OBJECTIVE:To evaluate the feasibility and initial outcome of reconstructing the defect femur by unicondylar osteoarticular altograft after resection of distal femur tumor.METHODS:Between July 2003 and August 2008,a total of 12 patients with distal femur tumor treated by unicondylar resection and fresh-frozen unicondylar osteoarticular allograft reconstruction of bone defects were retrospectively reviewed at the Department of Orthopedics,General Hospital of Chinese PLA.Of 12 patients,5 medial and 7 lateral femoral condyles were involved.There are 8 patients suffering from giant cell tumor,including 2 patients complicating with pathologic fracture,3patients suffering from osteosamoma and 1 patient suffering from low-grade fibrosarcoma.Before transplantation,MRI and/or CT were used to determine that the tumor was definitely limited in half condyle.Three cycles of chemotherapy preoperatively and six cycles of chemotherapy postoperatively were conducted in patients suffering from osteosarcoma and fibrosarcoma.Patients with giant cell tumor did not receive any intraoperative adjuvant treatment.The surgical margin of resected tumors was evaluated by histological examination.All patients were followed by radiograph or CT.Postoperative function was evaluated by Musculoskeletal Tumor Society (MSTS) scoring system at the time of the latest follow-up.RESULTS:All patients were followed up.The patients were followed up mean 35 months after transplantation.None of the patient died.No local recurrences and metastases were found at the latest follow-up.No evident immune rejection and deep infection were seen.No plate loosening or breakage was observed.All patients had their grafts retained at the time of the latest follow-up.Three patient's allograft showed subchondral bone collapse and articular deterioration,but the function was good.Instability of the knee joint was noted in 3 patients.The mean MSTS functional score (totally 30 points) was 26 points.CONCLUSION:For some patients with giant cell tumor or malignant tumors with clearly defined margins after chemotherapy.When the lesions were limited in half condyle and enough surgical margins can be achieved,reconstruction of bone defect with unicondylar osteoarticular allografts after bone tumors were resected appears to be a reliable alternative.

Objective To approach the effective treatment for simple bone cyst in adult. Methods Forty-eight cases were divided into two groups by visiting order, 20 cases (steroid group) were treated by prednisolone acetate and 28 cases (open resection and allograft group) were treated by open resection and allograft. The curative effect were contrasted between two groups. Results The follow-up time was 5-46(26.58 ± 10.81) months. Aecording to the Chigira's healing criteria for simple bone cyst, grade Ⅰ , Ⅱ , Ⅲ,V were 1, 2, 10 and 7 cases respectively in steroid group, contrasting to 0, 3, 5 and 20 cases respectively in open resection and allograft group. The recovery rate was 85.0%(17/20) in steroid group and 89.3%(25/28) in open resection and allograft group, which was no statistically significant difference between two groups (P＞0.05). Conclusions Although the two remedies are no obvious difference in curative effect,simple bone cyst at lower extremity of weight-bearing with obvious osteolysis in adult is recommended to open resection and allograft, otherwise or at upper extremity to steroid injection.

Cylindrical abdominoperineal resection (CAPR), also known as extralevator abdominoperineal excision (ELAPE), has been described as a method for improving the outcome of APR for advanced low rectal cancer, probably because of more pelvic dissection and less positive circumferential resection margin (CRM). Recently, there have been some hot issues associated with CAPR/ELAPE, such as pelvic floor reconstruction methods, prone or lithotomy positioning during pelvic procedure, postoperative chronic perineal pain, postoperative sexual and urinary nerves damage, etc. Individual cylindrical procedure based on clinical and anatomic research may be as effective as CAPR/ELAPE while minimizing the operative trauma and the damage to the nerves of the genital and urinary organs.
Abdomen ; surgery ; Digestive System Surgical Procedures ; Humans ; Pelvis ; surgery ; Reconstructive Surgical Procedures ; Rectal Neoplasms ; surgery

OBJECTIVETo discuss the application and therapeutic effect of tunable guide device in correction of prominent mandibular angle.

METHODSSince 2007, 50 cases with prominent mandible angle underwent mandible angle osteotomy with the tunable guide device. The patients were followed up for 3-6 months.

RESULTSNo severe complication happened. Local seroma occurred in one case. Improved esthetic results were achieved at both frontal and oblique view.

CONCLUSIONSThe mandibular angle osteotomy with the tunable guide device makes the procedure safe and easily performed.

Adult ; Female ; Humans ; Mandible ; abnormalities ; surgery ; Osteotomy ; instrumentation ; methods ; Young Adult

OBJECTIVETo assess the treatment outcome of ligation of the intersphincteric fistula tract plus bioprosthetic anal fistula plug(LIFT-plug) for transsphincteric perianal fistulas.

METHODSClinical data of 36 patients with transsphincteric perianal fiftula who were managed by the LIFT-plug technique between November 2010 and February 2012 were analyzed retrospectively.

