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 explore the correlation between Pi and Shen by observing the relationship between the metabolism of aristolochic acid (AA) and mRNA and protein expression levels of organic anion transporting polypeptide (oatp) superfamily member 2a1 and 2 b1 (oatp2al and oatp2bl) in renal, small intestinal, and large intestinal tissues of Pi deficiency syndrome (PDS) model rats.

METHODSTotally 46 Sprague-Dawley (SD) rats were randomly divided into four groups, i.e., the blank group (n = 12), the PDS group (n = 22), the AA-I group (n = 6), and the PDS AA-I group (n = 6). PDS model was established by subcutaneously injecting Reserpine at the daily dose of 5 mg/kg for 16 successive days. Carotid intubation was performed in 6 rats selected from the blank group and the PDS group. Pharmacokinetics of AA-I were detected at 5, 15, 30, 45, and 60 min after gastrogavage of AA-I. AA-I concentrations in renal, small intestinal, and large intestinal tissues of 10 rats selected from the PDS group were determined. Normal saline was administered to 6 rats selected from the PDS group and the blank group by gastrogavage. Renal, small intestinal, and large intestinal tissues were collected in the AA-I group and the PDS AA-I group at 60 min after gastrogavage of AA-I. mRNA and protein expression levels of oatp2a1 and oatp2b1 in each tissue were detected using real-time polymerase chain reaction (RT- PCR) and Western blot.

RESULTSCompared with the blank group, plasma concentrations of in vivo AA-I were obviously higher in the PDS group at 15, 30, 45, and 60 min after gastrogavage of AA-I with statistical difference (P < 0.05). Plasma concentrations of AA-I were obviously decreased at 60 min after gastrogavage of AA-I; AA-I concentrations in renal and large intestinal tissues were elevated; AA-I concentrations in small intestinal tissues were obviously reduced in the PDS group. There was no statistical difference in mRNA expression levels of oatp2a1 and oatp2b1 in the aforesaid three tissues of rats between the blank group and the PDS group. Compared with the blank group, mRNA expression levels of oatp2a1 and oatp2b1 decreased in small intestinal tissues of the AA-I group, and the mRNA expression level of oatp2a1 in large intestinal tissues significantly decreased (P < 0.05, P < 0.01). Compared with the PDS group, mRNA expression levels of oatp2a1 and oatp2b1 increased in renal tissues of the PDS AA-I group (P < 0.05); mRNA expression levels of oatp2b1 increased in large intestinal tissues of the PDS AA-I group (P < 0.05).

CONCLUSIONSThe difference in AA-I metabolism might be associated with changed expression levels of oatp2a1 and oatp2b1 in renal, small intestinal, and large intestinal tissues under Pi deficiency induced loss of transportation. Shen and Dachang played important roles in substance metabolism under Pi deficiency state, which proved Pi-Shen correlated in Chinese medical theories.

Animals ; Anions ; Aristolochic Acids ; metabolism ; Drugs, Chinese Herbal ; Kidney ; Medicine, Chinese Traditional ; Organic Cation Transport Proteins ; metabolism ; Peptides ; RNA, Messenger ; Rats ; Rats, Sprague-Dawley

Objective To evaluate the clinical features and the strategy for the diagnosis and treat- ment of bilateral testicular tumor.Methods The clinical data (including the signs and symptoms,imaging studies,tumor markers,treatment modalities and histopatbologic diagnoses) of 10 cases of bilateral testicular tumor from January 1980 to December 2004 were reviewed.Their age ranged from 19 to 58 years(mean,34 years).Of the 10 cases,8 with metachronous and 2 with synchronous testicular tumors were identified.The clinical stages at the primary and secondary tumor diagnosis were:5 cases of stageⅠ,3 of stageⅡ;and 6 cases of stageⅠ,1 of stageⅡ,and 1 of stageⅢ,respectively,in 8 metachronous tumor patients.Two syn- chronous tumor patients were both identified as stageⅠdisease.Histological examination showed the primary tumor (seminoma) in 4 cases and the secondary contralateral tumor (seminoma) in 3.Results Two syn- chronous tumor patients underwent bilateral radical orchiectomy simultaneously,and 8 underwent orchiectomy successively.Retroperitoneal lymph node dissection was performed in 3 cases.Postoperatively,hypogonadism occurred in 10 patients,and 7 of them received androgen replacement therapy.Follow-up ranged from 9 month to 23 years with a mean of 10.5 years.Two patients died of the disease;2 had metastasis (1 of them was alive with metastasis);2 had recurrences and underwent local resection.Conclusions Metachronous bilateral testicular cancers are more common than synchronous bilateral testicular cancers.Seminoma was the most common histopathologic type.Testis-sparing surgery can be performed in selected cases.

