Objective To observe the clinical effects of coronoid process of ulna osteotomy and bilateral anatomic locking plate on humerus condyle comminuted fracture in the elderly.Methods 17 elderly patients with humerus condyle comminuted fracture were collected in department of orthopaedics in our hospital from July 2005 to December 2013 and graded into C2 (6 cases) and C3 (11 cases) according to the standard of the American society for the prevention of bone trauma.All patients were treated by coronoid process of ulna osteotomy and bilateral anatomic locking plate and accessed by Mayo elbow performance score (MEPS) at the last follow-up.Results Postoperative incision in all patients were healed,and X-ray showed fracture healing occurred at 10 to 24 weeks after coronoid process of ulna osteotomy (average of 14 weeks).No iatrogenic ulnar nerve injury and nonunion were found at the follow-up.The MEPS were excellent in 13 cases,well in 3 cases,ordinary in 1 case,and the excellent and good rate was 94.1％.Conclusions Coronoid process of ulna osteotomy and bilateral anatomic locking plate in the treatment of humerus condyle comminuted fracture in the elderly have good clinical effects with many advantages such as exposure clearly,early elbow joint function exercise and avoiding the aggravation of elbow joint osteoarthritis.

Humans ; Minimally Invasive Surgical Procedures ; adverse effects ; methods

Objective To evaluate the improvement of cone beam CT (CBCT) image quality by using bewtie filter (F_1) and water calibration. Methods First the multi-level gain calibration of the detector panel with the method of Cal_2 calibration was performed, and the CT images of CATPHAN503 with F_0 and bowtic filter were collected, respectively. Then the detector panel using water calibration kit was calibrated, and images were acquired again. Finally, the change of image quality after using F_1 and (or) water calibration method was observed. The observed indexes included low contrast visibility, spatial uniformity, ring artifact, spatial resolution and geometric accuracy. Results Comparing with the traditional combination of F_0 filter and Cal_2 calibration, the combination of bowtie filter F_1 and water calibration improves low contrast visibility by 13.71%, and spatial uniformity by 54. 42%. Water calibration removes ring artifacts effectively. However, none of them improves spatial resolution and geometric accuracy. Conclusions The combination of F_1 and water calibration improves CBCT image quality effectively. This improvement is aid to the registration of CBCT images and localization images.

Objective To study the correlations between MR imaging and histological classification of intracranial meningiomas.Methods MR imaging findings of 128 cases of intracranial meningiomas proved by operation and pathology were analyzed retrospectively.Results On T 1-weighted images,29(49%) meningothelial meningiomas were hypointense, 11(19%) were slightly hypointense and 17(29%) were isointense, while fibrours meningiomas were respectively in 23(59%),5(13%) and 9(23%). On T 2-weighted images, 34(58%) meningothelial meningiomas were hyperintense, 15(25%) were slightly hyperintense and 10(17%) were isointense, while fibrours meningiomas were in 2(5%),8(20.5%) and 11(28%) respectively. Most of the intracranial meningiomas such as meningothelial, fibrours and transitional were iso- and hypo-intense to the cortex on T 1-weighted imaging. On T 2-weighted imaging, meningothelial, angiomatous and transitional were hyperintense or slightly hyperintense, while fibrous tended to be hypointense or slightly hypointense. Conclusion The signals of meningiomas of different histologic type on T 1-weighted images are no significant different.On T 2-weighted images,there are significant correlation between signal intensity and tumor histology.

Objective To discuss the feasibility of TIPS in the treatment of complicated Budd Chiari syndrome(BCS) and to evaluate its clinical effect. Methods Five patients (male/female=4/1) aged from 30 to 35(mean 33 years). Four of 5 patients with varied degree of esophago gastric varies had the history of upper gastrointestinal bleeding and two had obvious ascites. We punctured the stenotic or occluded hepatic vein into the branch of portal vein in liver parenchyma. Balloon catheter expanding and installing were followed by the gastric coronary vein embolization. Results Successful operation were obtained in all 5 patients. The mean portal vein pressure dropped from(4.7?1.3)kPa before operation to(3.5?1.5)kPa after TIPS. One patient died in 24 hours after an emergency TIPS. One patient died of liver function failure three weeks later. In the mean 64 months′ follow up, 2 of the remaining 3 patients received angiography examination and were demonstrated stenosis at the end of hepatic vein. Both patients were treated with re intervention successfully. Conclusion TIPS was a safe, effective, and feasible method in the treatment of patients with complicated BCS with portal hypertension.

