Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Nasal Septum ; injuries ; Skull Fractures ; diagnostic imaging ; Tomography, Spiral Computed ; Young Adult

Objective To evaluate the clinical results of uncemented fully porous-coated long femoral stems in treating Vancouver type B2 periprosthetic femoral fracture following hip arthroplasty.Methods A retrospective analysis was made on 12 patients (12 hips) with Vancouver type B2 periprosthetic femoral fracture treated using the uncemented fully porous-coated long femoral stem prosthesis combined with cerclage fixation with steal-wire or titanium cable devices from February 2006 to January 2013.There were 5 males and 7 females,aged average 69.8 years (range,62 to 79 years).The status of primary arthroplasty was uncemented bipolar hemiarthroplasty in 2 patients and total hip arthroplasty in 10 patients (2 cement and 8 cementless femoral stems).At the final follow-up,Harris hip score for clinical evaluation,Beals and Tower's criteria for radiological evaluation,and complications were recorded.Results There were no intra-operative complications such as femoral perforation and femoral fracture.All patients were followed up for mean 38 months (range,24-72 months).At the last followup,mean Harris hip score was 87.2 points (range,50 to 100 points).All fractures healed at average 16 weeks (range,12-28 weeks).All the 12 hips showed prosthesis stability despite there was one femoral stem subsidence of 3 mm.One patient slipped and sustained another periprosthetic fracture (Vancouver type B1) at postoperative 4 months and was treated successfully with locking plate and cables.According to the Beals and Tower's criteria,there were 10 excellent,1 good and 1 poor results.Final follow-up revealed no complications of deep vein thrombosis,dislocation and prosthesis loosening.Conclusion Uncemented fully porous-coated long femoral stems provide good primary stability that promotes fracture healing and offers a reasonable treatment of Vancouver B2 femoral periprosthetic fracture.

Objective To investigate the changes of vital signs, serum potassium and postoperative comfort of patients treated with MECT in the treatment of low-dose rocuronium.Methods 200 patients with MECT from June 2014 to June 2016 were selected and randomly divided into two groups, and the life signs and adverse reactions were analyzed and compared.Results There was no significant difference between the experimental group and the control group in the recovery time, the recovery time and the recovery time of the pharyngeal reflex.The recovery of spontaneous respiration in the experimental group was earlier than that in the control group, and the difference was statistically significant ( P<0.05 ) .There was no significant difference between the two groups (headache, drowsiness, postoperative irritability) compared with the control group, the incidence of muscle pain in the experimental group was significantly lower than that in the control group, the difference was statistically significant (P<0.05).Conclusion Pre-injection of rocuronium can reduce the level of serum potassium, shorten the recovery time of spontaneous breathing, and reduce the incidence of postoperative muscle soreness.Compared with the conventional MECT method, it can reduce the contraindication of MECT treatment and increase the comfort of patients.

ObjectiveTo study the significance of the non-invasive hemodynamic monitor system in the differential diagnosis of severe acute pancreatitis (SAP) combined with pulmonary edema. Methods Twenty-nine cases of SAP during fluid resuscitation treatment combined with pulmonary edema were reviewed and the data of the non-invasive hemodynamic monitor system was analysed and summarized.According to the diagnosis on discharge, 18 patients were enrolled in test group (noncardiogenic pulmonary edema group) and 11 patients were enrolled in control group(cardiogenic pulmonary edema group). The data of two groups were determined and compared. ResultsIn control group, cardiac output[(3.34±1.09) L/min], cardiac index [(2.06 ± 0.46) L/ (min·m2)], stroke volume [(41.89 ± 13.72) ml], stroke index[(25.59 ± 7.32) ml/m2], accelerate cardiac index [(59.24 ± 28.41) L/100 s2], left cardiac work index [(2.09 ± 0.67) (kg·m)/m2], left ventricular ejection time[(254.32 ± 27.34) ms], ejection fraction (0.37 ±0.03) and velocity index [(27.11 ± 11.32) L/100 s] were all significantly lower than those in test group [(4.12 ± 1.06) L/min, (2.64 ± 0.48) L/ (min·m2), (46.21 ± 11.81) ml, (28.87 ± 5.32) ml/m2, (79.43 ±29.01) L/100 s2, (3.21 ± 0.84)(kg·m)/m2, (281.29 ± 29.11) ms,0.54 ±0.04, (39.34 ± 12.11) L/100 s,respectively] (P < 0.01); pre-ejectionphase [(116.54 ± 22.37) ms] and systolic time ratio (0.48 ± 0.04) were significantly higher than those in test group[(95.24 ± 21.41) ms,0.36 ± 0.02,respectively] (P < 0.01 or <0.05). ConclusionNon-invasive hemodynamic monitor system is helpful in the early differential diagnosis of SAP combined with pulmonary edema.