RESULTSClinical healing of the fistula, defined as the absence of drainage with no evidence of residual fistula tract, occurred in 34(94.4%) patients. The operative time ranged from 12 to 35 minutes(mean, 17 minutes). The median postoperative length of stay was 5 days. The median healing time was 18 days. No complications requiring intervention occurred. The postoperative follow up was at least 3 months and two patients had recurrence(5.6%).

CONCLUSIONSLIFT-plug procedure for the management of transsphincteric perianal fistulas is simple with high healing rate, minimal invasiveness, quick healing, and without disturbance to anal function. LIFT-plug is an ideal procedure for intrasphinteric fistula.

Aged ; Fecal Incontinence ; Humans ; Ligation ; Operative Time ; Rectal Fistula ; surgery ; Recurrence ; Retrospective Studies ; Treatment Outcome ; Wound Healing

OBJECTIVEThe aim of this study was to evaluate the effect of anastrozole, a new generation aromatase inhibitor, on the lipid metabolism in postmenopausal Chinese women with early breast cancer, and observe the adverse reactions as well.

METHODSPostmenopausal women with early breast cancer patients took anastrozole 1 mg per day. The lipid profiles of total cholesterol, triglyceride, low density lipoprotein, and high density lipoprotein were assessed before taking the drug, 3 months, 6 months after taking medication, and later once a year, until the end of medication or follow-up. Patients taking lipid-lowering drugs were excluded. The adverse reactions during the process of taking medication was followed-up by telephone.

RESULTSTwo hundred and eighty-five postmenopausal breast cancer patients took part in the trial from Jan. 2003 to Jun. 2009. All patients had completed primary surgery and demonstrated a postmenopausal status. ER or PR positivity was confirmed by histopathology. Taking the medication from a minimum of one year to a maximum of 5 years, with a median time of 3.61 years. During the medication time, anastrozole significantly increased the levels of low density lipoprotein-cholesterol after 6 months of treatment, continuing to 5 years, from (3.08 ± 0.90) mmol/L to (3.59 ± 0.59) mmol/L, with a maximal increase of 18.2% higher than that before medication. Anastrozole significantly increased the levels of total cholesterol and high density lipoprotein-cholesterol after 1 years of treatment. Anastrozole significantly reduced the levels of triglycerides after 1 years of treatment. Anastrozole showed no significant effect on serum lipids in the patients with pre-existing hyperlipidemia. A more significant effect on blood lipids was observed in patients aged ≥ 60-years than that in patients less than 60 years of age. The rate of other adverse events were similar to that reported in foreign patients.

CONCLUSIONSFor the postmenopausal patients with breast cancer, taking anastrozole may lead to an abnormal lipid metabolism. Anastrozole significantly increases the levels of low density lipoprotein-cholesterol, total cholesterol and high density lipoprotein-cholesterol, and significantly reduces the level of triglycerides. The rate of other adverse events were similar to that reported in foreign patients. it is suggested that the blood lipid levels should be regularly assessed in patients with long-term anastrozole treatment. The rate of other adverse events similar to that reported with foreign patients, and patients tolerate this treatment well.

Age Factors ; Aged ; Aged, 80 and over ; Antineoplastic Agents, Hormonal ; therapeutic use ; Aromatase Inhibitors ; therapeutic use ; Breast Neoplasms ; blood ; complications ; drug therapy ; surgery ; Chemotherapy, Adjuvant ; Cholesterol ; blood ; Cholesterol, HDL ; blood ; Cholesterol, LDL ; blood ; Female ; Follow-Up Studies ; Humans ; Hyperlipidemias ; blood ; complications ; Lipid Metabolism ; drug effects ; Lipids ; blood ; Middle Aged ; Neoplasm Staging ; Nitriles ; therapeutic use ; Postmenopause ; Triazoles ; therapeutic use ; Triglycerides ; blood

Objectives To investigate the image quality,influencing factors and radiation doses of prospectively ECG-triggered spiral acquisition mode (Flash spiral mode)coronary computed tomography angiography (CCTA) using high-pitch dual-source CT in patients with different heart rates.Methods One hundred and thirty-four consecutive patients with mean heart rate (HR) ＞ 65 beats per minute (bpm) and ≤ 100 bpm were included in this study as group A using Flash spiral mode setting at 20％ -30％ of the R-R interval and 134 consecutive patients with mean HR ≤65 bpm were enrolled as group B using Flash spiral scan mode at 55％ of the R-R interval; 134 consecutive patients with mean HR ＞ 65 and≤100 bpm using spiral scan mode were included as group C. The image quality scores, effective radiation dose and influencing factors of image quality in three groups were assessed. All statistical analyses were performed using SPSS.Results (1)The non-diagnostic coronary artery segments in group A (28/1842,1.52％) were more than in group B (8/1819,0.44％ ) ( x2 =10.97,P =0.001 ) and there was no significant difference between group A and group C (32/1838,1.74％) ( x2 =0.280,P =0.345).The number of patients with non-diagnostic coronary segments in group A( 10/134,7.5 ％ )was more than in group B (2/134,1.5 ％,x2 =5.52,P =0.018 ),while there was no significant difference between group A and group C (9/134,6.7％,x2 =0.057,P =0.812).(2)The average heart rate variability (HRV) of patients with different image scores in the three groups wcrc significantly different. In group A,the HRV of score 1,2 and 3 were (2.29 ± 1.06),(5.17 ± 1.37),(8.88 ± 1.53) bpm,respectively (F =170.402,P =0.001 ).In group B were (2.26±1.01),(5.97 ±1.82),(12.00 ±9.64) bpm,respectively (F=95.843,P=0.001).In group C were (2.61 ±1.85),(7.90 ±3.97),(11.22 ±5.62) bpm,respectively (F=68.629,P=0.001 ). (3) The average effective radiation doses in groups A and B were significant lower than in group C [ A group was 1.04 ± 0.16,B group was 1.03 ± 0.16 and C group was 7.05 ± 1.05,t =65.5 ( A vs C),P ＜0.01 ( A vs C) ].Conclusions Flash spiral mode of high-pitch dual-source provides high image quality with significant reduction of radiation exposure in patients with HR ≤ 65 bpm. Patients with heart rates ＞65 bpm and ≤100 bpm without cardiac arrhythmia can perform CCTA using Flash spiral mode with image acquisition time setting at 20％-30％ of the R-R interval.

