Objective To determine the sensitivity and accuracy of CT do ub le-contrast arthrography (CTA) in detecting underlying soft-tissue and bony abno rmalities of recurrent anterior glenohumeral dislocations. Methods From March 19 90 to May 2003, 31 patients with the signs and symptoms of recurrent anterior in stability, which were 23 males and 8 females with an average age of 26.7 years ( ranging, 22 to 46 years), were recruited for the study. All patients suffered fr om more than three times of glenohumeral dislocations, underwent CT arthrography after intraarticular injection of air and radiographic contrast medium before o peration. The surgical procedures included open Bristow operation in 25, Bankart operation in 3, Putti-Platt operation in 2, and a combination of Bankart and ca psular tightness operation by arthroscopy in 1. Each patient also underwent arth roscopy or open surgery and the observations were compared with CTA. Results Les ions of labrum and capsulo-ligamentous complex were the two most common abnormal ities demonstrated by surgical findings, which were respectively found in 28 and 20 patients at surgery. Anterior glenoid labral abnormalities, including of tea r, detachment, degeneration, were detected on CTA in 26 of 28, 2 of glenoid labr al degeneration were undetected on CTA, and the accuracy rate diagnosis on CTA w as 93.5%, while the sensitivity of CTA was 92.8%. Capsular lesions, including of marked medial scapular insertion, glenoid marginal stripping, and loss of inter vening scapular marginal soft tissues, were detected on CTA in 19 of 20, 1 of ca psular glenoid marginal stripping was undetected on CTA, and the accuracy rate d iagnosis on CTA was 87.1%, while, the sensitivity of CTA was 95%. Subscapularis tendon abnormalities, including of tears and irregularities, were visualized in 7 cases on CTA, but only 4 of which were identified during surgery. Furthermore, all of 15 Hill-Sachs defects, 6 Bankart bony defects, and 1 rupture of supraspi natus tendon suggested by CTA, were identified during surgery. For 26 of the pat ients with above kinds of lesion resulting in recurrent anterior glenohumeral di slocation, the accuracy rate of diagnosis was 83.7%. Conclusion The utilization of CT double-contrast arthrography can improve the understanding of multiple les ions associated with recurrent shoulder dislocation, it is contributed to select proper operative procedure.

Objective To investigate the result of McBride operation for treatment of hallux valgus with more than 5 years follow-up. Methods There were totally fifity patients who underwent McBride operation in this study. The follow-up period varied from 5 years to 10 years and 2 months (average 7 years and 1 month). The symptoms and deformity before and after operation were compared statisticly. Results The angle between first phalanx and metatarsal is strongly correlated with the angle between first and second metatarsal.The coefficience of pre- and post-operation is 0.84 and 0.71 respectively.There were 64 feet whose symptoms were eliminated and the deformity were corrected basically. The effective rate was 71.1% according to the assessment criteria discribed by doctor ZHU Lihua. The common complications were pain residue, local numbness, hallux valgus recurrence, hallux varus and claw toes. The measurment showed the angle between first phalanx and metatarsal significantly decreased after operation and the angle between first and second metatarsal also decreased following the hallux valgus correction. Conclusion McBride operation is a good and reliable method to treat young patients with mild to moderate hallux valgus. Complications are related to congenital foot deformity, severe valgus deformity and normal structure injuries during the operation.

Objective:To approach the clinicopathologic characteristics, treatment modalities, and prognosis of the patients with double primary carcinoma of endometrial carcinoma and colorectal carcinoma and analyze the relationship between this disease and Lynch syndrome. Methods:The clinicopathologic and follow-up data of 34 cases with double primary carcinoma of endometrial carci-noma and colorectal carcinoma treated in Cancer Hospital of Chinese Academy of Medical Sciences were reviewed. Results:The medi-an age of the 34 patients was 51.5 years old (ranging from 39 to 76). Twenty-two of the total cases (22/34, 64.7%) had tumor family his-tory. The pathologic results indicated that 79.4%(27/34) was endometrioid adenocarcinoma. In the 34 cases, 33 were treated by surgical procedure. Of the 33 cases undergoing surgery, 17 patients with endometrial carcinoma and 19 with colorectal carcinoma received fur-ther adjuvant treatment of chemotherapy and/or radiotherapy. The 2-and 5-year survival rates were 84.3%and 63.1%in the 34 cases, respectively. Conclusion:The age of onset is earlier in the patients with double primary carcinoma than in those with sporadic colorec-tal carcinoma. Some cases have cancer family history, and their survival rates are similar to those of the patients with sporadic colorec-tum carcinoma. Diagnosis of some patients with double primary carcinoma may be in line with Lynch syndrome.

