Volume 93  ·   Issue 33  ·  2013

Pulsatile tinnitus is one of the common symptoms of otology, with about 9 million patients in China^[1,2]。 Most patients have a strong desire to eliminate tinnitus torment and improve quality of life. Imaging examination plays an important and irreplaceable role in diagnosing the etiology of pulsatile tinnitus. At present, there is a lack of standards or guidelines for imaging examination methods for this disease. Based on the previous research, the Head and Neck Group of Radiology Branch of Chinese Medical Association puts forward the following examination guidelines for everyone's reference, and hopes to give timely feedback on problems found in reference use for further improvement.

To evaluate the sensitivity and specificity of computed tomographic angiography (CTA) for dural arteriovenous fistulas (DAVFs) in patients presenting with pulsatile tinnitus (PT).

The clinical and imaging data were collected for all patients undergoing CTA for PT from 2008 to 2012.Nine PT patients with DAVFs confirmed by digital subtraction angiography (DSA) and 9 age- and gender-matched control PT patients without DAVFs were selected.The CTA images were blindly analyzed by two experienced neuroradiologists for the following signs: asymmetric venous collaterals in extracranial space, asymmetric attenuation of internal jugular vein (IJV),asymmetric external carotid artery (ECA) branches,"shaggy"appearance of dural venous sinus, multiple transcalvarial channels, enlarged foramen spinosum, asymmetric cavernous sinus and enlarged cortical veins.

The sensitivities of the following DAVFs signs were quite different:asymmetric attenuation of IJV (89%), asymmetric venous collaterals (89%), asymmetric ECA branches (78%), shaggy dural venous sinus (67%), multiple transcalvarial channels (67%), enlarged foramen spinosum (56%), stenosis of venous sinus (33%) and asymmetric cavernoussinus (22%). The presence of asymmetricattenuation of IJV,asymmetric ECA branches, shaggy dural venous sinus, multiple transcalvarial channels and asymmetric cavernous sinus all demonstrated a highly specificity of 100% while the presence of asymmetric venous collaterals and enlarged foramen spinosum had a specificity of 89%.The presence of stenosis of venous sinus revealed a specificity of 78%.Enlarged cortical veins were all absent.

CTA may be used as a screening examination for DAVFs in PT patients.The presence of asymmetric venous collaterals, asymmetric attenuation of IJV, asymmetric ECA branches, shaggy dural venous sinus and multiple transcalvarial channels has a high sensitivity and specificity for diagnosis.Enlarged ECA branches usually serve as DAVFs feeders.Meanwhile, DAVF should be considered in PT patients when multiple transcalvarial channels and enlarged foramen spinosum are detected on high-resolution CT of temporal bone.

To improve the imaging diagnosis accuracy on masses of temporal bone associated with pulsatile tinnitus.

The CT and MRI features of masses in temporal bone associated with pulsatile tinnitus in 32 cases, confirmed by pathology, were retrospectively analyzed.

They were grouped into two according to the jugular bulb involved or not.In the group involving the jugular bulb, there were 5 cases with glomus jugular, 2 cases of them presented the feature of"salt-pepper".There were 5 cases with middle ear carcinoma, which presented the masses in the tympanic cavity and antrum,extended to the external auditory canal and eroded the eustachian tube and jugular bulb.There were 3 cases with endolymphatic sac tumors, which presented multiple bony spicules on CT images and high signal on T₁-weighted images.There was 1 case with metastatic tumor, which extensively eroded temporal and occipital bone, involved the jugular bulb, presented intermediate signal on T₁-weighted images and intermediate or high signal on T₂-weighted images, moderately enhanced following contrast administration.In the group not involving the jugular bulb, there were 15 cases with tympanic glomus, without ossicles and tympanic erosion, 7 cases of them limited to the promontory,7 cases of them filled the tympanic cavity and antrum and 5 cases extended deep into the external auditory canals, 1 case extended to the mastoid, 12 cases intensely enhanced with gadolinium.There were 2 cases with cholesterol granulomus of the middle ear, which presented the masses in the tympanic cavity and antrum and high T₁-weighted and T₂-weighted signal.There was 1 case with facial nerve hemangioma, which presented the enlargement and mass of the geniculate fossa involving the tympanic segment of facial nerve with the erosion and displacement of ossicles.On MR images,the mass was intensely enhanced after contrast administration.

Among the masses of temporal bone associated with pulsatile tinnitus, the paragangliomas are the most common and easy to be diagnosed by their imaging features.While the other masses of temporal bone are uncommon, they could also be diagnosed accurately by clinical and imaging characteristics.

