Acupuncture Therapy ; Adult ; Aged ; Combined Modality Therapy ; Female ; Femur ; blood supply ; Humans ; Male ; Middle Aged ; Moxibustion ; Osteonecrosis ; therapy

Objective To investigate the diagnosis,treatment and prevention strategies of pharyngostoma and esophagostoma caused by anterior cervical spine surgery.Methods A retrospective analysis were performed in 17 cases of anterior cervical operation complicated with pharyngeal and esophageal fistula from 1999 March to 2010 June,including 11 male cases and 6 female cases,aged from 7 to 67 years with the mean age of 44.23 years.16 cases (94％) got inflammation of anterior cervical surgery incision and throat pain.2 cases (11％) accompanied by high fever,whose body temperature was as high as 39.2° and incision particles or liquid flew after eating.17 cases underwent upper gastrointestinal radiography,and regular oral methylene blue.Barium overflew from fistula in 2 cases (11％) after upper gastrointestinal tract barium meal angiography,while methylene blue overflew from incision in 7 cases (41％) after oral methylene blue.Through X-ray examination,gas fistula before vertebral was visible in 14 cases (82％).A diagnosis can be made by outflow through fistula after barium esophagography or oral administration of methylene blue.For unknown but highly suspected pharyngeal and esophageal injury,operation can be confirmed if no improvement of symptoms was found after fasting,nasogastric or parenteral nutrition,and ant-infection treatment for 1 week.Results All of 17 patients underwent surgical treatment.During operation,fistula dot or small irregular shape can be seen in 8 cases;long stripe in 3 cases;boundary not clear or irregular in 2 cases;adhesion around the fistula of anterior cervical fascia,similar to tear in 1 case;two fistula in 1 case;fistula located in pharynx posterior wall or esophageal which was not clear or fistula of unknown reason in 2 cases (fascia might be not at the same side of incision or fascia was small and already closed).Pharynx posterior wall and esophageal fistula was found in 3 cases during surgical exploration,which was immediate sutured and placed with drainage tube.After 7 to 14 days,if flow was less than 30 ml,and no bacterial growth was found in 3 consecutive drainage fluids,we pull out the tube.Patients who underwent nasal feeding for 2 to 3 weeks,and then took liquid diets complained nothing,and cured after 1 month.12 cases underwent debridement,stitching fistula,irrigation and drainage tube placement instantly.The wash pipe was removed after 12 to 21 days and 3 consecutive drainage fluids showed no bacterial growth.Then 2 to 3 days later the drainage pipe was pull out.Two to three months later these patients healed.2 cases firstly underwent debridement and suture or part suture,and then the incision was opened and filled with nitrofurazonium gauze tamponade.Gradually pull out the filling gauze and change the dressing of wound.If the residual cavity was large or the drainage was pus,flush the wound with physiological saline once a day,then three times a week,and finally once a week.These patients healed after 6 to 12 months.Pharyngostoma or esophagostoma of all patients was found timely,and active surgical treatment was performed,so no obvious complications was found postoperatively.All 17 patients recovered and resumed diet after 1 to 12 months postoperatively.Conclusion Pharyngeal and esophageal fistula is a rare but severe complication after anterior cervical surgery,which seriously affect the effect of operation and even lead to death.Early diagnosis and active intervention can obtain satisfactory curative effect.

ObjectiveTo observe the clinical value of serum prealbumin in patients with chronic schistosome.Methodsone hundred and twenty six patients with chronic schistosome in the Gastroenterology Department and 40 healthy people in the Physical Examination Center of the First Hospital of Wuhan were enrolledin the study.Serum prealbumin(PA) and albumin(ALB) in healthy controls and patients with chronic schistosome before therapy and 1 st,2 nd,4 th weeks after therapy were detected and analyzed.ResultsBefore therapy,PA and ALB [(223.9 ± 43.2)mg/L, (41.5 ± 5.8)g/L] of patient group were lower than that of the control group [(314.5 ± 53.6)mg/L,(47.2 ± 6.9)g/L,t =4.527,2.786,respectively,all P＜ 0.05].After therapy,PAs of patient group at the 1 st,2 nd,4 th weeks [(245.8 ± 41.7),(258.3 ± 47.2),(282.9 ± 49.3)mg/L] were higher than that before the therapy (t =3.092,3.789,4.230,all P ＜ 0.05).ALB of patient group at the 1 st,2 nd,4 th weeks [(41.1 ± 4.7),(41.4 ± 5.2),(44.8 ± 4.5)g/L] were not significantly different compaired to that before therapy(t =0.123,0.119,0.156,all P ＞ 0.05).ConclusionsPrealbumin could quickly and sensitively respond to the changes of liver function.It could be used in the judgment of curative effect and prognosis of patients with schistosome.

