OBJECTIVETo assess the early efficacy of metallic modular radial head prostheses in patients with Mason III and IV unreconstructable radial head fractures.

METHODSThe medical records of 16 patients (9 males, 7 females) with a mean age of 43 years old (31 to 57) with Mason III/IV unreconstructable radial head fractures requiring metallic modular radial head replacement between January 2009 and March 2012, were reviewed retrospectively. The functional results were assessed by range-of-movement, Mayo elbow performance score (MEPS). All patients underwent radiographic evaluation for radial head height and radiolucent lines.

RESULTSFourteen patients were evaluated with follow-up for 12 to 33 months with an average of 23 months. Range of movement parameters was significantly lower in the affected elbow than in the unaffected side (P < 0.01). MEPS results were excellent in 9 cases, good in 2 cases, fair in 2 cases, and poor in 1 case. According to Grewal grading, there were 4 cases of periprosthetic lucencies of the radius and 1 case had significant clinical signs of loosening.

CONCLUSIONRadial head replacement with the metallic modular prostheses yields satisfactory results regarding range of motion and function of the elbow joint in short term. The evolution of this prostheses needs to be evaluated with further studies to assess mid-term and long-term follow-up results.

Adult ; Arthroplasty, Replacement, Elbow ; methods ; Female ; Fracture Fixation ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Radius ; surgery ; Radius Fractures ; physiopathology ; surgery ; Retrospective Studies

OBJECTIVETo explore possible alterations in velopharyngeal function after maxillary advancement.

METHODSTen patients (3 secondary deformity of cleft palate, 7 maxillary retrusion) had maxillary advancement surgery. Pre- and post-operative examinations consisted of lateral cephalometric radiography, nasopharyngoscopy and speech recording.

RESULTSThere was no significant changes on speech or velopharyngeal competence after maxillary advancement. Cleft palate patients appeared slight hypernasality and nasal emission.

CONCLUSIONSGood velopharyngeal function pre-operation is not affected after the surgery of maxillary advancement.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Osteotomy, Le Fort ; Palate ; physiopathology ; surgery ; Pharynx ; physiopathology ; surgery ; Voice Quality ; Young Adult

Objective To explore surgical treatment of gliomas involving the motor eloquent area. Methods Twelve cases of gliomas involving precentral gyrus were underwent awake surgery procedures assis- ted with neuronavigation and brain functional mapping by cortical electrical stimulation.Results Eleven ca- ses acquired accurate location of both lesions and eloquent areas by neuronavigation and direct cortical stimula- tion.7 cases of motor cortices and 2 cases of motor speech centers were confirmed during the operation.Re- section,verified by postoperative MRI,was total in 8 cases (66.7%) and subtotal in 4 patients.Histological examination revealed an infiltrative glioma in all cases (8 low grade astrocytomas,2 high grade astrocytomas and 2 glioblastoma).Four patients had no postoperative deficit,while the other 8 patients were impaired, with,in all cases except one,complete recovery in 7 days to one month.Conclusion Direct cortical elec- trical stimulations and awake surgery offer a reliable,precise and safe method,allowing functional mapping es- pecially useful in case of infiltrative cerebral tumors in eloquent areas.This technique allows improvement in the quality of tumoral resection and concurrently a minimization of the risk of definitive postoperative neurologi- cal deficit.

Objective:To assess the early efficacy of metallic modular radial head prostheses in patients with MasonⅢandⅣunreconstructable radial head fractures. Methods:The medical records of 16 patients (9 males,7 females) with a mean age of 43 years old (31 to 57) with MasonⅢ/Ⅳunreconstructable radial head fractures requiring metallic modular radial head replacement between January 2009 and March 2012 ,were reviewed retrospectively. The functional results were assessed by range of movement,Mayo elbow performance score (MEPS). All patients underwent radiographic evaluation for radial head height and radiolucent lines. Results:Fourteen patients were evaluated with follow up for 12 to 33 months with an average of 23 months. Range of movement parameters was significantly lower in the affected elbow than in the unaffected side (P<0.01). MEPS results were excellent in 9 cases,good in 2 cases,fair in 2 cases,and poor in 1 case. According to Grewal grading,there were 4 cases of periprosthetic lucencies of the radius and 1 case had significant clinical signs of loosening. Conclusion:Radial head replacement with the metallic modular prostheses yields satisfactory results regarding range of motion and function of the elbow joint in short term. The evolution of this prostheses needs to be evaluated with further studies to assess mid term and long term follow up results.

