Objective To investigate the value of CT and mammography for diagnosing breast masses.Methods 61 cases with breast mass confirmed pathologically were studied comparatively. The diagnostic accuracy was compared between the two mentioned diagnostic methods.Results The qualitative accuracy of CT in diagnosis of breast cancer, galactocele, lipoma, fibroadenoma, gynecomastia, breast hyperplasia was 80%(8/10), 100%(2/2), 100%(1/1), 100%(27/27), 100%(7/7), 100%(14/14), respectively. The qualitative accuracy of mammography in diagnosis of the above lesions was 70%(7/10), 50%(1/2), 0%(0/1), 81%(22/27), 43%(3/7), 71%(10/14), respectively. In the cases of breast cancer, mammography could detect clustered microcalcification foci in 4 of the 10 cases(40%). But CT could detect none of them. Mammography was superior to CT in demonstrating cluster microcalcifications which are important basis for diagnosing breast cancer. The overall accuracy of CT and mammography for diagnosing breast masses were 97% and 71%.Conclusion CT has a higher accuracy than mammography in determining the nature of breast mass. The synthetic application of both the two methods may raise the diagnostic level for early stage breast cancer.

[Objective]To investigate the role of CT measurement of distal femur rotational angle in total knee arthroplasty. [Methods]From April 1998 to April 2005,eighty-four patients(106 knees)underwent total knee arthroplasty(TKA),including 48 rheumatoid arthritis(RA)knees,and 67 osteoarthritis(OA) knees and one case of pigmented villonodullar synovitis.All the patients in the study were measured by computed tomographic scanning (CT). The examination was positioned in supination,or neutral position of the lower limbs.The distal femur was micro-scanned by 3 mm width.On the screen one line was made between the two hypocondyles of the femur,and another line was made between the medial epicondyle fossa and the external epicondyl fossa of the femur.The angles of the two lines were measured.The bone resection of femur antero-posterior condyle was performed according to the preoperatively measured angles.Six months after operation,the range-of-motion of knee was examined. A control group(49 knees in 40 patients) to the conventional TKA of the 3 degree external rotation bone resection was comparatively studied. All the operations were made by the same surgeon,and all the prostheseswere the type of PFC ( Press Fit Condyle).[Results]The results indicated that the rotational angles of the distal femur were above 3 degrees in north Chinece population with the male of 5.1 degrees (SD 1.7) and female of 5.8 degrees(SD1.5).[Conclusion]The rotational angler of the distal femur are above 3 degrees in north Chinece population. If the bone resection of femur was performed according to the preoperatively measured angles,the postoperative result is more favourable than the conventional bone resection according to the 3 degree external rotation.

Objective To explore the selection of prostheses for the elderly patients with severe displaced fracture of the femoral neck through retrospective comparison of the long term clinical results between bipolar hemiarthroplasty and total hip replacement. Methods From January 1986 to December 2002, 101 cases of Garden Ⅲand Ⅳtypes of the femoral neck fracture were treated with either bipolar hemiarthroplasty (Group A: 55 cases) or total hip replacement (Group B: 46 cases). The age of the patients at the time of operation ranged from 55 to 94 years old (mean: 70.4 years old) in Group A, and from 57 to 75 years old (mean 69.5 years old) in Group B. The average period of follow up was 4.9 years (1 to 10 years) in Group A and 3.5 years (1.5 to 5 years) in Group B. The clinical results were evaluated according to Harris and Merle d'Aubigue criteria. The perioperative complications were compared. Results The excellent and good clinical results were 78.12 %in Groups A and 95.65 %in Group B respectively. The rate of groin and thigh pains was higher in Group A (36.36 %) than in Group B (6.52 %). The flexion of the hip in Group A was more limited (mean 85 degrees) than in Group B (mean 110 degrees). There were more cases of sunken femoral stem in Group A. The perioperative complications were similar in both groups. Conclusions The total hip arthroplasty is the first choice for the elderly patients with severe displaced femoral neck fracture if the conditions of the patient and the skills of the surgeon permit. The bipolar hemiarthroplasty is suitable for patients of more than 75 years old, or for those with severe diseases.

