Volume 91  ·   Issue 39  ·  2011

In recent years, the incidence and detection rate of cerebrovascular diseases are increasing year by year, and the treatment concept and treatment technology of cerebrovascular diseases have also made great progress. The following is an introduction to the progress of surgical treatment of hemorrhagic and ischemic cerebrovascular diseases. 1. Hemorrhagic cerebrovascular diseases 1. Intracranial aneurysm: (1) Operative opportunity of intracranial aneurysm: The mortality rate of intracranial aneurysm subarachnoid hemorrhage is 30% ~40%. After bleeding patients are lucky enough to survive from the blow of initial hemorrhage, they face the threat of re-hemorrhage immediately. Patients may rupture again at any time, and the mortality rate of re-hemorrhage is higher (40% ~75%).

Objective To explore the efficacy and method of microsurgery for aneurysm on the top of basilar artery.Methods The investigators analyzed retrospectively the clinical data of 8 microsurgical patients with aneurysm on the top of basilar artery from May 2007 to September 2010.There were 5 males and 3 females with an average age of 52.6 years old.Six of 8 cases underwent clipping of aneurysm while other 2 patients received superficial temporal artery-radial artery-posterior cerebral artery bypass grafting surgery and clipping of aneurysm.Results On the basis of GOS ( Glasgow outcome score),the postoperative recovery was excellent in 7 patients.And 1 patient suffered insufficiency of oculomotor nerve similarly as preoperatively.Conclusion The surgical procedures for aneurysm of basilar artery are so complicated as to lead to many complications.A wise choice of operative approaches may yield a better outcome.

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in childhood and adolescence.Methods From our dedicated aneurysmal patient databank,the investigators reviewed 39 consecutive children and adolescents with 44 intracranial aneurysms.There were 24 boys and 15 girls.Results Twenty-two patients underwent endovascular treatment.Among them,8 patients received microsurgical therapy.Aneurysms became spontaneously thrombosed before therapy in 3 patients.One patient died pre-operatively from a re-rupture of aneurysm.And 5 cases were not treated at all.Conclusion lntracranial aneurysms in childhood and adolescence have many clinical and radiological characteristics:(1) remarkable male predominance; (2) middle cerebral artery is the most common site for aneurysms; (3) there is a high prevalence of giant,traumatic,dissecting and fusiform aneurysms; (4) both microsurgical approaches and endovascular treatment were effective.For some giant complex intracranial aneurysms,parent arterial occlusion or EC-IC (extracranial-intracranial) bypass is the best therapeutic choice.A majority of patients may have favorable outcomes.

Objective To retrospectively analyze the clinical characteristics and surgical outcomes of 3094 patients with cerebral arteriovenous malformation (AVM) over a course of 53 years.Methods The clinical data of 3094 consecutive AVM patients from July 1956 to April 2009 were collected and analyzed.The parameters included age (at diagnosis),gender,initial onset,Spetzler-Martin grade,relationship of lesion volume and blood,AVM with aneurysm,AVM with varices,surgical outcomes and mortality.Results Cerebral AVMs were more commonly diagnosed at a mean age of 27 ± 13 years old ( range:12 - 38 ).Hemorrhage ( n =1617,52.26％ ),headache ( n =550,17.78％ ) and seizure ( n =397,12.83％ ) were the first three common presentations.A total of 1486 patients were estimated by Spetzler-Martin grading system.And the percentage of grades 2 -4 patients was highly than that of other levels.The smaller the lesion volume,the greater risk of intracranial hemorrhage.Varices were found in 26 (0.84％) of 3094 AVM patients.And 12 (46.15％) patients with varices had a hemorrhage at presentation.Aneurysm was found in 66 (2.13％ ) of 3094 AVM patients.And 38 (57.58％) patients with varices had a hemorrhage at presentation.Among them,2013 patients received microsurgery treatment.The outcomes were recovery (83.51％),excellence ( 12.42％ ),no change (0.60％ ),deterioration (0.30％ ) and death (3.18％ ).The surgical mortality of the patients with a hemorrhage at presentation was 5.19％.Conclusion The first presentation of AVM is commonly apparent at a young age.And intracranial hemorrhage occurs often at dominant positions.AVM is one of the important reasons for spontaneous intracranial hemorrhage in youth.And the risk of hemorrhage is present for a patient's whole life.Microsurgery treatment can remove the lesion and eliminate the risk of hemorrhage immediately.With the applications of neurosurgery,navigation,ultrasound and intraoperative fluorescence angiography,the surgical treatment of AVM becomes safer and more reliable.

