OBJECTIVETo explore the value of employing the small intestinal feeding tube in treating high position intestinal obstruction of newborn infant.

METHODFive newborn infants (3 males and 2 females; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum, 1 had annular pancreas, and 2 had proximal small intestine atresia; 1 infant had malrotation). The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed, which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery, the anesthetist inserted via nose a 6Fr small intestinal ED tube, made by CREATE MEDIC CO LTD of Japan[

REGISTRATION NUMBERthe State Food and Drug Administration-instrument (Im.) 2007-NO.2661620]. Twenty-four hours after surgery, abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later, formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feeding tube. The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation, the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion. Ten to 22 days after operation, the tube was removed and the infant patients were discharged.

RESULTAll the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal. At the very beginning, the tube was occasionally blocked by milk vale in one infant and after 0.9% sodium chloride solution flushing patency restored. After that, the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper gastrointestine did not show anastomomotic stricture or fistula, or intestinal obstruction. After pulling out the tube, the symptoms disappeared and then the patient was discharged. One child was found to have diarrhea with no lactose nutrition liquid and given compound lactic bacteria preparations for oral administration, the symptom disappeared. In the 5 cases, the shortest hospital stay was 10 days and the longest was 22 days, the average stay was 16 days. Three to 5 days after operation the weight restored to birth weight, the weight had increased, when discharged, to an average of 5.5 g (kg·d).

CONCLUSIONThe small intestinal feeding tube was very effective for the postoperative nutrition maintenance of high position intestinal obstruction in newborn infants.

Anastomosis, Surgical ; Enteral Nutrition ; instrumentation ; methods ; Female ; Humans ; Infant, Newborn ; Intestinal Atresia ; surgery ; Intestinal Obstruction ; surgery ; Intestine, Small ; abnormalities ; surgery ; Intubation, Gastrointestinal ; instrumentation ; methods ; Length of Stay ; Male ; Nose ; Postoperative Care ; methods ; Retrospective Studies ; Time Factors ; Weight Gain

OBJECTIVEThe aim of work was to evaluate the efficacy of microvascular decompression (MVD) in patients with trigeminal neuralgia (TN) associated with hypertension.

METHODSFive hundred and thirty-eight cases of TN associated with hypertension treated with MVD were retrospectively analyzed, all the cases were treated with MVD in the zone of the ventrolateral medulla oblongata and inspected postoperative blood pressure.

RESULTSAmong 538 cases, 341 cases (63.4%) had cure result, 71 cases (13.2%) had obvious effectiveness, 53 cases (9.8%) had effectiveness, and 73 cases had no effectiveness. Four hundred and eighty-three cases have been followed 1.0 approximately 15.8 years, mean 6.3 years. At the time of their follow-up, 313 cases had cure result, 63 cases had obvious effectiveness, 42 cases had effectiveness and 65 cases had no effectiveness.

CONCLUSIONSIt was pathogenesis of nedulla oblongata by abnormal vascular tab, long-term aching stimulation and emotional stress. It was an effective method to treat TN associated with hypertension with MVD in this zone.

Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical ; methods ; Female ; Humans ; Hypertension ; complications ; Male ; Medulla Oblongata ; pathology ; Microsurgery ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Trigeminal Neuralgia ; complications ; surgery ; Vascular Surgical Procedures ; methods

OBJECTIVETo analyze the early clinical and radiographic outcomes of Hoffa fractures treated by a standard protocol of open reduction and internal fixation using headless compression screws combined with back buttress plate in a consecutive series of 8 Chinese patients.

METHODSOpen reduction and internal fixation was performed on all patients. The fractures were anatomically reduced and held temporarily by K-wire. If the ends of fractures were atrophic, autologous bone graft from the ipsilateral iliac crest was packed between the ends. Then the fracture fragments were fixed with AO 6.5 mm headless compression cannulated screws. At least two screws were used to provide rotational stability. One pre-contoured reconstruction plate was placed on the nonarticular surface posteromedially or posterolaterally as back buttress plate.

RESULTSAll the patients were followed up for at least 12 months (range 12-25 months). All fractures achieved anatomical reduction and healed clinically and radiographically. At recent follow-up, the mean flexion degree was 120.6° (range 110°-135°) and the mean extension degree was 2.5° (range 0°-5°). The average visual analogue scale score was 1.6 points (range 0-3). Six patients were assessed as excellent and 2 as good according to the hospital for special surgery knee score system. There were no superficial or deep infections, or hardware breakages. No patient had giving way or locking of the knee, though some had intermittent pain and swelling after strenuous exercise. Injury mechanism had significant influence on the functional outcome (P=0.046).

CONCLUSIONHeadless compression screws combined with back buttress plate and/or autologous bone grafting to treat old Hoffa fracture is one of effective measures. It would be conducive to not only fracture healing but also early exercise and functional recovery.

Adult ; Bone Plates ; Bone Screws ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged

OBJECTIVETo evaluate the clinical effects of microvascular decompression in treating trigeminal neuralgia.

METHODSSurgical experience and operative findings of 2643 cases of trigeminal neuralgia treated by microvascular decompression were analyzed retrospectively.

