In order to correct the dysfunction of head and neck with scar contracture, since 1980, sixty-two cases were undertaken the operation by using local skin flap to repair the soft tissue defect after scar resection. The skin flaps included pedicled delto-thoracic skin flap in 26 cases, cervico-thoracic skin flaps in 25 cases, cervico-shoulder flaps in 6 cases, pedicled vascularized extralong delto-thoracic skin flap in 4 cases and free parascapular flap in 1 case. Sixty cases had total survival of the flaps and 2 flaps had partial necrosis. After 1 to 10 years follow-up, the appearance and function of neck were excellent. It was suggested that grafting local skin flap was a good method to treat cicatricial deformity of neck especially using the skin flap with pedicle and vascular bundle.
ObjectiveTo evaluate the influence of pathological differentiation in the effect of preoperative chemo-therapy for patients with locally advanced gastric cancer (LAGC). MethodsThirty-two patients with LAGA received preoperative chemotherapy with oxaliplatin and capecitabine (XELOX regimen).According to the pathological examina-tion, patients were classified into better (well and moderate, 16 cases) and poorly (16 cases) differentiated groups, and the clinical response rate, type of gastrectomy, and negative tumor residual rate were compared between the two groups.Morphological changes and toxic reactions were monitored after chemotherapy. ResultsThe results showed that the clinical response rate in the better differentiated group was significantly higher than that in the poorly differentiated group (100% vs.6.4%, P=0.000).The partial gastrectomy rate in the better differentiated group was significantly higher than that in the poorly differentiated group (87.5% vs.25.0%, P=0.000).A significant shrinking of tumor size and necrosis of tumor tissues caused by chemotherapy could be observed. ConclusionThe better differentiated group with locally advanced gastric cancer is suitable for preoperative chemotherapy with XELOX regimen, and as a result of effective preoperative chemotherapy, much more gastric tissue can be preserved for better differentiated group.
ObjectiveTo explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients.MethodsBetween January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly.ResultsIn antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups (χ2=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant (P=0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months).ConclusionThe modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.
ObjectiveTo investigate the clinical effectiveness of high-glucose insulin mixture on the local treatment of patients with grade Ⅱ and Ⅲ pressure ulcers. MethodsA total of 124 patients with grade Ⅱ and Ⅲ pressure ulcers treated between January 2011 and June 2012 were randomly divided into three groups: saline group (group A, n=41), high-glucose insulin mixture group (group B, n=41) and modern dressing group (group C, n=42). We observed and compared the treatment effects among the three groups using both measurements of traditional evaluation criteria and pressure ulcer scale for healing (PUSH) after a week of dressing. ResultsThe overall treatment effects among the three groups were significantly different (χ2=30.453, P<0.001). The results of pairwise comparisons was that the treatment effect was significantly different between group B or C and group A (P<0.01), but the treatment effect was not statistically different between group B and C (P>0.05). Subgroup analysis for patients with grade Ⅱ or Ⅲ pressure ulcers also came to the similar results. ConclusionBoth high-glucose insulin mixture and modern dressing have significant effects on patients with grade Ⅱ and Ⅲ pressure ulcers. However, the high-glucose insulin mixture costs less and is worthy of extensive promotion.
