Objective To explore surgical technique and clinical outcome of transabdominal preperitoneal hernia repair (TAPP) and totally extraperitoneal hernia repair (TEP) in inguinal hernia repair. Methods 〗The clinical data of 23 patients underwent laparoscopic herniorrhaphy were retrospectively analyzed. Nine patients were underwent TAPP, and 14 patients underwent TEP. Results 〗None of patients was changed to open operation. Only one patient of TEP was changed to TAPP. Average operative time was (82.1±40.6) min. Blood loss was (5.7±3.0) ml. Disruption of peritoneum happened to 2 patients underwent TEP. The rate of postoperative complications was 21.7% (5/23), which included serum swelling (1 case), scrotal emphysema (2 cases), transient neurapraxia in the area of repair (1 case) and urinary retention (1 case). No chronic pain, foreign body sensation and infection were found. Average hospitalization after operation was (4.3±0.9) d. No recurrence was observed during a follow-up period of 1-15 months. Conclusion 〗Laparoscope herniorrhaphy is safe due to lower recurrence and complications. It also has the advantages of slight pain and rapid recovery.
Objective To evaluate the ability of inductive osteogenesis of allgraft demineralized bone containing basic fibroblast growth factor (bFGF/ALB) in repairing bone defect. Methods Thirty-two New Zealand white rabbits were randomly divided into four groups (groups A,B,C and D, n=8). A segmental bone defect of15 mm inlength was made on the bilateral radius respectively and the defects filled with ALB/bFGF in group A, with ALB in group B, with bFGF in group C and without any materials in group D serving as blank control. At 2, 4, 6 and 8 weeks after operation, all restored bones were evaluated by roentgenography, histological observation and Ca2+detection of osteotylus. Results The X-ray films showed that groups A and B had a little shadow of bone formation at 2 weeks, while groups C and D had transparent shadow; that group A had denser shadow and new bone formation at 4 weeks and 6 weeks, groups B and C had a little increase of shadow and group D had little shadow at fractured ends; and that group A had formation of bone bridge at 8 weeks, the new formed bone in fractured ends of group B closed with each other, the gap still existed in group C, and the defects filled with the soft tissue in group D. The Ca2+content of group A was higher than that of groups B, C and D at 4 weeks (Plt;0.05) and 8 weeks (Plt;0.01). The histological observaton showed that the degree of bone restoration of group A was superior to that of groups B, C and D. Conclusion bFGF/ALB is a good material to improve bone restoration.
目的 评价康艾注射液辅助化学疗法（化疗）对直肠癌术后临床疗效、生活质量及其不良反应的影响。 方法 2010年4月－2011年2月收治的50例直肠癌术后化疗患者，随机分为试验组与对照组，每组25例。两组均采用FOLFOX方案化疗，在化疗同时，试验组予静脉滴注康艾注射液辅助治疗。连续治疗6个周期，比较两组临床疗效、生活质量及其不良反应情况。 结果 试验组治疗有效率为84%，对照组为88%，差异无统计学意义（P＞0.05）；两组生活质量改善率差异无统计学意义（P＞0.05）；试验组胃肠道反应、白细胞计数下降发生率低于对照组，差异有统计学意义（P＜0.05）。 结论 康艾注射液用于直肠癌术后的辅助化疗可降低化疗的不良反应。
目的 探讨老年髋部骨折围手术期的治疗策略。 方法 回顾性分析2004年1月-2009年1月手术治疗的96例老年髋部骨折患者的临床资料。 结果 术前81.25%(78/96)合并内科疾病的患者，均安全度过手术期。术后发生并发症20例，发生率为20.83%。术前有并存疾病者手术治疗优良率为84.61%，术前无并存疾病者手术治疗优良率为94.44%；术前有无并存疾病患者的手术优良率比较，差异有统计学意义(Plt;0.05)。 结论 老年髋部骨折患者术前合并疾病较多，应视其个体情况，采取积极恰当的围手术期处理，积极控制和治疗合并疾病，才能降低围手术期并发症的发生率，取得优良的治疗效果。