To evaluate the value of temporal bone dual phase contrast enhancement computed tomography (DPCT) in diagnosing the causes of pulsatile tinnitus (PT).

We retrospectively analyzed the DPCT findings of 157 patients with unilateral PT.Temporal bone Highresolution CT (HRCT) was performed in 71 patients, magnetic resonance imaging (MRI) in 80 and digital subtraction angiography (DSA) in 89.

In 71 patients with both DPCT and HRCT scan, a total of 68 causes were found.The accuracy of DPCT was 100% it was significant higher than that of HRCT (77.9%).In 80 patients with both DPCT and MRI, 83 causes were known.The accuracy of DPCT (94.0%) was significantly higher than that of MRI (8.4%).In 89 patients with both DPCT and DSA scan, 99 causes were identified.The accuracy of DPCT was 91.9% and it was significantly higher than that of DSA (15.2%).

DPCT may be an ideal imaging modality for diagnosing the causes of PT.

To comparison of the type and the incidence of complications connected with the use of the Laryngeal Mask Airway (LMA) and sevoflurane anesthesia in different ages children.

160 ASAⅠ or Ⅱ children aged 1-10 yrs body mass index (BMI) 14-21 undergoing inguinal hernia repair operation were divided into 4 groups according to their ages,7 m-1 yrs in group A, 1-3 yrs in group B, 4-6 yrs in group C and 7-10 yrs in group D.General anesthesia was induced with sevoflurane and nitrous oxidein (N₂O) via a pediatric circle system.No premedication were given.Insertion conditions were noted as satisfactory (jaw relaxed, lash reflex disappeared, no coughing, gagging, swallowing).LMA were placed using the reverse technique, then ilioinguinal/iliohypogastric nerve blocks were performed.No neuromuscular blocking drugs were used and spontaneous breathing was permitted.LMA were removed after the end of operation, then the patient were sent to post-anaesthesia care unit (PACU).The time of operation and awakening, vital signs and Aldrete scale were recorded.The incidence of adverse effects (coughing, gross movement, laryngospasm, agitation, nausea, vomiting, sore-throat, respiratory depression, glossoptosis, breathholding and hypercapnia) were also noted.

There was no significantly difference in four groups about sex, BMI, operation time, the time of awakening and Aldrete score (P>0.05).The incidence of hyoxemia, glossoptosis, nausea, vomiting and cough were no significantly difference in four groups, but the incidence of hypercapnia was higher in group A than in other three groups.The incidence of agitation in group C were singnificantly higher than in group A and group B.The incidence of breathholding was higher in group A and group D than in group B and group C.

The age can influence complications connected with the use of the LMA and sevoflurane anesthesia in children.Respiratory complications is easy to occurred in children less than 1 years.Agitation is especially frequent in children 4-6 years.

To explore the clinical characteristics of pregnant uterine rupture, enhance its early diagnosis rate and improve its prognosis.

For this retrospective study,a total of 55 143 delivery cases at Tongzhou District Maternal& Child Health Hospital from January 1, 2003 to May 31, 2012 was analyzed.There were 2490 cases of scarred uterus and 68 cases had uterine rupture.And 62 of them belonged to scarred uterus rupture.And there were 52 653 cases of nonscarred uterus childbirth and 6 of them had rupture.

Significant differences existed in the rupture of scarred versus non-scarred uterus and maternal versus primipara women.Uterus rupture usually occurred at the incomplete rupture position of original surgical scar at 39 weeks or more.The scar thickness of lower uterine segment was≤3 mm on ultrasound.Three cases with laparoscopic myoma removal within 1 year had complete rupture at 36-38 weeks.Postpartum hemorrhage incidence was 42.65%.There were two cases of hysterectomy and 11 cases of neonatal asphyxia.

For second pregnancy of cesarean section, pregnancy should be terminated before 39 weeks if scar thickness of lower uterine segment is≤3 mm.Late rupture is to be monitored closely for those with laparoscopic myoma removal within 1 year.Meanwhile, we should strengthen the management of migrant and unemployed women.

To explore the application value of real-time intraoperative ultrasound in glioma surgery.

A total of 80 cases of glioma were localized by intraoperative ultrasound, and their resection degree was evaluated postoperatively by magnetic resonance imaging (MRI).

