ObjectiveTo evaluate and compare the outcomes of missed Monteggia fractures in children treated with ulnar angulation-distraction osteotomy and plate fixation or external fixation.Methods Nineteen patients,including 11 boys and 8 girls who presented with missed Monteggia fracture,were reviewed from July 2005 to June 2011.Twelve children (Group A) were treated with ulna angulation osteotomy and plate fixation,and 7 eases(Group B) with ulna angulation-distraction osteotomy and external fixator.Thirteen patients were classified as type Bado Ⅰ,and six as type Bado Ⅲ.The age,the delay from injury to surgery,complications,elbow and forearm function,and the healing time of the osteotomy were compared.ResultsAll 19 patients were followed up.The duration of missed dislocation was from 6 to 36 months (mean,10 months).Redislocation of the radiocapitellar joint occurred after surgery in one case in group A.Forearm compartment syndrome occurred in one case after surgery in group B.All patients,except one,regained full elbow flexion in group A and B,various forearm pronation limitation were noted in all patients (mean,15°).The average healing of osteotomy of group A and B was 8 weeks(6-15 weeks) and 22 weeks (10-44 weeks).ConclusionThe ulnar angulation-distraction osteotomy could correct the ulnar deformity in children of missed Monteggia fractures,which is the key issue to be corrected.Both of the fixation strategies can obtain the same treatment results.Preoperative assessment is most important,plate internal fixation was recommended for young age and short delay cases,on the contrary,we prefer to choose external fixator.

Objective To evaluate the effect of greater trochanteric transfer for the treatment of coxa brevis in children and adolescents.Methods From August 2005 to January 2011,twenty patients (22 hips)with coxa brevis underwent greater trochanteric transfer.Among them 18 patients (20 hips) were available for evaluation,including 4 boys and 14 girls,with an average age of 11.4 years (range,7.5-15.0 years) at operation.Five cases (6 hips) were caused by Perthes disease,and 13 cases (14 hips) were caused by developmental dysplasia of hip.Four patients (4 hips) had undergone greater trochanteric epiphyseodesis ever before.All patients were fixed with tension screw after the deformity was corrected during the operation.After operation,the human plaster spica was used for 6 weeks in all patients.Results All patients were followed up for 14 to 79 months (average,31 months).At the last follow-up,fatigue or pain in the hips disappeared or improved in 13 patients.Sixteen patients had limping and positive Trendelenburg sign preoperatively,at the last follow-up 9 patients got improvement.Twelve patients (13 hips) had limitation of abduction of the hip,the average range of abduction was 25.38°±1.20°,which was improved to 45.38°±1.05° at the last follow-up.The average articulotrochanteric distance and ratio of the distance from the greater trochanter tip to femoral head center and the radius of the femoral head at the last follow-up was (17.47+3.14)mm and 2.10±0.21,respectively,there were statistical differences compared with those before operation [(-2.89±4.62) mm and 1.59±0.22,respectiovely].The average leg-length discrepancy at the last follow-up was (0.78t±0.26) cm,which had on statistical differences compared with that [(0.83 ±0.33) cm]before operation.Conclusion Greater trochanteric transfer for the treatment of coxa brevis in children and adolescents could improve the clinical symptom,recover the normal anatomy of the proximal femoral,restore the hip biomechanics environment,but could uot improve the leg-length discrepancy.

An autopsy case of sudden death induced by alimentary tract hemorrhage was presented, which was caused by the unexpected rupture of clinically unrecognized tuberculous abdominal aortic a-neurysm (TAAA). The initial diagnosis was made of the syndrome of coronary heart disease and hyper-tensive disease. The detailed autopsy showed that the alimentary tract hemorrhage was caused by a sud-den rupture of the mass after posture changing was ascertained as the cause of death. The diagnosis of TAAA was determined by the autopsy findings. Analysis for the medical dispute of TAAA was de-scribed, and the difficulty of the diagnosis and medico-legal implications were also discussed.

OBJECTIVETo search for a convenient and effective needling method for treatment of hiccup.