Alternaria zinniae was a plant fungal pathogen isolated from a world-wide weed Xanthium occidentale,which could cause some weeds of Asteraceae disease. It was found that the fungus made disease spot on the leaf through producing secondary metabolite—phytotoxin. The toxin-producing capability of the fungus was studied. The optimal cultural conditions for producing phytotoxin were temperature 25℃,pH 6.5,cultured period 9~11d,rotating speed 110r/min,darkness and enough dissolved O_2,crude toxin was obtained through large scale fermentation. Analysis on the influence of time,temperature,lightness for storing on the stability of phytotoxin of Alternaria zinniae showed that the phytotoxin had the potential to develop as a herbicide originating from microorganism.

Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD),and to explore the indications and crucial techniques of posterior approach.Methods All of 17 Consecutive patients (8 males and 9 females) with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study,the mean age was 35.2±13.8 years with a range of 12-56 years.The clinical symptoms and signs was recorded,and preoperative imaging examination,including anteroposterior,lateral,dynamic films,MRI and CT of cervical spine,were performed to identify the series.There were 14 cases with atlanto-occipital fusion,7 cases with C2,3 fusion,6 cases with Chiari malformation,6 cases with Syringomyelia,and 8 cases with myelomalacia.The clinic symptoms include occiput/neck pain in 15 cases,cervical movement limitation in 13 cases,short neck in 9 cases,torticollis in 12 cases,Paresthesia in 14 cases,weakness in 13 cases,tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases.The postoperative X-rays,MRI or CT were used to observed the results of decompression,fixation and fusion.Neurological function was assessed by JOA scale and Ranawat's score before,after surgery and at final follow-up.Pre-and post-operative Chamberlain (CL),Wackenheim (WL),McGae (ML),atlantodental interval (ADI) and cervico-medullary angle (CMA) were analyzed by student t-test.Results The average operation time was 145 mins (90-210 mins) and blood loss was 175 ml (150-350 ml).The average follow-up was 44.47 months (9-94 months).JOA score was increased from 8.06 preoperatively to 15.20 postoperatively,the improvement rate was 77.2％.Preoperative Ranawat's score was Ⅱ in 1 case,Ⅲla in 12 cases,ⅢB in4 cases.Postoperative score was Ⅰ in 13 cases,Ⅱ in 4 cases.The preoperative CL,WL,ML,ADI and CMA were (12.52±5.17) mm,(6.59±3.04) mm,(6.96±4.32) mm,(9.88± 1.93) mm,115.35°± 12.40°,respectively.and the postoperative CL,WL,ML,ADI and CMA were (2.0±3.67) mm,(-3.06±1.85) mm,(-1.76±2.88) mm,(1.17± 1.18) mm,136.76°±11.44°,respectively.The perioperative complications were discovered in 2 cases,including 1 case of infection and1 case of cerebrospinal fluid(CSF) leakage.Conclusion Primary surgery of nerve release and bone reduction by posterior approach may be safe and efficient for the treatment of BI and IAAD.Preoperative evaluation,proper surgical indications and advanced surgical techniques are important for treatment results.

Objective To investigate the management and outcome of cerebrospinal fluid leakage(CSFL)complicating anterior cervical surgery.Methods1052patients were performed anterior cervical surgery between October1997and October2002.Of 1052cases,926cases were of cervical spondylotic myelopathy(CSM),and126of ossification of posterior longitudinal ligament (OPLL).11patients suffered from cerebrospinal fluid leakage during operation.There were8males and3females aging from46to72years(average,58years).In the group of CSM,there were2cases of CSFL(0.22%)occurred in resection of osteophyte of the posterior vertebral edge,who were serious CSM of C 4,5 and C 5,6 with severe anterior compression by osseous mass to spinal cord showed on MRI.In the group of OPLL,there were9cases of CSFL(7.14%)occurred in resection of the ossified posterior longitudinal ligament accompanied with severe spinal canal stenosis and anterior compression to spinal cord on radiological imagings,4of them were con-tinuous OPLL from C 2 to C 6 combined with herniation of cervical disc,3segmental,and2mixed.Results The defect area of spinal dura were(0.6～2.0)cm?(1.0～1.5)cm.The cerebrospinal fluid was blocked with fascia and absorbable gelatin sponge during the operation.If CSFL was persistent more than3days after oper-ation,expectant treatment was performed.After the operation,no CSFL occurred in8of 11patients,and the other3cases with postoperative CSFL were cured5,14and17days by dressing change,blocking the wound with gelatin sponge,and suturing of the wound respectively.All patients were followed up for 10to62months(mean,26months).No cerebrospinal fluid cyst and infection occurred.There were no significant negative effects of CSFL on the recovery of neuromuscular function.Conclusion CSFL following cervical anterior surgery can be cured by blocking up leakage of spinal dura during operation,however,conventional conservative treatment including of dressing change,antibiotics administration,horizontal position with low pillow are necessary after operation.

