Objective Improve understanding the clinical features of bladder varices with portal hypertension. Methods A 63-year-old male manifested seven episodes of painless gross hematuria and had a 9-year history of liver cirrhosis. Physical examination was unremarkable. There was thrombocytopenia of 56 × 109/L. Ultrasound showed splenomegaly. Cystoscopy revealed a 3. 0 cm × 5.0 cm sized hemangiomatous on the left lateral and anterior wall of the bladder. Computed tomography angiography revealed the vesical varicose veins flowing into the inferior mesenteric vein and then to the splenic vein. Results The patient was diagnosed vesical varices, liver cirrhosis and portal hypertension. Performed perivesical devascularization and in ultrasound one month after the operation the variees disappears. Conclusion Vesical varices can occur in liver cirrhosis and portal hypertension patients without history of abdominal and pelvic operation, and can be treated by perivesical devascularization.

OBJECTIVETo observe the clinical effects of repair of complicated tissue defects of several body parts with composite anterolateral femoral fascia lata perforator tissue flaps (fascial flap or fascial skin flap) with the aid of micro-surgery.

METHODSFrom February 2008 to August 2012, complicated tissue defects in 12 patients were repaired with composite anterolateral femoral fascia lata perforator tissue flaps. Two of the 12 patients suffered from a defect of scalp, skull, and dura mater as a result of resection of a malignant tumor of the scalp; 3 patients showed a defect of skin and tendo calcaneus in the heel and lower leg; 2 patients showed a defect of skin and extensor tendon in the dorsum of hands; the other 5 patients suffered from defects of skin and extensor tendon in the foot and ankle combined with exposure of bone or internal buttress plate. The size of tissue flaps ranged from 12 cm ×6 cm to 19 cm ×18 cm. The donor sites were closed by immediate suturing or skin grafting.

RESULTSAll 12 tissue flaps survived. Patients were followed up for 2 to 36 months. The flaps were shown to have good appearance, texture and function. Two patients with the defect of the scalp, skull and dura mater after a resection of the malignant tumor of the scalp did not have recurrence or herniation of brain tissue. The foot-raising function in 3 patients with the defect of skin and tendo calcaneus in the heel and lower leg was recovered, and according to Arner-Lindholm criteria the result was excellent in 2 cases and good in 1 case. The extension function of fingers of 2 patients with defects of skin and extensor tendon in the dorsum of hands was good according to the evaluation criteria of Chinese Medical Association Society of Hand Surgery for tendon repair of hand. The extension function of toes of 5 patients with defects of skin and extensor tendon in the foot and ankle combined with exposure of bone or internal buttress plate was recovered and improved.

CONCLUSIONSTransplantation of composite anterolateral femoral fascia lata perforator tissue flaps with the aid of micro-surgery is an effective method in repairing the tissue defects of skull, dura mater, and the extensor tendon of hands or feet, with restoration of the extension function.

Adult ; Fascia Lata ; transplantation ; Female ; Humans ; Male ; Middle Aged ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Soft Tissue Injuries ; surgery ; Young Adult