Objective To evaluate the safety of funnel technique for the placement of proximal thoracic pedicle screws (T1 -T5 ).Methods Between March 2006 and October 2010,105 patients undergoing pedicle screw placement of proximal thoracic vertebrae were retrospectively reviewed.There were 57 males and 48 females with an average age of 40.3 years old.According to the techniques of placing pedicle screws,they were classified into the funnel technique group ( group A,n =54) and bare hand technique group (group B,n =51 ).Their perioperative and postoperative complications were examined simultaneously.Postoperative CT (computed tomography) scans were performed in all cases to determine the instrument malposition.The percentage of malposition was analyzed between two groups and among different levels.Results A total of 402 proximal thoracic pedicle screws were placed in 105 cases.No injuries of spinal cord,large blood vessels or lung were reported.There were 13 intraoperative pedicle fractures and 4 dural tears.A total of 45 screws were misplaced in 105 patients (11.19％).In group A,the percentage of malposition was 10.14％.And there were no statistic significance among different levels ( P ＞ 0.05 ).In group B,the percentage of malposition was 12.31％ and no statistic significance existed among different levels ( P ＞ 0.05 ).No intra-group statistical significance was found for group A or B.Medial malposition was found in 17 cases.And lateral malposition occurred in 25 screws while only 3 screws penetrated anterior cortex.Among 59 patients with neurological deficits,37 cases showed postoperative improvements according to the AISA ( American Spinal Injury Association) scale.Conclusion The funnel technique is both safe and reliable for the placements of proximal thoracic pedicle screws.

Objective To describe the short-term outcomes of a non-pharmacological conservative approach to patients with LSS.Methods This is a prospective consecutive case series with short-term follow-up of 21 consecutive patients who were diagnosed with LSS.Patients recruited from the outpatients of orthopaedic department and rehabilitation department in the Peking University People's Hospital from March 2010 to March 2011.Patients had baseline interviews with follow-up questionnaires in the end of the first and the third month.Main outcome measures:pain intensity was measured using the Numerical Rating Scale (NRS) and disability was measured using the Roland Morris Disability Questionnaire ( RMDQ),as well as the 36-item Short Form Health Surrey (SF-36) and efficacy assessment for evaluation.Results All of 21 eligible consenting patients initially enrolling completed the follow-up.Pain at worst,functional status,quality of life improved significantly in the end of the first month.These were considered to be clinically meaningful in the end of the third month.No patients went on to require surgery.No major complications of treatment were noted.Conclusions A non-pharmacological conservative treatment may be useful and safe in bringing about clinically meaningful improvement in pain and disability in patients with LSS.Before surgical management,a non-surgical approach should be taken into account at first.

Objective To analyze the outcomes of surgical treatment for severe cervicothoracic kyphosis.Methods A retrospective study was performed for a total of 7 patients with severe cervicothoracic kyphosis.There were congenital malformation ( n =5 ) and cervicothoracic tuberculosis ( n =2 ).The mean preoperative Cobb angle of kyphosis was 89.3° (range:72 - 103° ).The average JOA (Japanese Orthopedic Association) score of neurological function was 11.2 ± 1.2 points.Preoperative halo-pelvic traction was performed and maintained for 25 -40 days according to the patient conditions.Then posterior instrumented fusion was performed.Results The average postoperative JOA score was 15.4 ± 1.6 points.The mean immediate postoperative Cobb angle was 53.4° (range:45 -67°).A mean correction rate of 40.2％ was achieved.All patients were followed up for a mean of 18 months (range:10-24).And a mean correction loss of 2.5° was observed at the final follow-up.Two patients had transient upper limb pain during distraction.There were no intra-operative or post-operative occurrences of spinal cord injury and other neurological complications.Conclusion Halo-pelvic traction plus posterior spondylodesis may be a safe and effective therapy of severe cervicothoracic kyphotic deformity.