Objective To investigate the clinicopathological features,survival,and the impact of postoperative adjuvant radiotherapy on the ovarian function in patients less than or equal to 35 years of age with stage ⅠB-ⅡA cervical cancer.Methods One hundred and eighty-six patients who were admitted to our hospital from 2000 to 2011 were retrospectively analyzed.An equal number of patients older than 35 years of age with cervical cancer within the same period were used as stage-marched controls.The Kaplan-Meier method was used to calculate the survival rates,and the log-rank test was used for pairwise comparison and univariate prognostic analyses.The Cox proportional hazards model was used for multivariate prognostic analyses.Results The patients less than or equal to 35 years of age had a significantly higher incidence of non-squamous carcinoma but significantly lower incidence rates of deep stromal invasion and lymph-vascular space invasion (LVSI) compared with the control group (P =0.000;P =0.008;P =0.000).Though young patients had significantly higher 5-year disease-free survival (DFS) and overall survival (OS) rates than the control group (93.7％ vs.84.5％,P=0.005;96.1％ vs.89.5％,P=0.033),age was not an independent prognostic factor (P =0.202;P =0.950).Among patients less than or equal to 35 years of age,lymph node metastasis and LVSI were independent prognostic factors for DFS (P =0.000;P =0.000),while LVSI and initial tumor size were independent prognostic factors for OS (P =0.000;P =0.000).There was no significant difference in the incidence of normal ovarian function between young patients treated with and without adjuvant radiotherapy after ovarian transposition (63％ vs.73％,P =0.422).Conclusions Patients less than or equal to 35 years of age with stage ⅠB-ⅡA cervical cancer have a better prognosis than the control group.However,age is not an independent prognostic factor.Postoperative adjuvant radiotherapy will not impair the function of transposed ovaries.

Objective To observe the pathologic type and degree of traumatic recurrent anterior dislocation of the shoulder by means of arthroscopy and discuss clinical results of modified Bristow method and arthroscopic Bankart reconstruction so as to provide refeFences for selecting operation methods.Methods A retrospective study was done off 62 patients(62 shoulders,44 males and 18 females.at av-erage age of 39.8 years.ranging from 21 to 67 years)with anterior recurrent dislocation of shoulder (mean duration of 87 months)admitted into our hospital from July 1997 to Oetcher 2007.All patients un-derwent preoperative arthroscopic examination that showed pathologic changes including injury of shoulder and humerus head,Bankart injury severity and laxitas of humerus glenoid ligament of articular capsule,which were used as referenee of surgical procedures.Modified Bristow's method or arthroscopic suture anchor Bankart reconstruction were performed according to arthroscopic results(pathologic change).The patients were assessed with the University of California at Los Angeles(UCLA)shoulder rating scale.Results There were 45 patients treated with modified Bristow,s method and 17 with arthroscopic suture anchor Bankart reconstruction.The follow.uD for mean 64.2 months showed that pre-and post-operative mean UCLA scores were(22.6±4.4)points and(29.8±4.2)points respectively(P＜0.01),the mean forward flexion(136.8±14.2)°and(156.6±17.8)°respectively(P＜0.01)and the mean ex-ternal rotation in 90°abduction(52.5±16.4)°and(72.4±11.3)°(P＜0.01).There were no redis-location at final follow-up,but there were 6 patients(9.6%)with positive apprehension test.Of all,60 patients(97%)returned to their pre-injury.work. Conclusions Observation of pathologic change of surgical procedure.Both modified Bristow's method and arthruscopic Bankart reconstruction are good methtxts for treatment of recurrent anterior shoulder dislocation under conditions of successful management of pathologic change of shoulder, restoration of normal anatomic structure of shoulder ioint and strict indi-cation control.