Acupuncture Therapy ; Adult ; Female ; Humans ; Laryngitis ; therapy

BACKGROUND:Open reduction is general y not advocated for the treatment of children clavicle fracture, because the thick and tough periosteum remains intact and attached by the ligament attachment. In clinic, twin-ring external fixation and simple suspension are commonly used, but there is no reliable basis on which method can get better effect.
OBJECTIVE:To compare the stability of twin-ring external fixation and simple suspension for the treatment of children clavicle fracture.
METHODS:The patients with children clavicle fracture and treated by twin-ring external fixation and simple suspension were selected from June 2008 to December 2012, including 17 patients treated with simple suspension and 22 patients treated with twin-ring external fixation. The X-ray film examination was performed regularly to observe the fracture healing and shoulder function.
RESULTS AND CONCLUSION:The 17 patients treated with simple suspension had good healing;three cases had gap between fracture ends at 1 week after treatment, and re-suspension to increase the height and final y two fracture ends contacted in one case;for the other two cases, there was stil gap between fracture ends, and changed for twin-ring external fixation, the fracture ends contacted. Al the 22 patients in the twin-ring external fixation group obtained healing;five cases had performance of upper extremity neurovascular compression on the fracture side after fixation;after releasing, three cases had recovery, and two cases were treated with simple suspension, the fracture ends began to contact;six cases had armpit redness;four cases had early sleep difficulties;two cases had gap between fracture ends at 1 week after treatment, and after re-adjust, the fracture ends contacted in two cases. The results showed both two methods could not cause appearance deformity, and both could get healing. The simple suspension fixation is easy to operate with reliable effect, and it is comfortable which make it easy to accept by the children, it has the advantages of early for functional exercise, less tissue damage, does not affect the blood supply;the twin-ring external fixation is easy to compress the axil ary arteries and nerves on both sides, thus resulting in upper extremity swel ing, numbness and skin redness, and it can cause discomfort night sleeping and poor comfort which is not easy for children to accept. But, no matter what method we take, the review after 1 week, as wel as the line between proximal and distal part and the contact between fracture ends is stil important.

BACKGROUND:Due to the emergence of drug-resistant tuberculosis and mismanagement in tuberculosis patients,the incidence of delayed healing or recurrent after spinal tuberculosis surgery is gradualy increasing,especialy in strongly predisposal children.Therefore,exploring the risk factors of delayed healing orpost-operative recurrence in pediatric patients after spinal tuberculosis surgery,wil have significance in the prevention and treatment of tuberculosis.OBJECTIVE:To analyze the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis,and evaluate the efficacy of individualized re-operation.METHODS:From June 1998 to June 2013,clinical data of 145 pediatric patients with spinal tuberculosis were reviewed retrospectively,and some cases of delayed healing or post-operative recurrence in spinal tuberculosis were compared with other without delayed healing or post-operative recurrence.The patient's age,gender,nutritional condition,lesion debridement,history of chemotherapy and internal fixation,complicated spinal lesion,scope of lesions,preoperative erythrocyte sedimentation rate ＞60 mm/h,and postoperative complications were analyzed by Logistic regression analysis.The risk factors of delayed healing or post-operative recurrence were analyzed.After re-operation,erythrocyte sedimentation rate,C-reactive protein and imaging studies were detected.RESULTS AND CONCLUSION:After surgery,29 cases appeared delayed healing or post-operative recurrence and 12 of them received re-operation.The incidence of delayed healing or post-operative recurrence in pediatric spinal tuberculosis was 20％and the re-operation rate was 8.3％.Logistic regression analysis showed that,nutritional condition,history of chemotherapy,lesion debridement,and scope of lesions were significantly correlated with delayed healing or post-operative recurrence (P＜0.05).While patient's age,gender,history of internal fixation,complicated spinal lesion,preoperative erythrocyte sedimentation rate ＞60 mm/h,and postoperative complications had no correlation with the delayed healing or post-operative recurrence (P ＞0.05).Individualized re-operation can achieve good outcomes.Experimental findings indicate that,the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis are very complex,enhancing the nutrition,complete debridement of lesions,and receiving chemotherapy can effectively decrease the incidence.According to the initial surgery and patient's conditions,individualized re-operation is the key to the success.

Objective To investigate the effects of nutritional support on the hypermetabolism of patients with digestive tract fistula complicated with severe abdominal infection. Methods Twenty-nine patients with digestive tract fistula complicated with severe abdominal infection were administered parenteral nutrition (PN) for 4 to 8 days, and then followed by enteral nutrition (EN) or EN + PN. The body weight, serum albumin, transferrin, prealbumin, fibronectin were monitored before and on the 10th and 28th day after nutritional support. Results The levels of serum prealbumin and fibronectin were increased significantly on the 10th day after nutritional support (t = 3.72, 3.52, P <0.01). The body weight, the levels of serum albumin, transferrin, prealbumin and fibronectin were significantly higher than those before nutritional support (t=3.97, 6.57, 7.09, 3.51, 3.58, P<0.01). Conclusion Nutritional support is effective in alleviating hypermetabolism of patients with digestive tract fistula complicated with severe abdominal infection.