Objective To analyze the clinical and neuroimaging features of central nervous system impairments in acute intermittent porphyria,and explore the possible mechanisms.Methods Six cases with intracranial lesions at our hospital from 1991 to 2011 and 13 cases reported in literatures were retrospectively reviewed.Results The clinical manifestations of central nervous system impairments included seizures,unconsciousness and cortical blindness,etc.EEG (electroencephalogram) showed slow wave or normal.CSF (cerebrospinal fluid) test indicated slightly higher or normal level of CSF protein.Neuroimaging studies showed two types of intracranial lesions.One type ( n =4) mainly affected the cortex and subcortical white matter,especially involving white matter.Another type( n =2 )affected the deep nuclei such as caudate,putamen and thalamus symmetrically.The symptoms of 13 cases reported in literature with central nervous system impairments included unconsciousness,hallucinations,seizures and cortical blindness.Their neuroimaging manifestations were similar with those of the patients at our hospital.Two additional cases showed predominantly cerebral cortex lesions with no involvement of white matter.Conclusion Acute intermittent porphyria can affect central nervous system,peripheral nervous system and autonomic nervous system.The neuroimaging features of brain may be lesions located in cortex,subcortical white matter and deep nuclei with different mechanisms.A correct diagnosis and a treatment decision should be made during an early stage.

Objective To determine the therapeutic efficacy and the influencing factors for the long/middle-term outcomes of percutaneous vertebroplasty (PVP) in the treatment of painful osteoporotic vertebral compression fractures (OVCFs).Methods This prospective study recruited a total of 131 consecutive OVCF patients treated with PVP at a single institution from March 2005 to December 2009.There were 106 females and 25 males.Pre- and postoperative evaluations included a visual analog scale (VAS) for pain,the Roland-Morris disability questionnaire (RDQ) scores and patient activity levels.Various factors probably correlated with long-mid term efficacy were also analyzed.Results Both VAS and RDQ scores decreased significantly (P ＜ 0.05 ).And the activity levels showed significant post-therapeutic improvement ( P ＜ 0.01 ) ; Univariate and multivariate analysis showed that the influencing factors for the long/middle term efficacy were age,number of OVCF(s) per time,activity level after discharge and newly occurring OVCF (Z =- 2.03,- 2.68,5.38 and - 1.73 ; P =0.043,0.007,0.001 and 0.034 respectively).Conclusion PVP is an efficient pain-relieving procedure.The long/middle-term efficacy after PVP is mostly correlated with both the patient age and the natural course of underlying conditions.

Objective To compare the clinical outcomes of two operative approaches of perineal dissection in rectal carcinoma undergoing abdominoperineal resection.Methods A randomized controlled trial was conducted in a total of 126 patients with rectal cancer undergoing the Miles operation from June 2007 to June 2011 at Henan Provincial Cancer Hospital.They were divided into 2 groups.One group ( Group A) underwent a direct dissection of urogential diaphragm while another group (Group B) received the traditional operative method.And the duration of perineal surgery,rupture of rectum or tumor,urethral injury and the pest-operative rate of perineal hemorrhage were compared between 2 groups.Results Group A had a shorter duration of perineal surgery ( ( 16±5) min vs (23 ±5) min,P =0.032).And the differences were significant statistically.However the rupture of rectum or tumor,urethral injury and the post-operative rate of perineal hemorrhage were equivalent for two groups ( 1 vs 5,2 vs 5,0 vs 1,1 vs 3,all P ＞ 0.05 ).Conclusion A direct dissection of urogential diaphragm offers more clinical advantages over the traditional operative method in abdominoperineal resection.

