Background and purpose:In all treatments of retroperitoneal tumors,surgical operation is still the only effective method which might cure the tumors.However,the patients were always in advanced stages when they were clinically diagnosed.The inferior cava of the patients always have been invaded by tumors,which is considered to be a relative surgical contraindication.This study was to explore the surgical method in treatment of retroperitoneal tumors with major blood vessels invasion,and in order to raise the resection rate and survival rate. Methods :Retrospective analysis of twelve cases which implicate major vessels and have parallel artificial vascular reconstruction during operations of retroperitoneal tumor from January 2003 to June 2007. Results :Twelve cases of retroperitoneal tumor and implicated major vessels were integrally resected,corresponding important vascular reconstructions were done,no short-term postoperative deaths. Conclusions :Retroperitoneal tumor involving abdominal important vessels is not a contraindication of radical surgical.Integrated resection of retroperitoneal tumor and implicated major vessels and corresponding important vascular reconstruction are safe,and can improve the resection rate and reduce the relapse rate,extend the survival time.

Background and purpose:Radical surgery remains the main treatment for the patients with pancreatic and duodenal cancer,but resectability rate is low when clinically diagnosed,portal vein/superior mesenteric vein or inferior caval vein invaded by tumors are a few of the main reasons.How to increase resectability of pancreatic cancer and duodenal cancer still is very challenging to the clinician.This study was done to explore the feasibility of the new surgical approach for the treatment of pancreatic and duodenal cancer with portal vein/superior mesenteric vein or inferior caval vein invasion.Methods:5 patients received pancreatoduodenectomy with vascular reconstruction between February 2002 and June 2005.Three patients with pancreatic head cancer underwent pancreatoduodenectomy combined with portal vein/SMV resection and vascular reconstruction and two patients with duodenal cancer underwent pancreatoduodenectomy combined with inferior caval vein resection and vascular reconstruction.Results:There was no surgery related death.The serious complications such as artificial blood vessel infections or obstructions were not experienced.After surgery,one patient died 10 months later,one patient died 24 months later,two patients survived for over 3 years and one patient over 4 years.Conclusions:Pancreatoduodenectomy with vascular reconstruction for patients with carcinoma of the pancreatic head or duodenum invading portal vein/superior mesenteric vein or inferior caval vein has been proved to be a safe treatment,it could improve the resectability of the tumor and prolong survival.

Objective To explore the early surgical treatment for sleep apnea in children with the influence of mental development,provide important basis for children with sleep apnea early surgery.Methods 40 children with sleep apnea underwent bilateral amygdala and/or adenoidectomy (observation group).The Chinese wechsler intelligence scale for children (C-WYCSI) was used for preoperative and postoperative 6 months of intelligence tests,including language IQ and operation IQ test two parts,a total of 11 points.Operation IQ but also contain visual analysis test(VA) and two categories,including geometry test (GD).According to the 1 ∶ 1 matching selection of the same gender,and age(± 3 months),family condition was quite healthy check-up preschool children comparing 40 cases as control group.Results Observation group preoperative total intelligence quotient (IQ),verbal IQ,IQ operation was 82,81,83,respectively,which were lower than those of the control group 101,101,101 (t =4.131,3.952,3.842,all P ＜ 0.05).Postoperative total intelligence quotient(IQ),verbal IQ and operation IQ 98,98,99,respectively,were in normal range,with no statistically significant difference were observed in the control group (all P ＞ 0.05).Conclusion Children with sleep apnea early surgical treatment can improve children mental development.Children with sleep apnea early,breathing and surgical indications should be early surgical treatment.