BACKGROUND: Recently emerged immunosuppressive scheme combined with basiliximab following liver transplantation, such as the early steroid withdrawal or half amount of steroid. Many studies demonstrated that it would not increase the rejection rate in reducing the use of steroid. However, there were rare reports addressing whether it was safe and effective to replace the steroid by basiliximab. OBJECTIVE: Through the application of non-steroid and early steroid withdrawal immunosuppressive scheme in patients of hepatocellular carcinoma following liver transplantation, to evaluate the therapeutic effect and safety of two treatments. METHODS: A total of 80 patients of hepatocellular carcinoma receiving liver transplantation were divided into the experimental and control group. In the experimental group, 33 patients were applied with non-steroid treatment (Tacrolimus+mycophenolate mofetil+basiliximab); additionally 47 patients were applied with early steroid withdrawal treatment (Tacrolimus+mycophenolate mofetil+ steroid). Steroid was reduced gradually from the first day after transplantation to discontinuation after 1 month. The rates of rejection, infection, cancer recurrence and 1 -year survival were measured. RESULTS AND CONCLUSION: Compared to the control group, the rates of infection and cancer recurrence were significantly smaller in the experimental group (P < 0.05). However, there was no significantly difference between 2 groups in the rates of rejection and 1 -year survival (P > 0.05). It revealed that the non-steroid treatment can be safely and effectively applied in the patients with hepatocellular carcinoma following liver transplantation. The non-steroid treatment can significantly cut down the infection rate and cancer recurrence rate, which has no effect on the rejection and 1 -year survival rate.

Adolescent ; Cyanosis ; complications ; Heart Septal Defects, Atrial ; complications ; Humans ; Male ; Pulmonary Wedge Pressure

Objective To explore the feasibility of single port laparoscopy in classification and treatment of Meckel's diverticulum in children and its guiding treatment.Methods The clinical data in 75 children cases of Meckel's diverticulum with symptoms treated in our hospital from Aug.2011 to Aug.2015 were retrospectively analyzed.Meckel's diverticulum was classified under single port laparoscopy.The operation modes were selected according to different classifications.The excised materials were submitted to the pathologic examination.Results Among 75 children cases,50 cases were the simple type of Meckel's diverticulum and 25 cases were complex type of Meckel's diverticulum.The average operative time in the simple type and complex type was (38.93±8.75) min and(55.64 ± 13.27) min respectively,average bleeding amounts were (46.58 ± 15.81) mL and (50.12 [16.90) mL respectively,average postoperative hospitalization time was (7.33±1.41)d and (7.52 ± 1.68)d respectively,the operative time in the simple type was less than that in the complex type(P＜0.05),the other two indexes had no statistical difference between the two groups(P＞0.05).The ectopic gastric mucosal pathological change was only seen in the simple type,while the inflammatory manifestation in the complex type had higher proportion.The main clinical manifestations were lower gestational tract bleeding and infection.The two groups all obtained follow up.One case of simple type appeared the symptoms of abdominal pain and hematochezia and was cured after the second operation.Conclusion Meckel's diverticulum can be divided into the simple type and complex type under single port laparoscopy.The operation mode can be selected according to different types.This method is safe and reliable and is worthy of being clinically promoted.