Objective To assess the nerve-sparing radical hysterectomy (NSRH) technique and its impact on postoperative voiding function. Methods Forty-fonr patients with International Federation of Gynecology and Obstetrics(FIGO) stage Ⅰ b1 - Ⅱ a cervical cancer were enrolled and randomized into NSRH group ( study group, n = 22) and conventional radical hysterectomy (CRH) group ( control group, n = 22). The pelvic autonomic nerve pathway (including hypogastric nerve, pelvic splanchnic nerve, inferior hypogastric plexus and bladder branch) was completely preserved in the NSRH group. Related parameters were compared between the two groups. Results The estimated blood loss in NSRH group and CRH group were (550±241) ml and (475±284) ml, respectively, with no significant difference (P >0. 05). The mean operation time in NSRH group and CRH group were (329±43) min and (272±56) min, respectively, with a significant difference (P < 0. 01). More patients in NSRH group had post-void residual urine volume (PVR) < 100 ml than that in CRH group on day 8 after surgery (68% vs. 18%, P <0. 01). The median duration of postoperative catheterization was significantly shorter in NRSH group (8 - 23 days, median 8 days) than that in CRH group ( 8 - 32 days, median 20 days; P < 0. 01 ). Neither surgery-related injury nor pathologically positive margin was reported in either of the groups. Conclusions NSRH is a feasible and safe technique for preserving bladder function. Larger prospective studies are needed to confirm the efficacy of this technique.

Objective To evaluate the feasibility of sentinel lymph node biopsy (SLNB) in patients with vulvar cancer. Methods Twenty-one patients with vulvar squamous cancer undergoing radical surgery admitted in Cancer Hospital of Chinese Academy of Medical Sciences from Oct.2004 to Apr.2008, were enrolled in the study. SLNB procedure was performed with blue dye alone in the first eleven patients, while the later ten patients, a combination procedure with radioactive tracer and blue dye was used to detect sentinel lymph node (SLN). All resected nodes were submitted to the pathological examination, which was considered as the gold standard to determine the efficacy of SLNB. The complications related to SLNB were also observed during the study. Results The sentinel node was identified in 20 patients (95%), included 8 cases with unilateral SLNs and 12 cases with bilateral SLN. A total of 83 SLN were identified with a mean number of 4.2 per patient (range, 1-9) or 2.6 per groin (range, 1-6). Difference between the mean number of SLN (4.4 per patient, 2.5 per groin) identified by blue dye or by combined procedure (3.9 per patient, 2.7 per groin) was not statistically significant (t=0.459,P=0.652;t=-0.421,P=0.717). Twenty patients were detected to positively superficial inguinal SLN and one of them also positively bilateral deep femoral SLN, 8 (10 groins) of them were detected positively nodal metastases. Among of eight patients, 7 (9 groins)of them were detected more than one SLN involved, while 1 of them were detected false-negative node involved. The false negative rate of was 10%(1/10), negative predictive value was 96%(22/23). No complications were attributed to the study. Conclusions SLNB procedure in vulvar cancer is feasible and safe. SLN identification appears to be highly accurate for detecting metastases in the ipsilateral inguinal lymphatic basins.

