ObjectiveTo compare the effectiveness of magnetic resonance spectroscopy (MRS) and Dynamic Contrast-enhancement (DCE-MRI) with 1.5 T MR scanner in diagnosing prostate cancer. MethodsFrom April 2011 to December 2012, based on the results of biopsy, we measured 216 regions of interest (ROIs) in images of MRS and DCE-MRI, comprised of 131 ROIs from cancer zone and 85 ROIs from non-cancer zone. The data were analyzed with statistical methods, including receiver operating characteristic (ROC) curve. ResultsThere were significant differences between the malignant group and the benign group (P<0.05) in Cit integral, Cho integral, CC/Cit ratio, the type of time-signal intensity curve, initial value, enhancement rate and ratio of enhancement. According to ROC curve, the area under curve (AUC) of CC/Cit and enhancement rate was 0.853 and 0.719, respectively. AUC of time to peak, time difference, enhancement rate and Cit integral was lower than 0.400. The optimal operating point (OOP) of CC/Cit was 0.775, with a specificity of 0.85 and a sensitivity of 0.79, and the AUC was 0.853. The OOP of the ratio of enhancement was 60.89, with a specificity of 0.66 and a sensitivity of 0.71, and the AUC was 0.719. ConclusionMRS is more sensitive and specific than DCE-MRI to diagnose prostate cancer when an 1.5 T MR scanner is used. On the other hand, MRS is susceptible to interference, but DCE-MRI can make up for these deficiencies.
ObjectiveTo assess the diagnostic value of procalcitonin (PCT) and/or (1,3)-β-D-glucan test (serum BG assay) for pulmonary infection. MethodsWe collected 1 027 cases randomly from January 24th, 2013 to January 25th, 2014. First, we accumulated isolates from these cases in sputum culture. Second, we compared PCT and sputum culture, serum BG assay and sputum culture, CT and serum BG assay. Then we accumulated these PCT and studied its distribution when PCT>0.5 ng/mL and when their sputum culture was positive. We also accumulated these serum BG assay results and studied its distribution when their sputum culture was positive for aspergillus or suggested aspergillus infection by CT. Finally, we estimated the significance of the combined use of PCT and serum BG assay for diagnosis of pulmonary infection. ResultsIn these cases, pathogens were mainly multiple drug-resistant organisms and tuberculosis, or fungi. We found that PCT value presented a skew distribution in disease with a median of 2.06 ng/mL. Single PCT or combination of PCT and sputum culture had similar distribution. With sputum culture as the reference, PCT sensitivity was 41.2% and specificity was 66.4%. In the cases of sputum culture aspergillus and CT suggestion of aspergillus infection, serum BG assay value distribution was similar, and the median and average were both lower than cut-off. With sputum culture as the reference, serum BG assay sensitivity was 13.2% and specificity was 84.1%. In the 12 cases with positive sputum culture and serum BG assay, serum BG assay median was 112.91 pg/mL. With CT as the reference, serum BG assay sensitivity was 21.4% and specificity was 75.0%. In the 17 cases with the same sputum and blood culture result with the PCT median of 7.51 pg/mL, there were three cases whose PCT value was under the cutoff and three cases whose serum BG assay value was above the cutoff. In evaluation of the combination of PCT and serum BG assay, the analysis had yielded that we could neither diagnose pulmonary infection with both being positive, nor exclude the disease with both being negative. ConclusionWith regard to PCT and serum BG assay, we should be prudent and wise and use it after reasonable evaluation and entire analysis.