Objective To perform an acceptance test for the IMRT system with independent collimator. Methods An ion chamber dosimeter were used to measure the startup characteristics of the accelerator and the absolute dose at isocenter and given characteristic points for three clinical cases ( a lower nasopharyngeal carcinoma, a lung cancer and a cervical cancer). The characteristic points represented the organs at risk or the target. A Mapeheck2 was used to measure dose maps of basic test fields and the treatment fields for the clinical cases. The basic test fields were as follows: 1 ). Symmetric fields in size of 2 cm ×2 cm, 5 cm ×5 cm, 10 cm× 10 cm, 20 cm ×20 cm, 2 cm × 10 cm, 10 cm ×2 cm, 5 cm ×20 cm and 20 cm ×5 cm;2). Asymmetric fields in size of 2 cm ×2 cm (x1 =4 cm, y1 = 10 cm;x2 = -2 cm, y2 = -8cm) and 5 cm ×5 cm (x1 = -2 cm, y1 = -5 cm;x2 =7 cm, y2 = 10 cm) ;3) A 20 cm ×20 cm composite field composed of five 20 cm× 4 cm narrow bar fields side by side. Gamma Index was used to compare calculated and corresponding measured dose distributions. When the criterion was 3% dose difference or 3 mm distance-to-agreement, the pass rate was required to be more than 90%. Results The accuracy of machine output was better than 2% when machine monitor units increased to 4. Among all basic test fields and all the treatment fields of three clinical cases, the maximal absolute dose error was -3.67%, and only the composite test field and two treatment fields of the lower nasopharyngeal carcinoma case had a pass rate slightly less than 90%, which were 83.6%, 88. 3% and 89. 7% ,respectively. For the three clinical cases the treatment delivery times were 15, 14, and 27 minutes, respectively. Conclusions The overall commissioning results are acceptable, and the system can be used in clinic.

Objective To investigate the effect of nerve growth factor (NGF) on the bone induction of recombinant human bone morphogenetic protein-2 (rhBMP-2) through local application of NGF in the osteoinductive process of BMP. Methods Thirty-six ICR mice were divided into the experimental group and control group at random, and rhBMP-2/collagen composite was implanted into the right thigh muscle pouch of each group. NGF or vehicle was daily injected into the implanted sites of BMP, respectively, for 7 days starting from the third day after surgery. At d10, d20 and d30 after implantation, new bone formation was measured radiographically, biochemically and histologically to compare the osteogenetic capacity of the two groups. Results In both groups, new bone formation was found at d10. However, there was significantly more new bone in the experimental group according to histological and radiographic examinations. At d10 and d20, alkaline phosphatase activity of the local tissue in the experimental group was significantly greater than that in the control group, and calcium and phosphonium contents of samples were also greater in the experimental group. Arrangement of collagen fibers became more regular in the experimental group than that in the control group. Conclusion NGF possesses synergistic effect on ectopic bone formation induced by rhBMP-2.

Objective To assess the value of endorectal elastography in the diagnosis of malignant rectal adenoma. Methods Sixty patients referred to the department of basic surgery of Peking Union Medical College Hospital for the evaluation of rectal adenoma from January 2011 to May 2013 were included in this prospective cohort. All patients underwent elasticity score (ES) and strain ratio(SR) examine before operation. To evaluate the reproducibility of the strain-ratio measurements, the intraclass correlation coefficient (ICC) was calculated. Compared with final operational pathological results,the diagnostic values of elasticity score and strain ratio method were assessed. Results Histopathological result showed there were 20 adenomas and 40 adenocarcinomas. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ERUS was 68%(27/40), 40%(8/20), 58%(35/60), 69%(27/39), 38%(8/21), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of elasticity score was 85%(34/40), 70%(14/20), 80%(48/60), 85%(34/40), 70%(14/20), respectively. The SR of adenocarcinomas was significantly higher than that of adenomas(2.82±1.81 vs 1.23±0.57, t=3.333, P < 0.05). The differences among the SR of benign adenoma, benign adenoma with severe atypical hyperplasia and completely malignant lesions were statistically significant (1.26±0.84 vs 2.94±1.95, 1.42±0.55 vs 2.94±1.95, t=2.619, 2.415, P=0.013, 0.021). When 1.240 was chosen as the best cut-off value of SR, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of strain ratio was 82%(33/40), 75%(15/20), 80%(48/60), 87%(33/38), 68%(15/22), respectively. Conclusion Endorectal elasotgraphy can accurately diagnose the malignant rectal adenoma, which can provide reliable preoperative imaging evidence for clinical operation mode.