METHODSNinety-four cases were randomly divided into treatment group treated by acupuncture at Tianding (LI 17) and a control group treated by selected routine acupoints, 47 cases in each group. They were respectively treated based on differentiation of symptoms and signs for less than 10 sessions, and their therapeutic effects were compared.

RESULTSThe therapeutic effects on primary excess syndrome of intractable hiccup in the two groups were superior to that secondary deficiency syndrome (both P < 0.05); there was no significant difference between the two groups in the therapeutic effect (P > 0.05).

CONCLUSIONAcupuncture at Tianding (LI 17) is a convenient method for hiccup with a definite therapeutic effect.

Acupuncture Points ; Acupuncture Therapy ; Hiccup ; therapy ; Humans ; Syndrome

Objective To investigate the state of endemic fluorosis, running status of water improvement project to reduce fluoride in Jiangsu province, and to provide a scientific basis for prevention and control of endemic fluorosis. Methods In 2008, in the ten key counties of endemic fluorosis (zone), in Xuzhou,Lianyungang and Suqian, a stratified sampling method was employed to select 40 diseased villages according to their past water fluoride survey data. All children aged 8 to 12 were examined dental fluorosis, and all adults over 16 years were examined clinical skeletal fluorosis. Thirty per cent of the 40 diseased villages were selected, and 20 adults over the age of 16 in each selected village were examined by X-ray, respectively;50% of the 40 diseased villages were selected, and 30 any time urine samples of children aged 8 to 12 in each diseased village were tested urine fluoride. In each city, select a county, the status of water improvement project to reduce fluoride, water supply capacity and coverage in the county were investigated. Results A total of 3560 children aged 8 to 12 were examined, the detection rate of dental fluorosis was 38.51% (1371/3560), tooth defect rate was 5.34% (190/3560), and dental fluorosis index was 0.8. Seven hundred and eight urine samples were tested, the median urinary fluoride was 1.47 mg/L and the range was 0.08 ~ 10.08 mg/L. Clinical detection of skeletal fluorosis was 21.3% among adults over the age of 16, and X-ray detection rate of skeletal fluorosis was 39.2% (123/314).Investigated a total of 248 facilities of centralized water improvement projects, no funds to run or damaged 49, the water fluoride > 1.0 mg/L was 18. Conclusions Endemic fluorosis in Northern Jiangsu province has not been controlled completely, but has a rising trend, we should further strengthen the supervision of water fluoride reduction.

An autopsy case of sudden death induced by alimentary tract hemorrhage was presented, which was caused by the unexpected rupture of clinically unrecognized tuberculous abdominal aortic aneurysm (TAAA). The initial diagnosis was made of the syndrome of coronary heart disease and hypertensive disease. The detailed autopsy showed that the alimentary tract hemorrhage was caused by a sudden rupture of the mass after posture changing was ascertained as the cause of death. The diagnosis of TAAA was determined by the autopsy findings. Analysis for the medical dispute of TAAA was described, and the difficulty of the diagnosis and medico-legal implications were also discussed.
Aneurysm, Ruptured/diagnosis* ; Aortic Aneurysm, Abdominal/diagnosis* ; Autopsy ; Death, Sudden ; Hemorrhage/etiology* ; Humans ; Tuberculosis/diagnosis*

Objective To discuss biomechanical mechanism of reconstructed joint capsule ligament stabilizing hip joint by means of three-dimensional finite element analysis.Methods A finite element model of total hip arthroplasty(THA)including ischiofemoral ligament reconstruction was construtted by using finite element analysis software Unigraphics NX 2.0 and SolidWorks 2006 to simulate seated leg crossing and obtain peak resisting moment and range of motion prior to impingement.Results The current form of finite element model was characterized by large deformation multi-body contact,large interfacial sliding and high elasticity and could clearly reflect real anatomy and biomechanical behavior of ischiofemoral ligaments.Compared with model with only metal,model of ischiofemoral ligament reconstruction could reduce the peak polyethylene stress at the impingement site and at the head egress site by typically 17%and 31%respectively,increase peak resisting moment by nearly 57%and provide 2.29-fold stability.Conclusions As a discrete structure within the posterior capsule of the hip joint,the ischiofemoral ligament may be the most important contributor to the mechanical integrity of the posterior stability structure.The joint capsule ligament must be reconstructed in hip arthroplasty.

