Objective To analyze the classification,MR manifestations,and the pathological basis of solitary necrotic nodule of the liver(SNN)in order to evaluate MRI as a diagnosing tool Methods The MR appearances of 9 cases with pathologically proved SNN were analyzed and correlated with the classification and pathological appearances.Relevant literature was reviewed.Results(1)Simple coagulative necrosis type(5 cases):The signal of lesions was hypo-intense or iso-intense on both T_1-and T_2- weighted images.After Gd-DTPA administration,the internal part of the lesions showed no enhancement,while the thin capsule of the lesions demonstrated mild or moderate delayed enhancement. These lesions,proved by pathology,were composed of central coagulative necrotic core and a peripheral hyaline fibrosis capsule.(2)Coagulative necrosis aceompanied by liquefactive necrosis type(1 case):On T_1-weighted images,the signal of hypo-intensity was found within these lesions and even lower signal intensity was found in the central area of larger lesions.On T_2-weighted images,the lesions had a bright core and a peripheral hypointensive or isointensive area.After Gd-DTPA administration,the internal part of the lesions showed no enhancement,while the thin capsule of the lesions demonstrated mild or moderate delayed enhancement.These lesions had a central coagulative necrosis core interleaved by slit- like liquefactive necrosis foci,and peripherally a thin capsule of hyaline fibrosis proved by pathology.(3)Multi-nodular fusion type,(3cases):On T_1-weighted images,the lesions were of hypointensive or isointensive signal and had multiple septa of isointensive signal.On T_2-weighted images,the lesions were of hypointensive or isointensive signal and had multiple septa of hyperintensive or isointensive signal.After Gd-DTPA administration,No enhancement was found except mild or moderate delayed enhancement found in the thin capsule and septa.These lesions were composed of central coagulative necrosis area and a peripheral hyaline fibrosis capsule with multiple internal septa proved by pathology.Conclusion MRI apperances can reflect the classification and pathological features of solitary necrotic nodule of the liver.

OBJECTIVETo introduce the postero- lateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases.

METHODSThis study consisted of 32 cases, 22 males and 10 females with the mean age of 48 years (range, 21-63 years), suffering from posterior malleolar fracture. All cases were treated with the posterolateral surgical approach to the ankle. The average follow-up period was 28 months (range, 24-35 months). The clinical outcomes of these cases were evaluated on the basis of the Olerud-Molander Ankle (OMA) score and plain radiographs.

RESULTSAll cases showed radiological evidence of bony union at follow-up. The average OMA score was 82 points; 21 cases had excellent scores (90-100 points), 9 good (61-90 points), and 2 fair (31-60 points). The excellent-to-good rate was 93.8%. Although most cases did not show any wound dehiscence or necrosis, one patient had a superficial infection which healed after using antibiotic dressing and one had sural cutaneous nerve injury that underwent spontaneous remission without any treatment after three months. In addition, one presented with mild symptoms of peroneal tendonitis that disappeared after plate removal.

CONCLUSIONThe posterolateral approach offers an effective technique for fracture reduction and fixation of large posterior malleolar fragments.

Ankle Fractures ; Ankle Joint ; surgery ; Bone Plates ; Fracture Fixation, Internal ; Humans

Objective To find out factors related to avascular necrosis (AVN) of femoral head through a retrospective study of patients with femoral neck fractures treated with cannulated screws.Methods Two hundred and thirty cases of femoral neck fracture whn had been treated with cannulated screws in our department from August 1994 to October 2003 were analyzed statistically.Six factors of patient,age,gender,fracture type (Garden clas- sification),reduction method (close or open),the quality of reduction (Garden Index) and time interval from injury to surgery were analyzed statistically with rank sum test and logistic multiple regression.Results Factors that might have an impact on avascular necrosis of femoral head were ranked in the following likelihood sequence: fracture type,quality of reduction,reduction method,time interval from injury to surgery and age.Gender was found to have little impact on the prognosis of femoral neck fracture (P＞0.05).Conclusions Fracture displacement is the most critical factor that influences the prognosis.Anatomical reduction (close or open) must be achieved to re- duce the risk of AVN.Timing of surgery shows its importance.High age will not lead to an increased incidence of AVN.