Objective To discuss the treatment of renal or adrenal tumor with cancer thrombus in the inferior vena cava. Methods From Jan 1984 to Apr 2008,29 cases of renal or adrenal malignancy with thrombosis involving the inferior vena cava underwent treatment.The diagnoses were confirmed by Doppler uhrasonography,CT and MRI.In the 29 surgical patiens the tumor thrombus was level I in 7,level Ⅱ in 10,level Ⅲ in 8 and levelⅣin 4.According to TNM classification,23 cases were classified to T2N.M.,1 case was T2Nl Mo,1 case was TzNlMl,1 case was T3NoMo,2 case were T3NlMl and 1 case was T3N2Mo.The mean tumor size was 8.7(4.O-16.O)cm in diameter.The mean tumor thrombosis length was 3.2(2.5-4.0)cm in level I,5.3(4.5-6.0)cm in level Ⅱ,8.2(6.5-9.O)cm in levelⅢand 15.1(12.0-18.5)cm in level IV. Results The operation was performed succesgfullv in 29 patients Patholocieal examination showed that 18 cases of clear cellcarcinoma,3 cases sarcomatoid carcinoma,2 cases renal papillary adenocarcinoma,1 case renal cell carcinoma (undifferentiated),1 case granule carcinoma,3 cases adrenocortical carcinoma and 1 case metastatic malignant melanoma of adrenal gland.Of 29 patients,3 were out of contact.Twenty-six patients were followed up for 35(0-62)months after treatment,3-and 5-year survival rates were 15/26 and 11/26.Three-year survival rates for stage T2 and T3 were 14/22 and 1/4.Five-year survival rates for stage T2 and T3 were 10/22 and 1/4.Three-year survival rates for level I、Ⅱ、Ⅲ andⅣ were 4/6,5/8,5/8 and 1/4.Five-year survival rates for level I,Ⅱ、Ⅲ andⅣ were 3/6,4/8,3/8 and 1/4.Three-year survival rates for a tumor thrombus in the below or above diaphragm were 14/22 versus 1/4,5-year survival rates were 10/22 versus 1/4.Three-year and 5-year survival rates for the patients without distant metastases and lymph node involvement were 12/18 and 9/18.Three-year and 5-year surviral rates for the patients with distant metastases and lymph node involvement were 3/8 and 2/8.The 3 surgical patients with metastatic disease died at 6,10,22 months. Conclusions Surgical treatment could be the preferred approach for the patients of renal or adrenal tumor with cancer thrombus in the inferior vena cava without distant metastases and lymph node involvement.It could improve the quality of life and may prolong survival.

Objective To improve the diagnosis and treatment quality of juxtaglomerular cell tumor of the kidney. Methods Three patients(2 females, 1 male) were diagnosed with juxtaglomerular cell tumor of kidney and underwent nephron-sparing surgery. Case 1 was female, 15 years old. She presented with hypertention of 245/135 mm Hg. The serum kalium was 2.5--3.0 mmol/L. Thelaboratory examination suggested that in decubitus and standing position, the plasma renin activity (PRA) was 2.2 and 3.5 μg · L-1 · h-1 , angiotensin Ⅱ (ATⅡ) was 181.2 and 481.4 ng/L; aldosterone(ALD) was 332.4 and 747.9 pmol/L, respectively. Dynamic enhanced CT scanning demonstrated a tumor with the diameter of 1.3 cm in right kidney. Case 2 was male, 39 years old. He presented with hypertention of 180/120 mm Hg. The serum kalium was 2. 7--3.0 mmol/L. In decubitus and standing position, PRAwas8.1 and 9.2 μg·L-1 · h-1, ATⅡ was 198.3 and 279.1 ng/L, ALD was 285.3 and 761.7 pmol/L, respectively. Dynamic enhanced CT scanning showed a tumor with the diameter of 1.2 cm in right kidney. Case 3 was female, 26 years old. She presented with hypertention of 210/120 mm Hg. The serum kalium was 4. 1 mmol/L. In decubitus and standing position, PRA was 0.1 and 0.3 μg · L-1·h-1 , ATⅡ 56.2 and 71.5 ng/L, ALD 321.3 and 421.1 pmol/L, respec tively. On dynamic enhanced CT scanning, a tumor with a diameter of 3.0era was located in left kidney. Results Partial nephrectomy was successfully performed in 3 patients, including 1 (case 2) retroperitoneal laparoscopic surgery. Pathologic examination revealed encapsulated tumors in all cases. Light microscopically, the tumor consisted of clusters of polygonal cells, and the cell had centrally located nuclei and slightly eosinophilic cytoplasm. Thick walled vessels were usually present. The tumors showed positive immunostaining for actin and CD34. Three patients were followed up for 23,4, 26 months respectively and all remained normotensive without any treatment. No recurrence or metastasis occurred. Conclusions Hypertention, increased PRA, secondary aldosteronism, hypokalemia are characteristics for juxtaglomerular cell tumor of the kidney. Dynamic enhanced CT scanning has high sensitivity. Partial nephrectomy or enucleation of tumor are both effective surgical treatment. Retroperitoneal laparoscopic surgery is safe and effective as well.

