OBJECTIVETo evaluate the feasibility and safety of CO2 laser supraglottoplasty for severe laryngomalacia in infants.

METHODSFrom January 2009 to December 2011, 32 infants with severe laryngomalacia were confirmed by electronic laryngoscope and clinical assessment in Shenzhen Children's Hospital. According to the choice made by the parents, 16 children accepted CO2 laser supraglottoplasty (group 1), the others were treated conservatively (group 2). The beginning observation point T0 was defined as the age on the first medicine taking day or the age of surgery. T1, T3, T6 were defined as 1, 3, 6 months following T0. Clinical symptoms included stridor, dyspnea, aspiration, and respiratory infections. The body weight, PSG reports, laryngoscope findings, cure rates of the two groups were compared.

RESULTSThe anatomical abnormalities were corrected surgically, and the symptoms ,such as stridor, dyspnea, and aspiration improved rapidly after the operation. The cure rates was higher in group 1 than in group 2 on T1, T3, T6 stage. There were statistically significant differences(χ(2) were 13.9, 28.1, 24.6 respectively; all P < 0.01). Children in group 1 gained weight better than in group 2. There was a statistically significant difference in Z scores median on T1, T3, T6 stage (z score were -0.848, -2.940, -4.110; P < 0.05, or P < 0.01 respectively). The lowest oxygen saturation in group 1 improved one month after the surgery (from average 0.686 ± 0.106 to 0.901 ± 0.041). There was a statistically significant difference (t = -7.876, P = 0.001). Complications included adhesion (1 case) and temporary new-onset aspiration (1 case).

CONCLUSIONSThe CO2 laser supraglottoplasty can resolve severe laryngomalacia symptoms including stridor, dyspnea and aspiration. It can reduce the frequency of respiratory infections, and contribute to weight gaining. The CO2 laser supraglottoplasty is effective, of high security and with rare complications.

Carbon Dioxide ; Glottis ; Humans ; Infant ; Infant, Newborn ; Laryngomalacia ; radiotherapy ; Laryngoscopes ; Lasers, Gas ; therapeutic use ; Low-Level Light Therapy ; Retrospective Studies

OBJECTIVETo evaluate the incidence of postoperative hemorrhage in children undergoing adenoidectomy, and to discuss its possible causes.

METHODSIncluded in this study were children who underwent adenoid and/or tonsil surgery at Shenzhen Children's Hospital between January 2004 and November 2009. The change of hemoglobin (Hb) and hematocrit (Hct) were retrospectively analysed. The blood loss was estimated by the change of Hct.

RESULTSThere were 2078 cases that accomplished the inclusion criteria in the period of study. Ten children bled 0.5 - 4.0 hours after surgery, without superfluous hemorrhage during the operation and post-tonsillectomy. This represented an incidence of 0.48%of immediate postoperative haemorrhage among the 2078 procedures analyzed. Statistical differences were found between boys (0.21%) and girls (1.10%, χ² = 5.597, P < 0.05). The change of Hb and Hct was positively correlated (r = 0.95, P < 0.01), the blood loss was positively correlated with the bleeding time (r = 0.66, P < 0.05). The causes of postoperative hemorrhage were coagulation system deficits, chronic nasopharyngitis, deficient hemostasis and immoderate ravage. To control the postoperative hemorrhage, 2 postnasal packing under topical anaesthesia and 8 electrocautery under general anaesthesia were applied.

CONCLUSIONSPoor operative technique and deficient hemostasis are the major causes of primary hemorrhage. Prompt operation to control the postoperative bleeding should be done 2 hours after bleeding under general anesthesia in order to avoid severe complications.

Adenoidectomy ; adverse effects ; Adolescent ; Child ; Child, Preschool ; Female ; Hematocrit ; Hemoglobins ; analysis ; Humans ; Infant ; Male ; Postoperative Hemorrhage ; etiology ; Retrospective Studies ; Tonsillectomy ; adverse effects

OBJECTIVETo explore the function and motor pathway of remained cerebral hemisphere by studying motor evoked potential of both upper extremities on patients long term after anatomical hemispherectomy.

