OBJECTIVE: To investigate the effect of soft tissue repairing at different times on the union of type III b tibial fracture. METHODS: From January 1987 to January 1999, seventy-six type III b tibial fractures were divided into 3 groups: early group(0 to 7 days), subacute group(8 to 30 days), late group(more than 30 days) according to the time of soft tissue repairing. The morbidity rates of complications such as infection, nonunion as well as the time to union were compared respectively. RESULTS: Followed up for 10 to 36 months (averaged 24 months), the infection and nonunion rates of early group were lower than that of subacute and late groups(P lt; 0.01), the average time of fracture union of early group was less than that of subacute and late groups. CONCLUSION: Early soft tissue repairing can decrease the complications and the time to union of Type III b tibial fracture obviously. The time of "early" should be limited in one week and as soon as possible.
ObjectiveTo analyze risk and therapy strategy of tiny gallbladder stones during laparoscopic cholecystectomy (LC).MethodThe clinical data of 932 patients with tiny gallbladder stones performed LC from September 2013 to July 2014 were analyzed retrospectively.ResultsThe LC was successful in all the patients. The gallbladders were ruptured in 86 (9.23%) patients during operation. Following up 1-3 months, there were 26 patients with right upper abdominal pain and with residual small stones in the abdominal cavity, 57 patients without uncomfortable symptoms and without residual gallstone, 2 cases complicated with lesser abdominal abscess, 1 case complicated with incision infection. The incisional hernia and acute pancreatitis were not found.ConclusionsThe gallbladder with full of tiny stones performed LC easily leads to choledocholithiasis or acute pancreatitis. If intraoperative gallbladder rupture, the tiny stones might be residual in the peritoneal cavity and lead to abdominal infection or abscess, and incision infection or trocar site hernia. Specific operation could effectively avoid adverse complications.
【摘要】 目的 探讨卵巢两性母细胞瘤的临床及病理组织学特征。 方法 观察总结2004年3月-2008年3月6例卵巢两性母细胞瘤的临床及病理学特征，以及免疫组化染色结果。 结果 患者以月经紊乱、闭经、绝经后阴道出血为主要临床表现。肿瘤含两种成分，即颗粒细胞和Sertoli-Leydig细胞，两者均呈成熟性的组织学形态，1例伴有异源性分化成分。6例肿瘤呈α-inhibin和vimentin强阳性，3例呈CD99阳性，5例呈calretinin阳性，2例的Sertoli细胞呈CK阳性。4例患者有随访资料，随访期14～60个月，均无瘤存活。 结论 两性母细胞瘤以内分泌异常相关症状为主要临床表现，大部分患者诊断时处于临床1期，预后较好。对诊断为两性母细胞瘤的患者应进行长期的临床随访。【Abstract】 Objective To observe the clinical pathologic and immunophenotypic features of gynandroblastoma. Methods The pathologic samples of six patients with gynandroblastoma from March 2004 to March 2008 were observed and analyzed. Immuohistochemistry staining was performed by SP method using antibodies of α-inhibin,CD99,Vimentin,Calretinin,CK,EMA. Results The main clinical features included menstrual disorders, amenorrhea, and postmenopausal bleeding. The tumor was composed of ranulose cells and Sertoli cells, both of which were well differentiated. Strongly positive expression of α-inhibin and vimentin was found in all the patients, while CD99 (+) was in three, calretinin (+) was in five, and CK (+) of Sertoli cells was in two. Four patients were followed up for 14-60 months and all were tumor free. Conclusion The main clinical features of gynandroblastoma are estrogenic or androgenic manifestations. Nearly all the patients are diagnosed in stage 1 and have a good prognosis. Patients with gynandroblastoma should be followed up for a long period.
【Abstract】 Objective To explore the clinical application and outcomes of preoperative second measurement of three-dimensional (3-D) CT reconstruction data for scoliosis orthopedic surgery. Methods Between August 2006 and March 2008, 11 patients with severe rigid scoliosis received surgery treatment, including 4 males and 7 females with an average age of 17.2 years (range, 15-19 years). Preoperative second measurement of 3-D CT reconstruction data was conducted to guide the surgery， including the angle and width of pedicle, the entry point, and the choice of screws whose lengths and diameters were suitable. A total of 197 pedicle screws were implanted. The operation time， blood loss， postoperative nerve function，and Cobb’s angles at sagittal and coronal view were all recorded， and the postoperative CT scan was performed to assess the accuracy of pedicle screw insertion according to Andrew classification. Results Pedicle screws were implanted within 1-11 minutes (mean, 5.8 minutes), and the blood loss was 450-2 300 mL (mean, 1 520 mL). The postoperative X-ray films showed the correction rates of Cobb’s angle were 68.5% in coronal view and 55.5% in sagittal view. The accuracy of pedicle screw insertion was rated as grade I in 77 screws (39.1%)，grade II in 116 screws (58.9%)， and grade III in 4 screws (2.0%) according to postoperative CT scan. All 11 cases were followed up 14 months to 2 years without any complications. Conclusion Preoperative second measurement of 3-D CT reconstruction data can make the surgery process easy and accurate in treatment of severe scoliosis.
