Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited syndrome. It will inevitably progress to colorectal carcinoma if not handled properly. The extracolonic manifestations of FAP play important role in the clinical diagnosis and prognosis of FAP patients. This paper reviews the clinical characteristics of FAP and current progress in its research.

Objective: To discuss the clinical manifestations of familial adenomatous polyposis (FAP) and summarize our experience in diagnosing and treating the FAP patients. Methods: Clinical data of 96 FAP patients (1985-2003) were reviewed and colonoscopic findings were analyzed retrospectively. Abdominal CT findings and endoscopic findings of the upper digestive tract in 22 FAP patients (2001-2003) were analyzed retrospectively in an attempt to seek extrarectal pathological manifestations in FAP patients. Results: Densely grown polyps were found in the colorectum in most patients (52/96, 54.2%), while moderate-to-high density of polyps were found in the left hemicolon and rectum. Frequency of cancerization was high for rectal adenoma (23/41, 56.1%). Of the 22 FAP patients, 19 (19/22, 86.3%) had proliferative polyps of the gastric antrum and 18 (18/22, 81.8%) had duodenal polyps, including 12 duodenal adenomatous polyps, without a single case of cancerization. In 3 of the 22 FAP patients, desmoid tumors were detected in the abdominal wall, abdominopelvic cavity or mesentery of small intestine 5 years after colectomy. Of the 3 patients, only one was cured by complete resection of the tumor. Conclusion: Dense growth of polyps in the colorectum is a typical clinical manifestation of FAP. Frequency of cancerization is high for rectal adenoma. Colonoscopy is safe and effective for early diagnosis of FAP. Presence of polyps in the upper digestive tract is a common extrarectal manifestation of FAP. Cancerization of duodenal adenoma is rare in Chinese FAP patients. Desmoid tumor significantly influences postoperative quality of life of FAP patients who received prophylactic colectomy.

Objective: To study the diagnostic value of colonoscopy in screening of family members of a familial adenomatous polyposis (FAP) family. Methods: The colonoscopic findings of 38 sibs from 23 FAP families (1985-2002) were retrospectively studied. The diagnostic value of colonoscopy for screening FAP in FAP families was analyzed through determining the amount, morphology, and pathology of polyps. Results: Sixteen of the 38 sibs were found to have polypous growths, the positive screening rate being 42.1%; of the 16 cases of polypous growths, one was found to be severe atypical proliferation. The left hemicolon and rectum had dense polyps. Conclusion: Colonoscopy is a safe and reliable screening examination in sibs of FAP families.

Objective: To evaluate the short- and long-term outcomes of subtotal proctocolectomy for familial adenomatous polyposis (FAP). Methods: Twenty-one FAP patients who had undergone subtotal proctocolectomy during 1985-2000 in our department were followed up colonoscopically to observe whether there was any recurrence of polyps in postoperatively residual colon or/and rectum. Results: Adenomatous recurrence with variant degrees was detected in the residual colon or/and rectum in all 21 patients, the recurrence rate being 100%. Polypous growth was denser in the residual rectum than in the proximal residual colon. The adenomatous polyp in one patient cancerized 4 years after the initial operation. The cumulative occurrence of colorectal cancer was 4.8%. Conclusion: Subtotal proctocolectomy is a simple procedure for FAP with fewer complications, but there is a risk of polyps cancerization in the residual colon or/and rectum.

Coloduodenal fistula (CDF) is uncommon, and it is often secondary to other colon and duodenal diseases that are benign or malignant. The clinical manifestations of CDF are variable, and upper abdominal pain, feculent vomiting and diarrhea are the common symptoms. Digestive tract contrast radiography and enhanced CT imaging are very helpful for diagnosing CDF, and gastrointestinal endoscopy can give more information about the fistula. Procedure selection should depend on whether the primary disease is malignant and the extent of the lesion. Because the duodenum has complicated anatomic relationship with its adjacent organs including bile duct system and pancreas, procedure for this clinical entity is a challenging task. Decision-making and experienced surgical skills are critical.
Colonic Diseases ; Duodenal Diseases ; Humans ; Intestinal Fistula

Objective To study the clinical value of color Doppler ultrasonography in typing tuberculous epididymitis.Methods The appearances of color Doppler ultrasound and the findings on operation were analysed in 33 patients with tuberculous epididymitis.Results Of the 33 patients,epididymis appeared as diffusely and heterogeneously enlarged lesions with increased flow in 2 cases,appeared as nodular lesions in 13 cases including nodi with echofree space in 3 cases, nodi with high-level echo patches in 3 cases, and low echo-level nodi in 7 cases. Multiple lesions in scrotum were detected in 17 cases, of whom epididymis up to 11 cases appeared as diffusely enlarged heterogeneous lesions with flow increased.The sonographic appearancs of tuberculous epididymitis could be divided into 3 types:diffusion type, nodus type and complicated type. Nodus type included 3 subtypes: purulence type, calcification type, and cheese type.The accuracy rate of ultrsound diagnosis was 87.9%.Conclusions Testis is easy to be involved when epididymitis appears as diffusion type, so surgical treatments should be early.Purulence type and complicated type need surgical treatments while calcification type does not. Antituberculous drug treatments can be tried before surgical treatments in cheese type.Sonography of urinary system is helpful for the diagnosis of asymptomatic tuberculosis in urinary system when tuberculous epididymitis is first suspected on sonography.

OBJECTIVETo evaluate the feasibility of mandibular "V-Line" osteotomy combined with mandibular outer cortex osteotomy for correction of low angle-square jaw.