Objective:To evaluate arthrography-assisted reduction in minimally invasive treatment of tibial plateau fractures.Methods:From January to May 2019, 9 patients with tibial plateau fracture were treated by arthrography-assisted minimally invasive surgery at Department of Orthopaedics and Traumatology, Hong-Hui Hospital. They were 6 males and 3 females with an average age of 45.5 years (from 27 to 63 years). According to the Schatzker classification, there were 6 cases of type Ⅱ, one of type Ⅲ and 2 cases of type Ⅳ. Arthrography was used to determine the lowest filling point of contrast medium after intra-articular injection and to ensure satisfactory reduction of articular surface after fracture reduction and bone grafting, followed by minimally invasive percutaneous plate implantation. Comparisons were made between preoperation and 6 months postoperation in the range of knee motion and knee scores of The Hospital for Special Surgery (HSS). Knee X-ray films were evaluated by the Rasmussen imaging system at 6 months postoperation. Collapse of articular surface was recorded pre- and post-operation as well as postoperative complications.Results:All the 9 patients were followed up for 6 to 9 months (average, 7 months). All patients achieved bony union within 12 weeks postoperation. The preoperative knee flexion (60.7°±13.1°) and HSS (51.9±5.7) were significantly improved to 122.4°±10.8° and 84.9±5.3 at 6 months postoperation ( P<0.05), but there was no significant difference between preoperation and 6 months postoperation in knee extension (4.4°±2.5° versus 4.6°±2.9°) ( P>0.05). The collapse of articular surface was improved from preoperative 9.5 mm (from 5 to 15 mm) to postoperative 1.3 mm (from 0 to 3 mm). The Rasmussen imaging scores at 6 months postoperation showed 6 excellent and 3 good. No such postoperative complications occurred as incision infection, joint stiffness, loosening or breakage of implants. Conclusion:Arthrography helps minimally invasive treatment of tibial plateau fracture because it can better display fracture collapse during operation and accurately judge indirect reduction of articular surface.

With the development of social economy, high-intensity energy is the direct cause of fracture, such as traffic accident, fall injury and tumble. Fracture healing is affected by many factors, such as malunion, delayed union, nonunion and wound infection. Tibial fractures are usually caused by high-energy mechanisms and can also be caused by low-energy mechanisms of ankle rotation. With the gradual deepening of orthopedic surgeons′ understanding of bone nonunion, the treatment of tibial nonunion is mainly divided into surgical treatment and non-operative treatment. Surgical treatment is generally the first choice for the treatment of bone nonunion, in which plate internal fixation plays an unique advantage in the treatment of tibial nonunion. By reviewing the recently published literature, this paper reviews the latest progress in the treatment of tibial nonunion with plate internal fixation.

