[Surgical outcomes of pediatric symptomatic epilepsy and their influencing factors].

OBJECTIVE: To investigate the surgical outcomes of pediatric symptomatic epilepsy and the influencing factors for postoperative outcomes. METHODS: A cohort of 48 children with symptomatic epilepsy received surgical treatment from October 2004 to September 2008. The surgical outcomes were followed up. RESULTS: A 27.3 months (range 12-51 months) follow-up was performed in 43 cases. Engel classification for evaluating postoperative epileptic outcomes showed that class I in 32 cases (74%), class II in 4 cases (9%), class III in 4 cases (9%) and class IV in 3 cases (7%). Preoperative seizure frequency is an independent predictor of postoperative epileptic outcomes (P<0.05). CONCLUSIONS: Operative treatment can lead to a favorable result in children with symptomatic epilepsy. Preoperative seizure frequency is an independent influencing factor for postoperative outcomes.

[Expression of peroxisome proliferator-activated receptor-gamma in human pituitary adenomas and its correlation to tumor invasiveness].

BACKGROUND & OBJECTIVE: Peroxisome proliferator-activated receptor-gamma (PPARgamma) is a nuclear transcription factor. Its ligant can inhibit proliferation and enhance differentiation of tumor cells, which plays crucial roles in metastasis and invasion of tumors. This study was to investigate the expression of PPARgamma in human pituitary adenomas and its clinical significance. METHODS: Immunohistochemistry (IHC) was used to investigate the expression of PPARgamma protein in 78 human pituitary adenomas, including 41 invasive and 37 non-invasive cases. The expression levels of PPARgamma mRNA in 33 human pituitary adenomas, including 16 invasive and 17 non-invasive cases, and three normal pituitary tissues obtained from autopsy were confirm by reverse transcription polymerase chain reaction (RT-PCR). The expression of PPARgamma in invasive and non-invasive pituitary adenomas was analyzed by Chi2 test and t test of the fourfold table. RESULTS: The positive rate of PPARgamma protein was significantly higher in invasive pituitary adenomas than in non-invasive ones (68.09% vs. 38.71%,P<0.05). The PPARgamma mRNA level was significantly higher in pituitary adenomas than in normal pituitary tissues (2.99+/-0.18 vs. 1.55+/-0.25, P<0.05), and higher in invasive pituitary adenomas than in non-invasive cases (3.95+/-0.43 vs. 2.40+/-0.24, P<0.01). CONCLUSIONS: PPARgamma is highly expressed in human pituitary adenomas, especially in the invasive ones. PPARgamma may be used as a new target for the treatment of pituitary adenomas.

[Electrocorticography monitoring in microsurgical treatment of solitary cavernous angiomas].

OBJECTIVE: To investigate the curative effect of electrocorticography (ECoG) monitoring in the microsurgical treatment of cavernous angiomas. METHODS: Clinical data of 71 patients with epileptogenic cavernous angiomas,who had been performed ECoG monitoring during the operation,were analyzed retrospectively. RESULTS: The foci of cavernous angiomas and epilepsy of the 71 patients were resected during the operation. In the 58 patients who were followed up,42 had not epileptic seizure,and 16 still had epileptic seizure,while the frequencies of 13 patients reduced to below 10%,and 3 patients over 10%. CONCLUSION: The drug treatment of epileptogenic cavernous angiomas can not control epileptic seizure,and the patients should receive the microsurgical treatment early. Electrocorticography monitoring can direct the surgical procedure,and control the postoperative epileptic seizure.

Expression of galectin-3 correlates with apoptosis in pituitary adenoma cells.

OBJECTIVE: To investigate the expressions of Galectin-3 (Gal-3), Bcl-2 and Bax in human pituitary adenomas, and to explore the interrelation among them. METHODS: RT-PCR and immunohistochemistry were applied to detect the mRNA and protein expressions of Gal-3, Bcl-2 and Bax in surgically excised human pituitary adenoma tissues, including invasive and non-invasive pituitary adenomas, and the correlation analysis was performed. RESULTS: The Gal-3 and Bcl-2 expressions in the invasive pituitary group were significantly higher than those in the non-invasive group, and the expression of Bax had no significant difference between the two groups. Pearsonos correlation analyses showed that the Gal-3 expression was positively correlated with Bcl-2, but was not correlated with Bax, which was inversely correlated with expression of Bcl-2. CONCLUSION: Gal-3 may function through a cell death inhibition pathway involving Bcl-2 to enhance cell proliferation, which result in the invasive growth of pituitary adenoma. These results indicate that Gal-3 has an important role in pituitary tumor cell proliferation and may serves as a possible therapeutic target in treatment of pituitary tumors.

[Effect of different tidal volume ventilations on atelectasis in patients during general anesthesia by CT scan].

