Thirty three tibial fractures treated with interlocking intramedullary nail(IMN) were reviewed. Of all the patients, 16 were fixed with reamed IMN, and 17 with nonreamed IMN. There were 22 closed and 11 open fractures. Twenty seven patients were followed up for an average of 17.9 months (4 to 31 months). Of all the patients, 22 healed in 6 months, delayed healing occurred in 1,and in 1 the distal locking screw was broken. In the close fractures, the mean time from fracture to operation was 3.55 days (from the injury day to 27 days) , and in the open fractures operation was all done on the day of injury. Nonreamed IMN was used in 12 closed fractures (54.5%, 12/22 ) , and reamed IMN was used in 4 open fractures (36.3%, 4/11). There was no postoperative compartment syndrome or infection. The interlocking intramedullary pin is indicated for the tibia fractures, and early operation is feasible . The nonreamed interlocking intramedullary pin is suitable for open fractures and multi injuries.

Objective To introduce the donor heart preservation techniques and study the clini- cal results in 26 patients undergoing orthotopic heart transplantations with long donor ischemia time (DIT) in our center.Methods From Sept.2004 to Aug.2006,26 patients underwent orthotopic heart transplantation at our center with DIT longer than 360 min.Crystalloid cardioplegia was infused through aortic root after aorta was cross clamped.UW solution was used when donor heart was removed.All patients underwent bicaval anastomotic cardiac transplantation.NO was inhaled through ventilator during and after operation in patients with pulmonary hypertension.Results DIT was 360- 560 (mean 401?43) min.There was no operative death in this group.Echocardiography and X-ray examinations in one month were normal.One case of abnormal coronary orifice was subjected to re- anastomosis of aorta.One case of renal failure post-operation was subjected to blood dialysis.Conclu- sion With proper donor heart procurement and preservation,recipient selection,anastomotic technique,efficient postoperative surveillance and pulmonary hypertension treatment,transplanted patients with long DIT can obtain the satisfactory short-term outcome.

Objective To study the advantage and disadvantage of two types of rat heart trans- plantation models.Methods Twenty Wistar rats served as donors and 20 SD rats as recipients ran- domly in two groups.Abdominal working and nonworking cardiac transplantation models from Wistar to SD rats were established.In the working model,the donors pulmonary artery was anastomosed to the left atrial appendage.The left ventricle ejected volume through an end to side anastomosis of the donor's aorta to the recipient's abdominal aorta.In the nonworking cardiac transplantation model,the donor's pulmonary artery was anastomosed to the recipient's inferior vena cava and the donor aorta was anastomosed to the recipient aorta.Results Working model and nonworking model were successfully established.The survival rate of both models was 90 %.Total operating time of the working model was 10 min shorter than the nonworking model.Postoperative UCG demonstrated the working trans- planted hearts had ejection.Conclusions Rat abdominal working cardiac transplantation model was used perfectly with high rate of survival and shorter total operating time.The working model approached cardiac physiological functions more than the nonworking model.

BACKGROUND:Hidden blood loss, after total knee arthroplasty, attracts surgeons’ attention. There are various hypotheses about etiopathogenisis of hidden blood loss, but no one can reasonably explain its mechanism. OBJECTIVE:To research the correlation of free fatty acids and hidden blood loss after total knee arthroplasty, and explore the etiology and mechanism of hidden blood loss after total knee arthroplasty. METHODS:Clinical data of 42 osteoarthritis patients who underwent primary unilateral total knee arthroplasty were colected in this study. Intraoperativeand postoperative dominant blood loss was recorded. Blood samples were colected preoperatively and 24, 48, 72, and 96 hours postoperatively. Changes in hemoglobin, erythrocyte count, hematocrit and free fatty acids were detected in blood. Hidden blood loss was obtained by Gross equation. Simultaneously, stains were added to the blood smear. Changes of cels morphology were observed under a microscope. RESULTS AND CONCLUSION:(1) Hemoglobin and erythrocyte count decreased significantly at 24 and 48 hourspostoperatively, and significant differences were determined as compared with that preoperatively (P< 0.01). (2) Free fatty acids levels increased significantly within 24 hours after surgery, and decreased to preoperative levels at 72 and 96 hours later.Hidden blood loss was also significant at 24 and 48 hours after surgery, which showed positive correlation with free fatty acids content. (3) A plenty of abnormal erythrocytes were observed under the microscope. At 24 and 48 hours postoperatively, erythrocyte shrinkage and damage were mainly presented. At 96 hours, no significant abnormality was found. (4) These results indicated that free fatty acids were strongly associated with postoperative hidden blood loss. Surgeon should pay attention to the fatty droplets which may enter into the circulation in the process of reaming the femoral canal so as to reduce intraoperative total blood loss.