METHODSFrom Jul. 2005 to Nov. 2007, 31 patients with low angle-square jaw were corrected with mandibular "V-Line" osteotomy combined with mandibular outer cortex osteotomy. The patients were followed up for 6-24 months. Pre- and Post-operative standard images and X-ray cephalometric examination were used to assess the therapeutic effect.

RESULTSThe wounds were healed primarily in all the 31 cases with no severe complication. The lower labial numbness was happened in 13 cases, which was recovered within 4 months. All the patients achieved esthetic improvement at the frontal and lateral view. The mandibular angle and the mandibular plane angle reached 110 degrees - 120 degrees and 25 degrees - 30 degrees after operation. The distance between the angles was decreased.

CONCLUSIONSThe low angle-square jaw can be corrected satisfactorily with mandibular "V-Line" osteotomy combined with mandibular outer cortex osteotomy.

Adult ; Feasibility Studies ; Follow-Up Studies ; Humans ; Jaw Abnormalities ; surgery ; Mandible ; surgery ; Osteotomy ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the operation indication and safety of presacral tumor.

METHODSClinical data of 36 patients with presacral tumor from November 1990 to May 2006 treated in our hospital, in whom 23 patients underwent trans-sacral operation, were analyzed retrospectively.

RESULTSThe operation time was from 43 to 210 min (average 94 min). The volume of blood loss was from 30 to 2000 ml (average 350 ml). Hospital stay was from 8 to 16 days (average 10.7 days). There were 13 different pathology types of tumors in the 36 patients including 26.4% of malignancy. Complications of trans-sacral operation included 1 case of ureteral damage, 1 case of sacral wound hernia, 1 case of presacral abscess who was healed by sigmoid stoma and wound drainage.

CONCLUSIONTrans-sacral resection of low presacral tumor is safe and effective with less trauma, less bleeding and quick recovery.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pelvic Neoplasms ; surgery ; Retrospective Studies ; Sacrum ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the clinical effects of close reduction and percutaneous minimally invasive fixation in the treatment of proximal humerus fractures.

METHODSFrom April 2008 to March 2010, 28 patients with proximal humerus fracture were treated with close reduction and percutaneous minimally invasive fixation. There were 21 males and 7 females, ranging in age from 22 to 78 years,with an average of 42.6 years. The mean time from suffering injuries to the operation was 1.7 d. Nineteen cases caused by falling down, 9 cases by traffic accident. The main clinical manifestation was swelling, pain and limited mobility of shoulders. According to Neer classification, two part fractures were in 17 cases and three part fractures in 11 cases. The locking proximal humerus plate was used to minimally fixation through deltoid muscle under acromion. The operating time,volume of blood loss, the length of incision and Constant-Murley assessment were applied to evaluate the therapeutic effects.

RESULTSThe mean operating time was 40 min, the mean blood loss was 110 ml, and the mean length of incision was about 5.6 cm. The postoperative X-ray showed excellent reduction and the plate and screws were successfully place. Twenty-eight patients were followed up for 6 to 24 months (averaged 14.2 months). The healing time ranged from 6 to 8 weeks and all incision was primarily healed. There were no cases with necrosis head humerus, 24 cases without omalgia, and 4 cases with o-malgia occasionally. All the patients can complete the daily life. The mean score of Constant-Murley assessment was 91.0 +/- 5.8, 24 cases got an excellent result, 3 good and 1 fair.

CONCLUSIONClose reduction and percutaneous minimally invasive fixation, not only can reduce surgical invasive, but also guarantee the early function activities. It has the advantages of less invasive, fixed well and less damage of blood circulation.

Adult ; Aged ; Female ; Fracture Healing ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Shoulder Fractures ; physiopathology ; surgery

OBJECTIVETo discuss the correlation between sonographic appearance of different degrees of acute unilateral testicular ischemia and histological changes of the testis after reperfusion.

METHODSThirty-two male rabbits were equally divided into a control (sham operation) group and 3 ischemia groups. Unilateral testicular ischemia models were established under the color Doppler ultrasound (CDU) observation and allocated according to different degrees of ischemia to Group A (with homogeneous echoes and slightly decreased flow signals), B (with heterogeneous echoes and obviously decreased flow signals) and C (with radial or small-shredded low echoes and absence of flow signals). Then contrast-enhanced ultrasonography (CEUS) was performed, followed by reperfusion of the ischemic testes. A month later, the histological changes of the testes were observed and the correlation of the histological changes with the sonographic and CEUS manifestations was analyzed.

RESULTSConcerning the CEUS parameters such as the arrival time (AT), reperfusion rate, time-to-peak (TTP), half descent time (DT/2) of the ischemic testes, Groups A and B showed significant differences from the control group (P < 0.05). The peak-base difference (PBD) was significant in Group B (P < 0.05) but not in A (P > 0.05), and no enhancement was seen in Group C. As for Johnson's scores obtained 1 month later, Group A exhibited no significant difference (8.70 +/- 0.39) (P > 0.05), Group B showed significant difference (6.01 +/- 0.88) (P < 0.05), and Group C extremely significant difference (3.16 +/- 1.05) (P< 0.001) from the control group (9.10 +/- 0.11).

CONCLUSIONCEUS is superior to CDU in evaluating the perfusion of testicular ischemia. Sonographic appearances of testicular ischemia are significantly correlated with histological changes of the testis after reperfusion. Ultrasonography helps to predict the spermatogenetic function of ischemic testes after reperfusion.

Animals ; Disease Models, Animal ; Ischemia ; diagnostic imaging ; pathology ; Ischemic Preconditioning ; Male ; Rabbits ; Reperfusion Injury ; diagnostic imaging ; pathology ; Testicular Diseases ; diagnostic imaging ; pathology ; Testis ; diagnostic imaging ; pathology ; Ultrasonography, Doppler, Color