Objective: There is limited clarity concerning the risk of dementia after pneumonia with intensive care unit (ICU) stay. We conducted a nationwide cohort study, which aimed to investigate the impact of dementia after pneumonia with and without intensive care unit admission. Methods: Data was obtained from Taiwan’s National Health Insurance Research Database between 2000 and 2015. A total of 7,473 patients were identified as having pneumonia required ICU stay, along with 22,419 controls matched by sex and age. After adjusting for confounding factors, multivariate Cox regression model analysis was used to compare the risk of developing dementia during the 15-years follow-up period. Results: The enrolled pneumonia patients with ICU admission had a dementia rate of 9.89%. Pneumonia patients without ICU admission had a dementia rate of 9.21%. The multivariate Cox regression model analysis revealed that the patients with ICU stay had the higher risk of dementia, with a crude hazard ratio of 3.371 (95% confidence interval, 3.093–3.675; p<0.001). Conclusion This study indicated that pneumonia with ICU stay is associated with an increased risk of dementia. A 3-fold risk of dementia was observed in patients admitted to the ICU compared to the control group.

OBJECTIVETo study the effect of cGMP-dependent protein kinase (PKG) on the pathogenesis of septic shock.

METHODSConfluent endothelial cells were disintegrated and centrifugated to obtain cell lysates after being treated with LPS or PKG activator 8-Br-cGMP. PKG activity of lysates was measured with radioactive isotope label method in a reaction system of phosphorylation of specific substrate H2B by PKG, and the shape and the distribution of intracellular filamentous actin were detected by specific fluorescence staining. For the control study, the PKG specific inhibitor KT5823 was used to pretreat the endothelial cells before the administration of LPS or PKG activator 8-Br-cGMP.

RESULTSExposure to LPS for 5, 10, 30 and 60 minutes led to a rapid time-dependent increase in endothelial PKG activity (P < 0.01 compared to the blank) and the polar distribution of intracellular filamentous actin and preincubation with KT5823 abolished these effects. 8-Br-cGMP was similar to LPS.

CONCLUSIONSThe results suggested that LPS can mediate PKG activation and the stress variety of filamentous actin in the vascular endothelial cells, which probably induce the endothelial hyperpermeability after septic shock.

Capillary Permeability ; Cyclic GMP ; analogs & derivatives ; pharmacology ; Cyclic GMP-Dependent Protein Kinases ; physiology ; Cytoskeleton ; metabolism ; Endothelium, Vascular ; cytology ; metabolism ; Humans ; Lipopolysaccharides ; pharmacology ; Shock, Septic ; metabolism ; Signal Transduction

OBJECTIVETo investigate the effect of alendronate on the prevention and treatment of aseptic loosening of prosthesis.

METHODSA rat model of particle-induced osteolysis was used. Thirty-xis SD rats were divided into three groups: negative control group, positive control group and experiment group. Alendronate was administered by ig in experiment group. Positive control group and experiment group received intro-articular injections of ultrahigh molecular weight polyethylene (UHMWPE) particles at 4, 6, 8, 10 weeks postoperatively. Negative control group was received injection with mixture solution of mouse serum and PBS only. All animals were sacrificed at 12 weeks after operation for histologic examination. In vitro human peripheral blood mononuclear (PBMC)were separated and cultured and divided into five groups as group A: PBMC group, group B: PBMC and particles,group C:PBMC and particles with 10(-4) mol/L alendronate, group D:PBMC and particles with 10(-5) mol/L alendronate, group E: PBMC and particles with 10(-6) mol/L alendronate. The production of IL-1beta, IL-6, TNF-alpha in each group were tested.

RESULTSAlendronate could prevent particle-induced osteolysis. The production of IL-1beta, IL-6, TNF-alpha was inhibited when alendronate was used.

CONCLUSIONAlendronate can inhibit bone absorptive factors expression induced by wear particles and may be used in the prevention and treatment of aseptic loosening of prosthesis.

