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 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

The treatment of fracture has been greatly improved, but the incidence of nonunion is still high and which is a challenge that orthopedic clinicians. The treatment of nonunion has been the concern to the scholars. New technologys of surgical and non-surgical therapies continue to emerge, and achieve good clinical efficacy. In particular the development of non-surgical therapy has brought hope for non-invasive treatment of nonunion. This paper attempts to make a review of the status and progress of non-surgical treatment of bone nonunion which are more commonly used in clinical.
Bone Marrow Transplantation ; Bone Morphogenetic Proteins ; therapeutic use ; Fractures, Ununited ; therapy ; Genetic Therapy ; High-Energy Shock Waves ; therapeutic use ; Humans ; Transplantation, Autologous ; Ultrasonic Therapy

OBJECTIVETo compare the early clinical results of thoracoscopic and mini-open thoracotomic anterior correction for idiopathic thoracic scoliosis.

METHODSTwenty-three cases with idiopathic right thoracic scoliosis were divided into 2 groups. Group A includes 8 females with average age of 14.8 years and average Cobb angle of 54 degrees . The Risser sign was +++ approximately ++++. These patients were operated on with thoracoscopic Eclipse instrumentation. Group B covers 2 males and 13 females with average age of 13.8 years and average Cobb angle of 57 degrees . The Risser sign was ++ approximately ++++. These patients were operated on with mini-open thoracotomic anterior instrumentation. The operative time, blood loss, postoperative drainage, instrumented levels, curve correction and early loss of correction of both groups were analyzed.

RESULTSThe patients of group A had average operative time of (360 +/- 72) min, (629 +/- 145) ml of intra-operative blood loss, (7.4 +/- 1.1) of instrumented levels, (500 +/- 150) ml of post operative drainage, 74 +/- 14% of curve correction rate and (8.6 +/- 2.7)% of early loss of correction after 6 approximately 18 m follow-up. The patients of group B had average operative time of (246 +/- 64) min, (300 +/- 110) ml of intra-operative blood loss, (7.8 +/- 0.9) of instrumented levels, (210 +/- 90) ml of post operative drainage, (70 +/- 12)% of curve correction rate and (4.6 +/- 1.9)% of early loss of correction. The curve correction rates of thoracoscopic and mini-open thoracoscopic anterior correction were not significantly different (P >0.05). But the operative time, blood loss, postoperative drainage, and early loss of correction showed significant difference (P <0.05).

CONCLUSIONSThoracoscopic and mini-open thoracotomic anterior correction for idiopathic thoracic scoliosis have their own indications. Both techniques are safe and effective to correct the idiopathic thoracic scoliosis with satisfied early results. But the early loss of correction of mini-open thoracotomic anterior correction is significantly less than that of thoracoscopic anterior correction.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Scoliosis ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; surgery ; Thoracoscopy ; Thoracotomy ; methods ; Treatment Outcome

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 investigate the feasibility of construction of tissue-engineered skin in vitro.

METHODSFibroblasts were seeded on the dermal surface of acellular dermal matrix (ADM). 7 days later, epidermal cells (5 x 10(5)/cm2) were mixed with fibroblasts (0.2 x 10(5)/cm2) and then seeded on epidermal surface of ADM. The culture medium was the mixture liquor containing K-SFM in half and the culture supernatants of fibroblasts in half. In the control group, only epidermal cells (5 x 10(5)/cm2) were seeded and cultured with K-SFM. After composite skin was cultured for 1 week and 3 week, samples were harvested respectively for morphological study and to receive identification by immunohistochemistry.

RESULTSAfter 3-week culture, there were 3-4 continuous layers of cells in the epidermis in the experiment group. The epidermis was attached tightly to the dermis with trochanterellus. But in the control group, there were just 1-2 layers of cells in the epidermis which was not connected to the dermis. Strong positive dye of Laminin indicated that basement membrane was thoroughly formed in the experiment group. The same result was demonstrated by transmission electron microscope.

CONCLUSIONSThe mix-seeding of epidermal cells and few fibroblasts would promote the adhesion and proliferation of epidermal cells on ADM, and the formation of basement membrane.

Animals ; Cells, Cultured ; Coculture Techniques ; Epidermis ; cytology ; Fibroblasts ; cytology ; Skin, Artificial ; Swine ; Tissue Engineering ; Tissue Scaffolds

OBJECTIVETo study the anatomy of angular nerve (AN), so as to provide safe approach for the denervation surgery of corrugator supercilii, depressor supercilii and procerus.

METHODS10 fresh cadaver (20 sides)were perfused and fixed with formalin. Dissection was performed in the 10 x operating microscope. The plexus of the zygomatic branch and the buccal branch were detected to confirm the AN. The relationship of AN with the surrounding blood vessels was observed. We tracked AN until it entered corrugator supercilii, depressor supercilii and procerus.

RESULTS(1) AN was classified into I, II, III type according to its formation pattern. Type I (20%, 4/20 sides) AN is single, which is mainly from the plexus of buccal branch plus the zygomatic branch from the orbicularis oculi muscle. In type II (20%, 4/20 sides), the single AN was formed by buccal branch plexus and zygomatic branch plexus in the "Four Muscle Gap". In type III (60%, 12/20 sides), the AN had two branches in the "Four Muscle Gap". (2) The three types AN passed inferior to the support ligament at the suborbital part, and then transversed medial to the support ligament at the medial canthus, along the vessels of medial canthus. (3) The branch of AN enters the depressor supercilii or procerus 2.19 to 4.28 mm above the medial canthus ligament. The backward branch enters the levator labii superioris alaeque nasi 6.89 to 9.38 mm below the medial canthus ligament.

CONCLUSIONSThe approach of denervation surgery for AN should be performed medial to the support ligation, between 2.19 mm above the medial canthus and 6.89 mm below the medial canthus.

Adult ; Cadaver ; Denervation ; Facial Muscles ; innervation ; Facial Nerve ; anatomy & histology ; surgery ; Female ; Humans ; Male