Aged ; Female ; Humans ; Lymphoma, Large B-Cell, Diffuse ; pathology ; Urinary Bladder ; pathology

Objective To discuss the common causes for postoperative complications after treatment of spinal fractures and their preventive measures.Methods To analyze the 32 failed eases who received internal fixation for their thoracolumbar fractures between July 1998 and April 2005 in our department.Their preoperative and postoperative results of X-ray,CT and MIR examinations were reviewed to find out the causes for failure.Three of them were treated through anterior approach and 29 through posterior approach.Eighteen screws broke in eight eases, the rods got loosened in eight cases and broken in four cases,15 pedicte screws were mis-located in eight cases and the implants got loosened in three cases.Results Thirty patients had to get a reoperation.Two were cured through non-surgical treatment.The causes for failure were found to be as follows:1,incorrect operation approach;2,in- stability of the front-middle colunm;3,unskillful operation;4,ignorance or the lesion to the adjacent vertebral discs; 5,flaws in pedicle screw design.Conclusion To prevent postoperative complications after internal fixation for spinal fractures,surgeons should strictly stick to the indications before operation,choose a proper approach and method for internal fixation,try to stabilize the front-middle column by the first intention,and have a good command of anatomy and operation skills.

Objective To investigate the inhibitory effect of paclitaxel on rat graft arteriosclero- sis and the mechanism.Methods The rat abdominal aortic allograft model was used.All rats were divided into three groups:isograft control group (Wistar to Wistar),allograft group (Wistar to SD) and allograft paclitaxel-treated group (Wistar to SD).Rats in allograft paclitaxel-treated group re- ceived paclitaxel (2 mg?kg~(-1)?d~(-1)) from the operation day to post-operative day 14 and others received same dosage of vehicle (0.9% normal saline).Animals were sacrificed and the grafts were harvested at 30th day after operation.Intimal proliferation was studied by light microscopy.The apoptosis of vascular smooth muscle cells (VSMCs) was detected by transmission electronic microscopy and termi- nal deoxynucleotidyl transferase biotin nick end-labeling (TUNEL) method.Results Morphological analysis showed that grafts had no change after operation in isograft control group,but in allograft group intimal proliferation,inflammatory cells infiltration in neointima and adventitia and stenosis of allografts were obvious.After treatment with paclitaxel,there was a significant decrease in intimal proliferation,inflammatory cells infiltration and stenosis.Apoptosis index of VSMCs was higher in the allograft paclitaxel-treated group than other groups.Conclusion Paclitaxel can inhibit intimal pro- liferation in aortic allografts and prevent the graft from arteriosclerosis possibly by inducing the apoptosis of VSMCs.

Adolescent ; Humans ; Male ; Neurofibroma, Plexiform ; Neurofibromatoses ; Parotid Neoplasms

BACKGROUND:In the animal model of spinal cord injury associated with fractures, the trauma is severe and postoperative survival rate is low. The improved Al en method and open femoral osteotomy method for making animal model has many advantages, such as simple operation, no need of special equipment, quick establishment, shortened operation time and reduced intraoperative bleeding, so they are suitable for preparing a femoral fracture model combined with spinal cord injury.
OBJECTIVE:To design an animal model of femoral fracture combined with spinal cord injury, which can maintain long time survival, meet clinical features, and is simple and easy.
METHODS:Forty-eight male Sprague-Dawley rats were randomly divided into simple femoral fracture group and femoral fracture merging spinal cord injury group. Femoral fracture model was caused by opening osteotomy to cause transverse fracture and implantation of internal fixator in femur. According to the improved Al en method, a self-made blow device was applied to cause acute T 10 segment contusion injury of spinal cord in rats. Thus the femoral fracture model merging spinal cord injury was successful y established. The rats in two groups were grossly observed at different time points after the modeling, and the fracture healing at 4 weeks was detected.
RESULTS AND CONCLUSION:Al the animal models of femoral fracture with spinal cord injury survived, which exhibited the loss of sensory and motor function of the lower limbs, but could slowly creep forward by the upper limbs. In the first 3 days, the rats had poor appetite and few activity, with tail suspension at night there were no ischemia and necrosis of the limb fracture. At 4 weeks, one rat in simple femoral fracture group died, while four rats in femoral fracture merging spinal cord injury group died, with the survival rate of 83.33%, intramedul ary fixation were not prolapsed. In the two groups, continuous bone cal us formation was found in the fracture, and the bone cal us volume in femoral fracture merging spinal cord injury group was significantly higher than those in simple femoral fracture group. The results demonstrated that combining the improved Al en method with smal lateral incision open femoral osteotomy is a simple and feasible method for the establishment of femoral fracture model merging spinal cord injury, and the models survive for 4 weeks.

28 days after injury (P < 0.05). In the fracture+spinal cord injury group, the level of serum transforming growth factor beta 1 had a rapid increase on the 7th day, and reached the peak on the 14th day, and then, this level had no significant decrease until the 28th day. In the simple fracture group, the level of serum transforming growth factor beta 1 began to increase on the 2nd day, reached the peak on the 7th day, and then decreased gradualy. Remarkable changes of serum transforming growth factor beta 1 levels in patients with bone fracture combined with spinal cord injury may be associated with fracture healing in different periods.