Objective To investigate the possible role of interstitial cell of Cajal (ICE)in the pathogenesis of diabetic gastroparesis and the protective effect of"Xiaopi prescription (消痞方)".Methods Fifty healthy male Spregue-Dawley (SD) rats were randomly divided into 5 groups (each n=10):normal, model,and 3 Xiaopi prescription groups:low,middle and high dosages.Diabetes was induced by intravenous injection of alloxan,and equal amount of normal saline was intravenously injected in the normal group.Gastric lavage method was used to administer the traditional Chinese medicine decoction of Xiaopi prescription in corresponding amount (5,10 and 20 g?kg~(-1)?d~(-1)) in respective low,middle and high dosage groups.In the normal control group and diabetic model group,only equal amount of normal saline was administered into the stomach.Gastric emptying rate was measured by method of nutritious semisolid paste;c-kit positive cells of ICC were quantitatively measured with immunohistochemistry assay and computer image analysis system;c-kit mRNA positive cells were quantitatively measured with in situ hybridization and computer image analysis system.Results①Gastric emptying rate:The rate was significantly lower in the model group than that in the normal control group (P0.05),but higher than those in the model group and the low dosage group (all P0.05).②c-kit immmunohistochemistry:c-kit positive cell presented yellow in color,and its membrane was stained yellow,this kind of cells primarily were distributed around the neural plexus in the inter-space between the circular and longitudinal muscular fibers, and around the ganglionic cells forming"sheath-like"structure.The results of numbers of c-kit positive cells in the various groups:the number of the cells in the model group was significantly lower than that in the normal group (P0.05),but the numbers in the former two dosage groups were obviously higher than those in the model group (all P0.05),being significantly lower than that in the normal group,middle and high dosage groups (all P0.05),but obviously higher than those in the model group (all P0.05),being significantly lower than that in the normal,middle and high dosage groups (all P

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 detect the prevalence of spinal cord abnormality in "idiopathic" left thoracic scoliosis and analyze its clinical significance.

METHODSFrom October 1997 to October 2003, 59 "idiopathic" left thoracic scoliosis were treated, including 31 males and 28 females. The age was from 7 to 44 years with an average of 15 years. The Cobb angle was from 15 degrees to 108 degrees with average 56 degrees . The holocord MRI was made for all patients.

RESULTSThirty-three patients were found cord abnormality, including 24 Chiari malformation with syringomyelia, 5 syringomyelia, 1 Chiari malformation with syringomyelia and diastematomyelia, 1 Chiari malformation with syringomyelia and tethered cord, 1 syringomyelia with tethered cord, and 1 Dandy-Walker malformation. The prevalence of spinal cord abnormality in left thoracic scoliosis was 56%. Compared to the left thoracic scoliosis without cord abnormality, the left thoracic scoliosis with cord abnormality had been found more in males and the patients with bigger Cobb angle (P < 0.05).

CONCLUSIONSFor left thoracic scoliosis, especially male patient or patient with bigger Cobb angle, associated cord abnormality should be highly suspected. Preoperative holocord MRI is very meaningful for this kind of patients.

Adolescent ; Adult ; Child ; China ; epidemiology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Prevalence ; Scoliosis ; complications ; surgery ; Spinal Cord Diseases ; diagnosis ; epidemiology ; etiology ; Thoracic Vertebrae

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

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 explore the clinical features and treatment results of brachial plexus palsy caused by halo traction before posterior correction in patients with severe scoliosis.