Objective To evaluate the cl inical results of the femoral reconstruction technique in patients with proximal femoral deformity in total hip arthroplasty. Methods Between March 2004 and June 2009, total hip arthroplasty procedures were performed on 25 patients (26 hips) with hip joint disease and proximal femoral deformity, including primary osteoarthritis of the hip joint (2 hips), developmental dysplasia of the hip (8 hips), traumatic arthritis of the hip (14 hips), and tuberculosus arthritis of the hip (2 hips). There were 10 males (10 hips) and 15 females (16 hips), with an average age of 64 years (range, 42-82 years). The disease duration was 10 months to 25 years (mean, 10.6 years). The Harris score was 44.2 ± 5.1, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 45.0 ± 2.7 before operation. According to Berry’s classification system of primary disease, 8 hips were classified as developmental dysplasia of hip, 7 hips as malunion of fracture, 2 hips as chronic tuberculosis, 2 hips as sl ipped femoral epiphysis, 1 hip as previous subtrochanteric osteotomy, 1 hip as previous shelf operation of the acetabulum, and 5 hips as previous internal fixation; according to the anatomic site of the deformity, there were 5 hips of greater trochanter, 10 hips of femoral neck level, 10 hips of metaphyseal level, and 1 hip of diaphysis. Results All wounds healed by first intention. Deep venous thrombosis occurred in 3 patients within 1 week, and were cured with braking and anticoagulant therapy. Bursal synovitis of great trochanter occurred in 1 patient after 6 weeks, and was eased after taking drugs for pain rel ief. All patients were followed up 1 year and 6 months to 6 years, with an average of 3 years and 3 months. The Harris score and WOMAC score at last follow-up were 88.4 ± 3.6 and 82.0 ± 5.2 respectively, showing significant differences when compared with preoperative scores (P lt; 0.05). The X-ray films at last follow-up showed good location of prosthesis and no loosening expect 1 patient who had aseptic loosening and was given revision at 8 months postopera tively. Conclusion Proximal femoral deformity classification will contribute to the choice of prosthesis and surgical strategy,thus the good results of femoral reconstruction and cl inical results would be obtained.
Objective To analyze the risk factors of hospitalized children with acute asthma exacerbation in Chongqing region. Methods A total of 193 cases were randomly selected from the hospitalized children with acute asthma exacerbation in Chongqing Children’s hospital and Jiangjin District People’s Hospital from January 2009 to December 2009. A self-designed questionnaire was used to collect data. A control group of children were randomly selected from the out-patients who received regular maintain therapy without asthma attacks for more than 3 months. Results The first independent risk factor of asthma hospitalization was respiratory infection ( 85. 5%, 165 /193) . Irregular use of control medications was the second important factor for the acute exacerbation. There were 75% ( 138 /193) patients didn’t take controlmedications regularly, includes 102 undiagnosed and 36 pre-diagnosed cases which was more common than that in regular maintain therapy group ( 21/110, 19. 1% ) . A variety of allergen-induced acute exacerbation of asthma was also common, which accountted for 9. 3 % ( 18/193) . There were more boys than girls ( M/F:124 /69) and no significant difference in the family history of allergic diseases ( P gt; 0. 05) . Conclusion Respiratory infection, under-diagnosis of asthma, and irregular use of the control medications are risk factors of acute exacerbation in children with asthma in Chongqing region. Meanwhile allergen exposure warrantsmore attention.