Objective To study the status of diabetic foot and its related factors in Hanzhong area in recent years, and to provide a scientific basis for the prevention and management of diabetic foot complicated by type 2 diabetes. Methods A stratified sampling method was used to select 528 patients with type 2 diabetes among permanent residents in Hanzhong from April 2016 to April 2022. Relevant medical history and laboratory examination data were collected, and the incidence of diabetic foot was calculated. The influence of related factors on the risk of diabetic foot was analyzed by regression model. Results Among 528 subjects in this study, the disease course and body type of T2DM showed that male patients had significantly longer disease, and the proportion of overweight and obesity was higher, P<0.05. The incidence of diabetic foot was 16.29% (86 cases). The proportion of male patients and female patients was 24.66% and 5.93%（χ²=27.516，P<0.05）. The proportion of male patients complicated with diabetic foot was higher than that of female patients (P<0.05). At the same time, the incidence of Wagner Grade I was higher in males than in females (P<0.05). The effects of potential factors on the risk of diabetic foot were discussed by gender. Univariate analysis and multivariate logistic regression analysis indicated that the risk factors of diabetic foot in male T2DM patients included: Increased course of disease, increased age, poor blood glucose control, increased total cholesterol level, increased BMI level and increased platelet to lymphocyte ratio . Potential risk factors in women include increased course of disease, age, poor blood sugar control (increased glycosylated hemoglobin levels) and increased platelet to lymphocyte ratios in all cases（P<0.05）. Conclusion The current prevalence rate of type 2 diabetes patients complicated with diabetes foot in Hanzhong area is 16.29%, which is still high , and the prevalence rate of men is significantly higher than that of women. Older age, long duration of T2DM, poor blood glucose control, increased total cholesterol level, increased blood uric acid level, decreased urine pH value, and increased platelet lymphocyte ratio are potential risk factors for diabetes foot. Male patients should also pay attention to the occurrence of overweight and obesity tendency to reduce the risk of diabetes foot.

Objective To preliminarily analyze the influencing factors of benign thyroid nodule malignant transformation and provide a basis for early intervention of benign thyroid nodule malignant transformation. Methods Selected 158 patients with benign thyroid nodules who visited our hospital from January 2019 to January 2022 for inclusion in the study, and followed up for 3 year to observe whether the nodules had malignant changes. The age, gender and dietary habits were collected. 3 mL of fasting venous blood of subject were collected , and the level of TT3, TT4, FT3, FT4, TSH, TgAb, CEA, thyroglobulin and calcitonin were collected. Results The results of this study suggest that the plasma levels of serum TgAb, TSH, TT4, TT3, FT3, FT4, CEA, thyroglobulin, and calcitonin of subjects were not statistically significant between sexes. The results of univariate analysis showed that compared with non malignant group, the patients in malignant nodule group were younger, the longest diameter of nodule was smaller, TgAb level was higher, TSH level was higher, FT3 level was lower, the proportion of internal calcification was higher, thyroglobulin level was higher, CEA level was higher, calcitonin level was higher, and the proportion of abnormal lipid metabolism and glucose metabolism was also higher, which was statistically significant (P<0.05). Multivariate logistic regression analysis showed that TgAb positive, internal calcification, increased carcinoembryonic antigen level, dyslipidemia, elevated thyroglobulin level, and abnormal glucose metabolism, elevated calcitonin level were associated with the increased risk of node canceration, and increased total FT3 level was associated with the reduced risk of canceration (P<0.05). Conclusion TgAb positive, internal calcification, increased carcinoembryonic antigen level, small nodule diameter, abnormal blood lipids, elevated thyroglobulin level, low total FT3 level, abnormal glucose metabolism, and elevated calcitonin level are associated with the increased risk of malignant transformation of benign thyroid nodules, which should be paid attention to clinically.