Objective To explore the clinical significance of sphingosine kinase 1 ( SPHK1 ) in the invasion,metastasis and prognosis of gastric cancer.Methods Immunohistochemistry was employed to analyze the expression of SPHK1 in 206 clinicopathologically characterized gastric cancer cases from January 2001 to December 2005 at Zhejiang Provincial People's Hospital.Results SPHK1 protein was detected in 3 (7.5％ ) of 40 human non-tumor mucosa.All samples expressed the protein at a low level.SPHK1 protein was detected in 181 (87.9％) of 206 human gastric cancer cases.An elevated expression of SPHK1 protein was detected in 126 (61.2％) tumors.And SPHK1 protein was up-regulated in gastric cancer lesions compared with adjacent noncancerous tissues( P =0.001 ).The expression of SPHK1 was correlated with the depth of invasion,lymph node metastasis,distant metastasis and TNM stage ( P =0.039,0.003,0.020,0.003).In stages Ⅰ - Ⅱ and Ⅲ,the 5-year survival rate of the patients with a high expression of SPHK1 was significantly lower than those with a low expression (53.6％ ( 15/28 )vs 68.6％ (24/35),7.8％ (6/ 77) vs 30.8％ ( 12/39 ),P =0.009,0.006).In stage ⅣV,the expression of SPHK1 was not correlated with the 5-year survival rate ( P ＞ 0.05 ).Further multivariate analysis suggested that lymph node metastasis,distant metastasis,TNM stage and the up-regulation of SPHK1 were independent prognostic indicators for gastric cancer.Conclusion The expression of SPHK1 in gastric cancer is significantly associated with lymph node metastasis,distant metastasis and a poor prognosis.SPHK1 may become a useful marker of predicting tumor progression and prognosis.

Objective To explore the clinical features and prognosis of the patients with synchronous double primary malignancy of esophagus and cardia.Methods The clinical data of patients with synchronous primary esophageal and cardiac carcinomas undergoing surgery at our hospital between April 1988 and April 2009 were retrospectively reviewed.All data were analyzed by the SPSS 15.0 software.The overall survival rates (OS) were calculated and compared with the Kaplan-Meier method and the Log-rank test.The prognostic factors were identified by Cox's hazard regression model.Results Among all 47 cases,esophageal carcinoma was missed preoperatively in 1 patients and cardiac carcinoma in 12.The 1-,3- and 5-year overall survival rates (OS) of the whole group were 81.5％,49.1％ and 34.3％ respectively.And the median survival time was 33 months.The univariate analysis of prognostic factors showed that radical resection,N stage of esophageal carcinoma ( 2009 ),N stage of cardiac carcinoma (2009) and TNM stage of cardiac carcinoma (both 2002 and 2009 ) might influence the long-term survival.However,according to the multivariate analysis,only radical resection and N stage of cardiac carcinoma (2009) were independent prognostic factors.Conclusion With preoperative combined examination of esophagography and esophagoscopy and thorough intraoperative detection,the clinicians may reduce the rate of missed diagnosis for synchronous double primary esophageal and cardiac carcinomas.Radical resection of primary lesions and thorough dissection of loeoregional lymph nodes may improve the patient survival.

Objective To explore the values of serum copper and serum free copper in the diagnosis of Wilson's disease ( WD),its carrier and viral hepatitis and explore the guiding significance of monitoring serum copper in the treatment of WD.Methods A total of 80 WD patients ( hepatic type,n =60; encephalic type,n =20),30 carriers,20 patients with viral hepatitis were enrolled and their levels of serum copper were determined.The neural symptoms were scored by modified Young grade.Hemogram,hepatic functions,blood clotting functions,serum copper and urinary copper were tested throughout all 8 courses of treatment with sodium dimercaptopropane sulfonate (DMPS).The patients were treated with zinc after discharging.All data were analyzed.Results The free serum copper increased in the patients with WD (0.17 mg/L ±0.04 mg/L) 、carriers (0.13 mg/L ±0.03 mg/L) and severe viral hepatitis (0.12 mg/L).A slight increase was also observed in the WD carriers.The level of serum copper was correlated with hepatic functions but not with the severity of neural symptoms.The serum copper increased in the patients with no improvement of neural symptoms.However,the serum copper decreased in the WD patients with the improvement of neural symptoms.The serum copper was stabilized at approximately 0.2 mg/L during the long-term treatment period.Conclusion There is auxiliary diagnosis significance of serum copper in the determination of WD.Hepatic functions in hepatic type WD affect the level of serum copper.The serum copper of encephalic type WD can not indicate the severity of neural symptoms.The elevated level of serum copper indicates a poor prognosis.The serum copper is an effective marker in monitoring the development and therapeutic efficacy of the disease.

