Acute Disease ; Adult ; Aged ; Dengue ; diagnosis ; Diagnosis, Differential ; HIV Infections ; diagnosis ; HIV-1 ; immunology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; Young Adult

Acupuncture has become a popular alternative modality in the treatment of back pain. However, few have reported complications related to this treatment modality. This study reports a rare case of septic arthritis of the lumbar facet joints, developing after acupuncture, and its devastating effects upon the patient. A 68-year-old female developed septic arthritis of the lumbar facet joints after acupuncture for symptomatic control of lumbar spondylosis and stenosis while waiting for surgery. Subsequently, successful control of the infection required a total of 4 hospital admissions over a 2-year period, a CT guided spinal biopsy and 6 months of antibiotics.

Objective To evaluate the diagnostic value and limitation of MRI for chromophobe renal cell carcinoma.Methods MRI features of 5 cases with pathology proved chromophobe renal cell carcinoma were analyzed retrospectively.Results All tumors showed homogenous isoin-tensity or slightly hypointensity on T1 weighted images and isointensity or slightly hyperintensity on T2 weighted images.Slightly hyperintensity were showed on DWI images,the mean ADC value of tumors was 1.42×10-3 mm2/s.On the contrast enhanced images,all the mass showed slight to moderate enhancement ,1 case had spoke-wheel-like enhancement,1 case showed flowed out blood vessels in the tumor.Conclusion The preoperative diagnosis is difficult for chromophobe renal cell carcinoma,MRI is a valuable method which could provide useful information for qualitative diagnosis.

OBJECTIVE:To investigate the prognosis of coronary heart disease complicated with heart failure patients abandon-ing percutaneous coronary intervention (PCI) and receiving drug comprehensive therapy. METHODS:From Dec. 2010 to Jul. 2012,217 patients with coronary heart disease complicated with heart failure in our hospital were divided into operation group (105 cases) and non-operation group (112 cases). Based on routine treatment,operation group was given aspirin combined with clopidogrel before and after PCI,and non-operation group was given aspirin combined with clopidogrel all the time. The patients were followed up regularly during discharging from hospital to May 2015 by outpatient,telephone and coronary angiography re-checking,lasting for 24-38 months. Death cases,readmission and revascularization again caused by main adverse cardio-cerebrovas-cular events were recorded during follow-up period. RESULTS:7 cases and 8 cases in operation group and non-operation group did not accept follow-up;median follow-up time was 33 months and 32 months,respectively. Case number of myocardial infarction, heart failure and death in non-operation group was more than operation group,with statistical significance (P<0.05). 94 patients survived in operation group in 3 years,with survival rate of 95.9%;66 in non-operation group,with survival rate of 63.5%;with statistical significance(P<0.05). The survival time of non-operation group was shorter than that of operation group,with statistical significance(P<0.05). CONCLUSIONS:Although we still cannot get the conclusion that PCI is a better treatment or drug therapy is better. But the survival rate of patients are not optimistic 3 years after abandoning PCI coronary heart disease patients with severe myocardial ischemia should choose PCI firstly.

Air Pollutants, Occupational ; analysis ; Coke ; Fatty Liver ; epidemiology ; Humans ; Logistic Models ; Male ; Occupational Exposure ; adverse effects ; Risk Factors

· AIM: To study the effects of topical anesthesia on corneal thickness in myopic eyes with Orbscan topography system and to assess the application prospect of this device in determining the corneal thickness for refractive surgery.and 5 minutes after administration of one drop of Benoxil (Oxybuprocaine) 4g/L solution (Santen, Japan) to 98 eyes (98 patients). The numeric value of the corneal thinness (THN) and the mean central corneal thickness (CCT) of 2mm in diameter were obtained before and after the instillation. The changes in anterior chamber depth (ACD) were also studied.P＜0.001) and CCT by 3.10±7.13μm (t=-4.310, P＜0.001) were found following the instillation of the topical anesthetic. There were no statistically significant changes in ACD (t=1.288, P=0.201).immediate effects on the corneal thickness in myopic eyes and this have implications for corneal refractive surgery and even for the accuracy of applanation tonometry.

