OBJECTIVETo study the surgical treatment of recurrent laryngeal nerve (RLN) injury caused by thyroid operation.

METHODSFrom 1970 to 2001, 50 patients with RLN injury were caused by thyroid operation. The causes, location, type, operative procedures and follow-up were retrospectively analyzed.

RESULTSUnilateral RLN injury occurred in 46 cases and bilateral nerve injury in 4 cases. The RLN injuries were located within 2cm below the point of RLN entering to throat in 45 nerves (83.3%), other places in 6 nerves (11.3%), and unknown location in 3 nerves (5.4%). Transection of the nerve was found in 19 nerves (36.5%), suture or scare pressing the nerve in 35 nerves (64.8%). All the injured nerves were repaired surgically. Meanwhile all 4 patients with bilateral RLN injuries underwent tracheotomy. Of the 50 cases, 44 cases (88.0%) were followed up for more than 1.5 years. Among the 44 followed-up patients, phonation was restored to normal or obvious improvement in 42 cases (95.5%), and improvement in 2 (4.5%). Of the 35 patients with 39 nerves underwent indirect or direct laryngoscopy, the affected vocal cord movement entirely recovered in 21 cords (53.8%), partially recovered in 7 cords (17.9%), uncovered in 11 cords (28.3%). There was no relation between the recovery of phonation or vocal cord movement with the timing or the procedure of repairing operation.

CONCLUSIONSThe location of most RLN injuries caused by thyroid surgery are just below the point of RLN entering to throat, and most are mechanical injury, and need operation to resolve the cause. Once the RLN injury is made, an operation should be performed as early as possible.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Recurrent Laryngeal Nerve Injuries ; Retrospective Studies ; Thyroidectomy ; adverse effects ; Treatment Outcome ; Vocal Cord Paralysis ; etiology ; surgery

BACKGROUNDAlleviation of microcirculation disorders in severe acute pancreatitis (SAP) can improve survival rates, and low molecular weight heparin (LMWH) is well known to have potent ameliorative effect on microcirculation disorders caused by anti-coagulant activity. The aim of this study was to investigate the effects of LMWH on pancreatic microcirculation in SAP in rats.

METHODSSD rats were randomly divided into 3 groups: sham operation (S) group, SAP group, and LMWH treatment (LT) group. The concentrations of serum amylase, tumor necrosis factor-alpha (TNF-alpha), endothelin-1 (ET-1), pancreatic ultrastructure were examined at 24 hours after the models were set up in each group.

RESULTSCompared with S group, the concentration of serum amylase, ET-1, and TNF-alpha in SAP group were significantly increased (P < 0.001); After LMWH treatment, the concentration of serum amylase, ET-1, TNF-alpha were decreased significantly compared with SAP group (P < 0.001, 0.01, 0.001, respectively). On electron microscopy, the microthrombosis in LT group was significantly less than that in SAP group. The 3-day survival rate in SAP group (25.0%) was significantly lower than that in S group (100.0%, P < 0.05) and in LT group (87.5%, P < 0.05).

CONCLUSIONSThe disorder of pancreatic microcirculation may be involved in the inflammatory response of rats with SAP. LMWH can effectively improve the survival rate of SAP, and alleviate the severity of microcirculation disorders through its antithrombin effects and down-regulate the levels of serum ET-1 and TNF-alpha.

Acute Disease ; Animals ; Anticoagulants ; pharmacology ; Disease Models, Animal ; Endothelin-1 ; blood ; Heparin, Low-Molecular-Weight ; pharmacology ; Microcirculation ; drug effects ; Microscopy, Electron ; Pancreas ; blood supply ; pathology ; ultrastructure ; Pancreatitis ; blood ; drug therapy ; physiopathology ; Rats ; Rats, Sprague-Dawley ; Survival Rate ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo analyze the application of vertebral pedicle screw fixation in the treatment of burst fracture of thoracolumbar vertebrae.

METHODSA total of 48 cases (31 males and 17 females, aged from 18-72 years, mean: 41.3 years) with thoracolumbar vertebrae burst fracture were treated by pedicle screw system since January 2004. According to the AO classification of thoracolumbar vertebrae fracture, there are 36 cases of Type A, 9 of Type B and 3 of Type C.

RESULTSAll patients were followed up for 6-25 months (average 12 months), no secondary nerve root injury, spinal cord injury, loosening or breakage of pedicle screw were observed. The nerve function of 29 patients with cauda equina nerve injury was restored to different degrees. The vertebral body height returned to normal level and posterior process angle was rectified after operation.

CONCLUSIONSThe vertebral pedicle screw internal fixation was technologically applicable, which can efficiently reposition and stabilize the bursting fractured vertebrae, indirectly decompress canalis spinalis, maintain spine stability, scatter stress of screw system, reduce the risk of loosening or breakage of screw and loss of vertebral height, and prevent the formation of posterior convex after operation.

Adolescent ; Adult ; Aged ; Bone Screws ; Female ; Humans ; Internal Fixators ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries

OBJECTIVETo summarize the detailed failure mechanisms of revision hip arthroplasties and related risk factors.

