OBJECTIVETo investigate the clinical application of a new temporary abdominal wound closure,vacuum system for temporary management of the open abdomen.

METHODSVacuum pack system consisted of polyethylene sheet,surgical towel,silicone drain, adhesive plastic drape. Clinical data of the patients undergoing exploratory celiotomy were recorded,and the indications for such temporary abdominal closure and its complications were reviewed.

RESULTSThirteen trauma patients underwent such vacuum abdominal closure for 15 times, including 5 times (33.3%) for increased intra- abdominal pressure so that tension-free fascial closure was unable to achieve, 4 times (26.7%) for reexploration, 2 times (13.3%) for damage control, and 4 times (26.7%) for combined factors. Finally, seven patients (53.8%) received direct closure and 5 patients (38.5%) received skin grafting after granulation because the defect could not be closed directly. One patient (7.7%) died before abdominal closure was attempted. None of the patients developed enterocutaneous fistula and evisceration. Three patients (23.1%) developed intra-abdominal abscess.

CONCLUSIONSThe vacuum pack is a better temporary abdominal wound closure device, and primary closure can be achieved in most of the patients. The technique is simple and easily mastered with a low complication rate.

Abdominal Injuries ; surgery ; Adolescent ; Adult ; Bandages ; Female ; Humans ; Laparotomy ; instrumentation ; methods ; Male ; Middle Aged ; Vacuum ; Young Adult

OBJECTIVETo study the correlation of vascular endothelial growth factor-C (VEGF- C) expression and lymphatic microvessel density (LMVD) with clinicopathological features and prognosis in colon cancer.

METHODSThe expression of VEGF-C and VEGFR-3 was detected by immunohistochemical staining with monoclonal antibodies against VEGF-C and VEGFR-3 in 44 cases with primary colon cancer. LMVD was calculated.

RESULTSVEGF-C positive rate was 43.2% (19/44). VEGF-C expression was associated with tumor (P=0.003), lymph node metastasis (P=0.002), Dukes stage (P=0.001). The mean LMVD was 10.14+/- 4.19. LMVD was associated with lymph node metastasis (P=0.002), Dukes stage (P=0.001). LMVD in VEGF-C(+) group was (11.34+/- 4.83) higher than (9.24+/- 3.48) in VEGF-C(-) group, but there was no statistically significance between the two groups (P=0.105). The survival rate of the patients with positive VEGF-C was lower than that with negative VEGF-C (P=0.0225). The median survival time of the patients with LMVD(+) group was shorter than that with LMVD(-) (P=0.0036). Distant metastasis (P=0.0004), lymphatic metastasis (P=0.021) and LMVD (P=0.0469) were independent prognostic factors.

CONCLUSIONSVEGF-C and LMVD appear to be new prognostic factors for colon cancer. Furthermore, LMVD may be a new independent prognostic factor.

Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms ; metabolism ; pathology ; Female ; Humans ; Lymphangiogenesis ; Lymphatic Metastasis ; Lymphatic Vessels ; Male ; Middle Aged ; Prognosis ; Vascular Endothelial Growth Factor C ; metabolism ; Vascular Endothelial Growth Factor Receptor-3 ; metabolism

OBJECTIVETo determine the effect of composite restoration on reinforcement of weakened tooth structure and the possible mechanism.

METHODSSixty freshly extracted non-carious maxillary premolars were collected and divided into 6 groups with 10 specimen in each group. MOD cavities (buccolingual width: 2.8 to 3.2 mm; palatal cusp width: 2.0 mm; cusp height: 5.0 mm) were prepared individually. Group 1 was prepared and not restored (control). The other 5 groups were restored with silver amalgam alloy (group 2), Z250 without bonding (group 3), F2000 (group 4), Z250 (group 5) and Z350 nanocomposite (group 6) (3M ESPE) respectively. The fracture resistance of the tested teeth was determined by applying a vertical splitting load through a specially shaped steel rod at a crosshead speed of 1 mm/min. The data were analyzed by ANOVA.

