Analysis of CT and MR imaging features of the brain in patients with hydrogen sulfide poisoning based on clinical symptom grading.

OBJECTIVE: To retrospectively analyze CT and MR imaging features of the brain in patients with hydrogen sulfide poisoning based on clinical symptom grading and to investigate their correlations with clinical symptoms and patients' prognosis. METHODS: A retrospective analysis was performed of CT and MR imaging data of the brain in 40 patients with hydrogen sulfide poisoning in our hospital. There were four main imaging manifestations. Patients were clinically graded according to the central nervous system symptom scores of the Poisoning Severity Score (PSS) and staged according to the gas inhalation time segment. Based on clinical symptom grading, the frequencies and proportions of four imaging signs that occurred in each group were counted, their development trends were analyzed, and the correlations of imaging features with clinical grading and prognosis were calculated. RESULTS: Forty patients were divided into minor, moderate and severe clinical grades and classified into four stages. In patients with minor and moderate clinical grading, only one patient suffered from generalized brain edema at stage 1, with a good prognosis. Patients with severe clinical grade showed the highest probability of presenting with the four imaging signs. The imaging signs were correlated with the severe clinical grade and a poor prognosis (P = 0.000, R = 0.828; P = 0.000, R = 0.858). CONCLUSION: In patients with the severe clinical grade, generalized brain edema and symmetrical hypodensity/abnormal signals in the bilateral basal ganglia and around the lateral ventricles were the main findings and were shown to persist. The presence of imaging signs can assist in the clinically effective evaluation of clinical symptom grade.

Surgical strategy and management outcomes for adjacent multisegmental spinal tuberculosis: a retrospective study of forty-eight patients.

STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate the clinical outcomes of 4 different procedures for the treatment of adjacent multisegmental spinal tuberculosis (AMSST) and to investigate the selection strategy of the optimal procedure with respect to focal characteristics. SUMMARY OF BACKGROUND DATA: Because of the lack of support of the anterior columns of multiple segments, AMSST is thought to confer high risks for the development of kyphosis and paraplegia. However, there are few reports regarding the clinical outcomes of the surgical treatment for AMSST have been investigated. METHODS: From August 1999 to June 2010, 48 patients with AMSST were enrolled in this study. Seven patients (A group) underwent a single-stage anterior operation. Eighteen patients (AP group) underwent a single-stage posterior and anterior combined operation. Eighteen patients (P group) underwent a single-stage posterior operation. Five patients (DP group) underwent computed tomography-guided drainage and local chemotherapy combined with a 2-stage posterior operation. The patients were followed up clinically and radiologically for an average of 29.6 months. RESULTS: The cohort consisted of 29 males and 19 females, aged 4 to 54 years. The patients exhibited significant improvements in deformity and neurological deficits. Graft union was achieved in all patients 5 to 12 months postoperatively. Surgery-related complications were noted in 1 and 2 patients in the AP and P groups, respectively. Postoperative recurrence occurred in 1 and 2 patients in the AP and P groups, respectively. All 48 patients had been cured at the final follow-up. CONCLUSION: This study demonstrated that the 4 procedures can safely and effectively achieve nerve decompression, graft fusion, and kyphosis correction. Individualized procedures should be chosen according to the patient's general condition, focal characteristic, type of complication, and surgeon's experience. LEVEL OF EVIDENCE: 3.