[Objective]To discuss the relationship between partial upper limb edema in the cervical spondylosis patients and the decompression operation.[Method]Ten cervical spondylosis cases with partial upper limb edema were reviewed,including 7 cases of cervical spondylotic myelopathy,2 cases of cervical radiculopathy and 1 case of OPLL(ossification of the posterior longitudinal ligament).Seven cases were treated with subtotal vertebrectomy and anterior internal fixation,one with subtotal vertebrectomy and anterior discectomy,2 cases with posterior decompression and fusion.All the patients were available for follow-up to evaluate the decay of the edema.[Result]All the 10 patients' edema disappeared with the duration from one day to over half a year.The treatment of anterior surgery made patients' edema disappear quicker than that of posterior surgery.[Conclusion]The occurrence of the upper limb edema in the cervical spondylosis patients is related to do with the irritated sympathetic nerve.The edema can be reduced in short term after the decompression operation.

BACKGROUND: To evaluate the operative efficacy of chronic venous insufficiency (CVI), we used to emphasize on the improvement of clinical symptom and physical sign without quality of life (QOL).OBJECTIVE: To assess the QOL in CVI patients before and after operation.DESTGN: Comparative observation, scale evaluation and one-year follow-up.SETTING: Department of Vascular Surgery, Renji Hospital, Shanghai Second Medical University.PARTICIPANTS: 169 CVI patients (209 lower limbs) including 89 males and 80 females with an average age of (56±13) years and disease course of (11 ±3)years, who were treated at Department of Vascular Surgery, Renji Hospital,Shanghai Second Medical University from July 2001 to December 2003, were enrolled. All patients knew the therapeutic scheme and evaluation dimensions.METHODS: Three types of operation according to the reflux range and whether deep venous valve imcompetence were carried out. Forty-six subjects with 56 limbs in the superficial venous group received saphenous vein high ligation with stripping the saphenous and varicose vein. Seventy-three subjects with 87 limbs in the perforating venous group underwent both perforating vein ligation and saphenous vein high ligation with stripping the saphenous and varicose vein. Fifty subjects with 66 limbs in the deep venous group received the same operations of group 1 and group 2, in addition to external banding valvuloplasty of the superficial femoral vein. The chronic venous insufficiency questionnaire (CIVIQ) was applied to assess the patients' QOL one week before varicose vein surgery and one year later. The main impairment in QOL focused on 4 dimensions (20 questions), namely pain, physical dimension, social function and psychological dimension. There were five grades to each question (from 1 to 5 points accompany with the serious situation). Total CIVIQ score was sum score of 20 questions. 100 points indicated ideal QOL.MATN OUTCOME MEASURES: CIVIQ scores in CVI patients before and after operation.RESULTS: All 169 CVI patients were involved in the result analysis. ①Sex differences of CIVIQ: The total scores of patients were obviously elevated one year after operation (P ＜ 0.05). There was no significant difference in CIVIQ scores of both sexes (P ＞ 0.05). The total score was markedly elevated after operation (P ＜ 0.05). ②Relationship between CIVIQ scores and operation type: No significant difference was found in the superficial venous group, the perforating venous group and the deep venous group (P ＞ 0.05). The total CIVIQ scores in the deep venous group before operation were significantly lower than those in the superficial venous group and the perforating venous group (P ＜ 0.05).CONCLUSION: Reasonable operation type can improve the QOL in CVI patients. No significant difference is found in QOL improvement of patients of both sexes.