Objective To explore the cl inical effectiveness of debridement in treatment of Pes anserinus bursitis under arthroscopy by comparing the curative effect of three therapies: local block therapy, open operation and debridement under arthroscopy. Methods From January 2000 to January 2007, 90 cases of unilateral Pes anserinus bursitis were treated with debridement under arthroscopy (group A, n=30), local block therapy (group B, n=30) and open operation (group C, n=30),respectively. The group A included 18 males and 12 females, aged (40.0 ± 2.5) years old; the locations were left knee in 16 cases and right knee in 14 cases; 10 cases had injury history, 7 cases had tired history and 13 cases had no obvious inducement; the course of disease was (24.0 ± 3.2) weeks. The group B included 17 males and 13 females, aged (37.0 ± 2.5) years old; the locations were left knee in 15 cases and right knee in 15 cases; 10 cases had injury history, 8 cases had tired history and 12 cases had no obvious inducement; the course of disease was (26.3 ± 3.5) weeks. The group C included 16 males and 14 females, aged (39.8 ± 2.2) years old; the locations were left knee in 18 cases and right knee in 12 cases; 8 cases had injury history, 10 cases had tired history and 12 cases had no obvious inducement; the course of disease was (25.0 ± 3.9) weeks. There was no statistically significant difference in the general data among three groups (P gt; 0.05). Results All patients were followed up 15 months on average (12-24 months). In group C, the inflammatory reation occurred at wound in 9 cases (30%) at 3-10 days after operation and was cured after symptomatic management; other incision healed by first intention; and showing statistically significant differences when compared with other 2 groups (P lt; 0.05). In group C, joint swell ing occurred at 1 week after operation in 1 case, l imitation of joint motion in 2 cases at 10-12 weeks after operation and was recovered after symptomatic management. In group B, 21 cases (70%) had a recurrence at 6-12 months after operation, all patients of other 2 groups had no recurrence; showing statistically significant differences between group B and groups A, C (P lt; 0.05). At last follow-up, the pain remain rates were 3.3% (group A), 0 (group B) and 33.3% (group C), and the compl ication incidence rates were 3.3%, 26.7% and 70.0%, respectively; all showing statistically significant differences among three groups (P lt; 0.05). At last follow-up, there were statistically significant differences in the visual analogue scale (VAS) score, the HSS score, and range of motion (ROM) between preoperation and postoperation in group A (P lt; 0.05); there was no statistically significant difference in the VAS score, HSS score and ROM between preoperation and postoperation in group B (P gt; 0.05); the ROM of postoperation in group C was smaller than that of preoperation (P lt; 0.05). There were statistically significant differences in the VAS score and HSS score between group A and groups B, C (P lt; 0.05), and in ROM among three groups after operation (P lt; 0.05). Conclusion The treatment of Pes anserinus bursitis with debridement under arthroscopy has advantages of easy-to-do, less compl ication, low relapse rate and good functional rehabil itation.
Objective We searched and reviewed medical evidence to find the guide of treatment for local advanced nasopharyngeal carcinoma. Methods Firstly, we put forward clinical questions. Secondly, we searched medical evidence from Medline (1985-2002), Embase (1984-2000), Cochrane library (2002.1) and ACP. And then we reviewed the results. The key words we used were "nasopharyngeal carcinoma, chemotherapy and radiotherapy randomized" and "meta analysis or randomized control trial". Results Through searching, we got 17 papers including 1 systematic review and 16 randomized control trials, in which there were 8 prospective randomized phase Ⅲ trials. Most of these trials concluded that combination chemo-radiotherapy were better than radiotherapy alone. We think these results were suitable for our patient’treatment decision. Conclusion To treat our patients,we choosed the method of the mutimodality of squeitial neoadjuvant chemotherapy, concurrent chemo-radiotherapy and adjuvant chemotherapy with the drug doses down-adjusted.
Glioma related epilepsy (GRE) is a complication that seriously affects the quality of life and treatment process of glioma patients. The genes and biomolecules in the tumor microenvironment may contribute to the mechanisms and pathways of epilepsy. In addition, it has been found that epileptic seizures can promote the growth of brain tumors, making controlling epilepsy a key factor in treating brain tumors., However, in current understanding, not all genetic molecular features carried by gliomas themselves are involved in the pathogenesis of GRE. With the deepening understanding of GRE, it has been discovered that some molecular features of gliomas are involved in the pathogenesis of GRE, mainly through the Ras/Raf/MAPK (MEK)/ERK and PI3K/AKT/mTOR pathways, which are also involved in the pathogenesis of gliomas. In 2021, the World Health Organization (WHO) classified diffuse gliomas into two categories: adult and pediatric, and further subdivided them into types such as astrocytoma, oligodendroglioma, and glioblastoma. This classification helps to more accurately understand and apply the molecular characteristics of gliomas, promote the standardization of tumor pathological diagnosis, and may have an impact on the treatment and prognosis evaluation of GRE. This review links genes and biomolecules in the tumor microenvironment through the latest WHO classification, summarizes previous research and recent findings, and provides a deeper understanding of the molecular characteristics of gliomas and their relationship with epilepsy related molecular pathways. It explores more effective treatment methods to suppress epilepsy symptoms and tumor growth, which is of great significance for improving the diagnosis and treatment of GRE.
