Objective To investigate the methods and therapeutic effects of anterolateral thigh perforator free flaps for reconstruction of soft tissue defects around the ankle.Methods A retrospective case series study was made on 30 patients treated with anterolateral thigh perforator free flaps for traumatic soft tissue defects around the tibia between January 2010 and June 2016.There were 22 males and eight females,with the age range of 16-58 years [(41.5 ± 1.2) years].Dimension of the soft tissue defect ranged from 9 cm ×4 cm to 23 cm × 12 cm.Flap stabilization time,flap survival rate,postoperative complications,second plastic surgery rate,and ankle joint function by Baird-Jackson score were recorded.Results All patients were followed up for (13.0 ± 5.4) months (range,6-24 months).Time for flap stabilization was (6.5 ± 1.1) days.All flaps survived except in one patients with flap loss due to postoperative arterial thrombosis.Postoperatively,one patient had arterial crisis,one had venous thrombosis,and one presented sinus formation due to infection.No second plastic surgery was carried out.According to the Baird-Jackson score,the results were excellent in 25 patients and good in five.Conclusion Anterolateral thigh perforator free flaps for reconstruction of traumatic soft tissue defects around the tibia has advantages of easy harvesting and survival,less postoperative complications,less second surgery,and good function recovery.

Objective To investigate the clinical results of left ventricle retraining procedure. Methods From Apr. 2001 to May 2004, 7 consecutive cases of simple TGA underwent left ventricle retraining procedure, which was composed of aorto-pulmonary shunt and pulmonary artery banding. At the operation, the ratio of systolic pulmonary/systemic pressure increased from 0.34 to 0.76. Contemporary atrial septum excision was performed in 2 cases and pulmonary artery banding revision in one. Results There was no hospital death in this series. 4 cases underwent second stage arteries switch operation (ASO) successfully 2 weeks after primary retraining procedure and discharged uneventfully. 1 case was readmitted 3 months later for ASO and died of postoperative hepatic failure. 2 cases were discharged without second staged operation because of postoperative complications. Conclusion Left ventricle retraining is necessary preparation for ASO in cases of simple TGA beyond the neonatal period. Atrial communication plays an important role in left ventricle retraining procedure. The surgical results of rapid two-stage ASO are quite satisfactory.

rotein binding toxin and pathogenic components, and reduce clinical symptoms and patients'prognoses, which is more effective than HP or CVVHDF.

BACKGROUND:Pathological change and compression of multiple vertebra often occur following senile osteoporosis,myeloma and metastatic tumor.However,there are few studies concerning treatment of multiple vertebral lesion shaping.OBJECTIVE:To explore therapeutic efficacy,announcements of multiple pathological thorax-lumbar vertebrae treated with once only percutaneous vertebroplasty (PVP).DESIGN,TIME AND SETTING:The observational experiment.Patients were selected from the Department of Spinal Surgery,Department of Rehabilitation,and Department of Tumor,Taihe Hospital from November 2004 to October 2008.PARTICIPANTS:A total of 31 patients from the Department of Spinal Surgery,Department of Rehabilitation,and Department of Tumor,Taihe Hospital with senile osteoporosis combined with compression fracture,general lymphadenomatosis of bones and osteolytic metastatic tumor,14 males,17 females,with an age of 56-82 years old.METHODS:Thirty-one cases of multiple pathological thorax-lumbar vertebrae were treated with PVP.Following local anesthesia,affected vertebral body underwent vertebrae root puncturation.Under strict monitoring,bone cement was injected into the vertebral body in order.Following surgery,vertebral body condition and patients' reaction were observed.Therapeutic efficacy was evaluated 1 week following surgery.MAIN OUTCOME MEASURES:The following parameters were measured:centrum puncture success ratio,disposable centrum forming number,bone cement injection quantity,centrum bone cement distribution situation,leakage of bone cement to soft tissue and vein surrounding the vertebra,ache alleviation,and complications.RESULTS:A total of 75 vertebroplasy was used 33 times,2 vertebral bodies at least once only,and 5 vertebral bodies at most once only,with an average of 2.27 vertebral bodies once only.4-12 mL of bone cement was injected in each vertebral body,averagely 7.5 mL.Uniformity injection was done in 49 cases,and partial injection in 26 cases.Without serious complications,all the patients relieved in local pain parts following surgery.Significant remission or disappearance was determined in 20 cases,and partial remission in 11 cases.CONCLUSION:PVP is a safe and effective method in treatment of multiple pathological thorax-lumbar vertebrae.The key of operation is reasonable injection and thorough monitoring.