METHODSFive patients after anatomical hemispherectomy, who were marked 5 dispersive sites on head to perform transcranial magnetic stimulation. Recording motor evoked potential of target muscles (brachioradialis muscle and abductor pollicis brevis) of both upper extremities respectively when muscle resting and contracting.

RESULTSOnly affected abductor pollicis brevis of case 2 and only affected brachioradialis muscle of case 4 and 5 recorded motor evoked potential when muscle resting. Motor evoked potential of some cases can be recorded simultaneously in homonymous muscles of both sides when muscle resting or contracting.

CONCLUSIONSThere exists motor cortex that controls movement of ipsilateral limbs and also ipsilateral motor pathway of corticospinal connection at patients after anatomical hemispherectomy. It also means that the motor function of affected limbs has potency to recover well after hemispherectomy. The mirror movement after hemispherectomy is possible relate to overlap of both limbs' motor cortex.

Adult ; Evoked Potentials, Motor ; physiology ; Female ; Follow-Up Studies ; Hemispherectomy ; Humans ; Male ; Motor Cortex ; physiopathology ; Postoperative Period ; Transcranial Magnetic Stimulation ; Upper Extremity ; physiopathology

OBJECTIVETo study further the most important and frequent genetic alterations of p53 and epidermal growth factor receptor (EGFR) in astrocytic gliomas.

METHODS(1) EGFR expression was examined in samples collected from 37 astrocytic gliomas and 6 normal brain tissue using reverse transcriptase polymerase chain reaction and immunohistochemical staining. (2) p53 gene mutation and accumulation were detected simultaneously in the same specimens using PCR-SSCP, DNA sequencing and immunohistochemical staining.

RESULTSThe frequency of p53 mutation in diffuse astrocytomas, anaplastic astrocytomas, primary glioblastomas and secondary glioblastomas was 1/10, 4/19 (21.1%), 4/6 and 2/2, respectively and the frequency of EGFR overexpression was 5/10, 10/19 (52.6%), 5/6 and 2/2, respectively. Both p53 accumulation and EGFR overexpression increased accompanied by a successive increase of degree of the glioma malignancy.

CONCLUSIONSEGFR overexpression is not infrequently seen, however, p53 mutation is rarely seen in the low grade gliomas. Both p53 gene mutation and EGFR overexpression are often associated with primary and secondary glioblastoma. Consequently, EGFR overexpression and p53 gene mutation are not mutually exclusive in astrocytic gliomagenesis but synergistically to promote the glioma progression.

Adult ; Aged ; Astrocytoma ; genetics ; metabolism ; pathology ; Base Sequence ; Brain Neoplasms ; genetics ; metabolism ; pathology ; DNA Mutational Analysis ; Female ; Gene Expression Regulation, Neoplastic ; Glioblastoma ; genetics ; metabolism ; pathology ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Molecular Sequence Data ; Mutation ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational ; RNA, Messenger ; biosynthesis ; genetics ; Receptor, Epidermal Growth Factor ; biosynthesis ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Tumor Suppressor Protein p53 ; biosynthesis ; genetics

OBJECTIVETo develop a real-time fluorescent PCR protocol suitable for the routine screening of AZFc/DAZ microdeletions on the Y chromosome in azoospermic and oligozoospermic male infertility patients.

METHODSA set of real-time fluorescent PCR was established. Eighty-seven azoospermic and ligozoospermic patients undergoing ICSI in the IVF center and 30 azoospermic men undergoing testicular biopsy in the clinic of urology surgery were screened for AZFc/DAZ microdeletions of Y chromosome.

RESULTSEleven cases (9.4%) of AZFc/DAZ microdeletions were found in 117 cases of azoospermic and oligozoospermic patients by screening of realtime fluorescent PCR. Four cases (6.6%) were found in 61 oligozoospermic patients, and 7 cases (12.5%) were found in 56 azoospermic patients.

CONCLUSIONThe real-time fluorescent PCR protocol presented in this study is an easy and reliable method for detection of AZFc/DAZ microdeletions on the Y chromosome, which yields identical results to those of the multiplex PCR.