RESULTSTwo thousand four hundred and eighty-seven of 2643 cases were cured, 76 cases were ineffectiveness, 48 cases were effectiveness and 31 were ineffective. One patient died. Two thousand one hundred and thirty-six cases were followed up in 3-240 months, 1918 cases were cured, 85 cases were obviously effective, 39 cases were effective and 30 were ineffective. Sixty-four cases were pain relapsed and 37 cases were cured by second operation among them.

CONCLUSIONThe etiology of trigeminal neuralgia is that the unusual vascular oppress the root entry zone, and arachnoid membrane circling the nerve is thickened and sticked. To untie the arachnoid membrane and decompress the offending vascular is the effective methods in treating trigeminal neuralgia.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Treatment Outcome ; Trigeminal Neuralgia ; etiology ; surgery ; Vascular Surgical Procedures ; methods

Adult ; Aged ; Female ; Humans ; Joint Instability ; complications ; diagnosis ; physiopathology ; surgery ; Lumbar Vertebrae ; pathology ; physiopathology ; Male ; Middle Aged ; Spinal Canal ; pathology ; physiopathology ; Spinal Stenosis ; complications ; diagnosis ; physiopathology ; surgery

BACKGROUNDOccluders licensed for clinical use are not fit for some special Krichenko E patent ductus arterioses. The Amplatzer vascular plug I (AVP1) has not been licensed for use for closure of patent ductus arteriose. We report our initial experience to occluding special type patent ductus arterioses with the AVP1-a single lobe device of single layer Nitinol mesh for short vessel landing zones.

METHODSPatients referred with small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter underwent occlusion using AVP1. All cases underwent pre-, intra- and post-procedural echocardiography and chest X-ray at the completion of the procedure, the next day and at a 30-day, 3-month and 6-month follow-up visits. Device sizing for device waist diameter and length was based on aortography.

RESULTSFrom April 2008 to June 2012, 26 patients with a mean age of (7.6 ± 8.0) years (range 6 months-32 years) and a mean weight of (23.8 ± 14.8) kg (range 7-67 kg) underwent successful patent ductus arteriose closure. The mean ductus diameter was (2.1 ± 0.7) mm (range 1-3 mm). Transpulmonary (22/26) and transaortic approaches (4/26) were used. No persistent patency was observed after 24 hours and after one month. No device displacement, residual flow and iatrogenic coarctation of the aorta were observed after three months and six months.

CONCLUSIONSThe AVP1 makes it easy to close some Krichenko E patent ductus arterioses. Smaller delivery catheter profile and symmetric cylindrical device shape allow for use for small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter and small patients through transaortic approaches. Broader experience is required to further delineate device and patient selection as well as to document its long-term efficacy and safety.

Adolescent ; Adult ; Child ; Child, Preschool ; Ductus Arteriosus, Patent ; surgery ; Female ; Humans ; Infant ; Male ; Septal Occluder Device ; Young Adult

BACKGROUNDImaging-guided thermal ablation using different energy sources continues to gain favor as a minimally invasive technique for the treatment of primary and metastatic hepatic malignant tumors. This study aimed to evaluate the performance of microwave ablation with 2450-MHz internally cooled-shaft antenna in ex vivo and in vivo porcine livers.

METHODSAll studies were animal care and ethics committee approved. Microwave ablation was performed using a noncooled or cooled-shaft antenna in 23 ex vivo (92 ablations) and eight in vivo (36 ablations) porcine livers. Diameters of the coagulation zone were observed on gross specimens. The coagulation diameters achieved in different microwave ablation parameter groups were compared. Curve estimation analysis was performed to characterize the relationship between applied power and treatment duration and coagulation diameter (including short-axis and long-axis diameter).

RESULTSCoagulation zones were elliptical and an arrowed-shaped carbonization zone around the shaft was observed in all groups. But the antenna track was also coagulated in the noncooled-shaft antenna groups. In ex vivo livers, the short-axis diameter correlated with the power output in a quadratic curve fashion (R(2) = 0.95) by fixing ablation duration to 10 minutes, and correlated with the ablation duration in a logarithmic curve fashion (R(2) = 0.98) by fixing power output to 80 W. The short-axis reached a relative plateau within 25 minutes. In in vivo livers, short-axis diameter correlated with the coagulation duration in a sigmoidal curve fashion (60 W group R(2) = 0.76, 80 W group R(2) = 0.87), with a relative plateau achieved within 10 minutes for power settings of 60 W and 80 W.

CONCLUSIONSThe internally cooled microwave antenna may be advantageous to minimize collateral damage. The short-axis diameter enlargement has a plateau by fixing power output.

Animals ; Catheter Ablation ; Liver ; surgery ; Microwaves ; Swine

OBJECTIVETo obtain specific anti-epidermal growth factor receptor variant III (EGFRvIII) single chain antibody (ScFv) by phage antibody library display system.