Alendronate ; administration & dosage ; Animals ; Cytokines ; metabolism ; Female ; Humans ; Joint Prosthesis ; adverse effects ; Joints ; metabolism ; surgery ; Male ; Osteolysis ; drug therapy ; metabolism ; prevention & control ; Prosthesis Failure ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the clinical effect of the treatment of the ununited lower limb fracture with reamed intramedullary interlocking nail.

METHODSFifty-two patients with ununited lower limb fracture were treated with intramedullary interlocking nail (femur 36, tibia 16). The main cause of nonunion was interternal fixation loosening or fracture (41 cases, 78.8%), other reasons included bone defection, bone infection or too much traction of fracture (11 cases, 21.2%). According to X-ray classification: 41 cases in type hypertrophy, 11 cases in type atrophy. All these patients need operation to remove the primary implant, clean the hard bone, ischemia bone and scar, manual ream and fix by intramedullary interlocking nail, then bone graft were done around the fracture site. With the knee joint stiffness, relax it by manipulate or operation.

RESULTSBeside 3 superficial infection (2 delayed healing and 1 healing after debridement), other 49 wounds healed on time. All cases were followed up for an average of 25.2 months, ranging from 12 months to 39 months. All the ununion healed from 5 to 11 months, mean union time were 6.1 months. Deep tissue infection, fat embolism, implant loosening, nail broken or nonunion were not found in this series. According to judet standard on the movement of knee, the excellent-good rate was 82.7%.

CONCLUSIONSIntramedullary interlocking nail is effective to treat nonunion of lower limb fracture.

Adolescent ; Adult ; Aged ; Bone Nails ; Bone Transplantation ; Female ; Femoral Fractures ; surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; methods ; Fractures, Ununited ; surgery ; Humans ; Lower Extremity ; injuries ; surgery ; Male ; Middle Aged ; Tibial Fractures ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the mechanism, clinical features and treatment of odontoid fracture combined with lower cervical spinal injury.

METHODSFrom January 1999 to December 2004, 57 cases of type II or shallow type III odontoid fractures were studied retrospectively. Six cases were found combined with lower cervical injury, the mean age was 54 years, and 4 of the 6 cases were complicated with cervical spondylarthrosis or ankylosing spondylitis. For the lower cervical injury, fracture-dislocation was found in 2 cases, the disruption of disc and ligament was found in 4 cases among which 2 cases were suffered from incomplete spinal cord injury; Both were caused by lower cervical spinal injury. All of the 6 cases were performed with surgery in odontoid fracture and lower cervical spinal injury simultaneously; Lower cervical spinal injuries were stabilized firstly in 2 cases, which responsible for neurological involvement; For the other 4 cases without neurological involvement, stabilization was performed in odontoid fracture firstly in 2 cases, due to inability to achieve reduction of odontoid fracture preoperatively, however, for the another 2 cases with anatomic reduction of the odontoid fracture preoperatively, lower cervical injuries were stabilized firstly.

RESULTSAfter an average follow-up of 10 months, all cases were obtained solid fusion both in odontoid fracture and lower cervical spinal injury, and without the complications associated with operation and prolonged bed rest. Two cases with neurological defect improved 1 scale in Frankel score.

CONCLUSIONSThe incidence of odontoid fracture combined with lower cervical spinal injury is about 10.5% of the odontoid fracture, and it is vulnerable in the elderly patient with cervical spondylarthrosis. MRI should be used routinely for accurate diagnosis. Surgical stabilization is the choice of treatment due to facilitating early rehabilitation and reducing the complications. The surgical schedule is planned according to the fact of neurological involvement and the extent of stability between the odontoid fracture and lower cervical spinal injury.

Adolescent ; Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Odontoid Process ; injuries ; Retrospective Studies ; Spinal Fractures ; diagnosis ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the clinical effects of the minimal invasive osteotomy treatment for hallux valgus combined with tailor's bunion deformity.