Objective To explore the value for localization of cystic lymph node in laparoscopic cholecystectomy. Methods Clinical data of 100 cases who underwent laparoscopic cholecystectomy in Affiliated Hospital of Southern Medical University and The Third Division Hospital of Xinjiang Production and Construction Corps were collected to analyze retrospectively, for exploring the relationship of localization of cystic lymph node, cystic artery, cystic duct, and liver door. Results Of the 100 cases, 81 cases (81.0%) were found lymph node, in which 76 cases (76.0%) were found 1 lymph node and 5 cases(5.0%) were found lymph node more than 1, the other 19 cases(19.0%) were not found lymph node. Of the 76 cases who were found only 1 lymph node, lymph nodes were located above the anterior branch of cystic artery in 48 cases, below the anterior branch of cystic artery in 21 cases, and adjacent to the posterior branch of cystic artery in 7 cases. The operation was successful in all patients without death, of which 3 cases were transferred to laparotomy. The operation time were (43.0±6.5) min (25-116 min), and hospital stay after operation were (3.0±0.6) days (2-6 days). No serious complications of bile leakage, bile duct injury, and death happened after operation, and all cases were cured and discharged. Conclusion Cystic lymph node in the calot triangle is in relatively fixed position of laparoscopic cholecystectomy, it can help to guide judging anatomical hepatic portal region of each organization structure, and can to confirm the location of cystic artery and cystic duct, which is helpful to prevent injury during the operation of laparoscopic cholecystectomy.
Ambulatory surgery has been vigorously promoted in China while there is a lack of unified management norms. Shanghai has a long-term pilot operation of ambulatory surgery in China, which has a certain management foundation. And it has actively promoted the standardized management since 2014. This article introduces the development and preparation of the Shanghai local standard The Hospital Management Specification of Ambulatory Surgery and the main structure and key technical content of the standard, in order to promote the standardization of ambulatory surgery management for reference.
ObjectiveTo systematically review the efficacy and safety of transfemoral transcatheter aortic valve replacement (TFTAVR) under local anesthesia (LA) and general anesthesia (GA). MethodsElectronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang and CBM were searched to collect randomized controlled trial and cohort studies on clinical outcomes of TFTAVR under LA and GA from inception to September 2020. Two authors independently screened literature, extracted data and assessed the quality of studies, and a meta-analysis was performed by using Stata 16.0 software. ResultsA total of 30 studies involving 52 087 patients were included in this study. There were 18 719 patients in the LA group and 33 368 patients in the GA group. The results of meta-analysis showed that the in-hospital all-cause mortality rate [RR=0.65, 95%CI (0.45, 0.94), P=0.021], 30-day all-cause mortality rate [RR=0.73, 95%CI (0.62, 0.86), P＜0.001], 30-day stroke [RR=0.82, 95%CI (0.68, 0.98), P=0.025], cardiac arrest [RR=0.50, 95%CI (0.34, 0.73), P＜0.001], ICU stay time [RR=−6.86, 95%CI (−12.31, −1.42), P=0.013], and total hospital stay time [RR=−2.02, 95%CI (−2.59, −1.45), P＜0.001] in the LA group were all better than those in the GA group. There was no significant difference in the in-hospital stroke [RR=0.83, 95%CI (0.69, 1.00), P=0.053], in-hospital myocardial infarction (MI) [RR=1.74, 95%CI (0.43, 7.00), P=0.434], or 30-day MI [RR=0.77, 95%CI (0.42, 1.42), P=0.404] between the two groups. ConclusionLA provides a safe and effective way to induce sedation without intubation, and may be a good alternative to GA for TFTAVR.