Objective To investigate the safety of ovarian preservation for stage Ⅰ endometrial carcinomas in women aged 40 years and younger.Methods Seventy-five cases of stage Ⅰ endometrial cancer aged 40 years and younger from Jan 1999 to Jan 2012 were treated in Cancer Hospital , Chinese Academy of Medical Sciences.They were further divided into two groups:20 patients who underwent ovarian preservation (group A) and 55 patients who underwent oophorectomy (group B).Clinical and pathological recordings of these patients were reviewed and compared.Results In the group A , there were 13 patients preserved both ovaries , and 7 patients preserved a single ovary.While there were no significant differences in the age, body mass index, surgical staging, histology, grade, cytology of peritoneal lavage or ascites , and postoperative treatment between two groups ( all P>0.05 ).The differences in the level of CA 125 [ 25%(5/20) versus 18%(10/55)] and number of patients underwent pelvic lymphadenectomy [35% (7/20) versus 84%(46/55)] were statistically significant between two groups (all P<0.05).Of seventy-five cases, only two patients relapsed and all survived after a median follow-up time of 31.7 months ( range:0 to 160 months).Kaplan-Meier analysis revealed no difference in overall survival (100.0% versus 100.0%) and disease free survival ( 90.0% versus 95.5%) between two groups ( P =0.579 ).Conclusions Ovarian preservation has no statistically significant impact on the survival of young patients with stage Ⅰa, well differentiated endometrial cancer.Large-scale, prospective clinical studies are needed to validate the safety of ovarian preservation for those patients.

OBJECTIVETo evaluate the effects of alendronate on the structural properties of trabecular bone.

METHODSAlendronate was administered at a daily p.o. dose of 0.5 mg/kg over a 12-week period in hound dogs (n = 8 for both the control and treated group), and the structural indices of the lumbar vertebral (L1 and L2) trabecular bone were assessed directly from 3-D images.

RESULTSTreatment with alendronate increased bone volume fraction by 9.5% and 7.7% in L1 and L2 respectively. Trabecular thickness significantly increased after alendronate treatment, whereas trabecular separation remained constant. The degree of anisotropy for the alendronate-treated group was decreased compared with that of the control group. Bone surface to volume ratio declined significantly in the alendronate-treated group, whereas alendronate induced a higher bone surface density.

CONCLUSIONAlendronate increased the structural properties of canine trabecular bone after short-term treatment at a dose of 0.5 mg x k(-1) x day(-1).

Alendronate ; pharmacology ; Animals ; Anisotropy ; Biometry ; methods ; Bone Density ; Bone and Bones ; anatomy & histology ; drug effects ; Dogs ; Female ; Lumbar Vertebrae ; anatomy & histology ; drug effects

Objective To evaluate the clinical efficacy of treatment of severe thoracolumbar burst fractures by posterior short-segment instrumentation without spinal fusion and assess radiographic imaging and function recovery after surgery.Methods Thirty-eight patients with severe monosegmental thoracolumbar burst fractures treated between July 2011 and March 2013 were analyzed retrospectively.Operation procedures were posterior short-segment pedicle screw distraction reduction and fixation combined with screw insertion to the injured vertebrae and calcium sulphate augmentation.In addition,there was no need for posterolateral interbody fusion.X-ray and CT were performed before and after operation to evaluate local kyphotic angle,anterior fractured vertebral body height and canal encroachment.Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before and after operation as well as in follow-up.Results All patients were followed up for average 14 months (range,3-20 months).Local kyphotic angle was (21.2 ±4.3)° before operation,(3.5 ± 1.8)°immediately after operation,and (4.8 ± 2.7) ° in final follow-up.Relative anterior vertebral height was (54.8 ± 14.6)％ before operation,(91.7 ± 8.0)％ after operation,and (87.2 ± 6.0)％ in final follow-up.Mean canal encroachment was (48.0 ± 4.5)％ preoperatively,(23.8 ± 7.8)％postoperatively,and (8.8 ± 4.6) ％ in final follow-up.In final follow-up,six patients with American Spinal Injury Association (ASIA) grade C on admission showed improvement to grade D (n =2) and grade E (n =4) ; 10 patients with ASIA grade E on admission showed improvement to grade E; 22 patients with grade E had no changes.ODI and VAS scored 15.5 ±8.8 and 2.3 ±0.8 in final follow-up with substantial improvement from those before operation (P ＜ 0.01).Complications from internal fixation were not found during follow-up.Conclusion Posterior short-segment fixation without fusion is one of the foremost effective methods for severe thoracolumbar burst fractures,for it can effectively restore the sagittal spinal alignment and the fractured vertebral body height.