Objective To discuss the diagnosis and treatment of spontaneous perforation of the large intestine.Methods The clinical data of 9 cases with spontaneous perforation of the large intestine admitted into our hospital since 1994 were analyzed retrospectively.Results All the 9 cases were over 60 years of age,had no specific clinical manifestations,and were misdiagnosed preoperatively.Among them,4 cases had a(longstanding) history of hypertension and arteriosclerosis,and 6 cases had habitual constipation.There was 1 case with perforation of transverse colon,1 case of descending colon,3 cases of sigmoid colon,and 4 cases of upper rectum.Four cases underwent exteriorization after a simple closure of the perforation,while in the other 5 cases closure of the perforation was followed by a loop colostomy.The postoperative complications included cardiac arrhythmia(1 case),lung infection(2 cases),and infection of incisional wound(1 case).All cases recovered smoothly and were discharged.Conclusions Spontaneous perforation of the large intestine usually presents in old patients,and frequeatly occurs in the rectum and sigmoid colon.It is usually misdiagnosed preoperatively,and surgical intervention should be performed as soon as possible.The operation should be simple.It is crucial to intensify management after operation.

Objective Measure the epicondyles of the distal femur on magnetic resonance image(MRI), in order to locate presicely the surgical transepicondylar axis(STEA) in total knee arthroplasty(TKA) and to provide theoretical basis for the designing of the size of the femoral component. Methods Totally 78 normal knees of Chinese individuals were studied. The images of coronal, sagittal and traverse sections of the knee were obtained by magnetic resonance image. Measurement included the width of the STEA, distance between the epicondyles and the joint line, anterior posterior width of the medial and lateral epicondyles, posterior condyle angle. Results The width of the STEA averaged(79.55±4.90)mm in males, and femles(71.18±4.22)mm. The distance from the epicondyles to the joint line was correlated with the width of the STEA, so was the anterior posterior width of epicondyles. PCA averaged(4.22±2.07)°. Conclusion The size of the epicondyles in Chinese is significantly smaller than that of the Westerns. The ratio between anterior posterior width of the medial epicondyle and the width of the STEA is 0.84, and is 0.87 between anterior posterior width of the lateral epicondyle and the width of the STEA. The distance from the epicondyles to the joint line is helpful to locate the STEA. The reliability is poor to locate the STEA by touch or PCL.

Objective To report the clinical outcomes of open reduction and internal fixation for capitellum fractures in adolescents.Methods From January 2010 to January 2015,14 adolescents with capitellum fracture were admitted to our department.They were 12 males and 2 females,aged from 12 to 16 years (13.7 years).By the Dubberley classification,we had 2 cases of type ⅠA,8 cases of type ⅡA,3 cases of type Ⅲ A and one of type Ⅲ B.We summarized their clinical characteristics and injury mechanisms.At the last follow-up,the therapeutic efficacy was assessed by the Mayo elbow function scores,and the ranges of motion of the elbow and forearm on the affected side were recorded.Results The 14 patients obtained an average follow-up of 12 months (from 6 to 18 months).All the cases achieved fracture union within 3 months,but malunion appeared in one.At the last follow-up,the ranges of flexion and extension of the affected elbow averaged 120.6° (from 110° to 135°),and the ranges of lateral rotation of the affected forearm averaged 160.3° (from 150° to 175°).According to the Mayo scores at the last follow-up,the elbow function was rated as excellent in 12 and as good in one.Mild traumatic arthritis occurred in 3 cases.Conclusions Capitellum fractures in adolescents are often Dubberley type A ones without a complicated fracture of the posterior condyle.Usually,the capitellum is impacted by the radial head in the process of elbow extension with valgus stress.After definite diagnosis,open anatomical reduction and reasonable and reliable internal fixation can result in good clinical results.

OBJECTIVE To investigate approaches to the prevention of sharps injuries. METHODS A retrospective questionnaire was performed for 193 nurses of a general hospital from the time of Jan 2004 to Jun 2005. RESULTS The questionnaires indicated that 46.1% nurses had suffered sharps injuries,with averaged of 1.6 times per person,of which 36.7% and 32.4% were caused respectively by syringe needles and glass wares.Opening ampules,disposal of used sharps,installing the syringe needles and transmitting sharp devices were the four major events in which sharps injuries might happen,accounted for 29.5%,22.3%,15.8% and 10.1%,respectively.It is also noted that 79.1% nurses suffering from the injury wore no gloves. CONCLUSIONS Occupational hazards of sharps injuries are threatening nurses.Certain prophylactic measures should be taken to control and prevent sharps injuries.

OBJECTIVE To investigate related factors of urinary tract infection due to indwelling catheter.(METHODS) A total of 19 cases of urinary tract infection due to indwelling catheter were retrospectively analyzed.RESULTS Among 49 patients with indwelling catheter 19 patients got urinary tract infection,the infection rate was 38.78%.The incidence of urinary tract infection of patients at 1-10 d,11-20 d,21-30 d and over 30 d catheter was 20.00%,30.77%,37.50%,and 69.23%,respectively. Escherichia coli was the most common pathogen(isolated),the others were Enterococcus faecalis,Candida albicans,Enterobacter cloacae,et al.CONCLUSIONS The operation of indwelling catheter,continued times of indwelling catheter,improper application of antibiotics are the important risk factors of urinary tract infection.The infection rate could be decreased after taking(prevention) measures according to various related factors.