OBJECTIVETo evaluate the clinical value of magnifying endoscopy in diagnosis and treatment of colorectal benign neoplastic lesions.

METHODSSeventy-eight colorectal lesions in 61 patients were examined with magnifying colonoscopy after indigo carmine dyeingìand pit pattern diagnosis was made for every lesion according to Kudos classification to differentiate neoplastic lesions from non-neoplastic lesions. The lesions were resected by endoscopic polypectomy and mucosectomy or surgical treatment. The diagnoses made by magnifying colonoscopy were compared with pathologic results.

RESULTSThe diagnostic sensitivity of magnifying endoscopy for neoplastic lesions was 98.4% and specificity was 85.7%. The overall accuracy for adenoma and early colorectal cancer was 96.2%. 89.7% of adenomatous lesions were treated by endoscopic resection.

CONCLUSIONThe magnifying colonoscopy can provide instantaneous and accurate diagnosis of neoplastic lesions in colon and rectum,as well as minimally invasive treatment.

Adult ; Aged ; Colonoscopy ; Colorectal Neoplasms ; diagnosis ; pathology ; therapy ; Coloring Agents ; Female ; Humans ; Male ; Middle Aged

OBJECTIVESTo investigate the diagnosis, therapy and prognosis of renal oncocytoma.

METHODSThe data of 26 patients of renal oncocytoma in the department of urology of the Peking University First Hospital from 1999 to 2010 were collected. Retrospective analysis of renal oncocytoma clinical characteristics of patients including pathological characteristics and long term follow-up, treatment methods, and prognosis was undergone.

RESULTSThe mean age of these patients was (55 ± 14) years, mean tumor size was (4.1 ± 1.3) cm, corresponding to a mean tumor volume of (24.0 ± 21.1) cm(3). All of these cases were unilocular unilateral. All of these 26 patients received surgical treatment, 5 cases accepted partial nephrectomy while the other cases accepted radical nephrectomy. After a median follow-up time was (47 ± 34) months (range 4 - 144 months) for 25 patients who had been followed up, there was no disease recurrence, progression or death attributed to oncocytoma.

CONCLUSIONSRenal oncocytoma is an uncommon tumor. It exhibits numerous features which are characteristic but not necessarily unique.Preoperative renal mass biopsy is the only way for pre-nephrectomy histologic diagnosis of oncocytoma.

Adenoma, Oxyphilic ; diagnosis ; surgery ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; diagnosis ; surgery ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Treatment Outcome

Objective To compare the difference in pulse pressure variation(PPV)to predict volumetric response in children with ventricular septal defect(VSD)and tetralogy of Fallot(TOF). Methods VSD group consisted of 38 patients,aged 1.05 ± 0.75 years,while TOF group consisted of 36 patients,aged 1.15 ± 0.68 years. After separation from cardiopulmonary bypass,fluid infusion therapy was administered. PPV was recorded using pressure recording analytical method along with cardiac index(CI)before and after fluid infusion. Patients were considered as responders to fluid loading when CI increased ≥15%.Receiver operating characteristic(ROC) analysis was used to assess the accuracy and cutoffs of PPV to predict volumetric response.Results The PPV val-ues before and after fluid infusion were significantly lower in TOF group than that in VSD group(P < 0.01 for both).In VSD group,27 were responders and 11 nonresponders.ROC curve area was 0.89 and cutoff value 17.4%. In TOF group,26 were responders and 10 nonresponders.ROC curve area was 0.79 and cutoff value 13.4%.Con-clusion PPV is predictive of volumetric response in VSD and TOF patients following cardiac surgery.PPV's pre-dictivity and cutoff value are higher than the former. PPV is affected by right ventricle-pulmonary artery circula-tion,under-fluid infusion should be avoided in TOF due to lower PPV,over-fluid infusion should be avoided in VSD due to higher PPV.