Gallbladder carcinoma (GC) is the most common malignant tumor in bile duct system.Xanthogranulomatous cholecystitis (XGC) is a benign inflammatory gallbladder disease.It is often misdiagnosed between them.This paper,through reviewing the literature and summarizing our own clinical experience,will give a better understanding on the two diseases,which was summarized as follows:inflammation is important both in the pathogenesis of GC and XGC,and we can make the correct diagnosis and choose an appropriate treatment by analy zing the feature of disease history,image data and rapid intraoperative pathological diagnosis.Radical resection remains the first choice in the treatment of GC,but the extent of resection is controversial.Normally,cholecystectomy is sufficient for curing XGC,but different surgeries are needed according to the specific disease conditions.

· AIM: To investigate the role of intercellular adhesion molecule-1 (ICAM-1) in the graft rejection of rabbit penetrating keratoplasty (PKP).· METHODS: Sutures were used to produce corneal neovascularization (CNV) on New Zealand white rabbits to make PKP model. Graft mean survival time and rejection index were determined. The levels of sICAM-1 in serum and aqueous humor were dynamically determined by enzyme-linked immunosorbent assay (ELISA).Immunohistochemical technique was used on cornea to get the evidence of expression and distribution of ICAM-1.· RESULTS: Graft mean survival time is (12.4±1.3) days.The mean sICAM-1 levels in aqueous humor and serum in the control animals that did not undergo surgery were (16.6±3.6)ng/L and (95.2±6.3) ng/L respectively. Levels in aqueous humor and serum for the graft rejection group increased postoperatively, continued to increase to (53.9±19.2)ng/Land (378.8±30.6)ng/L, compared to those in the other group (P ＜0.01). ICAM-1 positive cells were found in the graft rejection group.· CONCLUSION: ICAM-1 plays a critical role in initiating and maintaining corneal graft rejection. Sequential determination of serum sICAM-1 after operation may be of value in the prediction and diagnosis of acute rejection.

Objective To observe the perioperative management of cardiac surgery and extracorporeal circulation method in patients with glucose-6-phosphate dehydrogenase deficiency(G6PD).Methods Ten patients with G6PD deficiency underwent uneventful cardiac surgery procedures between January 2005 and December 2010.Twenty patients who had non-G6PD deficiency were as a control group,the selected conditions were the same gender,age,body mass,the risk of heart disease surgery.The preoperative management in patients with G6PD deficiency mainly focused on avoiding the drugs implicated in haemolysis,reducing the surgical stress,using moderate hypothermia extracorporeal circulation and enhancing blood conservation.Observed indicators included the assisted ventilation time,urine volume,the drainage volume of chest tube,the amount transfusion of red blood cells and plasma,the level of hemoglobin and serum total bilirubin in the 2nd day after surgery,ICU stay.Results Compared with the control group,patients with G6PD deficiency had no significant difference in duration of ventilation after the operation,drainage,urine,Hgb,bilirubin levels,and blood transfusion[(9.3 ± 4.5)h vs (8.6 ± 5.7)h,(2100 ±670)ml vs (1950 ± 490) ml,(253 ± 146)ml vs (260 ± 120)ml,(1.3 ± 1.0)U vs (1.8 ± 1.2)U,(96 ± 25)g/L vs (99 ± 12)g/L,and (24 ± 8)μmol/L vs (27 ± 1 l)μmol/L,t =0.978,2.032,1.257,0.891,2.182,2.271,and 1.329,all P ＞ 0.05].The duration of ICU discharge was significantly longer in the glucose-6-phosphate dehydrogenase deficient group[ (2.6 ± 0.6)d vs (1.8 ± 1.5)d,t =2.704,P ＜ 0.05].Conclusions Cardiac surgery can be performed safely in patients with G6PD deficiency with enhanced perioperative management.