OBJECTIVE: To investigate the effect of different tidal volume ventilations on the amount of atelectasis during general anesthesia. METHODS: Twenty adults, ASA physical status I and status II patients, who were scheduled for elective excision of intracranial lesion were randomly divided into 2 groups: Group TV (traditional tidal volume ventilation, 10 mL/kg) and Group LV (low tidal volume ventilation, 6 mL/kg). Atelectasis, as determined by CT and artery blood gas (ABG) analysis, was measured before the anesthesia, after the tracheal intubation, and at the end of the operation, respectively. Respiratory mechanical parameters were measured at 30, 120, and 240 min after the intubation. RESULTS: After the tracheal intubation, CT scan showed obvious atelectasis in both groups. The atelectasis area was(4.35+/-2.15)cm2 (3.12%+/-1.94%) in the TV group and (4.80+/-2.45)cm2 (3.89%+/-2.11%) in the LV group, with a nonsignificant difference between the 2 groups. At the end of the operation, there was no significant increase in the amount of atelectasis between and within the 2 groups. Artery blood gas analysis showed no difference after the tracheal intubation and at the end of the operation in either group. Ppeak, Pplat, Pmean and lung compliance(Cst)were significantly higher in the TV group than those in the LV group. CONCLUSION: Low tidal volume(6 mL/kg) ventilation is more feasible during general anesthesia in patients with healthy lungs, and it does not increase the atelectasis and impairment of gas exchange.

[Gamma knife treatment for pituitary prolactinomas].

OBJECTIVE: To evaluate the outcome of gamma knife for prolactinomas. METHODS: Eighty-nine patients were treated by gamma knife and 51 were followed up. The dose to the tumor margin ranged from 18 Gy to 35 Gy (mean 26.1 Gy). The maximum radiation dose varied from 36 Gy to 60 Gy (mean 50.41 Gy). The mean tumor diameter was 15.5 mm (5 - 26 mm). RESULTS: The follow-up data were available for 51 patients ranging from 6 to 108 months (mean 37 months). The tumor growth control rate was 100%. The endocrinological remission rate was 40%. The rate of hypopituitarism was 17.6%. CONCLUSION: Gamma knife radiosurgery can be used as a primary treatment for selected prolactinomas,especially for pituitary microadenomas.

[Detection and clinical significance of urinary epidermal growth factor in brain tumor patients].

OBJECTIVE: To investigate the clinical significance of urinary epidermal growth factor (EGF) in patients with brain tumors. METHODS: The levels of EGF in urine samples collected from 20 patients (9 low grade astrocytomas, 6 anaplastic astrocytomas, and 5 meningiomas) and 5 healthy individuals were determined. EGF levels were measured by radioimmunoassay technique. A preoperative and one postoperative determination were performed. RESULTS: Preoperative urinary EGF levels of astrocytoma patients were statistically higher than those of meningioma patients and the controls (P < 0.01). Preoperative urinary EGF levels showed a positive correlation with the degree of malignance in the astrocytoma patients (P < 0.05). A significant decrease of the postoperative levels of EGF was observed in the astrocytoma patients who underwent gross total resection (P < 0.01). The pre/postoperative urinary EGF levels of the meningioma patients showed no significant fluctuations and showed no significant difference with those of healthy individuals (P > 0.05). CONCLUSION: The urinary EGF levels of astrocytoma patients correlate with the WHO grade of malignance and significantly decrease after gross total removal. Urinary EGF may be of practical value in diagnosing and evaluating the surgical efficacy of astrocytomas.

[Gamma knife treatment for pituitary adenomas].

OBJECTIVE: To evaluate the function and effect of Gamma knife radiosurgery (GKR) in controlling the tumor growth and improving endocrinological abnormality of pituitary adenomas. METHODS: Two hundred and twenty-eight cases of pituitary adenoma were treated with Leksell Gamma knife. 1.0 Tesla MRI and Gamma-Plan system were used to orientate the tumor. The margin dose was 12 - 35 Gy, mean 21.3 Gy; the center does was 24 - 70 Gy, mean 46.6 Gy (NFA, 31.8 Gy; FA, 50.3 Gy). RESULTS: One hundred and sixteen cases (NFA, 28; FA, 88) were followed up for 4 - 67 months, and the mean was 27.4 months. The growth of tumors in 113 cases (97.4%) was controlled. The tumor volume became smaller in 98 cases (84.5%). Three cases (2.6%) grew larger in tumor size. A significant decrease of excessive hormone production was seen in 89.8% of the patients, and the endocrinological normalization rate was 49.7% (PRL, 47.2%; GH, 57.1%; ACTH, 55.6%). Postradiosurgical complications were seen in 6%. CONCLUSION: Gamma knife radiosurgery is safe and effective in controlling the tumor growth and improving endocrinological abnormality of pituitary adenoma.