Objective To determine clinical characteristics and perinatal outcomes of non overweight/obese ( pre-pregnancy body mass index BMI ＜ 24 kg/m2 ) pregnant women with polycystic ovary syndrome (PCOS).Methods The screening of PCOS was performed when they were at first prenatal visit in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from May,2008 to July,2010.61 PCOS women of pregnancy women with BMI ＜ 24 kg/m2 were considered as the study subjects,and 122 pregnant women without PCOS matched by age and pre-pregnancy body mass index (BMI) were selected as the control ones.Patients with history of pre-pregnancy diabetes,hypertension,cardiovascular disease,renal diseases and multiple pregnancies were excluded from the study.We followed pregnancy outcomes of two groups until delivery.Results Significantly higher total cholesterol,triglycerides concentrations and low density lipoprotein cholesterol concentrations were found in the PCOS group than in the controls.PCOS women with BMI ＜ 24 kg/m2 had significantly higher rates of GDM ( 27.9％ ( 17/61 ) ) and pre-eclampsia ( 13.1％ (8/61) ) compared with the controls ( 15.6％ ( 19/122 ),1.6％ (2/122)),P ＜ 0.05,＜ 0.01,respectively.No statistical significance was found in prevalence of pregnancy-induced hypertension,polyhydramnios,oligohydramnios,macrosomia,premature rupture of membranes,placental abruption,macrosomia,fetal death and neonatal congenital abnormality between the two groups ( all P ＞ 0.05 ).Conclusions It is at increased risk of GDM and pre-eclampsia in non-overweight/obese PCOS women,this risk seemed to be due to PCOS itself rather than obesity.

Objective To investigate the inhibitory effect and apoptosis induction on human esophageal carcinoma EC9706 cell by Fufangkushen.Methods The experiment of Fufangkushen was designed into three groups including 25.00 μl/ml group,6.25 μl/ml group and control group in vitro.The method of MTT was used to evaluate the growth inhibition effects.Proliferating cell nuclear antigen (PCNA) was detected by immunohistochemistry (IHC) in vitro.The morphological changes of cells were observed under inverted microscope.FACS was used to analyze the distribution of cell cycle and apoptosis.The expressions of Bc1-2,Fas and caspase-3 in EC9706 cells were detected by Western blotting.The clone formation in plate was used to test the capacity of cell clone formation.Nude mice experiments were conducted to investigate the tumor inhibition of Fufangkushen in vivo.The mice were divided into 3 groups of 200 μl/d treatment,25 μl/d treatment and saline control.PCNA and Bc1-2 were detected by IHC.And the apoptotic index was detected by terminal transferase dUTP nick end labeling (TUNEL) on xenograft of nude mice.Results The proliferative capacities of 25.00 μl/ml group were lower than that of the control group at 48,72,96 h respectively( all P ＜0.01 ).IHC showed the PCNA expressions,cell clone formation rate were both lower than that of control group (in 25.00 μl/ml treatment group both P ＜0.05 ).Many apoptotic cells could be observed.And the apoptotic rate was higher in 25.00 μl/ml group than that in the control group ( (25.2 ± 7.3 ) ％ vs ( 3.4 ± 1.5 ) ％,P ＜ 0.01 ).After a treatment of Fufangkushen,the activation of caspase-3andtheFas were higher((21.3 ±4.4)％ vs (1.8 ±0.6)％,(30.2 ±8.3)％ vs (5.4 ± 1.6)％,both P ＜0.01 ),the Bc1-2 were lower (P ＜ 0.01 ) were observed in vitro.Comparing with the saline control group,the tumor weight in 200 μl/d treatment group were lower ( (987 ± 386 ) vs ( 1935 ± 838) mg,P＜0.01) and the apoptotic index higher ((33.8±8.7)％ vs (5.3±1.4)％,P＜0.01).Conclusion Fufangkushen can inhibit the proliferation of EC9706 cells and induce the cellular apoptosis.The mechanism of apoptosis is probably associated with the arrest of cell cycle,the up-regulation of Fas,the down-regulation of Bcl-2 and the activation of caspase-3 in ESCC EC9706 cells.