METHODSFrom May 2007 to May 2009, Forty-nine feet of 32 patients (a mean age of 57 years old) of hallux valgus combined with tailor's bunion deformity were reviewed retrospectively, including 2 males(2 feet) and 30 females (47 feet). All patients were treated by the minimal invasive osteotomy. The axial and lateral films of all feet with loading were taken before and after operation. The hallux abducto valgus angle(HAV),intermetatarsal angle(IM), fourth-fifth intermetatarsal angle (IM 4 to 5), modified fourth-fifth intermetatarsal angle (MIM 4 to 5), Metatarsophalangeal-fifth angle (MPA) and lateral deviation of the fifth matatarsal angle (LDA) were compared before and after operation. Therapeutic effects of all the patients were observed after operation, the item including AFAS score and WEN Jian-min's therapeutic effects standard.

RESULTSThe average operating time was 40 minutes. All the patients were followed up,and the duration ranged from 6 to 24 months. The HAV angle, IM angle, IM 4 to 5 angle, MIM 4 to 5 angle,MPA angle and LDA angle significantly decreased after operation. The AFAS score significantly raised after operation. According to the criteria, 33 feet got an excellent result, 15 good and 1 fair.

CONCLUSIONThe minimal invasive osteotomy treatment for hallux valgus combined with tailor's bunion is effective and safe. This method is mini-trauma,less pain and it can make a very soon rehabilitation. This method has widely clinical value.

Adult ; Aged ; Aged, 80 and over ; Bunion, Tailor's ; surgery ; Female ; Hallux Valgus ; surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Osteotomy ; methods

OBJECTIVETo study clinical characteristics and resistance of wound surface infections, so as to guide clinical diagnosis and rational administration.

METHODSThe clinical setting and laboratory results were collected by analyzing 20 strains of Bacillus cereus isolated from clinical samples in patients from our hospital from October 2011 to June 2012, including 18 males and 2 females,ranging in age from 22 to 67 years old, averaged (47.30 +/- 11.16) years old. The courses of disease ranged from 5 to 20 days. All the patients were treated with nutrition support therapy, debridement and the corresponding antibiotic therapy. The patients had anemia, low protein hyperlipidemia and wound contamination history while Bacillus cereus infected. Thirty people were selected as normal group, including 23 males and 7 females,with an average age of (45.20 +/- 15.05) years old. Infection control condition was assessed by comparing culture for pathogens and patients wound redness or exudation cases before and after treatment. Antimicrobial susceptibility test was conducted by K-B method.

RESULTSA total of 20 stains of Bacillus cereus were isolated from wound surface infections in department of orthopedics of our hospital. Among them,the infections were correlated with the wound contamination (16/20), malnutrition (20/20), and open-fracture (20/20), operation time (15 cases > 3 h). The laboratory blood test showed that the levels of TP [(49.94 +/- 8.24) g/L], ALB [(29.54 +/- 5.45 ) g/L] and Hb [(103.20 +/- 11.79) g/L] in the infection group was lower than those of control group; in the contrast, the levels of WBC [(8.35 +/- 2.31) x 10(9)/L], NEUT [(6.98 +/- 1.99) x 10(9)/L], hs-CRP [(73.60 +/- 55.14) mg/L] and CK [(900.10 +/- 1 259.12) IU/L] were higher in the infection group than those of control group, and the differences were statistically significant (P < 0.01). The diameter of inhibition zone in penicillin, cefazolin, cefuroxime, ceftazidime, cefepime, cotrimoxazole, erythromycin were less than 15 mm, and suggested that Bacillus cereus resisted to these antibiotics. However, the diameter of inhibition zone in clindamycin, vancomycin, gentamicin, ciprofloxacin, imipenem were larger than 20 mm and this data indicated that the bacteria were highly sensitive to these antibiotics.

CONCLUSIONOrthopedic patients who immunocompromised, hypoproteinemia and accompanied by open wounds and contaminated wound susceptible to infect Bacillus cereus; sensitive antimicrobial drugs should be selected on the basis of supplement albumin, symptomatic and supportive treatment.

Adult ; Aged ; Anti-Bacterial Agents ; pharmacology ; Bacillus cereus ; drug effects ; isolation & purification ; Female ; Humans ; Male ; Middle Aged ; Orthopedics ; Wound Infection ; microbiology