OBJECTIVETo find an effective operative procedure against reflux after esophagogastric anastomosis with mucosal valve.

METHODSFour hundred and sixty-four patients with esophageal or cardiac cancer were randomly divided into three groups according to anastomosis modes. Group A underwent esophagogastric anastomosis with mucosal valve (175 cases), group B with mechanical stapler (151 cases) and group C one layer anastomosis with handcraft suture (138 cases). The gastroesophageal reflux index (GERI) was examined by isotope,and 24 h esophageal pH was also monitored. The esophageal motor function was compared among three groups.

RESULTSThe reflux rates were 0, 33.3%, and 6.7% in group A, B, C respectively. The esophageal motor function and the 24 h esophageal pH monitoring indicated that the various indexes were approaching to the normal level in group A, but the various indexes in group B and C were significantly different from the normal values (P< 0.05).

CONCLUSIONThe esophagogastric anastomosis with mucosal valve has better antireflux effect and can prevent the reflux esophagitis after esophageal or cardiac cancer eradication.

Adult ; Aged ; Anastomosis, Surgical ; methods ; Esophageal Neoplasms ; therapy ; Esophagus ; surgery ; Female ; Gastroesophageal Reflux ; prevention & control ; Heart Neoplasms ; therapy ; Humans ; Male ; Middle Aged ; Mucous Membrane ; surgery ; Stomach ; surgery

OBJECTIVETo determine if miniprostheses would form a capsule of significantly different biophysical, biochemical and histologic properties than the conventional silicone implant.

METHODSFour miniprostheses (experimental group) and one big silicone implants (control 1 group) were separately implanted beneath the panniculus carnosus muscle of 30 rabbits. After 3 months, measures related to contracture and capsular histology were performed on anesthetized animals.

RESULTSBaker ranking, capsular incision width and capsular thickness of the control groups were evidently higher than that of experimental groups (P < 0.01). Implant compression of the control groups was evidently lower than that of the experimental group. Histology revealed a thinner, more flexed capsule around the miniprostheses as compared with big silicone implants.

CONCLUSIONSThe miniprostheses form a looser and thinner capsule than the conventional silicone implant.

Animals ; Breast Implantation ; adverse effects ; Breast Implants ; adverse effects ; Contracture ; pathology ; Female ; Postoperative Complications ; pathology ; Rabbits

OBJECTIVETo explore the use of triamcinolone acetonide for the prevention of implant capsular contracture.

METHODS20 rabbits were randomly undivided into 2 groups of 10 animals each. Every 10 ml silicone implant was implanted beneath the panniculus carnosus muscle of one rabbit. At the same time, a modified expander catheter was mounted on the implant. This catheter has many lateral holes and the end was blind. Triamcinolone acetonide (10 mg/3 ml) was infused through the expander pot and catheter as the experimental groups. On the other hand, 3 ml saline was used as the control group at 1, 2, and 3 months. At 6 months, measures related to contracture and capsular histology examinations were performed on anesthetized animals.

RESULTSBaker scores, capsular incision width and capsular thickness of the saline groups were evidently higher than that of triamcinolone acetonide groups (P < 0.01). Implant compression of the saline groups was evidently lower than that of triamcinolone acetonide group. Histology revealed a thinner capsules and less fibrous tissue deposition around the triamcinolone acetonide group, as compared with saline group.

CONCLUSIONSIt is effective to deliver triamcinolone acetonide to reduction of capsular contracture through the catheter and its pot.

Animals ; Breast Implantation ; adverse effects ; Contracture ; etiology ; prevention & control ; Female ; Postoperative Complications ; prevention & control ; Rabbits ; Triamcinolone Acetonide ; therapeutic use