Impacted femoral neck fractures should be treated operatively as displaced fracture. Many authors suggested emergency operation. The principle of treatment of femoral neck fractures is anatomic reduction, fragmental compression,and rigid fixation. Closed reduction must be done in most cases. When close anatomic reduction can not be achieved, open reduction should be considered.Implants used recently consist of pins , screws,hook pins and gliding screws with side plate. Every implant has its own advantages, disadvantages and indications. The principle of treatment of femoral neck fractures in young patients is emergency operation (within 12h after trauma), anatomic reduction (open reduction when necessary), and rigid fixation with screws. Some authors stated the necessity of anterior capsularoctomy.

Osteoporosis is considered as the most important factor which causes the fracture of the femoral neck. Comminution of fracture and rigidity of fixation are greatly affected by the degree of osteoporosis. Femoral neck fractures in young patients are mainly caused by severe trauma. Although Garden classification is widely accepted in classifying femoral neck fractures, in the recent decades some doctors have found out some shortcomings in Garden classification in practical application. It has been suggested to classify the femoral neck fractures simply into displaced and undisplaced ones. Arthroplasty used to be thought as the choice of treatment of femoral neck fractures in the elderly. Application of arthroplasty must accord with the indications, not only with the age of the patient or the degree of the displacement of the fracture. There is no X ray diagnosis specially for the avascular necrosis of femoral head secondary to femoral neck fracture, other than Ficat Arlet grade system. MRI is considered to be the only method to diagnose the avascular necrosis of femoral head at an early stage and to defect its extent and location.

Employment ; Humans ; Japan ; Surveys and Questionnaires

Background Suprachoroidal hemorrhage (SCH)is a rare but devastating complication of ophthalmic surgery,and it is crucial to be aware of the risk factors and select effective treatment. Objective Present study was to assess the treatment and risk factors of SCH induced by intraocular surgery. Methods Retrospective case series were carried out to investigate the clinical data of 15 eyes from 15 patients with SCH at Peking Union Medical College Hospital.The risk factors of SCH were analyzed.Written informed consent was obtained before any medical examination and treatment.SCH was occurred in 10 eyes during intraocular surgery,while the SCH was diagnosed in other 5 eyes 1-3 days after operation.Surgical drainage was carried out in 8 eyes,of which 3 eyes combined with vitrectomy besides surgical drainage and other 5 eyes were treated with medication alone.Results SCH was completely removed and absorbed in 12 eyes.The visual acuity was improved in 6 eyes,unchanged in 6 eyes and decreased in 3 eyes.Nine eyes complicated with retinal detachment and reattached in 6 eyes after treatment.Seven eyes combined with hypermyopia,6 eyes combined with glaucoma,and 1 eye was aphakia.Four patients combined with hypertension,and 2 patients had diabetes mellitus. Conclusions SCH induced by intraocular surgery develops rapidly and violently,and it can result in vision loss without effective treatment.Suturing surgical incision immediately,applying hypertonic agents and sclerotomy drainage are the urgent approaches to treat SCH.Medicines and/or sclerotomy could be optional according to the amount of bleeding and other ocular complication.The risk factors of SCH include myopia,glaucoma and the instantly dropping of intraocular pressure.

RhoA, a small GTPase, is involved in a wide array of cellular functions in the central nervous system, such as cell motility, cytoskeleton rearrangement, transcriptional regulation, phagocytosis and cell growth. It is not known how spinal cord injury (SCI) affects the expression of RhoA in different nerve cells. In the present study, we investigated the changes of RhoA expression in remote areas of the injury at the 3rd, 7th and 30th day after SCI, which was established by T10 contusion method. Moreover, we examine its expression profile in neurons, astrocytes and microglia. RhoA was found to be weakly expressed in these nerve cells in normal spinal cord. Western blotting showed that, after SCI, the total RhoA expression was up-regulated, and the RhoA expression was increased and peaked at the 7th day. Double immunostaining revealed specific and temporal expression patterns of RhoA in different nerve cells. The expression of RhoA in neurons started to increase at day 3, peaked at day 7 and then decreased slightly at day 30. Expression of RhoA in astrocytes increased moderately after SCI and peaked at day 7. There was no obvious change in RhoA expression in microglia after SCI in remote areas. This study demonstrated that, after SCI, RhoA expression exhibited different patterns with different nerve cells of spinal cord. RhoA expression patterns also changed with time after SCI, and among different nerve cells in the injured spinal cord. These findings can help us better understand the roles of RhoA in SCI.

