OBJECTIVETo evaluate the clinical effect of a new surgical approaches for repairing the acute Achilles tendon rupture.

METHODSFrom January 2009 to January 2014, 21 patients with Achilles tendon rupture were treated by 2 minimally invasive incisions and remaining skin bridge of achilles tendon end including 16 males and 5 females with an average age of 44.3 years old ranging from 21 to 57 years old. Postoperative complications, the range of movement of affected ankle joint, the circumference calf and ankle on both side, time of reture to work and sports activity were observed and recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate the functional recovery.

RESULTSAll patients were followed up for 6 to 36 months with an average of 13.5 months. No skin necrosis, wound infection, deep vein thrombosis,re-rupture and sensory disturbance with the ankle or foot in the sural nerve distribution were found. At 1 year after operation, there was no significant difference in the range of movement between affected foot (55.4 ± 6.5)° and unaffected foot (56.3 ± 3.7)° (t = 0.872, P = 0.325). There was significant difference in AOFAS between preoperative (65.1 ± 6.9) and postoperative (94.3 ± 5.5) (t = 7.672, P = 0.013). All patients returned to work and study at an average of 10 weeks (ranged from 6 to 15 weeks) and 15 patients returned to normal sports activities at 21 weeks (ranged from 18 to 24 weeks). Calf and ankle circumferences decreased by 0.45 cm (0.3 to 0.8 cm) and increased by 0.4 cm (0.2 to 0.7 cm), respectively in the injured leg as compared with the contralateral leg.

CONCLUSIONThe simplicity of the technique of minimally invasive incision and skin bridge for acute closed Achilles tendon reconstruction is an effective and reliable method with low complication.

Achilles Tendon ; surgery ; Acute Disease ; Adult ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Rupture

Objective To compare the clinical effect of different percutaneous endoscopic removal of nucleus pulposus vertebral plate gap into the road in the treatment of L5 and S1 lumbar intervertebral disc protrusion.Methods 120 cases with lumbar intervertebral disc protrusion in our hospital were randomly divided into group A and group B,60 cases in each group.Group A was given the intervertebral foramen mirror vertebral plate gap into the way,group B was given the posterior intervertebral disc mirror reserves the yellow ligament treatment.The operation time,number of perspective,intraoperative blood loss,length of incision,visual analogue scale (VAS),hospitalization days,Oswestey disability index (ODI) before and after surgery were compared between two groups.The curative effect was evaluated by the Macnab criteria.Results The operation time,number of perspectives,intraoperative blood loss,surgical incision length,VAS score,hospitalization days in group A were (58.69±5.26)min,(2.56±0.52)times,(80.23±20.45)mL,(1.63±0.33)cm,(2.95±0.77)points,(4.98±0.84)d,respectively,those in group B were (60.36±5.31)min,(2.55±0.48)times,(75.69±2.96)mL,(1.56±0.21)cm,(2.98±0.69)points,(5.01±0.86)d,the differences between the two groups were not significant (all P＞0.05).Immediate postoperation and postoperative 3 months,the ODI scores of group A were (36.96±10.58)points,(9.26±0.23)points,(6.35±0.44)points,respectively,and those of group B were (37.02±9.85)points,(9.42±0.65)points,(6.30±0.39)points,immediately after operation,postoperative 3 months,the ODI scores of the two groups were lower than before operation,compared with immediate postoperation,the ODI scores of postoperative 3 months were significantly reduced,the difference was statistically significant (P＜0.05).At immediately after operation,postoperative 3 months,the ODI score between the two groups had no significant difference (P＞0.05).The excellent rate of group A was 90.00％,which of group B was 91.67％,the difference between the two groups was not obvious (P＞0.05).Conclusion Intervertebral foramen mirror the vertebral plate gap into the road and posterior intervertebral disc mirror reserves are yellow ligament in treatment of L5 and S1 lumbar intervertebral disc protrusion will achieve good operation effect,no obvious difference was found between the two methods,before undergoing surgery for the patients'' individual condition and indications for judgment,and to choose appropriate surgical method.

Total 52 patients with breast lesions underwent dynamic contrast-enhanced breast MRI; and the breast vascularization was scored on the MRI vascular maps with a range of 0 to 3. The mean number of vessels per ipsilateral breast in malignant cases was higher than that of benign cases (3.8±2.0 vs. 1.3± 1.0; P=0.000). When the breast vascularity score 0-1 was defined as benign and 2-3 was defined as malignant, the sensitivity and specificity was 79% and 83%, respectively. Results indicate that dynamic contrast-enhanced breast MRI is of value in diagnosis of malignant breast lesions.

Europe ; Humans ; Nasal Polyps ; diagnosis ; therapy ; Sinusitis ; diagnosis ; therapy

Adult ; Female ; Humans ; Male ; Mercury Poisoning ; diagnosis ; therapy ; Middle Aged