All gliomas were located precisely by real-time intraoperative ultrasound under the guidance of preoperative MRI.Among them,72 cases underwent total resection,2 cases had residual tumor on post-operative MRI.Subtotal resection was performed in 8 cases.And one of them had larger residual tumor on post-operative MRI.The accuracy rate of resection was 96.2%.There was no complication related with ultrasound.

Intraoperative ultrasound may help a neurosurgeon to locate lesions, select optimal approaches, guide operative procedures and estimate the extent of resection.Because of its small, flexible and convenient features, it will be widely used in neurosurgery.

To observe the sedative and analgesic effects of dexmedetomidine (Dex) and its influence on respiration and blood pressure, evaluate electrophysiological monitoring and explore the optimal dose of Dex for brain nuclei lesion in Parkinson′s disease (PD) patients.

Approved by hospital ethics committee, 60 PD patients undergoing brain nuclei lesion ablation were randomly allocated into 3 groups (n=20 each).No sedative anesthetic was used in group A| In group B, Dex 0.3μg/kg intravenously for initial bolus (duration 15 min) and then 0.3μg·kg^-1·h^-1continuous infusion| In group C, Dex 0.5μg/kg intravenously (duration 15 min) for initial load and then 0.3μg·kg^-1·h^-1continuous infusion.The parameters of mean arterial pressure (MAP), heart rate (HR), pressure of end-tidal carbon dioxide (P_ETCO₂), respiratory rate, blood oxygen saturation (SpO₂), observer′s assessment of alertness/sedation (OAA/S) and verbal rating score (VRS) were recorded at 0 min (baseline),5 min (T₁),10 min (T₂),15 min (T₃),20 min (T₄),30 min (T₅) and 60 min (T₆) after the dosing of Dex.

HR and respiratory rate decreased in groups B and C compared with baseline.In group C, P_ETCO2 was much higher, compared with baseline (P<0.05).Blood pressures of three groups were well-controlled.The incidence of pain (VRS≥1) in group A was significantly higher than those of groups B and C (P<0.05).And the incidence of sedation (OAA/S>1) in group C was much higher than those of groups A and B.The electrophysiological signal of two patients in group C was severely affected.

At an initial intravenous dose of Dex 0.3μg/kg and a maintenance dose of 0.3μg·kg^-1·h^-1, electrophysiological monitoring for surgery is not affected in PD patients undergoing brain nuclei lesion ablation.With a minimal interference of breath, Dex has not only well-controlled effects on sedation,analgesia and blood pressure, but also makes patients comfortable.

To explore the clinical efficacy of endoscopic repairing pediatric blowout fracture of orbital floor with autologous bone fragment.

A total of 12 cases with blowout fractures of orbital floor between March 2010 and June 2012 at Third Hospital of HeBei Medical University were reviewed.They underwent nasal endoscopic reconstruction of autologous bone fragment in situ.Medicinal biomaterial glue was used for fixation.A 6-month follow-up was performed and the therapeutic efficacies of anatomic and functional recovery were evaluated.

No further vision loss or infection occurred postoperatively.Diplopia disappeared over a period of 3 days to 6 months.At 3 months post-operation, diplopia vanished completely (n=9), and peripheral vision diplopia persisted (n=3).Only 1 case had still peripheral vision diplopia at 6 months.Enophthalmos:≥2 mm (n=1), 1 mm (n=3) for one week after surgery and only 1 mm (n=1) at one month follow-up.Passive traction test was negative in all cases and computed tomograph (CT) revealed no bone redislocation postoperatively.

Endoscopic repair of pediatric blowout fracture of orbital floor with autologous bone fragment in situ is both effective and safe.

To validate the accuracy of atlanto-axial pedicle screw placement with a rapid prototyping drill guide template and analyze the factors of screw deviations.

Computed tomography (CT) scan was performed in 16 cervical specimens.And three-dimension cervical vertebrae was reconstructed by Mimics software.The ideal trajactory for atlanto-axial pedicle screws was designed with a complementary basal template for posterior surface of atlanto-axial corresponding anatomical structure.Then drill guide template was materialized in a rapid prototyping machine.These templates were used during operation.The entry point and ideal and actual trajactories were measured after matching the positions of preoperative and postoperative specimens at designated coordinate axis.

The average displacement of entry point of left and right C1 pedicle screw in x, y, z axis was (0.14±0.59), (0.31±1.32), (0.27±0.68), (0.23±0.55), (0.43±1.21) and (0.30±0.72) mm.And the average displacement of entry point of left and right C2 pedicle screw in m, n, p axis was (0.25±0.85), (0.52±1.52), (-0.27±0.67), (0.44±0.87), (0.38±1.48), (-0.14±0.62) mm.No statistically significant difference existed (P>0.05) in deviation of entry point and between ideal and actual trajectories.

