Objective:To evaluate the reliability of localization of the impacted teeth by assessing various conventional radiographies. Methods:32 patients with impacted teeth were included. The impacted teeth were localized by conventional roentgenographic techniques including panoramic radiography (PR) and linear tomography (LT).Results:Dentomaxillary orthopantomographic solution (PR,LT and PR combined with LT) clearly presented the position of the impacted teeth. Serial cross-section linear tomography also ensured the shape and axis of the impacted teeth captured on the radiograph. The accuracy of the localization was further verified by the surgical exposure in 5 cases. Conclusion:Orthopantomographic assessing can directly and precisely localize the buccal and lingual position of the impacted teeth.

The effects of antibacterials are mainly focus on inhibiting the proliferation of the bacteriums or killing them directly in various ways. Consequently, antibacterials were mainly used in the therapy of infectious diseases. However, besides the effect of anti bacterials, some antibacterials have other effects as well, such as the effects of antitumor, immunomodulation and antivirus etc. So it is very important to understand the effects and their mechanisms of antibacterials roundly so as to apply them more rationally.

ObjectiveTo retrospectively analysis the role of intercostal artery reconstruction in spinal cord protection for patients with extent thoracoabdominal aotic aneurysm (TAAA) repair.MethodsFrom August 2003 to August 2010,extent Crawford Ⅱ TAAA repair were performed in 81 consecutive patients with mean age (39.4 ± 10.3) years and 61 (75.3％)were males.All the procedures were performed under profound hypothermia with interval cardiac arrest.Patientswere opened with a thoracoabdominal incision.Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium.T6 to T12 intercostal arteries and L1,2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8mm branch for keeping spinal cord blood perfusion.Visceral arteries were joined into a patch and anastomosed to the end of the main graft.Left renal artery was anastomosed to an 8mm branch or joined to the patch.The other 10mm branches were anastomosed to iliac arteries.ResultsWith 100％ follow-up,early mortality was 7.4％ (6/81),one patient was dead result from cerebral hemorrhage,three from renal failure,one from heart failure because of myocardial infarction and one from rupture of cliac artery dissection.Postoperative spinal cord deficits was 3.7％ (3/81),temporary paraplegia were observed in 2 patients and paraparesis occurred in 1 patient,but all of them were without bladder or rectum deficits.Neo- intercostal arteries were clogged in 12 patients within follow-up,and two of those patients with Marfan syndrome underwent pseudoaneurysm after intercostal arteries reconstruction.The mean survival time in this group is (54.22 ± 3.03 )months (95％ CI:44.37 months,59.90 months)with survival rate 92.37％ after 1 year,89.02％ after 2 years,85.54％ after 5 years.Three patient were dead with long term follow-up,one were resulted from cerebral hemorrhage at 20th month,one from rupture of ascending aorta at 23rd month and the last from rupture of aorta ulcer.ConclusionIntercostal artery reconstruction is a reliable method in spinal cord protection for patients with TAAA repair.It is a feasible method with acceptable surgical risks and satisfactory results.It can achieve long term result with less risk of spinal cord deficits and good quality of daily life.

Objective Retrospectively analyze the mid-term clinical results of single-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement(T/STAR).This study describes our experience in this operation in single center of aortic disease at Fuwai Hospital.Methods From February 2004 to February 2011,21 patients with hypertension or Marfan syndrome underwent one-stage total or subtotal aortic replacement for aortic dissection or aortic aneurysms.16 male and 5 female,aged (34 ±9) years.Operations wore performed under circulatory arrest with profound hypothermia.Patients were opened with a mid-sternotomy and a thoracoabdominal incision.Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium.During cooling,the ascending aorta or aortic root was replaced.At the nasopharyngeal temperature of 20 ℃,the aortic arch was replaced with selective antegrade cerebral perfusion.Staged aortic occlusions allowed for replacement of descending thoracic and abdominal aorta.T6 to T12 intercostal arteries and L1,2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8 mm branch for keeping spinal cord blood perfusion.Visceral arteries were joined into a patch and anastomosed to the end of the main graft.Left renal artery was anastomosed to an 8mm branch or joined to the patch.The other 10 mm branches were anastomosed to iliac arteries.Results Early mortality was4.8％ ( 1/21 eases),the only one patient was dead result from renal failure and multiple organ failure.There were no postoperative spinal cord deficits occurred,two patients were stroked at day 5th and 7th respectively.Three patients were operated with tracheotomy because of respiratory insufficiency.Operation was undertaken on one patient with splenenctomy result of spleen rupture during first aortic aneurysms repair.All patients were follow-up,ranging from 18 to 84 months postoperatively,all 20 survivors were alive and had good functional status.One patient was reoperated with aortic valve replacement because of massive valve insufficiency after two years.Neo- intercostal arteries were clogged in 3 patients within follow-up,and two of those patients with Marfan syndrome underwent pseudoaneurysm after intercostal arteries reconstruction.Conclusion Single-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement is safely and effectively.It is feasible with acceptable surgical risks and satisfactory results.It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement and has satisfactory mid-term results.