METHODSFrom November 1988 to July 2008 revision of total hip arthroplasties was performed in 327 patients. The medical history, clinical and imaging material and operation records were investigated.

RESULTSRegarding revision as the end point of the study, the reasons for 327 revision arthroplasties were aseptic loosening in 226 hips (69.1%), infection in 52 hips (15.9%), periprosthetic fracture in 22 hips (6.7%), instability in 17 hips (5.2%), stem fracture in 5 hips (1.5%) and liner dissociation in 5 hips (1.5%).

CONCLUSIONSThe main failure mechanisms of primary hip arthroplasties are aseptic loosening and infection of implants, which could be attributed to improper selection of operation indications and implants and limitations to surgical philosophy and technique.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Periprosthetic Fractures ; Prosthesis Failure ; Reoperation ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; Treatment Failure

OBJECTIVETo put some improvements to the traditional transforaminal lumbar interbody fusion (TLIF) and discuss its clinical significance.

METHODSCompleted the traditional posterior lumbar interbody fusion (PLIF) and TLIF procedure in 12 fresh cadavers, dissect further to expose the surrounding anatomical structures, and put the modified TLIF surgery according to the anatomical findings. And simulated the operation in 12 fresh cadavers, analyzed its feasibility and potential advantages.

RESULTSThe early anatomical study found that the related nerve root was in a state of high tension and certain risk of injury when completed the traditional PLIF and TLIF surgery, and found certain operational area between the superior articular process and the midline structures of the spinous processes and interspinous ligaments. Put the modified TLIF surgical approach according to the anatomical findings, which the operating area is located in PLIF outside and TLIF inside. As the following words: Take a posterior-middle incision, preserve the supraspinous and interspinous ligaments, and the spinous processes, dissect the bilateral paravertebral muscle, expose lamina and facet joints, not including transverse process, and remove unilateral inferior two third lamina, inferior articular process and expose the articular surface of the superior articular process, then dispose the intervertebral space for interbody fusion obliquely in the unilateral approach. Successfully completed the modified TLIF procedure in 12 fresh cadavers, the results showed that the technique has the following advantages. (1) Only remove unilateral inferior two third lamina and inferior articular process, preserve the supraspinous and interspinous ligaments, and the spinous processes, not expose the transverse process. (2) Both central canal, and lateral recess and nerve root canal of the operative side can be decompressed effectively simultaneously. (3) Avoid excessive traction to the thecal sac and traversing nerve roots and decrease the injury rate due to the reservation of the midline structures and the oblique manipulation, and less injury rate of the exiting nerve root, because of not necessary to expose it routinely.

CONCLUSIONSThe modified TLIF is safe and feasible, could effectively reduce the nerve roots injuries. Maybe it's a better choice for most of the Chinese patients at present.

Autopsy ; Humans ; Lumbar Vertebrae ; anatomy & histology ; surgery ; Spinal Fusion ; methods

BACKGROUNDPeople with metabolic syndrome are at higher risk for developing coronary artery disease (CAD). The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was conducted to assess the prevalence, characteristics, in hospital and long term prognosis of CAD with metabolic syndrome and to determine the factors influencing the prognosis of the disease.

METHODSThe DESIRE registry contains data of 3696 patients with CAD between 2001 and 2004. Mean long term followup was (829 +/- 373) days. Diagnosis of metabolic syndrome was based on modified International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome, using body mass index (BMI) instead of waist circumference.

RESULTSOf 2596 patients with complete records of height, weight, and so on, 1280 (49.3%) were identified with metabolic syndrome. The patients with metabolic syndrome had higher level of body mass index, systolic blood pressure, diastolic blood pressure, fasting glucose and disordered blood lipid (all P < 0.0001), with higher creatinine [(10.5 +/- 4.3) mg/L vs (9.9 +/- 2.9) mg/L, P < 0.0001] and the number of white blood cells [(7.49 +/- 2.86) x 10(9)/L vs (7.19 +/- 2.62) x 10(9)/L, P = 0.008) compared with those without metabolic syndrome. The patients with metabolic syndrome showed severer coronary angiographic alterations (left main artery and/or > or = 2-vessel) (73.6% vs 69.6%, P = 0.031). There were no significant differences of major adverse cardiac and cerebral events (MACCE) or mortality in hospital between the two groups. During followup, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly (11.8% vs 10.0%, P = 0.044). Fasting blood glucose (> or = 1000 mg/L) and triglyceride (TG, > or = 1500 mg/L) were responsible for most of the increased risk associated with the metabolic syndrome (adjusted OR 1.465, 95% CI 1.037 - 1.874, P = 0.032; OR 1.378, 95% CI 1.014 - 1.768, P = 0.044).

CONCLUSIONSThe prevalence of metabolic syndrome was very high in CAD patients. The metabolic syndrome confers a higher risk of long term MACCE in patients with CAD, and dysglycaemia and hypertriglycaemia appear to be responsible for most of the associated risk.