Both human handling and inherent hardware and software factors are main reasons for a deviation of C1-C2 pedicle screw placement assisted by a rapid prototyping drill guide template.Ease of operation and individualized design are the advantages of drill guide template so as to greatly improve the precision of screw placement and reduce screw deviation.

To analyze the clinical outcomes of percutaneous kyphoplasty under local anesthesia for osteoporotic vertebral compression fractures.

In this study, 76 elderly patients with osteoporotic vertebral compression fractures undergoing percutaneous kyphoplasty were followed up for 2-3.1 years.They were divided into 3 groups according to different ages:60-69 yrs (A group), 70-79 yrs (B group) and 80- 91 yrs (C group).Pre- and post-operative and last follow-up evaluations were conducted.And the parameters of bone mineral density (BMD), kyphotic angle, change of visual analog scale (VAS), Oswestry disability index, average vertebral body height, complications and costs of hospitalization were recorded and analyzed.

BMD decreased with advancing age and had statistical significance between three groups (P<0.05).Three thoracic spine fractures and 6 lumbar spine fractures could not be detected with digital radiography and were observed only on magnetic resonance imaging (MRI).The pre-operative levels of visual analogue scale and Oswestry disability index increased in all groups.No statistical significance existed between A and B groups.But there was statistical significance between A or B and C groups (P<0.05).Pre- and post-operative assessments showed that statistically significant improvements were found in visual analogue scale and Oswestry disability index in all groups (P<0.05).And statistically significant improvements were found for the pre- and post-operative kyphotic angles and vertebral body heights in A, C group and B groups (P<0.05).The sites for symptomatic leakage of cement included paravertebral vein (n=2),intervertebral disc (n=1) and paravertebral space (n=2).Adjacent vertebral fracture occurred in 1 patient at 17 months and underwent percutaneous kyphoplasty.The mean operative duration was 28 minutes per vertebrae and the mean cost of hospitalization at RMB yuan 33 778.

As a simple and safe procedure for osteoporotic vertebrae compression fractures, percutaneous kyphoplasty may relieve pain quickly, restore vertebral height, prevent further fractures and improve the patient′s quality-of-life.

To evaluate the effects of administrating protamine to reverse heparin on intraoperative hemostatic time, postoperative drainage and postoperative complications in carotid endoarterectomy.

A retrospective cohort study of 125 cases of carotid endoarterectomy was undertaken at Department of Vascular Surgery, Peking Union Medical Hospital in 2012.They were divided into 2 groups: heparin (H group) and heparin+ intra-operative administration of protamine (H+P group).Their medical history, preoperative clinical findings, intraoperative hemostatic time, postoperative drainage volume and complications were compared between two groups and statistically analyzed.

Fifty cases received heparin alone and 75 cases had heparin reversal with protamine.Drainage volumes at Day 1 postoperation were less in H+P group than those in H group with statistically significant difference ((14±13) vs (19±12) ml, P=0.038).And total postoperative drainage volumes were less in H+ P group with statistical significant difference ((20±17) vs (26±15) ml, P=0.035).Intraoperative hemostatic time was less in H+ P group than that in H group with statistical significant difference ((30±11) vs (36±11) min, P=0.030).There was no mortality.Only one case was re-operated for cervical hematoma.Cerebral ischemic symptoms of one patient in the H+ P group became worse postoperatively and recovered after conservative medical treatment.

During carotid endoarterectomy, the application of protamine may significantly decrease intraoperative hemostatic time and postperative wound drainage.And protamine has no effect of increasing the risks of periperative stroke.

To separately evaluate the embryo implantation rate (IR), clinical pregnancy rate and multiple pregnancy rate between women<38 years old or≥38 years old in fresh or frozen thawed embryo transfer cycles, or in single or double embryo transfer cycles.

A total of 7465 single or double embryo transfer cycles between January 2010 and December 2012 at Affiliated Sir Run Run Shaw Hospital, Zhejiang University were analyzed.There were 1546 single embryo transfer cycles and 5919 double embryo transfer cycles; 2447 fresh embryo transfer cycles and 5018 frozen-thawed embryo transfer cycles.