Chromosome Deletion ; Chromosomes, Human, Y ; Deleted in Azoospermia 1 Protein ; Fluorescence ; Humans ; Infertility, Male ; genetics ; Male ; Polymerase Chain Reaction ; methods ; RNA-Binding Proteins ; genetics

BACKGROUND: Amniotic membrane has a unique structure that can block the penetration of certain substances, to ensure normal nutrition supply for the surrounded tissues, and is also characterized by anti-adhesion, good tissue compatibility, mild inflammatory reaction, few fibers and biodegradability. OBJECTIVE: To compare the effects of fresh amniotic membrane and acellular amniotic membrane to prevent adhesion and promote tendon healing during the repair of tendon sheath defects. METHODS: Sixty healthy male leghorn chickens were selected, and the model of tendon injury and tendon sheath defects was established at the third toes. The animal models were then randomly divided into three groups and underwent repair with fresh amniotic membrane (group A), acellular amniotic membrane (group B), and no treatment in control group (group C), respectively. Histological observation and biomechanical analysis of the third toes were performed after repair. RESULTS AND CONCLUSION: (1) Histological observation. Congestive edema and inflammatory response were found in all animals at 2 weeks after repair, but mildest in the group A and severest in the group C. These inflammatory responses gradually alleviated over time in the three groups. At 12 weeks after repair, the new tendon sheath formed in all the animals, which was more mature than that at 4 weeks after repair. The synovial cells on the surface of the tendon sheath were arrayed tidily with dense structure in the groups A and B, but in the group C, the synovial cells were distributed disorderly with loose structure and prominent fibrous tissues. (2) Biomechanical analysis. Tendon sliding distance in the groups A and B was significantly larger than that in the group C at 4, 8, 12 weeks after repair (P < 0.05), but there were no significant difference in the distance between the groups A and B (P > 0.05). At 4 and 8 weeks after repair, the maximum tensile strength was largest in the group A, sequentially followed by group B and group C (P < 0.05), but there were no significant difference among the three groups at 12 weeks after repair (P > 0.05). To conclude, both fresh amniotic membrane and acellular amniotic membrane can promote tendon healing and prevent the adhesion of tendon through tendon sheath reconstruction, but the fresh amniotic membrane is preferred to promote early tendon healing compared with acellular amniotic membrane.

OBJECTIVETo develop a multiplex PCR protocol, which could be suitable for routine screening of microdeletions on the Y chromosome in azoospermic and oligozoospermic male infertility patients.

METHODSFive multiplex sets were established. Eighty-seven azoospermic and oligozoospermic patients undergoing intracytoplasmic sperm injection (ICSI) in the in vitro fertilization (IVF) center and 30 azoospermic men undergoing testicular biopsy in the clinic of Urology Surgery were screened for microdeletions of Y chromosome.

RESULTSA total of 19 (16.2%) cases of microdeletions were found in 117 azoospermic and oligozoospermic patients by screening of Y chromosome microdeletions. Of these, 11 cases (18.0%) were found in 61 oligozoospermic patients, and 8 cases (14.3%) were found in 56 azoospermic patients.

CONCLUSIONThe multiplex PCR protocol presented in this study is an easy-to-do and reliable method for detecting microdeletions on the Y chromosome. Routine screening of microdeletions on the Y chromosome for azoospermic and oligozoospermic patients is essential.

Chromosome Deletion ; Chromosomes, Human, Y ; genetics ; Female ; Genetic Testing ; methods ; Humans ; Infertility, Male ; diagnosis ; genetics ; Male ; Polymerase Chain Reaction

OBJECTIVE: To explore the laparoscopic partial gastrectomy and the indications. METHODS: Eighteen patients who underwent laparoscopic partial gastrectomy from August 2005 to May 2006 were analyzed retrospectively. RESULTS: Sixteen patients (including 6 with gastric cancer, 9 with duodenal ulcer, and 1 with gastric multiple polyps) underwent laparoscopic partial gastrectomy. The other two patients underwent an open surgical procedure (1 patient with the tumor size large than 6 cm, and the other patient with bleeding after loosening one clip). The rate of intraoperative subcutaneous emphysema was 5.88% (1/17), and no death occurred. The operation time was (285+/-30)min on average, the estimated blood loss was (130+/-50)mL, and the hospitalization was (11+/-4)d. One case of obstruction of distal loop happened after the surgery, and the rate was 6.25% (1/16). The patients were followed up for 1 approximately 9 months postoperatively. Trocar puncture-site metastases occurred in one patient. CONCLUSION Laparoscopic partial gastrectomy is safe and feasible with skillful laparoscopic technique and with restricted indications, and the surgical outcome may be similar to that of the open surgery.
Adult ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Stomach Diseases ; surgery