Objective To introduce the clinical application and method of endoscopic harvesting the sural nerve in the carbon dioxide gas cavity. Methods 7 cases with peripheral nerve defect were involved, including 5 men and 2 women. The length of nerve defects ranged from 5 to 8 cm, all the nerve defects were repaired by autogenous sural nerve grafting. The sural nerve were removed from 9 calves in 7 cases. Along the course of the sural nerve in the proximal calf, a transverse 1.0 to 1.5 cm incision was done for endoscope approach, another transverse 0.5 to 1.0 cm incision was done lateral to the sural nerve for operation approach. Using abdominoscope system, the sural nerves were cut and removed smoothly in the cavities which were maintained the gas pressure 10 to 15 mm Hg with carbon dioxide insufflation. All the peripheral nerve defects of 7 cases were repaired as cable graft with harvested sural nerve. Results The length of nerve graft harvested from 30 to 42 cm in 9 calves. It took about 30 minutes to harvest the nerve in each side. There was no abvious injuries found by pathologic inspection. No carbonemia and air embolism occurred on patients during operating time, no complications of hypodermic pneumatosis and hematoma occurred on all cases. All patients followed up from 6 to 10 months, the function recovery of the nerves was good. The muscle power was obtained 2 to 4 grade, the sensation was obtained S3 to S4 grade. The function recovered as fast as the traditional operation of sural nerve transfer. Conclusion The method of endoscopic harvesting the sural nerve in the carbon dioxide gas cavity with minimal incision is easy to perform. Compared with the long longitudinal incision and multiple stair-step incision, the method can get less invasive and traumatic, and good aesthetic results. This technique deserves the doctor application in clinical work.

Objective To explore the strategy of damage control in clinic treatment of severe limb (finger) with multiple injuries.Methods Severe multiple injuries patients with ISS evaluation more than 16 points were chosen for this study.Simple replatations of severed limb(finger) were perfored in 40 patients while their multiple injuries were actively treated.Results Among the 40 cases, all cases survived.1-3 years follow-up showed that the results were excellet in 8, good in 21, middle in 7, and poor in 4, with an excellent or good rate of 72.5 percent.Conclusion Multiple specialties cooperation, early treatment of multiple injuries and experienced microsurgery operation are the keys to improve success rate of replantation of severed limb(linger) with multiple injuries.

Objective To explore a simple and effective way of establishing a mice orthotopic tracheal transplantation model in studying bronchiolitis obliterans to reduce operation time. Methods Tracheas from C57BL/6 mice (n=30) were im?planted into Balb/c mice (n=30). Grafts and hosts were matched according to body weight.Orotracheal intubation and endo-stentwas used for trachea anastomose and animal model was establish. Operating time was also noted. Grafts were harvest?ed on Days 15, 30 and 60 after transplantation, using HE staining to observe pathological changes of allograft. Trachea block?ing rate was also calculated. Results Until survival of trachea transplantation, the operative time of donor′s and the recipi?ent′tracheas resection were (7.0±1.0) min and (7.0±1.0) min respectively.Orotracheal intubation the endo-stentestablish?ment cost(1 ± 0.5)min. Trachea anastomose took(20.0 ± 4.0)min and the operation time last(43.0 ± 10.0)min. Conclusion The improvement of orthotopic tracheas transplantation usingOrotracheal intubation the endo-stenfor trachea anastomose is esay-operated and did required complicate skills and instruments with high successful rate. So it is an ideal and stable model in studying bronchiolitis obliterans.

Objective To investigate the difference of clinical efficiency and safety in obsessive-compulsive disorders (OCD) treatment with escitalopram or paroxetine.Methods A total of 156 OCD patients were randomly divided into escitalopram group (ESC group) and paroxetine group (PAR group).Yale-Brown Obsessive Compulsive Scale (Y-BOCS),Hamilton Depression Scale (HAMD) and Treatment Emergent Symptom Scale (TESS)were used to evaluate the clinical efficiency and safety before and after1,2,4,6,8 weeks treatment.Results The cure rate(21.79％ vs 17.95％) and effective rate(70.51％ vs 71.79％) had no statistically difference between ESC group and PAR group,and incidence of side effect had no significant difference between two groups(x2 =1.99,P＞0.05).Compared with the group before treatment,HAMD scores were significantly decreased from the first weekend in ESC group,but in PAR group HAMD scores did not decrease until the second weekend,and the differences were also significant(P＜0.05).Conclusion Escitalopram is a safety,effective and well-tolerated drug in the treatment of obsessive-compulsive disorder.