OBJECTIVE To discuss the management methods of sputum sample retained clinically based on the praxiology,and aim at improving the quality of the sputum retained. METHODS Through investigating the quality of sputum sample retained routinely from the department of internal medicine in a general hospital at the duration from Sep 2004 to Feb 2005,the intervention effect was evaluated by carrying out the measure of praxiology intervention. RESULTS The qualification rate was 23.7% for the sputum sample retained routinely from the hospital at the duration from Sep 2004 to Feb 2005,after carrying out the measure of praxiology intervention,the qualification rate was 30.1% at the duration from Apr 2005 to Aug 2005.Statistic data showed that there was no significant difference. CONCLUSIONS The quality of the sputum sample retained routinely is poor,and the measure of praxiology intervention failed to improve the quality of the sputum sample.Microscopy is the most important measure to ensure the quality of the sputum sample for the cytology test before cultivating the sample,and should be a routine test in hospital.The study on praxiology intervention will be further carried out in the future.

Objective To investigate the clinical efficacy of liver resection combined intraoperative choledochoscope for intra‐hepatic biliary calculi .Methods A retrospective analysis of clinical data in seventeen patients with intrahepatic biliary calculi ,who have been received liver resection combined intraoperative choledochoscope in the department of hepatobiliary surgery during 2005 to 2014 was conducted .According to the distribution of intrahepatic bile duct stones ,six cases located in left liver lobe ,five cases lo‐cated in left half liver ,three cases located in liver section Ⅵ ,one case located in liver section Ⅶ ,one case located in liver section Ⅷ , one case located in left liver lobe associated with right posterior lobe lower segment .Seventeen cases were treated with hepatolobec‐tomy or segmental liver resection (single clamp method combined first hilar occlusion) ,among which six cases received hepatic left lateral lobectomy ,five cases received left hemihepatectomy ,three cases received partial hepatic resection in paragraph Ⅶ ,one case received partial hepatic resection in paragraph Ⅶ and one in Ⅷ ,one case received the left lateral lobe combined right posterior lower segmental resection ,ten cases at the same time received choledocholithotomy and T tube drainage .Results All patients were cured without serious complications ,no long term stone recurrence .Conclusion Liver resection combined intraoperative choledochoscope is positive and effective treatment for intrahepatic biliary calculi patients .

BACKGROUND:Umbilical cord blood as a source of hematopoietic stem cel s has become a hot topic. Adjuvant therapy of umbilical cord blood transfusion has been used in China to correct renal anemia of uremia patients. OBJECTIVE:To evaluate the efficacy and safety of umbilical cord blood mesenchymal stem cel s in the treatment of renal anemia, and to compare with the effects of different sources of mesenchymal stem cel s with different transplantation methods on the treatment of kidney diseases. METHODS:A retrospective analysis was conducted on six renal anemia patients in the Department of Outpatient, Henan Red Cross Blood Center between January 2010 and December 2012. The experiment was approved by Medical Ethics Committee, six patients were informed consent for treatment programs, and parturients and their families have signed the informed consent. The newborns umbilical cord blood of 80-140 mL were col ected with closed sterile plastic blood bags, and then the separated umbilical cord blood mesenchymal stem cel s were transfused into the renal anemia patients through the superficial vein in the back of the hand with the number of≥1×108/copy, two copies per time, and re-transfused after 4 days, a total of three times. The blood hematocrit, hemoglobin, red blood cel s in urine, renal blood flow changes were observed before and after treatment. RESULTS AND CONCLUSION:The hemoglobin, blood hematocrit, red blood cel s in urine and renal blood flow were significantly increased before and after treatment (P<0.05). Transfusion of multiple copies of umbilical cord blood mesenchymal stem cel s through the superficial vein in the back of the hand is convenient and safe, which is considered as a new method for the treatment of renal anemia. But there are certain limitation in the data and the conclusion as the clinical research was designed as self-control, so further confirm is needed.

Objective To investigate the influence of early rehabilitation and defibrase on the hemodynamic cerebral vascular dynamic index (CVDI) of hemiplegic patients with acute cerebral infarction. Methods Ninety hemiplegic patients with acute infarction were randomly divided into a rehabilitation and a control group. Both groups received defibrase routine treatment. The rehabilitation group received systematic rehabilitation training in addition. The Fugl-Meyer assessment ( FMA) , the Scandinavian Scoring Scale ( SSS) and Barthel's index ( MBI) were employed to evaluate the functioning of the two groups. The CVDIs of all patients were quantified before and after treatment. Results The FMA, MBI and SSS scores as well as the CVDIs of both groups had improved after 4 weeks of treatment, but all were more improved in the rehabilitation group than in the control group. Conclusions Early rehabilitation was effective for relieving neurological impairment and improving ability in the activities of daily living for patients with acute cerebral infarction.

Objective To investigate the clinical effect of a new type of disposable heparin freedialysis tube in uremic patients without heparin dialysis. Methods A total of 110 patients withoutheparin dialysis were divided into control group and observation group by random digits table method with55 cases each. Based on the same pre dialysis and dialysis for heparin saline flushing of discontinuoussaline on the control group using the traditional dialysis pipe for hemodialysis without heparin, theobservation group used disposable non heparin dialysis pipe for hemodialysis without heparin. The numberof patients with venous catheter blockage, blood loss and completion of dialysis time in two groups wasrecorded. Results The number of patients with venous catheter blockage, blood loss and completion ofdialysis time was 6, 6, 47 cases in control group and 0, 0, 54 cases in observation group. The differences were statistically significant (χ2=4.407, 4.407, 4.356, P<0.05). Conclusions The new disposableheparin free dialysis tube can reduce the loss of blood and prolong the treatment time, and the operation issimple, safe and effective, and has good application value and application prospect.