METHODSA total of 300 cases of severe scoliosis received halo traction before posterior correction in our department from July 1997 to November 2004. Among them, 7 cases were complicated with brachial plexus palsy. The average Cobb angle was 110 degree (range, 90 degree-135 degree). Diagnoses were made as idiopathic scoliosis in 1 case, congenital scoliosis in 3 cases, and neuromuscular scoliosis in 3 cases. Additionally, diastematomyelia and tethered cord syndrome were found in 3 cases and thoracolumbar kyphosis in 2 cases. Weight of traction was immediately reduced when the patient developed any abnormal neurological symptoms in the upper extremity, and rehabilitation training was undertaken. Simultaneously, neurotrophic pharmacotherapy was applied, and the neurological function restoration of the upper limbs and the recovery time were documented.

RESULTSTraction was used for an average of 3.5 weeks (range, 2-6 weeks) before spinal fusion for these 7 patients. The average traction weight was 8 kg, which was 19% on average (range, 13%-26%) of the average body weight (40.2 kg). These 7 patients had long and thin body configuration with a mean height of 175 cm. The duration between symptoms of brachial plexus paralysis and the diagnosis was 1-3 hours. All of these 7 patients presented various degrees of numbness in the ulnar side of the hand and forearm. Median nerve paresis was found in 3 cases and ulnar nerve paresis in 4 cases. Complete recovery of the neurological function had been achieved by the end of three months.

CONCLUSIONSThe clinical features of brachial plexus palsy caused by halo traction include median nerve paresis, ulnar nerve paralysis, and numbness in the ulnar side of the hand and forearm, which may be due to the injury of the inferior part of the brachial plexus, i.e., damage of C8 and T1 nerve roots. Complete recovery of neurological function can be expected when the patient is kept under careful observation for recognizing this complication as soon as possible, then immediately reducing or removing the traction weight, and adopting rehabilitation training and neurotrophic pharmaceutical treatment.

Adolescent ; Adult ; Brachial Plexus Neuropathies ; etiology ; therapy ; Child ; Female ; Humans ; Male ; Paralysis ; etiology ; therapy ; Prognosis ; Scoliosis ; therapy ; Traction ; adverse effects

OBJECTIVETo investigate the association of matrilin-1 gene polymorphisms with adolescent idiopathic scoliosis (AIS) risk.

METHODSThis study population consisted of 419 patients with AIS and 460 healthy controls. The maximum Cobb angle of AIS patients was recorded. For initial screening, the 7 tagSNPs were genotyped in 197 cases and 172 controls. Next, we validated any significant associations in additional sample of 222 cases and 288 controls. Single-marker and haplotype analysis were employed. Genotyping was performed by PCR-RFLP method.

RESULTSWe found that allele G of rs1149048 was a significant predisposition allele of AIS (P = 0.0027, OR = 1.34 within 95% CI = 1.11 approximately 1.62), and individuals with genotype GG had a higher risk for AIS compared to AA + AG (P = 0.0008, OR = 1.61 within 95% CI = 1.22 approximately 2.12). Polymorphism of rs1149048 was also associated with curve severity in AIS patients. And a significantly higher in maximum Cobb angle was found in patients with GG genotype (P = 0.002).

CONCLUSIONSIt is concluded that the tagSNP rs1149048 polymorphism in the MATN1 promoter region is associated with both susceptibility and disease severity in AIS.

Adolescent ; Cartilage Oligomeric Matrix Protein ; Case-Control Studies ; Child ; Extracellular Matrix Proteins ; genetics ; Female ; Follow-Up Studies ; Genetic Predisposition to Disease ; Genotype ; Glycoproteins ; genetics ; Humans ; Linkage Disequilibrium ; Male ; Matrilin Proteins ; Polymorphism, Single Nucleotide ; Scoliosis ; genetics ; Young Adult