0.05) both in AFS assay and MTT assay to detect the apoptosis of the cell lines. However, there was significant difference ( P

Ojective To study the application and the effect of extrathoracic minimally invasive surgery on the patients with mediastinal mass. Methods The therapeutic result of 6 cases of mediastinal mass resected through minimal extrathoracic approach were retrospectively reviewed. Results 6 patients underwent successfully operation and recovered smoothly without any complication or operation death. A following up period lasting two years showed that no recurrence or metastasis occurred. Conclusions Extrathoracic minimally invasive surgery has the advantages of minimal invasion, quicker recovery and complete resected tumor. It may substitute the classical thoracotomy and could obtain the same therapeutic in the selective cases.

Objective: To explore the application value of multi-slice spiral CT based on low dose technique in diagnosis of rib fracture. Methods: 58 patients with highly suspected rib fracture patients were examined by DR and multi-slice spiral CT. 3D reconstruction were finished after MSCT examination at the workstation, including MPR(multi-planar reconstruction), and volume rendering technique(VR). And the results were compared between DR and CT. Results:58 patients all successfully completed the chest X-ray film and multi-slice spiral CT examination. Multi-slice spiral CT image quality fully met the requirements of clinic. It can not only diagnose, but also display the number, location and morphology of rib fracture. 45 cases were diagnosed with chest DR rib fracture and suspected fracture, and the positive rate was 77.59%(45/58). 56 cases were definitely diagnosed with multi-slice spiral CT scanning and three-dimensional reconstruction rib fracture, and the positive rate was 96.55%. Conclusion: The patients can receive lower dose and the tube can be used for a longer time by low dose technique. 3D reconstruction techniques of multi-slice spiral CT not only improve the accuracy of diagnosis, but also display rib fracture morphology clearly, so its clinical value is much higher than DR.

The cingulate cortex, especially its anterior portion has been found to be connected with the head of the caudate nucleus in our previous study. In order to ensure accurate placement of adequate amounts of HRP in the cingulate cortex, a microiontophoretic delivery technique coupled with single cell recording was employed. The use of electrophysiological criteria as aids in placing the injection is described in detail. It was found that the influence of the caudate neuron was inhibitory, and the cingulate neurons responded with monosynaptic IPSPs to caudate neuron stimulation. Following HRP injections into the cingulate cortex, the retrogradely labeled cells were found in the head of the caudate nucleus. It is obvious that some neurons of the head of caudate nucleus which have inhibitory effect on unit discharge of the cingulate cortex project to the anterior portion of the cingular cortex.

BACKGROUNDLung cancer is still the most common cause of cancer death. Although it is reported that the 5-year survival rate for lung cancer has been greatly increased, surgical results are controversial. The aim of this study is to investigate and evaluate the improvement of survival of lung cancer surgically intervened in PUMC hospital during the last 15 years.

METHODSFrom January 1989 to December 2003, 1574 cases of lung cancer underwent surgical treatment and obtained follow-up. The results were retrospectively a- nalysed . All cases in this series were divided into two groups according to time, group A (1999-2003) and group B (1989-1998), and the differences of survival rate between group A and group B were compared.

RESULTSThe morbidity and mortality of group A decreased significantly when compared to group B (11.2% vs 19.2%, 1.06% vs 1.93%, respectively, P < 0.01). However, the 3- and 5-year survival rates had been obviously raised from 42.35% to 56.07%, and from 28.46% to 38.99%, respectively (P < 0.05 ). A significant improvement in survival was observed in patients with stageI, stage II and stage IIIA, but not in stage IIIB and stage IV. Also, the patients with lobectomy had better results but those with exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection did not show better results.

CONCLUSIONSLobectomy associated with systematic dissection of mediastinal lymph nodes has become the standard mode for the resectable lung cancer. Combination of complete resection and lymph nodes dissection, with postoperative adjuvant chemotherapy based on platinum/3rd generation medicine, have preliminarily been justified and proved an important approach for effective improvement of long-term survival of lung cancer.