Objective The mortality rate of the children after surgical repair of congenital heart disease associated with acute renal injure has been reported to be 30％-79％.Peritoneal dialysis is the common treatment method for those patients,but the optimal time to initiate peritoneal dialysis is still controversial.The aim of this study was to investigate the clinic outcome of early peritoneal dialysis to the children following cardiac surgery.Methods We performed a retrospective chart of children following cardiac surgery from January 2008 to December 2009.The total number was 4561,62 of them were performed PD treatment.Data on the PD treatment children were collected from pre-operation to hospital discharge.Early peritoneal dialysis group was defintes as PD initiated at operation room or the interval between the end of operation to starting peritoneal dialysis less than 3hrs.the others were traditional PD group.Results The whole PD treatment rate was 1.36％,15 patients died.The mortality were 10.71％ (3/28) in early PD and 35.29％ (12/34) in conditional PD group respectively (P =0.036).2 patients were met RIFLE(risk,injury,failure,loss,and end-stage renal disease,RIFLE)classification as failure grade in early PD group while 10 patients in traditional PD group (P =0.001).After PD treatment 24hrs,the Vasoactive-Inotrope Scores and serum creatinine values were much lower in the early PD group children than those in the traditional PD group[(19.00 ±2.39) vs(37.00±5.22),P=0.002;(50.51 ±21.84) vs(130.13±76.09),P=0.001)].Conclusion This study shows that early PD can prevent the children after congenital heart surgery to develop AKI,and reduce the severity of the clinic status.Early intervention with PD is associated with low mortality.

Objective To explore the embolization technique,embolus choice and preventing complications of transcatheter internal iliac artery embolization in treating pelvis massive hemorrhage.Methods Bilateral selective internal iliac artery embolization utilizing gelfoam was done in 11 patients of pelvis massive hemorrhage (including 3 cases of bladder carcinoma,5 cases of cervix carcinoma,one case of choriocarcinoma and 2 cases of puerperal hemorrhage.Results Prompt hemostasis was obtained immediately after first embolization in all 11 patients,one of them showed recurrent bleeding after 24 hours and underwent treatment again.Patients were followed up for 10~90 days,no hemorrhage or any kind of complication noted in all patients.Conclusion Transcatheter internal iliac artery embolization is a simple,less invasive,safe and effective therapy for pelvis massive hemorrhage,should be taken as the first choice.

Objective To study the clinical value of DSA diagnosis and interventional therapy for non-neoplastic lower digestive tract hemorrhage. Methods Non-neoplastic lower digestive tract hemorrhage were diagnosed in 21 patients. Eight cases underwent embolization with gelfoam and 13 cases with infusion of pitressin. Results Intestinal angiodysplasia was found in 14 cases, colonic diverticulum in 2 and hemorrhage of unknown cause in 5. Hemorrhage in all patients was stopped after the interventional therapy with no serious complications. During the follow-up of 25～74 months, intestinal angiodysplasia bleeding recurred in 4 patients. Conclusions DSA is very helpful in the diagnosis of non-neoplastic lower digestive tract hemorrhage and interventional therapy is safe and effective for the stoppage of the bleeding.

Objective Through comparing ultrasound-guided microwave ablation (MWA) with surgical resection for the treatment of nodular goiter to evaluate the effect of RFA on the thyroid function.Methods A total of 50 patients with nodular goiter,who were admitted to authors' hospital during the period from January 2010 to January 2013 to receive ultrasound-guided MWA,were selected and used as the study group;and other 96 patients with nodular goiter,who were encountered at authors' hospital during the same period to receive partial thyroidectomy,were collected and used as the control group.Of the 50 patients in the study group,RFA of unilateral lobe nodules was performed in 8 and RFA of bilateral lobe nodules in 42.Among the 96 patients in the control group,unilateral lobe nodules were seen in 52 and bilateral lobe nodules in 44.Postoperative complications were recorded,the serum FT3,FT4,TSH levels were determined at one week,as well as one,3,6 and 12 months after the treatment.The results were statistically analyzed.Results All patients were followed up for 12 months.In the study group,no complications occurred;one week after RFA the serum FT3 and FT4 levels increased while the serum TSH level decreased when compared with preoperative ones,and the differences were statistically significant (P＜0.05).In the control group,bleeding asphyxia occurred in one patient,hoarseness in 5 patients and hypocalcemia convulsion in 3 patients.One week after partial thyroidectomy,the serum FT3 and FT4 levels increased while the serum TSH level decreased when compared with preoperative data,and the differences were statistically significant (P＜0.05).One week after surgery thyroxine replacement therapy was routinely given to 44 patients who had received bilateral subtotal thyroidectomy.Three patients who had received unilateral subtotal thyroidectomy developed hypothyroidism at 3,6 and 8 months after the surgery respectively.In other 49 patients receiving unilateral subtotal thyroidectomy the serum FT3,FT4,TSH levels determined at one,3,6 and 12 months after surgery were significantly different from those in the patients of the study group (P＜0.05).Conclusion For the treatment of nodular goiter,ultrasound-guided MWA is quite safe.MWA has very slight effect on thyroid function and is definitely superior to subtotal thyroidectomy.Therefore,MWA is a minimally invasive technique which is worthy of clinical promotion.

