Objective To investigate the diagnosis and treatment of primary hyperparathyroidism (PHPT) with urolithiasis.Methods The clinical data of 9 PHPT patients who were evaluated with simple metabolic evaluation in 881 urolithiasis from 2000 to 2005 were summarized and the references were reviewed.Results The level of serum calcium was (2.96±0.48)mmol/L before operation, (1.94±0.42) mmol/L after operation.The level of parathyroid hormone(PTH) was(1133.53±788.21)pmol/L before op-eration,(74.52±49.17)pmol/L after operation.The level of serum calcium and PTH changed significantly after the parathyroidectomy (P<0.01).Follow-up for 14 months to 6 years.the ureteral stones fragments with lithotripsy were clear after 3 months and followed without recurrence,although the renal stones without lithotripsy were followed with no significant change.Conclusions Increase of serum calcium or increase of PTH above double with normal serum calcium may be helpful for diagnosis of PHPT with urolithiasis.Ureteral stone with PHPT should be treated together.Renal stone with PHPT may be followed up after the parathv-roidectomy,and be treated until the complications were occurred.It suggests that the maidend diagnosed pa-tient with urolithiasis should be added with simple metabolic evaluation,including serum calcium, phospho-nium and PTH.

Objective:To explore the clinical effect of the simultaneous innervated "Bi-system bone flap" on preventing postoperative spontaneous resorption of the bone grafts and recovering lip sensation after reconstructing mandibular defects.Methods:Patients with segmental mandibular defects from the Department of Oral and Maxillofacial Head and Neck Oncology, Shanghai Ninth People’s Hospital were prospectively selected. Following the screening, they were randomly divided into an innervated group and a control group according to the random number table. When the free vascularized iliac bone flap was used to repair the mandibular defect, the ilioinguinal nerve was chosen to innervate a composite tissue flap containing one pedicle (deep circumflex iliac artery), double islands (an internal oblique muscle flap and an iliac bone flap) and one nerve (ilioinguinal nerve). We anastomosed the ilioinguinal nerve with the inferior alveolar nerve and the mental nerve in the innervated group. In the control group, no nerve was involved in the composite tissue flap which contained one pedicle (deep circumflex iliac artery) and double islands (internal oblique muscle flap and iliac bone flap). CT value(Hu) decrease rate, width and height of iliac bone flap 6 months after the operation were used to evaluate the postoperative resorption. The algesia examination, two-point discrimination test and current perception threshold (CPT) test of sensory nerves were used to evaluate the recovery of the lower lip sensation. P value less than 0.05 in independent-samples t test meant the statistically significant difference. Results:Eight patients between 17-38 years old were included with an averaged age of 29.5 years, and the range of mandibular defects was 5-9 cm. There were 4 cases in the innervated group and 4 cases in the control group. All the iliac bone flaps survived. The appearance was satisfactory, and no severe complications were found in the donor and recipient sites. In six-month follow-up, the CT value decrease rate of the bone grafts was (3.13±1.21)% in the innervated group, less than that (20.32±5.23)% in the control group, and the difference was statistically significant ( t=-6.401, P=0.006). Few changes of width and height of the bone grafts were found 6 months after surgery in both groups, and the difference was not statistically significant ( P>0.05). The sensation of the lower lip in the operation area was recovered in the innervated group to some extent, and no obvious pain was showed in the control group. In the two-point discrimination test, it was more than 20 mm in the affected side of the control group, while it was less than 20mm in the innervated group. In the healthy side of the two groups, it was less than 14 mm. The results of the quantitative sensory examination in affected lower lip by CPT test showed that two cases in the innervated group were mild sensory dysfunction, one slight sensory dysfunction and one moderate sensory dysfunction, while all cases in the innervated group were severe sensory dysfunction. The sensory dysfunction of the healthy side was milder than that of the affected side. Conclusions:The innervated "Bi-system" DCIA flap can prevent postoperative osteoporosis of the bone grafts and recover the sensation of the lower lip following mandibular reconstruction, improving the quality of mandibular defect reconstruction.

Objective:To explore the clinical effect of the simultaneous innervated "Bi-system bone flap" on preventing postoperative spontaneous resorption of the bone grafts and recovering lip sensation after reconstructing mandibular defects.Methods:Patients with segmental mandibular defects from the Department of Oral and Maxillofacial Head and Neck Oncology, Shanghai Ninth People’s Hospital were prospectively selected. Following the screening, they were randomly divided into an innervated group and a control group according to the random number table. When the free vascularized iliac bone flap was used to repair the mandibular defect, the ilioinguinal nerve was chosen to innervate a composite tissue flap containing one pedicle (deep circumflex iliac artery), double islands (an internal oblique muscle flap and an iliac bone flap) and one nerve (ilioinguinal nerve). We anastomosed the ilioinguinal nerve with the inferior alveolar nerve and the mental nerve in the innervated group. In the control group, no nerve was involved in the composite tissue flap which contained one pedicle (deep circumflex iliac artery) and double islands (internal oblique muscle flap and iliac bone flap). CT value(Hu) decrease rate, width and height of iliac bone flap 6 months after the operation were used to evaluate the postoperative resorption. The algesia examination, two-point discrimination test and current perception threshold (CPT) test of sensory nerves were used to evaluate the recovery of the lower lip sensation. P value less than 0.05 in independent-samples t test meant the statistically significant difference. Results:Eight patients between 17-38 years old were included with an averaged age of 29.5 years, and the range of mandibular defects was 5-9 cm. There were 4 cases in the innervated group and 4 cases in the control group. All the iliac bone flaps survived. The appearance was satisfactory, and no severe complications were found in the donor and recipient sites. In six-month follow-up, the CT value decrease rate of the bone grafts was (3.13±1.21)% in the innervated group, less than that (20.32±5.23)% in the control group, and the difference was statistically significant ( t=-6.401, P=0.006). Few changes of width and height of the bone grafts were found 6 months after surgery in both groups, and the difference was not statistically significant ( P>0.05). The sensation of the lower lip in the operation area was recovered in the innervated group to some extent, and no obvious pain was showed in the control group. In the two-point discrimination test, it was more than 20 mm in the affected side of the control group, while it was less than 20mm in the innervated group. In the healthy side of the two groups, it was less than 14 mm. The results of the quantitative sensory examination in affected lower lip by CPT test showed that two cases in the innervated group were mild sensory dysfunction, one slight sensory dysfunction and one moderate sensory dysfunction, while all cases in the innervated group were severe sensory dysfunction. The sensory dysfunction of the healthy side was milder than that of the affected side. Conclusions:The innervated "Bi-system" DCIA flap can prevent postoperative osteoporosis of the bone grafts and recover the sensation of the lower lip following mandibular reconstruction, improving the quality of mandibular defect reconstruction.