Objective To explore the impact of Rac1 activation on the proliferation and migration under the stimulation of PDGF-BB ( platelet derived growth factor-BB).Methods The inhibitory effects of Rac1 inhibitor (NSC23766) and Rac1siRNA on the proliferation and migration of vascular smooth muscle cell under the stimulation of PDGF-BB were measured by CCK8 assay and Transwell chamber.The time characteristics of Racl activity and pi-JNK expression under the stimulation of PDGF-BB was detected by GST pulldown assay and Western blot.And the inhibitory effects of NSC23766 and RaclsiRNA on the Rac1 activation and pi-JNK expression were also measured.Results Migration and proliferation of vascular smooth muscle cell increased significantly after the stimulation of PDGF-BB ( 50 μg/L).Migration and proliferation was inhibited significantly after a pretreatment of RaclsiRNA and various concentrations of NSC23766(25,50,100 μg/L).After the stimulation of PDGF-BB,the expression of pi-JNK and Rac1 activity increased over time.Rac1-GTP peaked at 5 minutes and pi-JNK at 15 minute.The expressions of piJNK at 15 minutes and Rac1-GTP at 5 minutes were inhibited significantly by Rac1siRNA and NSC23766 in a concentration-dependent manner.Conclusion JNK phosphorylation is controlled by Racl activation.And Rac1 activation play a pivotal role in the migration and proliferation of aortic smooth muscle cell under the stimulation of PDGF-BB.

Objective To explore the morphological and expressional changes of Th1 cells and Th2 cells in retina of a rat model of glaucoma vaccinated by Cop-1 ( Copolymer-1 ) and elucidate the possible neuroprotection roles played by Th1/Th2.Methods After modeling,the aqueous outflow from the right eyes was blocked by a ligation of three of four episcleral veins.There were 48 rats with elevated IOP ( intraocular pressure) immunized by Cop-1 ( Cop-1 group),48 rats with elevated IOP immunized by PBS ( phosphate buffered saline) (PBS group) and 10 rats without any treatment (normal group).The experimental rats were immunized with Cop-1/PBS emulsified in a total volume of 0.4 ml complete Freund's adjuvant.The immunization was administered subcutaneously at the base of tail.Immunofluorescence was employed to test the distribution and activation of Thl and Th2 cells in retina at Days 3,7,10,17,24 and 31 post immunization respectively for each group.Western blot was selectively performed according to the results of immunofluorescence to verify if there was a similar variation of the retinal expression of IL-4 protein.Results The results of immunofluorescence showed the numbers of Thl cells peaked at Day 7 in both Cop-1 ( (216 ± 21 )/mm2) and PBS groups (( 194 ±27 )/mm2 ).And no statistical significance existed between two groups (P＞0.05).The numbers of Th2 cells in the experimental groups peaked at Day 7 with statistical significance ( Cop-1 group:300 ± 28/mm2 vs PBS group:129 ± 27/mm2 ) ( P ＜ 0.01 ).With the prolongation of experimental period,the number of Th2 cells decreased gradually in the Cop-1 group but remained greater than that of the PBS group afterward ( P ＜ 0.05 ).The Western blot results showed that the expression of IL-4 in the Cop-1 group ( 1.91 ± 0.05 ) was significantly higher than that of the PBS group (0.51 ±0.04) from Day 3 and peaked at Day 7 (2.11 ±0.06 vs 0.57 ±0.05).Then the IL-4 expression decreased gradually in the COP-1 group but still represented statistical significance versus the PBS group until Day 31 post-immunization ( P ＜0.001 ).Conclusion The retinal activation and accumulation of IL-4 are found in a rat model of chronic glaucoma immunized by Cop-1.Thus Th2 cells may play vital roles in the Cop-l-induced neuroprotective autoimmune responses.

