Objective To introduce the mini-open anterior correction under video assisted thoracosco- py for thoracic idiopathic scoliosis and report its clinical results.Methods From July 2001 to 2006,37 ca- ses of right thoracic idiopathic seoliosis were surgically corrected with mini-open anterior instrumentation. There were 4 males and 33 females with average age of 14.1 years and average Cobb angle of 56?.Fourteen cases with Lenke I A 14 cases,IB ++-++++ 14 cases,IC 9 cases.The Risser sign was ++-++++. The operative time,blood loss,instrumented levels,correction rate and loss of correction were analyzed. Results The operative time averaged 220 miu.The intraoperative blood loss averaged 320 ml.The average number of instrumented levels was 7.8.The postoperative Cobb angle was 16.8?on average with correction rate of 70%.With a follow-up of 18-36 months,the loss of correction averaged 4.6%,but no hardware complications.Conclusion The clinical results of mini-open anterior correction under thoracoscopy for tho- racic idiopathic scoliosis were satisfactory.It may minimize the complications of classical thoracotomic anterior correcion and mav reduce the high requirement for anesthesia,long operative time and high cost of thoraco- scopic anterior instrumentation.

OBJECTIVETo investigate the feasibility and clinical results of a new mini-open approach in the anterior instrumentation of thoracolumbar scoliosis by comparing with traditional open approach.

METHODSSeventy-two patients with the idiopathic thoracolumbar scoliosis underwent one stage anterior instrumentation and spinal fusion. In group A, the patients received anterior mini-open approach without dissecting diaphragm. There were total 34 cases with average age of 16 years old, ranging from 12 to 25 years. The average Cobb angle was 58 degrees with a range of 42 degrees to 76 degrees pre-operatively. The instrumentation levels were from T(11) to L(3) in 18 cases, T(11) to L(2) in 6 cases, T(11) to L(4) in 10 cases. In group B, the patients were treated with traditional open approach. Total 38 cases with average age of 17 years old, ranging from 13 to 26 years, were included. The average Cobb angle was 54 degrees with a range of 40 degrees to 74 degrees pre-operatively. The instrumentation levels were from T(10) to L(3) 7 cases, T(11) to L(3) 20 cases, T(11) to L(4) 11 cases.

RESULTSIn group A, the average curve correction was 81% with post-operative Cobb angle 12 degrees ranging from 4 to 16 degrees . Sagittal alignment restoration was satisfied in this group. In group B, the average curve correction was 73% with post-operative Cobb angle 15 degrees . The rehabilitation time was shorter in group A than in group B. No death, vascular injury and neurological complication occurred. Exudative pleurisy occurred in two patients in each group and cured very well.

CONCLUSIONSMini-open anterior instrumentation for thoracolumbar scoliosis without diaphragm dissection is proved to have the same outcomes as the traditional anterior approach, without the increase of complication.

Adolescent ; Adult ; Child ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Scoliosis ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; surgery ; Treatment Outcome

OBJECTIVETo evaluate an alternative landmark for thoracic vertebral screw insertion using the nutrient artery entrance on the posterolateral wall of thoracic vertebral bodies, and to discuss its clinical significance.

METHODSTwenty normal adult cadaver thoracic vertebral specimens were obtained randomly. Measurements included the number of nutrient artery entrance on left and right wall of thoracic vertebral bodies from T5 to T12, the diameter of the maximal nutrient artery entrance (d), the distance from nutrient artery entrance to the superior (A) or posterior (B) margin of the vertebral body, the distance between the posterior edge of the vertebral body and the nutrient artery entrance line (C) or the upper costal facet line (D). The length between left and right nutrient artery entrance (a) or costal facet (b) was measured too.

RESULTSFrom T5 to T12, the nutrient artery entrance were all underneath the upper costal facet. There were no significant differences between left and right side of anatomic measurements of each vertebral body from T5 to T12. The distance of A increased from T5 to T12, and the diameter and distance of B were no significant differences from T5 to T12. There were significant differences between the value C and the value D from T5 to T10.

CONCLUSIONSThe anatomical position of the nutrient artery entrance is relatively settled, and it could be used as a new landmark for screw placement.

Adult ; Arteries ; anatomy & histology ; Bone Screws ; Cadaver ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Models, Anatomic ; Thoracic Vertebrae ; anatomy & histology ; blood supply ; surgery

BACKGROUNDSurgery for severe kyphoscoliosis is frequently unsatisfying because of loss of correction, high rate of pseudarthrosis and neurological complications. Several authors reported that the anterior fusion with strut grafts might improve the surgical outcome. This article describes and assesses the surgical strategies and the application of autogenous tibial strut in the treatment of severe kyphoscoliosis.