RESULTSThe average fracture resistance of the 6 groups was: (245.29 +/- 39.49) N (group 1), (255.09 +/- 42.14) N (group 2), (267.34 +/- 31.56) N (group 3), (293.90 +/- 33.42) N (group 4), (337.81 +/- 32.63) N (group 5) and (349.08 +/- 32.93) N (group 6). There was no significant difference between the group 1, group 2 and group 3. The fracture resistance of group 4, group 5 and group 6 was higher than that of group 1 and group 2 (P < 0.05). Significant difference was noted between group 5 and group 3 (P < 0.01). The fracture resistance of group 4 was much lower than that of group 5 and group 6 (P < 0.01). No significant difference was found between group 5 and group 6.

CONCLUSIONSThe use of composite increased the fracture resistance of the tooth with an MOD restoration. This effect was related to the adhesive force, polymerization shrinkage stress and the elastic modulus of the composite.

Bicuspid ; Composite Resins ; Compressive Strength ; Dental Stress Analysis ; Humans ; In Vitro Techniques ; Root Canal Filling Materials ; Tooth Fractures ; prevention & control

OBJECTIVETo explore clinical effects of Ilizarov technique at stage I for repairing tibial post-traumatic osteomyelitis with bone and skin defect.

METHODSFrom June 2010 to December 2013,44 patients with tibial post-traumatic osteomyelitis with bone and skin defect were treated with Ilizarov technique at stage I . Among them, there were 35 males and 9 females aged from 18 to 70 years old with an average of 42.5 years old. Bone defect ranged from 4 to 16 cm, skin defect ranged from 3 cm x 4 cm to 5 cm x 16 cm. The operation was performed debridement thoroughly, removed inflammatory bone section, osteotomy invasively, install circular external fixator by Ilizarow technique; screw nut were rotated at 1 week after operation, and prolonged 0.5 to 1.0 mm everyday. Wound surface, new born callus and bone healing were observed to evaluate clinical effects.

RESULTSAll patients were followed up from 11 to 36 months with an average of 18.5 months. Bone defect after osteotomy was from 6 to 22 cm with an average of 11.5 cm; the time of wound healing time ranged from 21 to 79 d with an average of 38 d; bone defect healing time was from 8 to 15 months with an average of 12.5 months. All patients were cured, no recurrent infection, refracture and shorten of calf deformity were occurred.

CONCLUSIONRepairing tibial post-traumatic osteomyelitis with bone and skin defect by llizarov technique at stage I has advantages of less trauma, low inflammatory recurrence rate, could avoid multiple complex operation, and receive definite curative effect.

Adolescent ; Adult ; Aged ; Female ; Humans ; Ilizarov Technique ; Male ; Middle Aged ; Osteomyelitis ; surgery ; Osteotomy ; Tibia ; surgery

OBJECTIVETo compare profiles and related factors of irregular bleeding induced by different types of low-dose hormone therapy (HT) and a Chinese formulated herbs products.

METHODSApplied with open-labeled, randomized, and clinical trial design, 136 postmenopausal women were assigned into four groups: group A: estradiol valerate (E2 V) 1 mg/d + medroxyprogesterone acetate (MPA) 2 mg/d; group B: conjugated equine estrogen 0.45 mg/d + MPA 2 mg/d; group C: tibolone 1.25 mg/d; group D: a Chinese formulated herbs product (Kuntai) 4# tid. Each subject took element calcium 400 mg/d and vitamin D 200 IU/d concomitantly. Modified Kupperman scores were assessed on baseline and every 3 months thereafter and irregular bleeding was recorded on menopausal diary every day. The duration of this study was 1 year. Results The efficacies were similar in three HT-managed groups, but was better than in group D, although the latter was also effective in alleviating menopausal symptoms. Hazard ratio (HR) of irregular bleeding was 1.00 in group C, 2.43 in group A (95% CI: 1.08-5.46), 3.12 in group B (95% CI: 1.42-6.88), and 0.73 in group D (95% CI: 0.26-2.04). Most cases initially experienced bleeding in the first 3 months but such initiation was a bit later in group C. Endometrium, as detected by B-mode ultrasound, increased approximately 1 mm in HT groups, while it was a bit thicker in group C. Long periods in reproductive age and short time since menopause were high risk factors for irregular bleeding.

CONCLUSIONProfiles of irregular bleeding in 3 commonly used types of low-dose HT are different and some factors such as long period in reproductive age and short time since menopause may contribute to bleeding initiation.

