[Surgical treatment of ruptured anterior circulation aneurysms in elders].

OBJECTIVE: To explore some related problems in surgical treatment of ruptured anterior circulation intracranial aneurysms in elders. METHODS: The clinical data of 38 elderly patients with ruptured anterior circulation intracranial aneurysms were analyzed retrospectively.Such related problems as indication, timing and complications of operation were discussed through their Modified Rankin scales at discharge and half a year later. RESULTS: Their Hunt-Hess grades were I (n = 6), II (n = 17), III (n = 5), IV (n = 6) and V (n = 4) respectively. Among them, 33 cases were complicated preoperatively with other vital diseases while another 5 previously healthy (III, n = 3; II, n = 1; IV, n = 1). And their modified Rankin scales of discharge and half-a-year follow-up were 0 (n = 12 vs 12), 1 (n = 10 vs 10), 2 (n = 4 vs 4), 3 (n = 3 vs 1), 4 (n = 3 vs 3), 5 (n = 4 vs 3) and 6 (n = 2 vs 3) respectively. All scales of 5 cases of previously healthy patients were 0-2. CONCLUSION: Operation is vital for rescuing patient life and achieving excellent outcomes. Age is not a risk factor for intracranial aneurysms of elders.Early and aggressive operation is recommended for those without contraindications. Physical status is more important than age in decision-making.

[Intraoperative decisions and surgical efficacies of trigeminal neuralgia responsible vessels].

OBJECTIVE: To explore the types of primary trigeminal neuralgia (TN) responsible vessels and curative efficacies of microscopic vascular decompression (MVD). METHODS: A total of 162 primary TN patients underwent MVD from August 2004 to the present at our hospital.Their clinical data were collected and analyzed. There were 69 males and 93 females with an age range of 22-88 years. RESULTS: The most common responsible vessels were superior cerebellar artery (n = 65, 40.12%), anteroinferior cerebellar artery (n = 45, 27.78%), multiple vessels (n = 26, 16.05%), posteroinferior cerebellar artery (n = 16, 9.88%), veins (n = 6, 3.70%) and vertebral artery (n = 4, 2.47%). And the pressure points were at the root of trigeminal nerve (n = 139, 85.80%), distal part (n = 16, 9.88%) and root and distal part (n = 7, 4.32%). Postoperatively pain disappeared in all patients (including one case on second surgery). Postoperative follow-ups were conducted for 132 cases.Two cases recurred over 8 years and the recurrence rate was 1.52%. CONCLUSION: MVD is preferred method for primary TN non-responsive to pharmacotherapy. Identification and treatment of responsible vessels remain a key. Venous and distal pressure points should be taken care.

[Correlation of surgical timing and prognosis for ruptured intracranial aneurysms].

OBJECTIVE: To explore the correlation between surgical timing and clinical prognosis for ruptured intracranial aneurysms. METHODS: A series of 187 patients with intracranial aneurysm treated surgically at our department were analyzed retrospectively. Among them, 101 patients received an average follow-up period of 9 months (range: 6 - 14). Timings of operation that might affect the clinical efficacies of microsurgery were analyzed. The modified Rankin scale (mRS) of discharge and the corresponding follow-up mRS were all analyzed. RESULTS: Timing of operation was negatively correlated with mRS of hospital discharge (P < 0.05), but it had no correlation with follow-up mRS (P > 0.05); patients whose discharge mRS were 1, 2, 3 or 4 had better long-term efficacies (P < 0.05) while those with a discharge mRS of 5 fare worse (P > 0.05). CONCLUSION: The short-term efficacy of early microsurgery for intracranial aneurysms is worse than those of medium and late microsurgery. But no obvious differences exist between the long-term efficacies of early, medium and late microsurgery. The patients whose discharge mRS were 1, 2, 3 or 4 have better long-term efficacies.

[Clinical experiences of normal saline pressed injection via lumbar puncture in the treatment of apnea due to acute tonsillar hernia].

OBJECTIVE: To summarize the clinical experiences of normal saline pressed injection via lumbar puncture in the treatment of acute tonsillar hernia induced apnea. This procedure was routinely carried out after external ventricular drainage and/or lesion removal via open craniotomy. METHODS: During the period of 1969 to 2005, a total of 43 patients failed to regain respiratory after external ventricular drainage using rapid small hole cranio-puncture apparatus or lesion removal via open craniotomy. They underwent lumbar puncture and normal saline was pressed injected via a lumbar puncture needle. The patient data were retrospectively analyzed. RESULTS: Eleven of 43 patients had spontaneous respiration and fully recovered (25.6%), 16 patients regained respiration but died eventually (37.2%) and 16 patients failed to regain respiration (37.2%). The effective rate was 62.8%. CONCLUSION: For the patients failing to regain respiration after external ventricular drainage or supratentorial lesion removal via open craniotomy, the conservative treatment should not be the first choice. The pressed injection of normal saline via lumbar puncture may rescue some patients.

Optimization of transfection efficiency of small interfering RNA in purified human prolactinoma cells.

BACKGROUND: Control of hypersecretion of certain hormones is one of the key targets in the treatment of pituitary adenomas. RNA interference has been shown to inhibit protein expression, and thus it may represent a promising method for the treatment of pituitary adenomas. In the present study, transfection efficiency of small interfering RNA (siRNA) was optimized in human prolactinoma cells. METHODS: First, a method was optimized to extract highly purified human prolactinoma cells in vitro. The extracted cells were verified to retain the physiological features of prolactin (PRL) secretion. Second, three conditions for siRNA transfection were tested by the evaluation of transfection efficiency and cell viability. The proper transfection condition was verified for human prolactinoma cells. Third, the siRNA for prolactin was transfected into the human prolactinoma cells, and the suppression of PRL mRNA was evaluated by quantitative real-time reverse transcription-PCR. RESULTS: The siRNA of 100 pmol with Lipofectamine 2000 of 5 µl for 1 × 10(6) cells was proved preferable, with transfection efficiency being 53.3% and cell viability being 69.7%. In the preliminary experiment the siRNA against PRL decreased the mRNA of PRL by 34.0%. CONCLUSION: It is possible to inhibit hormone hypersecretion by RNA interference, that may eventually enable therapeutic siRNA drugs developed.

[Study on prognostic factors of chronic severe hepatitis].

OBJECTIVE: To analyze factors influencing prognosis and to develop a prognosis predicting model for patients with chronic severe hepatitis. METHODS: Clinical data from 408 patients suffering from chronic severe hepatitis were divided into improved group and deteriorated group. The main clinical and laboratory variables were analyzed as predictive factors of prognosis with logistic regression analysis. RESULTS: It was shown that age, sex, TBil, DBil, [Cl-], [Na+], WBC, MCV, PT, NH3, PTA, and BUN were different between the two groups with statistical significance (P < 0.05). The prognosis predicting model was P = 1/(1 + e(-y)), Y = -4.636 + 0.022X1 + 0.034X2 + 0.096X3 + 0.047X4 - 0.042X5, (X1-age, X2-TBil, X3-BUN, X4-MCV, X5-PTA). CONCLUSION: Age, TBil, BUN, MCV and PTA are the independent risk factors related to prognosis of chronic severe hepatitis.