Objective To explore the clinical outcomes of locking plate fixation of intertrochanteric fractures in patients with deformed proximal femur.Methods A retrospective review was made of the 25 patients with intertrochanteric fracture and deformed proximal femur who had been treated from January 2009 to July 2015.They were 17 men and 8 women,from 22 to 76 years of age (mean,45.2 years).The proximal femoral deformities were postpoliomyelitis syndrome in 6 cases,fibrous dysplasia in 4,malunion in 13,and hip varus caused by implant breakage following intramedullary nailing in 2.By AO classification,there were 4 cases of type 31-A2.1,3 ones of type 31-A2.2,16 ones of type 31-A3.1,and 2 ones of type 31-A3.2.All the patients were treated by open reduction plus locking plate fixation.At the final follow-up,function of the affected hip was evaluated by the Hip Disability and Osteoarthritis Outcome Score (HOOS),and quality of life of the patients was evaluated using the SF-36 health survey questionnaire.Results The 25 patients were effectively followed up for 12 to 24 months (mean,17.4 months).No infection,pneumonia,fat embolism,or deep venous thrombosis of lower limb was observed.The fractures healed without nonunion or refracture after a mean time of 5.9 months (range,from 3 to 6 months) in the 25 patients.By the HOOS evaluation at the final follow-ups,the 25 patients scored,on average,83.7± 15.6 in pain,55.6± 14.1 in symptoms,53.6 ± 9.5 in daily living function,52.7 ± 8.9 in sports and recreational activities and 62.4 ± 12.3 in quality of life;by SF-36 evaluation,they had a mean total score of 71.2 ± 13.8.Both the HOOS and SF-36 scores were not significantly different from the pre-injury values (P ＞ 0.05).Conclusion Locking plate fixation is a simple and effective way for the intertrochanteric fractures complicated with deformed proximal femur because intramedullary nailing is difficult or infeasible.

Objective To investigate the time course and prognosis of perioperative deep venous thrombosis in hip fracture patients.Methods A prospective study was conducted to analyze the clinical data of 88 patients with hip fractures who were injured within 24 h in the Department of Traumatic Orthopedics,Honghui Hospital,Xi'an Jiaotong University from September 2017 to March 2018.The patients were divided into anticoagulant group (n =53) (low molecular weight heparin combined with physical prevention) and non-anticoagulant group (n =35) (physical prevention only).The patients were examined by deep venous examination of the lower limbs every 24 h after they were admitted to hospital.The number and incidence of new thrombosis within 4 d after injury and 7 d after operation were recorded.The histogram was recorded.The prognosis of thrombosis and the occurrence of thrombosis in different fracture sites were also recorded.Counting data were expressed by percentage (％),and x2 test was used for comparison between groups.Results In the anticoagulant group,33 cases of deep venous thrombosis occurred in 53 cases,and the incidence rate was 62.26％.Deep venous thrombosis occurred in 29 of 35 patients in non-anticoagulant group (82.86％).The difference between the two groups was statistically significant (P ＜ 0.05).In anticoagulant group,thrombosis occurred in 10 cases (18.87％),7 cases (13.21 ％),1 case (1.89％),5 cases (9.43％),7 cases (13.21％) and 3 cases (5.66％) on the 1st,2nd,3rd and 4th day after injury.In non-anticoagulant group,thrombosis occurred in 7 cases (20.0％),8 cases (22.86％),2 cases (5.71％),1 case (2.86％),4 cases (11.42％),3 cases (8.57％),1 case (2.86％),1 case (2.86％),1 case (2.86％),1 case (2.86％) and 1 case (2.86％) respectively on the 1st,2nd,3rd,4th and 6th days after operation.Of the 62 thrombus cases,22 (35.48％) were changed from unilateral to bilateral,6 (9.68％) disappeared,3 (4.84％) from distal to proximal (1 case of pulmonary embolism),1 (1.61％) from proximal to distal,and 30 (48.38％) remained unchanged.43 cases of femoral neck fracture,27 cases of deep vein thrombosis,the incidence rate was 62.79％,45 cases of intertrochanteric fracture,35 cases of deep vein thrombosis,the incidence rate was 77.78％.There was no significant difference between the two groups (P ＞ 0.05).Conclusions Despite routine prophylactic anticoagulation therapy,the incidence of deep venous thrombosis is still high in hip fracture patients.The peak time of perioperative deep venous thrombosis in hip fracture patients was 2 d after injury and 2 d after operation.There was no significant change in thrombus after conventional anticoagulation therapy in patients with deep venous thrombosis during perioperative period,and even some of the thrombus changed from unilateral to bilateral.