Objective To study the methods,therapeutic effect and complications of transcatheter uterine artery embolization(TUAE)for hysteromyoma.Methods There were 82 patients with hysteromyoma confirmed by clinical,color Doppler ultrasound and CT in this study.Among them,5 hysteromyoma located under mucous membrane,72 in the myometrium,5 under serous membrane.15 cases were single hysteromyoma,67 were multiple hysteromyoma.Bilateral uterine arteries were embolized with lipiodol-pingyangmycin emulsion(LPE)and Gelfoam particles using Seldinger technique.All patients were followed up for 3 to 6 months.Results The successful rate of catheterization almost reached 100%.B-mode ultrasound examination 3 months after the procedure showed averagely 51% of decrease in volume of the masses and decrease of blood flow of tumors in all cases,the volume of tumors decreased 43% and 19 hysteromyoma disappeared for 6 months later.Menses returned to regular cycle.In the patients with anemia,the hemoglobin concentration recovered to normal level.The rate of complication was 6%(5/82),and recovered to normal after special treatment.Conclusion TUAE is an effective and less invasive way to treat hysteromyoma,the complications of TUAE are preventable and curable.

Objective Endothelin is a key role in the pathogenic of pulmonary arterial hypertension. High concentrations of endothelin-1 have been recorded in plasma and lungs of patients with pulmonary artery hypertension associated with congenital heart disease, and the concentrations of endothelin-1 was correlated with severity degree of pulmonary arterial disease.Endothelin exerting vasoconstrictor and mitogenic effects by binding to two distinct receptor isoforms in the pulmonary vascular smooth muscle cells: endothelin A and B receptors. Bosentan is an orally active dual ( A and B) endothelin receptor antagonist that has been shown to improve exercise capacity, haemodynamics, and clinical worsening in many clinical trials, but have no experience in post-operation of congenital heart disease with PAH. In our country, there are lots of elder patients of congenital heart disease accompany with pulmonary arterial hypertension. And they have poor prognosis after operation because pulmonary arterial hypertension leads to right ventricular failure and sudden death. So we hope bosentan can improve clinical outcome of these patients. This time we present the results of the bosentan trial in post-operative patients still with pulmonary arterial hypertension, a randomized controlled trial designed to assess the efficacy and safety of the dual endothelin receptor antagonist bosentan in post-operative pulmonary arterial hypertension, and present the first experience of bosentan for these patients.Methods This study was a prospective clinical trial. The objects were 30 patients ( age:4 months - 6.8years,weight:5 - 15 kg) who still had pulmonary artery hypertension at one week after cardiac defects repaired. They were randomized to controlled ( n = 15 ) or to bosentan ( n = 15 ). Dosage regimen: 10 - 20 kg patients, 31. 25 mg qd ( 4 weeks ) ,31.25 mg bid ( 8 weeks);5 - 10 kg patients, 15.6 mg qd ( 4 weeks), 15.6 mg bid ( 8 weeks). Evaluate the efficacy and safety of Bosentan through the amelioration of pulmonary arterial systolic pressure, WHO functional class, and clinical worsening. Results We monitored pulmonary arterial systolic pressure after operation by echocardiogram 2 times, baseline ( 1 week after operation) and at 12 weeks later. The pulmonary arterial systolic pressure decreased 19.5 mm Hg in Bosentan group( P =0. 000), and decreased 10.3 mm Hg in control group(P =0. 164), with the mean treatment effect of 9.2 mm Hg (P=0.049,95%CI:0. 1 -18.3). The effct of bosentan on haemodynamics is also reflected in the reduction plasma ET-1 concentration in bosentan group. Plasma ET-1 in control group increased (0. 15 ±0.1 )fmol/ml(P =0.77), however, decreased (2.01 ±0.3)fmol/ml (P=0. 03) in bosentan group; Bosentan prevented post-operation PAH. Bosentan treatment was associated with lower incidence of worsening NYHA functional class compared with controlled(0 in the bosentan group vs 13% in the placebo group) There was a delay in time to clinical worsening with bosentan compared wih controlled group. Abnormal liver function occurred in 2 cases in bosentan group but resolved after discontinuation of bosentan treatment, no other side effects. Bosentan produced hemodynamic improvement and was well tolerated in infant. Conclusion Bosentan administration in patients with postoperative PAH is safe and efficient. Bosentan is a new effective approach to therapy for postoperative pulmonary arterial hypertension in children.