METHODSThe total RNA was extracted from the spleen B cells of BALB/c mice immunized with pep-3-OVA protein, and the first-strand cDNA was synthesized by reverse transcription. Antibody VH and VL gene fragments were amplified and joined to a ScFv gene with the linker. The ScFv gene was ligated into the phagemid vector pCANTAB5E, which was transformed into competent E. coli TG1. The transformed cells were then infected with M13KO7 helper phage to yield the recombinant phage to construct the phage ScFv library. Pep-3-BSA protein was used to screen the phage antibody library and ELISA carried out to characterize the activity of the antibody.

RESULTSThe VH and VL gene fragments of the antibody were about 350 bp and 320 bp in length as analyzed by agarose gel electrophoresis. The ScFv gene was 780 bp, consistent with the expected length. The recombinant phagemid with ScFv gene insert was rescued, and an immune phage ScFv library with the content of 5.0x10(6) was constructed. The recombinant ScFv phage had a titer of 3.0x10(4) cfu/ml, and the fourth phage harvest yielded 56 times as much as that of the first one. SDS-PAGE demonstrated a molecular mass of the soluble ScFv of about 28 kD. ELISA results indicated good specificity of the ScFv to bind EGFRvIII.

CONCLUSIONAn immune phage ScFv library is successfully constructed, and the ScFv antibody fragment is capable of specific binding to EGFRvIII.

Amino Acid Sequence ; Animals ; Antibody Specificity ; Base Sequence ; Immunoglobulin Fragments ; genetics ; immunology ; Immunoglobulin Heavy Chains ; genetics ; Immunoglobulin Light Chains ; genetics ; Mice ; Mice, Inbred BALB C ; Molecular Sequence Data ; Mutant Proteins ; genetics ; immunology ; Peptide Library ; Receptor, Epidermal Growth Factor ; genetics ; immunology ; Single-Chain Antibodies ; genetics ; immunology

OBJECTIVETo retrospectively analyse the clinical outcome of emergency treatment of senile intertrochanteric fractures with proximal femoral nail antirotation (PFNA).

METHODSFrom September 2008 to March 2009, 35 senile patients with intertrochanteric fracture, aged from 65 to 92 years with an average age of 76.5 years, were treated with PFNA within 24 hours after injury. There were 10 type I fractures, 19 type II and 6 type III according to upgraded Evans-Jensen classification system. All patients were complicated with osteoporosis, and 19 patients had preexisting internal medical diseases. According to the rating scale of disease severity by the American Society of Anesthesiologists (ASA), there were 9 grade I, 14 grade II, 8 grade III, and 4 grade IV.

RESULTSThe duration for operation ranged from 45 to 73 minutes with an average of 57.6 minutes. The volume of blood loss during operation ranged from 50 to 120 ml with an average of 77.5 ml. Patients could ambulate 2-4 days after operation (mean 3.5 days). Hospital stay was 4-7 days (mean 5.3 days). Full weight bearing time was 10-14 weeks (mean 12.8 weeks). During hospitalization period, there was no regional or deep infection, hypostatic pneumonia, urinary tract infection and bedsore except for 2 cases of urine retention. All cases were followed up with an average period of 12.3 months, and bone healing achieved within 15-18 weeks (mean 16.6 weeks). No complications such as delayed union, coxa vara or coxa valga, screw breakage or backout occurred and only 2 cases had trochanter bursitis because of thin body and overlong end of the antirotated nail. According to the Harris grading scale, the results were defined as excellent in 21 cases, good in 9 cases and fair in 5 cases, with the excellent and good rates of 85.7%.

CONCLUSIONThe emergency treatment of senile intertrochanteric fracture with proximal femoral nail antirotation has the advantages of minimal invasion, easy manipulation, less blood loss, shorter length of stay, less complications, and the preliminary clinical effect is satisfactory.

Aged ; Aged, 80 and over ; Alzheimer Disease ; complications ; Bone Nails ; Emergency Treatment ; Female ; Fracture Fixation, Internal ; methods ; Hip Fractures ; complications ; surgery ; Humans ; Length of Stay ; Male ; Postoperative Complications

OBJECTIVETo explore the expression of transforming growth factor beta1 (TGFbeta1) and its type I receptors activin-like kinase 1 (ALK1) and ALK5 mRNA in the development of brain arteriovenous malformation (BAVM).

METHODSThe mRNA expressions of TGFbeta1, ALK1and ALK5 were detected with semiquantitative RT-PCR in patients with BAVM.

RESULTSThe expressions of TGFbeta1 and ALK5 mRNA increased significantly in BAVM, and their relative expression quantity were 0.777-/+0.047 and 0.585-/+0.074, respectively. However, ALK1 mRNA expression declined significantlies with a relative expression of 0.173-/+0.044 in comparison with the control group (0.720-/+0.098, P<0.01).

CONCLUSIONThe balance of TGFbeta1 and its type I receptors ALK1 and ALK5 mRNA expressions may play important role in the development of BAVM.

Activin Receptors, Type II ; genetics ; Adolescent ; Adult ; Brain ; metabolism ; pathology ; Female ; Gene Expression ; Humans ; Intracranial Arteriovenous Malformations ; genetics ; Male ; Middle Aged ; Protein-Serine-Threonine Kinases ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Receptors, Transforming Growth Factor beta ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Transforming Growth Factor beta1 ; genetics