Adult ; Aged ; Double-Blind Method ; Estradiol ; administration & dosage ; analogs & derivatives ; Estrogen Replacement Therapy ; adverse effects ; Estrogens, Conjugated (USP) ; administration & dosage ; Female ; Humans ; Medroxyprogesterone Acetate ; administration & dosage ; Metrorrhagia ; etiology ; Middle Aged ; Norpregnenes ; administration & dosage ; Phytotherapy ; adverse effects ; Postmenopause ; Risk Assessment

Objective To explore the approach and early effects of endovascular stent-graft deployment in the treatment of portal stenosis of cancerous thrombus.Methods Six cases with portal vein stenosis of cancerous thrombus,which caused by primary hepatic carcinoma(5 cases)and eholangiocarcinoma(1 case)and the severity of stenosis showed on contrast enhanced CT were more than 75% or occluded,were performed percutaneous transhepatie or transsplenic portography.FLUENCY~(TM) endovascular stent-graft(10 mm diameter)was placed at the position of stenosis after gastroesophageal varices embolization.Portal pressure was measured pre-and post-deployment.Results Stents were successfully placed in all patients.The average portal pressure decreased from 50.7 cm H_2O(1 cm H_2O = 0.098 kPa)to 41.3 cm H_2O after endovascular stent-graft deployment.The restenosis were found in 2 cases after one month.Haematemesis and refractory aseites appeared in one case respectively,the other 4 cases showed no significant symptoms above caused by portal hypertension.Conclusion It is safe and feasible for endovaseular stent-graft deployment in the treatment of portal stenosis of cancerous thrombus.Selecting the suitable indications,the symptoms of portal hypertension can be controlled effectively.

OBJECTIVETo evaluate the stability of hearing results and complications in long-term following-up who underwent reconstruction surgery.

METHODSSix hundreds and seventy five cases (700 ears) of congenital aural atresia were reviewed from January 1984 to January 2001 at the Department of Otorhinolaryngology Head and Neck Surgery, Tongren hospital. Except 40 ears undone hearing reconstruction, 635 cases (660 ears) underwent long-term following-up for 3 to 19 years, with an average of 7.9 years.

RESULTSStenosis and recurrent infection of the external auditory canal (EAC) were the most frequent complications. Stenosis was seen in 120 ears, and 2 ears re-atresia, with an incidence of 18.48% (122/660). Recurrent infection of the cavity and canal skin happened in 6 ears. Closure of the air-bone gap (ABG) post-operation were gained in all cases, and ABG gains 20 dB or more occurred in 512 ears (77.57%), but 30 dB or more in 231 ears (35%). Following-up results: Stable hearing results gained in 450 ears over the length of following-up; the hearing worsened than that of 3 weeks postoperatively occurred in 160 ears, including 2 ears with sensorineural hearing loss. Hearing deteriorated more than 20 dB happened in 35 ears, and 10-15 dB in others cases but still be improved compared with that of preoperation.

CONCLUSIONSAtresiaplasty surgery in individuals with congenital aural atresia can yield reliable, lasting hearing results in 68.2% (450/660), with a low incidence of complications; the initial improved hearing deteriorated gradually over the first 6 months post-operation, which are related with the stenosis and infection of canal. Cavity adhesion, bony EAC re-growth, ossicular chain re-fixation or displace may affect the hearing results in some cases. Even unilateral aural atresia may benefit from the reconstruction surgery and achieve serviceable hearing results.

Adolescent ; Adult ; Child ; Child, Preschool ; Ear Auricle ; abnormalities ; Ear Diseases ; congenital ; surgery ; Ear, External ; abnormalities ; Ear, Middle ; abnormalities ; Female ; Hearing ; Humans ; Male ; Otologic Surgical Procedures ; Reconstructive Surgical Procedures ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the indication and results of three methods for total ear reconstruction.

METHODS960 cases of total ear defect were treated with skin expansion and autogenous rib cartilage framework (n = 786), or skin expansion and Medpor framework (n = 150), or ear prosthesis (n = 24). The indication and results of the three methods were analysed.

RESULTSGood cosmetic results were achieved with all three methods. Autogenous rib cartilage framework was suitable for patients under 30 years old with unaffected skin at mastoid region. Medpor framework was good for grown-up, especially over 30 years old, or with mild infection at mastoid region. Patients with severe skin injury at mastoid region or unwilling to accept surgery should choose ear prosthesis.