METHODSSevere kyphoscoliosis patients (n = 39) admitted from April 1998 to September 2003 formed the study group. Different surgical strategies had been used according to the flexibility, neurological function and curve level. All patients received staged anterior and posterior surgery with a tibial strut used in the anterior fusion. The patients were followed up for 9 months to 6 years (mean 37 months).

RESULTSThe mean preoperative and postoperative kyphosis was 82 degrees and 52 degrees respectively, and the mean scoliosis was 84 degrees and 44 degrees respectively. Complications included pseudarthrosis (2 cases, one with graft fracture and the other with hook displacement), posterior elements fractures (4), pleura penetrations (3, in the plastic surgery of the thoracic cage), dura tear (2), exudative pleuritis (2, in the anterior surgery), and tibia fracture of the harvesting site (1). The mean loss of correction in coronal and sagittal plane was 6 degrees and 7 degrees respectively. Except for 1 case, the patients with incomplete paraplegia showed improvements to varying extents.

CONCLUSIONAutogenous tibial strut can provide excellent support to the kyphoscoliotic spine: it reduces pseudarthrodic rate, loss of correction and complications of graft harvest, it also prevents the occurrence of neurological impairment.

Adolescent ; Adult ; Child ; Female ; Humans ; Kyphosis ; physiopathology ; surgery ; Male ; Scoliosis ; physiopathology ; surgery ; Spinal Fusion ; Tibia ; transplantation ; Transplantation, Autologous

OBJECTIVETo evaluate the value of some parameters in predicting of growth peak height velocity (PHV) of the girls with adolescent idiopathic scoliosis (AIS) by histomorphological studying on iliac crest cartilage.

METHODSIliac crest cartilages were harvested during posterior surgery from girls with AIS. The samples were then paraffin embedded after stored in formalin solid over 24 hours, sectioned vertical to the calcification at the thickness of 5 microm, and stained with Hematoxylin and Eosin. The histological grading of the proliferating activity of it was observed under the microscope. Parameters included chronologic age, menarche status, wrist skeletal age, digital skeletal age, elbow epiphysis and Risser sign were recorded. The histological grading data were compared with these parameters in terms of their accuracy in the prediction of PHV of the scoliosis.

RESULTSThe specimens of 53 AIS patients with an average age 14.0 years were stained successfully. The proliferating activity of the iliac crest cartilage decreased when the AIS girl was over 13.0 years of chronologic age, 14.0 years of wrist skeletal age, post menarche or Risser sign was no less than grade 3.

CONCLUSIONSAll the parameters evaluated can be used to show the end of PHV. Three parameters, including 11 years old of chronologic age, 12 years of the wrist skeletal age, unfusion of the elbow epiphysis and the thelarche, can be used in predicting the beginning of PHV.

Adolescent ; Age Determination by Skeleton ; Age Factors ; Cartilage ; pathology ; Cell Proliferation ; Child ; Female ; Humans ; Ilium ; pathology ; Menarche ; Scoliosis ; pathology ; physiopathology

OBJECTIVETo analyze thoracic complications related to the convex thoracoplasty for the treatment of rib hump deformity in patients with thoracic scoliosis.

METHODSBetween December 2003 and September 2007, 548 patients with thoracic scoliosis underwent posterior spinal correction and the convex thoracoplasty. There were 167 male and 381 female, with an average age of 16.1 years (range, 12 to 38 years). The mean preoperative rib prominence was 35 degrees (range, 16 degrees to 50 degrees).

RESULTSThe mean number of resected ribs was 4.1. The mean rib prominence was 7 degrees (range 2 degrees to 17 degrees) after operation. No death happened. Thoracic complications related to the thoracoplasty consisted of respiratory insufficiency in 1 (0.2%) patient,intraoperative tear of parietal pleura in 29 (5.3%), with a subsequent pleural effusion in 6 and pneumothorax in 3. In the other patients, no obvious tear of parietal pleura was found during operation. However, 6 (1.1%) patients had pleural effusion after operati on.

CONCLUSIONThe thoracic complications related to convex thoracoplasty can be decreased by improving the surgical skill and using respiratory function monitoring.

Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Postoperative Complications ; prevention & control ; Scoliosis ; surgery ; Thoracic Vertebrae ; surgery ; Thoracoplasty ; adverse effects

OBJECTIVETo investigate the expression of Csk-binding protein (CBP) in esophageal carcinoma and its association with the tumorigenesis and progression of esophageal cancer.

METHODSRT-PCR and Western blotting were employed to determine the expressions of CBP at the mRNA and protein levels in 50 pairs of fresh esophageal carcinoma tissue and the adjacent normal tissues.