Objective Retrospectively analyze 47 cases received reoperation with aortic disease after aortic valve replacement to deepen the understanding of aortic valve disease.Methods From January 2003 to June 2012,47 patients with previous aortic valve replacement received aortic root or other aortic operation because of new aortic disease.38 male and 9 female,the interval (6.0 ± 3.8) years. All cases with new aortic disease were diagnosed by cardiac ultrasound and aortic computed tomography.Bentall's procedure were operated on 14 patients,total aortic arch replacement with elephant trunk procedure on 14 patients,aortic root and aortic arch with elephant trunk procedure on 7 patients,ascending aortic replacement on 10patients,total thoracic and abdominal aorta replacement on 2 cases.All patients were followed by clinic interview or telephone.Results Aortic dissection and aneurysmal dilatation were occurred on ascending aorta,each account for 50％,in patients with previous aortic valve replacement because of rheumatic valve disease and bicuspid aortic valve; 3 cases with Marfan syndrome occurred ascending aortic dilatation and 4 cases occurred aortic dissection.Diameter in ascending aorta increased (5.2 + 7.1)mm per year and aortic sinus (3.3 ± 3.1)mm per year.The value of ascending aortic dilatation per year in patients with rheumatic disease was higher than patients with Marfan syndrome(P ＜ 0.05).47 patients were re-operated in fuwai hospital,1 patients died in operating room because aortic dissection seriously involved right coronary artery.7 patients have renal insufficiency after operation and all were cured by hemofiltration; neurological complication occurred in 14 patients including that 7 patients stroked and 7 patients had transient brain dysfunciotn.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time were(53.49 +33.79) months.8 cases were died during follow-up and threeyear survival rate was 83％.There were no cases received operation due to aortic disease during follow-up.Conclusion Deepening the understanding of aortic valve disease combine ascending aorta changes,especially pay attention to patients with previous aortic valve replacement because of Marfan syndrome and rheumatic disease during follow-up after first operation,all efforts should decrease the occurrence of aortic adverse events in long term.

ObjectiveTo evaluate the diagnostic value of high-frequency ultrasonography for dorsal wrist cyst.MethodsThe ultrasonographic characteristics of 136 dorsal wrist cysts were retrospectively studied and compared with the pathological results, the locations and the imaging characteristics of the cysts were analysed, hence to conclude the diagnostic value of high-frequency ultrasonography.ResultsBased on the anatomical location diagnosed by high frequency ultrasound, the 136 dorsal cysts were divided into three types: extensor retinaculum cysts, synovial tendon sheath cysts and dorsal interosseous ligament cysts, each accounted for 1.5% (2/136), 24.3% (33/136) and 74.2% (101/136) of the study group. The most frequently detected locations for dorsal cysts were dorsal scapholunate ligament,tendinous sheath of extensor digitorum and extensor indicis, as well as tendinous sheath of extensor carpi radialis longus and brevis,each accounted for 60.3% (82/136), 8.1% (11/136) and 6.6% (9/136) of all dorsal wrist cysts respectively. Dorsal wrist cysts had typical ultrasonographic features on 2-D gray-scale ultrasonography, the extensor retinaculum cyst demonstrated as a well-marginated, small-sized and oval anechoic area, which was commonly located in the oedematous extensor retinaculum, but it had no adjunction with the extensor tendon, and it was accompanied with dorsal scapholunate ligment cyst frequently. Synovial tendon sheath cyst demonstrated as a oval or eggplant-shaped anechoic area which was usually winding around the extensor tendon, but it had no adjunction with the dorsal interosseous ligament and the extensor retinaculum. Meanwhile, the dorsal interosseous ligament appeared to be normal strip-like echo texture with a smooth and clear margin. Dorsal interosseous ligament cyst demonstrated as a out-of-shape anechoic area and located superior to the injured ligament. Meanwhile, the impaired ligament was thickened with uneven margin and decreased echo texture. No blood lfow signals was detected in all dorsal wrist cysts by color doppler lfow imaging.ConclusionHigh-frequency ultrasonography can be used to diagnosis dorsal wrist cysts, and can be served as the preferred imaging modelity to guide the clinical treatment.

Objective To analyze the etiology and surgical results through 17 cases with retrograde aortic dissection after thoracic endovascular repair.Methods From March 2009 to March 2014,17 patients were diagnosed with retrograde type A aortic dissection after thoracic endovascular repair,the mean age was 53 years,13 male and 4 female.Type B aortic dissection as the primary disease were 13 cases,aortic aneurysm and aortic ulcer were 2 cases respectively.All cases with new type A aortic dissection were diagnosed by cardiac ultrasound and aortic computed tomography.All patients were received aortic root and total aortic arch replacement plus elephant trunk procedure.All patients were followed by clinic interview or telephone.Results The interval time was from 1 to 2 200 days,5 patients were diagnosed before discharge,12 patients during clinical follow-up.The primary tear in 12 patients were located the area which were anchored by bare mental stent,in 2 cases were nearby the bare stent,the other 3 cases were located anterior part of ascending aorta.1 patient was died due to cerebral hemorrhage after operation.3 patients had renal insufficiency after operation and all were cured by hemofiltration;neurological complication occurred in 3 patients including that 1 patient stroked,1 patient cerebral hemorrhage and 1 patient had transient brain dysfunction,4 patients had pulmonary complication and 2 patients with intestinal dysfunction.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time was(35-±21) months.2 cases were died during follow-up and five-year survival rate was 87.5 ％.One patient was reoperation with total thoracic abdominal aorta replacement,five-year free from reoperation was 85.7％.Conclusion The retrograde type A dissection after thoracic endovascular repair were closely related with proximal bare mental stent,part of cases were silent symptom,the clinical fellow with aortic enhanced computed tomography were necessary to detect the serious complication.Operation scheme was safely and effectively,aortic arch replacement plus elephant trunk procedure was the preferred method to repair retrograde aortic dissection.