Objective To investigate the influence of competitive flow at different lelves on wall shear stress (WSS) of left internal mammary artery graft after coronary artery bypass grafting. Methods The left internal mammary artery (LIMA) left anterior descending (LAD) anastomotic model was extracted and reconstructed from CT images based on thresholding method by using SimVascular software. The competitive flow was divided into three groups according to different stenosis of LAD, including no competitive flow group (100% stenosis of LAD), mild competitive flow group (50% and 75% stenosis of LAD) and severe competitive flow group (0% and 30% stenosis of LAD). The hemodynamic performace of the anastomotic model under different conditions of competitive flow was observed by computational fluid dynamics (CFD) method. Results With the increment of competitive flow, the value of WSS was decreased gradually while the oscillation of WSS was increased remarkably in LIMA graft. The time average WSS (TAWSS) of LIMA graft in severe competitive flow group (0% stenosis: 2.73 Pa, 30% stenosis: 2.85 Pa) was lower than that in the mild competitive flow group (50% stenosis: 4.77 Pa, 75% stenosis: 6.01 Pa) and no competitive flow group (100% stenosis: 8.64 Pa), while its oscillatory shear index (OSI) (0% stenosis: 0.206; 30% stenosis: 0.085) was much higher than that in other two groups (50% stenosis: 0.014; 75% stenosis: 0.013; 100% stenosis: 0.006). Conclusions When the stonosis of LAD was smaller than 50%, the WSS in LIMA graft was obviously lower and oscillatory due to severe competitive flow. Such unfavorable feature of WSS may influence the long term-patency of LIMA graft and long term-survival of operations.

OBJECTIVETo evaluate the surgical technique and indication on descending aortic aneurysms.

METHODSFrom January 1996 to June 2006, 41 patients with descending aortic aneurysm underwent operation, including DeBakey type III dissection in 26, false aneurysm in 6, true aneurysm in 4, and residual or newly complicated type III dissection after the surgery of Marfan syndrome in 5. Operations were performed by left heart bypass in 9, femoral-femoral bypass in 7, pulmonary-femoral bypass in 2, and deep hypothermic circulatory arrest in 23. The whole thoracic descending aorta was replaced in 15, and intercostal arteries were reimplanted in 12.

RESULTSOne patient died of acute renal failure with the hospital mortality 2.4%. Main complications: respiratory dysfunction in 6, renal dysfunction in 6, recurrent nerve injuries in 4, chylothorax in 2, and no paraplegia.

CONCLUSIONSSurgical intervention of descending aortic aneurysm still has its unique advantages and indications; surgical safety is markedly improved by the use of deep hypothermic circulatory arrest.

Adolescent ; Adult ; Aged ; Aortic Aneurysm, Thoracic ; surgery ; Extracorporeal Circulation ; methods ; Female ; Follow-Up Studies ; Humans ; Hypothermia, Induced ; Male ; Middle Aged ; Retrospective Studies

UNLABELLEDTo explore the occurrence patterns of pulmonary complications at different stages in haploidentical bone marrow transplantation, a series of clinical data as the onset time, etiology, management choices and prognosis in 18 patients with pulmonary disorders were summarized. The results showed that in 18 out of 70 patients after bone marrow transplantation occurred pulmonary complications which included pneumonia affected by bacteria (7 cases), fungus (5 cases) and cytomegalovirus (CMV, 4 cases), bronchiolitis obliterans organizing pneumonia (BOOP, 1 case), and idiopathic pneumonia syndrome (1 case), out of which 8 cases died. Fungal and CMV pneumonia occurred predominantly 2 to 3 months after transplantation, whereas bacterial pneumonia was observed in the duration of 3 to 12 months and 4 cases of them suffered from secondary fungal infections during treatment. BOOP and idiopathic pneumonia syndrome were diagnosed 12 months and 50 days after transplantation respectively.

IN CONCLUSIONpulmonary complications were commonly seen in haploidentcal bone marrow transplantation, and fungal pneumonia might be the main cause that needs intensive management.

Adult ; Bone Marrow Transplantation ; adverse effects ; Cryptogenic Organizing Pneumonia ; etiology ; Cytomegalovirus Infections ; etiology ; Female ; Haplotypes ; Humans ; Lung Diseases ; etiology ; Male

UNLABELLEDTo explore the occurrence patterns of neurological complications following haploidentical bone marrow transplantation, a series of clinical data as the onset time, etiology, choices of therapies and prognosis in 10 patients with neurological disorders were summarized. The results showed that complications occurred in 10 out of 74 patients after bone marrow transplantation, which include 3 with encephalorrhagia, 3 infection, 1 epilepsy, 1 Guillian-Barr's syndrome, 1 encephalopathy and 1 schizophrenia. 4 patients died of neurological complications.

IN CONCLUSIONneurological complications commonly occurred in haploidentical bone marrow transplantation, and encephalorrhagia might be the main indication that needs intensive care. Moreover, central nerve system infection and peripheral nerve diseases associated with slow immune reconstitution should have clinical interests.