CONCLUSIONSSatisfactory results can be achieved with suitable methods for total ear reconstruction.

Adolescent ; Adult ; Child ; Child, Preschool ; Ear, External ; abnormalities ; surgery ; Female ; Humans ; Male ; Middle Aged ; Prostheses and Implants ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Tissue Scaffolds ; Young Adult

OBJECTIVETo investigate the safety and efficacy of fast track surgery (FTS) management in gastric cancer undergoing D2 gastrectomy.

METHODSEighty gastric cancer patients undergoing D2 gastrectomy were recruited prospectively. Patients were assigned to receive FTS management (n = 40) or conventional perioperative care (n = 40). The FTS care included shorten preoperative fasting time, no nasogastric decompressing tubes and abdominal drainage placed, early postoperative oral feeding, multimodal analgesia, and early mobilisation. The length of postoperative hospital stay, medical cost, nutritional status, gut function, and postoperative complications in the two groups were recorded and compared.

RESULTSFTS group was associated with a significantly shorter postoperative hospital stay compared with conventional care group [(5.6 +/- 1.3) d vs. (9.4 +/- 1.9) d, P < 0.05]. Medical cost was less [(18 620 +/- 2360) Yuan vs. (20 370 +/- 2440) Yuan, P < 0.05] and duration of intravenous infusion [(3.5 +/- 1.4) d vs. (5.8 +/- 1.9) d, P < 0.05] was also shorter. First passage of flatus was earlier in FTS group than in conventional care group [(4.3 +/- 0.4) d vs. (5.5 +/- 0.9) d, P < 0.05]. Loss of body weight in the postoperative period was less in FTS group [(3.2 +/- 0.8) kg vs. (4.3 +/- 1.6) kg, P < 0.05]. There was no difference in morbidity or mortality between the two groups.

CONCLUSIONFTS in D2 gastrectomy is safe and efficient, and it can shorten postoperative hospital stay and hasten return of gut function.

Adult ; Aged ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Humans ; Length of Stay ; Male ; Middle Aged ; Perioperative Care ; Postoperative Complications ; prevention & control ; Prospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

BACKGROUNDAlemtuzumab has been used in organ transplantation and a variety of hematologic malignancies (especially for the treatment of B-cell chronic lymphocytic leukemia). However, serious infectious complications frequently occur after treatment. The reason for increased infections postalemtuzumab treatment is unknown at this stage. We explore the effect of alemtuzumab on intestinal intraepithelial lymphocytes (IELs) and intestinal barrier function in cynomolgus model to explain the reason of infection following alemtuzumab treatment.

METHODSTwelve male cynomolguses were randomly assigned to either a treatment or control group. The treatment group received alemtuzumab (3 mg/kg, intravenous injection) while the control group received the same volume of physiological saline. Intestinal IELs were isolated from the control group and the treatment group (on day 9, 35, and 70 after treatment) for counting and flow cytometric analysis. Moreover, intestinal permeability was monitored by enzymatic spectrophotometric technique and enzyme-linked immunosorbent assay.

RESULTSThe numbers of IELs were decreased significantly on day 9 after treatment compared with the control group (0.35 ± 0.07 × 10 8 and 1.35 ± 0.09 × 10 8 , respectively; P < 0.05) and were not fully restored until day 70 after treatment. There were significant differences among four groups considering IELs subtypes. In addition, the proportion of apoptotic IELs after alemtuzumab treatment was significantly higher than in the control group (22.01 ± 3.67 and 6.01 ± 1.42, respectively; P < 0.05). Moreover, the concentration of D-lactate and endotoxin was also increased significantly on day 9 after treatment.

CONCLUSIONSAlemtuzumab treatment depletes lymphocytes in the peripheral blood and intestine of cynomolgus model. The induction of apoptosis is an important mechanism of lymphocyte depletion after alemtuzumab treatment. Notably, intestinal barrier function may be disrupted after alemtuzumab treatment.

Alemtuzumab ; Animals ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Apoptosis ; drug effects ; Flow Cytometry ; Intestines ; cytology ; Lymphocytes ; drug effects ; Macaca fascicularis ; Male ; Microscopy, Electron, Transmission