Objective: To study the treatment of complicated and giant carotid body tumor. Methods: A giant carotid body tumor was dissected 2 years ago. The external carotid artery was embolized by means of catheterization before surgical intervention, and techniques of internal shunting and autogenous blood transfusion was used during the operation. Results: The tumor was resected completely without cerebral vessel disorders and major cephalic nerve injuries. Conclusion: The application of radial intervention of external carotid artery, shunting of internal carotid artery and autogenous blood transfusion are helpful to the treatment of giant and re operative carotid body tumor.

ObjectiveAnalyze the results of distal aortic reoperation in Marfan syndrome patients after proximal aortic surgery.MethodsBetween January 2000 and January 2010, 28 Marfan patients underwent surgical repair of distal aortic disease after aortic root surgery at our institution.There were 20 males and 8 females.Age ranged from 23 to 52 years [ mean (38.5 ± 8.7) years ].First time operations were Bentall procedure in 24, David procedure in 4.There were 8 cases of Stanford A dissection and 20 cases of aortic root aneurysm.The second time operations included 1 partial aortic arch replacement, 2 total arch replacements, 7 total arch replacements combined with stent elephant trunk, 6 descending thoracic aorta replacements,10 thoracoabdominal aorta replacements and 2 total aorta replacements.The interval between the lst and 2nd operation was 1 to 12 years [mean (6.43 ±3.07) years].The surgical technique used for distal procedures was dependent on the pathology of the aorta.Median repeat sternotomy was used for surgical exposure in 10 patients, who required an arch/proximal descending aortic procedure.Cardiopulmonary bypass (CPB) was established through the right axillary perfusion and right femoral venous drainage in all of these patients.16 patients were operated on through a left-sided incision, namely, a posterolateral thoracotomy, or a thoracoabdominal incision, depending on the distal extent of aortic replacement.For such patients, the left femoral vessels were cannulated for CPB in 14 patients and the rest 2 patients were operated on without CPB.Two patients with total aorta replacement were operated on through a median sternotomy combined with thoracoabdominal incision.22 patients underwent deep hypothermic circulatory arrest because of the replacement of anrtic arch or the extensive aneurismal arch.Reconstruction of intercostal arteries (T8-L1) was performed in 16 patients for the protection of spinal cord.ResultsTwo patients (7.1％) died postoperatively.Neurological morbidity included 1 patient with stroke, 1 paraplegia and 2 temporary paraparesisThree patients required temporary tracheotomy for prolonged weaning form the respirator.All patients were followed up for 10-118 months [mean (40.8 ±29.5) months].Two patients died during follow-up.The survival rate was (94.5 ± 1.3)％,(90.6 ± 1.4) ％ at 1-and 5-year, respectively.ConclusionDistal aortic reoperation in Marfan patients can be performed with good short-and long-term results.Complete aortic arch replacement with elephant trunk technique, if safely performed,should be considered for Marfan patients presenting with type A dissection.

Objective To analyze risk factors for cerebral neurological injury after operation of acute Stanford type A aortic dissection.Methods Between January 2005 and December 2011,329 cases of acute Stanford type A aortic dissection patients underwent aortic arch replacement were retrospectively analyzed.Univariate and multivariate analysis(multiple logistic regression) were used to identify the risk factors for postoperative cerebral neurological injury including permanent neurological dysfunction (PND) and temporary neurological dysfunction (TND).Results Cerebral neurological injury occurred in 77 cases (23.4％),PND 11 cases(3.3％) and TND 66 cases(20.1％).Multiple logistic regression showed that age(OR =1.087,95％ CI 1.013-1.166,P =0.020) and stroke history (OR =10.383,95 ％ CI 1.596-67.534,P =0.014)were independent risk factors for PND,serum creatinin (OR =1.013,95 ％ CI 1.004-1.023,P =0.006),WBC (OR =1.199,95 ％ CI 1.087-1.324,P =0.000) and peak intraoperative glucose level (OR =1.011,95％ CI 1.004-1.018,P =0.003) were independent risk factors for TND.Conclusion The older age or stroke history indicate the occurrence of PND,Whereas the higher WBC lever preoperative or higher intraoperative glucose level indicate the occurrence of TND.The incidence of TND probably will be reduced by controlling intraoperative hyperglycemia actively.