Objective To determine the 95 ％ effective target plasma concentration (EC95) of remifentanil for tracheal tube tolerance during the recovery period from anesthesia following cervical spine surgery.Methods Thirty ASA Ⅰ or Ⅱ patients,aged 18-60 yr,weighing 50-80 kg,scheduled for elective cervical spine surgery under total intravenous anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of propofol,sufentanil and rocuronium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol and target-controlled infusion of remifentanil.The target plasma concentration (Cp) of remifentanil was set at 4-6 μg/L.BIS value was maintained at 40-60.Infusion of propofol was stopped at the end of surgery.Participants were allocated to a dose of remifentanil by 3-patient cohorts.Six Cps were selected from 1.0-3.5 μg/L before beginning and they were 1.0,1.5,2.0,2.5,3.0,3.5 μg/L.The Cp of remifentanil was 3.0 μg/L in the first cohort.After completion of the trial in each cohort,the posterior probability of each concentration was calculated according to the condition of sedation/analgesia and anterior probability of each concentration.The concentration with the posterior probability closest to 95 ％ was chosen as Cp in the next cohort.The concentration-probability curve was made according to the posterior probability of each concentration,and then EC95 and 95 ％ confidence interval of remifentanil were calculated.Results The EC95 and 95 ％ confidence interval of remifentanil were 2.77μg/L (2.65-2.83 μg/L) for tracheal tube tolerance during the recovery period from anesthesia following cervical spine surgery.Conclusion The EC95 of remifentanil for tracheal tube tolerance during the recovery period from anesthesia is 2.77 μg/L in patients undergoing cervical spine surgery.

Objective To investigate the effects of improved end-to-end invagination pancreaticojejunostomy on the occurrence of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 396 patients who received pancreaticoduodenectomy at the Cancer Hospital of Shandong Province from January 2001 to January 2011 were retrospectively analyzed.All patients were divided into the improved group(235 patients)and traditional group(161 patients)according to different anastomotic methods.All the operations were done by the same surgical group,and the digestive tract was reconstructed by the Child method.Patients in the improved group received improved end-to-end invagination pancreaticojejunostomy,and patients in the traditional group received traditional end-to-end anastomosis.The volume of operative bleeding,operation time,incidence of pancreatic fistula and duration of hospital stay of the 2 groups were compared.All data were analyzed using the t test,chisquare test or Fisher exact probability.Results The operative blood loss,operation time and duration of hospital stay were(383 ±56)ml,(7.2 ± 1.0)hours,(21 ±3)days in the improved group,and(381 ±39)ml,(7.0 ± 0.5)hours,(22 ± 5)days in the traditional group,with no significant difference between the 2 groups(t =0.388,1.680,-1.835,P ＞ 0.05).No operative death was detected in the 2 groups,and the overall incidence of pancreatic fistula was 7.6％(30/396).The incidence of pancreatic fistula of the improved group was 0(0/235),which was significantly lower than 18.6％(30/161)of the traditional group(P ＜ 0.05).Patients complicated with pancreatic fistula in the traditional group were cured by drainage,somatostatin administration and parenteral nutrition.Conclusion Improved end-to-end invagination pancreaticojejunostomy can significantly reduce the incidence of pancreatic fistula after pancreaticoduodenectomy.

Objective To investigate the clinical safety and efficacy of mechanical thrombectomy(MT) with Solitaire stent compared with the selective intra-arterial thrombolysis (IAT) in the treatment of acute cerebral infarction.Methods Totally 82 cases patients with severe acute ischemic stroke caused by middle cerebral artery stenosis from January 2014 to May 2016 in the stroke treatment center of the first people's Hospital in ZunYi city who were applied with the mechanical thrombectomy or the selective intra-arterial thrombolysis was included,and a comparative analysis was conducted on the mTICI rating to assess the interventional recanalization,the NIHSS score after the treatment,bleeding rate,and conditions of neurological functional recovery 90 days after operation.Results There were 42 cases applied with the mechanical thrombectomy (MT group),40 cases applied with the intra-arterial thrombolysis (IAT group).The total effective rate reached 85.70％ in the MT group and 62.50％ in the IAT group,the difference was significant (P ＜ 0.05).Compared with NIHSS score before operation,the score after the treatment showed a decreased trend.And the NIHSS score of MT group was better than that of the IAT group in a week after the treatment (P ＜ 0.05).The bleeding rate was lower in the MT group with statistically significant difference (P ＜ 0.05).Conclusion Compared to IAT,MT can provide broader time window,higher recanalization rate and better outcome in patients with severe acute ischemic stroke.

Objective To evaluate the clinical feasibility of performing the placement of drainage tube via transnasal route in treating mediastinal anastomotic fistula after surgery of esophageal cancer.Methods A total of 6 patients with mediastinal anastomotic fistula after surgery of esophageal cancer,who were admitted to authors' hospital during the period from August 2015 to January 2016,were included in this study.The diagnosis was confirmed by esophageal radiography and thoracic CT scan in all the 6 patients.Under X-ray monitoring,the drainage tube was inserted into the cavity of mediastinal fistula with the help of a guide wire guidance,and continuous negative pressure suction was adopted.The jejunum nutrition tube was inserted via the same nostril if feeding tube was not placed.Results Successful placement of fistula drainage tube and jejunum nutrition tube was achieved in all the 6 patients.In one patient the fistula drainage tube had to be re-placed as the drainage tube was obstructed five days after initial placement.Under X-ray monitoring the mean time used for the drainage tube placement was 33 min (range of 23-48 min).The procedure was well tolerated by all the 6 patients,and no procedure-related complications occurred.After continuous negative pressure suction that lasted for 6-40 days (mean of 23 days) the fistulae healed.Conclusion For the treatment of mediastinal anastomotic fistula after surgery of esophageal cancer,the placement of fistula drainage tube under X-ray monitoring is simple,safe and effective.(J Intervent Radiol,2017,26:250-252)

The maxillary first premolar is a transitional tooth between incisors and molars. Most maxillary first premolars have 2 root canals. However, the bilateral maxillary first premolar with 3 roots and 3 canals has not been described. This article reports a rare case:The bilateral maxillary first premolar with 3 roots and 3 canals.