ObjectiveTo investigate the job satisfaction, emotional state and related factors of medical staff participating in online consultation of West China Internet Hospital during the COVID-19 epidemic.MethodsThrough literature review and expert consultation (Delphi method), the questionnaire was developed, and the online consulting medical staff of West China Hospital of Sichuan University were invited to conduct the questionnaire survey from 26 January to 19 June 2020, and finally the statistical analysis was summarized.ResultsA total of 132 valid questionnaires were retrieved. Of the 132 subjects, 127 people (96.2%) expressed satisfaction or special satisfaction with the online consulting office format; 103 respondents (78.0%) said that online consulting did not affect or completely did not affect the work and life; 81 people (61.4%) consulted online more than 5 days a week, and 108 people (81.8%) worked within 2 hours a day; the vast majority (97.7%) of the research subjects were satisfied with the content of the training materials and the related support work of the coordination group. Only 29 (22.0%) of the study participants believed that the epidemic caused negative emotions, mainly due to the severity of the epidemic.ConclusionThe online consulting medical staff are satisfied with the office form, training materials and coordination work group of the COVID-19 epidemic, and think that it does not affect their work and life. 22.0% of medical staff have negative emotions, and the severity of the epidemic is the main reason.
Objective To investigate the surgical procedures and cl inical outcomes of the neurovascular free flap based on dorsal branch of digital artery of ring finger graft for repair of finger pulp defect. Methods From February 2006 to May 2009, 11 cases (11 fingers) of finger pulp defect with tendon and bone exposure were treated, including 8 males and 3 females with an average age of 29 years (range, 23-40 years). The defect locations were thumb in 2 cases, index finger in 5 cases, and middle finger in 4 cases. The defect size ranged from 1.0 cm × 1.0 cm to 2.5 cm × 2.0 cm. The time frominjury to operation was 1-9 hours. The flap size ranged from 1.5 cm × 1.5 cm to 3.0 cm × 2.5 cm. Five flaps carried the dorsal branch of digital nerve, 6 flaps carried nervi digitales dorsales. The flaps were cut from proximal radial dorsal ring finger in 4 cases and from promximal ulnar dorsal ring finger in 7 cases. Defect of donor site was repaired with full-thickness skin grafting. Results All flaps and grafted skins survived; wound and incision of donor site achieved heal ing by first intention Eleven patients were followed up 6 to 24 months with an average of 12 months. The other finger flaps had good texture and shape except for 1 flap with sl ightly bloated. The activities of finger distal interphalangeal joint were normal, the two-point discrimination of finger pulp was 7-12 mm. The extension and flexion activities of donor fingers were normal, the ringl ike thread scar left at the donor site. Conclusion It is an ideal method to use the neurovascular free flap based on dorsal branch of digital artery of ring finger graft for repair of finger pulp defect, which has the advantages of simple operation, good appearance, and functional recovery.
Objective To investigate the expression and clinicopathological features of fumarate hydratase (FH) in multiple leiomyoma of the uterus. Methods Relevant clinicopathological data of patients with multiple leiomyoma of the uterus diagnosed pathologically between September 1, 2018 and August 31, 2019 were collected from the Department of Pathology of West China Second University Hospital. The morphology, FH protein expression and prognosis of FH negative patients were observed. Results A total of 900 patients were included. Among them, there were 825 cases of nonatypical leiomyomas, 36 cases of leiomyoma with bizarre nuclei, 34 cases of cellular leiomyoma and 5 cases of mitotically active leiomyoma. A total of 69 patients with negative FH expression were included, with an average age of (37.28±8.22) years. Among them, there were 43 cases of nonatypical leiomyomas, 19 cases of leiomyoma with bizarre nuclei, 6 cases of cellular leiomyoma, and 1 cases of mitotically active leiomyoma. At low magnification, staghorn shaped blood vessels, alveolar pattern edema, palisade distribution of smooth muscle cells and bizarre nuclei smooth muscle cells could be seen in patients with negative FH expression. At high magnification, cytoplasmic eosinophilicglobules andeosinophilic nucleolus surrounded by a halo could be seen in patients with negative FH expression. Among the 69 cases with negative FH expression, 60 cases (86.96%, 60/69) were followed up. All patients survived, of which 24 cases (40%, 24/60) recurred. Conclusion Immunohistochemically, the marker FH for multiple leiomyoma of the uterus is helpful to improve the identification of FH deficient leiomyoma in clinical work as well as early diagnosis in hereditary leiomyomatosis renal cell cancer syndrome.