Adult ; Aged ; Blood Glucose ; analysis ; Coronary Artery Disease ; complications ; physiopathology ; therapy ; Female ; Humans ; Lipids ; blood ; Male ; Metabolic Syndrome ; complications ; epidemiology ; Middle Aged ; Myocardial Revascularization ; Prognosis

OBJECTIVETo evaluate the risk factors related to mortality in old patients with coronary heart disease after revascularization.

METHODSA total of 675 patients (498 males) with age >or= 70 years old who received revascularization during July 2003 to June 2004 and followed up > 30 days after discharge were included in this study. Clinical characteristics, death and major adverse cardiac and cerebral events (MACCE) during follow up were recorded.

RESULTSThe patients were followed up for a mean period of (754 +/- 355) days. 27 patients (4.0%) died and MACCE developed in 50 patients (7.4%) during follow up. Female and patients with anemia took a significantly higher risk of mortality (RR = 2.750, 95% CI 1.116 - 6.779, P = 0.028, RR = 0.385 95% CI 0.164 - 0.904, P = 0.028, respectively); Creatinine level is positively related to mortality rate. When comparing patients with Cr > 115 micromol/L and Cr > 177 micromol/L with patients with Cr < 115 micromol/L, the hazard rate was 2.963 and 10.785, respectively (95% CI 1.114 - 9.952, P = 0.035 and 95% CI 2.659 - 78.097, P = 0.000) after adjustment for other risk factors.

CONCLUSIONPreexisting anaemia (male Hb < 120 g/L, female Hb < 110 g/L), renal insufficiency (Cr > 115 micromol/L) and female gender were found to be independent risk factors for mortality in old patients with coronary heart disease post revascularization.

Aged ; Aged, 80 and over ; Coronary Disease ; mortality ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Myocardial Revascularization ; Postoperative Period ; Prognosis ; Regression Analysis ; Risk Factors ; Sex Factors ; Survival Analysis

BACKGROUNDThe methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF-s) - simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome. Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage.

METHODSTo treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization.

RESULTSAll iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4 - 46 days (mean (15 +/- 10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6 - 24 months (mean (11.8 +/- 3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed.

CONCLUSIONThe results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure.

Adolescent ; Adult ; Aged ; Arteriovenous Fistula ; etiology ; therapy ; Bandages ; Catheterization, Peripheral ; adverse effects ; Female ; Femoral Artery ; pathology ; Femoral Vein ; pathology ; Humans ; Male ; Middle Aged

OBJECTIVETo study the clinical and laboratory features of the patients with Menkes disease.

METHODThree infants were diagnosed as Menkes disease. Their clinical feature, laboratory findings, radiological manifestation and genes were reviewed.

RESULTAll the three cases were male infants. Their clinical manifestations began at the 3, 5 and 6 months after birth. They all had light complexion, sparse fuzzy woolly hair. The main clinical manifestation was severe mental retardation. The first and the third case also had focal clonus seizures. The second case had feeding difficulty after birth. Their hair showed pili torti and trichorrhexis nodosa microscopically. Their ceruloplasmin in plasma were 32.3 mg/L, 72.5 mg/L and 60.7 mg/L, which were significantly lower as compared with the normal values. Their neuroimaging findings were cortical atrophy, delayed myelination of the white matter and tortuosity of the intracranial vessels. The gene examination of the first and the second case showed deletion and nonsense mutation on exon 14 respectively.

CONCLUSIONMenkes disease is an X-linked recessive disorder characterized by a copper-transporting ATPase defect. The main clinical manifestation is progressive nerve damage. Patients with the disease have special face and hair abnormality, and have morphological changes of brain blood vessels and cerebral atrophy.

Ceruloplasmin ; analysis ; Clinical Laboratory Techniques ; Humans ; Infant ; Male ; Menkes Kinky Hair Syndrome ; blood ; diagnosis

OBJECTIVETo evaluate the efficacy of three-dimensional anal and endorectal ultrasound in identifying the internal opening and tracing the tract of the anorectal fistula.

METHODSFrom November 2008 to January 2010, 127 patients suffering anorectal fistula were managed with three-dimensional endoanal and endorectal ultrasound. The internal opening, the tract of the fistula and fistula trace were identified by the ultrasonography with three-dimensional imaging. All results were confirmed and compared with findings from the operation.

RESULTSThe internal opening of the fistula was specified in 116 patients, the accuracy rate was 91.3% (116/127). The internal opening of the fistula was located above the dentate line in 112 patients, and located in rectal ampulla in 4 patients. The main fistula tract was identified in all the patients, the accuracy rate was 100%. In this group, the fistula tunneled as follows: trans-sphincteric in 47 patients, intersphincteric in 75 cases, supra sphincteric in 2 cases, extra sphincteric in 3 patients. Secondary extension was found in 37 patients, the accuracy rate was 100% (37/37).

CONCLUSIONSThree-dimensional anal and endorectal ultrasound is an effective way for localizing the internal opening and the tract of anorectal fistula. It can provide valuable information for curative operation.

Adult ; Aged ; Endosonography ; methods ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Rectal Fistula ; diagnostic imaging ; Young Adult