OBJECTIVESTo evaluate therapeutic effects of hepatic resection in liver metastasis of colorectal cancer (LMCC).

METHODSThe clinical data of 133 cases of LMCC received hepatic resection from January 1, 2000 to December 31, 2005 in Zhongshan Hospital were analyzed retrospectively. The relationship between hepatic resection and survival rate was also concerned.

RESULTSOne hundred and thirty-three cases received curative hepatic resection in all 470 LMCC cases, of which 30 cases from synchronous liver metastasis (SLM) group (totaled 196 cases) and 103 cases from metachronous liver metastasis (MLM) group (totaled 274 cases). Mortality rate during operation was 3.3% in SLM and 1.9% in MLM (P < 0.05). All patients were followed-up till June 31, 2006, the 1, 3, 5 year survival rates and median survival time of SLM were similar to those of MLM, but its recurrence rate was higher (36.7% vs 20.4%, P = 0.030). The 1, 3, 5 year survival rate in the 49 patients who were operable but received non-operation treatment were significantly lower than those in operated patients (P = 0.003). In 30 SLM cases, 22 received I stage resection of their primary and liver metastasis tumor and 8 received liver metastasis resection after the primary surgery (II stage operation), 1, 2, 3 year survival and the median survival time were similar in the two groups. With COX multivariate analysis, incision margin > or = 1 cm (P = 0.036) and reoperation after recurrence (P = 0.041) were protective survival factors, and post-operation recurrence (P = 0.023) was survival risk factor.

CONCLUSIONSCurative hepatic resection is the first choice of therapy in liver metastasis of colorectal cancer and it can improve survival.

Colorectal Neoplasms ; pathology ; surgery ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; secondary ; surgery ; Neoplasm Recurrence, Local ; Survival Analysis ; Treatment Outcome

BACKGROUNDRecently there has been a great deal of interest in the role of serum uric acid (SUA) in atrial fibrillation (AF). The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation.

METHODSThree hundred and thirty patients diagnosed with paroxysmal AF were analyzed. Patients were categorized into quartiles on the basis of their pre-operative SUA measurement and follow-up, and Kaplan-Meier estimation with a Log-rank test was used for the analysis of the influence of SUA on the recurrence of AF. Pre-procedural clinical variables were correlated with the clinical outcome after ablation using multivariate Logistic analysis. A Cox proportional hazards model was used to estimate the relationship between SUA and the recurrence of AF.

RESULTSAfter a mean follow-up of (9.341 ± 3.667) (range 3.0 - 16.3) months, recurrence rates from the lowest SUA quartile to the highest SUA quartile were 16.0%, 26.4%, 28.3%, and 29.3% respectively (P = 0.014). After adjustment for gender, body mass index (BMI), hypertension, serum levels of high sensitivity C-reactive protein (hsCRP), triglyceride (TG), left atrial diameter (LA), estimated glomerular filtration rate (eGFR), and SUA, there was an increased risk of recurrence in subjects in the highest SUA quartile compared with those in the lowest quartile (hazard ratio 2.804, 95% confidence interval 1.466 - 5.362, P = 0.002). Following multivariate Logistical analysis, SUA was found to be an independent predictor of recurrence (hazard ratio 1.613, 95% confidence interval 1.601 - 1.625, P = 0.014).

CONCLUSIONIn a retrospective study of patients with paroxysmal AF undergoing catheter ablation, elevated preoperative SUA levels were associated with a higher rate of recurrence of AF.

Aged ; Atrial Fibrillation ; blood ; surgery ; Catheter Ablation ; Electrophysiology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Uric Acid ; blood