Objective To evaluate Color Doppler ultrasonography follow up for patients of femoropopliteal arteriosclerosis after interventional therapy.Methods We used Color Doppler ultrasound (CDU) in 57 cases' follow-up of endovascular intervention therapy of femoropopliteal arteriosclerosis lesion to monitor and analyze arterial hemodynamics after endovascular intervention therapy.Results An average follow-up of 13 months( range:3 -33 ) was achieved.31 of the 57 cases were found with mild stenosis,8 cases were moderate stenosis,6 cases were severe stenosis,12 cases were complete occlusion.In these 57 cases there were 7 in Fontaine stage Ⅰ,42 cases in Fontaine stage Ⅱ,6 cases were Fontaine stage Ⅲ,2 cases were Fontaine stage Ⅳ.Ankle brachial index (ABI) ABI≥I.0 in 2 cases,0.8≤ABI ＜ 1.0 in 10 cases,0.8≤ABI ＜ 1.0 in 31 cases,and ABI ＜0.5 in 14 cases.There was significant correlation between stenosis and Fontaine stage ( r =0.47,P ＜ 0.01 ),so was between stenosis and ABI ( r =0.66,P ＜ 0.01 ).In this series 29 cases also underwent DSA,and the results between CDU and DSA were significandy consistent ( Kappa value =0.61,P ＜ 0.01 ).The sensitivity of CDU was 92％,the specificity was 75％ and the accuracy was 89.2％.Conclusions CDU can continuously monitor hemodynamics after endovascular intervention therapy.It is a sensitive,non-invasive and effective method to evaluate the clinical efficacy of endovascular intervention.

Objective To evaluate transcatheter thrombolysis via the small saphenous vein in the treatment for lower limb acute mix-deep venous thrombosis. Method From Jan 2005 to Mar 2007.37 patients with lower limb acute mix-DVT underwent catheter-directed thrombolysis via the small saphenous vein with urokinase(149 ±71)×104 IU continuous infusion.The venous patency score and the rate of patency improvement were observed by venograms before and after therapy.Twenty-two patients were followed up for(12 ±4)months. Results Venous patency score were significantly improved(Z=-5.330,P＜0.01).The mean rate of venous patency was 50.17%±15%,and there was no complication.Venogram on 6～12 month follow up showed a venous patency of 58%±13%(Z=-3.545,P＜0.01),and that on 13～18 months was 68%±20%(Z=-2.201,P＜0.05). Conclusion This preliminary experience suggests that catheter-directed thrombolysis via the small saphenous vein with urokinase for acute lower limb mix-DVT iS safe and effective.

Objective: To discuss the clinical effect of the treatment of metaphyseal cancellous bone fracture with fragment fixation system implants(FFS).Methods:Thirty patients treated with FFS were reviewed.Results:The patients were followed up for 7～　24 months (8.7 months in average).The fractures in all cases were healed in 6 months and the function recovered or nearly reeovered. Conclusion:By traction with FFS to treat this kind of fracture,the fractures and joint function recovered.The operation is simple and trauma is little.

Objective To study the concentration of plasma total homocysteine(tHcy) in patients with chronic renal failure(CRF).Methods 105 chronic renal failure patients and 35 health individuals to our hospital were chosen to measure the level of tHcy using enzymatic cycling assay method.Results The mean level of tHcy in renal failure period C RF patients was significantly higher than that in normal controls (t =3.12,P ＜ 0.05),and the level of plasma tHcy was significantly higher in Uremia stage than in renal failure period in CRF patients (t =6.41,P ＜0.05),and the level of plasma tHcy was significantly higher in renal failure period than in renal function decompensated period in CRF patients (t =11.27,P ＜ 0.05).Conclusion The level of plasma tHcy were significantly elevated in patients with CRF,and there is a trend that the level of plasma tHcy increases with severity of CRF.Serum tHcy concentration have significant value in the diagnosis and understanding the condition of patients with CRF.