Medical record abstract A 20-year-old female patient was admitted to the hospital on May 14, 2010 due to "fever, headache and vomiting for 4 days". The patient felt headache, accompanied by nausea and vomiting, and felt weakness in his limbs after getting up 4 days before the hospital. On the second day, she developed fever, with a maximum body temperature of 38.5℃, still accompanied by headache, vomiting, and occasional dizziness. She was examined locally and given "antipyretic drugs" and other treatments. The patient still had fever, occasional gibberish, and delusions of persecution. On May 14, 2010, she was admitted to the hospital with central nervous system infection. Neurological examination: fever, body temperature 38℃, clear mind, mental abnormalities, manifested as episodic mania, gibberish, self-harm, persecution, exaggerated delusions. Sometimes she was indifferent, unwilling to talk to others, unable to identify family members, and could simply answer between attacks, with obvious memory loss, normal muscle tone and muscle strength of the limbs, negative pathological signs and negative meningeal irritation signs.

Ovarian mature teratoma (MCTO), also known as dermoid cyst, is the most common germ cell tumor in women of childbearing age, accounting for about 10% ~20% of ovarian tumors [1-4]. MCTO can be composed of mature tissues of one or more germ layers, and is a benign ovarian tumor with rare malignant transformation. The malignant transformation rate reported in the literature is 1% ~2% [1-4]. The cause of malignant transformation is unknown. The clinical characteristics and diagnostic progress of this disease are summarized as follows. 1. Histopathology: Malignant MCTO has similar manifestations to MCTO, which is also a cystic mass, containing a large amount of hair, oil, teeth and other tissues from different germ layers. The differences are as follows: (1) The cyst wall surface of malignant MCTO is rough and granular; (2) It is invasive, can penetrate the whole cyst wall and adhere to the surrounding organs. Pathological necropsy shows that malignant transformation often occurs in solid nodules ("cephalic segment") on the inner wall of the cyst or the thickened part of the cyst wall [3,5].

Avastin, whose chemical name is bevacizumab, is the world's first anti-tumor angiogenesis drug. It is produced by Roche Company of Switzerland. It mainly controls and treats tumors by degenerating tumor blood vessels, normalizing surviving blood vessels, and continuously inhibiting the growth of neovascular and regenerative blood vessels. Combined chemotherapy can effectively control tumor growth and metastasis from blood vessels. It was marketed in the United States in 2004 and has been widely used for the treatment of colon cancer, brain cancer, lung cancer and kidney cancer. In 2010, Avastin injection was approved by the State Food and Drug Administration of China to be marketed in China for the first-line treatment of metastatic colon cancer.

A 36-year-old worker suffered from headache for 25 days, aggravated with unresponsiveness and blurred vision for 7 days. He was admitted to the hospital on January 31, 2009. Before 32 days, the patient began to have headache, which was persistent and gradually aggravated, without nausea and vomiting. He was still able to work at that time and went to the local township health clinic. After taking compound acetaminophen tablets, the headache symptoms were partially relieved. Before 12 days, the patient gave up work and rested at home because of unbearable headache. During the rest period, the headache symptoms were relieved, and he started to work before 7 days. Subsequently, the headache was significantly aggravated, accompanied by memory loss, unresponsiveness and blurred vision. Since the headache appeared, there was no cough, fever, night sweats and limb twitching at night, no limb weakness and unsteady walking, no defecation disorders and consciousness disorders. There was no history of hypertension and tumor. Occupational hygiene investigation: The patient has worked in this unit continuously for 3 years. From 1 month before the onset of the disease to the onset of the disease, the patient was transferred to a "sticky" position, working for 8~10 h every day, the workshop of this position is small, Lack of ventilation facilities, no protective measures, and no other workers working with them.