Adolescent ; Adult ; Bone Marrow Transplantation ; adverse effects ; immunology ; Child ; Female ; Histocompatibility ; Humans ; Intracranial Hemorrhages ; etiology ; Leukemia ; surgery ; Male ; Nervous System Diseases ; etiology

To investigate the efficacy and feasibility of parent non-T cell depleted haploidentical bone marrow transplants (haploidentical BMT) for children with leukemia, the efficacy of haploidentical BMT was evaluated in 8 leukemia children (1.9-9 years) received hematopoietic stem cell transplantation, donors were their parents with HLA-mismatched for two or three loci. Five children were pre-conditioned with a myeloablative regimen consisting of high-dose cytarabine (Ara-C), cyclophosphamide (CY) and total body irradiation. Busulfan (BU), Ara-C and CY were used for preconditioning regimen in other three children. The donors were given G-CSF prior to marrow harvest and the non-T-cell depleted grafts were used. A combination of CsA, MTX, ATG, mycophenolate mofetil (MMF) and CD25 monoclonal antibody were used for GVHD prophylaxis. The results showed that rapid engraftment was observed in all cases after transplantation by cytogenetic evidence. The mean time of neutrophil count exceeded 0.5 x 10(9)/L and the mean time of platelet count exceeded 20 x 10(9)/L were 16 and 17 days after transplantation respectively. Incidence of lethal aGVHD was lower, II-III acute aGVHD was found only in one out of eight patients. Chronic GVHD was observed in five patients, 4 from which showed local cGVHD, one developed extensive cGVHD. During the follow-up of 33 months (range 7-56 months), two patients died from relapsed leukemia, including one relapsed as donor-origin leukemia. Disease-free survival was achieved in the remaining six patients. No death occurred during the follow-up of 6 months. It is concluded that above-mentioned preconditioning regimen and GVHD prophylaxis procedure in non-T-cell depleted bone marrow transplantation from HLA-mismatched parents are effective approaches and safe strategy for the treatment of children leukemia.
Bone Marrow Transplantation ; adverse effects ; methods ; Child ; Child, Preschool ; Female ; Graft vs Host Disease ; prevention & control ; Haploidy ; Humans ; Infant ; Leukemia ; therapy ; Leukemia, Myeloid, Acute ; therapy ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; therapy ; T-Lymphocytes ; cytology

This study was purposed to investigate the correlation between the dose infused megakaryocytic precursors (CD34+, CD34+CD61+) and recovery time of platelet count following an allogeneic PBSCT and/or BMT through quantitative detection of CD34+ and its subpopulation in peripheral blood and BM mobilized by G-CSF. 24 patients with various hematologic malignancies received PBSCT/BMT from their HLA matched or unrelated donors and haploidentical siblings in April-December 2007. 20 evaluated patients were divided into 2 groups according to different transplant schemes. HLA matched group received PBSCT regime and haploidentical group received PBSCT combined with BMT. CD34+CD61+ subpopulations in sample from patients receiving PBSCT/BMT were measured by flow cytometry immediately or storage over night. The results showed that the median number of infused CD34+, CD34+CD61+ and CD34-CD61+ cells in haploidentical group were 6.24x10(6)/kg (1.53-20.48), 66.19x10(4)/kg (8.16-493.83), and 34.38x10(6)/kg (14.71-109.16) respectively, in HLA matched group those were 4.88x10(6)/kg (1.00-8.24), 14.16x10(4)/kg (11.63-96.87), and 13.50x10(6)/kg (1.74-35.61), respectively. Median days of ANCs>0.5x10(9)/L and platelets>20x10(9)/L were 18.5 (11.0-29.0) days and 16.5 (9.0-35.0) days in haploidentical group respectively; in HLA matched group those were 14.5 (9.0-24.0) and 10.5 (6.0-37.0) respectively. A significance difference of median days for ANC engraftment presented between two groups (p=0.048). There was no significant difference of time for platelet engraftment between 2 groups. For patients with CD34+ cell dose>2x10(6)/kg there was significant difference of time of platelet engraftment between HLA matched and haploidentical groups (p=0.006). The number of CD34+CD61+ cells infused in 12 haploidentical patients or in 8 HLA matched patients were much better correlated with the time of platelet recovery up to 20x10(9)/L than that of number of CD34+ cells infused in total 20 patients (r=-0.768 and p=0.004 for haploidentical CD34+CD61+ cells, r=-0.747 and p=0.033 for HLA matched CD34+ CD61+ cells, r=-0.449 and p=0.047 for CD34+ cells). There was an inverse correlation between the number of infused CD34+ CD61+ cells and time of platelet engraftment. Therefore, as the number of CD34+ CD61+ cells increased, duration of platelet engraftment (time to reach platelet count of 20x10(9)/L) shortened significantly. It is concluded that the determining the number of megakaryocytic precursor by flow cytometry may predict the platelet reconstitutive capacity of the allogeneic hematopoietic stem cell transplantation, which is in haploidentical PBSCT and in BMT.
Antigens, CD34 ; immunology ; Bone Marrow Transplantation ; Female ; Flow Cytometry ; Graft Survival ; Haploidy ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Megakaryocytes ; cytology ; immunology ; Platelet Count ; Thrombopoiesis ; Transplantation, Homologous