ObjectiveTo explore a better segment of fixation and fusion for high-grade spondylolisthesis. MethodsA total of 21 patients with high-grade spondylolisthesis who had undergone reduction and posterior instrumented fusion between July 2007 and March 2012, were retrospectively reviewed. All cases underwent posterior spinal canal decompression, Schanz screws fixation and reduction, and intervertebral and posterolateral fusion. The concept of "unstable zone" and the feature of spinal deformity helped us to identify the most appropriate segment to fuse. The pre/post-operative differences on slip percentage, pelvic incidence (PI) and lumbosacral angle were compared and analyzed. The nerve function was evaluated by physical examination and neurological Frankel grade. The Visual Analogue Scale (VAS) and Oswestry Disability Index were used to assess clinical and functional outcomes of lower limbs. Bone fusion was assessed using CT reconstruction. ResultsAll patients were followed up between 12 and 48 months. The clinical and radiological outcomes such as VAS scores and PI angle were all improved compared with that of preoperative, and the differences were all statistically significant (P<0.05). ConclusionFor children with severe spondylolisthesis, if not combined with structural scoliosis, the fixation and fusion level should be up to the upper vertebra which PI angle>60°, and try to protect the posterior longitudinal ligament complex in case adjacent segments become instability or even slip. For adults with severe spondylolisthesis, if not combined with other spinal disorders such as severe osteoporosis, only mono-segmental fusion is recommended after reduction. If the slipped vertebrae could not be reduced to Meyerding gradeⅠ, two or more segments would need to be fixed and fused.
ObjectiveTo summarize the experience in management of occult cerebrospinal fluid leakage (CSFL) in posterior thoracolumbar surgeries, and to explore the best drainage duration, as well as to analyse the ways to reduce the risk of CSFL. MethodsA retrospective analysis was made on the clinical data of 26 patients with occult CSFL in posterior thoracolumbar surgeries between January 2011 and January 2013. There were 15 males and 11 females, with the average age of 48.7 years (range, 36-59 years). Headache occurred in 19 cases, and 5 cases had nausea with 3 cases also having vomiting after operation. Drainage tube unobstructed and no CSFL from the skin incision were observed in 23 cases at the postoperative 2nd day, and the drainage pipe clamp test was performed at the 3rd day. Twenty-one patients had no CSFL and were given extubation; 2 cases having CSFL were given extubation after conservative treatments for 10 days. Three patients had CSFL with ineffective conservative treatments at the postoperative 2nd day, then received reoperation, incision suture, and drainage. At the postoperative 3rd day, if no CSFL was observed, these patients were given extubation and stayed in bed for 3-5 days. ResultsAll incisions healed and the healing time was 7-15 days (mean, 8 days). No incision infection, persistent CSFL, and other complications occurred. After extubation, headache, nausea, vomiting, and other symptoms were alleviated immediately. All patients were followed up 12-24 months (mean, 16 months). MRI at the postoperative 6th month showed no subcutaneous epidural pseudocyst. ConclusionThe quality of suturing is the key factor to prevent occult CSFL in posterior thoracolumbar surgery. Under the premise of good suture quality, extubation can be given at the postoperative 3rd day. Before extubation, the drainage pipe clamp test can be performed to make sure no CSFL and to reduce the risk of CSFL from the surgical incision after extubation.
ObjectiveTo evaluate the surgical outcomes of modified Blalock-Taussig shunts in the patients with congenital heart diseases of diminutive pulmonary blood. MethodsWe retrospectively analyzed the clinical data of 39 patients with congenital heart diseases of diminutive pulmonary blood, who underwent modified Blalock-Taussig shunts with Gore-Tex vessels in the First Affiliated Hospital, Hunan University of Chinese Medicine between June 2007 and June 2013. There were 23 male and 16 female patients at age of 6 months to 16 years (4.64±3.85) years, body weigh at 4.5-43.0 (14.81±8.69) kg. ResultsThere were 4 postoperative deaths. The early mortality was 7.69% (3/39). The arterial oxygen saturation increased from 64.28%±8.05% to 81.07%±5.76% (P < 0.01). Ideal pulmonary flow in each patient was obtained. Pulmonary arteries were significantly improved compared with those before operation. McGoon ratio (1.11±0.16 versus 1.58±0.22, P < 0.01) and Nakata index (113.98±14.84 mm2/m2 versus 160.98±26.65 mm2/m2, P < 0.01) increased with a statistical difference. Two-stage radical operations were performed in 8 patients. ConclusionsModified Blalock-Taussig shunt is effective in promoting development of the pulmonary arteries and improving cyanosis significantly. Modified Blalock-Taussig shunt can correct hypoxia to prepare for the radical operation．