Objective To evaluate the results of acromioclavicukr crook plate in treatment of acromioclavicular joint dislocation and distal clavicular fracture and discuss causes for complications and preventive measures.Methods From September 2003 to April 2007,open reduction and acromiocla vicular crook plate fixation was done on 38 patients with acromioclavicular joint dislocation and distal clavicular fracture including 17 with acromioclavicular dislocation and 12 with distal clavicle fractures.Postoperative rehabilitation began early.Results Of all,27 patients were followed up for mean 21 months (3-37 months) and obtained bone healing.The internal fixation was removed at 6-8 months postoperatively and the outcome was evaluated with Karlsson rating system,which showed 22 patients at grade A,four at grade B and one at grade C.There was no dislocation or fracture after the internal fixation was removed ranging.Three patients with limited abduct motion <90° during certain movements got better after plate removal.One patient had acromio clavicular erosion.Conclusions The application of acromioclavicular crook plate provides accurate anatomical reduction and early rehabilitation and enables fast functional recovery.Technically,the implant needs to be used precisely.It is better to get appropriate early exercise and remove plate as early as possible.

OBJECTIVETo investigate the feasibility of establishing an integrated regional network for ST-segment elevation myocardial infarction (STEMI) care in China and evaluate the implementation effect of this network.

METHODSBased on real-time electrocardiogram transmission technology, we established an integrated regional network for STEMI care (IRN-STEMI) with Xiamen Heart Center as the core center, 120 Emergency Systems, PCI-capable hospitals and other community health units as core elements of this network. Reperfusion treatment data of Xiamen Heart Center including the number of patients receiving primary percutaneous coronary intervention (PCI), the mean first medical contact to balloon (FMC-to-B) time, the mean door to balloon (D-to-B) time, the mean length of hospital stay, the mean medical cost and in-hospital mortality were compared before (n = 165) and at 1 year after the built-up of IRN-STEMI (n = 343).

RESULTSCompared to pre-IRN-STEMI era, primary PCI ratio (84.5% (290/343) vs. 75.5% (185/245)) were significantly increased post establishment of IRN-STEMI within the network (P = 0.06). STEMI patients admitted in Xiamen Heart Center was significantly increased from 165 to 256, the annual mean FMC-to-B time ((110.3 ± 34.0)min vs. (137.9 ± 58.5) min, P < 0.01) and D-to-B ( (76.5 ± 33.0) min vs. (107.3 ± 38.0) min, P < 0.01) , as well as the mean medical cost were significantly decreased ( (51 398 ± 22 100) RMB vs. (56 970 ± 24 593) RMB, P < 0.05), while the mean length of hospital stay ((9.0 ± 4.3)d vs. (9.7 ± 4.8)d, P > 0.05) and in-hospital mortality (3.1% (8/256) vs. 3.0% (5/165) , P > 0.05) remained unchanged before and after the setting of IRN-STEMI in Xiamen Heart Center.

CONCLUSIONEstablishment of an integrated regional network system for STEMI patients in China is feasible. With collaboration of qualified heart center, EMS and PCI-capable and non-PCI capable local hospitals, establishment of IRN-STEMI effectively increased the ratio of primary PCI for STEMI patients, it also significantly shortened the FMC-to-B and D-to-B time, decreased mean medical cost, thus, the regional IRN-STEMI network might be an effective working system for improving the medical care for STEMI patients.

China ; epidemiology ; Community Networks ; Cost Control ; Electrocardiography ; Hospital Mortality ; Hospitalization ; Humans ; Length of Stay ; Myocardial Infarction ; mortality ; therapy ; Percutaneous Coronary Intervention ; Time Factors