Objective To study the clinical effect of anterior cruciate ligament(ACL) reconstruction with different grafts under arthroscope. Methods A retrospective analysis was done on 68 cases of ACL injury.ACL reconstruction with bonepatellar tendonbone autograft and interface screw fixation were performed in 26 cases(group A) and quadruple semitendinosus tendon autograft and endobutton plate fixationin in 38 cases (group B). ACL reconstruction with bonepatellar tendonbone allograft cryopreserved and interface screw fixation were performed in 4 cases (group C). Therewere 16 males and 10 females with an average age of 26.4 years (16-45 years) in group A, 24 males and 14 females with an average age of 24.6 years (13-48 years) in group B, and 3 males and 1 female (55-65 years) in group C. The left knee involved in 14 cases, 27 cases and 3 cases, and the right knee involved in 12 cases, 11 cases and 1 case in groups A, B and C, respectively. The disease courses were 1 week to 15 months (group A), 1 week to 16 months (group B) and 2 weeksto 28 months (group C).The intermediate myodynamic recovery, IKDC score and Lysholm score were compared among 3 groups. Results All patients were followed 12-36 months (17.5 months in group A, 18.5 months in group B and 16.5 months in group C). No intra articular infection, phlebothrombosis of leg, vascular injury and nerve injury occurred. Lysholm scores was increased from preoperative 65.3±4.8 to postoperative 95.1±4.3 in group A, from 68.4±5.6 to 93.0±5.9 in group B and from 60.3±6.7 to 92.2±4.3(excellent in 3 cases and good in 1 case) in group C; the excellent and good rates were 88.5% (excellent in 18 cases, good in 5 cases and fair in 3 cases) in group A, 86.8% (excellent in 28 cases, good in 5 cases and fair in 5 cases) in group B, IKDC scores were 93.7±3.8 (group A), 95.7±4.7 (group B) and 94.8±3.6(group C); the knee joint functions were normal in 19 cases(73.1%), in 30 cases (78.9%) and in 3 cases, were fair in 5 cases (19.2%), in 5 cases (13.2%) and in 1 cases in groups A, B and C respectively. Conclusion The transplantation of bonepatellar tendonbone autograft , quadruple semitendinosustendon autograft and bonepatellar tendonbone allograft all can reconstruct and strengthen the stability of knee joint. Bonepatellar tendonbone allograft is better selection for the ACL injury in elder and quadruple semitendinosus tendon autograft is suitable to adolescent patients with disrupted ACL.
Objective To investigate the blood clotting dysfunction of invasive pulmonary aspergillosis(IPA)and the therapeutic effect of low molecular hepafin in a mouse model．Methods The neutropenic IPA mouse model was constructed by being given cyclophosphamide to depress immunologic function，and then intranasally challenged with Aspergillus fumigatus conidia．(1)Blood clotting function were assessed by bleeding time，clotting time，platelet count and antithrombase-III(AT-III)activity．Seventy-two mice were randomly assigned into 4 groups．Group A received only normal saline．group B received normal saline to substitute the cycloph0sphamide，and the rest equal to group D．Group C received normal saline to substitute the AspergiUus fumigatus conidia suspension，and the rest equal to group D．Group D(model group)received cyclophosphamide(intraperitoneally，150 mg／kg，d4，d1)and Aspergillus fumigatus conidia suspension(intranasally，40 μL／mouse，1．5×10∧5／mL，d0)．Six mice were randomly sacrificed in each group for analysis of blood clotting function per 24 h after inoculation for 3 times．(2)Therapeutic effect of low molecular heparin was determined by survival time of IPA mice．One hundred and eighteen mice were randomly assigned into 4 groups after challenged with 6×10 conidia／mouse and received one of the following regimens daily from dl to d7 after challenge，vehicle(group E，n=29)，low molecular heparin(group F，n=30，subcutaneous injection，1000 IU／kg，qd×7 d)，amphotericin B(group G，n=29，intraperitoneal，1 m kg，qd×7 d)，low molecular heparin plus amphotericin B(group H，n=30)．Mice survivals were recorded once daily to d21 after innoculation．Results (1)AT-III activity of group D decreased significantly 24 h after innoculation．Bleeding time and clotting time decreased significantly and AT—III activity decreased sequentially 48 h after innoculation．The platelet decreased significantly 72 h after innoculation，and bleeding time shoaened further．Clotting time was longer than that 0f 48 h．but still shorter than norm al and AT-III activity decreased sequentially．There were significant differences when comparing group D with group A，B and C(all Plt;0.01)．And there was no significant difference between group A，B and C(all Pgt;0．05)．(2)Survival analysis indicated that the therapeutic effect of low molecular hepafin plus amphotericin B was better than that of amphotericin B or low molecular heparin alone．No therapeutic effect was found in group F(group E vs group F，Pgt;0．05，both group E and group F compared with group H，P lt;0．01．Group H vs group G，P lt;0．05．Both group E and group F compared with group G，P lt;0．05)．Conclusions The results suggest that there is blood clotting dysfunction in IPA mice and AT—III activity may be an early index to monitor the disfunction．Compared with the therapeutic effect of amphoterinein B alone，low molecular hepafin plus amphoterincin B can prolong survival of neutropenic IPA mice