Objective To study the expression and regulation of pro‐inflammatory cytokinesTNF‐α,IL‐1 ,IL‐6 in mononucle‐ar macrophages stimulated with staphylococcal protein A (SpA) .Methods THP‐1 was incubated with PMA and induced into mononuclear macrophages .Then the macrophages were incubated with varying concentrations of SpA under different time points . The effect of SpA on macrophage proliferation was measured by MTT method .The levels of inflammatory cytokines ,TNF‐α,IL‐1 and IL‐6 from the cultured cell media were measured by ELISA respectively .The levels of mRNA expression corresponding to TNF‐α,IL‐1 and IL‐6 were detected by RT‐PCR from the macrophages stimulated with SpA .All statistical analyses were performed by SPSS17 .0 software .Results The MTT result indicated that SpA had a positive effect on the proliferation of THP‐1 cells in a dosage depended manner .The addition of SpA could enhance the mRNA expression of TNF‐α,IL‐1 and IL‐6 in the stimulated mac‐rophages .It also showed a specific dose‐effect and time‐effect correlation .The macrophages secreted inflammatory cytokines and its corresponding mRNA reached its peak levels at 12 h post stimulation .Compared with the control group ,the expression and release of TNF‐α,IL‐1 and IL‐6 in macrophages from the experimental group was increased with statistical significance(P<0 .01) .Conclu‐sion SpA can promote the secretion and expression of early pro‐inflammatory cytokines ,such as TNF‐α,IL‐1 and IL‐6 in macro‐phages .Therefore ,SpA plays a very important role in the initiation and development of the staphylococcus aureus sepsis .

OBJECTIVETo study the classification and individualized treatment of the terminal phalanx of thumb duplication.

METHODSFrom Apr. 2003 to Dec. 2012, 76 patients with 77 involved thumbs duplication at the level which is distal to the interphalangeal joint were retrospectively studied. Based on the morphology (the nail width and the thumb circumference) and the deviation of the thumb, we classified the terminal phalanx of thumb duplication into 5 types as Type A (no bony connection called floating thumb), Type B(asymmetry and no deviation), Type C(asymmetry and deviation), Type D (symmetry and no deviation) and Type E(symmetry and deviation). Different surgical procedures were selected according to different types. Simple excision of the smaller thumb was adopted for Type A case. Removement of the smaller thumb (usually the radial) and of the collateral ligament of the interphalangeal joint were selected for Type B. Removement of the smaller thumb (usually the radial) and reconstruction of the collateral ligament of the interphalangeal joint, as well as corrective osteotomies at the neck of the proximal phalanx were performed for Type C. The modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint were adopted in Type D. The classical Bilhaut-Cloquet procedure, or the modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint and corrective osteotomies at the neck of the proximal phalanx were performed in Type E. The results were assessed by an evaluation form for thumb duplication by the Japanese Society for Surgery of the Hand.

RESULTSAccording to our new classification standard, there were 3 cases with Type A duplicated thumbs, 36 with Type B, 13 with Type C, 15 with Type D, 10 with Type E. All the 76 patients underwent the individualized surgical treatment. The patients were followed up for 6-60 months. According to the evaluation form, excellent results were achieved in 66 thumbs, good in 9 thumbs and fair in 2 thumbs.

CONCLUSIONSThe new classification could comprehensively describe the clinical features of the terminal phalanx of congenital thumb duplication. Individualized therapy, including basic and repeated surgical procedure could be adopted for each type with satisfactory results.

Child ; Collateral Ligaments ; surgery ; Finger Phalanges ; surgery ; Humans ; Orthopedic Procedures ; methods ; Osteotomy ; methods ; Polydactyly ; classification ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Thumb ; abnormalities

Objective To investigate why benign, paroxysmal positional vertigo (BPPV) recurs.Methods Three hundred persons diagnosed with BPPV who had been treated at Tongji Hospital of Huazhong University of Science and Technology between April 2012 and April 2014 were given a telephone follow-up at least one year after their manual repositioning treatment.The respondents were divided into a healthy group and a recurrence group according to whether they said their vertigo had recurred.The age and gender distributions of the two groups were compared, along with their underlying diseases and living-related factors.Causes of the recurrence were then hypothesized.Results Single factor analysis and binary logistic regression analysis showed that overwork, an age over 45, travelling frequently, long use of computers, sleep disorders, oral intake of calcium tablets, posterior circulation ischemia and hyperlipidemia were all closely related to the BPPV recurrence.Age over 45 showed the strongest correlation.Conclusion Aging is the greatest risk factor for the recurrence of BPPV.Posterior circulation ischemia, hyperlipidemia, overwork, sleep disorders, long use of computers and being on business frequently are also predictors of relapse.