RESULTSCBP mRNA and protein expressions in normal tissues were 1.43- and 1.28-fold higher than those in the cancer tissues, respectively (P<0.05). The expressions of CBP mRNA and protein were positively correlated (P=0.015). The decreased expressions of CBP were significantly correlated to lymph node metastasis of esophageal cancer (P<0.05).

CONCLUSIONThe expression of CBP gene is decreased in esophageal carcinoma, which might contribute to the tumorigenesis and progression of this malignancy.

Adenocarcinoma ; metabolism ; pathology ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Down-Regulation ; Esophageal Neoplasms ; metabolism ; pathology ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; RNA, Messenger ; genetics ; metabolism ; src-Family Kinases ; genetics ; metabolism

OBJECTIVETo evaluate the clinical importance of titanium mesh cage (TMC) in anterior instrumentation for scoliosis.

METHODSThirty-six consecutive patients with thoracolumbar/lumbar adolescent idiopathic scoliosis were treated with anterior derotation and instrumentation using autologous bone grafting and TMC for interbody fusion. The average age of patients was 17 years (ranged from 14 to 22 years), in which 5 cases were male and 31 cases were female.

RESULTSThe coronal Cobb angle before surgery, 2 weeks after surgery, and 13 months at the follow-up was measured as 56 degrees , 15 degrees , and 18 degrees respectively, while the thoracic kyphosis from T(5) to T(12) was 30 degrees , 33 degrees , and 37 degrees respectively, and the lumbar lordosis from L(1) to S(1) was 46 degrees , 56 degrees , 51 degrees . There were no death, infection, implant failures or collapse of intervertebral space. Intraoperative injury of lacteal occurred in one patient, but no postoperative complications happened. One of two patients who had pleural effusion was managed with close drainage. Exudative pleurisy occurred in one patient, the sympathectomy effect occurred in three patients who presented asymmetry of skin temperature and resolved in short term.

CONCLUSIONSCoronal and sagittal alignment can be well corrected and maintained with TMC in anterior scoliosis surgery, collapse of intervertebral space and lumbar kyphosis can be prevented.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Orthopedic Fixation Devices ; Retrospective Studies ; Scoliosis ; surgery ; Spinal Fusion ; instrumentation ; methods ; Thoracic Vertebrae ; surgery ; Titanium

0.05) and the two methods had good correlation(r=0.822).CONCLUSIONS The method of FCST established by as in this study is simple,repeatable,with high accuracy and easy to determine MIC and has good application prospects in clinical antifungal susceptibility testing.

OBJECTIVETo investigate the role of lung resistance-related protein (LRP) in intrinsic multidrug resistance (MDR) of bladder cancer and detect the relationship of LRP expression with the clinical pathologic parameters.

METHODS66 patients were studied with newly diagnosed primary bladder cancer (T(a) = 12, T(1) = 26, T(2) = 11, T(3) = 10, T(4) = 7; G(1) = 35, G(2) = 19, G(3) = 12). No patient was treated preoperatively with either radiation or chemotherapy. Reverse transcription-polymerase chain reaction (RT-PCR) was performed for measure of mRNA expression for LRP, multidrug-resistance gene 1 (MDR1), and multidrug resist nce-associated protein 1 (MRP1). Expressions of LRP, P53 and P63 proteins were examined by immunohistochemistry staining.

RESULTSLRP mRNA had the highest expression rate (64%, 42/66) among three MDR markers in primary bladder cancers without chemotherapy and its level was significantly higher in normal bladder tissue than in TCC of bladder (t = 2.82, P < 0.01), in low grade than in high grade cancers (t = 4.14, P < 0.01), and in superficial than in invasive cancers (t = 3.58, P < 0.05). LRP mRNA expression showed no correlation with either MDR1 or MRP1, but close correlation with LRP protein level (r = 0.89, P < 0.01). LRP was associated with low-grade (r = 0.81, P < 0.01) and low-stage (r = 0.78, P < 0.05) cancers, but not with tumor suppressor P53 or P63 (P > 0.05).

CONCLUSIONSThe grade and stage-related expression pattern of LRP indicates that it may be a predictive index for intrinsic MDR in bladder cancer. Anti-cancer drugs out of the MDR spectrum of LRP may be more effective for patients with early bladder cancer.

ATP-Binding Cassette, Sub-Family B, Member 1 ; biosynthesis ; genetics ; Adult ; Aged ; Carcinoma, Transitional Cell ; genetics ; metabolism ; pathology ; Drug Resistance, Multiple ; Drug Resistance, Neoplasm ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Multidrug Resistance-Associated Proteins ; biosynthesis ; genetics ; Neoplasm Proteins ; biosynthesis ; genetics ; RNA, Messenger ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Urinary Bladder Neoplasms ; genetics ; metabolism ; pathology ; Vault Ribonucleoprotein Particles ; biosynthesis ; genetics