Objective To evaluate the feasibility and the clinical value of extraperitoneal laparoscopic radical prostatectomy in treatment of localized prostate cancer.Methods Clinical data of 26 patients with localized prostate cancer treated with extraperitoneal laparoscopic radical prostatectomy were analyzed retrospectively.All patients were pathologic diagnosed with prostate cancer by preoperative prostate biopsy or transurethral resection of prostate surgery.Gleason grade was from 6-8.Results Twenty-six operations were successfully accomplished ,without converting to open approach.The operative time was 120-270 min(mean was 165 min) ,the intraoperative blood loss was 180-650 ml (mean was 320 ml) ,indwelling catheter time 12-19 d (mean was 14 d).There were 6 cases with little uroclepsia, satisfactory with urination after contract urethral sphincter for 1-3 Months.Pathologically confirmed all prostate cancer;2 cases of positive margins after surgery plus endocrine therapy.All the cases were followed up from 2 to 36 months.The biochemical recurrence was 5 cases who had undergone endocrine therapy.Conclusion Extraperitoneal laparoscopic radical prostatectomy is a safe and feasible procedure with little trauma, small bleeding and fast recovery which is well worth popularizing.Replace open surgery may become frist choice therapeutic method for localized prostate cancer.

Objective To discuss the surgical indications,relative merits and clinical outcomes of anterior reconstruction plate fixation for treating unstable posterior pelvic ring injuries.MethodsA retrospective study was done on clinical data of 36 patients with unstable posterior pelvic ring injuries treated with anterior reconstruction plate fixation from August 2004 to July 2010 and followed up for minimum one year.There were 25 males and 11 females,at mean age of 35.8 years ( range,13-62 years).There were two patients with anterior dislocation of the sacroiliac joint and 34 with posterior dislocation.According to Tile classification,there were four patients with type B fractures ( B1:3,B2:1 ) and 32 with type C fractures (C1-1:17,C1-2:12,C2:2,C3:1 ).Results All patients were followed up for average 2.3 years ( range,1-6 years).Fat liquefaction and superficial infection were founded in two patients who were cured by dressing change and frequent but low-dose blood transfusion.Eight patients were subjected to iatrogenic lateral femoral cutaneous nerve injury.Meanwhile,five of them was recovered after treatment with neurotrophic drugs,but there were still three patients leaving lateral thigh numbness.One patient had L5 nerve root injury due to pull force,and was recovered after three months of neurotrophic drug therapy.According to Matta and Tometta criteria,the reduction results were excellent in 23 patients,good in 11 and fair in four,with excellence rate of 94％.No reduction loss or implant failure occurred.According to Majeed scoring system,the clinical outcomes were excellent in 17 patients,good in 14,fair in four and poor in one,with excellence rate of 86％.Of the seven patients pre-operatively associated with sacral plexusinjury,three obtained full recovery,two got partial recovery and two were free from recovery.Conclusion The anterior reconstruction plate fixation takes advantages of wide surgical indications,simple exposure,low infection rate,satisfactory reduction and solid fixation and may be a main treatment method for unstable posterior pelvic ring injuries.

OBJECTIVETo evaluate the feasibility and post-operation stability of extreme lateral transforaminal lumbar interbody fusion (E-TLIF) and other traditional surgical approach via bio-mechanical test.

METHODSThere were 24 normal lumbar spine segment of swine were divided into the following four groups: control group, standard group (internal fixed with pedicle screws only), transforaminal lumbar interbody fusion (TLIF) group and E-TLIF group. The specimen in anteflect, hypsokinesis, lateral flexion and rotate movements were tested respectively with bio-mechanical devices to study on the load-straining changes and biomechanics index.

RESULTSAfter TLIF or E-TLIF, specimen turned out more steady than normal control group (t = 4.17 - 4.53, P < 0.01). Compared with TLIF group [linear displacement (3.98 ± 0.22) mm, angular displacement 3.03° ± 0.18°], specimen after E-TLIF [linear displacement (3.40 ± 0.09) mm, angular displacement 2.57° ± 0.12°] were more stable in biomechanics index on lateral flection movement (t = 2.61, P < 0.05), but no difference on axial or rotational movements (P > 0.05).

CONCLUSIONE-TLIF is a safe and more efficient operation approach.

A 63-year-old gentleman presented with a one-year duration of progressive neurogenic claudication. However, unlike most patients who presents with leg symptoms, his pain was felt in his scrotal and perianal region. This was exacerbated with walking and standing, but he had immediate relief with sitting. An magnetic resonance imaging (MRI) was performed which showed severe central canal stenosis. An L3/4 and L4/5 surgical decompression and a transforaminal lumbar interbody fusion was performed, and the patient made good recovery with immediate resolution of symptoms. Although rare, spinal stenosis should be considered a differential when approaching a patient with perianal and scrotal claudication, even in the absence of leg claudication. An MRI is useful to confirm the diagnosis. This rare symptom may be a sign of severe cauda equina compression and we recommend decompression with predictable good results.
Cauda Equina ; Constriction, Pathologic ; Decompression ; Decompression, Surgical ; Diagnosis ; Humans ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Spinal Stenosis* ; Walking