(1) Regardless of whether fresh or frozenthawed embryo was used for transfer, there was no significant difference in embryo implantation rate between single and double embryo transfer groups in women<38 years.The clinical pregnancy rate significantly increased if double embryos were replaced (fresh embryo transfer, 53.3% vs 35.5%; frozen-thawed embryo transfer, 59.8% vs 38.0%,P<0.01).Twin pregnancy rate also significantly increased (fresh embryo transfer, 28.7% vs 0.6%; frozen-thawed embryo transfer, 31.1% vs 3.0%, P<0.01); (2) embryo implantation rate in fresh embryo transfer significantly increased in women≥38 years old between groups of single or double embryo transfer (20.3% vs 9.5%, P<0.05).No significant difference existed in IR for frozen-thawed embryo transfer.The clinical pregnancy rate significantly increased (P<0.01) if double embryos were replaced (fresh embryo transfer, 33.2% vs 9.5%; frozen-thawed embryo transfer, 39.0% vs 21.1%, P<0.01).Twin pregnancy rate was 19.4% in fresh embryo transfers versus 13.4% in frozen-thawed embryo transfers.There was no twin pregnancy in single embryo transfers.

Compared with single embryo transfer in women<38 years, double embryo transfer can significantly increase the rates of clinical pregnancy nd twin pregnancy.Decision is made after thorough consultations and single embryo transfer is justifiable.Double embryo transfer is indicated for women≥38 years.

To detect the antibodies against human fibrinogen (FIB) β_67-77peptide and citrullinated human FIB β_67-77peptide in rheumatoid arthritis (RA) and examine their diagnostic values in RA.

The antibodies against FIB β_67-77peptide and citrullinated FIB β_67-77peptide were detected by enzyme-linked immunosorbent assay (ELISA) in 227 RA patients, 188 other connective tissue disease and 100 healthy controls.And their clinical applications were analyzed in the diagnosis of RA.

(1) The prevalence and titer of IgG,IgA and IgM isotypes of anti-citrullinated FIB β_67-77peptide antibodies in RA were significantly higher than those with other rheumatic diseases and healthy individuals.However, the prevalence of anti-FIB β_67-77peptide antibodies in RA patients was similar to those with other rheumatic diseases and healthy individuals (P>0.05). (2) The diagnostic sensitivity of IgG, IgA and IgM of anti-FIB β_67-77peptide antibodies for RA were 50.7%, 48.5% and 55.1% and the specificity 94.8%, 92.7% and 92.4% respectively.The sensitivity of combined detection of 3 subtypes was up to 87.7% and the specificity 78.5%. (3) No significant correlations existed between anti-citrullinated FIB β_67-77peptide antibodies, RF,anti-CCP antibody, AKA and APF respectively.Moreover, the seropositive rates of IgG, IgM and IgA of anti-citrullinated FIB β_67-77peptide were 52.9%, 39.2% and 54.9% in IgM-RF negative patients Versus 48.5%, 53.1% and 37.5% in anti-CCP antibody, AKA and APF negative patients respectively.

IgG, IgM and IgA antibodies to citrullinated FIB β_67-77peptide are sensitive and specific in the diagnosis of RA.And the test of anti-citrullinated FIB β_67-77peptide antibodies is especially useful in diagnosing RA with other negative autoantibodies.

To explore the effects of histone deacetylase inhibitors (HDACIs) on human osteosarcoma in vitro and in vivo.

HDACI suberoylanilide hydroxamic acid (SAHA) and sodium butyrate (SB) were employed to examine the effects on human osteosarcoma in vitro and in vivo.The in vitro effects of HDACI SAHA and SB were evaluated in SaOS₂ and U2OS human osteosarcoma cell lines.Cell growth, cell cycle progression and histone acetylation were examined by methyl tolyl sulfide (MTS), flow cytometry and Western blot respectively.In addition, SAHA or SB was administered for 4 weeks in a murine xenograph model for assessing the in vitro effects.

MTS assay revealed that SAHA and SB significantly suppressed the growth of SaOS₂and U2OS cells in a concentration-dependent manner.Western blot analysis indicated that the levels of acetylated H3 increased after HDACI treatment.Flow cytometry showed that SAHA arrested the cell cycle in G₁ and G₂/M phase, while SB arrested the cell cycle in G₂/M phase.The tumor growth of murine xenograph model with Sa OS₂ was inhibited by SAHA and SB compared with vehicle control.

HDACI SAHA and SB significantly inhibit the growth of human osteosarcoma cells and induce cell cycle arrest.Meanwhile, the tumor inhibitory effects were also validated in a murine xenograft model.