Objective To present a self-designed self-guided driver for clinical removal of cannulated screws. Methods The diameter of the selfguided rod is 2.8 mm and its length is 50 mm.The hexagonal driver head is 4 mm in height,2 mm in width and 5 mm in length.The other parts are similar to those of a solid driver.We then tested the stabilization of the selfdesigned driver by measuring the lateral load and displacement in 5 different experimental groups.Next we put it into use in the 26 patients who had been treated in our department from July 2008 to July 2009.They had been divided into 2 groups randomly.In the self-guided group,there were 9 males and 4 females,with an average age of 36 years and an interval of 30 months after the first operation.In the solid driver group.there were 7 males and 6 females.with an average age of 43 years and an interval of 21 months after the first operation. Results The mechanical tests revealed that the instrument designed by us was stable and could prevent lateral displacement.In clinic.the 39 screws were removed saccessfully in the self-guide driver group.The mean surgical time and incision in the self-guided driver group were significantly less and smaller than in the solid driver group.Conclnsions The self-guided driver is as stiff as a common solid driver and as stable as a cannulated driver.It can reduce the likelihood of screw invalidation which may make the operation very difficult and timeconsuming.It is a simple,timesaving,and less traumatic instrument,especially fit for removal of cannulated screws of the femoral neck.

Objective To study the incidence and prognosis of avascular necrosis of femoral head after internal fixation of femoral neck fractures. Methods 137 cases of femoral neck fracture treated with internal fixation between January 1993 and December 1999 were evaluated retrospectively. The average age was 49.1 years ( range, 17-77 years ). According to Garden classification, 4 cases were of stageⅠ; 23 of Ⅱ; 71 of Ⅲ; 38 of Ⅳ. One case could not be classified. The mean duration of follow-up was 49.1 months with a range from 14 to 95 months. Results Until January 2001, avascular necrosis of the femoral head was found in 51 cases (37.2%), among them late collapse occurred in 33 cases (24.1%). Avascular changes of the femoral head were found within 5 years after injury in most of the cases. The common clinical findings in the patients with avascular necrosis were: limited motion, limp and pain. Even if segmental collapse developed, about 30% patients had no complaint of pain, but the average Harris score was obviously lower than that of the patients without collapse. Statistical results showed that the related factors influencing the prognosis of avascular necrosis and late collapse were: degree of displacement of the fracture and quality of reduction. The location and extent of necrotic area were markably related to the development of late collapse. Conclusion Follow-up after operation of femoral neck fracture is important, it should be taken at least for 5 years. Close and thoughtful examination is recommended, especially in the 2nd to 3rd year after injury.

Objective To evaluate whether the MDR1 exon 26 genotype is associated with the dosage of FK506 and acute rejection in renal transplant patients. Methods One hundred and six patients who administrated FK506 after renal transplantation were retrospectively analyzed. The patients were investigated for MDR1 genotype determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) assays. According to the genotype, the patients were divided into 3 subgroups, wild homozygous-CC, mutant homozygous-TT and heterozygous-CT. At 3rd, 6th and 12th month after renal transplantation, enzyme-linked immunosorbent assay (ELISA) was used to measure the FK506 whole blood concentration. Whole blood FK506 concentration per dose/kg/day and acute rejection within one month postoperation were compared among 3 subgroups. Results Of the 106 patients, 32 (30.2 %), 44 (41.5 %) and 30 (28.3 %) were carriers of CC, CT, TT in MDR1 exon 26, respectively. The whole blood FK506 concentration per dose/kg/day for patients with CC was remarkably lower that that of the patients with either CT or TT (P

Objective To study the types of autoantibodies in patients with primary biliary cirrhosis.Methods There were 60 patients with primary biliary cirrhosis from January 1995 to December 2004 in People's Hospital. We analyzed those patients' autoantibodies results and clinical data.Results There were 75% patients with anti-mitochondrial antibody(45/60),and antinuclear antibodies were detected in 60%(36/60)PBC patients,with the following hierarchy of specificities:23%(14/60)speckled,20%(12/60)multiple nuclear dots,16%(10/60)nuclear membranous,6%(6/60)anti-centromere,1.6%(1/60)homogeneous,20%(12/60)anti-SSA,10%(6/60)anti-SSB and 1.6%(1/60)anti-RNP. Several patients showed multiple specificities. Comparing PBC patients with or without AMA,no statistically significant difference was found on ages,biochemical and immunological parameters.Conclusion AMA-negative PBC patients share the same clinical features with AMA-passive PBC. Except for AMA,other antibodies may present in PBC patients. Multiple nuclear dots and nuclear member antinuclear antibodies may be helpful for diagnosing PBC patients without AMA.

?Color vision has been an important part of the human visual function.It is determined by the phytochrome of cone.In many clinical cases of ocular fundus diseases, patients had color vision loss, which shows that color visions tests is necessary and meaningful.At present, doctors have not paid attention to it and adopt the tests rarely. The article summarizes the tests of color in common use and applications on the diagnosis and treatment for common ocular fundus diseases to be a theory basis.