impaired visual acuity ( n = 9 ), diplopia ( n = 7 ), ptosis (n=2), facial paresthesia ( n = 6 ), hemiparesis ( n = 1 ) and infrequent menstruation ( n = 4 ). MRI was major preoperative modality. All patients underwent craniotomy via frontotemporal approach with or without orbitozygomatic osteotomy. The tumor was removed through intradural approach in all patients. Results Total removal was achieved in 14 (48. 3% ) patients. And 13 (44. 8% ) and 2 (6.9%) patients had subtotal and partial procedures respectively. No postoperative death occurred. Follow-up study of 3 months to 6 years was conducted in 27 patients (93%). All headaches were relieved postoperatively. The central nervous symptoms improved in 12 patients. The neuroendocrine symptom had no improvement. The most common surgical complications included impaired visual acuity ( n = 2, 6. 9% ), paralyses of oculomotor nerve ( n = 17,58.6% ), abduct nerve (n = 8, 27.6% ) and trigeminal nerve ( n =4, 13. 8% ). A MRI follow-up of 1-6 years was obtained in 16 patients without recurrence. Conclusion Surgery is an effective management strategy for CSH. However, total tumor removal remains difficult. Complications such as cranial nerve injury are still rather troublesome.

Objective To investigate the clinical efficacy of arthroscopic debridement, shaping and soft tissue releasing in the treatment of severe elbow osteoarthritis and ankylosis. Methods Arthroscopies were performed in 34 patients with severe elbow osteoarthritis. Among them, 13 were accompanied by ankylosis. In arthroscopic surgery, articular cavity was cleared. And loose bodies, osteophytes of coronoid process and olecranon of ulna were excised, the corocoid fossa and olecranon fossa shaped and joint capsules and collateral ligments severely contracted properly released. Rehabilitation training was guided postoperatively. Arthralgia and range of motion of elbow were scored by Mayo's scoring criteria in contrast with that preoperatively. Results The pain and range of motion ( ROM ) of elbow improved obviously in 34 patients. Angle of extension postoperatively increased by 30°± 16°and angle of flexion increased by 34°±19°. Postoperative ROM of elbow show significant difference with the preoperative status ( P ＜ 0. 01 ).According to the Mayo's scoring criteria, the excellent and good rate was 85. 3%. Conclusion Arthroscopic treatment of severe osteoarthritis and ankylosis of elbow is reliable. Trauma of arthroscopy is minimal and complications are rare.

Objective To evaluate the outcome of surgical treatment for spinal deformity in patients with achondroplasia. Methods Six consecutive cases of 3 males and 3 females were recruited. The average age at surgery was 18.5 years old with a range of 12 to 36 years old. All patients suffered thoracolumbar kyphosis and lumbar stenosis. Four patients had neurological deficits due to severe spinal deformity.Posterior osteotomy and decompression were performed in all cases. Long cassette supine radiographs were taken before and after surgery and at the final follow-up. Correction of kyphosis, neurological outcomes (JOA (Japanese Orthopedic Association) scores ) and operative complications were recorded and analyzed.Results The average follow-up was 10. 2 months with a range of 5 to 24 months. The average operative duration was 320 min with a mean 1300 ml of blood loss. The average number of fusion segments was 8 with a range of 5 to 10 segments. Kyphosis was corrected from 53.3° to 13. 3° with a 75.0% correction rate. The average preoperative JOA score was 4. 5 points and improved to 8. 5 points at the final follow-up. Conclusion Posterior osteotomy and decompression is a preferred surgical regiment for thoracolumbar kyphosis and lumbar stenosis in patients with achondroplasia.

Objective To investigate the change of brain edema in patients with cerebral infarction (CI) by the measurement of noninvasive cerebral electrical impedance (CEI). Methods An invariable secure current at a frequency 50 kHz and an intensity of 0. 1 mA was applied into a person's brain. The CEI of values for both hemispheres of 200 healthy volunteers and 107 CI patients was measured. The results werecompared with the volume of edema on CT. Results ( 1 ) In healthy volunteers, the CEI values in the left and right hemisphere were 8. 0 ± 1.0 and 8.0 ± 0. 7 respectively. And there was no significant difference between either side(P ＞ 0. 05 ). Age, sex and different measuring time points did not obviously affect the CEI values(P ＞0. 05). (2)In CI patients, the CEI was more sensitive in the volumes of lesion which was more than 20 ml (80. 0% ) ,the CEI was75.9% and 83. 3% in the volumes of lesion which was 20 -50 ml and more than 50 ml respectively. The CEI was low when the volume fell under 20 ml; ( 3 ) The CEI of the ispsilateral side was higher than contralateral side in the patients at Day 3 after onset. It increased obviously at Days 3-5 after onset. The difference of two sides was the most significant. CEI of two sides was 9. 2 ±2. 1 and 8. 8 ± 1.8 ( n = 91, P ＜ 0. 01 ) respectively at Day 3 after onset CEI of the infarction side increased continuously at Day 5 after onset (9.2 ±2. 3 vs. 8. 6 ± 1.9) ( n = 84, P ＜0. 01 ) respectively. It gradually decreased at Day 7 after onset, but remained higher than that of the contralateral side ( 8.9 ± 2. 2 vs. 8.7 ±2. 3, n =68, P ＞0. 05 ); (4)There was a positive correlation between the ispilateral CEI and the volume of infarction detected within 24 hours ( n = 31, r = 0. 682, P ＜ 0. 05 ) and at Day 3 ( n = 56, r = 0. 602, P ＜0. 05) after onset. Conclusion CEI may be a sensitive parameter for noninvasive monitoring the change of brain edema in CI patients. The higher the CEI, the more severe edema resulted. The sensitivity of CEI is higher when the volume of infarction exceeds 20 ml. CEI is a new technique for judging the patient condition of brain edema noninvasively.

Objective To identify the impact of gene-gene interaction between DNMT3B and DRD1 on the risk of schizophrenia. Methods Two SNPs (rs2424908 and rs6119954) within DNMT3B and five SNPs (rs4532, rs5326, rs2168631, rs6882300 and rs267418 ) within DRD1 were genotyped in 365 schizophrenic patients and 365 healthy controls. The gene-gene interaction between DNMT3B and DRD1 was analyzed by Multifactor Dimensionality Reduction (MDR) software. Results The frequency of genotypes of rs6119954 within DNMT3B was significantly higher in patients than that in controls (χ2 = 8. 06 ,P =0. 018 ).MDR revealed that the significance were shown in patterns with 2 SNPs ( rs6119954-rs267418 ) ( OR =1.79, 95% CI:1.29-2.47;χ2 =12.51, P=0.0004) , 3 SNPs (rs6119954-rs5326-rs267418) (OR=2. 36, 95% CI: 1.73 - 3.22;χ2 = 29. 33, P ＜ 0. 0001 ) and 4 SNPs ( rs2424908-rs6119954-rs5326-rs267418) (OR=3.08, 95% CI:2.24 -4.24;χ2 =48.88, P＜0. 0001). Conclusion The gene-gene interaction between DNMT3B and DRD1 may exist and increase the risk for schizophrenia.