Objective To analyze the data from patients with pathologically proved granulomatous lung disease, including etiology, clinical, radiological features and laboratory results. Methods 36 patients with granulomatous lung disease confirmed by lung biopsy in Shanghai First People’s Hospital of Shanghai Jiao Tong University from January 2008 to June 2012 were retrospectively reviewed. The clinical presentation, radiological features and laboratory results were collected and statistically analyzed.Results After haematoxylin and eosin stain combined with special stain, the diagnoses were comfirmed, ie.13 cases of mycobacterial infection, 5 cases of aspergillar infection, 4 cases of cryptococcal infection, 6 cases of sarcoidosis, 4 cases of Wegener’s granulomatosis, 4 cases of unknown causes. Cough was the most common clinical symptom, followed by expectoration. Some patients also developed fever, chest tightness and weight loss. The lesions were widely distributed, of which the right upper lung was the common lesion of mycobacterial infection, inferior lobe of right lung was the common lesion of aspergillar infection. The common lesion of cryptococcal infection was uncertain. The common lesions of sarcoidosis and Wegener ’s granulomatosis were in left upper lung. Small nodule was the most common shapes of lesion, while mass and consolidation were present sometimes. Cavity, air bronchogram, pleural effusion, hilar and mediastinal lymph node enlargement could be found in the chest CT. Interferon gamma release assay, galactomannan antigen assay and latex agglutination test were helpful in the diagnosis of mycobacterial infection, aspergillar infection and cryptococcal infection induced granuloma. Conclusions The clinical presentations and radiological features of granulomatous lung disease are nonspecific. Histopathology obtained through biopsy is the key for the diagnosis. Immunological examination, test of new antigens to microorganism and clinical microorganism detection are valuble in the diagnosis and differential diagnosis of granulomatous lung disease.
ObjectiveTo explore the fusion effect of allograft Cages on transforaminal lumbar interbody fusion (TLIF).MethodsThe clinical data of 30 patients (38 vertebral segments) who underwent TLIF with allograft interbody fusion Cages between January 2015 and January 2017 were retrospectively analysed. There were 25 males and 5 females with an average age of 56.9 years (range, 44-72 years). The lesions included 20 cases of lumbar disc herniation, 7 cases of lumbar spondylolisthesis, and 3 cases of lumbar spinal stenosis. The operation section included 4 cases of L3, 4, 13 cases of L4, 5, 5 cases of L5, S1, 6 cases of L4, 5-L5, S1, and 2 cases of L3, 4-L4, 5. The disease duration was 6-36 months (mean, 12 months). The clinical effectiveness was evaluated by visual analogue scale (VAS) score, Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score at preoperation, 3 months and 6 months after operation, and last follow-up. The fusion rate was evaluated by anteroposterior and lateral X-ray films and CT three-dimensional reconstruction at 3 and 6 months after operation. The intervertebral space height was measured on anteroposterior and lateral X-ray films at preoperation, 3 days, 3 months, and 6 months after operation.ResultsThe operation time was 2.1-4.3 hours (mean, 3.1 hours), and the intraoperative blood loss was 150-820 mL (mean, 407.5 mL). The follow-up time was 8-25 months (mean, 16.4 months). One Cage split at 6 months after operation without Cage movement and neurologic symptoms; none of the other patients had Cage prolapse, displacement, and fragmentation. No local or systemic allergy or infection signs was found in all patients. No nerve compression or symptoms was observed during the follow-up. The postoperative VAS score, ODI score, and JOA score improved significantly when compared with preoperative scores (P<0.05); and the scores at 6 months and at last follow-up were significantly improved when compared with those at 3 months after operation (P<0.05); but no significant difference was found between at 6 months and at last follow-up (P>0.05). The fusion rate was 55.3% (21/38), 92.1% (35/38), and 100% (38/38) at 3 months, 6 months, and last follow-up postoperatively. The intervertebral space height was increased significantly at 3 days, 3 months, 6 months, and last follow-up postoperatively when compared with preoperative ones (P<0.05); and the loss of intervertebral space height was significant at last follow-up when compared with postoperative at 3 days (P<0.05).ConclusionThe allograft interbody fusion Cage contributes to the spine interbody fusion by providing an earlier stability and higher fusion rate.