OBJECTIVETo understand the clinical manifestations, diagnostic methods, surgical management and prognosis of retrosternal thyroid masses in various pathological types.

METHODSSixty-four cases of retrosternal thyroid masses with surgical intervention were analyzed retrospectively.

RESULTSTrachea-compressed symptoms (65%) and shadows beside the trachea at thoracic inlet (94%) were the most common clinical findings, chest X-ray (70%) and CT scan (96%) had higher diagnostic rate. No death occurred during operation or hospitalization among these patients. Total complications occurred in 15.7% cases (11/70) (including 3 preoperative cases with hoarseness) and postoperative pathological results were mainly multinodular goiter (54.7%), thyroid adenoma (21.9%) and thyroid carcinoma (15.6%) (including local carcinomatous change).

CONCLUSIONSDiagnosis of retrosternal thyroid mass can be correctly made by chest X-ray and CT scan. Most operations on retrosternal thyroid masses can be performed safely through cervical incision with minimal morbidity and low recurrence rate. Retrosternal thyroid carcinoma was potentially invasive and could hardly be resected completely, hence with poor prognosis.

Adenoma ; diagnosis ; surgery ; Adult ; Aged ; Carcinoma ; diagnosis ; surgery ; Female ; Goiter, Nodular ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thoracotomy ; Thyroid Gland ; diagnostic imaging ; surgery ; Thyroid Neoplasms ; diagnosis ; surgery ; Thyroidectomy ; Tomography, X-Ray Computed

Objective:To introduce ulnar shortening oblique osteotomy combined with arthroscopy technique for ulnar impaction syndrome and to evaluate the outcomes.Methods:From August 2012 to January 2015, data of 25 cases with ulnar impaction syndrome who were treated in our hospital with oblique osteotomy of the ulna and internal fixation were retrospectively analyzed. There were 14 males and 11 females with an average age of 32.5±4.9 years old (range, 18-62 years). All 25 cases had wrist triangular fibrocartilage complex (TFCC) injuries. Intraoperative arthroscopy was conducted to investigate the pathologic changes of the articular disk of the triangular fibrocartilage complex (TFCC), chondromalacia of the lunate and triquetrum, and tears of the lunotriquetral interosseous ligament (LTIL), debridement of the synovial membrane and the free edge of the central perforation of TFCC, to remove the cartilage from the lunate and triangular bone, and to perform oblique osteotomy of the ulna and internal fixation after repairing of TFCC ulnar tear. We evaluated the outcomes by means of comparing the postoperative values of modified Mayo and visual analogue scale (VAS).Results:There were 5 cases of IB, 5 of IIA, 7 of IIB, 4 of IIC, 4 of IID according to Palmer's classification. All 25 cases were followed-up for 24.6±1.9 months (range, 12-46 months). All patients achieved bone healing with an average of 14.0±1.9 weeks (range, 12-20 weeks). The mean value of preoperative ulnar variation was 3.8 ±1.5 mm which decreased to -1.5±0.5 mm after operation. The preoperative VAS was 7.8±0.7 which decreased to 1.3±1.5 at the latest follow-up. The modified Mayo value increased from 52.8±15.8 to 83.0±11.2. There were 19 cases with excellent wrist function, 5 good and 1 fair. The excellent-good rate was 96% (24/25). Grip strength value increased from 6.3±1.5 kg preoperative to 12.3±1.9 kg postoperative. There was no postoperative infection, delayed or nonunion of bone, but irritation of steel plate appeared in 10 patients, which disappeared after the removal of the steel plate.Conclusion:Arthroscopy combined with ulnar shortening oblique osteotomy technique for ulnar impaction syndrome can reduce wrist pain, increase hand grip strength, improve the activity of the wrist joint, and the clinical effect is positive.