Objective To explore the value of Nacotrend and the degree and prognosis of disturbance of consciousness in craniocerebral injured patients. Methods Forty craniocerebral injured patients were observed and Nacotrend index (NI) and Glasgow Coma Scale (GCS) were evaluated 24 h after the operation. After followed up for 3 months, the patients with Glasgow coma scale (GOS) 4-5 scores were enrolled into in good recovery group and the patients with GOS 1-3 scores were enrolled into bad recovery group. The correlation of NI and prognosis was analyzed. Results There were 17 cases in the good recovery group, and 23 cases in the bad recovery group. Pearson correlation coefficient of NI and GCS was 0.721, P<0.01. The level of NI in good recovery group was 64.26±12.73, in bad recovery group was 29.57±8.12, and there was significant difference (P<0.05). Conclusion NI can be used in coma patients for consciousness grading assessment and also can correctly evaluate the prognosis.

Objective To investigate the diagnostic criteria, clinical management and prognostic factors of primary central nervous system (CNS) histiocytic sarcoma (HS). Methods An adult patients with primary CNS HS was reported, and literature on the rare entity were reviewed. Results The patient had no previous history of disease. Magnetic resonance imaging (including magnetic resonance spectroscopy) suggested a mass in the frontal lobe with obvious vasogenic edema, which was considered glioma. Surgery was the initial treatment and the tumor was totally removed. The histological findings revealed the HS. The patient received concomitant chemoradiotherapy postoperatively and currently lived without recurrence. Conclusions Primary CNS HS is extremely rare hematopoietic malignant tumor. The pathological feature and comprehensive immunophenotype panel are the useful ways to establish the diagnosis till now. Primary CNS HS should be treated intensively with surgery, chemotherapy, and/or radiation therapy. However, prognosis is disappointed in most of patients. Concomitant chemoradiotherapy might be an alternative treatment.

Objective To investigate the relationship between chronic prostatitis and the coagulase-negative staphylococci (CNS),and to study the diagnostic value and clinical significance of CNS in expressed prostatic secretion (EPS). Methods Overall,428 patients with chronic prostatitis were included in this study.Their mean age was 31 years (range,18 to 46 years).The mean cause was 6 months (range,3 to 32 months).The mean NIH-CPSI score was 23.2.Bacterial culture and antimicrobial agent sensitivity test were applied to samples from the 428 patients.The samples were taken with 4 tubes from the lower urinary tract segmented by Meares-Stamey method. Results Bacteria were found in 248 patients (57.94%) out of 428 ones.Gram-positive bacteria were found in 195 cases(78.63%).In the 195 cases,staphylococci were found in 160 cases(64.25%,160/248).CNS were found in 89 cases(35.89%,89/248),most of which were epidermidis staphylococci 81 cases(32.66%).The next were saprophytic staphylococci 3 cases and hemolytic staphylococci 2 cases.There was no correlation between NIH-CPSI score and bacterial culture results.The sensitivity test results showed the rate of drug resistance of CNS from EPS was high for ?-lactamases,quinolones and aminoglycosides(51.9% to 100%). Conclusions The results suggest that CNS is a main kind of pathogen of chronic prostatitis,so considerable attention should be paid to it.In addition,it is of significant importance to apply bacterial culture and sensitivity test in EPS to the diagnosis and treatment of chronic prostatitis.

[Objective]To investigate the efficacy of treatment of C_(1～C) instability with 3D-fixation techniques.[Method]From July 2002 to July 2005,thirteen patients were treated with atlantal lateral mass screw associating with axoid pedicle screw;twelve patients were treated with axoid transarticular screw associating with posterior atlantal arch hook;sixteen patients were treated with Vertex and nine patients with Summit among them.[Result]There were 26 lateral mass screws,26 axoid transarticular screws,24 atlantoaxial transarticular screws and 24 posterior atlantal arch hooks were applied in the 25 patients.All patients were followed up.The follow up duration time was ranging from 10 to 36 months with the mean time of 16.7 months.No spinal injury and vertical artery injury was found. The postoperative JOA score was ranging from 13.6 to 15.9 with the mean score of 14.8 and the improvement rate of 89.5%.All fractures of odontoid process and all bone grafts had solid bone union.No failure and loosening of internal instrument was found.[Conclusion]The two 3D-fixation techniques are effective and reliable.