Objective:To evaluate the efficacy of arthroscopic minimally invasive reduction in the treatment of talus posterior process fractures.Methods:The clinical data were retrospectively studied of the 42 patients with talus posterior process fracture who had been admitted to Department of Orthopedics, The Fourth Hospital of Wuhan from January 2010 to June 2021. There were 25 males and 17 females, aged from 21 to 60 years (average, 40.5 years). They were assigned into 2 groups according to their different treatments. In the arthroscopic group of 15 cases, arthroscopic reduction and internal fixation (ARIF) were conducted via the posteromedial and posterolateral approaches; in the open reduction group of 27 cases, open reduction and internal fixation (ORIF) were conducted via the posteromedial para-Achilles approach. The 2 groups were compared in terms of operation time, blood loss, hospital stay, fracture clinical healing time, postoperative complications, and the American Society for Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at one year postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P> 0.05). The arthroscopic group incurred significantly less blood loss [(32.0±11.5) mL], hospital stay [(5.3±1.8) d], and fracture clinical healing time [(4.6±1.0) months], and a significantly lower incidence of postoperative complications [20.0% (3/15)] than the open reduction group did [(80.0±15.2) mL, (8.4±2.4) d, (6.3±2.2) months, and 29.6% (8/27)], but significantly longer operation time [(74.0±8.9) min] than the open reduction group [(62.9±5.1) min] ( P<0.05). The AOFAS ankle-hindfoot scores at one year postoperation in both groups were higher than those before operation. The AOFAS ankle-hindfoot scores in the arthroscopic group [(83.0±13.0) points] were significantly higher than those in the open reduction group [(72.3±16.0) points] ( P<0.05). Conclusion:ARIF is a preferred minimally invasive treatment for talus posterior process fractures, because it leads to a smaller incision, less blood loss, shorter hospital stay, quicker clinical healing, a lower incidence of postoperative complications, and better functional improvement of the ankle and hindfoot than ORIF.

OBJECTIVETo study the clinical manifestations, diagnostic methods, surgical management and prognosis of patients with neurogenic tumors of the mediastinum.

METHODOne hundred and ten patients with neurogenic tumors of the mediastinum were analyzed retrospectively.

RESULTSAfter operation, 2 patients died in hospitalization and 8 experienced such complications as Horner's syndrome or laryngeal recurrent nerve paralysis. In 102 patients with benign tumors, 2 patients had recurrence, and 4 patients with neurofibrosarcoma or malignant neurilemmoma died within 3 years postoperatively.

CONCLUSIONSMost neurogenic tumors of the mediastinum are benign and could be diagnosed by chest X-ray or CT. The clinical manifestations, diagnosis methods, surgical management of the dumbbell tumors differ from others. Minimal invasive surgery and video assist thoracoscopy surgery are of special value in treatment of the selected neurogenic tumors of the mediastinum. Benign neurogenic tumors rarely recur after complete resection, and malignant neurogenic tumors have poor prognosis.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Mediastinal Neoplasms ; diagnosis ; mortality ; surgery ; Middle Aged ; Neurilemmoma ; diagnosis ; mortality ; surgery ; Neurofibroma ; diagnosis ; mortality ; surgery ; Prognosis ; Retrospective Studies

Objective To investigate the diagnosis and surgical therapy of delayed diaphragmatic rupture.Methods Forty patients with traumatic diaphragmatic rupture with delayed presentation were collected in Peking Uniom Medical College Hospital from January 2000 to December 2016.In all 40 patients, 36 patients had traumatic past history, 32 patients had clini-cal manifestations when diagnosed.Left-sided diaphragmatic rupture was found in 32 patients and right in 8 patients.1 patient received emergency surgery and 39 received selective surgery.38 patients received transthoracic surgery and 2 patients received combined thoracic-abdominal surgery.36 patients received direct diaphragm suture and 4 patients received patch repair.Re-sults All patients were recovered from the hospital.The median length of postoperative hospital stay was 11 days( range, 5-26 days).1 patient was found intestinal obstruction and received enterolysis 19 days after surgery.Conclusion Delayed traumat-ic diaphragmatic rupture is a rare but serious disease.Careful past history, physical examination and CT scan with reconstruc-tion of diaphragm are helpful in diagnosis and differential diagnosis.Surgical therapy after diagnosis is the best treatment.